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Renal & Endocrine Disease - Coggle Diagram
Renal & Endocrine Disease
Renal pathology
The Kidney
130 – 150 grams each.
1/200 body weight.
20 – 25% of every heart beat.
Does for fluids/electrolytes what lungs do for air/gases.
Also
Blood pressure control.
Erythropoietin production.
Drug metabolism.
The Kidney Anatomy
Blood supply – vascular organ.
End arterial system.
Resistance vessels.
Peritubular capillaries -> venous system
Blood vessels
Arteries.
Arterioles: afferentand efferent.
Peritubular capillaries.
Veins.
Glomerulus
Mesangial cells
Mesangial matrix
Endothelial cells
Epithelial cells Visceral
Filter membrane
Hydrostatic pressure from the vascular side – (50-60mm mercury)
One way flow across membrane to urinary side
Results in
inflammation with pathology at the endothelial side of the membrane
no inflammatory reaction to pathology at epithelial side of membrane
Tubules;
Proximal cortical.
Loop of Henle.
Distal collecting ducts.
Black arrow: Normal glomerulus Blue arrow: Pink - proximal cortical tubule with many mitochondria Red arrow: Pale – distal tubule with few mitochondria
Proximal: many mitochondria – metabolically very active – prone to ischaemic injury
Distal: fewer mitochondria – less metabolically active. Mostly fluid and electrolyte transfer
Red granules = mitochondria (packed in proximal tubules
Interstitium
Inconspicuous.
Peritubular capillaries.
Fibrosis is a marker of prognosis in chronic diseases.
Congenital Anomalies
Bilateral renal agenesis. Potter syndrome. NB. Obstetrics/neonatology).
Unilateral renal agenesis.
Horseshoe kidney.
Hypoplasia.
Ectopia.
Dysplastic kidney.
Cystic Diseases. Inherited and Acquired
Inherited.
A.D.P.K.D. Autosomal dominant polycystic KD
Commonest inherited cystic kidney disease.
1 – 500 to 1 – 1000 births.
4th cause of CKD. (5 – 10% dialysis pts).
Presents 30’s to 50’s.
90% chromosome 16 (PKD1, PKD2).
10% chromosome 4.
A/W cell proliferation -> RCC.
A.R.P.K.D.
Autosomal recessive.
Rare. 1/ 20,000 births.
PCKD1 gene.
Chromosome 6P12.
Poor prognosis (Often stillborn).
Cysts radiate from cortex to medulla.
Others.
Nephronophthisis AR.
Medullary cystic disease AD.
Cytogenetic abnormalities.
Proliferative processes.
ADPKD most important.
Von Hippel-Lindau Syndrome
Autosomal dominant. Uncommon.
Kidney cysts. (Also pancreas, epididymis)
A/W Haemangioblastomas of retina, cerebellum and spine.
Chromosome 3p25 (Beside gene for RCC)
50% develop RCC.
Prophylactic bilateral nephrectomy.
Simple cysts. Very common.
Age related. Ischaemia 2nd ary to vascular disease.
Fibrosis leads to tubule obstruction and cyst formation.
Cystic lesions criteria on imaging determine follow up/ resection.
Cysts and Cancer
Predisposition to cancer.
All cystic types and causes.
Renal cell carcinoma.
Infective and inflammatory tubulo interstitial kidney diseases. Acute renal failure.
Acute Pyelonephritis and Urinary tract infection.
Pathogenesis Ascending UTI.
Role and cause of reflux in ascending UTIs.
Gram neg coliform bacilli > 85% of cases..
Haematogenous aetiology much less common.
Haematogenous acute pyelonephritis
Seeding of kidney in septicaemia.
Infective endocarditis (Embolisation).
Predisposing factors are kidney scars, immunosuppression and debility.
Ascending acute pyelonephritis.
Commoner in females (shorter urethra, absence of prostatic fluid protective effects, trauma and possible hormonal effects).
Colonisation of urethra and bladder.
Urinary tract obstruction and stasis of urine.
Vesicoureteral reflux.
Chronic Pyelonephritis. Scar formation and progressive renal failure.
Repeated acute infections. Common cause of end stage kidney disease in children.
Sterile reflux and scarring can occur, particularly with severe obstruction.
Refer to CRF.
Asymmetry. Features on IVU. An IVU is an X-ray examination of your kidneys and bladder.
Acute and chronic inflammation.
Thyroidisation of tubules.
Glomerular hypertrophy and secondary FSGS. Focal segmental glomerulosclerosis (FSGS) is a rare disease that affects the filters in your kidneys. When these filters are scarred, they are unable to filter your blood, which can lead to kidney damage and failure.
Vascular changes.
Predispose to struvite calculi.(Staghorn).
Special forms. Problems with inadequate macrophage destruction of e coli.
.Xanthogranulomatous - inflammation (XGI) is a rare benign inflammatory disease characterized by aggregation of lipid-laden foamy macrophages.
Malakoplakia- Malakoplakia is a rare granulomatous disease of infectious etiology that involves the skin and other organs.
Acute Tubulo - Interstitial Nephritis (TIN).
Almost all are drug induced. Pathogenesis. Unknown
Drug induced. Allergic. Hypersensitivity reaction.
Immune complex. Eg SLE.
Familial.
A/W other diseases, eg infections like Sjögren's syndrome and Uveitis
Drugs causing acute TIN.
PPI’s possibly more than all other drugs.
Antibiotics (Penicillins, Sulphonamides, others)
NSAID’s.
Molecular agents recently.
Eosinophils are the key pathological feature.
Acute renal failure while in hospital
Other causes of TIN
Familial. Eosinophils less prominent.
Sarcoidosis. Granulomas usually seen.
Tin can result in anuria
Hydronephrosis.
Congenital. Ureteropelvic junction (UPJ) obstruction is a blockage in the area that connects the renal pelvis (part of the kidney) to one of the tubes (ureters) that move urine to the bladder. It generally occurs when a baby is still growing in the womb. This is called a congenital condition (present from birth).? Smooth muscle dysplastic.
Acquired. From urethra to kidney.
Tumours.
Calculi.
5 to 10% of western world in lifetime.
Men > women
20’s to 30’s.
Types.
Calcium (phosphate or oxalate). Most common. 70%
Magnesium ammonium phosphate. (Struvite). a/w infections. 5 to 10%
Uric acid. Gout. Radiolucent. 5 to 10%
Cystine. Uncommon, children, cystinosis.1 to 2%.
Others/unknown type 5% or so.
Form in kidney or bladder.
Ureteric colic.
From <1mm to size of kidney
Clinical features
Renal colic. Severe pain.
Haematuria.
Pyelonephritis.
Hydronephrosis.
Treatment. Lithotripsy. Lithotripsy is a procedure that uses shock waves to break up stones in the kidney and parts of the ureter (tube that carries urine from your kidneys to your bladder). After the procedure, the tiny pieces of stones pass out of your body in your urine.
Pathogenesis
90% calcium containing i.e. radio opaque
Hypercalciuria (50% +). with normal serum calcium.
2 – 3% only with hypercalcaemia.
Struvite (staghorn). Infection as nidus.
Uric and cystine: raised levels.
Oxalate. Malabsorption syndromes. Ethylene glycol (anti-freeze) ingestion.
Others, eg lumen, wall, extramural.
Dilatation of renal pelvis and calyces.
Flattening of the papillae.
Atrophy of renal cortex.
Unilateral results in loss of kidney and raised BP.
Bilateral needs correction or death ensues.
Diseases of the Kidney. Surgical.
Tumours
Calculi.
Obstructing lesions.
Congenital.
Acquired.
Medical Renal Diseases. 5 clinical patterns of presentation.
Acute Renal Failure (ARF).
(7 days).
Acute loss of renal function, i.e ability to
Concentrate urine.
Conserve electrolytes.
Maintain fluid balance.
Excrete wastes.
Acute rise in serum Creatinine.
Abrupt loss of glomerular filtration.
Rise in Creatinine
Poor concensus on definition
Clinical course
Without dialysis. Often fatal.
Recovery requires regeneration of tubular epithelial cells.
Recovery takes 3 to 21 days usually.
ARF > 6-8 weeks. Probably permanent damage and occasionally fails to recover.
Classification
Pre – renal. Very common in ITU (Intensive Therapy Unit ) (20+%) 50% fatality.
Causes
Hypovolaemia.
CCF (congestive heart failure)
Sepsis.
Hepatic failure.
RAS. Bilateral.
NSAID’s. Arteriolar within the kidney but pre-nephron.
Renal.
Shock. All types.
Acute tubular necrosis.
Stable cells. Regenerate and recovery.
causes
GN. Glomerulonephritis (GN) Glomerulonephritis is a kind of kidney disease. It involves damage to the glomeruli, tiny filters inside your kidneys. Acute and crescentic.
Vascular causes.
Vasculitis. ANCA. Systemic disease.
Thrombotic lesions.
6 more items...
Renal artery stenosis/ thrombosis.
Emboli.
1 more item...
Latter 2 need to be bilateral.
TIN. tubulointerstitial nephritis
ATN. Toxic, Drugs (eg Gentamicin), contrast.
Tubule obstruction within kidney, e.g. casts.
Post renal.
Urinary tract obstruction.
Ureter. Calculi, tumour.
Bladder. Tumour, calculi, neurogenic.
Prostate. BPH (Benign prostatic hyperplasia) with inflammation.
Retroperitoneal. Malignancy, Mets in nodes.
N.B. needs to be bilateral
Haematuria. Blood in urine.
Nephrotic syndrome.(Abundant protein in the urine).
Nephritic Syndrome – Acute.
Chronic Renal Failure.
Urinalysis
RBC’s – Dysmorphic. GN.
Non dysmorphic Tumour, calculi, infection.
WBC’s – TIN.
Granular casts – ATN.
Normal urine. Pre-renal and post-renal causes.
