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P&T Block 5 Renal > L56 > Flashcards

Flashcards in L56 Deck (22)
1

What are histo changes that indicate chronic kidney disease?

Lose fxn tissue
↑Fibrosis = renal atrophy

2

Name some causes of chronic kidney disease

HTN -> nephrosclerosis
Diabetes
PCKD
Multiple myeloma -> amyloidosis

3

What is nephrosclerosis?

Changes in kidney due to chronic HTN
Implies benign aka long standing HTN

4

Gross appearance of the kidneys due to nephrosclerosis

Granular surface
Small/normal size

5

Histology of nephrosclerosis

1. Hyaline arteriosclerosis: PAS+
2. Medial hypertrophy: hyperplasia of elastic layers in the small vessels
Looking for
- Small cortex
- Thick arteries
- Crowded glomeruli

6

Describe hyaline arteriosclerosis

Chronic HTN or diabetes
Protein -> vasc wall -> thicker
Seen as pink
↓Vessel diameter -> end organ ISCHEMIA
Glomerular scarring = arteriolo-nephro-sclerosis

7

What are the 2 effects of ischemia due to nephrosclerosis?

1. Interstitial fibrosis
2. Glomerular sclerosis

8

What changes happen to the kidney during malignant HTN?

"Malignant nephrosclerosis"
1. "Flea bitten" hemorrhages as arterioles/capillaries rupture w/ high pressure
1. Fibrinoid necrosis of arterioles
2. Onion skinning = concentric, lumen narrows

9

Describe onion skinning

Ex of hyperplastic arteriolo-sclerosis
Hyperplasia of SM -> thickened vessel wall

10

What are the 2 causes of renal artery sclerosis?

1. Fibromuscular dysplasia - young women
2. Atherosclerosis - older pts
- Cholesterol plaques

11

When do you care about heterogenous wall thickening of the artery3 in the setting of renal artery sclerosis?

Causes more turbulent BF

12

What is the shape of an infarct caused by an embolus to the kidney?

Wedge!
Infarcted area will then scar

13

What 3 histo changes would make you think diabetic glomerulosclerosis? How do these translate into lab findings?

↑Mesangial matrix (nodules)
Thick basement membranes
Arteriolar hyalinosis
:abs:
1. Micro-albiminuria
2. Non-nephrotic and nephrotic proteinuria

14

Pathology of kidney changes in diabetes

Glycosylation structurally alters proteins
Vascular basement membrane becomes thick and leaky

15

PCKD: dominant or recessive? Unilat or bilat?

AD but presents progressively
- PKD1, chr 16
- PKD2, chr 4
Inolved in cell-cell matrix interactions
Bilat always

16

Initial presentation of PCKD

Hematuria

17

What are extra-renal manifestations of PCKD that you should be thinking of?

Cerebral aneurysm
Hepatic cysts
Cysts in other organs

18

Stains for renal amyloidosis

Congo red
Apple green birefringence

19

Pathogenesis of renal amyloidosis

Systemic amyloidosis: deposit of AL or AA`

20

Clinical presentation of renal amyloidosis

Nephrotic: heavy proteinuria
To chronic renal failure
Normal//enlarged size

21

What type of amyloid deposits in the kidney during multiple myeloma

AL - duh excess light chain

22

Findings in multiple myeloma

Cast nephropathy
Bence Jones proteinuria = Ig light chains in urine
HyperCa + uricemia