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What is nephrotic kidney disease?
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A 62-year-old with a 40 pack-year smoking history has three years of worsening exertional breathlessness. Imaging shows destruction that is worst in the upper zones, with the lung bases relatively preserved.
Which pattern of emphysema is this, and which part of the acinus is lost?
Smoke reaches the respiratory bronchioles first and the inflammatory response concentrates there, so the central acinus goes while the distal alveoli are spared early on. The upper zones take the larger dose, which is what puts the gradient at the top.
Smoking destroys the acinus from the middle outward and prefers the upper zones. That one sentence separates it from every other pattern.
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