Flashcards in Renal Pathology Puthoff Lecture Deck (114)
The general category of glomerular disorders is considered due to ____ disease
-immunologic (primary or secondary)
-but diabetes effect on kidney is largely hemodynamic not immunologic in terms of diabetic nephropathy
is glomerulonephritis due to infection? Difference bw glomerulonephritis and glomerulopathy
-in most cases no! but may have inflammatory infiltrates
-they are the same
How does the interstitium react to chronic kidney disease?
-by becoming fibrotic and may see some degree of inflammation and some edema of the interstitium as well
What diseases do you see nephrosclerosis?
-other disorders that affect blood vessels
difference between azotemia and uremia?
-uremia is azotemia PLUS a constellation of clinical findings and biochemical abnormalities resulting from renal damage
Acute Kidney injury
-Rapid decline in GFR
-Most severe form exhibit oliguria or anuria
-May result from glomerular, interstitial, vascular or acute tubular injury (ATN)
-Can be reversible, or progress to CKD
-defined with diminished GFR
Which disorders are characteristic of glomerular disease? And which disorders are characteristic of tubulointerstitial disease? Which are characteristic of both?
-Glomerular: nephritic syndrome, nephrotic syndrome, ASYMPTOMATIC hematuria or proteinuria
Tubulointerstitial: UTI, UT obstruction, renal tumors, nephrolithiasis
BOTH: renal tubular defects and acute renal failure
difference between neprholithiasis and nephrocalcinosis
-nephrolithiasis is kidney stones
-nephrocalcinosis is dystrophic calcification of kidney parenchyma
Why do you see lipids in nephrotic syndrome?
-bc when kidney is stressed it tries to make more proteins and the pathway it goes into makes lipoproteins that deposit primarily in proximal tubule
Glomerular disease characterized by severe proteinuria (albumin) (more than 3.5gm/day--less in children), severe edema, hyperlipidemia, and lipiduria
Glomerular disease dominated by acute onset of grossly visible hematuria, mild to moderate proteinuria, and hypertension. Proteinuria and edema common but not as severe
signs of nephritic syndrome with rapid decline (days-weeks) in glomerular filtration rate (GFR). Implies severe glomerular injury
-Rapidly progressive glomerulonephritis
-protein in urine but LESS than 3.5 gm/day;
-normal protein in urine is about UPTO 150mg/day
Isolated urinary abnormalities
-glomerular hematuria and/or subnephrotic range proteinuria
Where do you find endothelial cells?
-line ALL blood vessels
Where are podocyte foot processes located?
-directly on basement membrane which deep to the podocyte cells
Morphology of glomerulus
-initial nephron segment consists of a glomerulus and bowman's capsule (together make up the renal corpuscle) that captures and funnels the glomerular filtrate, the initial urinary stream into the tubular system
PAS stains what?
Three layers of the basement membrane
-lamina rara interna
-lamina rara externa
-within that are negatively charged anions--among those are HEPARIN which is how charge selectivity occurs
HEMATURIA, azotemia, oliguria, edema, HTN
Acute nephritic, proteinuria, and acute renal failure
>3.5 gm/day PROTEINURIA, hypoalbuminemia, hyperlipidemia, lipiduria
Azotemia-->uremia progressing for months to years
Chronic renal failure
Glomerular hematuria and/or subnephrotic proteinuria
Isolated urinary abnormalities
edema usually seen in nephritic or nephrotic syndrome?
Pathologic responses of the glomerulus to injury
-Hyalinosis and sclerosis
Pathologic responses of the glomerulus to injury--hypercellularity
-proliferation of native cells (mesangial cells, endothelial cells and visceral epithelial cells) and infiltrates of inflammatory cells (neutrophils, macrophages, etc mononuclear cells, etc)
-crescents: occur in Bowman's space--both necrotizing elements and cellular elements
Pathologic responses of the glomerulus to injury----Basement membrane
-thickening (breaks, sclerotic regions)
-deposits (electron dense deposits)
-glomerulus BM is not the same as glomerular filtration membrane!!
-glomerulus BM is PART of glomerular filtration