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Year 2 clinical pathology > Week 9 Renal system 1 > Flashcards

Week 9 Renal system 1 Flashcards

1
Q

What is the functions of the kidney?

A

Eliminating metabolic waste products

Regulating fluid and electrolyte balance

Influencing acid-base balance

Production of some hormones

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2
Q

What hormones are produced by the kidney?

A

Renin: fluid balance

Erythropoietin: stimulates red cell production

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3
Q

What are the different presentations of renal disease?

A

Acute renal failure

Nephrotic syndrome

Acute nephritis (nephritic syndrome)

Chronic renal failure

Haematuria

Proteinuria

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4
Q

What are the 5 ways of diagnosing a patient?

A 
Renal physician
Radiologist
Biochemist
Urologist
Pathologist
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5
Q

Where are the glomerulus in the kidney found?

A

Glomerulus are coiled capillary that are found in the bowmans space

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6
Q

What structures in the kidney allow filteration of the blood?

A

Podocyte foot processes, endothelial cells and basement membrane allow filtration

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7
Q

What are the immunological mechanisms of glomerular damage?

A

Circulating immune complexes deposit in glomerulus

Circulating antigens deposit in glomerulus

AutoAntibodies to basement membrane or other components of glomerulus

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8
Q

What is the consequence of immunoligical mechanisms that cause glomerular damage.

A

Lead to Complement activation
Neutrophil activation
Reactive oxygen species
Clotting factors

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9
Q

What are the non-immunological mechanisms of damaging glomerur?

A

Injury to endothelium of vessels e.g. hypertension
Altered basement membrane due to hyperglycaemia in diabetes

Abnormal basement membrane or podocytes due to inherited disease

Deposition of abnormal proteins in the kidney e.g. amyloid

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10
Q

What are the ischaemic mechanisms for causing tubular damage?

A

Hypotension –> septic shock can cause this

Damage to vessels within kidney

Glomerular damage

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11
Q

Why does glomerular damage cause damage to the tubular?

A

If anything damage the glomerular will damage the tubule because disruption to blood supply in the glomerular will reduce blood supply to the tubule and get necrosis and death

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12
Q

What are the toxic mechanisms of tubular damage?

A

Direct toxins
Hypersensitivity reactions e.g. to drugs

Deposition of crystals in tubules

Deposition of abnormal proteins in the tubules

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13
Q

What does damage to renal tubules correlate with?

A

The degree of damage to renal tubules correlates well with renal function
`

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14
Q

What are the mechanisms of vascular damage of the kidney?

A

Thrombotic microangiopathy

Vasculitis

Hypertension

Diabetes

Atheroma e.g. Renal artery stenosis

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15
Q

How does vasculitis cause vascular damage to the kidney?

A

Most common cause

Acute or chronic inflammation of blood vessel walls
obliteration of lumen by inflammation
various different types affecting different sizes of vessel
adults and children can be affected
e.g. Wegener’s granulomato

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16
Q

What is the thrombotic microangiopathy mechanism for vascular damage?

A

Not very common

Thrombi in capillaries and small arterioles
Due to damage endothelium
Causes of endothelial damage include bacterial toxins, some drugs, abnormalities in complement or clotting systems
e.g. Haemolytic uraemic syndrome

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17
Q

How do you name glomerular disease?

A

Glomerular disease name can be based on the actual disease that has a idiopathic cause sometimes

Or can be based on the appearance (when secondary to a known cause)

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18
Q

What is the cause of nephrotic syndrome?

A

Always due to damage to glomerulus

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19
Q

What is the consequence of nephrotic syndrome?

A 
Oedema --> can be chronic 
Proteinuria (>3g in 24h)
Hypoalbuminaemia
\+/- hypertension
\+/- hyperlipidaemia
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20
Q

What are the complications of nephrotic syndrome?

A

Infection

Thrombosis

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21
Q

What are the common causes of nephrotic syndrome in adults seen on renal biopsy?

A

Membranous nephropathy (most common)

Focal segmental glomerulosclerosis (FSGS)

Minimal change disease

Other causes: diabetes, lupus nephritis, amyloid

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22
Q

What is the profile of membranous nephropathy?

A

Idiopathic
Primary glomerular disorder of unknown cause
Usually adults 30-60, M>F
20-30% progress to end stage renal failure

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23
Q

What is focal segmental glomerulosclerosis?

A

A pattern of kidney damage with various possible causes (idiopathic, genetic, heroin use, HIV. Most are idiopathic)
M>F

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24
Q

In minimal change disease is the biopsy abnormal and in which gender is it more common in?

A

Biopsy is normal on light microscopy

M=F

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25
What is the common cause of nephrotic syndrome in children seen on renal biopsy?
Minimal change disease (most common) No abnormality seen on light microscopy Majority of children have excellent prognosis Focal segmental glomerulosclerosis (FSGS) rare Other causes are rare
26
What are the presentations of acute nephritis?
``` Oedema Haematuria Proteinuria Hypertension Acute renal failure ```
27
What are the common causes of acute nephritis?
``` Post-infective glomerulonephritis IgA nephropathy Vasculitis Lupus Other forms of primary glomerulonephritis ```
28
How does post infective glomerulonephritis occur?
Typically occurs a few weeks after Streptococcal throat infection The antibodies against strept cross react with the kidney and cause renal failure Most recover completely
29
How common is IgA nephropathy?
Most common primary glomerular disease worldwide Teenagers and young adults with haematuria 20-50% progress to renal failure over 20 years
30
How does vasculitis cause acute nephritis and what is its presentation?
Inflammation to the blood vessel that damage the glomerulus Presentation--> Fever, generally unwell, may have rash, myalgia, arthralgia
31
In who do you see lupus causing acute nephritis?
Young women
32
What are the common cause of acute nephritis in children?
Post-infective glomerulonephritis IgA nephropathy Henoch-Schonlein purpura
33
What is Henoch-Schonlein purpura?
Specific type of IgA nephropathy, M>F Typically young boys/teenagers with arthralgia, abdo pain, rash, haematuria, acute renal failure Most recover completely
34
What is haemolytic uraemic syndrome?
Typically children with E. Coli 0157 enteritis | Acute nephritis + haemolysis + thrombocytopaenia
35
What is the diagnosis and prognosis of acute renal failure?
Diagnosis – anuria/oliguria + raised creatinine and urea Many patients will recover and have good renal function if they had healthy kidneys previously Short term dialysis may be needed in some patients
36
What are the caues of acute renal failure?
Pre-renal: reduced blood flow to kidney Severe dehydration Hypotension e.g. Bleeding, septic shock, left ventricular failure ``` Post-renal: obstructed urinary tract Tumours of urinary tract Tumours in pelvis Bladder stones Prostatic enlargement ``` Renal: damage to kidney
37
When is biopsy helpful to identify acute renal failure?
When the cause is damage to the kidney Not useful in pre or post renal causes
38
What do all biopsies show in acute renal failure?
All biopsies will show “ATN” – acute tubular necrosis/ injury/damage/acute kidney injury (ATI/ATD/AKI)
39
What is the main cause of acute renal failure in adults?
Vasculitis --> rash fever, muscle pain Acute interstitial nephritis/tubulointerstitial nephritis (tubular damage with inflammation, most commonly caused by drug reactions)
40
What is the common cause of renal failure in children?
Henoch-Schonlein purpura Haemolytic uraemic syndrome Acute interstitial nephritis
41
What is the most common cause of acute renal failure?
Pre renal --> reduced blood flow to kidney
42
What are the complications of acute renal failure?
Cardiac failure (fluid overload) Arrythmias (electrolyte imbalance --> imbalanced potassium levels) GI bleeding Jaundice (hepatic venous congestion) Infection, especially lung and urinary tract
43
What is the treatment of acute renal failure?
Short term dialysis may be needed | Treat the underlying cause
44
Define chronic renal failure?
Permanently reduced GFR – reduced number of nephrons
45
What are the 5 stages of chronic renal failure?
Stage 1: Kidney damage with normal or increased GFR (>90 mL/min/1.73 m2) Stage 2: Mild reduction in GFR (60-89 mL/min/1.73 m2) Stage 3: Moderate reduction in GFR (30-59 mL/min/1.73 m2) Stage 4: Severe reduction in GFR (15-29 mL/min/1.73 m2) Stage 5: Kidney failure (GFR
46
What is the common cause of chronic renal failure in adults?
Diabetes (commonest) Glomerulonephritis Reflux nephropathy
47
What is reflux nephropathy?
Chronic reflux of urine up the ureter leading to repeated infections and scarring of the kidney Commonly for younger patients
48
At what stage of chronic renal failure do you need treatment?
Stage 4 and 5
49
If you are on dialysis what stage are you at?
Automatically stage 5
50
What are the common causes of chronic renal failure in children?
Developmental abnormalities/malformations Reflux nephropathy Glomerulonephritis
51
Why is renal biopsy not helpful in establishing chronic renal failure?
Kidney shows severe scarring with loss of glomeruli and tubules Similar changes are seen in end-stage renal disease due to any cause
52
What are the effects of chronic renal failure? (4)
Reduced excretion of water and electrolytes: oedema, hypertension Reduced excretion of toxic metabolites Reduced production of erythropoietin: anaemia Renal bone disease
53
What is the common cause if a elderly patient has acute renal failure?
Acute interstitial nephritis due to drug reactions Myeloma --> tumor of plasma cells which will release large amount of immunoglobins that accumulate in the glomeruls and tubules that cause damage to the kidneys
54
What is the diagnosis if a young male has haematuria and rash?
Henoch-Schonlein purpura
55
What is the possible diagnosis if a teenager/young adult has haematuria?
Post-infective glomerulonephritis | IgA nephropathy
56
What is the likely cause if a adult has renal failure, fever and mylgia?
Vasculitis?
57
What is the diagnosis if a young women has haematuria and facial rash?
Lupus
58
What is the diagnosis if a adult has nephrotic syndrome?
Membranous nephropathy | Mostly idiopathic
59
What is the likely diagnosis if a child has nephrotic syndrome?
Minimal change disease
60
What investigations are needed to identify the cause of isolated haematuria?
Cystoscopy and other urological investigations are likely to be needed
61
What are the likely renal cause of Haematuria +/- proteinuria with normal renal function?
IgA nephropathy Thin basement membrane disease Alport type hereditary nephropathy
62
What is thin basement membrane disease?
Inherited condition causing abnormally thin basement membranes in the glomerulus If no other renal disease present, kidney function will remain normal
63
What is Alport type hereditary nephropathy?
Inherited abnormalities of collagen type IV cause abnormal basement membrane in the glomerulus, sometimes with eye and ear problems Renal failure +/- deafness +/- ocular problems May be autosomal or X-linked
64
What is isolated proteinuria?
Proteinuria less than the nephrotic range, without haematuria, renal failure or oedema
65
What are the causes of isolated proteinuria in adults?
FSGS Diabetes Lupus
66
What is the common cause of isolated proteinuria in children?
Henoch-Schonlein purpura | FSGS
67
What is a complication of acute pyelonephritis ?
Abscess formation
68
What is Pyelonephritis ?
Infection of the kidney
69
What is the action of acute pyelonephritis?
Instrumentation of urinary tract Structural abnormalities of urinary tract
70
In who is acute pyelnophritis common in?
Diabetics | More common in women (ascending infection)
71
What are the two routes of pyelonephritis?
Infection can occur via haematogenous spread Infection via ascending route from bladder
72
What is chronic pyelonephritis associated with?
most associated with obstruction of urinary tract and reflux of urine up ureter
73
What can chronic pyelonephritis lead to?
Leads to scarring of the kidney and can lead to renal failure
74
What are the complications of chronic pyelonephritis?
Scarring of kidney | -Chronic renal failure
75
What is the cause of renal artery stenosis?
Due to atheroma (most common) or arterial dysplasia
76
What does renal artery stenosis lead to?
Leads to ischaemia of the affected kidney Activation of renin-angiotensin-aldosterone system leads to hypertension Loss of renal tissue due to ischaemia leads to reduced renal function
77
How does vasculitis affect the kidney?
Vasculitis is inflammation of blood vessels Various types occur and affect different sizes of vessels Inflammation can affect the glomerular vessels and lead to clotting with obliteration of capillary lumens and destruction of the glomerulus Inflammation of larger arterioles within the kidney can lead to hypoxia of the tubules Often affects other vessels around the body causing rash, muscle and joint pains Patients can also have fever and weight loss due to the inflammation
78
How does hypertesion affect the kidney?
Hypertension damages renal vessels leading to thickening of the vessel wall and reduction in size of the lumen This produces chronic hypoxia which leads to loss of renal tubules and reduced renal function Reduced blood flow in the kidney leads to activation of the renin-angiotensin-aldosterone system which exacerbates hypertension
79
How does diabetes affect the kidney?
Diabetes is the commonest cause of end-stage renal failure in Europe and the USA Hyperglycaemia is the main cause of diabetic nephropathy by damaging the basement membrane Basement membrane becomes thicker and the glomerulus produces excess extracellular matrix which forms nodules
80
How does myeloma affect the kidney?
Tumour of plasma cells producing immunoglobulins Excess immunoglobulins deposit in kidney tubules Tubules become damaged Inflammation and fibrosis of kidney occurs Loss of renal tubules leads to declining kidney function Renal impairment due to myeloma is usually irreversible

Year 2 clinical pathology (21 decks)

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