【高血压英文课件】Kidney

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Kidney,Normal,Pathology,Tumors,Congenital Anomalies,Clinical Manifestations,Cystic Diseases,Glomerular Diseases,Tubulo Interstitial,Diseases,Diseases of Vascular Origin,Urinary Tract Obstruction,Urolithiasis,KidneyNormalPathologyTumorsCon,1,Vascular diseases of Kidney,1.Hypertensive Renal Disease:,Nephrosclerosis-Benign & Malignant,2.Thrombotic Microangiopathies:,Childhood & Adult Hemolytic-Uremic Syndrome (HUS),Adult (female) Thrombotic Thrombocytopenic Purpura (TTP),Autoimmune Diseases,Toxemia of pregnancy,Severe bacterial infections.,3.Renal Artery Stenosis (RAS):,Atherosclerotic or Fibromuscular dysplasia,reversible hypertension,4.Renal Infarcts:,Embolic or Thrombotic.,Vascular diseases of Kidney,2,1. Hypertension,Most renal diseases cause HTN,HTN has marked effects on the kidneys,Benign Nephrosclerosis=,hyaline arteriosclerosis,Most are at risk for developing malignant hypertension,Malignant Nephrosclerosis=,Hyperplastic arteriolosclerosis,Fibrinoid necrosis of arterioles,Thrombotic Microangiopathy (Necrotizing Glomerulitis), renal blood flow therefore, renin -angiotensin system,BP,hypertension.,Clinical:,Neurological =Disoriented,coma,Eyes = Papilledema,Renal = proteinuria, Hematuria & RF,1. Hypertension,3,B,enign,N,ephrosclerosis,Fine leathery granularity,Benign NephrosclerosisFine lea,4,B,enign,N,ephrosclerosis,Hyaline change in small blood vessels,Benign Nephrosclerosis Hyaline,5,M,alignant,N,ephrosclerosis,Hyperplastic arteriolosclerosis (onion-skinning),Blood vessels have collagen deposits making the onion skinning appearance,Notice how lumen gets very small,Malignant NephrosclerosisHyper,6,2. Thrombotic Microangiopathies,Common findings:,Thrombosis in small vessels,Microangiopathic hemolytic anemia (MHA),Thrombocytopenia,Pathogenesis:,Endothelial injury,platelet aggregation,thrombosis,Vasoconstriction,ischemia,necrosis,A) Childhood Hemolytic Uremic Syndrome (HUS),E. coli (infected Hamburgers),Clinical:,renal failure is prominent,Intestinal bleeding, oliguria, Hematuria, MHA,HTN,B),TTP =,young females with High mortality,2. Thrombotic Microangiopathie,7,Fibrin Thrombi (Childhood HUS),Caused by DIC, HUS (,E. coli 0157H7,),Fibrin Thrombi (Childhood HUS,8,3. RENAL ARTERY STENOSIS (RAS),Cause,Atheromatous plaques,Fibromuscular dysplasia,Frequency,MC ( 70% of cases),Less common (30%),Sex,Old Males,Young Females,Results of surgery,Beneficial (60%),More beneficial (cure in 80%),3. RENAL ARTERY STENOSIS (RAS),9,F,ibromuscular,D,ysplasia,Fibromuscular dysplasia,Fibromuscular Dysplasia Fibrom,10,4. Renal infarcts,Branches of Renal artery - End arteries.,MCC= MI and thromboembolism from Atrial Fibrillation,Clinical:,Asymptomatic or,Large unilateral -May cause HTN,Extensive bilateral -May cause RF,4. Renal infarcts,11,R,enal,I,nfarcts,Renal Infarcts,12,R,enal,I,nfarcts,Renal Infarcts,13,Kidney,Normal,Pathology,Tumors,Congenital Anomalies,Clinical Manifestations,Cystic Diseases,Glomerular Diseases,Tubulo Interstitial,Diseases,Diseases of Vascular Origin,Urinary Tract Obstruction,Urolithiasis,KidneyNormalPathologyTumorsCon,14,Tubulo Interstitial diseases,1. Acute Tubular Necrosis,(,ATN,),2. Pyelonephritis,(,PN,),Acute,Chronic,3. Acute drug-induced Interstitial Nephritis,4. Analgesic Abuse Nephropathy,5. Metabolic Tubulointerstitial Disease,Urate,Hypercalcemia,Multiple Myeloma,Tubulo Interstitial diseases,15,1. Acute Tubular Necrosis,(,ATN,),Most serious but,reversible,kidney disease,Causes=,next slide,Pathology=,destruction of tubular epithelial cells,Acute suppression of renal function, urinary output 400 ml/day,ATN,ARF by mechanisms,Tubular cell injury, Tubulo glomerular feed back,Tubular obstruction by Hyaline or pigmented granular,casts,(Tamm-Horsfall proteins secreted by tubular epithelium),Back-leak of tubular fluid into the interstitial space (due to death of tubular cells),The outcome of all the above three is,GFR (oliguria),Clinical Course=,Three phases,Initial phase= (first 36 hrs.), Dominated by the cause,Maintenance phase= Oliguria & acute uremia,Salt & water retention,Hyperkalemia,and metabolic acidosis.,Rx, fluid & Electrolyte balance, dialysis,Recovery phase=Polyuria & electrolyte loss,Hypokalemia,(give lots of fluids + K,+,sparing diuretics),risk of infections,BUN & creatinine levels return to normal,1. Acute Tubular Necrosis (ATN,16,ATN,-,C,auses,ATN- Causes,17,ATN,Necrotic & Regenerating,tubular,epithelial cells,ATNNecrotic & Regenerating tub,18,2. Pyelonephritis (PN)=,Bacterial infection of kidney,Causes,chronic urinary tract infection,Routes of bacterial entry into kidneys,1.Ascending Infection (MCC),by vesico-ureteral reflux (VUR),2. Hematogenous Infection (septicemia),Helped by lower UT obstruction,Pathology =,Inflammation - renal parenchyma & pelvis,Clinical=,asymptomatic or cause severe flank pain & fever,Lab=,Bacteria, leukocytes & Casts,High risk pts=,DM, pregnancy & UT obstruction,Complications,= Necrotizing papillitis or papillary necrosis,(papillary necrosis is seen in 4 conditions?),(,CT scan - best investigation),Pathologic types =,Acute PN, Chronic PN,2. Pyelonephritis (PN)= Bacter,19,Acute Pyelonephritis =,Neutrophilic exudate within tubules and renal substance,kidney is almost unrecognizable,Complications=,papillary necrosis, Perinephric abscesses, Pyonephrosis, Scarring (Chronic Pyelonephritis),Chronic Pyelonephritis (CPN) =,Chronic tubulointerstitial inflammation,Characterized by=,CRF & HTN,Pathology =,corticomedullary scars overlying dilated blunted calyces.,Forms of CPN,1 Reflux nephropathy-associated type,MCC of CPN,MCC of reflux= Congenital intra-renal reflux With superimposed bacterial infection (E. coli).,2.Obstructive type,predisposes to recurrent bacterial infections (E. coli),Course=,Glomeruli undergo ischemic atrophy, total sclerosis with fine leathery granularity, shrunken.,Finally Glomeruli disappears,Acute Pyelonephritis = Neutrop,20,Acute Pyelonephritis,Neutrophilic exudate,within tubules and renal substance kidney is almost unrecognizable,Acute PyelonephritisNeutrophil,21,Chronic Pyelonephritis (CPN),Thyroidization of renal tubules,MOST Important,Chronic Pyelonephritis (CPN)Th,22,Chronic Pyelonephritis (CPN),obstruction,Chronic Pyelonephritis (CPN)ob,23,3 . Acute drug-induced interstitial nephritis,Manifests,2-40 days after the start of Rx (methicillin, ampicillin, rifampicin, thiazides, NSAID, cimetidine, . ),Clinical=,Presents with fever, skin rash, hematuria, proteinuria, sterile pyuria, Eosinophilia= (allergic, parasitic and Drug reactions), azotemia, and acute RF,Pathology =,Eosinophils and mononuclear infiltrates & Patchy tubular necrosis,Withdrawal of drug,recovery,4.,Analgesic Abuse Nephropathy,=,Chronic tubulointerstitial nephritis with papillary necrosis,Caused by=,Habitual intake of large doses,Acetaminophen (Tylenol),directly damages cells,Aspirin -vasoconstriction,ischemia,Pathology =,papillary necrosis,( other causes?),Clinical=,Presents with Polyuria, Nocturia,HTN, headache, GI symptoms, anemia, may develop UTI, may develop CRF,Complications=, risk for TCC (Transitional cell Carcinoma) - renal pelvis,3 . Acute drug-induced interst,24,Drug-induced interstitial nephritis,Numerous Eosinophils,Drug-induced interstitial neph,25,Analgesic Abuse Nephropathy,Papillary necrosis,Analgesic Abuse NephropathyPap,26,Analgesic Abuse Nephropathy,Can,slough,off and obstruct urinary tract,Analgesic Abuse NephropathyCan,27,5. Metabolic Tubulointerstitial Disease,Urate Nephropathy,: form of:,Acute RF (with cancer chemotherapy).,Chronic RF (with gout & chronic lead poisoning).,Hypercalcemia,:,cause RF by:,Nephrolithiasis (causing UT obstruction).,Nephrocalcinosis (causing renal atrophy).,Multiple Myeloma,:,Acute or chronic RF,result of Bence - Jones & Tamm-Horsfall proteinuria,Hypercalcemia & Nephrotoxic drugs,Cast nephropathy,Amyloid deposits- Light-chain nephropathy -AL,5. Metabolic Tubulointerstitia,28,MULTIPLE MYELOMA (plasma cells),Note tubular casts,MULTIPLE MYELOMA (plasma cells,29,Kidney,Normal,Pathology,Tumors,Congenital Anomalies,Clinical Manifestations,Cystic Diseases,Glomerular Diseases,Tubulo Interstitial,Diseases,Diseases of Vascular Origin,Urinary Tract Obstruction,Urolithiasis,KidneyNormalPathologyTumorsCon,30,OBSTRUCTIVE UROPATHY,(,HYDRONEPHROSIS,),Characterized by:,Unrelieved,UT obstruction,Leads to,renal atrophy, with,dilatation of,the,renal pelvis and calyses,“Hydronephrosis” all widened due to obstruction and distension in pelvis.,Still have glomerular filtration,increase in urine load,distension,If Bilateral,CRF,OBSTRUCTIVE UROPATHY (HYDRONE,31,H,YDRONEPHROSIS,Causes are:,Congenital anomalies,(vesicoureteral reflux, urethral valves, meatal stenosis),Urinary calculi,Benign prostatic hypertrophy,Tumors,Pregnancy,Neurogenic bladder,Inflammatory strictures (including retroperitoneal fibromatosis).,HYDRONEPHROSISCauses are:,32,H,YDRONEPHROSIS,“,Hydronephrosis,” all widened due to obstruction and distension in pelvis,HYDRONEPHROSIS“Hydronephrosis”,33,Kidney,Normal,Pathology,Tumors,Congenital Anomalies,Clinical Manifestations,Cystic Diseases,Glomerular Diseases,Tubulo Interstitial,Diseases,Diseases of Vascular Origin,Urinary Tract Obstruction,Urolithiasis,KidneyNormalPathologyTumorsCon,34,