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NBME 22 Answers

nbme22/Block 4/Question#37

A 53-year-old woman with a long history of ...

Tubular atrophy

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 +5  upvote downvote
submitted by haliburton(82),

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





 +4  upvote downvote
submitted by lala123(4),

found the explanation of question id 453 in uworld helpful





 +1  upvote downvote
submitted by keycompany(115),

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

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




 +0  upvote downvote
submitted by keycompany(115),

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

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. +