T11 - L2 Medical Renal Pathology

Question 1

what is the function of the kidney?

Answer 1

• regulate blood pressure
• cleans blood
• filters waste and toxins
• balances water
• Vit D activators
• regulates fluid/electrolyte balance
• regulation of acid-base balance
• production of hormones

Question 2

which hormones does the kidney produce?

Answer 2

renin

erythropoietin

Question 3

what does renin do?

Answer 3

regulates fluid balance (RAAS)

Question 4

what does erythropoietin do?

Answer 4

stimulates RBC production

Question 5

how does renal disease present?

Answer 5

• acute renal failure
• nephrotic syndrom e
• nephritic syndrome (acute nephritis)
• chronic renal failure
• rapidly progressive glomerulonephritis
• asymptomatic haematuria or proteinuria

Question 6

what is acute renal failure?

Answer 6

an abrupt loss of kidney function that develops within 7 days

• rapid rise in creatinine and urea

Question 7

what is Nephrotic syndrome?

Answer 7

a collection of symptoms due to kidney damage, including:

[proteinuria (more than 3.5 g/day), hypoalbuminaemia, oedema]

Question 8

what is chronic renal failure?

Answer 8

[slow decline in renal function]

Question 9

what is  Rapidly progressive glomerulonephritis?

Answer 9

[nephritic syndrome with rapid decline in GFR (glomerular filtration rate)]

Question 10

what structures enter the kidney at the hilum?

Answer 10

renal artery
renal vein
ureter

Question 11

renal circulation contains two capillary beds, what is considered the first capillary bed?

Answer 11

glomerulus

Question 12

what is the glomerulus responsible for?

Answer 12

filtration of fluid and solutes

Question 13

renal circulation contains two capillary beds, what is considered the second capillary bed?

Answer 13

peritubular capillary network

Question 14

renal circulation contains two capillary beds, what happens in the first capillary bed?

Answer 14

• The first capillary bed is the glomerulus, which is responsible for filtration of fluid and solutes.

Question 15

renal circulation contains two capillary beds, what happens in the second capillary bed?

Answer 15

The second capillary bed is the peritubular capillary network, which is where fluid and solutes reabsorbed by the tubules are returned to the circulation.

Question 16

which arteriole branches into the glomerular capillary network from the renal corpuscle?

Answer 16

afferent arterial

Question 17

what are mesangial cells?

Answer 17

mesangial cells are specialised cells in the kidney

• have contractile and phagocytic properties

Question 18

what does the glomerular filtration barrier consist of?

Answer 18

fenestrated endothelium

the glomerular basement membrane

visceral epithelial cells, or podocytes

Question 19

what is immunological glomerular injury?

Answer 19

Circulating immune Complex deposits in glomeruli

• deposition of circulating antigens
• antibodies to glomerular basement membrane
• inflammation = glomerular damage

Question 20

is goodpastures syndrome due to immunological or non-immunological glomerular injury?

Answer 20

immunological

Question 21

what is non-immunological glomerular injury?

Answer 21

• endothelial injury (e.g. hypertension)
• altered glomerular basement membrane (e.g. diabetes)
• inherited poocytopathy
• abnormal protein deposition (e.g. amyloidosis)

Question 22

is glomerular injury due to hypertension, immunological or non-immunological glomerular injury?

Answer 22

non-immunological

Question 23

is glomerular injury due to vasculitis, immunological or non-immunological glomerular injury?

Answer 23

non-immunological

Question 24

is glomerular injury due to diabetes, immunological or non-immunological glomerular injury?

Answer 24

non-immunological

Question 25

is glomerular injury due to amyloidosis, immunological or non-immunological glomerular injury?

Answer 25

non-immunological

Question 26

is glomerular injury due to post-infectious glomerulonephritis, immunological or non-immunological glomerular injury?

Answer 26

immunological

Question 27

what are two types of glomerular injury?

Answer 27

non-immunological

immunological

Question 28

what are two types of tubular injury?

Answer 28

ischaemic

toxic

Question 29

what causes ischaemic tubular injury?

Answer 29

• reduced BP
• blood vessel damage
• glomerular damage

= reduced perfusion = tubular damage

Question 30

what causes toxic tubular injury?

Answer 30

• direct toxins (endogenous or exogenous)
• hypersensitivity
• crystal deposits
• abnormal protein depositition

= tubular damage

Question 31

list some exogenous toxins that can cause tubular injury?

Answer 31

• Drugs (NSAIDs, aminoglycosides, ACEIs, diuretics etc.)
• Contrast medium
• Organic toxins (ethylene glycol, printer ink)
• Heavy metals.

Question 32

list some endogenous toxins that can cause tubular injury?

Answer 32

• Haemoglobin (haemolysis, transfusion reactions)
• Myoglobin (crush injury, statin drugs)
• Monoclonal immunoglobulin light chains (myeloma)
• Intratubular crystals (calcium oxalate, urates).]

Question 33

what is nephrotic syndrome (NS)?

Answer 33

Nephrotic syndrome is a collection of symptoms due to kidney damage.

• Proteinuria >3.5 g/24hrs or a urine protein/creatinine ratio >300-350 mg/mmol

Question 34

what are symptoms of nephrotic syndrome?

Answer 34

hypoalbuminemia, oedema, hyperlipidaemia, lipiduria

Question 35

what is the pathogenesis of nephrotic syndrome?

Answer 35

increased glomerular permeability to albumin and other plasma proteins

Question 36

what is the most common cause of nephrotic syndrome in adults?

Answer 36

Membranous Nephropathy