Path Test 4: Renal 2

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Path Test 4: Renal 2
2013-02-16 18:00:13
Path Test Renal

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
  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?
  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
  22. ADPKD mutation
  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?
    • 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
  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?
  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
  57. Oncocytoma gross appearance
    Tan to mahogany brown, centra scar
  58. Cells contain abundant mitochondria
  59. Benign tumor consisting of vessels, smooth muscle, and fat

    *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