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CRRAB II > Renal Pathology Lecture I > Flashcards

Renal Pathology Lecture I Flashcards

1
Q

What forms the backbone of the GBM?

A

Type IV collagen monomers. —3 alpha chains combine to for triple helix to make a monomer.

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2
Q

What is a large reason why the overall charge of GBM negative?

A

Heparin sulfate.

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3
Q

What is the function of the filtration slit diaphragm?

A

Exclusion of large proteins and albumin.

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4
Q

3 general categories of renal disease

A
  1. Glomerular (often immune mediated)
  2. Tubulointerstitial (toxic/ischemic and inflammatory)
  3. Vascular
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5
Q

Azotemia

A

Increased BUN and creatinine

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6
Q

Pre-renal causes of azotemia

A

Hypoperfusion (hemorrhage, shock, dehydration, CHF)

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7
Q

Post-renal causes of azotemia

A

Obstruction of urine flow (stone or tumor)

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8
Q

Uremia

A

Azotemia and clinical symtoms (gastroenteritis, anemia, peripheral neuropathy, pruritis, pericarditis etc.

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9
Q

Nephritic syndrome

A

Hematuria, mild to moderate proteinuria, HTN

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10
Q

Nephrotic syndrome

A

> 3.5g/day of proteinuria, edema, hypoalbuminemia, hyperlipidemia, lipiduria

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11
Q

Acute renal failure clinical presentation

A
  • -Rapid onset azotemia
  • -Oliguria or anuria
  • -Due to glomerular, tubulointerstitial, or vascular disease.
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12
Q

Chronic renal failure clinical presentation

A

–GFR

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13
Q

Clinical presentation of renal tubular defects

A

Polyuria
Nocturia
Electrolyte imbalances

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14
Q

4 stages of renal disease

A
  1. Diminished renal reserve
  2. Renal insufficiency
  3. Renal failure
  4. End-stage renal disease
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15
Q

Diminished renal reserve

A

GFR around 50% of normal. Normal range BUN/Cr

Asymptomatic

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16
Q

Renal insufficiency

A

GFR 20-50% of normal
Azotemia
Anemia
HTN

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17
Q

Renal failure

A

GFR

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18
Q

End stage renal disease

A

GFR

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19
Q

Clearance equation and definition

A

–Approximation of GFR

C=UV/P

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20
Q

Best analyte to measure clearance

A

Inulin

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21
Q

Cockcroft-gault formula

A

CrCL=((140-age)x weight (kg))/(72 x serum creatinine x0.85 (if female)

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22
Q

MDRD formula

A

GFR=175 x serum creatinine^-1.154 x age^-.203 x 0.742 (if female) and 1.212 (if black)

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23
Q

What is chronic kidney disease defined by?

A

Persistent reduction in GFR to less than 60. Less than 30 recommend seeing nephrology

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24
Q

When are clearance measurements still used?

A
  • -Unusual body size
  • -Rapidly changing kidney function
  • -GFR 60+
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25
BUN
- Rough est. of glomerular function - Normal 10-20 mg/dl - Combined w/serum creatinine, helps determine causes of azotemia - Sensitive to decreased renal perfusion
26
Pre-renal factors increasing BUN
- -Increased synthesis of urea | - -Decreased renal perfusion/low flow states
27
Renal factors increasing BUN
Glomerular disease, ATN, interstitial disease
28
Post-renal factors increasing BUN
Urinary tract obstruction (BPH, prostatic carcinoma, tumor, retroperitoneal mass, urinary calculi
29
Factors decreasing BUN
- -Decreased synthesis - -Hemodilution - -Generally not diagnostically useful
30
Creatinine
- -Normal 0.7-1.5 - -Most found in muscle. - -Slightly better est. of glomerular function than BUN
31
Pre-renal increases in creatinine
- -Increased synthesis (muscle hypertrophy, muscle necrosis, anabolic steroid use, high meat diet, intense exercise) - -Decreased renal perfusion (CHF, hypotension, shock, etc.)
32
Post-renal increase in creatinine
UTI
33
Normal BUN: creatinine ratio
10-15: 1
34
When do you see elevated BUN:creatinine ration
Pre-renal conditions. Disproportionate increase in proximal urea reabsorption.
35
What type of BUN:creatine ratio will you see in renal disease?
Normal ratio
36
Fraction of excreted sodium (FeNa)
(Urine Na x plasma Cr x 100)/ (urine Cr x plasma Na)
37
What does it mean if FeNa
Favors pre-renal disease
38
What does it mean if FeNa >2.0
Favors renal disease (ATN)
39
Proteinuria normal value
50 mg
40
Tests for proteinuria
- -Dipstick test (only sensitive to albumin, pH dependent, can get false + w/gross hematuria or dilute urine) - -Acid precipitation (detects albumin and globulins, false + w/some meds and gross hematuria)
41
Causes of proteinuria w/o renal disease
1. Postural (orthostatic) 2. Transient 3. Functional (heavy exercise, cold exposure, fever) 4. CHF 5. Massive obesity 6. Constrictive pericarditis 7. Renal vein thrombosis
42
Proteinuria w/renal disease
1. Glomerular pattern (albumin, small globulins, can reach nephrotic range) 2. Tubular pattern (beta2 microglobulin, will never reach nephrotic range)
43
% of people w/UT malformations
10%
44
What 2 things account for 20% of chronic kidney disease in children?
Renal dysplasia and hypoplasia
45
What accounts for 10% of chronic kidney disease in adults?
Polycystic kidney disease
46
Kidney agenenis
- -Bilateral incompatible with life. - -Unilateral w/normal function - -Lack of proper ureteric bud development
47
Kidney hypoplasia
- -Failure to develop to normal size - -Bilateral or unilateral - -No scarring - -Decreased # of renal lobes (6 or less) - -Most cases are acquired (slow scarring)
48
Ectopic kidneys
--Typically found just above pelvic brim or in pelvis
49
Horseshoe kidney
- -Fusion of upper (10%) or lower poles (90%) to form single horseshoe shaped kidney. - Not very uncommon
50
Cystic renal dysplasia
- -Unilateral or bilateral - -Gross: Enlarged, multi-cystic, irregular - -Micro: undifferentiated mesenchyme, cartilage, immature collecting ductules, variably sized cysts lined by flattened epithelium - -sporadic disorder - -Most also have lower tract anomalies
51
Autosomal dominant (adult) polycystic kidney disease
- -Hereditary - -Autosomal dominant - -Bilateral disease - -Multiple expanding cysts destroy renal parenchyma - -Only involving portion of kidney initially
52
Adult PCKD genetics
PKD1 gene on chromosome 16p13.3 in most cases
53
Adult PCKD gross kidney findings
- -Bilaterally enlarged kidneys, may be huge | - -Look like a bag of cysts
54
Adult PCKD micro findings
- -Cysts with variable lining | - -Normal parenchyma present between cysts
55
Clinical findings in adult PCKD
Asymptomatic | or pain and hematuria
56
Extra-renal anomalies in adult PCKD
Liver cysts (40% of pts) Intracranial berry aneurysms Mitral valve prolapse
57
Autosomal recessive (childhood) PCKD categories
--Perinatal --Neonatal --Infantile --Juvenile Only last 2 survive infancy
58
Gross findings in AR PCKD
Enlarged, smooth kidneys externally, cut sections show small cysts in the cortex and medulla
59
Micro findings in AR PCKD
Dilation of all collecting tubules (uniform cuboidal lining of cysts)
60
General info about AR PCKD
- -Bilateral - -Liver cysts and bile duct proliferation in almost all patients - -May see congenital hepatic fibrosis in 2 forms that survive infancy

CRRAB II (13 decks)

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