Renal Vascular Disease Flashcards
(35 cards)
What is the parthenogenesis for Benign Nephrosclerosis
- Medial and intimal thickening
- Hyaline deposition in arterioles
what can cause medial and intimal thickening in Benign Nephrosclerosis
Hemodynamic changes
aging
genetics
What is the gross morphology of nephrosclerosis
- kidney size is normal to reduced
- surface is granular
What are microscopic morphology changes in nephrosclerosis
- narrowed lumens of arterioles and small arteries
- scarring, glomerular sclerosis
- tubular atrophy
- Fibroelastic hyperplasia
what is fibroelastic hyperplasia
medial hypertrophy, reduplication of elastic lamina, myofibroblastic tissue in intima
what are clinical features of Nephrosclerosis
- mild proteinuria
Rarely nephrosclerosis does not cause renal insufficiency except in what?
- african descent
- severe hypertension
- underlying disease (diabetes)
What is the gross appearance of Malignant hypertension
“fea-bitten” apperance of kidney from petechial hemorrhages on cortical surface
What is the histology for malignant nephrosclerosis
Fibrinoid necrosis of arterioles
Hyperplastic ateriolitis “onion-skinning”
What does fibrinoid necrosis look like
vessel walls appear eosinophilic, granular
- stain positive for fibrin
What happens to the glomeruli in malignant nephrosclerosis
glomerulitis with neutrophils and necrosis
What is renal artery stenosis
- unilateral constriction decreases circulation/blood pressure
What is triggered by renal artery stenosis
RAAS system
What are 3 different ways renal artery stenosis can present itself
- atherosclerosis plaque occlusion
- Fibromuscular dysplasia of renal artery
- Ischemic kidney
Who is likely to get fibromusclar dysplasia of renal artery
women
3rd and 4th decades
Name 2 thrombotic microangiopathies
- hemolytic uremic syndrome (HUS)
2. Thrombotic thrombocytopenic purpura (TTP)
What goes wrong in thrombotic microangiopathies
- tissue dysfunction resulting from formation of microthrombi
- then vascular obstruction
- then tissue ischemia
HUS hemolytic uremic syndrome, injury occurs where
endothelial injury
- then platelet activation and thrombosis
What triggers the endothelial injury in typical HUS
shiga-like toxin
What goes wrong in atypical HUS
excessive activation of complement
TTP thrombotic thrombocytopenic purpura what goes wrong
platelet aggregation from very large multimers of vWF
- autoAbs to ADAMTS13
What causes typical HUS
intestinal infection with E. Coli strain 0157-H7
How do you distinguish HUP from TTP
HUS has normal ADAMTS13 plasma levels
symptoms for typical HUS
- flu like or diarrhea
- severe oliguria and hematuria
- microangiopathic hemolytic anemia
- thrombocytopenia
