after midterm- nephron Flashcards by denzie hurst

diabetes mellitus

desease of the glomerulus, arteries & arterioles, interstitium

How well did you know this?

Not at all

Perfectly

what happens to the glomerulus in diabetes mellitus

Glomerulus
Thickened basement membrane (diffuse glomerulosclerosis)
Mesangial expansion ( grows so big that it can block blood flow by narrowing capilary lumen whic increases the pressure in the capilary lumen -nodules (Kimmelstiel-Wilson [K-W] disease)
Basement membrane disease leads to proteinuria

How well did you know this?

Not at all

Perfectly

what happens in the blood vessels in diabetes mellitus

Vascular
Arterioles - Thickening of vessel wall - Narrowed lumen - Ischemia & tubular atrophy (kidneys stop working 20-30 years after getting diabetes, no blood coming coming in or out so its sclerotic)

Bacterial infection
Pyelonephritis (infection of the kidney)

How well did you know this?

Not at all

Perfectly

Pyelonephritis

Bacterial infection (infection of the kidney)
Acute or chronic
Spread
Blood (hematogenous)
Up from urethra & bladder (ascending infection)
seen when there is obstruction from the bladder

How well did you know this?

Not at all

Perfectly

which is more common for causing pyelonephritis

Ascending (♀ more common)
Bladder catheterization
After surgical procedures
Pregnancy (more pressure on the kidney)

How well did you know this?

Not at all

Perfectly

Acute Pyelonephritis

Suppurative infection
May have abscesses or
Pus permeates entire kidney filling renal pelvis

How well did you know this?

Not at all

Perfectly

Chronic Pyelonephritis

Usually evolves from acute pyelonephritis

- Destruction of renal parenchyma - Extensive scarring

How well did you know this?

Not at all

Perfectly

Renal Cell Carcinoma

85% of Cancers of the Kidney
27,000 Diagnoses in USA
Causes unknown
May develop more frequently in 	end-stage kidneys
smoking

How well did you know this?

Not at all

Perfectly

two most common tumor in adults

renal cell carcinoma and
clear cell type
in children: wilms

How well did you know this?

Not at all

Perfectly

how does renal cell carcinoma occur- pathology

Nodules or masses sharply demarcated from normal parenchyma
Invades through capsule into surrounding tissues
Commonly invades renal vein
smoking causes a hypoxic environment -
Cells reminiscent of Normal tubular cells
Filled with lipid - yellow colour

deletion of part of the 3rd chromosome which is suppose to help hypoxic enviro - 90% of ppl with renal cell carcinoma was this mutation

How well did you know this?

Not at all

Perfectly

why are the tumors yellow in renal carcinoma

rich in lipids

How well did you know this?

Not at all

Perfectly

Clinical Features od renal carcinoma- how do these patients present

Triad (seen 10% of time)
Flank pain (spot on back where kidney is)
Hematuria
Abdominal mass
Commonly discovered by CT
Microscopic hematuria
Five year survival = 40%

How well did you know this?

Not at all

Perfectly

Wilms’ Tumour

Nephroblastoma
Commonest tumour in infants
Often present at birth
Etiology:
Wilms’ tumour gene 1 (WT-1)

How well did you know this?

Not at all

Perfectly

Pathology- what does it look like

Renal mass replacing kidney
Micro
in the tumor there are Immature cells (like developing kidney)- stroma, glomeruli, tunule

How well did you know this?

Not at all

Perfectly

Clinical Features of wilmès

Discovered by routine palpation or by parents
Highly malignant
Surgery & chemotherapy  85% cure rate

How well did you know this?

Not at all

Perfectly

Renal Stones

“Nephrolithiasis”  “Calculi”
5% of Adults
4 groups
Calcium
Struvite
Uric Acid (gout)
Cystine

How well did you know this?

Not at all

Perfectly

calcium stones-

Calcium oxalate or Ca3 (PO4)2
75% of all Stones
Associated with abnormal Calcium metabolism
May be inherited- small in ureter or pelvis

Struvite Stones

MgNH4PO4
15% of all stones
Complication of infection (bacteria break down urea - NH4)

Uric Acid Stones

5% of all stones
50% of patients have Gout (hyperuricemia
usually dont cause symptoms- ppl with gout

Cystine Stones

1% of all stones
Rare condition from cystinosis
In born error of amino acid metabolism

Pathology- what is seen

Renal pelvis
Urinary bladder
Usually < 3 mm diameter (except struvite stones)
Struvite stones may form “staghorn calculi”

clinical features

Sex: M > F
Age: usually 20 – 30 years
Symptoms:
Hematuria
Renal colic
Bladder stones  chronic infections

cystitus

inflammation of the bladder wall- caused by bacteria, fungus, virus, parasite,
Acute or chronic

Urinary Tract Infections

Bacterial infections most common
Parasites
(e.g., Schistosoma hematobium)
rare in N. America, common elsewhere

Acute Cystitis

Visible congestion & mucosal hæmorrhages- very red | Occasionally see frank pus

Chronic Cystitis

``` See foci of Hæmorrhage Ulcers Thickening (from fibrosis) Resistant to Rx if: Diabetes Stones Prostate ```

Prostate- zones

located at the base of the bladder- divided into 3 zones (only know 2): 1: transitional zone- around the urethra- bening tumors are seen (cmpresses the urethra- bad pee stream, 2: peripheral zone- malignant appear here

Prostatic Hypertrophy

Enlargement of prostate Benign Prostatic Hypertrophy (BPH) Carcinoma - 80% of all men over 80 will have bening tumor

Benign Prostatic Hypertrophy

Reactive benign hyperplasia Relates to hormonal changes Aging (makes less testosterone, sex hormones in adiposites can convert testosterone to estrogen Nodular hyperplasia - compression of urethra Requires testosterone Exacerbated by estrogen Relative E/T ratio  with Age

Pathology

Nodular Distort urethra Compress peripheral portions into fibrous capsule “surgical capsule” Soft & pliable Hyperplastic glands surrounded by  fibro-muscular stroma Bladder may become trabeculated

Clinical Features

``` Urethral compression & urinary retention Urgency Straining Dysuria Frequency ``` Chronic obstruction Chronic cystitis Hydroureter Hydronephrosis

``` Clinical features of Nephrotic syndrome include all EXCEPT A. Edema B. proteinuria C. Hematuria D. Hyperlipidemia E. Hypertension ```

All of the following features are correct for post infectious glomerulonephritis EXCEPT: A. It usually occurs couple of weeks after sore throat. B. It is a immune mediated glomerulonephritis C. It usually presents as nephritic syndrome D. Antibodies are usually against streptococcal bacterial antigen E. It is fatal in children

All of the following are true regarding Minimal change disease EXCEPT A. It a common cause of nephrotic syndrome in children. b. it usually responds to corticosteroids C. Cause is unknown but cytokines have been implicated D. Dense immune type deposits are seen on EM E. No abnormality is seen on light microscopy

All of the features are correct regarding Membranous nephropathy EXCEPT: A. It is common cause of nephritic syndrome in adults b. It is an immune mediated disorder C. Glomerular basement membranes are thickened due to subepithelial deposits D. It progresses to renal failure in 30-40% of cases E. there is proteinuria but no hematuria

All of these statements regarding Diabetic nephropathy are correct EXCEPT: Of all the patients with diabetes approximately 90% of patients develop renal disease. Proteinuria usually develops 10-20 years after onset of diabetes. The predominant pathologic findings in glomeruli are diffuse and nodular glomerulosclerosis. Diagnostic lesion in glomeruli are known as Kimmelstiel Wilson type nodules Altered/thickened basement membrane causes increased permeability to proteins.

Types of urinary stones include all EXCEPT: A. Struvite (magnesium ammonia phosphate) B. Calcium oxalate or phosphate C. Arginine stone D. Uric acid stone E. Cystine stones

True/FalseAscending route of pyelonephritis is more common.

True/FalseMost common histologic type of renal cell carcinoma is transitional cell carcinoma, arising in transitional epithelium of renal pelvis.

True/FalseWilm’s tumor is most common malignant tumor of kidney in children and is due to mutation in retinoblastoma gene.