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Flashcards in kidney pathology Deck (45)
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what type of collagen is in the glomerulus

special type of type 4 (reticular fibres)

1

what is special about the collagen in the kidney

it has a strong negative charge - repels negatively charged species in the kidney - stopping their filtration

2

3 cell types in the glomerulus

endothelial cells lining the internal surface of the capillaries
mesangial cells in the stalk
epithelial cells (podocytes) that cover the urinary surface of the basement membrane

3

4 presentations in a patient presenting with nephrotic syndrome

oedema - typically whole body oedema
proteinuria
hypoalbuminaemia
hyperlipidaemia

4

what is another word for nephrotic syndrome

severe proteinuria

5

what causes nephrotic syndrome

when proteins (particularly albumin) escape into the urine

6

3 reasons why proteins are not normally filtered into the filtrate of the glomerulus

- negative charge repelled by the BM of the glomerulus
- physical structure of the membrane of collage type 4
- slit membrane between the podocytes

7

what are the key proteins of the slit membrane

nephrine, podocin and F1 and F2

8

what are the common causes of nephrotic syndrome

diabetes mellitus
some forms of glomerulonephritis
amyloid deposition
inherited abnormalities in those proteins that make up the slit membrane

9

proteinuria results from a ________ abnormality

glomerular filtration

10

acute renal failure definition

an acute reduction in glomerular filtration rate reflected as reduced creatinine clearance, and as a result an increasing serum urea and creatinine

11

what is the most commonest renal cause of acute renal failure

acute tubular necrosis

12

what is glomerulonephritis

injury to the glomerulus, most often immune mediated (eg. Type 3 hypersensitivity - depositing immune complexes)

13

what is the syndrome called when you have glomerulonephritis with no immune complexes involved

pauci-immune

14

when do you get crescents in the kidney

when there is acute glomerulonephritis associated with necrosis of part of the glomerulus leading to clumps of monocytes and epithelial cells and exuded fibrin = crescents

15

what is the commonest form of glomerulonephritis

IgA nephropathy

16

what is and what does membranous nephropathy lead to

proteinuria

17

how do glomeruli react to damage by the immune system

glomerular cells proliferate (epithelial, endothelial and mesangial)
inflammatory cells arrive (neutrophils, lymphocytes, monocytes)
BM may proliferate to make new layers of BM

18

what is the most common cause of end stage renal failure in australia

diabetic nephropathy

19

what causes diabetic nephropathy

hyperglycaemia

20

3 most important outcomes of tubulointerstitial injury

acute tubular necrosis (ischaemia)
acute pyelonephritis (infection)
acute/chronic tubulointerstitial nephritis

21

what causes acute tubular necrosis

blood supply falls to the nephron and therefore tubular epithelium dies --> degenerate and detach from the BM --> slough and leaving behind naked BM

22

what are some drugs that can lead to acute tubular necrosis

heavy metals
some antibiotics
some cancer chemotherapy drugs

23

what causes acute interstitial nephritis

allergic inflammation of the interstitium due to a drug

24

histological presentation of acute interstitial nephritis

lots of lymphocytes in the interstitium of the kidney

25

what is the histological presentation of acute pyelonephritis

bacteria in the medullary pyramids and foci of acute inflammation (necrosis)

26

what causes analgesic nephropathy

long standing use of compounds containing phenacetin with caffeine and aspirin lead to direct toxic effects of phenacetin metabolites

27

what does a kidney that has chronic renal failure look like macroscopically

rubbery, scarred, shrunken, knobbly kidney

28

what does a kidney with chronic end stage kidney disease look like histologically

most of the kidney has turned into collagen, interstitium is expanded and fibrotic and tubules are atrophied

29

at what stage of renal failure do you tend to have symptoms

when GFR is at 10%