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CP > renal pathology > Flashcards

renal pathology Flashcards

1
Q

what is the function of the kidneys? (5)

A 
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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2
Q

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

A

26,000 patients

10000 need dialysis

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3
Q

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

A

around 43,000 patients with CRF in England

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4
Q

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

A

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

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5
Q

what is the presentation of acute renal failure?

A

unwell, rapid rise in creatinine and urea

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6
Q

what is the presentation for nephrotic syndrome?

A

oedema, proteinuria, hypoalbuminaemia

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7
Q

what is the presentation for acute nephritis?

A

oedema, proteinuria, haematuria, hypertension, renal failure

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8
Q

what is the presentation for chronic renal failure?

A

slow decline in renal function, haematuria and proteinuria

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9
Q

who is involved in the diagnosis in renal problems

A 
renal physician
biochemist
pathologist
urologist 
radiologist
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10
Q

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

A

they carry out the clinical history and examination

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11
Q

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

A

they carry out blood tests. Mainly Urea and Creatinine

they carry out urine analysis for

  • protein
  • blood
  • electrolytes
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12
Q

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

A

they carry out renal biopsy and do the following tests

  • light microscopy
  • immunofluorescence
  • electron microscopy
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13
Q

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

A

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

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14
Q

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

A

they use radiology to determine whether there is

  • an obstruction
  • the size of the kidney
  • any structural abnormalities
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15
Q

what structures in the kidney filter?

A

podocytes, foot processes, endothelial cells and basement membranes

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16
Q 
what is the blood flow in the kidney (artery)?
Richard 
Said 
I 
Ate
Cake
At
Gloria's 
Evening
Party
A

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

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17
Q

what conditions can cause vascular damage ?

A 
hypertension
diabetes
atheroma - renal artery stenosis
vasculitis 
thrombotic microangiopathy
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18
Q

what are immunological causes of glomerular damage?

A

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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19
Q

what are the non-immunological causes of glomerular damage

A

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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20
Q

what are the causes of ischaemic renal tubular damage?

A

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

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21
Q

what are the causes of toxic renal tubular damage?

A

direct toxins
hypersensitivity reactions
crystal deposits
abnormal protein deposition

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22
Q

what classifies something as a direct toxins

A
  • drugs e.g. antibiotics, NSAIDs, ACEi, Diuretics
  • contrast medium
  • organic solvents
  • heavy metals
  • ethylene glycol
  • pesticides
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23
Q

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

A

damage to blood vessels
damage to glomerulus
damage to tubule

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24
Q

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

A

vasculitis

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25
Q

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

A

hypertension

thrombotic microangiopathy

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26
Q

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

A

amyloid

diabetes

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27
Q

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

A

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

28
Q

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

A

minimal change FSGS

29
Q

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

A

drugs and poisons e.g. gentamicin

30
Q

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

A

myeloma

31
Q

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

A

drugs e.g. penicillin

32
Q

what is the main inflammatory cause which damages tubule?

A

pyelonephritis

others e.g. sarcoid

33
Q

what is the main ischaemic cause that damages tubule?

A

shock
glomerular damage
vascular disorders

34
Q

what is nephrotic syndrome always due tp?

A

damage to glomerulus

35
Q

what is the features of nephrotic syndrome?

A

oedema
proteinuria >3g in 24hr
hypoalbuminaemia

36
Q

what are the complications to nephrotic syndrome

A

infection

thrombosis

37
Q

in adults what is the most common cause of nephrotic syndrome

A

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

38
Q

what are some common causes of nephrotic syndrome in adults?

A

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

39
Q

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

A

diabetes, lupus nephritis, amyloid

40
Q

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

A

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

41
Q

what are some common causes to nephrotic syndrome in children?

A

minimal change disease

focal segmental glomerulosclerosis

42
Q

what are the features of acute nephritis?

A 
Oedema
Haematuria
Proteinuria
Hypertension
Acute renal failure
43
Q

what are the causes of acute nephritis in adults?

A

Post infective glomerulonephritis

IgA nephropathy

Vasculitis

SLE

44
Q

what are the causes of acute nephritis in children

A

acute post-infective glomerulonephritis

IgA nephropathy

Henoch-schönlein purpura

haemolytic-uraemia syndrome

45
Q

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

A

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

46
Q

what is haemolytic-uraemia syndrome

A

this is typical children with E.coli 0157 enteritis

main symptoms include acute nephritis, haemolysis, thrombocytopenia

47
Q

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

A

reduced blood flow to the kidney caused by

  • severe dehydration
  • hypotension
    • bleed
    • septic shock
    • LVF
48
Q

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

A 
urinary tract obstruction
caused by
-urinary tract tumours
- pelvic tumour
-calculi
-prostatic enlargement
49
Q

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

A

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

50
Q

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

A

vasculitis

acute interstitial nephritis/tubulointerstitial nephritis

51
Q

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

A
  • PIGN
  • Henoch-Schönlein purpura
  • Haemolytic uraemia syndrome
  • Acute interstitial nephritis
52
Q

what are some of the complications of acute renal failure?

A 
cardiac failure (fluid overload)
arrhythmias (electrolyte imbalance)
GI bleeding (multifactorial)
Jaundice (hepatic venous congestion)
Infection esp. lung and urinary tract
53
Q

what GFR does kidney failure occur at?

A

GFR < 15ml/min/1.73m2 or dialysis

54
Q

what is isolated proteinuria?

A

proteinuria BUT less than nephrotic range

55
Q

what is the main causes of isolated proteinuria in adults?

A

FSGS
DM
SLE

56
Q

what is the main causes of isolated proteinuria in children?

A

FSGS

HSP

57
Q

what is isolated haematuria?

A

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

58
Q

what are the main causes of isolated haematuria?

A
  • 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
59
Q

what are the risk factors for acute pyelonephritis?

A

female, instrumentation, diabetes, urinary tract structural abnormalities

60
Q

what are the risk factors for chronic pyelonephritis?

A

urinary tract obstruction/reflux

61
Q

what are the complications for acute pyelonephritis?

A

abscess formation

62
Q

what are the complications for chronic pyelonephritis?

A

scarring, chronic renal failure

63
Q

what is the most common causes of renal artery stenosis?

A

due to atheroma also arterial dysplasia

64
Q

what is renal artery stenosis?

A

ischaemic injury of affected kidney

65
Q

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

A

diabetes

66
Q

how does diabetes (hyperglycaemia) cause damage

A
  • damaged basement membrane thickens and glomerulus produces excess extracellular matrix (nodules)
  • small vessel damage cause ischaemia and tubular damage
67
Q

what is myeloma?

A

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

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