Chronic Renal Failure

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Chronic Renal Failure

Chronic GN

<100 g kidney

Red-brown, diffusely granular surface

Symmetrically contracted

Chronic allograft nephropathy

Months or yrs after transplant

Increased BP

Analgesic abuse nephropathy

Runs a progressive course

Stop Analgesics before issues become severe

Papillary Necrosis, then TIN

Analgesic mixtures

Acetaminophen

Codeine

Caffeine

ASA

Phenacetin

ESRD

DDx

GIHAD (like jihad)

HTN, DM: >70% of cases

IN

GN

ADPKD

Most common potentially lethal single-gene disease

Course

Renal failure likely by 50s

50% by age 60

No specific RX

Rx infxn

Aspirate cysts for pain

Rx HTN

Path

2-3 Kg (HUGE)

Average: 100-150 g

Height...roughly 3 vertebral bodies

Clinical

Extrarenal

Cysts elsewhere

Intracranial Berry aneurysms

Hepatic cysts

Nephrolithiasis

Infxn

Palpable kidney

Flank, Abd pain

Hematuria

HTN b4 renal

PKD2

Chromo 4

Indolent

PKD1

Short arm, Chromo 16

85-90%

Chronic

Chronic + Obstruction = Bacterial Infection

Thyroidization

Hydronephrosis, Hydroureter

U-shaped scars

Acute

Micro

Abscess

Patchy involvement

Inflammatory cell infiltration

Gross

Enlarged

General

Factors

Calyx-tubular reflux

Vesicoureteral reflux

Paraplegia

Cystitis

Obstruction

Stones

BPH

Tumors

Spread

Bloodstream

S. Aureus

Upward

W/ or w/o Obstruction

Pelvis, Calyces, Parenchyma,

E. Coli

Hyalinization of Small Vessel Wall

Both Aff. & Eff. arterioles

DM

Pyelonephritis

Papillary necrosis

Can be seen in:

Armanni-Ebstein Lesion

Glycogen w/in epithelial cells (vacuolated)

Glomerulus

Exudative lesions of DM

Lipohyalin [cap]

Lipid

Eosinophilic

Diffuse > Nodular lesion

Diffuse thickening of BM

Kidney

Retina

Skeletal muscle

Skin

Common cause of ESRD

Clinical Findings

HTN

Renal Failure

Proteinuria

One arteriole

Primary HTN

Malignant nephrosclerosis

Onion-skin proliferation

"Flea-bitten kidney"

Tiny hemorrhages

Benign nephrosclerosis