Renal pathology Flashcards
Describe the pathological features of acute pyelonephritis
3
Infection travels up from Lower UTI ->Upper UTI = BACTERIAL INFECTION OF KIDNEY
- Bacteria travels upwards from urethera –> into the bladder
Causes :
- sex
- bacteria from faeces
- Bacterila infection = E.coli, proteus, enterobacter
- Vesicoureteral reflux (VUR), where urine flows back up ureter ( normally a valve stops it )
Pathogenisis :
1- UNILATERAL = only effects one kidney
1) Pathogen adheres to renal capillary
2) Chemokines bring neutrophils to renal epithelium , intersititum
- You can see this under the microscope = lobulated nucleus
3) Neutrophils infiltrate and die off , to make their way to the uring = increasing WBC levels in urine , also can cause WBC cell casts ,
Explain how glomerulopathies cause nephrotic and nephritic syndrome
-Immunological disturbance not due to infection with numerous sub types
2 main categories :
1) Dysfunction in glomelular filtration barrier (problems in basement membrane , no inflammatory cell infiltrate, oedema) = massive loss of protein in URINE = NEPHROTIC syndrome
2)Inflammation in the glomeruli , which causes haematuria, proteinuria, HT, = Nephritic Syndrome
You can also get mixed both nephrotic and nephritic …
Compare and contrast simple renal cysts and inherited polycystic kidney disease
Cyst =closed cavity or sac lined by epithelium , containing liquid or semi solid material
Simple cyst = harmless
Autosomal recessive polycystic kidney disease = more serious , presents in first few days of life , very fatal
Autosomal dominant polycystic kidney disease = presents later in life: kidney failure , 50% require treatment for kidney failure ,
Describe the pathological features of renal calculi
CSUC
1) calcium oxalate
2) Struvite
3) Uric acid
4) Cystein
Describe the pathological features of renal cell carcinoma
1) Angiomyolipoma: triad = blood vessel, clear fat cells, spindley smooth muscle cells = benign
2) Benign = Oncocytoma
Malignant tumour :
1- Renal caricinoma ( well rounded edges, clear cytoplasm and are arranged in nests with intervening blood vessels)
2-Wilms tumour in children
causes of respiratory alkalosis
1) Salicyate ingestion = ventillation = respiratory alkalosis
2) Hyperventilation = hypocapnia ( over breathing not enough CO2 )= alkalosis
3) Hypoxia
4) Liver diseases
5) Heart failure
6) 1) Asthma = irregular bronchoconstrictions , ventilation /perfusion mismatch = hypoxia, hypocapnia = alkalosis
Outline the main causes of acute renal failure
-Decrease in eGFR detected in hours or weeks
3 types :
1)Pre-renal AKI = disordered perfusion of kidney which is structurally normal due to :
-shock
-sepsis
-loss of blood
-MI ,arrhythmia
-heart failure , pulmonary emobolism
causes small volume of concentrated URINE
2) Renal AKI = nephrons have been damaged after prolonger pre renal insults
- ischaemic, hypoxic renal injury
- nephrotoxins
- Transporters in the walls don’t work , Na left in tubule , hence water left in tubule = less reabsorption
- increased urine
- osmolality decreases
- H+ transport doenst work so H+ cant be secreted , HCO3- production decreases too = metabolic acidosis
- hyperkalaemia
- risk of fluid overload as eGFR decreases
3) Post renal AKI
- Urinary drainage is obstructed : due to stones, benign or malignant cancer
Chronic renal failure
- symptoms ( funny boys like noodles in bread)
- signs
Decrease in eGFR over months or years which is irreversible !
Caused by diabetes and HT
- measure: U&E Serum creatine , eGFR
Symptoms :
Fatigue due to anemia Breathlessness Leg swelling Nausea, anorexia, weight loss due to toxins Itch Bone pain
SIGNS:
- pallour
- Oedema
- HT
- Proteinuria
Causes of chronic kidney disease
1) Diabetic Kidney disease leads to glomelular basemenr membrane thickening , mesangial expansion ,glomeluar sclerosis
2) Hypertensive , athersclerotic vascular disease
3) Glomerulonephritis
4) Polycystic kidney disease
consequences of low eGFR
(2)
Consequence of reduced renal tubular function
-Fluid retention (Heart failure,oedema)
-Reduced metabolite excretion
(Uraemia, increased creatine in serum , serum urate increases, increased drug levels )
Redcued renal function :
1-Reduced fluid reabsoprtion
2-Reduced K+ excretion
3-Reduced acid secretion and bicarbonate formation
Explain the body’s response in diabetic chronic kidney disease
Glomerulus Hypertension in Diabetes :
1) Thick but leak glomerulus basement membrane ( meaning albumin gets into the urine ), but the vessel is narrow = low grr
2) RAAS released –> Angiotensin 2 acts on efferent arteriole to cause vasoconstriction = EVEN higher pressure
3) Basement membrane = damages , glucose deposits
4) Thickening of renal mesangium , support system = diabetic glomerulus, HT ,
Chronic renal failure treatment
-Treat HT
-ACE, and Angiotensin receptor blockers
-Reduce CV risk (statins)
TREAT THE COMPLICATIONS:
-anaemia with erythopoetin injection (normally kidney will make EPO to make more RBC)
-Renal bone disease ( give activated VIT D)
-Hyperphosphataemia ( phosphate binding drugs)
-Hyperkalemia (restrict the dietary intake)
Acute Renal Kidney disease
renal
2) Renal AKI = nephrons have been damaged after prolonger pre renal insults
- ischaemic, hypoxic renal injury
- nephrotoxins
- Transporters in the walls don’t work , Na left in tubule , hence water left in tubule = less reabsorption
- increased urine
- osmolality decreases ( less solutes)
- Specific gravity decreases ( less solid matter)
- H+ transport doesn’t work so H+ can’t be secreted , HCO3- production decreases too = metabolic acidosis
- hyperkalaemia
- risk of fluid overload as eGFR decreases
pre renal kidney disease
1) Pre-renal AKI = disordered perfusion of kidney which is structurally normal due to :
- shock
- sepsis
- loss of blood
- MI ,arrhythmia
- heart failure , pulmonary emobolism
Causes small volume of concentrated URINE
- osmolality of urine is increased (meaning it has more particles in it )
- specific gravity increases ( more solid matters , ions)
Acute Post renal Kidney disease
3) Post renal AKI
- Urinary drainage is obstructed : due to stones, benign or malignant cancer
to treat this you must :
1) Exclude obstruction
2) prevent UTI
3) treat underlying causes
