Renal Vascular Diseases Flashcards
Nephrosclerosis is assoc. w/ what existing medical conditions?
HTN, DM
describe the gross pathologic characteristics of nephrosclerosis.
cortical surface w/ fine, even granularity
Describe the pathogenesis of nephrosclerosis.
focal ischemia induced by medial & intimal thickening and deposition of hyaline: narrows blood vessels and causes sclerosis
describe the renal pathogenesis of malignant HTN?
increased permeability of small vessels to fibrinogen and plasma proteins causes damage to vascular endothelium, platelet deposition, & focal necrosis of vascular wall tissue
Describe the histologic characteristics of malignant HTN.
hyperplastic arteriosclerosis: onion skin-like laminations of hypertrophied smooth muscle; fibrinoid necrosis
describe the pathogenesis of Hemolytic uremic syndrome.
Typical:
E. coli O157:H7: produces a shiga-like toxin causes endothelial injury and hemolytic anemia
What is the model 1 theory for the pathogenesis of HUS?
shiga-like toxin activates endothelial cells to increase expression of leukocyte adhesion molecules and decrease production of NO
what is the model 2 theory for the pathogenesis of HUS?
Shiga-like toxin binds directly to platelets or inhibition of complement protein Factor H causing hyperactivity of complement
Describe the pathogenesis of atypical HUS.
mutations of complement proteins or abs against complement proteins which leads to hyperactivity of complement; half of pts. have an H factor deficient; complement 1 & CD46 mutations
What role does factor H play in complement regulation?
breaks down alternative pathway C3 convertase to protect cells from complement damage
Describe the pathogenesis of thrombotic ,thrombocytopenic purpura/
Inactivating Abs against ADAMTS13 – plasma metalloprotease which regulates function of von Willebrand factor
More common in women, esp. < 40 yrs
describe the histologic and gross characteristics of thrombic microangiopathy.
Diffuse cortical necrosis:
Pale ischemic necrotic areas confined to cortex and columns of Bertini (conical projections of renal pelvis into renal medulla between the renal pyramids)
describe the pathogenesis of renal stenosis.
caused by increased renin production due to renal ischemia; common causes include atheromatous plaques, fibromuscular dysplasia (more common in young women, atrophied kidney
What is the main contributor of renal infarcts?
mural thrombosis of LA & LV
describe the gross characteristics of renal infarct.
pale, yellow, white areas containsing small foci of hemrrotic discoloration
what is atherosclerotic ischemic renal disease?
bilateral renal artery disease of chronic ischemia & renal insufficiently
what is atheroembolic renal disease?
typically secondary embolic disease to atherosclerosis in older individuals; assoc. w/ post-surgery complications
describe sickle cell nephropathy.
hematuria due to decreased concentrating ability: hypertonic hypoxic renal medulla and papillary necrosis
granulomatosis w/ polyangiitis induced vasculitis presents in which regions of the body?
renal vessels, URI, lungs; granulomas and necrosis also present
List the clinical presentations of GPA?
Perforation of nasal septum/ulcer
Recurrent sinusitis
Hemoptysis
Pulmonary infarction
Pneumonia
Pauci-immune crescentic GN
Saddle nose deformity
what Ab test would you order for suspected GPA?
c-ANCA/PR3-ANCA (GPA), MPO-ANCA/p-ANCA (microscopic polyangitis)
List the clinical presentations of Chronic Renal Failure.
Nonspecific complains:
Anemia
Loss of appetite/Anorexia
Vomiting
Malaise
Proteinuira
HTN
Azotemia
Edema
describe the gross characteristics of chronic renal failure.
Symmetrically SHRUNKEN kidneys
Diffusely granular, cortical surfaces
Cortex is thinned
describe the histologic characteristics of chronic renal failure.
Diffusely and globally sclerosed glomeruli
Tubular atrophy
Interstitial fibrosis
Lymphocytic infiltrate
Arterial and arteriolar sclerosis
