Renal Pathophys Part 1 - Schoeny (exam 3) Flashcards
Normal urine production per day?
1.5L
What is azotemia?
Elevated BUN and Cr +/- anuria
3 types of AKI?
Prerenal, renal, postrenal
Causes of prerenal AKI?
Low volume stimulus (hypovolemia, heart failure, sepsis)
Renal vascular pathology (stenosis, atherosclerosis)
Causes of intrinsic AKI?
ATN, glomerular disease, AIN
BUN:Cr in prerenal AKI?
> 20:1
BUN:Cr in intrinsic AKI?
<20:1
Causes of postrenal AKI?
Obstruction, kidney stones
Clinical symptoms of AKI?
Electrolyte disurbances Decreased urine output Lethargy Fatigue Nausea
Urine findings in prerenal AKI?
FENa < 1%
Urine sodium <20
Urine osmolality >500
Urine SG > 1.020
Urine findings in intrinsic AKI?
FENa>1%
Urine sodium >20
Urine osmolality <400
Urine SG <1.010
Most common causes of chronic renal failure?
DM, HTN, glomerulonephritis
4 stages of chronic renal failure and % GFR remaining in each stage?
Diminished renal reserve - GFR = 50%
Renal insufficiency - GFR =20-50%
Renal failure -GFR <20%
End stage renal failure - GFR<5%
A segmental glomerular disorder describes what?
A disorder where only a portion of the glomerulus is involved.
A global glomerular disorder describes what?
A disorder where all of the glomerulus is involved.
A focal glomerular disorder describes what?
A disorder where some of the glomeruli are involved.
A diffuse glomerular disorder describes what?
A disorder where almost all of the glomeruli are involved.
Techniques to evaluate glomeruli include what 3 types microscopy?
Light microscopy
Immunofluorescence
Electron microscopy
What types of stains are used in light microscopy?
What are they used for?
Periodic Acid Schiff (PAS) - highlights basement membrane and mesangium
Trichrome - highlights fibrosis
Silver - Highlights basement membrane
Immunofluorescence uses what type of antibodies?
IgG, IgM, IgA
A linear pattern on immunofluorescence indicates?
Reaction directed against antigen in glomerular basement membrane -> goodpasture syndrome
A granular pattern on immunofluorescence indicates?
Reaction against antigen/antibody immune complexes in glomerular basement membranes -> SLE
What can be seen on electron microscopy?
Structure and immune complex deposition
Clinical manifestation of glomerular diseases include(5)?
Nephrotic syndrome Nephritic syndrome Rapidly progressive glomerulonephritis Chronic renal failure Asymptomatic hematuria
Most glomerular diseases are _____ in nature
Immunologic
4 components of nephrotic syndrome?
Proteinuria (>3.5g/day)
Hypoalbuminemia
Generalized edema (anasarca)
Hyperlipidemia
Lipid droplets with maltese cross appearance with polarized microscopy indicates?
Nephrotic syndrome
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
What patient population is most susceptible to MCD?
males age 2-8 years
2:1 male to female ratio
What is associated with MCD in adults?
Lymphomas, leukemias, and NSAID use
Treatment for MCD?
Steroids
Findings of MCD on microscopy?
Proximal convoluted tubule laden with lipid and protein
T/F? Immunofluorescence has no abnormalities in MCD.
True
Second most common cause of nephrotic syndrome in children?
FSGS
Most common causes of nephrotic syndrome in adults?
FSGS
Is FSGS immunologic in origin?
No
What patient population has a ridiculously increased risk of FSGS?
Heroin users.
30x risk compared to rest of pop.
What is the treatment for FSGS?
haha tricked you there is no treatment
Prognosis for FSGS?
Bad. End stage renal disease within 10 years.
What are the microscopy findings in FSGS?
Segmental sclerosis of a few glomeruli on light microscopy
Positive for IgM and C3 on immunofluorescence
Non selective proteinuria is a finding in?
Membranous glomerulonephropathy
Membranous glomerulonephropathy is most often caused by?
How about some other causes?
Most often idiopathic.
Other causes: syphilis, malaria, Hep B or C, carinoma of lung and colon, melanoma, lupus, NSAIDS
Microscopy findings in membranous glomerulonephropathy?
Silver stain: thickened basement membrane extending between immune complexes
spike and dome formation*
Immunofluorescence: granular pattern positive for IgG
Electron microscopy: Subepithelial immune complexes
The single most common cause for end stage renal disease?
Diabetes!
What is the most common finding on light microscopy for patients with EDRD and diabetes?
Diffuse glomerulosclerosis
Nephritic syndrome is characterized by what symptoms?
Renal failure, hypertension, and hematuria.
Is proteinuria and edema associated more with nephrotic syndrome of nephritic syndrome?
Nephrotic
What casts are present in nephritic syndrome?
RBC casts
Do casts form when there is an issue at, above, or below the kidney?
At the kidney
Is glomerulonephropathy associated with nephrotic or nephritic syndrome?
nephrotic
But remember, glomerulonephritis is associated with nephritic syndrome.
Postinfectious glomerulonephritis most commonly occurs after what infection?
How long after?
Group A step
1-4 weeks after
Other causes of postinfectious glomerulonephritis include?
Staph infections, mumps, measles, Hep B and C, chicken pox
Prognosis for postinfectious glomerulonephritis?
Good! 90-95% recover completely
What would you expect serum complement level, ASO titer, and antiDNAse B to be in postinfectious glomerulosnephritis?
Low serum complement
High ASO titer and antiDNAse B
T/F? Postinfectious glomerulonephritis has positive findings on only light and electron microscopy?
F - + findings on light, electron and immunofluorescence
Findings on light microscopy for Postinfectious glomerulonephritis?
All glomeruli have increased number of cells
Silver stain “lumpy bumpy” - caused by staining of basement membrane growing around immune complexes
Findings on immunofluorescence in Postinfectious glomerulonephritis?
granular pattern, psotive for IgG, IgM, and complement
Findings for electron microsocopy in Postinfectious glomerulonephritis?
Immune complex deposition
________ is characterized by lung hemorrhage and severe rapidly progressing glomerulonephritis
Good Pasture Syndrome
Describe the findings on immunofluorescence of Goodpasture syndrome.
Linear pattern of distribution of complement and IgG along the basement membrane
There are two types of membranoproliferative glomerulonephritis. What are they are what are they associated with?
Type I - associated with hep B and C, and lupus
Type II, associated with hypocomplementemia
Prognosis for membranoproliferative glomerulonephritis?
Not great. 50% progress to chronic renal failure within 10 years
Chronic glomerulonephritis is characterized by?
sclerosis of glomeruli
Describe to gross pathology of the kidneys in chronic glomerulonephritis.
Pale and swollen cortex due to lipid deposition and interstitial edema
