renal pathology Flashcards by Imaani Goodier

what is the function of the kidneys? (5)

eliminates metabolic waste products 
regulate fluid/electrolyte balance
regulate acid-base balance 
produce hormones 
-renin: fluid balance RAAS 
Erythropoietin: stimulates erythrocyte production

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how many patients per year develop acute renal failure/year in England and of them patients how many needed dialysis ?

26,000 patients

10000 need dialysis

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how many patients develop chronic renal failure per year in England?

around 43,000 patients with CRF in England

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what’s the treatment options for those with chronic renal failure and the percentages?

50% will have a transplant
40% haemodialysis
10% peritoneal dialysis

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what is the presentation of acute renal failure?

unwell, rapid rise in creatinine and urea

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what is the presentation for nephrotic syndrome?

oedema, proteinuria, hypoalbuminaemia

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what is the presentation for acute nephritis?

oedema, proteinuria, haematuria, hypertension, renal failure

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what is the presentation for chronic renal failure?

slow decline in renal function, haematuria and proteinuria

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who is involved in the diagnosis in renal problems

renal physician
biochemist
pathologist
urologist 
radiologist

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what is the role of the renal physician in diagnosing a patient with renal problems

they carry out the clinical history and examination

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what is the role of the biochemist in diagnosing a patient with potential renal problems?

they carry out blood tests. Mainly Urea and Creatinine

they carry out urine analysis for

protein
blood
electrolytes

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what is the role of the pathologist in diagnosing a potential renal problem patient?

they carry out renal biopsy and do the following tests

light microscopy
immunofluorescence
electron microscopy

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what is the role of the urologist in diagnosing a renal problem patient?

they use cystoscopy to determine if there may be an obstruction or a haematuria.

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what is the role of the radiologist in diagnosing a potential renal patient?

they use radiology to determine whether there is

an obstruction
the size of the kidney
any structural abnormalities

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what structures in the kidney filter?

podocytes, foot processes, endothelial cells and basement membranes

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what is the blood flow in the kidney (artery)?
Richard 
Said 
I 
Ate
Cake
At
Gloria's 
Evening
Party

renal arteries –> segmental arteries –> interlobar arteries –> arcuate arteries –> corticol radiate arteries –> afferent arterioles –> glomerular capillaries efferent arterioles –> peritubular capillaries

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what conditions can cause vascular damage ?

hypertension
diabetes
atheroma - renal artery stenosis
vasculitis 
thrombotic microangiopathy

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what are immunological causes of glomerular damage?

antibodies to BM/glomerular components e.g. goodpastures syndrome, post-infective glomerolunephritis

circulating antigens deposit in glomerulus

circulating immune complexes deposit in glomerus

these cause complement and neutrophil activation.
reactive oxygen species and clotting factors.

this causes glomerular damage

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what are the non-immunological causes of glomerular damage

vessel damage via endothelial injury caused by vasculitis, HTN, clotting disorders, HUS

basement membrane damage caused by

altered basement membrane e.g. DM hyperglycaemia.
inherited disease e.g. aport disease
abnormal Protein deposition (amyloid) impair function e.g. myeloma, RA.

these all lead to glomerular damage

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what are the causes of ischaemic renal tubular damage?

hypotension - shock
vessel damage - vasculitis, HTN
glomerular damage
all lead to reduced perfusion which leads to tubular damage

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what are the causes of toxic renal tubular damage?

direct toxins
hypersensitivity reactions
crystal deposits
abnormal protein deposition

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what classifies something as a direct toxins

drugs e.g. antibiotics, NSAIDs, ACEi, Diuretics
contrast medium
organic solvents
heavy metals
ethylene glycol
pesticides

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what are the main causes of reduced blood flow in the kidney 3?

damage to blood vessels
damage to glomerulus
damage to tubule

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what is the main inflammatory cause that causes damage to the blood vessels?

vasculitis

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what is the main causes of endothelial damage that causes damage to the blood vessels?

hypertension | thrombotic microangiopathy

what are the main causes of abnormal deposits that cause damage to the blood vessels?

amyloid | diabetes

what are the main immunological diseases/ conditions that causes the damage to the glomerulus

membranous Anti-GBM disease IgA nephropathy lupus nephritis post-infective

what are the main non- immunological diseases/ conditions that causes the damage to the glomerulus

minimal change FSGS

what is the main cause of direct toxicity that damage the tubule?

drugs and poisons e.g. gentamicin

what is the main cause of abnormal deposits that cause the damage to tubule?

myeloma

what is the main cause of hypersensitivity that causes damage to tubule?

drugs e.g. penicillin

what is the main inflammatory cause which damages tubule?

pyelonephritis | others e.g. sarcoid

what is the main ischaemic cause that damages tubule?

shock glomerular damage vascular disorders

what is nephrotic syndrome always due tp?

damage to glomerulus

what is the features of nephrotic syndrome?

oedema proteinuria >3g in 24hr hypoalbuminaemia

what are the complications to nephrotic syndrome

infection | thrombosis

in adults what is the most common cause of nephrotic syndrome

membranous nephropathy usually in adult males 60 years old and younger. 20-30% progress to end stage renal failure

what are some common causes of nephrotic syndrome in adults?

Focal segmental glomerulosclerosis FSGS - this can have various causes usually idiopathic but also genetic, heroin use, HIV. more common in males minimal change disease - these have normal histology

what are some less common causes to nephrotic syndrome in adults?

diabetes, lupus nephritis, amyloid

what is the most commonest cause of nephrotic syndrome in children?

minimal change disease. they have a normal histology and an excellent prognosis

what are some common causes to nephrotic syndrome in children?

minimal change disease | focal segmental glomerulosclerosis

what are the features of acute nephritis?

``` Oedema Haematuria Proteinuria Hypertension Acute renal failure ```

what are the causes of acute nephritis in adults?

Post infective glomerulonephritis IgA nephropathy Vasculitis SLE

what are the causes of acute nephritis in children

acute post-infective glomerulonephritis IgA nephropathy Henoch-schönlein purpura haemolytic-uraemia syndrome

what is henoch-schönlein purpura and the features that occur in children?

specific IgA nephropathy (systemic vasculitis) often follows throat infection. occurs usually in teenage boys with arthralgia, abdominal pain, purpuric rash, proteinuria/haematuria, acute renal failure

what is haemolytic-uraemia syndrome

this is typical children with E.coli 0157 enteritis main symptoms include acute nephritis, haemolysis, thrombocytopenia

what is the pre-renal causes of acute renal failure?

reduced blood flow to the kidney caused by - severe dehydration - hypotension - bleed - septic shock - LVF

what are the post-renal causes to acute renal failure?

``` urinary tract obstruction caused by -urinary tract tumours - pelvic tumour -calculi -prostatic enlargement ```

when should a renal biopsy be done when assessing acute renal failure cause?

when the acute renal failure is due to damage to the kidney.

what's the main conditions that cause acute renal failure in adults?

vasculitis | acute interstitial nephritis/tubulointerstitial nephritis

what's the main conditions that cause acute renal failure in children?

- PIGN - Henoch-Schönlein purpura - Haemolytic uraemia syndrome - Acute interstitial nephritis

what are some of the complications of acute renal failure?

``` cardiac failure (fluid overload) arrhythmias (electrolyte imbalance) GI bleeding (multifactorial) Jaundice (hepatic venous congestion) Infection esp. lung and urinary tract ```

what GFR does kidney failure occur at?

GFR < 15ml/min/1.73m2 or dialysis

what is isolated proteinuria?

proteinuria BUT less than nephrotic range

what is the main causes of isolated proteinuria in adults?

FSGS DM SLE

what is the main causes of isolated proteinuria in children?

FSGS | HSP

what is isolated haematuria?

Haematuria +/- proteinuria with normal renal function: usually renal

what are the main causes of isolated haematuria?

- IgA nephropathy - Thin Basement membrane disease: inherited condition causing abnormally thin glomerular BM; renal function usually normal - Aport hereditary nephropathy: inherited abnormalities of type IV Collagen cause abnormal BM, sometimes with eye and ear problems - renal failure +/- deafness +/- ocular problems

what are the risk factors for acute pyelonephritis?

female, instrumentation, diabetes, urinary tract structural abnormalities

what are the risk factors for chronic pyelonephritis?

urinary tract obstruction/reflux

what are the complications for acute pyelonephritis?

abscess formation

what are the complications for chronic pyelonephritis?

scarring, chronic renal failure

what is the most common causes of renal artery stenosis?

due to atheroma also arterial dysplasia

what is renal artery stenosis?

ischaemic injury of affected kidney

what is the commonest cause of end-stage renal failure in developed world?

diabetes

how does diabetes (hyperglycaemia) cause damage

- damaged basement membrane thickens and glomerulus produces excess extracellular matrix (nodules) - small vessel damage cause ischaemia and tubular damage

what is myeloma?

a plasma cell tumour; excess Ig's deposit in tubules cause inflammation and fibrosis