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Flashcards in Renal Pathology Puthoff Lecture Deck (114)
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1

What do kidneys do?

-Excrete certain waste products of metabolism
-Precisely regulate the body's concentration of water, salt, calcium, phosphorus and other/cations/anions
-Serve as an endocrine organ--elaborating erythropoietin, renin, PGs, and regulating vitamin D metabolism
-Convert mor than 1700 L of blood prepay into the highly specialized, concentrated fluid known as urine

2

The glomerulus is what kind of organ

microvascular

3

The most common cause of end stage renal disease (ESRD) and second most cause? other causes?

-Diabetes is most common cause
-High BP is 2nd
-Other problems that cause kidney failure include: autoimmune diseases, such as Lupus and IgA nephropathy

4

Are most people with ESRD old or young? What ethnic groups most affected?

-young--63% under age 65
-Hispanics and Asian Americans fastest growing ethnic groups newly diagnosed with ESRD
-Currently more than 20 million Americans have some level of chronic kidney disease related to diabetes; as diabetes increases, demand for dialysis will too

5

CKD associated with what vitamin deficiency and what disease

-Folate
-which is associated with hyperhomocystenimia which is also associated with an increased risk for stroke/ASCVD

6

What happens if you only have one kidney?

-the single nephron GFR goes up and over time will lead to glomerulosclerosis
-Also causes elaboration of renin that occurs from golblat phenomenon?

7

The kidneys are what kind of organs? (intraperotineal or retroperitoneal?) at what level?

retroperitoneal
at the level of T12

8

Why is right kidney lower than left?

because of its position under the liver on the right

9

Where is the Renal angle?

Between lower border of 12th rib and lateral border of elector spinae muscle--Renal colic pain starts from this angle down and forwards to groin (CVA)--goes about to L2

10

How common are renal cysts?

-Common--More than 50% of those over 50% have parenchymal kidney cysts
-Generally small, contain serous fluid, unremarkable dilations of proximal tubules
-Often small and asymptomatic and are generally incidental findings, but can become quite large

11

Types of cysts (not all are small and unremarkable!!)

-simple cysts
-multilocular--subdivisions, some with smooth muscles in the wall
-dysplastic kidney--congenital anomalies
-adult and juvenile polycystic disease
-cystic tumor--some renal cell carcinomas can become cystic and have hemorrhagic areas

12

How do most diseases/disroders of the kidney present?

-hematuria--SCHITTT: stones, congenital anomalies, hemologic abnormalities like coagulopathies, infection, trauma, tumor, tuberculosis
-proteinuria
-edema
-mass
-HTN
-oliguria
-anuria
-asymptomatic
increased serum/urine creatinine
-decreased creatinine clearance
-increased serum BUN

13

By the time you palpate a mass for RCC what has happened?

the tumor has already metastasized if it is palpable

14

Single most important question to ask patient suspected of having renal disease and why is this the most important question?

Have you had this before?
-Because distinct differences between acute and chronic kidney diseases

15

Common imaging techniques of the kidney and associated GU organs

-US
-KUB--plain Ab film (not as common any more)
-Renal tomography
-IVP (not as common anymore bc associated with anaphylaxis and more invasive)
-Retrograde pyelography

Other techniques to evaluate the ureter, bladder or urethra
-Cystography
-Voiding urethrography

16

Additional imaging techniques of the kidney

-CT scan
-MRI, MRA
-Rdionuclide imaging
-Renal angiography

17

Techniques utilized on renal biopsy material

-light microscopy: standard stain (H&E), other (PAS, silver stains)
-Flouorescence microscopy (variety of targeted immunologic entities--glomerular diseases)
-Electron microscopy (transmission)
**WITH URINALYSIS
-Other techniques: increasingly, molecular and genetic analyses

18

Passage of materials through a membrane by a physical force

filtration

19

Osmosis is the diffusion of water across what kind of membrane

semipermeable--necessary for osmosis bc it restricts the movement of certain solutes allowing solvent to pass through but water can pass freely

20

Glomerulus is?

capillary loops between afferent and efferent arterioles

21

Most filtration occurs at which end of capillary bed? and osmosis/colloid osmotic pressure occurs at which end?

-filtration= arteriolar
-osmosis=venule via plasma proteins

22

Osmotic vs oncotic pressure

-osmotic=pressure developed by solutes dissolved in water working across selectively permeable membrane
-oncotic=colloid osmotic pressure which is form of osmotic pressure exerted by proteins (albumin) in a blood vessel's plasma that pulls water into circulatory system

23

Typical normal pattern for serum protein electrophoresis

-positive pole=large quantities of albumin (small molecule) migrates fastest towards positive pole
- positive to negative pole order: albumin, alpha1, alpha2, beta, gamma

24

Multiple myeloma serum protein electrophoresis findings

-IgG plasma cell malignancy dyscrasia with kappa light chains

25

Bence-Jones proteins effects on kidneys

-deposition of light chains in tubules which causes lots of tubular damage and can ultimately cause chronic renal failure

26

organs involved in causing edema in congestive heart failure

-kidney and liver

27

Nephrotic syndrome

-generalized edema

28

What can cause generalized edema

-kidney failure
-heart (congestive heart failure)
-Liver (not producing enough plasma proteins)
-GI proteins (caused by losing proteins--protein losing enteropathies)
-Lungs--because of its effect on the heart

29

What are the compartments or major morphologic components of the kidney?

-Glomeruli
-Tubules
-Interstitium
-Vessels
*Tubules and vessels are in interstitium)

30

Is diabetes primarily what kind of disease?
What about hypertension?

-diabetes=GLOMERULAR disease (microvasculature) manifestations
-HTN=vascular (arteriolar) disease manifestations (TUBULOINTERSTITIAL DISEASE)