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Patho 3 Shea > Renal 2 > Flashcards

Renal 2 Flashcards

1
Q
  • A complication of pyelonephritis seen in diabetics w/ acute pyelonephritis
A

Renal Papillary Necrosis

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2
Q
  • Necrosis of renal papillae is a combo of ischemia and necrosis at the tips of renal pyramids
  • Gross feature of necrotizing papillitis is sharply defined gray-white to yellow necrosis of apical 2/3 of the pyramids
  • Tips can break off and go into pyramids and into ureters and cause a blockage
A

Renal Papillary Necrosis

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3
Q

Renal Papillary Necrosis can lead to what?

A

Hydronephrosis (swelling of a kidney due to a build-up of urine)

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4
Q
  • Recurrent infections superimposed on obstructive lesions leads to recurrent bouts of interstitial inflammation and scarring
  • May evolve from acute pyelonephritis
  • Can cause chronic renal failure (esp if obstruction is cause)
A

Chronic Pyelonephritis

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5
Q
  • Loss of renal tissue, kidneys become small/irregularly scarred
  • One or both kidneys is involved (which is more common?)
A
  • Chronic Pyelonephritis
  • Usually just 1 kidney
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6
Q

What is the “hallmark” of chronic pyelonephritis?

A

Scarring involving the pelvis or calyces (or both), leading to papillary blunting and calyceal deformities

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7
Q
  • Micro: Interstitial fibrosis w/ mononuclear cell infiltration
  • Dilation & contraction of tubular lining epithelium w/ atrophy of cells
  • Dilated tubules w/ pink, glassy colloid casts (suggest appearance of thyroid tissue) –> thyroidization
A

Chronic Pyelonephritis

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8
Q
  • Proliferative arteriosclerosis
  • Blood vessels, tubules, and interstitium are all affected, (so renal function is affected)
A

Chronic Pyelonephritis

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9
Q

What is the #1 cause of acute renal failure?

A

Acute Tubular Necrosis

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10
Q
  • Destruction of tubular epithelial cells w/ acute suppression of renal function
  • Sudden decrease in arterial pressure will result in acute hypoperfusion of kidney w/ blood
A

Acute Tubular Necrosis

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11
Q

Typically occurs after an MI, all causes of cardiac arrest, and all forms of hypotensive shock

(Hypoxia)

A

Acute Tubular Necrosis

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12
Q
  • W/ Acute Tubular Necrosis (ATN), where is the reduction of blood flow most prominent?
  • What is most affected by the ischemia?
A
  • Blood flow reduction: Cortex
  • Ischemia: Corticol tubules
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13
Q
  • What are Tamm-Horsfall proteins and what are they associated with?
A
  • Proteinaceous casts in the distal tubules & collecting ducts
  • Acute Tubular Necrosis (ATN)
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14
Q

Is ATN reversible?

A

Yes, regenrates w/ new simple cuboidal cells that make up the tubules***

But, some people have to go on dialysis until recovery of tubules is complete…

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15
Q
  • Which 2 types of ATN are treatable/reversible?
  • How long until kidneys are functional again?
  • Which type of ATN is non-reversible?
A
  • Hypoxic/Anoxic
  • 2 days
  • Toxic (destroys kidney)
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16
Q

Which condition is seen in patients who attempt suicide w/ driniing radiator fluid?

A

ATN w/ disruption of basement membrane

(replaced by fibrosis, nephrotoxic)

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17
Q
  • What is the #1 organ affected by DM?
  • Which type of DM?
A
  • Kidneys
  • Insulin dependent
18
Q

Diabetic Neuropathy involves which 3 parts of the kidney?

A
  • Glomeruli
  • Blood Vessels
  • Interstitium

(and tubules, but focus on these 3)

19
Q
  • Changes of what include:
    • thickening of the basement membrane and an increased amount of mesangial matrix
A

Diffuse Glomerulosclerosis which occurs in the Glomeruli when pt has Diabetic Nephropathy

20
Q

Mesangial matric expansion may lead to formation of nodules in glomerular tuft

A

Nodular Glomerulosclerosis (Kimmelstiel-Wilson Disease)

21
Q

In which form of glomerular changes of DM has increased permeability of the basement membrane which results in proteinuria? which may be massive if it exceeds 3 grams of protein / day causing nephrotic syndrome.

A

Both

  • Nodular Glomerulosclerosis/Kimmelstiel-Wilson Disease
  • Diffuse Glomerulosclerosis
22
Q

What are the 3 layers of the Glomerular Filtration Membrane

A
  • Capillary Loop
  • Basement Membrane
  • Podocytes
23
Q
  • How long does it take proteinuria to develop?
  • What is proteinuria associated with?
A
  • 10-20 years
  • Glomerular changes in diabetes
24
Q
  • SEVERE proteinuria results in deterioration of renal function and chronic renal failure usually develops over a period of how long?
A

5 years

25
Q

Vascular changes in DM

  • Changes are most prominent in which vessels? Which shows what?
  • Vessel walls thicken
  • Vascular lumen narrow
A
  • Arterioles, which shows hyalinosis
26
Q

Vascular Changes in Diabetes leads to what 3 things?

A
  • Ischemia
  • Tubular atrophy
  • Papillary necrosis of pyramids
27
Q

What goes “hand in hand” with DM?

A

Papillary Necrosis

28
Q

Vascular Changes in DM

  • What can result if the necrotic papillae detach?
A

They can occlude the ureter causing obstruction

29
Q

What is an important “complication” from interstitial changes in DM?

A

The kidneys are prone to bacterial infections, so pyelonephritis is a an important complication

30
Q

What is the formation of calculi?

A

Urolithiasis

(urinary stones)

31
Q
  • Are urinary stones (urolithiasis) more common in men or women?
  • What age range is most common?
  • What are the 4 groups they are classified into?
A
  • Men
  • Most patients experience attack by 20 - 30 yrs old
  1. Calcium
  2. Struvite
  3. Uric Acid
  4. Cysteine stones
32
Q

What does uric acid lead to?

(common in men)

A

Gout

33
Q
  • What is the #1 cause of urolithiasis in the UK?
  • What is the #1 cause in the US?
A
  • UK: Calcium phosphate
  • US: Calcium
34
Q

What can a patient add to their diet to prevent recurrence of urolithiasis?

A

Drink cranberry juice

35
Q

Calcium stones are composed of either ____ or ____.

A
  • Calcium oxalate
  • Calcium phosphate
36
Q

Which conditions result in hyperexcretion of calcium? (2)

A
  • Hyperparathyroidism
  • Diffuse bone disease
  • Other hypercalcemic states
37
Q

What results from calcium oxalate stones if the stone goes to the ureter?

A

Renal colic

38
Q

**Are composed of magnesium ammonia phosphate or triple stones and accounts for 15% of tones**

A

Struvite Stones

39
Q

***Struvite Stones cause what?**

A

Renal Stones

(PANCE question, on his exam)!!**

40
Q
  • Stones that are complication of UTIs
  • Leads to formation of ammonia from urea in urine
  • Infections w/ “urea splitting bacteria” such as _____, converts urea to ammonia (which precipitates into these stones)
A
  • Struvite Stones
  • Such as proteus
41
Q

Staghorn Calculi

  • What are they associated with?
  • Describe them
A
  • Associated w/ infection
  • They form some of the largest stones
42
Q

Genus and Species of Struvite Stones

A
  • Genus: Proteus
  • Species: vulgaris

Patho 3 Shea (19 decks)

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