7- Diseases & Related Urine Findings Flashcards
1
Q
Congenital Anatomical Variations Affecting UT
A
– Duplicate sets of ureters
– Horseshoe kidney
– Vesicoureteral reflux (VUR)
2
Q
Acquired Anatomical Variations Affecting UT
A
– Accidents and injuries can damage the kidneys or urinary tract
– Benign prostatic hyperplasia (BPH)
3
Q
the most common renal congenital abnormality
A
Duplex Collecting System
4
Q
Duplex Collecting System is characterized by
A
complete or incomplete duplications
5
Q
Most common among
(what gender)
A
Females
6
Q
Def: two separate pelvicalyceal systems draining a single renal parenchyma
A
duplex kidney
7
Q
independent ureters that drain separately into the urinary or genital tract, and are seen in complete or incomplete duplication
A
double/duplicated ureters
8
Q
describe partial (incomplete) duplications
A
9
Q
Partial (incomplete) duplications can be associated with
A
ureteroureteral reflux and deformation of the ureter (ureterocele)
or
ureteropelvic junction obstruction of the lower pole of the kidney
10
Q
define: Complete duplications of the ureters
A
the two ureters drain separately
11
Q
describe how the Complete duplication ureters connect to the bladder
A
one ureter opens normally
the other opens in wrong place (ectopic)
12
Q
Most duplicated systems are (symptomatic/asymptomatic)
A
asymptomatic
13
Q
duplicated systems are important predisposing factor for the development of ___ in newborns or children
A
UTI
14
Q
Def: a coindition that can be severe enough to result in flank discomfort or even a palpable mass
A
hydronephrosis
15
Q
Hydronephrosis is a condition that typically occurs when the kidney
A
swells due to the failure of normal drainage to bladder
16
Q
Is hydronephrosis a primary or secondary disease?
A
secondary
17
Q
Def: is a congenital disorder affecting about 1 out of 400 people
(renal fusion or super kidney)
A
Horseshoe kidney
18
Q
most common disorders seen with horseshoe kidney include
A
- Turner syndrome (45,X0)
- Trisomy 18 (47,xx)
19
Q
The fused part of the horseshoe kidney is the
A
isthmus
20
Q
The isthmus is usually located at
A
L4/5 level between the aorta and inferior mesenteric artery
21
Q
Horseshoe kidney is most common in
(gender)
A
men
22
Q
what’s the symptoms of Horseshoe kidney?
A
none
it’s often asymptomatic
23
Q
Horseshoe kidney increase risk for development of some disease as a result of
A
poor drainage of the urine
24
Q
Def: an abnormal retrograde movement of urine from bladder into ureters
A
Vesicoureteral Reflux (VUR)
25
Define **primary** VUR
defect in development of the ureteral valve (short, ineffective flap valve) at the end of the ureter (only in children)
26
Define **secondary** VUR
occurs when an obstruction in the bladder or urethra causes urine to flow backward into the kidneys (at any age)
27
Urinary Tract Infection affects:
- bladder (cystitis)
- kidneys (pyelonephritis)
28
UTI Etiology
- Bacteria ( 80-85% E. Coli)
- Viral
- Fungal (candidiasis)
29
UTI **risk factors** are
- urinary tract obstruction:
In pregnancy urolithiasis prostate enlargement tumors etc.
- catheterization
- diabetes mellitus
- congenital anatomical abnormalities
30
Acute Cystitis symptoms
- dysuria (painful urination)
- increased frequency of urination
- increased urinary urgency
- **lower abdominal** pain (discomfort in the pelvic area)
- r**arely causes systemic** symptoms (fever, chills)
31
Pyelonephritis symptoms
- **causes systemic** symptoms (fever, chills, nausea, vomiting)
- **flank** pain
- dysuria
32
Urinary tract infection **urinalysis** findings
- cloudy urine
- unusual urine color
- pungent odor
- specific gravity over 1.025
– increased count of leukocytes (neutrophils)
– positive leukocyte esterase
– presence of bacteria (not always)
– may have positive nitrite
– alkaline urine is found in presence of bacteria
– WBC, or bacteria casts may be present, they **indicate only kidney** infection
33
a common cause of upper urinary tract obstruction are
Kidney stones
34
Kidney stones aka
Urolithiasis
35
Kidney stones can cause **severe pain** in passage known as
**ureteral (renal) colic**
36
Kidney stones classic presentation includes severe pain originating in the
**flank**, or **back**
radiating inferiorly and anteriorly to groin
37
Does changing postion releave kidney stones pain?
No
38
At least 50% of kidney stones patients will also have
- systemic symptoms (nausea, vomiting, tachycardia)
- dysuria due to obstruction of the urinary tract
39
**Hypertension** results in damage of blood vessels of the kidney known as
**benign nephrosclerosis**
40
Define benign nephrosclerosis
**hyaline** accumulates in the **wall of small arterioles** causing **hyaline arteriolosclerosis**, which leads to ischemia
41
**Diabetes mellitus** is manifested by
- polyuria
- polydipsia
- malaise
- fatigue
- microangiopathies (the small blood vessels of the body are injured)
- diabetic nephropathy
- peripheral neuropathy
42
Diabetic nephropathy is characterized by
- glomerular lesions (diffuse glomerulosclerosis, Kimmelstiel-Wilson lesions)
- renal angiopathy (hyaline arteriolosclerosis, atherosclerosis)
- pyelonephritis
43
Diabetic nephropathy is often manifested by
**nephr**_o_**tic** syndrome
44
Glomerular diseases present with
| (what conditons)
- nephr**_i_**tic syndrome
- nephr**_o_**tic syndrome
45
Define Nephr**_i_**tic Syndrome
**increased** permeability of the glomeruli for **red blood cells**, and **reduced** permeability for **water**
46
Nephr**_i_**tic Syndrome Signs and Symptoms
**- hematuria with RBC casts**
**- oliguria**
**- azotemia**
**- hypertension**
- proteinuria **\< 3g/d**
- edema
47
Define Acute proliferative glomerulonephritis
Immune complexes become lodged in the **mesangium** and **glomerular basement membrane** *below* the podocyte foot processes
48
Complement **activation** leads to
destruction of the basement membrane
49
Changes in urine in acute proliferative (post-streptococcal, postinfectious) glomerulonephritis are typical for **Nephritic syndrome** are:
- hematuria (gross- or micro-)
- oliguria
- edema (local, under the eyes)
- cell casts (red blood, and renal epithelial)
50
Define: Rapidly Progressive (Crescentic) Glomerulonephritis
syndrome of the kidney disorders
rapid loss of renal function
acute renal failure
death within months.
51
Rapidly Progressive (Crescentic) Glomerulonephritis is clinically _manifested_ by **Nephritic** syndrome
- severe **hematuria**
- dark, smoky colored urine
- red blood cell casts
**- oliguria, anuria**
- proteinuria \< 3 g/d
**- hypertension**
52
Crescentic glomerulonephritis also demonstrates _manifestations_ typical for **Nephr**_o_**tic** syndrome:
- heavy proteinuria (more than 3.5 g/day)
- generalized edema
53
Define Goodpasture’s Syndrome
autoimmune
formation of autoantibodies against **glomerular** and **alveolar basement membranes** (Type 4 collagen)
54
Goodpasture’s Syndrome is a kidney pathology that's associated with
**Nephr**_i_**tic** syndrome
55
Goodpasture’s syndrome symptoms in lungs
* Hemoptysis
* Dyspnea
* Hypoxia of the tiss
56
Goodpasture’s syndrome symptoms in kidneys
* **Hematuria**
* RBC casts
* **Oliguria**
* **Hypertension**
* Proteinuria
* **Azotemia**
57
Def: characterized by deposition of IgA and IgA immune complexes into **mesangium** (mesangial proliferation) **with distraction of the GBM**
Berger’s Disease
58
Berger’s Disease aka
IgA nephropathy
59
Berger’s Disease bigens within
| (time line)
**1-2 days**
60
Berger’s Disease begins 1–2 days within
(conditions)
acute respiratory
acute gastrointestinal
urinary tract infection
61
Berger’s Disease d is manifested by
**gross** hematuria
**Nephritic** syndrom
62
IgA nephropathy (Berger’s Disease) is the most common cause of ________ in the world
glomerulonephritis
63
Def: a syndrome tha's associated with increased permeability of the glomeruli for **proteins**, predominately **albumins**
Nephr**_o_**tic Syndrome
64
Nephrotic Syndrome Signs and Symptoms:
– **heavy** (massive) **proteinuria** (> 3.5 g/day) with foamy urine
**– *_hypo_*albuminemia**
**– generalized edema**
**– lipidemia and lipiduria**
– urinary microscopic fat globules and fatty casts
65
most common disease associated with **Nephrotic** syndrome in **adults** is
**Mebranous** Glomerulunephritis
66
Mebranous Glomerulunephritis Is characterized by
**diffuse thickening** of the glomerular **capillary wall**
67
In Mebranous Glomerulunephritis
There is deposition of immune complexes with their damage between
(what structures)
**glomerular basement membrane**
and
**visceral epithelial cells**
68
Mebranous Glomerulunephritis Signs and Symptoms
– **proteinuria** (foamy urine)
– hematuria
– **edema**
– mild hypertension
– nocturia
69
Membranoproliferative Glomerulunephritis (MPGN)
is usually presented by
**Nephrotic** syndrome
70
Membranoproliferative Glomerulunephritis (MPGN)
in some cases it's presented by presented by
**combined Nephrotic-Nephritic** syndromes
71
MPGN Signs and Symptoms:
– **proteinuria**
– **edema** (including puffiness around eyes, weight gaining)
– **hematuria** (urine is of pink or red color)
– urine is darker than usually (like tea or cola)
– **hypertension**
– **oliguria**
72
name the disease
**benign** disorder
most frequent cause of **Nephr**_o_**tic** syndrome in children
Minimal Change Disease
73
Minimal Change Disease aka
Lipoid Nephrosis
74
Describe Minimal Change Disease (Lipoid Nephrosis)
by diffuse **loss of foot processes of podocytes**
can onlt be found by **electron** microscopy
75
Minimal Change Disease (Lipoid Nephrosis)
signs and symptoms
**- massive proteinuria** (mostly albuminuria)
- hypoalbuminemia
**- generalized edema**
**- no hypertension (!)**
**- no hematuria (!)**
76
Minimal Change Disease (Lipoid Nephrosis) is treated with
**Corticosteroid** therapy
77
Def: a lesion characterized by
sclerosis of **some**, but **not all** glomeruli
only **a portion** of the **capillary tuft** is involved
Focal Segmental Glomerulosclerosis
78
Focal Segmental Glomerulosclerosis is acompanied with
Nephr**_o_**tic syndrome
or
heavy proteinuria
79
Focal Segmental Glomerulosclerosis
Electron microscopy shows
- diffuse loss of foot processes podocytes
**- focal detachment of the visceral epithelial cells** with denudation of the underlying GBM
80
Focal Segmental Glomerulosclerosis can affect
(what population)
**Children** and **adults**
81
Focal Segmental Glomerulosclerosis
Urine and clinical findings are typical for:
**Nephr**_o_**tic** syndrome
## Footnote
**Hypertension**
82
Nephritc vs Nephrotic
| (picture)
83
Describe Chronic Glomerulonephritis
**irreversible** and **progressive** glomerular
and
tubulointerstitial **fibrosis**
84
Chronic glomerulonephritis results in
**chronic kidney disease** (CKD)
and
**end-stage renal disease** (ESRD)
85
chronic glomerulonephritis develops over the span of
(time)
**years** or possibly **decades**
86
The progression of chronic renal failure developes within:
(time)
**months to several years**
87
Chronic Renal Failure Signs and Symptoms:
- oliguria
- accumulation of toxic waste products affects virtually all organ & systems
- anemia
- fatigue and weakness
- easy bruising
- renal osteodystrophy
- acidosis, hyperkalemia
- edema
- hypertension
88
Define oliguria
decreased GFR)
89
accumulation of toxic waste products includes which toxins?
uremic toxins
90
easy bruising is due to
platelet dysfunction)
91
renal osteodystrophy is due to
decreased production of vitamin D
92
decreased production of vitamin D results in
hypocalcemia
secondary hyperparathyroidism
93
Alport Syndrome Is a genetic condition, characterized by:
**- kidney disease** (glomerulonephritis, clinically manifested by **Nephritic** syndrome)
- l**oss of hearing** before age 30 y/o
- eye abnormalities
94
Acute Tubular Necrosis is a destruction and death of
**tubular epithelial** cells of the nephron
95
**Toxic** ATN is characterized by
**proximal tubular epithelium necrosis**
due to a toxic substance
96
in Toxic ATN, what causes acute kidney failure
Necrotic cells fall into the tubule lumen
97
Ischemic ATN can be caused when
kidneys are not sufficiently perfused for a long period of time or during shock
98
The proximal tubule and medullary thick ascending limb require
significant ATP
99
The proximal tubule and medullary thick ascending limb are most susceptible to
ischemic damage
100
Ischemic ATN specifically causes
skip lesions through the tubules
101
Acute Tubular Necrosis lab findings
– reduced GFR
– increased blood levels of BUN and creatinine (azotemia)
– severe oliguria
**– casts - epithelial renal cell casts** (granular cast)
102
Fanconi’s Syndrome is a disease that affect
(Strucutre)
**proximal** renal tubules
103
Fanconi’s Syndrome effecet kidneys with inadequate reabsorption of:
– amino acids
– uric acid
– glucose
– phosphates
– bicarbonites
104
Fanconi’s Syndrome may result in
**renal tubular acidosis**
105
Renal Tubular Acidosis involves
1- **decreased** ability to **secrete hydrogen ions** in the **distal** tubules
2- **decreased** ability to **reabsorb bicarbonate** in the **proximal** tubule
106
Define Nephrogenic Diabetes Insipidus
Kidney tubules defect
(distal convoluted tubules and collecting duct)
107
**central/neurogenic** diabetes insipidus is caused by
insufficient levels of ADH
108
In Nephrogenic Diabetes Insipidus, what's the Pt's urine volume and SG?
large volume
low specific gravity
109
Renal Glycosuria Involves inadequate reabsorption of glucose due to
**proximal** tubular dysfunction
110
In Renal Glycosuria, Renal histology is
**normal**
111
Renal Glycosuria
Patients have increased urinary glucose with elevated specific gravity despite _____ blood glucose levels
**normal** or **low**
112
In Renal Glycosuria Ketones are ____ present in the urine
**never**
113
Acute Interstitial Nephritis affects
**Interstitium** of the kidneys surrounding the **tubules**
114
In Acute Interstitial Nephritis, WBCs are increased in urine, especially
eosinophils
115
Hepatorenal Failure (HRF) is an acute onset in patients with
**severe liver diseases (cirrhosis)**
116
Hepatorenal Failure (HRF) is progressively intense \_\_\_\_\_\_\_\_which leads to oliguria, elevated BUN and creatinine, and renal failure
vasoconstriction
117
In Hepatorenal Failure (HRF) urine, abnormal crystals can be found in addition to
hyaline casts or **muddy-brown casts**
118
Phenylketonuria is due to
non-production of enzyme **phenyalanine hydrolase**
119
Phenylketonuria (PKU) resutls in
several intermediates excretion in large amounts in urine and sweat phenylketons
120
Phenylketonuria (PKU) excreted intermediates are
- phenylpyruvic acid
- phenyllactic acid
- phenylacetic acid
121
Phenylketonuria
Increased formation of phenylalanine metabolites resulting from
deficiency of phenylalanine hydroxylase
122
In alkaptonuria there is **lack of**
**homogentisic acid oxidase**
in the tyrosine pathway
123
homogentisic acid oxidase lack leads to accumulation of
**homogentisic acid** in tissues
124
Accumulation of homogentisic acid in cartilage results in
the cartilage degeneration (**ochronosis**)
125
Maple Syrup Urine Disease aka
branched-chain ketoaciduria
126
Maple syrup urine disease (MSUD) etiology
**inherited** metabolic disorder
127
Maple Syrup Urine Disease
Patients with this condition cannot break down:
leucine
isoleucine
valine
128
Cystinuria etiology
**inherited** disease
129
Cystinuria (cystinosis) is It is characterized by
inadequate reabsorption of amino acids in the **proximal** convoluted tubules
130
Cystine Disorders patients are more likely to have in their urine?
**cystine crystals** and **cystine renal stones**
131
Polycystic kidney disease (PKD) is
**inherited** disorder in which clusters of cysts develop primarily within kidneys
132
what are the 2 types of PKD?
* **Autosomal dominant** polycystic kidney disease
* **Autosomal recessive** polycystic kidney disease
133
Autosomal dominant PKD effects patiets at what age?
30's and 40's, but can happen in children
134
in Autosomal dominant PKD, does both parents needs to carry the disease?
No
only one parent is needed to carry the disease
135
Autosomal recessive PKD developes at what age?
shortly after birth
136
Does Autosomal recessive PKD require both parents to have the disease?
Yes
137
Which type of PKD is more common?
Autosomal dominant PKD
138
Polycystic kidney disease symptoms may include
- High blood pressure
- Back or side pain
- Headache
- Increase in the size of abdomen
- Blood in urine
- Frequent urination
- Kidney failure
- Urinary tract infections
