pathophysilogy course outline, Lecture notes of Pathophysiology

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MMP5202: ADVANCED PATHOPHYSIOLOGY

Renal Disease

Renal Microanatomy

Glomerular Microanatomy

The Details

Renal Functions

• (^) The Kidney does lots of stuff - (^) RBC production - (^) Erythropoietin - (^) Calcium metabolism - (^) By means of phosphate elimination. - (^) Acid-Base balance. - (^) Na + and K + balance

Nephritic Syndrome

• (^) Acute injury, multiple possible causes - (^) Major, acute injury to the glomerular basement membrane.
• (^) Basic clinical pattern
  • (^) RBCs in the urine
  • (^) RBC casts in urine
  • Decreased urine output
  • Increased protein
  • (^) Increased B/P

Urinary Casts

• (^) Material cleared or shed by a sick glomerulus.
• (^) Congeals within the
  • (^) Convoluted tubules or
  • (^) Collecting ducts
• (^) Creates a ‘cast’ of the interior of the duct it formed in.
• (^) Is Cleared in urine.
• (^) Observed microscopically

Chronic Renal Failure

• (^) Many causes
• (^) Progressive loss of renal function. - (^) Anemia - (^) Bleeding - (^) Increased infections - (^) Accumulation of nitrogen wastes - (^) Pericarditis - (^) Uremic frost

Glomerulonephritis General Features

• (^) Mesangial cell proliferation
• (^) Leukocyte infiltration
• (^) BM thickening
  • Regular (linear)
  • (^) Irregular (lumpy)

Acute Glomerulonephritis

• (^) Follows Streptoccocal infection
• (^) Antigen-antibody complexes lodge beneath the foot processes.
• (^) Elicit a flaming inflammatory reaction - (^) Complement deposited
• (^) Huge holes in BM
• (^) Nephritic syndrome

Acute Glomerulonephritis

• (^) Large number of immune complexes all at once
• (^) Collect under foot processes because of charge
• (^) Fix C’
• (^) Focal destruction of BM
• (^) Leakage of RBCs

Acute Glomerulonephritis

• (^) Anti-human IgG labeled with fluorescence.
• (^) Identifies the immune complexes
• (^) Granular pattern
  • (^) Irregular clumps
  • (^) Fix C’
  • (^) Membrane damage

Membranous Glomerulonephritis

• (^) Slow accumulation of Ag-Ab complexes
• (^) Small holes, but numerous
• (^) Tremendous protein loss