Introduction to Renal Pathology

Question 1

Effects of vascular disease on kidney fxn

Answer 1

Loss of GFR/Ability to excrete nitrogen

This will trigger H2O/Na conservation –> HTN

Question 2

Effects of glomerular disease

Answer 2

Loss of GFR/Selective Permeability
Filtrate with protein/red cells
Increased BUN/Creatinine
Oliguria
Low Na and Ca. Increased K and P

Question 3

Glomerular disease results from…

Answer 3

Disruption of glomerular architecture

Vascular disease involving the capillaries of the glomerulus

Question 4

Effect of long term glomerular disease

Answer 4

Post glomerular dysfunction, leading to global dysfxn of tubules and interstitium

Question 5

Three main effects of tubular disease

Answer 5

Loss of concentrating ability (high fractional excretion of sodium)
metabolic acidosis
formation of tubular casts

Question 6

Long term effects of tubular disease

Answer 6

Tubules will undergo regeneration if patient is kept alive long enough via dialysis

Question 7

Interstitial disease is associated with…

Answer 7

Loss of EPO–> anemia
Increased RAA –> HTN
Loss of Prostaglandin –> Renal Vasoconstriction/HTN

Question 8

Important thing to remember about occurance of interstitial disease

Answer 8

Almost never occurs alone

Usually with vascular/tubular disease

Question 9

How might obstruction of the collecting system present

Answer 9

Oliguria or Anuria w/out glomerular or tubular dysfxn

Eventually will lead to destruction of renal components, later GFR

Question 10

90% of the anatomic features are located…

Answer 10

in the cortex

Question 11

Which part of the kidney is at greatest risk for ischemia/infarction?

Answer 11

Tubules

Question 12

Glomerular disease interfering with blood flow will…

Answer 12

also affect the tubules because they are supplied by the efferent arterioles

Question 13

How big are capillary endothelium fenestrations?

Answer 13

70-100 nm in diameter

Question 14

Why are acidic glycoproteins essential to selective filtration in the glomerulus?

Answer 14

Anionic molecules are excluded in filtration while cationic molecules are selectively filtered

Question 15

Size of podocyte openings

Answer 15

20-30 nm

Question 16

Disruption of architecture of glomerulus will cause…

Disruption of foot processes

Answer 16

Nonselective loss of protein/cells

Selective loss of protein

Question 17

Structure of the PT

Answer 17

Long microvilli, numberous mitochondria, apical canaliculi, extensive intercellular digitations

Question 18

Loss of tubular function will cause

Answer 18

Loss of Na, H20

Loss of Bicarb –> Metabolic acodosis w/ anion gap

Question 19

Decreased Na and CL in the at the juxtoglomerular apparatus will trigger…

Answer 19

1. Increase in the afferent flow to the glomerulus

2. renin secretion (eventually causing efferent constriction via AT)

Question 20

Inchemia/Chronic inflammation of the interstitium will lead to…

Answer 20

Fibrosis, Anemia, HTN

Question 21

Broadly speaking, common causes of glomerular disease…

Answer 21

immunologic mechanisms of deposition

Question 22

Broadly speaking, most common causes of tubular/interstitial disease?

Answer 22

Toxicity, infection, or obstruction

Question 23

End stage renal failure occurs…

Answer 23

When all components of the kidney are involved

Question 24

There is a big table of renal syndromes you should probably review

Answer 24

sigh.

Question 25

A GFR below ____ results in renal failure. Below ____ is end-stage renal disease.

Answer 25

20-25% | 5%

Question 26

Effects of acute renal failure on BUN/Creatinine if its a glomerular problem?

Answer 26

Can't make the filtrate, cre and BUN stuck in the blood

Question 27

Effects of acute renal failure on BUN/Creatinine if its a bloodflow problem?

Answer 27

Whatever blood gets there is filtered, part of the urea is reabsorbed. BUN climbs faster than creatinine

Question 28

Effect of acute renal failure on urine

Answer 28

Oligouria/Anuria | Urine osmolality increased

Question 29

Electrolyte abnormalities in Acute Renal Failure

Answer 29

Up -- K and P | Down -- Na and Ca

Question 30

How do Kidneys tie in with parathyroidism? So what?

Answer 30

Hypocalcemia --> Stim parathyroids to secrete PTH --> Secondary Hyperparathyroidism. Ca loss from bones --> Renal Osteodystrophy

Question 31

Uremia implies a number of systemic complications associated with renal failure/azotemia. Tell me about them...

Answer 31

N/V, Esophagitis/Gastritis, Bleeding, Anemia, etc. | Peripheral neuropathy - Encephalopathy

Question 32

The one glomerular syndrome where treatment can turn it around

Answer 32

post-streptococcal glomerulonephritis

Question 33

What is Nephrotic Syndrome?

Answer 33

a syndrome of glomerular dysfunction in which the BM loses the ability to retain protein TECHNICALLY -- a daily loss of 3.5 gm of protein

Question 34

Why should you second guess giving a diuretic to a person with edema from nephrotic syndrome?

Answer 34

Intravascular volume is already low from sending it into the tissues.

Question 35

Important proteins lost in nephrotic syndrome

Answer 35

Albumin -- Edema Lipoproteins -- hyperlipidemia Low weight globulins + Complement -- Increased infections Anticoagulants -- Hypercoagulable state

Question 36

Common causes of nephrotic syndrome in adults and children

Answer 36

Children -- Minimal Change Disease | Adults -- Diabetes, SLE, Amyloidosis

Question 37

What is glomerulonephritis? (nephritic syndromes)

Answer 37

Immune mediated process affecting the glomerulus, typically leading to hematuria, changes in permeability, and GFR alterations.

Question 38

Why do isolated tubular syndromes cause acute renal insufficiency or renal failure?

Answer 38

Loss of tubular fxn --> increased glomerular pressure --> decreased GFR

Question 39

Hallmarks of tubular syndrome diagnostic indicators?

Answer 39

Presence of broad/granular casts Polyuria, Nocturia Renal Tubular Acidosis

Question 40

What do we call it when renal tubular acidosis gets goin...

Answer 40

Hyperchloremic Metabolic Acidosis

Question 41

Hallmarks of Chronic Renal Failure

Answer 41

Interstitial Fibrosis Vascular Insufficiency Loss of GFR Tubular Dysfxn

Question 42

Which symptoms of renal failure are more pronounced in chronic?

Answer 42

Systemic probs -- anemia, bleeding, diatheses, renal osteodystrophy, neurological symptoms, pericarditis