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Clinical Pathology > Theme 4 Lecture 4: Renal pathology > Flashcards

Theme 4 Lecture 4: Renal pathology Flashcards

1
Q

What does erythropoietin do?

A

stimulates erythrocyte production

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2
Q

What does renin control?

A

fluid balance and blood pressure regulation (RAAS)

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3
Q

What is the presentation of acute renal failure?

A
  • unwell, rapid rise in creatinine and blood urea (which are estimators of renal function)
  • occurs over a few days
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4
Q

What is the presentation of nephrotic syndrome?

A

oedema, proteinuria, hypoalbuminaemia, haematuria, hypertension, renal failure

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5
Q

What is chronic renal failure?

A

slow decline in renal function

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6
Q

What is the kidney divided into?

A

outer cortex, inner medulla, renal sinus

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7
Q

What is found in the renal cortex?

A

glomeruli and tubules

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8
Q

What are podocytes?

A

cells in the bowmann’s capsule in the kidneys that wrap around capillaries of the glomerulus

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9
Q

What is the name for the functional unit of the kidney?

A

nephron

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10
Q

Why does the glomerulus lie between afferent and efferent arterioles?

A

because arteries have muscles in the vessel wall so they are able to maintain the volume and pressure of blood flow to maintain the function of ultrafiltration

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11
Q

What does the nephron consist of?

A

proximal convoluted tubule, loop of henle, distal convoluted tubule and collecting duct

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12
Q

What 3 factors can contribute to the narrowing of renal vessels

A
  • hypertension
  • diabetes
  • atheroma e.g renal artery stenosis
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13
Q

What are the two conditions that can arise from vascular damage in the kidney?

A
  1. Thrombotic microangiopathy
    - thrombi in capillaries/ arterioles
    - endothelial damage by bacterial toxins, drugs, complement or clotting system abnormalities
    e. g haemolytic uraemic syndrome
  2. Vasculitis
    - acute/chronic vessel wall inflammation with lumen obliteration
    - various types affect different calibre vessels
    e. g wegener’s granulomatosis
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14
Q

What are the immunological causes of glomerular damage?

A
  1. circulating immune complexes deposit in glomerulus e.g SLE/ IgA nephropathy
  2. circulating antigens deposit in glomerulus
  3. antibodies to BM/ glomerular components e.g goodpastures syndrome
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15
Q

How does immunological damage of the basement membrane lead to glomerular damage?

A
  1. immune complexes/antigens or antibodies deposit in glomerulus
  2. complement activation
  3. neutrophil activation
  4. reactive oxygen species
  5. clotting factors
  6. glomerular damage
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16
Q

What are the non-immunological causes of glomerular damage?

A
  • endothelial injury e.g vasculitis, HTN, clotting disorders, HUS
  • altered basement membrane e.g DM hyperglycaemia
  • abnormal BM or podocytes due to inherited disease e.g alport disease
  • abnormal protein deposition (amyloid) impair function e.g RA
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17
Q

Which ischaemic causes cause reduced perfusion and therefore tubular damage?

A
  • hypotension e.g shock
  • vessel damage e.g vasculitis, HTN
  • glomerular damage
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18
Q

What are the toxic causes of tubular damage

A

-direct toxins
-hypersensitivity reactions - drugs
-crystal deposits e.g urate
-abnormal protein deposition e.g Ig’s
all of these cause inflammation of the tubular interstitial compartment

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19
Q

Which toxins can directly cause tubular damage?

A
  • drugs e.g antibiotics, NSAIDs, ACEi, diuretics
  • contrast medium
  • organic solvents
  • heavy metals
  • ethylene glycol
  • pesticides
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20
Q

What are some diseases of the kidney?

A
  • Membranous nephropathy (primary/secondary)
  • FSGS (primary/secondary)
  • Mesangiocapillary glomerulonephritis minimal change disease
  • Post-infective glomerulonephritis
  • Anti-GBM disease
  • IgA nephropathy
  • Henoch-Schönlein purpura
  • Lupus nephritis (in SLE)
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21
Q

What is mimimal change disease?

A

kidney disease where lots of protein lost in urine

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22
Q

What does crescentic mean?

A

rapidly progressive

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23
Q

What are the synonyms of glomerulonephritis?

A

nephropathy
glumerulopathy
nephritis

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24
Q

What are the features of nephrotic syndrome?

A
  • damage to the glomerulus
  • proteinuria (>3g in 24h)
  • oedema
  • hypoalbuminaemia
  • +/- hypertension
  • +/- hyperlipidaemia
  • complications - infection, thrombosis
25
Q

What are the causes of nephrotic syndrome in adults?

A
  1. membranous nephropathy (commonest)
  2. FSGS (focal segmental glomerulosclerosis)
  3. minimal change disease
  4. other causes - diabetes, lupus nephritis, amyloid
26
Q

What are the causes of nephrotic syndrome in children?

A
  1. minimal change disease (ommonest)

2. FSGS

27
Q

What are the features of acute nephritis?

A
  • oedema
  • haematuria
  • proteinuria
  • hypertension
  • acute renal failure
28
Q

What are the causes of acute nephritis in adults?

A
  • post infective glomerulonephritis
  • IgA nephropathy
  • vasculitis
  • SLE
29
Q

What are the symptoms of vasculitis?

A

unwell, fever, rash, myalgia, arthralgia

30
Q

What are the causes of acute nephritis in children?

A
  • post infective glomerulonephritis
  • IgA nephropathy
  • henoch-schonlein purpura
  • haemolytic uraemic syndrome
31
Q

Who gets HUS and what are the symptoms?

A

typically children with E.coli 0157 enteritis

acute nephritis, haemolysis, thrombocytopenia

32
Q

What are the signs and symptoms of acute renal failure?

A
  • renal function degenerates rapidly in hours/weeks
  • rapidly crescentic glomerulonephritis but not a specific disease
  • anuria/oliguria
  • raised creatinine and urea
  • malaise, fatigue, nausea, vomiting, arrhythmias
  • causes can be pre-renal, renal or post-renal
  • prognosis is good if no underlying renal disease
33
Q

Why would a patient with acute renal failure have arrhythmias?

A

electrolyte imbalance

34
Q

What are the pre-renal causes of acute renal failure?

A
  • reduced blood flow to kidney (most common)
  • severe dehydration
  • hypotension (bleed, septic shock, LVF)
35
Q

What are the causes of post-renal acute renal failure?

A

urinary tract obstruction:

  • urinary tract tumours
  • pelvic tumour
  • calculi
  • prostatic enlargement
36
Q

When can a renal biopsy be useful in diagnosing acute renal failure?

A

renal cause of acute renal failure e.g damage to kidney itself (not pre or post renal)

37
Q

Which conditions lead to acute renal failure in adults?

A
  • vasculitis

- acute interstitial nephritis (tubular damage with inflammation, usually due to drugs)

38
Q

Which conditions lead to acute renal failure in children?

A
  • PIGN (post infectious glomerulonephritis)
  • Henoch-schonlein purpura
  • HUS
  • acute interstitial nephritis
39
Q

what is another name for Henoch-schonlein purpura

A

IgA vasculitis

40
Q

What are the complications of acute renal failure?

A
  • cardiac failure (fluid overload)
  • arrhythmias (electrolyte imbalance)
  • GI bleeding
  • jaundice
  • infection esp. lung and urinary tract
41
Q

What are the features of chronic renal failure?

A
  • impaired renal function over a period of months or years
  • permanently reduced GFR - reduced no. functional nephrons
  • stage 4 and 5 usually require renal replacement therapy (dialysis or treatment)
42
Q

What are the effects of chronic renal failure?

A
  • reduced excretion of water/electrolytes: oedema, hypertension
  • reduced excretion of toxic metabolites
  • reduced production of erythropoietin: anaemia
  • renal bone disease (impaired excretion of phosphate/calcium)
43
Q

What is the commonest cause of chronic renal failure in adults?

A

diabetes

44
Q

What is the commonest cause of chronic renal failure in children?

A

developmental abnormalities/malformations

45
Q

What causes chronic renal failure in both adults and children?

A
  • glomerulonephritis

- reflux nephropathy (repeated infections/scarring)

46
Q

What is isolated proteinuria?

A
  • proteinuria but less than nephritic range
  • no allied haematuria, renal failure or oedema
  • may be benign or due to renal disease
47
Q

What are the causes of isolated proteinuria in adults and children?

A

adults: FSGS, DM, SLE
children: FSGS, HSP

48
Q

What is isolated haematuria?

A

haematuria +/- proteinuria with normal renal function

-investigation needed to exclude malignancy

49
Q

What are the causes of isolated haematuria?

A
  • IgA nephropathy
  • Thin basement membrane disease: inherited condition causing abnormally thin glomerular BM
  • Alport hereditary nephropathy: inherited abnormalities of type IV collagen cause abnormal BM sometimes with eye and ear problems
50
Q

What is pyelonephritis?

A

UTI where one or both of the kidneys become infected

51
Q

What are the risk factors for acute pyelonephritis?

A
  • female (ascending infection)
  • instrumentation
  • diabetes
  • urinary tract structural abnormalities
52
Q

What are the complications of acute pyelonephritis?

A

abscess formation

53
Q

What are the risk factors for chronic pyelonephritis?

A

urinary tract obstruction/reflux

54
Q

What are the complications of chronic pyelonephritis?

A

scarring, chronic renal failure

55
Q

How does hypertension damage renal vessels?

A

wall thickening and reduction in lumen size

56
Q

What are the two mechanisms of damage to the kidney due to hyperglycaemia?

A
  • damaged basement membrane thickens and glomerulus produces excess extracellular matrix (nodules)
  • small vessel damage causes ischaemia and tubular damage
57
Q

What is myeloma

A
  • plasma cell tumour
  • excess Ig’s deposit in tubules cause inflammation and fibrosis
  • renal tubule loss causes irreversible decline in renal function
58
Q

Which disease shows a characteristic crescent when stained with H&E and looked at under a microscope?

A

anti-GBM disease - crescents represent cells proliferating in bowman’s capsule in response to any severe glomerular injury

Clinical Pathology (57 decks)

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