Pathology Flashcards
Name 2 Nephritic syndromes
Post-streptococcal glomerulonephritis (PSGN) and IgA Nephropathy (Berger’s Disease)
Causes and risks of PSGN
2-4 weeks post strep infection, mostly in children. Infection leads to development of circulating immune complexes. (Type III hypersensitivity rxn) Deposited subendothelial and mesangial locations leads to inflammation of glomerulus.
SXS of PSGN
MILD proteinuria Hematuria RBC casts Azotemia HTN Edema/periorbital edema Coke colored urine
Tx of PSGN
Supportive care, generally resolves in 1 month
Cause of IgA Nephropathy
Mesangial deposition of IgA, IgA loses its galactose and the body can no longer recognize it. IgG attacks them, forming immune complexes that get trapped in kidney, secondary to GI or upper respiratory infection.
SXS of IgA Nephropathy
Episodic hematuria often within days of GI infx or upper respiratory infx
Name 3 Nephrotic syndromes
Membranous glomerulopathy
Focal Segmental Glomerulosclerosis (FSGS)
Diabetic Glomerulonephropathy
Causes of Membranous Glomerulopathy
Primary (75%): Idiopathic
Secondary: Lupus, NSAIDs, gold, penicillamine, hep B, hep C, syphilis, solid tumors
Tx of Membranous Glomerulopathy
Steroids + tx of underlying disease
Causes of Focal Segmental Glomerulosclerosis
Primary: Idiopathic
Secondary: Heroin drug use, HIV, interferon tx, congenital malformations, sickle cell disease
Tx of FSGS
Steroids, ACE inhibitors
Causes of Diabetic Glomerulonephropathy
Excess glucose causes the basement membrane of the efferent arterioles to thicken, creating an obstruction and increased pressure which leads to the expansion of the mesangial cells
Tx of Diabetic Glomerulonephropathy
(Slows disease progression, does not cure)
HTN: ACE/ARBs
Tx of hyperglycemia
2 types of Acute Tubular Necrosis (ATN)
Ischemic (hypovolemia, shock, renal artery stenosis, embolism in renal artery) causes skip lesions in tubules.
Toxic (PCT only, due to drugs, toxins, CCL4, radiocontrast)
Causes of acute/chronic Tubulointerstitial Nephritis
Acute: Acute bacterial pyelonephritis, acute interstitial nephritis (hypersensitivity reaction to drugs)
Chronic: Lead nephropathy, analgesic nephropathy, chronic urinary tract obstruction
Causes of Pyelonephritis (acute, recurrent, chronic)
(Common) Inflammation affecting the tubules, interstitium, and renal pelvis. Ascending infx most common.
85-90% caused by gram negative bacilli (most commonly E.coli)
Causes:
Urinary tract obstruction/stasis (organisms multiply)
Vesicoureteral reflux
Intrarenal reflux
SXS of pyelonephritis
Fever, flank pain, N/V, chills Unilateral Abdominal pain Myalgia Fatigue N & V Weakness
Causes of Acute Interstitial Nephritis
Due to drug/infx agent acting as a hapten, binding to cytoplasm or EC membrane binding sites with secondary immune mediated injury.
Ibuprofen/NSAIDs, acetaminophen, penicillins, cephalosporins, cimetidine, thiazide diuretics, cyclosporine
Causes of Nephrolithiasis
Habits, hereditary errors of metabolism cause excessive production and excretion of stone-forming substances (their urinary concentration exceeds their solubility), urine pH/vol, bacteria
Causes of Nephrosclerosis
Sclerosis of renal arterioles, causes local parenchymal ischemia
Causes: HTN or DM
Causes of Renal Artery Stenosis
From atherosclerotic plaque or fibromuscular dysplasia (Intractable HTN from renin release)
Causes: HTN
Describe Autosomal Dominant Polycystic Kidney Disease (ADPKD)
Mutation in PKD1 or PKD2. Fluid filled cysts in kidneys due to PKD1 or PKD2 not inhibiting cell proliferation.
Major cause of chronic kidney disease.
Name 2 malignant renal neoplasms
Renal Cell Carcinoma Wilms Tumor (Nephroblastoma)
Describe Hydronephrosis
Dilation of renal pelvis and calyces from retained urine.
Back pressure causes renal atrophy, compresses renal vasculature, decreased ability to concentrate urine, and damage to glomeruli.
Leads to scarring and atrophy of papillae
Inability to concentrate urine, salt wasting, HTN, if complete: anuria (incompatible with survival)
Describe Vesicoureteral Reflux (VUR)
Malposition of incompetent closure of UVJ allows for urine to reflux from the bladder. Congenital or acquired (scarring in adults causing obstruction)
