NBME 22 Tubular atrophy (NBME Answers)

NBME 22 Answers

nbme22/Block 4/Question#37 (reveal difficulty score)
A 53-year-old woman with a long history of ...
Tubular atrophy 🔍 / 📺 / 🌳 / 📖
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+9 upvote downvote
submitted by ∗haliburton(225)

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fibromuscular dysplasia in the left renal a. causes low flow resulting in low GFR. Chronic low GFR causes tubular atrophy. (excerpt and reference below).

Tubular atrophy is a general term that describes several patterns of chronic tubular injury with thickened tubular basement membranes, and clinically manifests as chronic kidney disease with decreased glomerular filtration rate. Increased extent of tubular atrophy and accompanying interstitial fibrosis correlates with worse prognosis. Proteinuria is variable, depending on cause.

https://www.ajkd.org/article/S0272-6386(16)30033-6/fulltext

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+5 upvote downvote
submitted by lala123(5)

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found the explanation of question id 453 in uworld helpful

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+4 upvote downvote
submitted by ∗makinallkindzofgainz(315)

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Dr. Sattar says that decreased blood flow --> atrophy. Fibromuscular dysplasia of the left renal artery is essentially renal artery stenosis --> atrophy of the left kidney

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+3 upvote downvote
submitted by ∗keycompany(351)

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Why would deposition of fibrinoid deposits (i.e. fibrinoid necrosis/malignant HTN) be wrong?

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amorah Kidney is smaller than normal, suggesting less blood flow to it. Won't see shrunken kidney in the case of HTN. +2

linwanrun1357 I have done so research showing that it should deposit collagen (see below). Anyway, fuck this question! http://www.pathologyoutlines.com/topic/heartfibromusculardysplasia.html +2

shapeshifter51 I ruled out selection A since it is involving the interlobar artery. Renal artery stenosis involves the "renal artery" and the stem gives you fibromuscular dysplasia with renal artery stenosis. +5

madamestep You'll see that with MALIGNANT hypertension. Think really really high HTN, preeclampsia. This is a slow, chronic process of ischemia. +1

+2 upvote downvote
submitted by ∗j000(17)

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ch 1.2 pathoma cellular injury kidney will undergo ATROPHY due to slow, progressive ischemia because the blood supply is cut off. examples where blood supply is cut off to the kidney 1) atherosclerosis of renal artery 2) fibromuscular dysplasia of renal artery

fibrinoid deposits happen in PAN (vasculitis), hypertensive emergency, and pre eclampsia.

i can see why this is confusing because both PAN and fibromuscular dysplasia have that string of pearls appearance

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+0 upvote downvote
submitted by ∗keycompany(351)

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wouldn’t chronic hypertension of the L-renal artery induce RAAS activation, and hence tubular hypertrophy with cortical atrophy?

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fcambridge I had a similar thought regarding mesangial hypercellularity. I missed a UW question on a similar topic. Unilateral renal artery stenosis results in hyperplasia of modified smooth muscle cells (JG cells) due to reduced RBF. The hyperplasia is intended to correct the supposed deficiency via increased production of renin. +

paperbackwriter Atrophy of the affected kidney (receiving less blood) and hypertrophy of the opposite kidney. +3

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