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Clinical Pathology > Renal System 1 > Flashcards

Renal System 1 Flashcards

1
Q

What is the function of the kidneys?

A
  • Eliminating metabolic waste
  • Regulating fluid & electrolyte balance
  • Influencing acid-base balance
  • Production of some hormones (renin, erythropoietin)
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2
Q

How do patients with renal disease present?

A
  • Acute renal failure= generally unwell, rapid rise in creatinine & urea
  • Nephrotic syndrome= Oedema, proteinuria & hypoalbuminaemia
  • Acute nephritis= Oedema, proteinuria, renal failure & haematuria
  • Chronic renal failure= slow decline in renal function
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3
Q

In the kidneys, what element allows filtration?

A

Podocytes, endothelial cells & basement membrane

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4
Q

What can cause damage to the kidney basement membrane? What does this ultimately lead to?

A
  • Circulating immune complexes & antigens deposit in glomerulus
  • Lupus nephritis
  • IgA nephropathy
  • Anti- GBM disease
  • Antibodies to basement membrane or other components
  • All lead to complement & neutrophil activation & reactive O2 species and clotting factors causing glomerular damage
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5
Q

What non-immunological mechanisms can cause glomerular damage?

A

Damage to vessel- Injury to endothelium of vessels, altered bm due to hyperglycaemia in DM
Damage to BM- Abnormal bm or podocytes due to inherited disease, deposition of abnormal proteins in the kidney (amyloid)

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6
Q

What ischaemic factors can lead to tubular damage?

A
  • Hypotension/ shock
  • Damage to vessels within kidney
  • Glomerular damage
  • All lead to reduced blood supply to tubules
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7
Q

What toxic factors can lead to tubular damage?

A
  • Direct toxins
  • Hypersensitivity reactions (drugs)
  • Deposition of crystals or abnormal proteins in tubules
  • All lead to direct tubular damage
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8
Q

What factors can cause vascular damage to the kidneys?

A
  • Hypertension
  • Diabetes
  • Atheroma (renal artery stenosis)
  • Vasculitis
  • Thrombotic microangiopathy
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9
Q

How does vasculitis damage blood vessels in the kidneys?

A
  • Acute/chronic inflammation of vessel walls
  • Obliteration of lumen by inflammation of glomerular vessels leading to clotting & destruction of glomerulus
  • Different types affect different vessels
  • Inflammation of larger arterioles within kidney can lead to hypoxia of tubules
  • Often affects other vessels so rash, joint & muscle pain
  • E.g Wegener’s granulomatosis
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10
Q

How does thrombotic microangiopathy lead to vascular damage in the kidneys?

A
  • Thrombi in capillaries & small arterioles
  • Due to damaged endothelium by bacterial toxins, drugs, abnormalities in complement or clotting system
  • E.g Haemolytic uraemic syndrome
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11
Q 
Give the:
-Complications
-Signs
-Causes
of nephrotic syndrome
A 
Causes= always due to damage to glomerulus- membranous nephropathy, FSGS, minimal change disease, other 
Signs= Oedema, proteinuria (>3g), hypoalbuminaemia
Comp= infection, thrombosis
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12
Q

What are the signs of acute nephritis?

A
  • Oedema
  • Haematuria
  • Proteinuria
  • Hypertension
  • Acute renal failure
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13
Q

What are the causes of acute nephritis in adults &children?

A

A=
Post-infective glomerulonephritis
(after strep throat, complete recovery)
IgA nephropathy (upto 50%= renal failure, teens/y.adults w/ haematuria)
Vasculitis (fever, unwell, rash, myalgia, arthralgia)
Lupus (autoimmune, y.women)

C=Post-infective glomerulonephritis
IgA nephropathy
Henoch-Schonlein purpura (Specific IgA nephropathy, y.boys w/abdo pain, arthralgia,rash, haematuria, acute renal failure)
Haemolytic-uraemic syndrome (E.Coli infection, acute nephritis, haemolysis, thrombocytopaenia)

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14
Q

How is acute renal failure diagnosed?

A

Anuria/oliguria & raised creatinine & urea

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15
Q

What are the causes of acute renal failure? (outside of the kidney)

A 
Pre-renal= reduced blood flow to kidneys, severe dehydration, hypotension (septic shock, bleeding, LVF)- renal biopsy not helpful
Post-renal= tumours in pelvis or urinary tract, bladder stones, prostatic enlargement- renal biopsy helpful
Intrinsic= damage to the glomeruli, renal tubules, or interstitium
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16
Q

What are causes of acute renal failure within the kidney?

A

Adults=Vasculitis, Acute interstitial nephritis (by drug reactions)
Children= Acute interstitial nephritis, Henoch-Schonlein purport, Haemolytic uraemic syndrome

17
Q

What are complications of acute renal failure and how is it treated?

A
  • Cardiac failure (fluid overload)
  • Arrythmias (electrolyte imbalance)
  • GI bleeding
  • Jaundice (hepatic venous congextion)
  • Infection
  • Short term dialysis & treat underlying cause
18
Q

What are causes of chronic renal failure?

A 
Adults= Diabetes, glomerulonephritis, reflux nephropathy
Children= glomerulonephritis, reflux nephropathy, developmental abnormalities/malformations
19
Q

What are the effects of chronic renal failure?

A

-Reduced excretion of H2O & electrolytes= oedema & hypertension
-Reduced excretion of metabolites
-Renal bone disease
-Reduced production of erythropoietin= anaemia

20
Q

Describe acute pyelonephritis and its complications

A
  • More common in women& diabetics
  • Bacterial lower UTI which tracks back up to the kidneys
  • Abscess formation
21
Q

Describe chronic pyelonephritis and its complications

A
  • Most associated with obstruction of urinary tract & reflux of urine
  • Leads to scarring of kidneys and can lead to chronic renal failure
22
Q

Describe renal artery stenosis

A
  • Due to atheroma or arterial dysplasia
  • Leads to ischaemia of affected kidney
  • Activation of renin-angiotensin-aldosterone system= hypertension
  • Loss of renal tissue due to ischaemia= reduced renal function
23
Q

How does hypertension damage the kidneys?

A
  • Damages renal vessels
  • Leads to thickening of vessel wall & reduction in lumen size
  • Produces chronic hypoxia leading to loss of renal tubules & reduced renal function
  • Reduced blood flow in kidney activates renin-angiotensin-aldosterone system exacerbating hypertension
24
Q

How does diabetes damage the kidneys?

A
  • Commonest cause of end stage renal failure
  • Hyperglycaemia main cause of diabetic nephropathy by damaging basement membrane
  • BM becomes thicker & glomerulus produces excess ECM which forms nodules
  • Also damages small vessels leading to ischamia & damage to renal tubules
25
Q

How does a myeloma damage the kidneys?

A
  • Tumour of plasma cells producing immunoglobulins
  • Excess deposited in kidney tubules
  • Tubules become damaged & inflamed & fibrosis occurs
  • Loss of renal tubules leads to decline in kidney function
  • Renal impairment usually reversible
26
Q

Clinical presentation of glomerulonephritis

A

Nephrotic=Proteinuria, oedema, hypoalbuminaemia, hyperlipidaemia
Nephritic=Haematuria, hypertension, proteinuria, low urine volume

27
Q

What are primary and secondary causes of nephrotic syndrome?

A
  • 1=minimal-change nephropathy, membranous nephropathy, and focal glomerulosclerosis
  • 2=diabetes mellitus, lupus erythematosus, and amyloidosis.
28
Q

What are primary and secondary causes of nephritic syndrome?

A
  • 1=IgA nephropathy, Post-streptococcal glomerulonephritis

- 2=Vasculitis, Goodpasture’s, SLE, Hep B&C

29
Q

What are the clinical features & causes of interstitial nephritis?

A

-Cause= drug effects/allergy, hypokalaemia, hypercalcaemia/ uric acid, infection, autoimmune (SLE, kawasaki, wegener)
-Features=haematuria, fever
Inc/dec urine, Mental changes,
Nausea/vomiting, rash, swelling/oedema

30
Q

Describe inherited kidney disease

A
  • ADPKD or ARPKD
  • fluid-filled cysts develop, multiply and grow in kidneys
  • abdo pain, recurrent UTI haematuria, kidney stones & kidney failure
  • may have cysts in liver, pancreas, spleen, ovaries, and large bowel

Clinical Pathology (56 decks)

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