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Yr 2 - Clinical Pathology > Renal Pathology > Flashcards

Renal Pathology Flashcards

1
Q

What 2 major hormones does the kidney produce?

A
  1. EPO
  2. Renin
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2
Q

How is serum creatinine and urea affected in acute renal failure?

A

Rapid rise in serum creatinine and urea

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3
Q

How is urine output affected during AKI?

A

Anuria/oliguria

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4
Q

What are the general symptoms of AKI?

A

Malaise, fatigue, nausea, vomiting, arrhythmias

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5
Q

In which 3 locations can the cause of AKI occur?

A
  1. Pre-renal
  2. Renal
  3. Post-renal
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6
Q

What is pre-renal AKI most commonly due to?

A

Reduced blood flow to kidneys (hypoperfusion):

  • Severe dehydration
  • Hypotension (bleed, septic shock, LVF)
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7
Q

What is renal AKI most commonly caused by?

A

Damage to kidney itself (often vasculitis)

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8
Q

What is post-renal AKI most commonly caused by?

A

Urinary tract obstruction:

  • Urinary tract tumours
  • Pelvic tumour
  • Calculi
  • Prostatic enlargement
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9
Q

Prognosis of AKI?

A

Prognosis usually good if no underlying renal disease (short term dialysis may be needed in some patients)

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10
Q

How can AKI lead to;

a) arrhythmias?
b) cardiac failure?
c) jaundice?

A

a) fluid overload
b) electrolyte imbalance
c) hepatic venous congestion

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11
Q

What is nephrotic syndrome?

A

A collection of symptoms due to kidney damage, causes your body to pass too much protein in your urine.

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12
Q

What is nephrotic syndrome always due to?

A

Damage to glomerulus

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13
Q

What is the commonest cause of nephrotic syndrome in adults?

A

Membranous nephropathy

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14
Q

What is membranous nephropathy?

A

A disorder where the body’s immune system attacks the filtering membranes in the kidney.

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15
Q

What are the 4 major causes of nephrotic syndrome?

A
  1. Membranous nephropathy (commonest)
  2. Focal segmental glomerulosclerosis (FSGS)
  3. Minimal change disease
  4. Other; diabetes, lupus nephritis, amyloid
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16
Q

What is FSGS?

A

Focal Segmental glomerulosclerosis is a type of glomerular disease and describes sclerosis in your kidney. The scarring of FSGS only takes place in small sections of each glomerulus.

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17
Q

What is minimal change disease?

A

Damage to glomeruli

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18
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

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19
Q

Where does minimal change disease get its name?

A

Normal histology

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20
Q

What is the 1 other major cause of nephrotic syndrome in children?

A

FSGS

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21
Q

What are the signs & symptoms of nephrotic syndrome?

A
  • Proteinuria; foamy urine
  • Oedema (particularly in feet and ankles)
  • Hypoalbuminaemia (due to proteinuria)
  • +/- hypertension
  • +/- hyperlipidaemia
  • BUT no sign of renal failure
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22
Q

What is the cause of oedema in nephrotic syndrome?

A

Due to low albumin levels –> reduction in oncotic pressure and an increase in filtration across the capillary, resulting in excess fluid buildup in the tissues (oedema).

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23
Q

What is acute nephritis (nephritic syndrome)?

A

Inflammation of kidneys

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24
Q

What does acute nephritis typically follow?

A

Can be after severe infection e.g. strep throat, hepatitis, HIV

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25
Q

Signs of acute nephritis?

A
  • Oedema
  • Proteinuria
  • Haematuria
  • Hypertension
  • Renal failure
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26
Q

What are 4 major cause of acute nephritis in adults?

A
  1. Post-infective glomerulonephritis
  2. IgA nephropathy
  3. Vasculitis
  4. SLE
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27
Q

What does post-infective glomerulonephritis follow?

A

Streptococcal infection

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28
Q

What is IgA nephropathy?

A

A kidney disease that occurs when IgA deposits build up in the kidneys, causing inflammation that damages kidney tissues.

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29
Q

What is IgA nephropathy also known as?

A

Berger’s disease

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30
Q

Prognosis of IgA nephropathy?

A

20-50% renal failure over 20 years

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31
Q

What are 4 major causes of acute nephritis in children?

A
  1. Post-infective glomerulonephritis
  2. IgA nephropathy
  3. Henoch-Schönlein purpura
  4. Haemolytic-uraemic syndrome
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32
Q

What is Haemolytic-uraemic syndrome?

A

Hemolytic–uremic syndrome (HUS) is a group of blood disorders characterised by:

  1. Acute nephritis
  2. Haemolysis
  3. Thrombocytopenia
33
Q

Which infection does haemolytic-uraemic syndrome often follow?

A

E. coli 0157 enteritis

34
Q

What is Henoch-Schonlein purpura?

A

IgA vasculitis that causes the small blood vessels in your skin, joints, intestines, and kidneys to become inflamed and bleed.

35
Q

What does Henoch-Schönlein purpura often follow?

A

Throat infection

36
Q

Symptoms of Henoch-Schönlein purpura?

A
  • usually affects boys/teenagers
  • arthralgia, abdominal pain, purpuric rash, proteinuria/haematuria, acute renal failure
37
Q

What is chronic renal failure?

A

Slow decline in renal function over time.

38
Q

How does CRF affected GFR?

A

Permanently reduced GFR due to reduced number of functional nephrons

39
Q

What are the 5 stages of CRF?

A
  • Stage 1: Normal/ increased GFR (>90ml/min/1.73m2)
  • Stage 2: Mild GFR reduction (60-89ml/min/1.73m2)
  • Stage 3: Moderate GFR reduction (30-59ml/min/1.73m2)
  • Stage 4: Severe GFR reduction (15-29ml/min/1.73m2)
  • Stage 5: Kidney failure (GFR < 15ml/min/1.73m2 or dialysis)
40
Q

What would a biopsy of CRF show?

A

Kidney shows severe scarring with loss of glomeruli and tubules

41
Q

Effects of CRF on;

a) excretion of water/electrolytes
b) excretion of toxic metabolites
c) EPO
d) bones

What are the effects of each?

A

a) reduced excretion –> oedema, hypertension
b) reduced excretion –> toxic buildup effects
c) reduced production –> anaemia
d) renal bone disease due to inability to activate vitamin D

42
Q

Consequences of CRF:

43
Q

Patients can also present with proteinuria and haematuria with no renal disease. What can isolated proteinuria be due to?

A

May be benign e.g. postural, related to pyrexia or exercise

44
Q

What 3 conditions can cause isolated haematuria with normal renal function (+/- proteinuria)?

A
  1. IgA nephropathy
  2. Thin basement membrane disease
  3. Alport hereditary nephropathy
45
Q

What is thin basement membrane disease?

A

Inherited condition causing abnormally thin glomerular basement membrane BUT renal function usually normal

46
Q

What is Alport hereditary nephropathy?

A
  • Inherited abnormalities of type IV collagen that causes abnormal BM
  • Renal failure +/- deafness +/- ocular problems
47
Q

Structure of kidney

48
Q

What does the renal corpuscle consist of?

A

Glomerulus + Bowman’s capsule

49
Q

What is the glomerular tuft?

A

The glomerular tuft is a network of capillaries within the glomerulus, that performs the first step in blood filtration within the kidney

50
Q

The interior of the Bowman’s capsule collects the filtrate from the filtering capillaries of the glomerular tuft.

Describe the 3 layers of the glomerular filtration barrier

A
  1. Endothelial cells
  2. Basement membrane
  3. Podocytes (foot processes)
51
Q

Function of the glomerular filtration barrier?

A
  • Prevent leakage of macromolecules and blood cells to glomerular filtrate
  • Allows passage of small molcules; small proteins, electrolytes, H20 etc
52
Q

Describe the order of blood flow through the kidney

A
  1. Branches of renal artery
  2. Afferent arteriole
  3. Glomerulus (capillary network)
  4. Efferent arteriole
  5. Branches of renal vein
53
Q

Describe the endothelial lining of the glomerulus

A

Fenestrated –> contain small pores

54
Q

What are the 2 components of the glomerulus?

A
  1. Endothelial lining
  2. Basement membrane
55
Q

Arterioles have muscle within their vessel wall. What does this enable them to do in the kidney?

A

Enables them to maintain the volume and pressure of blood flow within the glomerular tuft to enable it to perform function of filtration.

56
Q

Diseases can affect which 3 major components of the kidney?

A
  1. Vascular
  2. Glomerular
  3. Tubular

These 3 compartments are very intimately related; diseases tend to affect all 3.

57
Q

What is vascular renal disease?

A

Any condition that causes damage to blood vessels can result in renal pathology.

58
Q

What are the 5 major causes of vascular renal disease?

A
  1. Hypertension
  2. Diabetes
  3. Atheroma (e.g. renal artery stenosis)
  4. Vasculitis
  5. Thrombotic microangiopathy
59
Q

What condition is a major cause of renal vasculitis?

A

Wegener’s granulomatosis

60
Q

What is thrombotic microangiopathy?

A

A clinical syndrome defined by the presence of haemolytic anaemia (destruction of red blood cells), low platelets, and organ damage due to the formation of thrombi in capillaries and small arteries.

61
Q

What are the triggering factors of thrombotic microangiopathy?

A

Endothelial damage by bacterial toxins, drugs, complement or clotting system abnormalities e.g. haemolytic uraemic syndrome

62
Q

Glomerular renal disease can be divided into what 2 categories?

A
  1. Immunological
  2. Non-immunological
63
Q

What are the immunological causes of glomerular renal disease?

A
  1. Circulating immune complexes deposit in the glomerulus (e.g. SLE, IgA/membranous nephropathy)
  2. Circulating antigens deposit in glomerulus
  3. Antibodies to basement membrane/glomerular components (e.g. Goodpasture’s syndrome, post-infective glomerulonephritis)
64
Q

How do all of these immunological causes lead to glomerular renal disease?

A
  • These all cause basement membrane damage which leads to:
    • Complement activation
    • Neutrophil activation
    • Reactive oxygen species
    • Clotting factors

These all lead to glomerular damage.

65
Q

What are 4 non-immunological causes of glomerular renal disease?

A
  1. Endothelial injury e.g. vasculitis, HTN
  2. Altered basement membrane e.g. DM hyperglycaemia
  3. Abnormal BM or podocytes due to inherited disease e.g. Alport disease
  4. Abnormal protein deposition (amyloid) impair function e.g. myeloma

These all cause vessel damage or basement membrane damage.

66
Q

How can diabetes lead to renal disease?

A

Hyperglycaemia leads to thickening of basement membrane (damage)

67
Q

How can hypertension lead to renal disease?

A

Endothelial injury

68
Q

Tubular renal disease is due to which 2 major causes?

A
  1. Ischaemia
  2. Toxins
69
Q

Which toxins can cause tubular damage?

A
  • Direct toxins
    • Drugs e.g. antibiotics,
    • NSAIDs, ACEi, diuretics
    • Contrast medium
    • Organic solvents
    • Heavy metals
    • Ethylene glycol
    • Pesticides
  • Hypersensitivity reactions – drugs
  • Crystal deposits e.g. urate
  • Abnormal protein deposition e.g. Ig’s
70
Q

Why are the renal tubules highly susceptible to ischaemia?

A

The tubules are very metabolically active

71
Q

What can cause ischaemic tubular damage?

A
  • Hypotension e.g. shock
  • Vessel damage
    • E.g vasculitis, HTN
  • Glomerular damage
72
Q

Why do conditions that cause glomerular damage tend to eventually cause tubular damage?

A

Due to reduced perfusion to the tubules

73
Q

Renal disease causes:

74
Q

What is pylonephritis?

A

Kidney infection (pyelonephritis) is a type of urinary tract infection (UTI) that generally begins in your urethra or bladder and travels to one or both of your kidneys.

75
Q

Risk factors for acute pyelonephritis?

A
  • Female (ascending infection)
  • Instrumentation
  • Diabetes
  • Urinary tract structural abnormalities
76
Q

Complications of acute pyelonephritis?

A

Abscess formation

77
Q

Complications of chronic pyelonephritis?

A

Scarring, chronic renal failure

78
Q

Risk factors for chonic pyelonephritis?

A

Urinary tract obstruction/reflux

Yr 2 - Clinical Pathology (80 decks)

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