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57 Cards in this Set
- Front
- Back
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Describe the following parts of the nephron
1. glomerulus 2. Bowman's capsule 3. Proximal tubule 4. Loop of henle 5. distal tubule 6. collecting duct |
About 1 million nephrons in adult human kidney
Glomerulus - tuft of capillaries where blood is filtered Bowman’s capsule - collects glomerular filtrate Proximal tubule - most solute exchange, fluid reabsorption; convoluted and straight parts; “brush border” Loop of Henle - descending limb (thin), thin ascending limb, thick ascending limb Distal tubule - convoluted continuation of thick ascending limb of loop of Henle (anatomically defined) Collecting duct - collects about 6 distal tubules; others join to form duct of Bellini |
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What kind of stains are used for kidneys and why?
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PAS stain - stains carbohydrates. can visualize basement membranes.
many pathologies arise from changes in basement membrane. |
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Podoctyes? Where does ultrafiltration happen?
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Structures that wrap around the capillaries that are similar to epitehlial cells.
-do express some proteins that are unique. -they create a slit diaphragm - proteins cross bridges (nephrin) that result from hereditary mutations. -filtration slits between the processes is where ultrafiltrate hapens. All collects in the Bowman's space |
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Where can you find foot process?
What is at the center of the cross section of the glomerulus? |
Arranged in a tubular like fashion (if ou look at a cross section) on the endothelium. In the central area is the mesangium consists of mesangial cells.
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Describe the primary role and specific functions of the kidney
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PRIMARY ROLE: Regulate body fluid composition and distribution
Specific functions: • Separate wastes from the blood • Control total volume of body fluid (water) • Manage blood pressure • Regulate body fluid pH and solute concentration • Secrete or modify certain hormones related to its physiologic role |
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What are most of the functions of the kidney accomplished through?
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With the exception of its endocrine function, most of these functions
are accomplished via selective and actively adjusted filtration of the blood |
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Name the pathology associated with teh following
1. Separate wastes from blood 2. control total volume of body fluid (water) 3. manage blood pressure 4. regulate body fluid pH and solutes 5. secrete or modify certain hormones |
1. uremia, urine abnormalties
2. edema 3. hypertension 4. uremia, edema 5. hypertension, anemia |
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What are some symptoms associated with uremia?
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UREMIA is the generalized ill condition associated with renal failure, characterized by
fatigue, anorexia, decreased mental acuity, nausea, vomiting, itchiness, fine motor abnormalities, etc. The condition is attributed to buildup of nitrogenous wastes in the blood. |
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What are some clinical indications for kidney biopsy?
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Rapidly progressive glomerulonephritis
Acute Renal Failure (“A-R-F”) Chronic Renal Failure Acute nephritic syndrome Nephrotic syndrome Asymptomatic hematuria Asymptomatic proteinuria |
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The kidney is considered to consist of 4 compartments..
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-Glomeruli
-Tubules -Interstitium -Vasculature kidney may be approached diagnosticaly by systemically considering each compartment individually |
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What are the acute and chronic disease processes that can occur in the glomeruli?
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Acute: cellular crescent, primary podocyte injury
Chronic: global/segmental sclerosis. immune complex deposition |
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What are acute and chornic processs of tubules?
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Acute: tubular injury, tubulitis
chronic: tubular atrophy, hyaline cast deposition |
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What are acute and chronic diseases of intersititium?
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Acute: intersitial nephritis
peritubular capillaritis Chronic: interstitial fibrosis capillary C4d deposition |
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What are acute and chronic diseases of vasculature?
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Acute: vasculitis, endothelialitis
Chornic: arterial scleorosis, amyloidosis |
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What are some mechanisms of glomeruluar disease?
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• Visceral epithelial (podocyte) injury
• Immune complex deposition • Paraprotein deposition • Cell-mediated/inflammatory injury / crescent formation • Endothelial cell injury • Mesangial proliferation |
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What are some patterns of glomerular injury?
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• Diffuse - widespread involvement throughout kidney
• Focal - local, isolated, or “punctate” involvement within kidney • Global - involvement of entire glomerulus • Segmental - involvement of portion or isolated lobules of glomerulus |
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Describe what we would see for nephritic syndrome (itis = inflammed)
1. urine sediment 2. proteinuria 3. edema 4. hypoalbuminemia 5. hyperlipidemia 6. plasma Cr |
1. urine sediment: active
2. proteinuria - variable 3. edema - variable 4. hypoalbuminemia- not usually 5. hyperlipidemia - not usually 6. plasma Cr - may be elevated |
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Describe what we would see for nephrotic syndrome (osis = diseased)
1. urine sediment 2. proteinuria 3. edema 4. hypoalbuminemia 5. hyperlipidemia 6. plasma Cr |
1. urine sediment - inactive
2. proteinuria - Heavy (>3.5g/day) 3. edema - yes 4. hypoalbuminemia - yes 5. hyperlipidemia - yes 6. plasma Cr - rarely elevated |
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What are some causes of nephrotic syndrome
1. primary glomerular diseases 2. systemic |
Primary Glomerular Diseases
Membranous Glomerulonephritis Minimal Change Disease Focal Segmental Glomerulosclerosis (FSGS) Membranoproliferative Glomerulonephritis (MPGN) IgA Nephropathy Other Glomerulonephritides Systemic Diseases Diabetes Mellitus Amyloidosis Systemic Lupus Erythematosus Other causes (drugs, infections, malignancy, hypersensitivity, etc.) |
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What are some disease characteristics and pathophysio of membranous glomerulonephritis
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Disease Characteristics:
• Most common cause of nephrotic syndrome in adults • Usually idiopathic (85%) • Secondary forms due to drugs, tumors, SLE, infections, diabetes • Variable course & steroid response Pathophysiology: • Associated with sub-epithelial deposition of autoantigen-antibody complexes in glomerular capillary wall • Local damage due to complement activation • Podocyte foot process effacement |
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What are some disease characteristics and pathophysio of minimal change disease (FSGS)
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Disease Characteristics:
• MCD is most common cause of nephrotic syndrome in children (both diseases seen at all ages) • Some hereditary forms of FSGS • MCD is highly responsive to steroids • FSGS poorly responsive to steroids and usually progresses to renal failure Pathophysiology: • Primary feature of both diseases is podocyte foot process effacement • FSGS also associated with focal and segmental glomerular sclerosis due to more severe glomerular injury • Glomeruli are light microscopically normal in MCD |
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What are some causes of nephritic syndrome
1. acute proliferative glomerulonephritis 2. rapidly progressive glomerulonephritis |
Acute Proliferative Glomerulonephritis
Classic presentation of nephritic syndrome Prototype dz: Poststreptococcal glomerulonephritis (children) Rapidly Progressive Glomerulonephritis Rapid clinical progression: nephritic syndrome, ARF, death Characterized by crescent formation in glomeruli Three groups based upon immunologic findings: Type I: anti-GBM antibodies (Goodpasture Syndrome) Type II: immune complex mediated (postinfectious, etc.) Type III: pauci-immune / ANCA associated (vasculitides) |
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Describe 3 immune mechanisms in glomerular disease
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A) Deposition of preformed immune complexes in glomeruli
B) Formation of immune complexes by interaction of circulating antibodies with antigens deposited in glomeruli C) Direct interaction of circulating antibodies with glomerular components |
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Describe the disease characteristics and pathophysio of poststreptococcal glomerulonephritis
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Disease Characteristics:
Usually children • 1 to 4 wks after strep infection: group A beta-hemolytic strep Presents with nephritic picture Typically complete recovery Pathophysiology: Antibody mediated against circulated or planted antigen Diffuse proliferation and leukocyte infiltration Sub-epithelial “humps” correspond to immune deposits |
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What are the major causes of tubulointerstitial nephritis
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Pyelonephritis
Usually bacterial (ascending urinary tract infection) Primarily involving the pelvis of the kidney (hence “pyelo”) Drug-induced Interstitial Nephritis Synthetic penicillins Other synthetic antibiotics NSAIDs |
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What is the pathogenesis and cause of thrombotic angiopathy (primary endothelial injury)
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Pathogenesis:
Direct, often chronic endothelial injury Altered permeability of endothelium to macromolecules and water Basement membrane redundancy (“double contours”) Causes: Pro-coagulant states (thrombophilia) Autoimmune disorders Toxic injury affecting components of the vascular wall Physical factors such as irradiation Metabolic diseases with an important vascular component |
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What is a characterstics of crescental glomerulonephritis?
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you see capillary infiltration outside of the cresent of the endothelial cell versus what you see in poststreptococcal glomerulonephritis in which you would see the infiltration inside the glomerulus
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What are the distinct characterstics of thrombotic angiopathy?
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-arteriolar sclerosis, hyalinosis.
-hyperplastic arteriosclerosis (onion-skin lesion) |
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What are the characteristics of end stage kidney disease?
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-Vessels show a lot of vascularization.
Uremia, proteinuria, hypertension, etc. Insidious onset - often discovered very late Prognosis is poor 30-50% will be on dialysis Transplantation is best current therapeutic option |
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Describe the histologic techniques of renal biopsy..
1. light microscopy 2. immunofluroscence microscopy 3. transmission electron microscopy |
Light Microscopy
• General purpose evaluation of all compartments of the kidney (glomeruli, tubules, interstitium, blood vessels), using histochemically-stained tissue sections • This is the most important and generally useful modality; therefore a light microscopy specimen should almost always be obtained Immunofluorescence Microscopy • Provides high contrast visualization of immunoglobulin and complement deposition (a common disease mechanism in the kidney) • Requires special type of microscope Transmission Electron Microscopy • Allows for visualization of fine cell structure (ultrastructure), as well as fine structure of extracellular material (deposits, etc.) • Requires technically involved processing and special equipment |
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What part of the kidney in terms of of its outside appearance exist all the way through adulthood?
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Embryological depressions that give the kidney its distinct appearance.
simple renal cyst. Such cysts occur either singly or scattered around the renal parenchyma and are not uncommon in adults. |
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What needs to be intact in order fo the kidney to function?
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The corticomedullary junction. If this is disrupted, we know that there will be problems.
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What type of pathology would we not need to worry about?
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Fluid filled cysts. even though they can be large, they are benign
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How often can you see double ureters?
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A partial or complete duplication of one or both ureters occurs in about 1 in 150 persons. There is a potential for obstructive problems due to the abnormal flow of urine and the entrance of two ureters into the bladder in close proximity, but most of the time this is an incidental finding (except to a urologist).
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What's a horshoe kidney?
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a congenital anomaly that most often occurs in association with other anomalies or syndromes with specific genetic defects such as trisomy 18.
However, it can also occur as an isolated anomaly. The possible problem here is that the ureters take an abnormal course across the "bridge" of renal tissue and this can lead to partial obstruction with hydronephrosis. |
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Why do calculi form?
Name the different types and how often they form. |
Increased excretion of solutes.
Can get caught where the urter and pelvis meet, any type of narrowing. Calculi = crystalline deposits, usually one 1 side of the kidney. Most common are Calcium oxalate and Calcium phosphate (75%) Magnesium ammonium phosphate (struvite, or "triple phosphate") 12% Uric acid 6% Cystine 1% Other 6% |
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What are struvite stones?
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"infection" stones because bacteria such as Proteus that split urea to ammonia favor their formation. Uric acid stones may be seen in association with gout, but often are not, and may just reflect increased precipitation of urates in an acid urine. Rare cystine stones also form in acid urine.
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What are the clinical symptoms of urinary tract canaliculi?
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. Their passage is marked by intense abdominal or back or flank pain. This pain can be paroxysmal, known as renal or ureteral "colic". Hematuria may also be present. Larger stones that cannot pass may produce hydronephrosis or hydroureter
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What commonly happens with canaliculi?
What are some other ways where urine flow can be obstructed? |
It can get stuck and cause urine to back up.
There also mgith be tumors outside the ureters that constricts them, preventing outflow. Staggering canaliculi actually forms in the kidneys itself. |
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Describe stasis of urine and hydronephrosis
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a ureteral calculus caught at the ureteropelvic junction. This kidney demonstrates marked hydronephrosis with nearly complete loss of cortex. Such a kidney would be non-functional. If the other kidney had sufficient function, then renal failure will not ensue. There is sufficient renal reserve capacity that it is possible to survive with half of a normal kidney.
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What is hyperemia in the kidney suggest?
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Suggests infection in the kidney. See a lot of redness, perhaps pus.
This may happen as a result of focal hydronephrosis. Stasis from obstruction and dilation led to infection. |
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What do you need to observe in an abnominal CT scan?
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Should notice the positioning of the kidneys, the size of the kidney, notice any dilations of ureter.
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What may be placed in the kidney to assist in urine flow?
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A stent.. can be placed from renal pelvis to bladder.
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What is pyelonephritis?
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infection of the kidney. can happen through ascending infection (lower in GU tract and works its way up to the ureter. can occur due to hemotogenous spread)
-vesicoureter reflux: reflux of urine from bladder to the ureter. |
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What are some distinct histopathologic features of pyelonephritis?
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Prulent exudate consisting of neutrophils and debris are present in the renal tubules. Note the tubular destruction and abscess (bottom half), and normal looking tubules (top half).
aggregate of neutrophils: abscess. |
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Chronic pyelonephritis?
If the renal pelvis is dilated, where would the obstruction be? |
causes distinct changes in kidne that result in structural changes in scarring and indentation (more than fetal lobulations).
the cortex starts to degenerate and be replaced with scar tissue. may notice dilating calyces that decrease function of kidney. if the pelvis is dilated, the obstruction to flow would be at the uretopelvic junction. |
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What are the histopathological features of chronic pyelonephritis?
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Lymphocytes, macrophages, many plasma cells.
Glomeruli will scar over. intersitial space is filled with fibrosis. |
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In a kidney transplant, where would you pace the new kidney?
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Place it in the abdomen and attach it to the bladder. keep the old one where it is as long as its not infected
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What's another common cause of obstruction, especially in men?
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Obstruction also caused by prostatic hypertrophy. The markedly enlarged prostate seen here has not only large lateral lobes, but a very large median lobe as well that obstructs the prostatic urethra and led to chronic urinary tract obstruction. As a result, the bladder became both enlarged and hypertrophied as it had to work against the obstruction with every episode of urination. That is why the surface of the bladder appears trabeculated. Note also that a yellowish-brown calculus formed in the bladder.
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Adult polycystic kidney disease
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-Autosomal dominant with complete penetrance due to mutation of 16p1.3 (PCKD1 locus) that codes for polycystin 1 a tubular organizer.
-can see cysts exanding leading to hypertension, many die of ruptured berry aneurysms. -can causes cysts in pancreas, liver, etc. Patients can get dialysis. -usually asymptomatic in pts uness they have hypertension. can grow VERY large (football size) until they are noticed - can see blood appearance in cysts. |
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Chronic renal dialysis
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-can see cysts here too but here, the kidneys are and cysts never exceed 2 cm. much smaller than that in polycystic kidney disease.
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Urothelial (transitional cell) carcinoma
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papillary tumors project on the calcyces.
cancer shows much more disorder, can see frond like papillary projects on slide |
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Renal cell carcinoma
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very large before they are detected, diagnosed at very late stages.
most common one has a very yellow appearnace with areas of hemorhhage. presenting features: flank pain, back pain, blood urine, abdominal mass. -can be diagnosed through MRI. may see tumors on lower pole of the kidney. do a symmetery check. can see different densities within the large kidney. |
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Describe the histopathology of renal cell carcinoma
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: the neoplastic cells have clear cytoplasm and are arranged in nests with intervening blood vessels. This appearance is why they are often called "clear cell carcinomas"
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What can often happen with renal cell carcinoma?
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tumor can extend to the IVC up to the heart. this can block the blood supply to the adrenal glands.
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Describe the normal mucosa of urniary bladder
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Urothelium normally consists of 4 to 6 layers of cells. The uppermost layer consists of umbrella cells (not well seen in this image) which may have irregular hyperchromatic nuclei.
looks like schools of fish swimming to the surface. |
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Severe acute cystitis
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hyperemia of mucosa.
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