Renal 2 Flashcards
- A complication of pyelonephritis seen in diabetics w/ acute pyelonephritis
Renal Papillary Necrosis
- 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
Renal Papillary Necrosis
Renal Papillary Necrosis can lead to what?
Hydronephrosis (swelling of a kidney due to a build-up of urine)
- 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)
Chronic Pyelonephritis
- Loss of renal tissue, kidneys become small/irregularly scarred
- One or both kidneys is involved (which is more common?)
- Chronic Pyelonephritis
- Usually just 1 kidney
What is the “hallmark” of chronic pyelonephritis?
Scarring involving the pelvis or calyces (or both), leading to papillary blunting and calyceal deformities
- 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
Chronic Pyelonephritis
- Proliferative arteriosclerosis
- Blood vessels, tubules, and interstitium are all affected, (so renal function is affected)
Chronic Pyelonephritis
What is the #1 cause of acute renal failure?
Acute Tubular Necrosis
- 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
Acute Tubular Necrosis
Typically occurs after an MI, all causes of cardiac arrest, and all forms of hypotensive shock
(Hypoxia)
Acute Tubular Necrosis
- W/ Acute Tubular Necrosis (ATN), where is the reduction of blood flow most prominent?
- What is most affected by the ischemia?
- Blood flow reduction: Cortex
- Ischemia: Corticol tubules
- What are Tamm-Horsfall proteins and what are they associated with?
- Proteinaceous casts in the distal tubules & collecting ducts
- Acute Tubular Necrosis (ATN)
Is ATN reversible?
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…
- Which 2 types of ATN are treatable/reversible?
- How long until kidneys are functional again?
- Which type of ATN is non-reversible?
- Hypoxic/Anoxic
- 2 days
- Toxic (destroys kidney)
Which condition is seen in patients who attempt suicide w/ driniing radiator fluid?
ATN w/ disruption of basement membrane
(replaced by fibrosis, nephrotoxic)
- What is the #1 organ affected by DM?
- Which type of DM?
- Kidneys
- Insulin dependent
Diabetic Neuropathy involves which 3 parts of the kidney?
- Glomeruli
- Blood Vessels
- Interstitium
(and tubules, but focus on these 3)
-
Changes of what include:
- thickening of the basement membrane and an increased amount of mesangial matrix
Diffuse Glomerulosclerosis which occurs in the Glomeruli when pt has Diabetic Nephropathy
Mesangial matric expansion may lead to formation of nodules in glomerular tuft
Nodular Glomerulosclerosis (Kimmelstiel-Wilson Disease)
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.
Both
- Nodular Glomerulosclerosis/Kimmelstiel-Wilson Disease
- Diffuse Glomerulosclerosis
What are the 3 layers of the Glomerular Filtration Membrane
- Capillary Loop
- Basement Membrane
- Podocytes
- How long does it take proteinuria to develop?
- What is proteinuria associated with?
- 10-20 years
- Glomerular changes in diabetes
- SEVERE proteinuria results in deterioration of renal function and chronic renal failure usually develops over a period of how long?
5 years
Vascular changes in DM
- Changes are most prominent in which vessels? Which shows what?
- Vessel walls thicken
- Vascular lumen narrow
- Arterioles, which shows hyalinosis
Vascular Changes in Diabetes leads to what 3 things?
- Ischemia
- Tubular atrophy
- Papillary necrosis of pyramids
What goes “hand in hand” with DM?
Papillary Necrosis
Vascular Changes in DM
- What can result if the necrotic papillae detach?
They can occlude the ureter causing obstruction
What is an important “complication” from interstitial changes in DM?
The kidneys are prone to bacterial infections, so pyelonephritis is a an important complication
What is the formation of calculi?
Urolithiasis
(urinary stones)
- 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?
- Men
- Most patients experience attack by 20 - 30 yrs old
- Calcium
- Struvite
- Uric Acid
- Cysteine stones
What does uric acid lead to?
(common in men)
Gout
- What is the #1 cause of urolithiasis in the UK?
- What is the #1 cause in the US?
- UK: Calcium phosphate
- US: Calcium
What can a patient add to their diet to prevent recurrence of urolithiasis?
Drink cranberry juice
Calcium stones are composed of either ____ or ____.
- Calcium oxalate
- Calcium phosphate
Which conditions result in hyperexcretion of calcium? (2)
- Hyperparathyroidism
- Diffuse bone disease
- Other hypercalcemic states
What results from calcium oxalate stones if the stone goes to the ureter?
Renal colic
**Are composed of magnesium ammonia phosphate or triple stones and accounts for 15% of tones**
Struvite Stones
***Struvite Stones cause what?**
Renal Stones
(PANCE question, on his exam)!!**
- 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)
- Struvite Stones
- Such as proteus
Staghorn Calculi
- What are they associated with?
- Describe them
- Associated w/ infection
- They form some of the largest stones
Genus and Species of Struvite Stones
- Genus: Proteus
- Species: vulgaris
