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SRNAAnatomy II > Renal Pathology > Flashcards

Renal Pathology Flashcards

1
Q

Pre Renal AKI Diagnostic criteria

A

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

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2
Q

Renal blood supply compromised by 2 things

A

• Renal artery stenosis • Renal vein thrombosis/stenosis

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3
Q

Causes of Renal Artery Stenosis (FASAN()

A

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

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4
Q

Most common cause of Renal artery stenosis is

A

Atherosclerosis

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5
Q

Most common layer affected in Fibromuscular dysplasia

A

MEDIAL layer

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6
Q

Fibromuscular Dysplasia : What do you see?

A

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

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7
Q

Most common cause of contribute to development of Fibromuscular Dysplasia

A

– Genetic

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8
Q

Complications of Fibromuscular Dysplasia

A

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

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9
Q

Treatment of Fibromuscular Dysplasia

A

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

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10
Q

Scleroderma Renal Crisis (SRC) is an

A

uncontrolled accumulation of collagen & widespread vascular lesions

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11
Q

Scleroderma Renal Crisis (SRC) causes

A

Causes thickening of the vascular wall and narrowing of lumen

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12
Q

Scleroderma there is

A

• intimal thickening of the interlobular & arcuate arteries

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13
Q

What comes after interlobar arteries

A

Afferent

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14
Q

Scleroderma Renal Crisis (SRC) Pathophysiology

A

• Endothelial injury and oxidative stress lead to ↑ fibroblast activity

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15
Q

SRC and renin

A

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

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16
Q

SRC there is regulation?

A

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

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17
Q

Just before the afferent are the

A

INTERLOBULAR

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18
Q

SRC outcome is that

A

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

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19
Q

Risk factors for developing SRC: (GPR)

A

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

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20
Q

Treatment of SRC meds

A

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

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21
Q

Nephrosclerosis 2 types

A

Benign and MALIGNANT

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22
Q

Benign nephrosclerosis Occurs with _____

A

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

23
Q

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

A

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

24
Q

What happens to vessels in Malignant Nephrosclerosis?

A

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

25
Q

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

A

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

26
Q

Renal Vein Thrombosis has same risk factors as

A

as DVT (Virchow’s Triad

27
Q

RVT is associated with

A

Renal Vein Entrapment Syndrome

28
Q

Most commonly affected populations for RVT

A

New born infants with dehydration Adults with nephrotic syndrome

29
Q

Signs/Symptoms of RVT

A

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

30
Q

Tx of RVT

A

anticoagulation, surgical thrombectomy

31
Q

Renal Vein Entrapment Syndrome

A

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

32
Q

In renal vein entrapment

A

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

33
Q

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

A

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

34
Q

3 parts involved in Renal vein entrapment syndrome

A

– Aorta – Superior Mesenteric Artery – Renal Vein

35
Q

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

A

Left gonadal vein forms anastomosis with L. renal vein

36
Q

What is hepatorenal syndrome

A

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

37
Q

In Hepatorenal syndrome

A

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

38
Q

2 types of Hepatorenal Syndrome

A

• Type I, and Type II Two types:

39
Q

Types I hepatorenal syndrome (CAO)

A

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

40
Q

Type II Hepatorenal syndrome (GCC)

A

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

41
Q

Hepatorenal Syndrome Treatment (MAL)

A

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

42
Q

Other Prerenal Causes NSAIDS

A

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

43
Q

Other Prerenal Causes CARDIO RENAL

A

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

44
Q

Sepsis prerenal causes

A

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

45
Q

Hypovolemia causes of Pre-renal (GHDDO)

A

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

46
Q

Angiomyolipoma composes of _____, ____ and ______

A

Composed of blood vessels, smooth mscle & fat cells

47
Q

• Most common benign kidney tumor

A

Angiomyolipoma

48
Q

Angiomyolipoma associated with

A

Tuberous Sclerosis

49
Q

In Angiomyolipoma, mass can

A

Mass can compress kidney or vessels can rupture

50
Q

Identify all Label parts

A

A- Arcuate

B- Interlobular

C- Interlobar

D- Renal Artery

E- Inferior Segmental Artery

F- Ureteric branch of the renal artery

51
Q

Identify kidney issue as benign or malignant

A
52
Q

Identify issues as benign or malignant Nephrosclerosis

A
53
Q

Identify condition in picture

A

Fibromuscular Dysplasia

SRNAAnatomy II (16 decks)

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