Vascular Dz

Question 1

Benign Nephrosclerosis

Answer 1

Medial/intimal thickening, narrow lumen leads to focal patchy ischemic atrophy, tubular atrophy, interstitial fibrosis

hyaline in arteriolar walls
Fibroelastic hyperplasia
Grain leather cortical surface
Sub capsular scars - sclerotic glomeruli, tubular dropout
Collapse GBM, collagen in Bowman space, periglomerular fibrosis, total sclerosis of glomeruli
Wedge infarct or regional scars

Blacks: renal insufficiency
Severe HTN

Question 2

Malignant arteriosclerosis - Malignant HTN

Answer 2

Flea bitten petechial hemorrhages
Fibrinoid necrosis
Onion skinning - interlobular and arteriolar aa.
narrow a. lumens leads to ischemic atrophy, infarct

Black, men, HTN, young

> 200/>120
papilledema, retinal hemorrhages, encephalopathy

Aldosterone - Na+ reten; K+ loss
Ang II increase BP

Question 3

Renal Artery Stenosis

Answer 3

bruit over kidney, sodium retention

concentric atheromatous plaque, thrombosis
Fibrous or fibromuscular thickening - I/M/A
Ischemic kidney - diffuse ischemic atrophy, crowded glomeruli atrophic tubule, interstitial fibrosis, focal inflammatory infiltrates

Nonischemic kidney - more severe arterioloscerlosis

Question 4

Hemolytic Uremic Syndrome (HUS)

Answer 4

Endothelial cell injury
Patchy or diffuse cortical necrosis, sub capsular petechiae
glomerular cap occlusion, walls thick - swelling, subendo deposits
Disrupted mesangial matrix = mesangiolysis
Fibrinoid necrosis of interlobular and arteriolar a. - occlusive thrombi

Typical; E coli O157:H7 - Shiga-like toxin inhibits Factor H = hyper activation of complement; D, sudden hematemesis, melena, hematuria, severe oliguria; HTN, neurologic S/S

Atypical: No D, Factor H, I, CD46 mutations; splitting, onion skinning narrows lumens - hypo perfusion and ischemic atrophy
*antiphospholipid syndrome, postpartum, systemic sclerosis, malignant HTN, chemo, radiation, scleroderma

Prompt dialysis

Question 5

Thrombotic Thombocytopenio Purpura (TTP)

Answer 5

Platelet activation

ADAMTS13 deficient - no vWF reg
Micro thrombi in beds
Fever, 50% renal failure, females under 40, relapsing and remitting

Patchy or diffuse cortical necrosis, sub capsular petechiae
glomerular cap occlusion, walls thick - swelling, subendo deposits
Disrupted mesangial matrix = mesangiolysis
Fibrinoid necrosis of interlobular and arteriolar a. - occlusive thrombi
splitting, onion skinning narrows lumens - hypo perfusion and ischemic atrophy

Question 6

Atherosclerotic Ischemic Renal Disease

Answer 6

Bilateral renal a. disease
chronic ischemia w/ renal insufficiency
Older adults

Question 7

Atheroembolic Renal Disease

Answer 7

Sudden obstruction of renal A or segmental branches
atrophy, fibrosis, hemorrhage, necrosis
Cholesterol crystal in emboli - rhomboid clefts

flank pain, abdominal pain, hematuria, arterial HTN, arrhythmia, N/V, oliguria, anuria

Older w/ severe atherosclerosis

Question 8

Sickle cell nephropathy

Answer 8

hypertonic hypoxic media - accelerates sickling, dehydrates RBC and concentrates HbS

patchy papillary necrosis, cortical scarring, sclerosing glomerular lesions

hematuria, hyposthenuira, proteinuria

progressive GS w/ nephrotic syndrome S/S

Question 9

Diffuse cortical necrosis

Answer 9

Abruption placentae, septic shock, surgical complication = systemic hypoperfusion/hypoxia

cortex pale, patchy ischemia, coagulative necrosis
micro thrombi - acute necroses
hemorrhages into glomeruli with fibrin plugs in glom cap

massive acute cortical necrosis, sudden anuria - uremic death

unilateral or patchy survivable

Question 10

Renal infarcts

Answer 10

Mural thrombosis - no collateral circulation
White infarct, clinically silent
24 hr - sharp demarcation, pale, yellow-white areas ringed by zone of intense hyperemia
wedge shaped
progressive fibrous scaring - gray-white V
Ischemic coagulative necrosis