Vascular + Tubulointerstitial Disease of Kidney

Question 1

How is hypertensive nephrosclerosis classed and their causes?

Answer 1

Benign nephrosclerosis and malignant nephrosclerosis

Benign - due to chronic HTN (>140/90)

Malignant - due to accelerated HTN (rapid rise in BP with existent chronic HTN) or malignant HTN (>180/110)

Question 2

Complications of hypertension

Answer 2

• Renal failure
• Peripheral vascular disease
• Retinopathy
• TIA, stroke
• LV hypertrophy

Question 3

What are the pathological features of benign hypertensive nephrosclerosis?

How may it present?

Answer 3

• Thickening (sclerosis) of small arteries
• Ischaemic damage to glomeruli and tubules

Presents with asymptomatic urinary abnormalities such as proteinuria.

Question 4

What are the pathological features of malignant hypertensive nephrosclerosis?

How does it present?

Answer 4

Medical emergency requiring immediate control of BP.

Causes:

• Severe damage to small arteries
• Ischaemic injury to glomeruli and tubules

Presents with acute renail failure.

Question 5

What is renal artery stenosis?

Answer 5

Narrowing of the main renal artery.

Can be due to atheromatous disease in eldery, or fibromuscular dysplasia (thickening of intima/media/adventitia)

Question 6

What are the four tubulointerstitial diseases?

Answer 6

• Acute tubular necrosis
• ACute and chronic tubulointerstitial nephritis
• Chronic pyelonephritis
• Myeloma kidney

Question 7

What is acute tubular necrosis?

Answer 7

Tubular injury duet o ischaemia or toxins. Causes oliguria, uraemia and in late stages, hypokalaemia.

Question 8

Histological differences in acute vs chronic tubulointerstitial nephritis?

Answer 8

Acute - neutrophilic/eosinophilic infiltrate with interstitial oedema

Chronic - lymphcytic infiltrate with tubular atrophy and interstitial fibrosis (irreversible)

Question 9

Aetiology of tubulointerstitial nephritis:

Answer 9

• Drugs - NSAIDs
• Infection
• Immunological - transplant rejection

Question 10

Two clinical settings of chronic pyelonephritis?

Answer 10

• Reflux nephropathy - congenital vesicoureteric reflux
• Obstructive nephropathy - ureteric obstruction

Question 11

What occurs in chronic pyelonephritis?

Answer 11

Chronic inflammation leading to scarring on renal calyces, pelivs and tubulointerstitium.

Question 12

WHat is myeloma kidney?

Answer 12

Malignant proliferation of plasma cells.

Question 13

What are the complications of myeloma kidney?

Answer 13

• Cast nephropathy - tubular obstruction by light chain casts causing acute renal failure
• Amyloidosis - deposition of proteins in glomeruli/vessels, leading to severe proteinuria