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Patho II, Renal > Glomerular and Tubular Diseases > Flashcards

Flashcards in Glomerular and Tubular Diseases Deck (44)
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1

In 70kg person kidney filters about

180 L /d

2

What fraction of cardiac output goes to renal blood flow

20% - 25%

3

Classic collection of symptoms in glomerular

Hematuria
Proteinuria
Lowered GFR
HTN

4

Two different special constellations of symptoms that can manifest in patients with glomerulonephritis

Nephritic and Nephrotic syndromes

5

Nephrotic syndrome - collection of signs

Proteinuria (> 3.5g/day)

Hypoalbuminemia

Edema

Hyperlipidemia

Lipiduria

6

Nephritic syndrome - collection of signs

Accumulation of RBC, WBC, immune complexes, and some protein - forming casts, brown urine

Decreased GFR > High BP, Oliguria

7

Most common cause of secondary nephrotic syndrome

Diabetes

(HTN #2)

8

Five categories of glomerular disease

Acute glomerulonephritis
Rapidly progressive glomerulonephritis
Chronic glomerulonephritis
Nephrotic syndrome

9

The abrupt onset of hematuria and proteinuria with decreased GFR and salt/water retention. Typically followed by full renal recovery

Acute Glomerulonephritis

- hypercellular / thickened glomerulus
- narrowed capillaries
- decreased filtration

10

Common cause of acute glomerulonephritis

Post-Strept, autoimmune

7-10 days after original infection

presents as Acute Nephritic Syndrome
(HTN, Hematuria, Increased BUN SrCr, Oliguria)

11

Most common cause of primary glomerulonephritis

Berger's Disease

IgA nephropathy

12

Also called crescentric glomerulonephritis because of its tendency to cause proliferation of epithelial cells in the glomerulus.

Always autoimmune

Usually progresses to renal failure

Rapidly Progressive Glomerulonephritis

13

GFR trends in Rapidly Progressive Glomerulonephritis

GFR drops by 50% within 3 months

14

Rapidly Progressive Glomerulonephritis results when (specific to glomerulus)

When most of the glomeruli are damaged enough to allow FIBRIN to enter Bowman's space, which prevents filtration and permanently scars

15

Wegener's granulomatos is an example of what type of Rapidly Progressive Glomerulonephritis (RPGN)

Type III, ANCA antibodies

Antibodies not visible histologically

Makes up 50% of RPGN

16

SLE, IgA nephropathy, post-strep GN is an example of what type of RPGN

Type II, immune complex deposition

GRANULAR DEPOSITION OF COMPLEXES

25% of RPGN

17

Goodpasture's is an example of what type of RPGN

Type I, Anti-GBM (antibodies to type IV collagen)

LINEAR DEPOSITION OF COMPLEXES

25% of RPGN

18

Patients with acute glomerulonephritis who develop chronic renal failure slowly over 5-20 years

Chronic Glomerulonephritis

19

Typical features of chronic glomerulonephritis

Hypercellularity in the mesangium and obliteration of glomerular capillaries

Often found incidentally, occult proteinuria / HTN

*Significant scar tissue from ongoing autoimmune injury

20

Hypercellularity in the mesangium and obliteration of glomerular capillaries are typical features of -

Chronic glomerulonephritis

21

A classic example of chronic glomerulonephritis, and one of the most common causes of NEPHROTIC syndrome in adults

Membranous Glomerulonephritis

Autoimmune

25% recover completely

22

Membranous GN vs RPGN Type II

Type II RPGN, immune complex deposition (IgA, SLE)

*Unlike RPGN, in Membranus GN immune complexes trigger complement and MAC ATTACK*

23

Sudden appearance of proteinuria and edema (nephrotic), with unknown etiology. Relatively benign

Minimal Change GN

24

Most common cause of renal failure

Secondary GM (diabetes, HTN, atherosclerosis, vasculitis)

25

How to distinguish glomerular disease from interstitial or tubular

Patient Hx

UA
- Hematuria
- RBC Casts
- Lipiduria
- Proteinuria

26

UA with red cells, casts, mild proteinuria.

More severe symptoms not present (edema, proteinuria >3.5g, HTN)

Patients often present with asymptomatic haematuria and proteinuria discovered on routine examination, or in IgA nephropathy for eg with episodes of gross haematuria

Focal Nephritic UA patterns

Damage to < 1/2 of patient's glomeruli

27

Similar to focal disease, but may also have heavy proteinuria (even nephrotic range), obvious edema, hypertension and/or renal insufficiency

‘full house’ urinary sediment – red cells, white cells, red cell casts, white cell casts, hyaline casts

Diffuse Nephritic UA patterns

Damage to all or nearly all glomeruli

28

Heavy proteinuria (> 3.5g / d)

Lipiduria (Maltese cross)

Few cells, few casts

Nephrotic UA patterns

29

Extrinsic causes of obstructive uropathy

Pregnancy

Inflammation (PID, peritonitis, diverticulitis, salpingitis)

Tumurs (PROSTATE, rectum, bladder, ovaries)

30

Timeline of obstructive damage

1. Collecting system dilates - triggers growth of new tissue in ureters

2. Collecting system stretches and enlarges, damaging tubular cells

3. Fibrosis begins in the tubules and the interstitial space (repair process)

4. Fibrosis triggers cytokines, which causes more damage

1 week - 3 months

31

Obstructive Uropathy Lab Findings

Dilute Urine (inability to concentrate)

Metabolic Acidosis (inability to secrete H+)

Hyperkalemia (inability to secrete K)

Hyponatremia (inability to reabsorb Na)

Uremia (can't secrete urea)

32

Common cause of AKI, usually occurs due to ischemia or drug exposure, usually diagnosed with elevated BUN/Cr levels

Acute Tubular Necrosis

Ischemic, Nephrotoxic

33

Ischemic Acute Tubular Necrosis leads to

Tubule cell death > tubular occlusion by sloughed cell debris

>Tubule occlusion raises pressure at Bowman's Space and LOWERS GFR

34

Common Sites of Injury in Obstructive Uropathy

Uterosacral Ligament

Pelvic Brim

Crossing of Uterine Artery

Tunnel of Wertheim

Near Utero-vesicle junction

35

How might ATN show in UA

Granular casts, muddy silty urine

36

Sequence of ATN

1. Initiation phase - drop in GFR, bump in BUN/Cr

2. Maintenance phase - GFR low, BUNCr slowly rise, oliguria, uremia, fluid retention

3. Recovery phase - tubular cells regenerate and function slowly recovers

37

ATN phase in which there is a drop in GFR, bump in BUN/Cr

Initiation phase

38

ATN phase in which GFR is low, BUNCr slowly rise, oliguria, uremia, fluid retention

Maintenance phase

39

ATN phase in which tubular cells regenerate and function slowly recovers

Recovery phase

40

Diseases associated with Nephrotic Syndrome

Primary Renal Disease
- Minimal Change GN
- Focal segmental glomerulosclerosis
- Membranous GN

Secondary Renal Disease
- SLE
- Hep B C
- HIV
- DM
- Malignancy

41

Which kind of renal cystic disease can become neoplastic?

Acquired Renal Cystic Disease

- usually a result of end stage renal disease
- cysts found throughout, usually in cortex

42

Autosomal Dominant PKD, which chromosome

Chromosome 16

Associated cysts throughout body

43

Renal tumor found in infants/children

Wilm's tumor / Nephroblastoma

44

Renal cancer found in adults

Renal Cell Carcinoma, Adenoma, Oncocytoma