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Renal disease > Renal Vascular Disease > Flashcards

Renal Vascular Disease Flashcards

1
Q

Renal Infarcts

When does Infarct become well-demarcated?

A

After 24hrs

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2
Q

Thrombotic microangiopathies

Acute

Microscopic

A

Glomerular capillary occlusion by thrombi

Thickened capillary walls (endothelial swelling and debris)

Disrupted mesangial matrix

Fibrinoid necrosis of interlobular aa

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3
Q

HUS
Typical

Pathogenesis

A

Endothelial injury triggered by Shiga-like toxin

Ass. With consumption of contaminated food

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4
Q

Diffuse Cortical Necrosis

Seen after

A

Catastrophic conditions such as abruptio placentae, septic shock

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5
Q

HUS
Typical

Htn association and prognosis

A

50% with htn

Renal fxn recovers within weeks

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6
Q

Thrombotic microangiopathies

Chronic

(Atypical HUS and TTP ONLY!)

Microscopic

A

Glomerular capillary wall thickening

Tram Tracking (splitting of GBM)

Artery/arteriole wall thickening, persistent hypoperfusion, atrophy, renal failure, htn

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7
Q

HUS
Atypical

MC complement-regulatory protein deficiency

A

Factor H deficiency

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8
Q

HUS
Typical

Clinical features

A

Infxn with E. coli strain O157-H7

Kids, flu-like symptoms, bleeding symptoms, hematuria, oliguria, microangiopathic hemolytic anemia, thrombocytopenia

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9
Q

Thrombotic microangiopathies

Acute

Typical, atypical HUS and TTP

Gross morphology

A

Cortical necrosis, subcapsular petechiae

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10
Q

HUS
Typical

E. Coli strain association

A

O157-H7

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11
Q

Diffuse Cortical Necrosis

Morphology

A

Cortex only, massive ischemic (coagulative) necrosis, thrombi

Rapidly fatal without supportive tx

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12
Q

Malignant Hypertension

Glomerular changes

A

Necrotizing glomerulitis with neutrophils and necrosis

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13
Q

Renal Infarcts

MC cause
MC source

A

Emboli

Left heart

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14
Q

TTP

Pathogenesis

A

PLATELET AGGREGATION from large multi eras of vWF

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15
Q

HUS
Atypical

Pathogenesis

A

Excessive activation of complement from:
Inherited mutation of complement-regulatory proteins

Acq. Causes (scleroderma, htn, chemo, immunosuppressive drugs, radiation)

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16
Q

TTP

Prognosis

A

<50% mortality with exchange transfusions

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17
Q

Renal Infarcts

What replaces infarct?

A

Scar tissue

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18
Q

TTP

Gene defect and gene function

A

ADAMTS 13 (plasma Metallica protease:

Cleaves multi ears of vWF

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19
Q

Thrombotic microangiopathies

Chronic

(Atypical HUS and TTP ONLY!)

Morphology

A

Scarring of renal cortex

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20
Q

Renal Infarcts

Clinical presentation

A

+/- pain, tenderness, hematuria

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21
Q

Renal Artery Stenosis

Morphology

A

Ischemic kidney: Reduced size, crowding of glomeruli, atrophic tubules, interstitial fibrosis

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22
Q

Malignant Hypertension

Gross

A

Flea bitten appearanc (petechial hemorrhages)

Swelling, edema

Poor cortical demarcation

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23
Q

Atheroembolic Renal Disease

Cholesterol emboli

A

Clear clefts of cholesterol seen in embolus

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24
Q

Benign Nephrosclerosis

Gross morphology

A

Kidney size: Reduced to normal

Surface is granular

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25
Q

Diffuse Cortical Necrosis

Seen in pts after…

A

Obstetric emergencies

26
Q

HUS
Atypical

Associated conditions

A

Anti-phospholipid Ab syndrome

Pregnancy

Vascular renal disease

Chemo/immunosuppression/radiation

27
Q

Atheroembolic Renal Disease

A

Embolization of atherosclerotic plaque fragments into renal vessels

28
Q

Atheroembolic Renal Disease

MC site of occlusion

A

Arcuate and interlobular arteries

29
Q

HUS
Atypical

Prognosis

A

Half have relapsing course progressing ESRD

30
Q

Benign Nephrosclerosis

Pathogenesis

A

Medial and intimal thickening

Hyaline deposition in arterioles

31
Q

Benign Nephrosclerosis

Cause

A
  1. Htn

Aging or genetics

32
Q

Renal Artery Stenosis

What cause htn?

A

Angiotensin II (vasoconstrictor) production

33
Q

Malignant Hypertension

Histology

A

Fibrinoid necrosis of arterioles (eosinophilia vessel walls, granular)

34
Q

Atherosclerotic Ischemic Renal Disease

A

Bilateral renal artery disease

Common cause of chronic ischemia, renal insufficiency in older adults

Surgical intervention preserves fxn

35
Q

HUS
Atypical

How to distinguish from TTP

A

ADAMTS13 plasma levels

36
Q

Renal Infarcts

Morphology

A

Single or multiple

Wedge-shaped

Soft, pale yellow, well demarcated (>24hr)

37
Q

Renal Artery Stenosis

Pathogenesis

A

UNILATERAL constriction decreases intracranial circulation/blood pressure

38
Q

HUS
Atypical

Clinical features

A

Adults

Majority have inherited deficiency of complement-regulatory proteins

39
Q

What is a common cause of chronic ischemia, renal insufficiency in older adults?

A

Atherosclerotic Ischemic Renal Disease

Bilateral renal artery disease

40
Q

Atheroembolic Renal Disease

What to look for on PE

A

Purple lesions on feet (occlusion of vessels from emboli)

41
Q

Renal Artery Stenosis

Causes

A

Atherosclerotic plaque occlusion (70%): old, diabetic, men

Fibromuscular dysplasia: young women

42
Q

Thrombotic microangiopathies

Name them

A

Hemolytic Uremic Syndrome (HUS)

Thrombotic thrombocytopenic purpura (TTP)

43
Q

Renal Artery Stenosis

What cells release renin?

A

Juxtaglomerular cells

44
Q

HUS
Typical

Association (clinical presentation)

A

Ass. With consumption of contaminated food

45
Q

TTP

2 types of _______ deficiencies

A

ADAMTS13

  1. AutoAbs to ADAMTS13 (MC)
  2. Inherited deficiency of ADAMTS13
46
Q

Renal Artery Stenosis

What is released with load perfusion to kidney?

A

Renin

47
Q

Malignant Hypertension

Characteristic Histology

A

Hyperplastic arteriolosclerosis

“Onion-skinning” (elongation, proliferation of smooth mm cells)

48
Q

Renal Infarcts

Why do they cause severe damage?

A

End-organ circulation, limited collateral circulation

49
Q

TTP

Common pt

A

Female >40

50
Q

Total Renal Infarct

Where is vascular compromise?

A

Main renal artery

51
Q

TTP

Clinical Features

A

Pentad: Fever, neurologic symptoms, microangiopathic hemolytic anemia, thrombocytopenia, renal faliure

52
Q

Thrombotic microangiopathies

Pathogenesis

A

Tissue dysfunction resulting from formation of microthrombi -> vascular obstruction ->tissue ischemia

53
Q

Total Renal Infarction

A

Entire kidney infarcts

Vascular compromise at main renal artery

54
Q

HUS

Pathogenesis

A

Endothelial injury -> platelet activation and thrombosis

55
Q

Benign Nephrosclerosis

Clinical Features

A

Mild proteinuria

Rarely causes renal insufficiency except in:
African descent, severe hypertension, diabetes

56
Q

Renal Artery Stenosis

Which kidney is effected by hypertension?

A

Opposite kidney

57
Q

Benign Nephrosclerosis

Microscopic

A

Narrowed lumens of arterioles (hyalinization)

Glomerular sclerosis, loss of tubules, alternate with preserved parenchyma (granular surface)

Fibroelastic hyperplasia: medial hypertrophy, duplication of elastic lamina

58
Q

Atheroembolic Renal Disease

Commonly seen after…

A

Follows intervention (AAA repair, aortic valve angioplasty etc.) in elderly pts with atherosclerotic disease

59
Q

Diffuse Cortical Necrosis

Pathogenesis

A

Rare complication of massive hemorrhage

Results from obstetric emergency

Complete bilateral cortical necrosis

60
Q

Renal Artery Stenosis

Htn effects on diseased kidney?

A

None, protected by reduction of blood flow, stenosis

Renal disease (6 decks)

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