[2] LESSON 7: RENAL DISEASES Flashcards by Arriane Cyrel (MTI)

Kidney diseases are often classified into three types based on the morphologic component initially affected and susceptibility to disease varies with each other:

(1) Glomerular, (2) Tubular, and (3) Tubulointerstitial

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: immune complex formation and deposition

Immunologic

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: exposure to chemicals, toxins and amyloid materials

Non-immunologic

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Deposition of immune complexes formed in response to Group A Streptococcal infection

Acute PostStreptococcal Glomerulonephritis

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Marked by the sudden onset of symptoms consistent with glomerular membrane damage

Acute PostStreptococcal Glomerulonephritis

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Signs and symptoms: edema, fever, fatigue, hypertension

Acute PostStreptococcal Glomerulonephritis

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Urinalysis: gross hematuria, proteinuria, RBC casts, dysmorphic RBCs, hyaline and granular casts, WBC

Acute PostStreptococcal Glomerulonephritis

Rapidly Progressive/Crescentic Glomerulonephritis

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Additional lab findings: increase BUN and ASO titer

Acute PostStreptococcal Glomerulonephritis

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More serious form of acute glomerular disease that involves deposition of immune complexes from systemic immune disorders

Rapidly Progressive/Crescentic Glomerulonephritis

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Damaged glomeruli allow release of cells and fibrin into the Bowman’s capsule leading to pressure changes

Rapidly Progressive/Crescentic Glomerulonephritis

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Urinalysis: gross hematuria, proteinuria, RBC casts, dysmorphic RBCs, hyaline and granular casts, WBC

Acute PostStreptococcal Glomerulonephritis

Rapidly Progressive/Crescentic Glomerulonephritis

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(+) Antiglomerular Basement Membrane Ab

Goodpasteur Syndrome

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May lead to chronic glomerulonephritis and end-stage renal disease

Goodpasteur Syndrome

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Signs and symptoms: hemoptysis and dyspnea

Goodpasteur Syndrome

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(+) Antineutrophilic Cytoplasmic Antibody (ANCA) that targets neutrophils in the vascular walls initiating immune response and granuloma formation in the lungs and kidneys

Wegener’s Granulomatosis

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Other lab findings:

increase serum BUN and creatinine

Wegener’s Granulomatosis

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Allergic purpura that causes decrease in the number of platelets and affects vascular integrity

Henoch Schonlein Purpura

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Signs and symptoms: red skin patches, blood in sputum and stool

HenochSchonlein Purpura

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Urinalysis: proteinuria, hematuria, RBC casts

Goodpasteur Syndrome

Wegener’s Granulomatosis

HenochSchonlein Purpura

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Involves IgG deposition on the glomerular membrane leading to pronounced thickening

Membranous Glomerulonephritis

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Seen in SLE, Sjogren’s syndrome, secondary syphilis and hepatitis B infection

Membranous Glomerulonephritis

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Urinalysis: hematuria and proteinuria

Membranous Glomerulonephritis

Membranoproliferative Glomerulonephritis

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Cellular proliferation affecting capillary walls or the glomerular basement membrane

Membranoproliferative Glomerulonephritis

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Other lab findings: decreased serum complement

Membranoproliferative Glomerulonephritis

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Gradual worsening of symptoms leading to loss of kidney function

Chronic Glomerulonephritis

Signs and symptoms: fatigue, anemia, hypertension, edema and oliguria

Chronic Glomerulonephritis

Urinalysis: hematuria, proteinuria, glucosuria, isosthenuria and many casts

Chronic Glomerulonephritis

Other lab findings: increased BUN and creatinine, electrolyte imbalance

Chronic Glomerulonephritis

igA deposition on the glomerular membrane leading to thickening

IgA nephropathy/Berger’s Disease

most common cause of glomerulonephritis

IgA nephropathy/Berger’s Disease

Involves membrane damage and changes in the electrical charges of the basement membrane leading to the passage of high molecular weight proteins and lipids into the urine

Nephrotic Syndrome

Loss of albumin causes decrease in capillary oncotic pressure and edema

Nephrotic Syndrome

Urinalysis: massive proteinuria (>3.5 g/day), lipiduria (fat droplets, oval fat bodies, fatty and waxy casts), hematuria

Nephrotic Syndrome

Other lab findings: decreased serum albumin, increased serum lipids

Nephrotic Syndrome

Acute onset may occur as a result of circulatory disruption causing systemic shock and decrease in blood pressure

Nephrotic Syndrome

Urinalysis: hematuria

Alport Syndrome

Inherited disease that affects the glomerular basement membrane (lamellated appearance with areas of thinning)

Alport Syndrome

Disruption of podocytes occurring primarily in children following allergic reactions and immunizations

Minimal Change Disease

Associated with heroin and analgesic abuse, and AIDS

Focal Segmental Glomerulosclerosis

Disruption of the podocytes in certain areas of the glomerulus

Focal Segmental Glomerulosclerosis

Most common cause of end-stage renal disease

Diabetic Nephropathy/Kimmelstiel-Wilson

Glomerular damage may be due capillary thickening, increase proliferation of the mesangial cells, increase deposition of cellular and non-cellular materials

Diabetic Nephropathy/Kimmelstiel-Wilson

Most common cause of end-stage renal disease

A. GLOMERULAR DISEASE

B. TUBULAR DISEASES

C. TUBULOINTERSTITIAL DISEASES

D. OTHER RENAL DISORDERS

 May be due to actual tubule damage, and metabolic or hereditary disorders

TUBULAR DISEASES

 Damage to the renal tubular epithelial cells due to ischemia and nephrotoxic agents

Acute Tubular Necrosis

 Urinalysis: hematuria, RTE cells, RTE casts, other casts

Acute Tubular Necrosis

Failure of tubular reabsorption in the PCT (glucose, amino acids, phosphorus, sodium, potassium, bicarbonate and water)

Fanconi’s Syndrome

 Urinalysis: glycosuria, possible mild proteinuria

Fanconi’s Syndrome

Inherited defect of tubular response to ADH or acquired from medications

Nephrogenic Diabetes Insipidus

Disorders affecting the interstitium also affects the tubules due to their close proximity

TUBULOINTERSTITIAL DISEASES

Majority of these disorders involve infections and inflammatory conditions

TUBULOINTERSTITIAL DISEASES

 Most common renal disease that involves the lower urinary tract (urethra and bladder) or the upper urinary tract (renal pelvis, tubules and interstitium)

Urinary Tract Infection

 Signs include frequent and burning urination

Urinary Tract Infection

 Bacterial culture performed to determine the causative agent

Urinary Tract Infection

: most frequently encountered infection that may ascend to the upper urinary tract

Cystitis

: affects the renal tubules and interstitium

Pyelonephritis

Urinalysis: WBC, bacteria, mild proteinuria, microscopic hematuria and increased pH

Cystitis

Allergic inflammation of the renal interstitium in response to certain medications

Acute Interstitial Nephritis

Formation of stones in the renal calyces, renal pelvis, ureters and bladder

Renal Calculi/Lithiasis

May be passed in the urine and obstruct the urinary tract

Renal Calculi/Lithiasis

: may be due to metabolic disorders or diet

Calcium oxalate/phosphate (~75%)

: frequently accompanied by UTI involving urea-splitting bacteria

Magnesium ammonium phosphate

: associated with increased intake of foods with high purine content

Uric acid

: seen in conjunction with hereditary disorders of cysteine metabolism

Cystine

Removal: surgery or high-energy shock waves

Primary Calculi Constituents

May be acute or chronic

Renal Failure

Chronic form may result from the gradual progression of original disorder which eventually leads to end-stage renal disease

Renal Failure

Renal Failure Progression to end-stage renal disease is characterized by:  Marked decrease in GFR (?)  Steadily rising azotemia (?)  (?) imbalance  (?) urine  Proteinuria  Renal (?)  Telescoped (?)

<25 ml/min BUN and creatinine Electrolyte Isosthenuric glycosuria sediment

infection of the renal tubules and tissue

inability to respond to ADH

granulomatosis with (+)ANCA

most common cause of glomerulonephritis

most common UTI

marked decrease in GFR & isosthenuria

lamellated glomerular basement membrane

autoimmune disorder causing pronounced glomerular membrane thickening

aka rapidly progressive glomerulonephritis

streptococcus that may cause glomerulonephritis sequelae

hallmark urine sediment in glomerulonephritis

(+)antiglomerular basement membrane antibody

characterized by lipiduria

inherited disorder of the renal tubules

cell to which ANCA is directed

A patient who tested positive for HIV exhibits mild symptoms resembling the nephrotic syndrome.

A 40-year-old patient diagnosed with SLE develops macroscopic hematuria, proteinuria, and the presence of RBC casts in the urine sediment.

A 50-year-old patient diagnosed with SLE exhibits symptoms of gradually declining renal function and increasing proteinuria.

A patient who has taken outdated tetracycline develops glycosuria and a generalized aminoaciduria.

A patient known to form renal calculi develops oliguria, edema and azotemia.

A patient has a normal blood glucose and glucosuria (2 disorders)

A 6-year-old boy with respiratory syncytial virus has macroscopic hematuria.

A patient with severe lower back pain and microscopic hematuria is scheduled for lithotripsy.

The patient positive for ANCA exhibits pulmonary and renal symptoms.

POINTS to PONDER..... A 22-year-old female BMLS student performs a urinalysis on her own urine as part of a lab class. Significant results include: Color: yellow Appearance: Cloudy pH: 7.5 Nitrite: positive Leukocyte esterase: 2+ 20-40 WBC/hpf 0-3 RBC/hpf 2-5 squamous epithelial cell/lpf Moderate bacteria All other results were normal. What do these findings suggest? Is/Are there any of these results which is/are not consistent with the others? Why do you say so?

The term [?] describes a series of screening tests that are capable of detecting a variety of renal, urinary tract, and systemic diseases.

“routine urinalysis”

Urine specimen has been referred to as a [?] of the urinary tract, which is painlessly obtained. It also yields a great deal of information quickly and economically.

liquid tissue biopsy

Disorders in the body can affects renal function considering that the major function of the kidney is filtration of the blood to remove waste products.

The kidneys are consistently exposed to potentially damaging substances.

Renal disorders are classified according to the anatomical structures affected. These can be glomerular, tubular or tubulointerstitial in nature.

Glomerular disorders may present as nephritic or nephrotic syndromes.

The hallmarks of nephritic glomerular disorders are grossly visible hematuria and mild to moderate proteinuria.

They may be immune or non-immune mediated.

Nephrotic glomerular disorders on the other presents with heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia leading to hyperlipiduria.

Examples of nephritic disorders include acute proststreptococcal glomerulonephritis, rapidly progressive glomerulonephritis, Goodpasteur syndrome, Wegener’s granulomatosis, membranous glomerulonephritis, membranoproliferative glomerulomephritis, Berger’s disease and chronic glomerulonephritis.

Tubular disorders are those that primarily affects the renal tubules resulting to dysnfunctional reabsorption of substances. These include acute tubular necrosis, Fanconi syndrome and nephrogenic diabetes insipidus.

Tubulointerstitial disorders initially affects the renal interstitium and progresses to cause tubular damage. These disorders are often caused by infection such as urinary tract infection or inflammation such as acute interstitial nephritis.

Other disorders of the urinary system include the formation of calculi or lithiasis in the kidneys (pelvis and calyces), ureters and bladder.

Calculi formation is brought about by the precipitation of urine crystals, the most common of which is calcium oxalate or calcium phosphate.

Renal failure often results from the gradual progression of another disorder which may eventually lead to end-stage renal disease.

which is cytotoxic to collagen leading to complement activation and capillary destruction

(+) Antiglomerular Basement Membrane Ab

targets neutrophils in the vascular walls initiating immune response and granuloma formation in the lungs and kidneys

(+) Antineutrophilic Cytoplasmic Antibody (ANCA)

Acute onset may occur as a result of circulatory disruption causing systemic shock and decrease in blood pressure

Nephrotic syndrome