Polycystic disease of the kidney (PKD) is a disorder in which major portion of the renal parenchyma is converted into cysts of varying size .
Fluid-filled cysts distributed over the kidney results in massive enlargement of the kidneys.
Polycystic disease of the kidney (PKD) is a disorder in which major portion of the renal parenchyma is converted into cysts of varying size .
Fluid-filled cysts distributed over the kidney results in massive enlargement of the kidneys.
In this presentation I have tried to cover renal disorder associated with vascular pathology of kidney. Classification, various disorder in detail with histopathology images H&E and special stains and clinical presentations. Hope it helps understanding the entity better.
Sickle cell nephropathy (SCN) is presence of sickled erythrocytes in the renal medulla that result in decreased medullary blood flow, ischemia, microinfarcts and papillary necrosis in the kidneys
Brief explanation of each *refer harrison textbook for details causes of TIN
Acute interstitial nephritis
Chronic interstitial nephritis
Reflux nephropathy
Papillary necrosis
Sickle-cell nephropathy
In this presentation I have tried to cover renal disorder associated with vascular pathology of kidney. Classification, various disorder in detail with histopathology images H&E and special stains and clinical presentations. Hope it helps understanding the entity better.
Sickle cell nephropathy (SCN) is presence of sickled erythrocytes in the renal medulla that result in decreased medullary blood flow, ischemia, microinfarcts and papillary necrosis in the kidneys
Brief explanation of each *refer harrison textbook for details causes of TIN
Acute interstitial nephritis
Chronic interstitial nephritis
Reflux nephropathy
Papillary necrosis
Sickle-cell nephropathy
Autosomal Dominant Polycystic Kidney Disease
Genetic
Pathogenesis Of ADPKD
Association of ADPKD
Clinical Features of ADPKD
Diagnosis and Investigation of ADPKD
Management of ADPKD
Abstract: Uremia is a clinical manifestation of chronic kidney failure (CKD) and is defined as the elevation of urea levels in plasma associated to fluid, electrolytes and hormonal imbalances and metabolic abnormalities. Uremia even though arises from CKD, it can also occur with Acute Kidney injury (AKI). The terms uremia was first coined by Piorry which translates to urine in blood. Also, Uremia and uremic syndrome have been used interchangeably for a long time. Comparatively, Azotemia is also uremia but the only difference is that the urea elevation in azotemia is not high enough to have manifesting signs or symptoms. Thus, Uremia is pathological and symptomatic manifestations of severe azotemia.
Urea itself has direct and indirect toxic effects on our body; parathyroid hormone (PTH), beta2 microglobulin, polyamines, advanced glycosylation end products, and other middle molecules, are thought to contribute to the clinical syndrome. Patient’s symptoms range from mild bleeds to severe congestive heart failure. If left untreated complications include seizure, coma, cardiac arrest, and death. He most severe is cardiac arrest secondary to electrolyte abnormalities such as hyperkalemia, metabolic acidosis, or hypocalcemia. The patients, who are diabetic, tend to develop severe hypoglycemic reactions if the medications are not adjusted for creatinine clearance. Renal failure and renal osteodystrophy may cause early onset osteoporosis or formation of adynamic bone which predisposes the patient to fractures on mild trauma. Also medications the patient was previously on can lead to unwanted side effects due to impaired clearance e.g. Digoxin toxicity secondary to renal failure, increased sensitivity to narcotics.
Key Words: Uremia, Uremic syndrome, Chronic kidney failure, azotemia, beta 2 microglobulins, congestive heart failure, electrolyte abnormalities, hyperkalemia, hyocalcemia, metabolic acidosis, creatinine, osteodystrophy
This presentation comprises of congenital anomalies of kidney and urinary tract made concise and in depth for PG preparation. It contains all important topics of the regarding subject covered in detail.
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3. 3/22/2023 3
Cystic Kidney Diseases:
Renal Cysts
Inherited
Enlarged Kidneys with cysts in
medulla and cortex.
PKD
Shrunk kidneys with
cysts in the medulla
Medullary Cystic
Kidney.
Non-Inherited
Multi-Cystic Dysplastic
Kidney.
4. Definition
Polycystic kidney disease (PKD) is
an inherited disorder characterized
by the development of multiple
cysts develop primarily within
kidneys, causing kidneys to enlarge
and lose function over time.
3/22/2023 4
7. Autosomal Dominant PKD (ADPKD)
3/22/2023 7
PKD 1 (85 % of cases, on chromosome 16) or PKD2 (15% of cases, on chromosome 4) genes
mutations. Its dominant on personal level but recessive on cellular level.
Could form anywhere of the nephron, but less than 5% of nephrons are affected.
Microscopic cysts at birth and progressively enlarge over the 3rd or 4th decade. Enlarge cysts compress renal parenchyma
and lead to fibrosis.
Called Adult PKD, and it’s the most common genetic cause of renal failure.
8. Associated features and
complications
3/22/2023 8
Nephrolithiasis and UTI
Infection or hemorrhage into the cyst.
Intracerebral berry syndrome
Other organ cysts (Liver, pancreas, colon,
spleen, seminal vesicles and aortic root).
Abdominal and inguinal hernias.
10. Treatment
3/22/2023 10
No curative treatment.
Drain cysts if symptomatic.
Treat infections with antibiotics.
Treat HTN with ACEi or ARBs.
For Kidney failure, dialysis or kidney transplant.
11. Autosomal Recessive PKD (ARPKD)
3/22/2023 11
PKHD1 gene mutation, which codes for fibrocystin proteins in kidneys and bile ducts.
Occurs in fetal period and causes oligohydramnios and Potter sequence. Pulmonary hypoplasia is the most
common cause of death in neonatal life in ARPKD patient.
Associated with congenital liver fibrosis that could lead to portal HTN and its complications.
Associated with dilated bile ducts ( lead to cholestasis if in hepatic bile ducts, and ascending
cholangitis in CBD)
13. Diagnosis
3/22/2023 13
Prenatal ultrasound shows bilateral
enlarged kidneys with cysts,
hepatomegaly, dilated bile ducts and
oligohydramnios.
Molecular genetics if the diagnosis is
not clear.