Renal Pathology Flashcards
The kidney has a large functional reserve and as such there is typically damage >75% before impairment
True
The glomerulus is lined by 3 things namely
Fenestrated endothelium
Basement membrane
Pododcytes or foot processes
Gaps between endothelial cells are known as
Fenestrae measuring 70-100nm
The basement membrane of the glomerulus consists mainly of
Type IV collagen
Heparan sulphate
Laminin
Glycoprotein
With a thickness of 250-400nm
The visceral epithelia of the glomerulus is
Poeocytes or foot processes
Embedded into the bm and separated from adjacent ones by 20-30nm filtration skits bridged by thin diaphragm (nephrin that attaches to intracellular proteins known as podocin)
The parietal epithelium faces the bowman’s space and is not in contact with the BM. T/f
T
The functions of the mesangial cells of the glomerulus
Phagocytosis
Contractility
They lie between the capillaries
What are the layers of the glomerular basement membrane
Central lamina densa
Between a lamina rara interna and externa
Two types of azotemia include
Pre renal: reduced renal blood flow leading to hypoperfusion with or without parenchyma damage
Post renal: obstruction of urine flow beyond the level of the kidneys
Azotemia=asymptomatic
Uremia=symptomatic
T/f
Obviously
Are you dumb 😒
Nephritic syndrome
A clinical syndrome that presents as
P-proteinuria (mild-moderate)
H-hematuria (grossly visible or microscopic)
A-Anasarca (less than in nephritis syndrome tho)
R- red cell casts (from breakdown of red cells)
O- oliguria
A-azotemia
H-hypertensiom
Nephrotic syndrome
A clinical syndrome in which there is increased permeability of the glomerulus and thus presents as
H- hypoalbuminemia(<3g/dl)
H- hyperlipidemia/lipiduria
O-nephrotic
P- heavy proteinuria(>3.5g/day)
E- severe edema
Acute kidney injury
Characterised by a sudden and often reversible reduction in kidney function often denoted by
Rapid decline in GFR(within hours to days)
Concurrent dysregulation of fluid/electrolyte balance
Retention of metabolic waste(azotemia)
In severe cases, oliguria or anuria is present
The types of AKI and their causes include
Pre renal- reduced blood volume as a result of dehydration from vomiting, diarrhea etc
Hemorrhage
Shock, sepsis
Intrinsic renal…due to injury of the kidney in cases of acute tubular necrosis
Drugs, toxins, glomerulonephritis, lupus nephritis
Post renal- typically due to obstruction asin urethral stricture, bladder cancer,enlargement of the prostate
Chronic renal failure
Defined as presence of diminished GFR that is persistently less than 60ml/minute/1.73m² for at least 3 months from any cause and or persistent albuminuria
End result of all chronic renal parenchymal diseases.
End stage renal disease
occurs when the Gfr is <5% of normal . Terminal stage of uremia.
Secondary diseases with glomerular involvement
DM
SLE
Goodpastures disease
Wegener’s granulomatosis
Amyloidosis
Hence schnolein purpura
Pathologic responses of glomerulus to injury
Hate- hypercellularity( epithelia, mesengial cells or leukocyte infiltration, formation of crescents)
Sucking- sclerosis
Hate- hyalinosis
boobs-basement membrane thickening
Pathogenesis of glomerular injury
Disease caused by in situ formation of immune complexes
Diseases caused by deposition of circulating immune complexes
Due to antibodies directed against normal components of the glomerular basement membrane with crossreactivity asin good pastures disease
Cell mediated immunity in glomerulonephritis
Diffuse is to focal as global is to?
Segmental
Complications of nephritis syndrome
Infections especially staphylococcal and pneumococcal diseases probably due to loss of immunoglobulin in urine
Thrombosis(anticoagulation disorders) due in part to loss of antithrombin 3 in urine
Renal vein Thrombosis
Lipid based diseases
ESRD
Death
The most frequent Systemic causes of nephrotic syndrome
Das sad
DM
Amyloidosis
SLE
Uniform and diffuse effacement of podocytes is seen on light microscopy in minimal change disease
False, only seen on electron microscopy with no immunofluorescence
In which type of glomerulonephritis is there selective proteinuria typically to albumin
Minimal change
Prognosis of minimal change
Good to corticosteroid therapy especially children >90%
However proteinuria may recur and some patients may become steroid dependent or resistant although this typically resolves by puberty