Chronic Renal Disease
Progressive nephron destruction over timeĀ leads to progressive loss of renal functionĀ
chronic renal failure is not reversible due to nephron destructionĀ
if all nephrons have been irreversibly damaged - known as āend stage kidneyā
uraemia, polyuria, biochemical change
however less metabolic disturbance than with acute TRF (total renal failure)
Potential causes:
vascular diseaseĀ
glomerulonephritisĀ
diabetesĀ
Response of Glomeruli to damage
Endothelial cell proliferation:Ā
occlusion of capillary; reducing flow through glomeruli - correlates with oliguria and uraemiaĀ
Mesangial cell proliferation:Ā
associated with increased matrix production
Ā over many years leads to sclerosis and loss of capillary lumenĀ
Basement membrane thickening:Ā
e.g. may be due to immune complexes or amyloidĀ
(the above are an attempt of regeneration in response to inflammation)
Capillary wall necrosis:Ā
usually fibrinoid; e.g. necrotising vasculitis, malignant hypertensionĀ
Ā Crescent formation:Ā
epithelial cell proliferation; reaction to glomerular capillary damageĀ
severe glomerular damage only - large numbers = poor prognosis
characterises rapidly progressive diseaseĀ
serum proteins and fibrin in Bowmanās capsule cause overgrowth of the epithelial liningĀ
as crescent enlarges - compresses the glomerular tuft - which shrivels and becomes non-functional
once crescents are established disease type can only be determined by examining unaffected glomeruli
Next up: nephortic and nephritic syndrome











