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Flashcards in Pathology 2 Deck (31):
1

What happens in acute disease to the interstitium?

The interstitium will swell

2

What is the difference in cell structure between the distal and proximal tubule?

Microvilli

3

What is the most common type of kidney disease?

Tubulointerstitial diseases

4

What are the most important causes of tubulointersititial injury

Ischemic
Infection
Acute or Chronic Tubulointerstitial Nephritis

5

What usually causes Acute tubular necrosis?

Almost always due to ischaemia

6

What happens to dead cells in the tubules?

Epithelial cells degenerate and detach from tubular basement membrane (slough off)

7

What is the result of acute tubular necrosis?

Without functioning epithelium the tubule can no longer fulfil its functions: the glomerular filtration rate falls, electrolyte balance fails, urea and creatinine accumulate in blood etc.

8

Is ATN reversible?

ATN is a reversible lesion; if the patient is supported (which may mean dialysis) regeneration and complete recovery occur but may take weeks

9

What is associated with recovery from ATN?

Recovery is often associated with diuresis (increased production of urine)

10

What are some causes of delayed function after renal transplant?

– Problems due to the transplantation procedure (particularly ischaemia)
– Early rejection (can happen very early)
– Drug toxicity (many immunosuppressive drugs unfortunately potent nephrotoxins !)
– Recurrent primary disease (though it would be very early !)

11

What is the distinction between hypoperfusion and ischemic ATN?

Hypoperfusion is ischemia for a short time, ATN is the same process over an extended period which causes necrosis of tubular epithelium – it’s no longer just a lack of raw material, it’s damage to the machinery (which now needs repair before it can work again).

12

Seen with toxins that affect tubular epithelium?

– Heavy metals (esp. mercury)
– Some antibiotics
– Some cancer chemotherapy drug

13

How does Acute interstitial nephritis present?

Usually presents as acute renal failure, sometimes with some blood or protein in urine

Lymphocytes are seen under the microscope

14

How do drugs cause ATN?

Very often due to drug allergy (e.g. antibiotics)

15

What is Pyelon?phritis

Bacterial infection that affects the kidney

16

What part of the nephron are usually infected by bacteria?

Everything except glomerulus

17

What type of infection is pyelonephritis?

Almost always gram negative
Ascending infection

18

What are the symptoms of pyelonephritis?

– Acute onset
– Fever, chills, lumbar tenderness and pain
– Discomfort when urinating (and frequency)

19

Is kidney function maintained in Pyelonephritis?

Renal function usually preserved. Hypertension not a component

20

Most common gram negative causes of Pyelonephritis?

– E. coli
– Klebsiella sp.
– Proteus sp.
– Pseudomonas sp

21

What causes Chronic Pyelonephritis?

Generally obstruction

22

What occurs as the result of Chronic Pyelonephritis?

Results in interstitial scarring, tubular atrophy, depressed ‘saddle shaped’ scars visible on the renal surface

23

What is reflux nephropathy?

Renal damage due to backflow (NOT obstruction) of urine from the lower tract

24

what is Analgesic nephropathy?

A chronic, progressive tubulo-interstitial disease induced by the prolonged use of particular analgesics

25

What is end stage kidney disease?

Kidneys that are no longer able to perform their tasks, particularly the maintenance of urea and creatinine levels in blood

26

What is the treatment of ESKD?

Treatment requires some form of renal replacement therapy (Dialysis or Transplantation)

27

What happens if ESKD is untreated?

Untreated they lead to worsening ureamia and death

28

What does an ESKD look like macroscopically?

Shrunken, pitted and scarred kidney

29

Causes of dialysis and transplant in Australia?

–32% diabetic nephropathy
–24% glomerulonephritis
–14% hypertension
– other include Analgesic Nephropathy, inherited conditions, chronic pyelonephritis, reflux nephropathy

30

What percentage of the kidney needs to be destroyed to be symptomatic?

90%

31

How do we deal with kidney disease?

Need to tackle the causes