8. Renal Pathology A - Cox

• nephritic syndrome - inflammatory glomerular injury

  • oliguria
  • hematuria
  • decrease GFR
• Nephritic syndrome - acute onset with visible hematuria

  • RBC casts in urine
  • proteinuria
  • azotemia (increase BUN and Creatinine)
• Nephrotic syndrome - glomerular syndrome due to heavy proteinuria

  • excretion of protein in urine > 3.5 g
  • edema
  • hyperlipidemia
• microhematuria - > 3 RBC

  • glomerular hematuria small breaks in GBM - letting RBC through
• Rapidly Progressive Glomerulonephritis (RPGN) = loss of kidney function

  • urine contain - hematuria and proteinuria
  • crescent glomerular formation
• What is azotemia?

  increase BUN and creatinine due to decrease kidney function
• Azotemia - decrease GFR is because the kidney cannot excrete waste
• Uremia is associated with renal failure and abnormally low GFR
• Azotemia is caused by prior kidney injury
• Acute Kidney injury (AKI) will cause rapid decline in kidney function

  • leading to dysregulation of electrolytes and volume
• Acute kidney injury will cause increase in

  • BUN and creatinine - azotemia
• AKI will lead to

  • HTN
  • edema
  • decrease urine output
  • AMS
• What is the most common cause of intrinsic AKI?

  ischemic or toxic damage
• Chronic kidney disease is based on

  1. decline of kidney function for > 3 month AND
  2. evidence of kidney damage (albuminuria or abnormal biopsy) OR
  3. GFR < 60 mL/min
• ** Pyelonephritis

  • upper UTI
  • collecting system
  • parenchyma
• UTI - asymptomatic bacteriuria

  • 2 urine culture with the same organism
• ANCA (antineutrophil cytoplasmic autoantibodies) is activation of neutrophil to endothelial glomerular capillaries

  • leading to immune mediated damage
• 3 types of glomerular disease

  1. deposition of circulating immune complex
  2. granular IF pattern
  3. anti-GBM antibody glomerulonephritis
  4. linear IF pattern
  5. antibody against glomerular trapped antigen
  6. granular IF pattern
• podocyte injury is initiated by antibodies

  • will cause foot process effacement detachment
  • BM degradation
• podocyte injury will lead to plasma protein being lost into urinary space
• Podocytopathy

  1. macrophage and monocyte activated release mediators
  2. activate immune reaction
  3. platelet aggregation during immune response
  4. lead to thrombosis and injury
  5. resident glomerular cell hypertrophy