Chronic Renal Failure
Hyalinization of Small Vessel Wall
One arteriole
Primary HTN
Benign nephrosclerosis
Malignant nephrosclerosis
"Flea-bitten kidney"
Tiny hemorrhages
Onion-skin proliferation
Both Aff. & Eff. arterioles
DM
Clinical Findings
Proteinuria
Renal Failure
HTN
Common cause of ESRD
Diffuse thickening of BM
Skin
Skeletal muscle
Retina
Kidney
Glomerulus
Exudative lesions of DM
Diffuse > Nodular lesion
Lipohyalin [cap]
Eosinophilic
Lipid
Kidney
Armanni-Ebstein Lesion
Glycogen w/in epithelial cells (vacuolated)
Papillary necrosis
Pyelonephritis
Pyelonephritis
General
E. Coli
Pelvis, Calyces, Parenchyma,
W/ or w/o Obstruction
Spread
Upward
Bloodstream
S. Aureus
Factors
Obstruction
Tumors
BPH
Stones
Vesicoureteral reflux
Cystitis
Paraplegia
Calyx-tubular reflux
Acute
Gross
Enlarged
Micro
Inflammatory cell infiltration
Patchy involvement
Abscess
Chronic
Gross
U-shaped scars
Hydronephrosis, Hydroureter
Micro
Thyroidization
Chronic + Obstruction = Bacterial Infection
ADPKD
PKD1
85-90%
Short arm, Chromo 16
PKD2
Indolent
Chromo 4
General
Clinical
HTN b4 renal
Hematuria
Flank, Abd pain
Palpable kidney
Infxn
Nephrolithiasis
Extrarenal
Hepatic cysts
Intracranial Berry aneurysms
Cysts elsewhere
Path
Gross
2-3 Kg (HUGE)
Micro
Course
No specific RX
Rx HTN
Aspirate cysts for pain
Rx infxn
Renal failure likely by 50s
ESRD
DDx
GN
IN
HTN
ADPKD
DM
Analgesic abuse nephropathy
Analgesic mixtures
Phenacetin
ASA
Caffeine
Codeine
Acetaminophen
Papillary Necrosis, then TIN
Course
Stop Analgesics before issues become severe
Chronic allograft nephropathy
Increased BP
Proteinuria
Months or yrs after transplant
Chronic GN
Symmetrically contracted
Red-brown, diffusely granular surface
<100 g kidney