Path Test 4: Renal 2

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BrookeNH10
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201012
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Path Test 4: Renal 2
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2013-02-16 18:00:13
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Path Test Renal
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Path Test 4 Renal 2
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  1. Most common cause of acute renal failure
    Acute Kidney Injury
  2. 4 Causes of Acute Kidney Injury
    • Ischemia
    • Direct toxic injury to tubules
    • Acute tubulointerstitial nephritis
    • Urinary obstrucion
  3. AKI:  Clinical recovery
    Hypokalemia, increased urine output, increased vulnerability to infxn
  4. Increased urine volumes often seen w/ nephrotoxins
    Non-oliguric acute kidney injury
  5. 3 causes of Acute Pyelonephritis
    • Acute suppurative inflammation (normally bacterial)
    • Hematogenous induced by septicemia
    • Ascending Infxn
  6. 3 Complications of Acute Pyelonephritis
    • Papillary Necrosis
    • Pyonephrosis
    • Perinephric abscess
  7. Vesicoureteral reflux:  Acute or chronic pyelonephritis
    Acute
  8. Pain at CVA
    Pyuria (neutrophils in urine)
    WBC casts in urine (confirm renal involvement)
    Acute Pyelonephritis
  9. Acute Pyelonephritis produces
    • Fibrosis
    • Cortical scarring
  10. Chronic Pyelonephritis:  Scarring in
    calyces, renal pelvis
  11. 2 Major forms of Chronic Pyelonephritis
    • Reflux nephropathy
    • Chronic Obstructive Pyelonephritis
  12. Do tubulointerstitial diseases involve the pelvocalyceal system?
    No
  13. Most common form of pyelonephritic scarring
    Reflux Nephropathy

    *Typically begins in childhood due to UTI and coexisting vesicoureteral reflux (unilateral OR bilateral)
  14. Leads to recurrent infxns an parenchymal atrophy
    Chronic Obstruct Pyelonephritis

    *Can be bilateral as w/ posterior urethral valves
  15. Dilated calyces most prominent at Upper and lower poles
    • Chronic pylonephritis
    • Reflux nephropathy
  16. Renal Papillary Necrosis associated w/
    • Analgesic abuse (phenacetin)
    • DM
    • Sickle cell anemia
  17. Renal papillary necrosis is due to relative ischemia of the
    Renal Medulla
  18. Complications of Renal Papillary Necrosis
    • Ureteral obstruction
    • Transitional Cell Carcinoma
  19. Obstructive uropathy that predisposes to stones
    Bilateral, partial
  20. Urolithiasis:  Most common
    Calcium oxalate and phosphate
  21. Urolithiasis:  Associated w/ urea-splitting bacteria like Proteus
    Struvite
  22. ADPKD mutation
    16p
  23. Symptoms of ADPKD
    • Bilateral enlargment of kidneys
    • Innumerable cysts
  24. ADPKD associated w/
    • cerebral berry aneurysms
    • mitral valve prolapse
    • Cysts in liver, spleen, pancreas, or lungs
  25. ARPKD:  Children who survive infancy usually have
    • Hepatic cysts associated w/ bile duct proliferation
    • Progressive fibrosis (congenital hepatic fibrosis)
  26. Symptoms of ARPKD
    • Symmetrically enlarged kidneys w/ smooth surfaces
    • Numerous slit-like cysts replace the cortex and medulla
  27. ARPKD mutation
    PKHD1 gene
  28. Incidental finding in adults
    Small cysts (< 5 cm) found in collecting ducts of the renal papillae
    Medullary sponge kidney
  29. Medullary Sponge Kidney has a normal
    renal cortex
  30. Cysts of Medullary Sponge Kidney may
    contribute to the development of kidney stones or pyelonephritis
  31. Cysts in the medulla (usually at the corticomedullary junction)
    • Nephronopthisis
    • Adult-Onset Medullary Cystic Disease
  32. Cause of renal insufficiency in N and AOMCD
    Cortical tubulointerstitial damage
  33. 3 types of Nephronophthisis
    • Sporadic, non-familial
    • Familial juvenile nephronophthisis (most common)
    • Renal-retinal dysplasia
  34. Inheritance:
    Familal Nephronopthisis?
    AOMCKD?
    • FM:  AR
    • AOMCKD: AD
  35. Sporadic disorder characterized by presence in the kidney of abnormal structures
    Multicystic Renal Dysplasia
  36. Prolonged dialysis presents with cortical and medullary cysts (0.5- 2 cm)
    Acquired (Dialysis-Associated) Cystic Disease
  37. Cysts of Acquired Cystic Disease
    Clear fluid often containing calcium oxalate crystals
  38. Acquired Cystic Disease results in an increased risk for
    • Renal Cortical Adenomas
    • Renal Cell Carcinoma
  39. Sporadic findings in renal cortex of asymptomatic individuals
    Single or multiple, bulge from surface
    1-5 cm in diameter
    Simple renal cysts
  40. Less than 0.5 cm in diameter
    Tan-grey, well-circumscribed cortical nodule
    Renal Papillary Adenoma
  41. Prognostic factor of renal papillary adneoma
    Size
  42. Variegated yellow mass w/ areas of hemorrhage and cystic degeneration
    Renal Cell Carcinoma
  43. Renal Cell Carcinoma grading is based on
    Nuclear Atypia
  44. Renal Cell Carcinoma mutation
    Von Hippel-Lindau (VHL)
  45. 3 Classic Diagnostic features of RCC
    • CVA pain
    • Palpable mass
    • Hematuria
  46. RCC is associated w/
    paraneoplastic syndromes
  47. RCC metastasizes before or after it causes symptoms?
    before
  48. Most common type of Renal Cell Carcinoma
    Clear Cell Type
  49. Inheritance of RCC:  Clear Cell Type
    Sporadic, associated with loss of sequences on short arm of chromosome 3 (involves the VHL gene area)
  50. Chromophil RCC
    RCC:  Papillary RCC
  51. Foam cells in the papillary cores (papillary growth pattern)
    RCC:  Papillary RCC
  52. Trisomies associated w/ Papillary RCC
    Trisomies 7, 16, 17; loss of Y in male pts.
  53. Gene for familial form mapped to a locus on chromosome 7 for the MET proto-oncogene.
    Papillary RCC
  54. Prominent cell membranes, pale eosinophilic cytoplasm, peri-nuclear halo
    RCC:  Chromophobe RCC
  55. Bellini duct
    Collecting duct cells in the medulla
    Hobnail pattern
    RCC:  Collecting Duct Carcinoma
  56. Epithelial Tumor composed of large eosinophilic cells w/ small nuclei containing nucleoli
    Oncocytoma
  57. Oncocytoma gross appearance
    Tan to mahogany brown, centra scar
  58. Cells contain abundant mitochondria
    Oncocytoma
  59. Benign tumor consisting of vessels, smooth muscle, and fat
    Angiomyolipoma

    *Prone to spontaneous hemorrhage
  60. Chronic Kidney Disease stages
    • I: GFR < 90
    • II:  GFR 89-60
    • III:  GFR:  59-30
    • IV:  GFR 29-15
    • V:  GFR < 15
  61. Blood presure is stable for long periods of time
    Benign HTN
  62. Alterations associated w/ benign HTN - hyalinzes arterioles, intimal hyperplasia, sclerotic glomeruli
    Benign nephrosclerosis
  63. Diastolic >120
    Malignant HTN
  64. Malignant Nephrosclerosis
    Onion skinning of arteries and fibrinoid necrosis of arterioles and glomeruli
  65. Renin Levels:
    Benign HTN?
    Malignant HTN?
    • B- low or normal plasma renin levels
    • M- high renin
  66. Flea bitten kidney
    Malignant HTN
  67. High renovascular levels cause HTN by
    • Vasoconstriction
    • Aldosterone-mediated salt retention
  68. Renovascular HTN
    • Elevated plasma renin levels
    • Renal artery narrowing
  69. Most common cause of renovascular HTN
    Atherosclerosis (disease of aging)
  70. Fibrous or fibromuscular thickening that occurs primarily in the media of the artery; common in women; bilateral
    Fibromuscular Dysplasia

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