Renal disease Flashcards
how does the kidney regulate the following:
Regulation of blood pressure
Regulation of calcium and bone metabolism
Regulation of haematocrit
Regulation of blood pressure
- Renin
Regulation of calcium and bone metabolism
- 1,25 Dihydroxycholecalciferol
Regulation of haematocrit
- Erythropoietin
what is the Basic unit of the kidney?
nephron
what creates charge-dependent (anionic) and size-dependent barrier/filter in the glomerulus of the nephron?
podocytes
what are the untis in the Nephron and their various roles?
The Proximal Convoluted Tubule
- is always doing the most - reabsorption n co-transport
Descending loop of henle
- permeable to H20
Ascending loop of henle
- actively resorbs sodium and chloride
DCT
Regulates pH via active transport
Regulates Na K via active transport
Regulates calcium
Collecting Duct Resorbs water (principal cells, antidiuretic hormone) Regulates pH (intercalated cells, proton excretion)
how would you describe the endothelial cells of the glomerulus?
fenestrated
give an example of a condition involving Immune Complex deposition in the Kidney.
what findings would there be?
condition - membranous glomerulonephritis:
IgG would be seen on EM
leads to complement activation so C3 seen too
subendothelial deposits
lack of podocyte foot processes
Primary disease is autoimmune
Antibody against phospholipase A2 type M receptor (PLA2R) in 75% of cases
what is the aetiology, presentation and associations of :
Polycystic Kidney Disease
Adults
Autosomal Dominant
Presents in adulthood with hypertension, flank pain and haematuria
PKD1, PKD
Association: Berry aneurysms
Cysts on the kidney commonly develop in patients with ___?
end stage renal disease who are on dialysis
list some causes of AKI / AK failure
Pre-Renal: Failure of perfusion, dehydration (eg vomiting)
Renal: Acute tubular injury, acute glomerulonephritis, thrombotic microangiopathy
Post-Renal: Obstruction
what is the Commonest cause of acute renal failure?
Acute tubular injury
what are the causes of Acute tubular injury?
Tubular epithelial cells damaged by:
Ischaemia
Toxins (contrast, haemoglobin, myoglobin, ethylene glycol)
Drugs - NSAIDs
- Failure of Glomerular Filtration
list some causes of Acute Tubulo-Interstitial Nephritis
Immune injury to tubules and interstitium
Due to infection and drugs - DRUGS major cause
What are the ivx findings of Acute Tubulo-Interstitial Nephritis?
Heavy interstitial inflammatory infiltrate with tubular injury
Can see eosinophils, granulomas
what Presents with oliguria with urine casts containing erythrocytes and leucocytes?
tips: may also have crescents present & Proliferation of cells within Bowman’s space
Acute Glomerulonephritis
what iis the aetiology and features of Anti-GBM Disease?
The antibody attacks C-terminal domain of Type IV collagen
antibodies directed against the glomerular basement membrane
Linear deposition of IgG
can cause pulmonary haemorrhage if targets alveolar BM
which Immune Complex Associated Glomerulonephritis is Usually ANCA-associated?
Pauci-Immune Crescentic Glomerulonephritis
define nephrotic syndrome
Proteinuria (>3.5g/day)
Hypoalbuminemia
Oedema
Hyperlipidaemia
list some causes of nephrrotic syndrome
Non-Immune Complex Related:
Minimal Change Disease
Focal Segmental Glomerulosclerosis
Immune Complex Mediated:
Membranous Glomerulonephritis
Systemic Disease:
Diabetes mellitus
Amyloidosis
SLE
give some features of Minimal Change Disease
Glomeruli look normal by light microscopy
Effacement of foot processes on electron microscopy
Common cause of nephrotic syndrome in children
Generally responds to immunosuppression
how does Diabetic Nephropathy present?
Typically starts as microalbuminuria before progression to proteinuria and nephrotic syndrome
Pattern seen is Nodular Glomerulosclerosis
What are the Commonest forms off amyloid in kidneys?
AA, derived from serum amyloid associated protein (SAA), an acute phase protein; patients tend to have a chronic inflammatory state
AL, derived from immunoglobin light chains; 80% of patients have multiple myeloma
ivx for amyloid?
Congo red stain – pink in normal light
Polarised light – apple green birefrringence
list some causes of a thin Basement Membrane?
how would it present?
name 1 eg condition?
Hereditary defect in Type IV collagen synthesis
Basement membrane <250nm thickness
Haematuria is only consequence in most cases
presentation - microscopic haematuria
Alport’s Syndrome
X-linked dominant mutations affecting ⍺5 subunit
Forms exist in which mutation affects ⍺3 or ⍺4 subunit
Typically progressive, renal failure in middle age
Often have deafness, ocular disease
how does IgA Nephropathy present?
microscopic haematuria
Can be seen with small-vessel vasculitis (Henoch-Schönlein Purpura)
30% develop end stage renal failure
list the causes of CKD in order with the most common first ?
Diabetes – 27.5% Glomerulonephritis – 14.1% Polycystic Kidney Disease – 7.4% Pyelonephritis – 6.5% Hypertension – 6.8%
on histology, global glomerulosclerosis is noted. what is this indicative of?
Hypertensive Nephropathy
which antibodies are present in SLE?
Anti-nuclear and Anti-dsDNA antibodies are typical
