2. Renal Pathology 1L - Cox

• Renal infarct - due to vascular obstruction

  • causing tissue ischemia and coagulative necrosis
• renal infarct - usually due to emboli from left atrial mural thrombi - like atrial fibrillation

  • also
  • endocarditis
  • AAA
  • atherosclerotic emboli
• Renal infarct - are white

  • anemic type - wedge shape
• liquefactive necrosis - associated with infection

  • due to
  • organism releasing enzymes
  • immune response
• pyelonephritis - both coagulative and liquefactive
• renal cortical necrosis is due to severe systemic illness

  • necrosis is limited to cortex - column of Bertin
• renal cortical necrosis - reverse rim sign

  • non-enhance renal cortex
  • normal enhancing renal medulla
• Nephrolithiasis - kidney calculi (stones)
• nephrolithiasis - contain calcium + matrix mucoprotein

  • calcium oxalate
• calcium oxalate found in neural to alkaline pH
• non opaque to radiopaque = stones

  • Ca2+
  • struvite
  • cystine
• Nephrolithiasis caused by low fluid intake

  • low urine volume causing high concentration of solutes
  • hypercalciuria
• urinary tract stones - nephrolithiasis caused by 2 things

  • stone forming constituents in urine
  • randall plaque
• Randall plaque - renal papillae have deposits of calcium phosphate

  • usually in thin LOH BM eroding into interstitium
• nephrolithiasis - clinical: acute onset of severe flank pain radiating to groin
• Dipstick analysis

  • pH > 7 = urease organism = struvute
  • ph < 5 - uric stones
• bladder stones - is usually associated with urinary stasis

  • BOO - bladder obstruction outlet
• Schistosomiasis bladder stones - caused by flukes

  • deposition of eggs in bladder and ureter walls causing bladder wall calcification + stones
• lithogenic medication - stones related to medication

  • 2 types
  • medication containing stones constituents
  • metabolically induced
• lithogenic medication - radiolucent