renal tubular injury Flashcards
histologically what does the PCT look like ?
cells are larger than in the DCT
ample cytoplasm
less number of lining cells so less number of visible nuclei
histologically what does the DCT look like ?
less cells in number cells are smaller however the lumen is wider pale cytoplasm many nuclei
what are the causes of tubular injury ?
hypotension/ischaemia
obstruction
toxicity
inflammation
what type of drugs could cause tubular injury?
gentamicin
anti-retrovirals
contrast agents
what is acute tubular necrosis a result of ?
prolonged untreated acute kidney injury
what are the causes of acute tubular necrosis?
1.marked trauma
septicemia
acute pancreatitis
2.poisons, drugs and organic solvents
what is the nature of the clinical course of acute tubular necrosis ?
initial phase
maintenance phase
recovery phase
what are the features of the initial phase of ATN ?
lasts 36b hours
slight reduction in urine
rise in BUN
what are the features of the maintenance phase of ATN ?
lasts from a few days to three weeks
marked oliguria
uremia
fatal if not treated
what are the features of the recovery phase ?
a remarkable increase in the volume of urine takes place yet with severe electrolyte imbalance
what is the gross picture of the kidneys during ATN ?
kidneys are enlarged
pale , necrotic cortex and a congested medulla
what is the microscopy like in Ischemic ATN ?
short segments of distal and proximal convoluted tubules with foci of ruptured basement membrane
what is the microscopy in nephrotoxic ATN ?
the whole length of the proximal convoluted tubule is damaged but with preservation of tubular basement membrane
what are the expected investigation results inn nATN ?
glycosuria with normal blood glucose
alkali urine
low serum bicarb and phosphate
what is the cause of atherosclerosis (senile) kidney ?
atheroma of the renal artery
what is the gross picture of the senile kidney ?
kidney is contracted with an irregular outer surface
what are the renal lesions associated with hypertension ?
nephrosclerosis
what does nephrosclerosis eventually lead to ?
interstitial fibrosis
tubular atrophy
focal global glomerulosclerosis
what is the gross picture of nephrosclerosis ?
bilateral symmetrical atrophy of the kidneys
what does the microscopy look like in advanced cases of nephrosclerosis ?
fibroelastic hyperplasia
what is the value for malignant hypertension ?
200/120 mm hg
what is a flea bitten appearance associated with ?
pin point petechial hemorrhages are associated with malignant hypertension affecting the kidneys at a gross level
what does onion skin appearance on microscopy indicate?
hyperplastic arteriolosclerosis
what is the early clinical presentation of malignant hypertension ?
early symptoms are related to increased intracranial pressure
what is the full-blown syndrome of malignant hypertension ?
characterized by papiloedema encephalopathy cardiovascular abn renal failure
what is the triad for hemolytic uremic syndrome ?
microangiopathy hemolytic anemia
thrombocytopenia
acute renal damage