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Medical Pathology and Genetics
PPT 12: The kidney
18
Pathology
Graduate
02/26/2012

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Cards

Term
List the 4 main functions of the kidney
Definition
-excretion of waste products
-regulation of water/salt
-maintenance of acid/base balance
-secretion of hormones
Term
Is glomerular disease usually acquired or congenital?
Definition
usually acquired, rarely congenital
Term
What is the difference between primary and secondary glomerular diseases?
Definition
-primary: the kidney is the only (or predominant) organ affected
-secondary: associated with systemic conditions such as DM, HTN, or SLE
Term
Most acquired glomerular disease has an __________ basis
Definition
immune
Term
What is the immune basis of glomerular disease?
Definition
-circulating antigen-antibody complexes lodge in the glomerular basement membrane (GMB)
-autoantibodies bind to antigens on GBM
-These trigger a local inflammatory response involving complement and WBCs, damaging the glomerulus
Term
What are the two classifications of glomerular disorders?
Definition
-those that manifest with predominantly high-level proteinuria (nephrotic syndrome)
-those that manifest with predominantly high-level hematuria (nephritic syndrome)
Term
What are 6 signs and symptoms of nephrotic syndrome?
Definition
-massive proteinuria (>3.5 g/day)
-hypoalbuminemia
-severe edema
-hyperlipidemia
-lipiduria
-diseases associated with nephrotic syndrome generally cause chronic kidney dysfunction
Term
What is the most common cause of nephrotic syndrome in adults?
Definition
focal and segmental glomerulosclerosis (FSGC)
Term
What is FSGC, is it usually primary or secondary? What is the tx? What is the prognosis?
Definition
-may be primary
-secondary event with other diseases (HIV, heroin use, IgA nephropathy, maladaption to nephron loss, congenital disorders)
-response to corticosteroid is poor
-Prognosis is poor: 50% suffer renal failure after 10 years
Term
What is usually the initiating event in FSGC? how does sclerosis develop?
Definition
-damage to the podocyte
-deposition of hyaline masses in the glomeruli represents the entrapment of plasma proteins and lipids in the foci of injury where sclerosis develops
Term
Is recurrence of FSGC common post transplant?
Definition
yes
Term
What is the most common cause of nephrotic syndrome in children?
Definition
minimal change disease
Term
How does minimal change disease develop? What can be seen on microscopic exam? What is the tx?
Definition
-insidious development in otherwise healthy kids
-minimal light microscopic changes with some effacement of foot process and podocytes
-more than 90% of cases respond to a short course of corticosteroids
Term
What causes membranous neuropathy? (MN)
Definition
autoimmune reaction to an unknown renal antigen
Term
What is physically happening in MN?
Definition
-subepithelial immune deposits
-thickening of GBM
-subepithelial spikes of GBM between the immune deposits
-little or no inflammation
Term
How does MN develop? What is the tx?
Definition
insidious
does not respond well to corticosteroid therapy
Term
What are 4 common signs and symptoms of nephritic syndrome?
Definition
hematuria
oliguria with azotemia
proteinuria
hypertension
Term
What is nephritic syndrome most commonly caused by?
Definition
-proliferation of cells within the glomeruli
-leukocyte infiltration
-inflammatory response injures capillary walls
-RBC escape into the urine
-Hemodynamic changes cause reduction in GFR
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