Renal Pathology

Question 1

Pre Renal AKI Diagnostic criteria

Answer 1

• 0.3 mg/dL rise in creatinine over 48-hour period and/or • ≥1.5 times the baseline value within the 7 previous days

Question 2

Renal blood supply compromised by 2 things

Answer 2

• Renal artery stenosis • Renal vein thrombosis/stenosis

Question 3

Causes of Renal Artery Stenosis (FASAN()

Answer 3

– Fibromuscular Dysplasia (younger pts) _ Atherosclerosis (elderly pts) MOST COMMON – Scerloderma Renal Crisis (SRC) – Angiomyolipoma – Nephrosclerosis

Question 4

Most common cause of Renal artery stenosis is

Answer 4

Atherosclerosis

Question 5

Most common layer affected in Fibromuscular dysplasia

Answer 5

MEDIAL layer

Question 6

Fibromuscular Dysplasia : What do you see?

Answer 6

Alternating pattern of stenosis and aneurysms causes “string of beads” appearance:

Question 7

Most common cause of contribute to development of Fibromuscular Dysplasia

Answer 7

– Genetic

Question 8

Complications of Fibromuscular Dysplasia

Answer 8

• Weakened wall predisposes to renal artery dissection • Renal emboli of thrombus formed in aneurysms

Question 9

Treatment of Fibromuscular Dysplasia

Answer 9

– Angioplasty, usually without stent placement – Ex vivo reconstruction in complex cases with RA branches affected

Question 10

Scleroderma Renal Crisis (SRC) is an

Answer 10

uncontrolled accumulation of collagen & widespread vascular lesions

Question 11

Scleroderma Renal Crisis (SRC) causes

Answer 11

Causes thickening of the vascular wall and narrowing of lumen

Question 12

Scleroderma there is

Answer 12

• intimal thickening of the interlobular & arcuate arteries

Question 13

What comes after interlobar arteries

Answer 13

Afferent

Question 14

Scleroderma Renal Crisis (SRC) Pathophysiology

Answer 14

• Endothelial injury and oxidative stress lead to ↑ fibroblast activity

Question 15

SRC and renin

Answer 15

Causes arterial stenosis and hyperplasia of juxtaglomerular apparatus = ↑ renin production

Question 16

SRC there is regulation?

Answer 16

• Up-regulation of endothelin-1 receptors leads to vasospasm and cortical ischemia resulting in additional renin production

Question 17

Just before the afferent are the

Answer 17

INTERLOBULAR

Question 18

SRC outcome is that

Answer 18

rapidly progresses to oliguric renal failure, commonly in the absence of previous signs of renal disease.

Question 19

Risk factors for developing SRC: (GPR)

Answer 19

– Genetic (African Americans have↑ risk) – Presence of a progressive skin disease – Recent high dose corticosteroids (60% of SRC cases)

Question 20

Treatment of SRC meds

Answer 20

Tx: – ACEi – Ca++ channel blockers – Dialysis – Renal transplant

Question 21

Nephrosclerosis 2 types

Answer 21

Benign and MALIGNANT

Question 22

Benign nephrosclerosis Occurs with _____

Answer 22

essential HTN or DM • Renal function minimally affected or proceeds to chronic kidney injury slowly.

Question 23

Malignant Nephrosclerosis a.k.a Process ________(fast or slow)

Answer 23

• a.k.a. “Hypertensive Nephrosclerosis” • Process occurs very quickly

Question 24

What happens to vessels in Malignant Nephrosclerosis?

Answer 24

• Vessel walls lose elastic fibers, become fragile, rupture easily

Question 25

For Nephrosclerosis, what is seen and what are they secondary to ?

Answer 25

Pinpoint hemorrhages seen throughout kidney • 2o to malignant HTN (ex. 180/120 mmHg)

Question 26

Renal Vein Thrombosis has same risk factors as

Answer 26

as DVT (Virchow’s Triad

Question 27

RVT is associated with

Answer 27

Renal Vein Entrapment Syndrome

Question 28

Most commonly affected populations for RVT

Answer 28

New born infants with dehydration Adults with nephrotic syndrome

Question 29

Signs/Symptoms of RVT

Answer 29

may be asymptomatic, or have flank or low back pain if acute thrombus

Question 30

Tx of RVT

Answer 30

anticoagulation, surgical thrombectomy

Question 31

Renal Vein Entrapment Syndrome

Answer 31

• Renal vein stenosis - Vascular compression disorder resulting in renal venous HTN

Question 32

In renal vein entrapment

Answer 32

Compression of the Left renal vein between the Superior Mesenteric Artery & Abdominal Aorta

Question 33

Renal Vein Entrapment Syndrome • a.k.a. “

Answer 33

nutcracker syndrome” due to similarity of vessel position to a nutcracker:

Question 34

3 parts involved in Renal vein entrapment syndrome

Answer 34

– Aorta – Superior Mesenteric Artery – Renal Vein

Question 35

Renal Vein Entrapment Signs/Symptoms – Left gonadal vein forms anastomosis with L. renal vein

Answer 35

Left gonadal vein forms anastomosis with L. renal vein

Question 36

What is hepatorenal syndrome

Answer 36

Hepatorenal Syndrome • Liver ds. causes hypotension = ↓ renal perfusion, ↓GFR and oliguria. Kidney secretes more renin

Question 37

In Hepatorenal syndrome

Answer 37

Diseased liver fails to remove excess angiotensin & vasopressin which travel to kidneys causing ↑↑↑vasoconstriction resulting in kidney failure. (positive feedback loop)

Question 38

2 types of Hepatorenal Syndrome

Answer 38

• Type I, and Type II Two types:

Question 39

Types I hepatorenal syndrome (CAO)

Answer 39

• Type I – acute renal decompensation – Creatinine \>2.5 mg/dL – Often fatal

Question 40

Type II Hepatorenal syndrome (GCC)

Answer 40

• Type II – chronic renal decompensation. – Creatinine \>1.5 mg/dL – GFR \<40 ml/min.

Question 41

Hepatorenal Syndrome Treatment (MAL)

Answer 41

– Manage fluid & electrolytes, bleeding, infections, and encephalopathy – Administer systemic vasoconstrictors (α-adrenergic agonists and terlipressin) and albumin – Liver transplantation (and kidney in some cases)

Question 42

Other Prerenal Causes NSAIDS

Answer 42

NSAIDs: inhibit COX = ↓ levels of PGE2 and prostacyclins. In patients with marked volume depletion = excessive vasoconstriction (afferents)

Question 43

Other Prerenal Causes CARDIO RENAL

Answer 43

Cardiorenal Syndrome =\> decompensated HF =\> ↓ C.O. =\> ↓ renal perfusion pressure leads to progressive renal dysfunction/failure.

Question 44

Sepsis prerenal causes

Answer 44

Sepsis: LPS (liposaccharides) endotoxin causes ↑ in NO = widespread vasodilation and shock. ↑ Renin = excessive vasoconstriction

Question 45

Hypovolemia causes of Pre-renal (GHDDO)

Answer 45

Hypovolemia • GI losses • Hemorhhage • Dehydration • Diuretics • Osmotic diuresis

Question 46

Angiomyolipoma composes of \_\_\_\_\_, ____ and \_\_\_\_\_\_

Answer 46

Composed of blood vessels, smooth mscle & fat cells

Question 47

• Most common benign kidney tumor

Answer 47

Angiomyolipoma

Question 48

Angiomyolipoma associated with

Answer 48

Tuberous Sclerosis

Question 49

In Angiomyolipoma, mass can

Answer 49

Mass can compress kidney or vessels can rupture

Question 50

Identify all Label parts

Answer 50

A- Arcuate B- Interlobular C- Interlobar D- Renal Artery E- Inferior Segmental Artery F- Ureteric branch of the renal artery

Question 51

Identify kidney issue as benign or malignant

Answer 51

Question 52

Identify issues as benign or malignant Nephrosclerosis

Answer 52

Question 53

Identify condition in picture

Answer 53

Fibromuscular Dysplasia