Renal Pathology

Question 1

What is GFR?

Answer 1

A measure of the balance of hydrostatic and colloid osmotic forces across the capillary membrane (net filtration pressure).

Question 2

How is GFR measured? And the equation?

Answer 2

The capillary coefficient (Kf) which is the permeability multiples by the filtering surface area of capillaries. GFR = Kf * net filtration pressure.

Question 3

What are the 2 categories of kidney disease and how do they differ?

Answer 3

Acute; stop kidney function, through they can recover.

Chronic; there is gradual loss of function and irreversible loss of many functioning nephrons.

Question 4

What are some causes of acute Prerenal failure/disease? Most important one?

Answer 4

Cardiac failure(e.g. MI), primary renal hemodynamic abnormalities(e.g. excessive blockage of prostaglandins synthesis), etc…

Question 5

What are some causes of chronic Renal failure/disease? Most common ones?

Answer 5

Metabolic disorders(e.g. diabetes mellitus), renal vascular disorders(e.g. atherosclerosis), etc…

Question 6

Describe the cycle of harm that can occur with kidney disease?

Answer 6

The cycle of harm starts with primary kidney disease which causes the loss of nephrons thus increasing arterial pressure which can cause further harm. Therefore, in order to stop this cycle the issue with arterial pressure must be dealt with.

Question 7

What major process of urine formation can be pathophysiologically influenced?

Answer 7

Filtration; CVD, pathology of bowman’s capsule.
Tubule functions; damage to renal epithelial cells causing disruption of reabsorption and solute transporters.
Neurological and endocrine control; abnormal hormone levels or receptor defects.

Question 8

How is renal defects detected?

Answer 8

Presences of proteins in the urine(e.g. albumins), urine color, pain, abnormal creatinine clearance.

Question 9

How are renal defects treated?

Answer 9

Treat primary causes (e.g. CVD, BP) and drug treatments to control tubular function or diuresis.

Question 10

What are the common symptoms of renal disease?

Answer 10

Fluid changes(e.g. increased blood volume), CVS(e.g. heart failure), skin(e.g. pale), GI(e.g. vomiting), Blood(e.g. anaemia)

Question 11

Describe at least 4 defects to issues with a diseased glomerular capillary.

Answer 11

1. sub-epithelial deposits as in membranous nephropathy.
2. Large sub-epithelial deposits in acute post infectious glomerulonephritis.
3. Sub-endothelial deposits in diffuse proliferative lupus glomerulonephritis.
4. Damage if epithelial foot process in proteinuria.
   * LOOK AT NOTES

Question 12

What are some factors that can decrease GFR?

Answer 12

Renal disease, diabetes, hypertension, urinary tract obstruction, decreased renal blood flow, decreased arterial pressure, etc…

Question 13

What are some causes of acute renal failure?

Answer 13

Small vessel and/or glomerular injury, tubular injury(necrosis), etc…

Question 14

What is the functions of PGs?

Answer 14

Control process such as inflammation, blood flow, formation of blood clots, etc…

Question 15

Examples of NSAIDs that block PGs?

Answer 15

Up to 20 drugs do this (e.g. aspirin, ibuprofen, etc…)

Question 16

What are the effects of PGs? What types of PGs stimulate renin and aldosterone?

Answer 16

PGs affect vascular tone (increases renal blood flow) and NaCl transport. PGI2 and PGE2 stimulate renin and aldosterone release.

Question 17

What are the routes of exposure of heavy metals?

Answer 17

Inhalation, diet, skin, etc…

Question 18

How can metal concentration be measured?

Answer 18

Metal concentrations can be measured from the blood, urine, hair, etc…
Renal pathologies: metals in urine of tissue, measure of renal function, histology

Question 19

Describe the RAAS. What was the initial problem and how is it solved?

Answer 19

The initial problem was low BP and the solution is renin, angiotensin, and aldosterone increase which allows for more fluid and sodium in the body (negative feedback loop).

Question 20

Diabetes; what does the overproduction of angiotensin II cause?

Answer 20

overproduction of angiotensin II causes oxidative stress and endothelial cell injury.

Question 21

Diabetes; what causes an overproduction of aldosterone?

Answer 21

Insulin

Question 22

What is a major problem of transplant?

Answer 22

Organ transplants can become an issue due to immunogenic rejection of the foreign organ.

Question 23

What is diabetes insipidus?

Answer 23

An imbalance of fluids in the body which causes the individual to produce large amounts of urine.

Question 24

What are the 2 types of DI? And how does ADH relate?

Answer 24

Central; when ADH is not released or made, due to congenital defects, trauma or infection. (Large volumes of DILUTE urine produced as a result since ADH concentrates urine).
Nephrogenic; when ADH is normal but kidneys don’t respond. (Large volumes of DILUTE urine produced as a result due to defective ADH receptors, diuresis, etc…).

Question 25

What tubular buffer increases in renal disease?

Answer 25

Kidney disease disrupts the ability to remove phosphorous hence and increase in phosphate.