Vascular diseases and TIN Flashcards
What happens in minimal change disease?
Minimal change disease total effacement of foot processes after they fuse due to electrical charge displacement.
is it better to diagnose someone with nephritic synd?
Nephritic syndrome is almost always due to glomerulonephritis. Acute renal failure is a useless diagnosis
What are the types of crescentic GN?
Type 1 2 and 3 crescentic glomerulonephritis
as
antiglGBM disease presents with people having anti alpha 3 chain type 4 antibodies GBM
pulmonary-renal syndrome
immunofluorescence IgG antibodies
electron microscopy does not show the complexes due to low resolution of the interaction
ac
pauci immune glomerulonephritis
anti-neutrophil cytoplasmic antibody
autoantibodies against enzymes in the cytoplasm of neutrophils
small vessel vasculitis
Wegener granulomatosis, Churg-strauss syndrome
crescents in histology
no immune complexes on immunofluorescence nor electron microscopy
cc
hypertensive nephrosclerosis is damage done due to High BP. 2 types; benign due to chronic hypertension malignant.
renal disease can cause HBP and vice versa (viscious cycle)
malignant hypertension can be completely de novo. bp 180/110. BP should be dropped urgently but in a controlled way. severe damage to arteries and ischaemic damage. fibrinoid necrosis of arterioles. hyperplastic arteriolopathy. (onion skinning)
benign HT nephrosclerosis is caused by thickening of the walls of the small arteries and arterioles of the kidneys causing smaller lumen and in turn ischaemic damage to glomerulus and tubular atrophy as well as interstitial fibrosis. Can result in surface granularity on the kidneys. thickening of intima and media arterioles become damaged and leaky and plasma protein trapped in wall of arteriole this is known as hyalinosis
atrophic
a
renal artery stenosis is an uncommon cause of secondary hypertension. narrowing in one of the renal arteries (in elderly caused by atherosclerosis) kidney recognizes low oxygen and responds with more renin creating ANG2 which will constrict all the arteries in the circulation rasining BP altogether.
ACE inhibitor use this mechanism.
Fibromuscular dysplasia causes intermittent (back and forth) thickening of renal artery until kidney.
a
acute tubular necrosis most common cause of renal failure. Toxic causes (endogenous which are native to the body and exogenous which are from elsewhere) and ischaemic causes. could be caused.
Crush injuries can cause release of myoglobin into blood damaging kidneys.
not much can be done at maintenance phase. in recovery phase there is a massive output in urine production due to loss of ability to concentrate urine and electrolytes become disturbed.
a
acute tubular necrosis most common cause of renal failure. Toxic causes (endogenous which are native to the body and exogenous which are from elsewhere) and ischaemic causes. could be caused.
Crush injuries can cause release of myoglobin into blood damaging kidneys.
not much can be done at maintenance phase. in recovery phase there is a massive output in urine production due to loss of ability to concentrate urine and electrolytes become disturbed.
acute and chronic tubulointerstitial nephritis (TIN)
causes of TIN include Drugs (until proven otherwise)
TIN is idiosyncratic and not dose related.
drug acts as a hapten combination of tubular protein and the drug that elicits the immune reaction (immune cells in urine and acute renal failure)
acute pyelonephritis is always due to infection whereas TIN is usually drug related
microabscesses in acute pyelonephritis.
treat acute pyelonephritis
d
chronic pyelonephritis
reflux nephropathy is due to damage to valve in causes
das
chronic pyelonephritis presents with coarse irregular corticomedullary scars resemble thyroid tissue and interstitial scarring
asasdas
myelomic kidney is kidney damage caused by multiple myeloma
myeloma is a malignant tumour that causes many symptoms and signs. Kidney injury in many ways. cast nephropathy, amyloidosis, acute tubular necrosis, light chain deposition disease, renal vein thrombosiss
no urine flow through tubul
immunoglobulin is abnormal and huge in numbers and monoclonal. the light chains can be secreted on their own coming out
histology shows fracture lines
amyloid is a type of protein resistant to degradation putting pressure on tissues around them creating atrophy. Beta pleated sheets can be detected by salmon-pink congo red on polarizing LM.
What is hypertensive nephrosclerosis?
2 types:
Benign nephrosclerosis when BP > 140/90 it is due to chronic hypertension.
Most cases of chronic hypertension are caused by primary hypertension.
Malignant hypertension:
Accelerated hypertension which can happen suddenly in an accute manner. BP > 180/110 which causes acute end-organ damage. Third most common cause of renal failure.
What causes secondary hypertension?
Renal factors (renal disease causes hypertension and hypertension causes renal disease it’s a vicious cycle)
endocrine
Cardiovascular
Neurological
Can hypertensive nephrosclerosis cause proteinuria?
Yes it is possible
What is hyalinosis?
Entrapped plasma protein within wall of arterioles
How should malignant hypertensive nephrosclerosis be treated?
As a medical emergency which requires urgent and controlled reduction in BP.
How does malignant hypertensive nephrosclerosis cause disease?
Severe damage to small arteries and arterioles and ischaemic injury to glomeruli and tubules
How does malignant hypertensive nephrosclerosis present?
Acute renal failure and high BP
How should malignant hypertensive nephrosclerosis be treated?
Bring down BP in a slow and controlled fashion to prevent stroke.
What is fibrinoid necrosis?
instead of just hyalinosis there is necrosis of smooth muscle within wall of arteriole and the necrosis resembles fibrin
