6- Renal Pathophysiology
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Transcript of 6- Renal Pathophysiology
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Renal Pathology
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Introduction:150gm: each kidney1700 liters of blood filtered 180 L of G. filtrate 1.5 L of urine / day.Kidney is a retro-peritoneal organBlood supply: Renal Artery & VeinOne half of kidney is sufficient reservekidney function: Filtration, Excretion, Secretion, Hormone synthesis.
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Kidney Location:
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Kidney Anatomy:
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Renal Pathology OutlineGlomerular diseases: GlomerulonephritisTubular diseases: Acute tubular necrosis interstitial diseases: PyelonephritisDiseases involving blood vessels: NephrosclerosisCystic diseasesTumors
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Clinical Syndromes:Nephritic syndrome.Oliguria, Haematuria, Proteinuria, Oedema.Nephrotic syndrome.Gross proteinuria, hyperlipidemia, Acute renal failure Oliguria, loss of Kidney function - within weeksChronic renal failure.Over months and years - Uremia
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IntroductionFunctions of the kidney:excretion of waste productsregulation of water/saltmaintenance of acid/base balancesecretion of hormonesDiseases of the kidneyglomerulitubulesinterstitiumvessels
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Azotemia: BUN, creatinine Uremia: azotemia + more problems Acute renal failure: oliguria Chronic renal failure: prolonged uremia
Abnormal findings
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Glomerular diseasesNephrotic syndromeMinimal change diseaseFocal segmental glomerulosclerosisMembranous nephropathyNephritic syndromePost-infectious GNIgA (immune) nephropathy
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Nephrotic SyndromeMassive proteinuriaHypoalbuminemiaEdemaHyperlipidemia
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Adults: systemic disease (diabetes)Children: minimal change diseaseCharacterized by loss of foot processesGood prognosisCauses
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Minimal change disease
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Minimal change diseaseNormal glumerular structure
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Normal glomerulusMinimal change disease
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Focal Segmental GlomerulosclerosisPrimary or secondarySome (focal) glomeruli show partial (segmental) hyalinizationUnknown pathogenesisPoor prognosis
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Focal segmental glomerulosclerosis
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Membranous GlomerulonephritisAutoimmune reaction against unknown renal antigenImmune complexesThickened GBMSubepithelial deposits
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Membranous glomerulonephritis
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Nephritic SyndromeHematuriaOliguria, azotemiaHypertension
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Post-infectious GN, IgA nephropathyImmunologically-mediatedCharacterized by proliferative changes and inflammationCauses
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Post-Infectious GlomerulonephritisChild after streptococcal throat infectionImmune complexesHypercellular glomeruliSubepithelial humps
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Post-infectious glomerulonephritis
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IgA NephropathyCommon!Child with hematuria after (URI) Upper Respiratory Infection IgA in mesangiumVariable prognosis
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IgA nephropathy
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Tubular and interstitial diseasesInflammatory lesionspyelonephritis
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PyelonephritisInvasive kidney infectionUsually ascends from UTIFever, flank painOrganisms: E. coli, Proteus
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Women, elderlyPatients with catheters or mal-formationsDysuria, frequencyOrganisms: E. coli, ProteusUrinary Tract Infection
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Acute pyelonephritis with abscesses
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Pyelonephritis
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Cellular cast
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Chronic pyelonephritis
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Drug-Induced Interstitial NephritisAntibiotics, NSAIDSIgE and T-cell-mediated immune reactionFever, eosinophilia, hematuriaPatient usually recoversAnalgesic nephritis is different (bad)
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Drug-induced interstitial nephritis
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Acute Tubular NecrosisThe most common cause of ARF!Reversible tubular injuryMany causes: ischemic (shock), toxic (drugs)Most patients recover
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Acute tubular necrosis
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Benign NephrosclerosisFound in patients with benign hypertensionHyaline thickening of arterial wallsLeads to mild functional impairmentRarely fatal
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Benign nephrosclerosis
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Malignant nephrosclerosisArises in malignant hypertensionHyperplastic vesselsIschemia of kidneyMedical emergency
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5% of cases of hypertensionSuper-high blood pressure, encephalopathy, heart abnormalitiesFirst sign often headache, scotomasDecreased blood flow to kidney leads to increased renin, which leads to increased BP!5y survival: 50%Malignant Hypertension
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Malignant hypertension
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Adult Polycystic Kidney DiseaseAutosomal dominantHuge kidneys full of cystsUsually no symptoms until 30 yearsAssociated with brain aneurysms.
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Adult polycystic kidney disease
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Childhood Polycystic Kidney DiseaseAutosomal recessiveNumerous small cortical cystsAssociated with liver cystsPatients often die in infancy
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Childhood polycystic kidney disease
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Medullary Cystic Kidney DiseaseChronic renal failure in childrenComplex inheritanceKidneys contracted, with many cystsProgresses to end-stage renal disease
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TumorsRenal cell carcinomaBladder carcinoma
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Renal Cell CarcinomaDerived from tubular epitheliumSmoking, hypertension, cadmium exposureHematuria, abdominal mass, flank painIf metastatic, 5y survival = 5%
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Renal cell carcinoma
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Bladder CarcinomaDerived from transitional epitheliumPresent with painless hematuriaPrognosis depends on grade and depth of invasionOverall 5y survival = 50%
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Bladder carcinoma
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