Flashcards in Tubular injury Deck (13)
What parts of the kidney fall under intrinsic renal damage?
Glomerulus and tubules
Found in the connective tissue of the kidney - interstitium
What 3 categories can we divide renal injury into?
Pre - renal kidney injury
Injury to the interstitium
Why are the tubules often the site of kidney injury?
Problems that affect the blood supply affects the tubule disproportionately
Tubular cells are very metabolically active
Tubules have major role in movement of molecules from urine to the blood
Tubules may become blocked
How does the role of the tubules make them more predisposed to tubular injury?
The movement of molecules from the urine to the blood sometimes includes toxins
These toxins are often found in high concentration in the tubules
Cause damage in the tubules
How does the fact that the tubules are very metabolically active make them predisposed to tubular injury?
Cells require lots of energy to perform normal function
Any reduction in the substrates that provide energy to the cells lead to kidney injury
How may tubules become blocked?
Substances can precipitate in the urine
May lead to inflammatory response and damage
What does the biopsy of a healthy kidney look like?
Tubules are preserved
Tubular cells are large and healthy
Tubular cells have little gaps between them
What does the biopsy of a diseased kidney look like?
Gaps in tubules - cells that line the tubules are unhealthy/died
Space between the tubules - oedema
Glomerulus is preserved - no major problems
Does the glomerulus remain preserved after tubular injury?
Kidney biopsies see no major structural problems in the glomerulus of a kidney with tubular injury
What causes tubular injury?
Impaired perfusion - pre-renal injury that continues for long enough causes tubular injury
Toxins - concentrate in tubular cells
Substances that precipitate - causes inflammatory response
What are the two types of toxins that can lead to tubular injury?
Endogenous - myoglobin or hemoglobin
Exogenous - antibiotics, antiretrovirals, iodinated radiocontrast
What are the two types of substances that can precipitate and cause tubular injury?
Endogenous substances - uric acid, immunoglobulin light chains
Exogenous substances - antivirals