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Endocrinology and diabetes (DEN 303) > Pathology of renal disease > Flashcards

Pathology of renal disease Flashcards

1
Q

We filter (fluid)

A

180 litres per day

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2
Q

We resorb (fluid)

A

178 litres per day

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3
Q

Urine amount

A

2 litres per day

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4
Q

How does the kidney work?

A 
Glomerular capillary
-blood comes in
Interstitium
-bigger molecules like red blood cells and albumin too big to pass into interstitium
-smaller molecules like urea and creatinine passed through into tubules
Tubules (site of most work) 
-site of resorption  
-eventually urine comes out
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5
Q

What can go wrong?

A 
Not enough filtration
-not enough blood flow
-blocked filter
-lack of glomeruli 
Too much filtration
-leaky membranes
Too little reabsorption
-faulty tubules
Blocked/ inflamed tubules
Tubules die off in chunks
Tumours can develop
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6
Q

Blood pressure vs urine output

A

Blood pressure drops –> urine output drops
Blood pressure increases
–> urine output increases
Low BP for long time –> renal failure

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7
Q

Renal disease - causes of acute renal failure

A

Lack of blood flow due to haemodynamic shock (bleeding, trauma)
Blocked filter
Leaky filter
Non-functioning tubules

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8
Q

What substances increase in concentration in renal failure?

A

Urea and creatinine levels in blood

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9
Q

Filter blockage and creatinine

A

Filter blockage leads to rise in creatitine levels

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10
Q

Causes of a blocked filter

A 
Nothing to see (minimal change)
-minimal change glomerulonephritis
Proteins (membranous)
-deposited in 'filter'
-membranous glomerulonephritis
Cells (proliferative)
-proliferative glomerulonephritis
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11
Q

membranous glomerulonephritis

A

Membranes are thickened

Deposits of proteins in the glomerulus

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12
Q

Granular kidney post-mortem

A

Should be smooth
Groups of glomeruli have died off
Down to 30-40% leads to renal failure

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13
Q

Renal disease –> causes of chronic renal failure

A 
Lack of glomeruli 
-chronic hypertension
Blocked filter
-chronic glomerulonephritis
Non-functioning tubules
-tubulointerstitial disease
--> crystals or casts
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14
Q

Acute renal failure caused by too much filtreation - leaky membranes/ filters leads to

A

Proteinuria
-caused by bigger molecules than can usually pass through e.g. albumin
-frothy urine in morning
Test by dipstick in (blood and protein tested)

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15
Q

Too little resorption - Faulty tubules leads to

A

< reabsorption
> urine
Can lead to acute renal failure
Back to normal in couple of weeks with tubular dialysis

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16
Q

Blocked/ inflamed tubules causes

A 
Casts
Crystals
Blood clot
Bowel prep (cleans out colon)
-calcium phosphate crystals can build up
Inflammatory cell buildup (e.g. UTI for a long time)
-bacteria
-neutrophils
-macrophages
17
Q

Renal disease –> tubules die off in chunks due to

A

Infection e.g.

  • pyelonephritis
  • papillary necrosis
18
Q

Renal cell carcinoma incidence

A

3% of all new cancers
8,000 cases per year in UK
Rates going up since 1975

19
Q

Renal cell carcinoma risk factors

A 
Obesity
Cigarette smoking
-stuff you smoke gets excreted in urine
von Hippel Lindau syndrome
Acquired renal cycstic disease (dialysis)
20
Q

Renal cell carcinoma spread

A

Direct
Lymphatic
Peritoneum
Blood –> bone

21
Q

Renal cell carcinoma treatment

A

Radiotherapy

Surgical resection

22
Q

Renal cell carcinoma prognosis

A

Dependent on stage

Average 40% 5 year survival

23
Q

Transitional cell carcinoma of the renal pelvis

-signs and symptoms

A

Haematuria

Loin pain

24
Q

Transitional cell carcinoma of the renal pelvis

-risk factors

A

Cigarette smoking
Industrial dyes e.g. aniline
Long term painkillers

25
Q

Transitional cell carcinoma of the renal pelvis

-incidence

A

<1% of all cancers

26
Q

Transitional cell carcinoma of the renal pelvis

-treatment

A

Surgical resection

27
Q

Transitional cell carcinoma of the renal pelvis

-spread

A

Direct
Lymphatic
Peritoneum
Blood

28
Q

Renal disease –> types of tumours

A

Renal cell carcinoma

Transitional cell carcinoma

29
Q

Not enough filtration - not enough blood flow

A

Sluggish flow means that small molecules needing to be filtered out don’t have enough chance to
-waste products like urea and creatinine accumulate
Low blood pressure –> considerably lower urine output
-will increase after fluids
-can lead to acute renal failure

30
Q

Causes of blocked filter (leading to acute renal failure)

A

Acute glomerulonephritis

  • nothing to see: minimal change glomerulonephritis
  • proteins: membranous glomerulonephritis
  • ->proteins are blocking the filter
  • ->histology: membranes are thickened and proteins deposited in glomerulus
  • cells: proliferative glomerulonephritis
  • ->inflammatory cells are blocking the filter
  • ->histology: inflammatory cells stacking up
31
Q

Causes of ‘leaky’ filter (leading to acute renal failure)

A

Acute glomerulonephritis

  • minimal change
  • membranous
32
Q

Causes of non-functioning tubules (leading to acute renal failure)

A

Acute tubulular necrosis

  • ischaemia
  • toxins (myoglobin or ethylene glycol)
33
Q

Types of renal disease

A

Acute renal failure
Chonic renal failure
Tumours
Infection

34
Q

Not enough filtration - blocked filter

A

If filter is blocked, nothing can come out
-kidneys have a lot of capacity so can be quite blocked before we notice change
Toxins will accumulate in blood
-urea and creatinine (these are easy to measure)

35
Q

Not enough filtration - lack of glomeruli (including causes)

A

Ones there are working but not enough
Causes
-age: lose some as go through life
-chronic hypertension: high BP thickens BVs supplying glomerulus, knocks off glomeruli
Raised creatinine and urea
Often leads to stage 1 chronic kidney disease in 70s
-30-40% glomeruli working will lead to chronic renal failure
Granular appearance of kidney post mortem

36
Q

Tubule dysfunction causes

A

Lack of blood supply can lead to acute tubular necrosis

Susceptible to toxins e.g. myoglobin, ethylene glycol

37
Q

Blocked/ inflamed tubules leads to

A

Waste products can’t get out to urine

Can lead to chronic renal failure

Endocrinology and diabetes (DEN 303) (5 decks)

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