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66 Cards in this Set

  • Front
  • Back
Outer zone of the kidney that contains Glomeruli and Tubules
Part of Kidney that contains tubules, loops of henle, and collecting ducts
Blood enters the glomerulus through the __1__ and exits through the __2__
1. Afferent arteriole

2. Efferent arteriole
What do Afferent arterioles originate from?
Interlobular arteries

**which originate from Larger Lobar and Arcuate Arteries
What is another name for Visceral Epithelial Cells of the Glomerulus?
Podocytes which have foot processes
Describe the Endothelial Cells of the Glomerulus
Form the capillary and are FENESTRATED, allowing filtration of plasma
Where are Mesangial Cells located?
central portion of the Glomerulus in the area where several loops meet; they are surrounded on all sides by mesangial matrix
Modified smooth muscle cells in the media of the Afferent arteriole that secrete Renin
Juxtaglomerular Cells

**Renin converts Angiotensin I -> Angiotensi II --> Vasoconstriction --> Aldosterone secretion from Adrenal Cortex = increased Sodium and Water reabsorption in distal tubules
Cells of the distal tubule near the afferent arteriole; sense Sodium concentration in the tubule fluid; provide first impulse for the secretion of Renin
Macula Densa
Contractile and phagocytic cells of the Glomerulus
Mesangial cells
This is the most common form of Acute Renal Failures

What is the cause?
What pathology is seen?
Prerenal Failure

-Heart failure
-Shock from surgery

Tubular Necrosis
What are the 4 causes of Renal Failure?
1. Glomerular disease due to Acute Glomerulonephritis
2. Tubulointerstitial Nephritis due to a drug reaction
3. Vasculitis due to Wegener Granulomasotis
4. Toxic tubular necrosis due to Mercury poisoning
What are 4 causes of Postrenal Failure?
1. Intratubular obstruction due to Acute Urate Nephropathy
2. Renal-pelvic obstruction due to Nephrolithiasis
3. Ureteric obstruction due to Urinary stones
4. Bladder/Urethral obstruction due to Prostatic hyperplasia
What are the 4 progessive steps to Chronic Renal Failure?
1. Diminished Renal Reserve
2. Renal Insufficiency
3. Renal Failure
4. End-stage Renal Failure
GFR that is 50% of normal
Diminished Renal Reserve
List the characteristics of Renal Insufficiency
1. GFR 30-50% of normal fxn
2. Azotemia = elevated blood nitrates (BUN & Creatinine)
3. Anemia = decreased EPO release = Normocytic, Normochromic
4. HTN
5. Reduced concentrating capacity
List the characteristic of Renal Failure
1. GFR 20-25% of normal
2. Kidney cannot regulate solutes and fluid volume
3. Edema
4. Metabolic Acidosis
What are the characteristics of End-stage Renal Disease?

GFR is less than 5% of normal
List the features of Uremia
1. Fluid and Electrolyte abnormalities = edema, acidosis, K+ increases
2. Phosphate increases and cannot be excreted = causes Ca+ imbalance = Hypercalcemia -> Parathyroid stimulation to secrete PTH -> Secondary Hyperparathyroidism
3. Bleeding time is prolonged due to abnormal platelets
4. GI effects = NVD, esophagitis, gastritis, colitis
5. Neuromuscular disorders -> Hypercalcemia = impulses cannot be transmitted b/c of imbalance b/w free and IC Ca+
Describe Potter Syndrome
Renal agenesis resulting in Oligohydramnios (low amniotic fluid b/c baby cannot excrete it)
-Potter facies = flattened nose, low-set ears, recessed chin
Where is the most common place for Ectopic Kidney?
Pelvis (pelvic brim)

**b/c of abnormal location, kinking or tortuosity of ureters may cause some obstruction to urinary flow
Fusion of the kidneys, usually at the lower pole; may cause Urinary tract obstruction b/c of impingement on the Ureters
Horseshoe Kidneys
Describe the Adult form of Polycystic Kidney Disease
1. Autosomal Dominant
2. incidence of 1:1000
3. due to PKD-1 mutation
4. Bilaterally enlarged kidneys
5. Symptoms appear in adult life
6. Renal failure 5-10 years thereafter
Explain the pathogenesis of the cysts in Adult Polycystic Kidney Disease
1. Mutation in PKD-1 gene
2. Polycystin-1 protein is a transmembrane protein that keeps cell anchored to eachother = mutated
What are the associated conditions of Adult Polycystic Kidney Disease?
1. Liver Cysts (30%)
2. Splenic Cysts (10%)
3. Pancreatic cysts (5%)
4. Berry aneurysms (20%)
5. Diverticulosis coli
HTN, hematuria, and bilateral palpable renal masses in a patient with Mitral Valve Prolapse
Autosomal Dominant Polycystic Kidney Disease
List the 6 clinical findings in Nephritic Syndrome
1. Hematuria = inflammation causes the glomerulus to rupture thru the BM and leack blood into Bowman's Capsule = "smoky brown urine" or "bouillon-soup like"
2. Proteinuria = increased permeability of GBM
3. Hypoalbuminemia = causes Edema due to loss of oncotic pressure
4. Oliguria = due to reduced GFR
5. Edema = due to Salt and Water retention = Periorbital edema; Somnolence of affected kids is related to Brain Edema
6. Hypertension = due to reduced GFR -> Macula Densa -> JG apparatus -> Renin secretion
List 3 general causes of Nephritic Syndrome
1. Immune-complexes deposit in the capillary of Glomeruli
2. Anti-GMB Ab's
3. Planted antigens from endogenous or Exogenous organisms = Strep antigen stuck in kidney
Define Acute Postinfectious Glomerulonephritis
Acute NEPHRITIC syndrome 1-2 weeks after infection with Group A Beta-hemolytic Streptococci
A 10 year old girl presents to the clinic complaining of eye swelling. You remember this child from 3 weeks ago when she was seen for Pharyngitis. Upon taking a history and performing a physical, you find that the patient has pronounced periorbital edema, has been urinating very little despite adequate fluid intake, and has a blood pressure of 150/9. Lab findings include Azotemia, Hematuria, Red Cell Casts in the urine, and increased ASO Ab titer.
Acute Postinfectious Glomerulonephritis

**Immune-complex disease
What age group does Acute Postinfectious Glomerulonephritis usually occur in?
-90% recover
-9% persistent hematuria, proteinuria
-1% chronic renal disease
What pathology is seen under the light microscope in ACUTE POSTINFECTIOUS GN
-Endothelial cells
-Mesangial cells
What pathology is seen in Immunofluorescence in ACUTE POSTINFECTIOUS GN?
Irregular coarse granular Lumpy-bumpy pattern = deposits of IgG or C3
-deposits are in the Mesangium and along the Basement Membrane
What pathology is seen on EM in ACUTE POSTINFECTIOUS GN?
Electron-dense Humps on the EPITHELIAL side of the basement membrane = Subendothelial localization
Lupus is a systemic disease that is more common in __1__ and __2__
1. Women

2. African-americans
In Lupus Glomerulonephritis, what is there a deposition of?
Lupus Glomerulonephritis is associated with deposits in these places
1. Blood vessels
2. Tubular Basement Membrane
3. Interstitium

**can basically cause deposition anywhere in the kidney
What test is used to judge the activity of Lupus?
Total Serum Complement
-low in lupus b/c it has been consumed
Only disease that we know that causes deposits on the Subendothelial side
Lupus Glomerulonephritis
B = Endothelial cell
C = Epithelial Cell
D = Mesangial cell
E = Bowman capsule
Label the letters
Autosomal Dominant Polycystic Kidney Disease
-both kidneys have large cysts
What is this showing?
Autosomal Dominant Polycystic Kidney Disease
What is this picture showing?
- small cysts
What is this picture showing?
Acute Postinfectious GN
What would cause this pathology?
Capillary Lumens are occluded -> low GFR
-hypercellularity of Endothelial cells, Mesangial cells, PMN's

Postinfectious GN
What is the obvious pathology here?

What is the cause?
Subepithelial humps of immune complex deposits

Acute Postinfectious GN
What pathology do you see here?

What is the cause?
Acute Postinfectious GN

"lumpy-bumpy" IF = IgG, IgM, and C3 deposits throughout glomerulus
What is the cause of this?
Lupus Glomerulonephritis
What would be the cause of these pathologies?
Subendothelial deposits

Lupus Glomerulonephritis
What is seen here?

What is the cause?
Subepithelial Deposits
capillary is occluded

Lupus Glomeruonephritis
What is seen here?

What is the cause?
BUN/Cr ratio is greater than 15: Pre-renal or Renal failure?
What is Azotemia largely related to?
decreased GFR
When azotemia becomes associated with a constellation of clinical signs and symptoms
Prerenal azotemia is encountered when there is _______ that impairs renal function in the ABSENCE of parenchymal damage
When is Postrenal Azotemia seen?
whenever flow is obstructed below the level of the kidney
X-linked dominant disease with a defect in the synthesis of the alpha5-subtype of collage type IV in the GBM
Alport's Syndrome
A patient presents with hereditary nephritis, sensorineural hearing loss, and ocular defects. What is the diagnosis?
Alport Syndrome
A 10-year-old boy presents to the clinic complaining of a red tinge to his urine. A more detailed history reveals that he was diagnosed with mild nerve deafness 2 years earlier and also developed cataracts 1 year ago. Lab studies confirm hematuria as well as the presence of RBC casts
Alport syndrome
Development abnormality that may be uni- or bilateral. Results from irregular differentiation and morphogenesis of the Metanephros. Parenchyma of these abnormal kidneys consists of immmature nephrons, often showing signs of Cystic dilation
Cystic Renal Dysplasia
A child presents with an enlarged, unilateral flank mass. Biopsy shows abnormal structures persisting in the kidney (i.e. cartilage, immature collecting ductules, striated muscle)
Cystic Renal Dysplasia
Heavy proteinuria (> 3.5 grams/day)

Nephritic or Nephrotic?
Azotemia (BUN:Cr > 15)
Proteinuria (<3.5 g/day)
Edema = periorbital
Nephritic Syndrome
RBC casts

Nephritic or Nephrotic?
Generalized edema

Nephritic or Nephrotic?
Fatty casts with Maltese crosses and Oval Fat bodies

Nephritic or Nephrotic?
Why is there HTN in Nephritic Syndrome?
reduced GFR causes a release of renin