7- Diseases & Related Urine Findings Flashcards
Congenital Anatomical Variations Affecting UT
– Duplicate sets of ureters
– Horseshoe kidney
– Vesicoureteral reflux (VUR)
Acquired Anatomical Variations Affecting UT
– Accidents and injuries can damage the kidneys or urinary tract
– Benign prostatic hyperplasia (BPH)
the most common renal congenital abnormality
Duplex Collecting System
Duplex Collecting System is characterized by
complete or incomplete duplications
Most common among
(what gender)
Females
Def: two separate pelvicalyceal systems draining a single renal parenchyma
duplex kidney
independent ureters that drain separately into the urinary or genital tract, and are seen in complete or incomplete duplication
double/duplicated ureters
describe partial (incomplete) duplications
Partial (incomplete) duplications can be associated with
ureteroureteral reflux and deformation of the ureter (ureterocele)
or
ureteropelvic junction obstruction of the lower pole of the kidney
define: Complete duplications of the ureters
the two ureters drain separately
describe how the Complete duplication ureters connect to the bladder
one ureter opens normally
the other opens in wrong place (ectopic)
Most duplicated systems are (symptomatic/asymptomatic)
asymptomatic
duplicated systems are important predisposing factor for the development of ___ in newborns or children
UTI
Def: a coindition that can be severe enough to result in flank discomfort or even a palpable mass
hydronephrosis
Hydronephrosis is a condition that typically occurs when the kidney
swells due to the failure of normal drainage to bladder
Is hydronephrosis a primary or secondary disease?
secondary
Def: is a congenital disorder affecting about 1 out of 400 people
(renal fusion or super kidney)
Horseshoe kidney
most common disorders seen with horseshoe kidney include
- Turner syndrome (45,X0)
- Trisomy 18 (47,xx)
The fused part of the horseshoe kidney is the
isthmus
The isthmus is usually located at
L4/5 level between the aorta and inferior mesenteric artery
Horseshoe kidney is most common in
(gender)
men
what’s the symptoms of Horseshoe kidney?
none
it’s often asymptomatic
Horseshoe kidney increase risk for development of some disease as a result of
poor drainage of the urine
Def: an abnormal retrograde movement of urine from bladder into ureters
Vesicoureteral Reflux (VUR)
Define primary VUR
defect in development of the ureteral valve (short, ineffective flap valve) at the end of the ureter (only in children)
Define secondary VUR
occurs when an obstruction in the bladder or urethra causes urine to flow backward into the kidneys (at any age)
Urinary Tract Infection affects:
- bladder (cystitis)
- kidneys (pyelonephritis)
UTI Etiology
- Bacteria ( 80-85% E. Coli)
- Viral
- Fungal (candidiasis)
UTI risk factors are
- urinary tract obstruction:
In pregnancy urolithiasis prostate enlargement tumors etc.
- catheterization
- diabetes mellitus
- congenital anatomical abnormalities
Acute Cystitis symptoms
- dysuria (painful urination)
- increased frequency of urination
- increased urinary urgency
- lower abdominal pain (discomfort in the pelvic area)
- rarely causes systemic symptoms (fever, chills)
Pyelonephritis symptoms
- causes systemic symptoms (fever, chills, nausea, vomiting)
- flank pain
- dysuria
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
a common cause of upper urinary tract obstruction are
Kidney stones
Kidney stones aka
Urolithiasis
Kidney stones can cause severe pain in passage known as
ureteral (renal) colic
Kidney stones classic presentation includes severe pain originating in the
flank, or back
radiating inferiorly and anteriorly to groin
Does changing postion releave kidney stones pain?
No
At least 50% of kidney stones patients will also have
- systemic symptoms (nausea, vomiting, tachycardia)
- dysuria due to obstruction of the urinary tract
Hypertension results in damage of blood vessels of the kidney known as
benign nephrosclerosis
Define benign nephrosclerosis
hyaline accumulates in the wall of small arterioles causing hyaline arteriolosclerosis, which leads to ischemia
Diabetes mellitus is manifested by
- polyuria
- polydipsia
- malaise
- fatigue
- microangiopathies (the small blood vessels of the body are injured)
- diabetic nephropathy
- peripheral neuropathy
Diabetic nephropathy is characterized by
- glomerular lesions (diffuse glomerulosclerosis, Kimmelstiel-Wilson lesions)
- renal angiopathy (hyaline arteriolosclerosis, atherosclerosis)
- pyelonephritis
Diabetic nephropathy is often manifested by
nephrotic syndrome
Glomerular diseases present with
(what conditons)
- nephritic syndrome
- nephrotic syndrome
Define Nephritic Syndrome
increased permeability of the glomeruli for red blood cells, and reduced permeability for water
Nephritic Syndrome Signs and Symptoms
- hematuria with RBC casts
- oliguria
- azotemia
- hypertension
- proteinuria < 3g/d
- edema
Define Acute proliferative glomerulonephritis
Immune complexes become lodged in the mesangium and glomerular basement membrane below the podocyte foot processes
Complement activation leads to
destruction of the basement membrane
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)
Define: Rapidly Progressive (Crescentic) Glomerulonephritis
syndrome of the kidney disorders
rapid loss of renal function
acute renal failure
death within months.
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
Crescentic glomerulonephritis also demonstrates manifestations typical for Nephrotic syndrome:
- heavy proteinuria (more than 3.5 g/day)
- generalized edema
Define Goodpasture’s Syndrome
autoimmune
formation of autoantibodies against glomerular and alveolar basement membranes (Type 4 collagen)
Goodpasture’s Syndrome is a kidney pathology that’s associated with
Nephritic syndrome
Goodpasture’s syndrome symptoms in lungs
- Hemoptysis
- Dyspnea
- Hypoxia of the tiss
Goodpasture’s syndrome symptoms in kidneys
- Hematuria
- RBC casts
- Oliguria
- Hypertension
- Proteinuria
- Azotemia
Def: characterized by deposition of IgA and IgA immune complexes into mesangium (mesangial proliferation) with distraction of the GBM
Berger’s Disease
Berger’s Disease aka
IgA nephropathy
Berger’s Disease bigens within
(time line)
1-2 days
Berger’s Disease begins 1–2 days within
(conditions)
acute respiratory
acute gastrointestinal
urinary tract infection
Berger’s Disease d is manifested by
gross hematuria
Nephritic syndrom
IgA nephropathy (Berger’s Disease) is the most common cause of ________ in the world
glomerulonephritis
Def: a syndrome tha’s associated with increased permeability of the glomeruli for proteins, predominately albumins
Nephrotic Syndrome
Nephrotic Syndrome Signs and Symptoms:
– heavy (massive) proteinuria <strong>(> 3.5 g/day)</strong> with foamy urine
– hypoalbuminemia
– generalized edema
– lipidemia and lipiduria
– urinary microscopic fat globules and fatty casts
most common disease associated with Nephrotic syndrome in adults is
Mebranous Glomerulunephritis
Mebranous Glomerulunephritis Is characterized by
diffuse thickening of the glomerular capillary wall
In Mebranous Glomerulunephritis
There is deposition of immune complexes with their damage between
(what structures)
glomerular basement membrane
and
visceral epithelial cells
Mebranous Glomerulunephritis Signs and Symptoms
– proteinuria (foamy urine)
– hematuria
– edema
– mild hypertension
– nocturia
Membranoproliferative Glomerulunephritis (MPGN)
is usually presented by
Nephrotic syndrome
Membranoproliferative Glomerulunephritis (MPGN)
in some cases it’s presented by presented by
combined Nephrotic-Nephritic syndromes
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
name the disease
benign disorder
most frequent cause of Nephrotic syndrome in children
Minimal Change Disease
Minimal Change Disease aka
Lipoid Nephrosis
Describe Minimal Change Disease (Lipoid Nephrosis)
by diffuse loss of foot processes of podocytes
can onlt be found by electron microscopy
Minimal Change Disease (Lipoid Nephrosis)
signs and symptoms
- massive proteinuria (mostly albuminuria)
- hypoalbuminemia
- generalized edema
- no hypertension (!)
- no hematuria (!)
Minimal Change Disease (Lipoid Nephrosis) is treated with
Corticosteroid therapy
Def: a lesion characterized by
sclerosis of some, but not all glomeruli
only a portion of the capillary tuft is involved
Focal Segmental Glomerulosclerosis
Focal Segmental Glomerulosclerosis is acompanied with
Nephrotic syndrome
or
heavy proteinuria
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
Focal Segmental Glomerulosclerosis can affect
(what population)
Children and adults
Focal Segmental Glomerulosclerosis
Urine and clinical findings are typical for:
Nephrotic syndrome
Hypertension
Nephritc vs Nephrotic
(picture)
Describe Chronic Glomerulonephritis
irreversible and progressive glomerular
and
tubulointerstitial fibrosis
Chronic glomerulonephritis results in
chronic kidney disease (CKD)
and
end-stage renal disease (ESRD)
chronic glomerulonephritis develops over the span of
(time)
years or possibly decades
The progression of chronic renal failure developes within:
(time)
months to several years
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
Define oliguria
decreased GFR)
accumulation of toxic waste products includes which toxins?
uremic toxins
easy bruising is due to
platelet dysfunction)
renal osteodystrophy is due to
decreased production of vitamin D
decreased production of vitamin D results in
hypocalcemia
secondary hyperparathyroidism
Alport Syndrome Is a genetic condition, characterized by:
- kidney disease (glomerulonephritis, clinically manifested by Nephritic syndrome)
- loss of hearing before age 30 y/o
- eye abnormalities
Acute Tubular Necrosis is a destruction and death of
tubular epithelial cells of the nephron
Toxic ATN is characterized by
proximal tubular epithelium necrosis
due to a toxic substance
in Toxic ATN, what causes acute kidney failure
Necrotic cells fall into the tubule lumen
Ischemic ATN can be caused when
kidneys are not sufficiently perfused for a long period of time or during shock
The proximal tubule and medullary thick ascending limb require
significant ATP
The proximal tubule and medullary thick ascending limb are most susceptible to
ischemic damage
Ischemic ATN specifically causes
skip lesions through the tubules
Acute Tubular Necrosis lab findings
– reduced GFR
– increased blood levels of BUN and creatinine (azotemia)
– severe oliguria
– casts - epithelial renal cell casts (granular cast)
Fanconi’s Syndrome is a disease that affect
(Strucutre)
proximal renal tubules
Fanconi’s Syndrome effecet kidneys with inadequate reabsorption of:
– amino acids
– uric acid
– glucose
– phosphates
– bicarbonites
Fanconi’s Syndrome may result in
renal tubular acidosis
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
Define Nephrogenic Diabetes Insipidus
Kidney tubules defect
(distal convoluted tubules and collecting duct)
central/neurogenic diabetes insipidus is caused by
insufficient levels of ADH
In Nephrogenic Diabetes Insipidus, what’s the Pt’s urine volume and SG?
large volume
low specific gravity
Renal Glycosuria Involves inadequate reabsorption of glucose due to
proximal tubular dysfunction
In Renal Glycosuria, Renal histology is
normal
Renal Glycosuria
Patients have increased urinary glucose with elevated specific gravity despite _____ blood glucose levels
normal or low
In Renal Glycosuria Ketones are ____ present in the urine
never
Acute Interstitial Nephritis affects
Interstitium of the kidneys surrounding the tubules
In Acute Interstitial Nephritis, WBCs are increased in urine, especially
eosinophils
Hepatorenal Failure (HRF) is an acute onset in patients with
severe liver diseases (cirrhosis)
Hepatorenal Failure (HRF) is progressively intense ________which leads to oliguria, elevated BUN and creatinine, and renal failure
vasoconstriction
In Hepatorenal Failure (HRF) urine, abnormal crystals can be found in addition to
hyaline casts or muddy-brown casts
Phenylketonuria is due to
non-production of enzyme phenyalanine hydrolase
Phenylketonuria (PKU) resutls in
several intermediates excretion in large amounts in urine and sweat phenylketons
Phenylketonuria (PKU) excreted intermediates are
- phenylpyruvic acid
- phenyllactic acid
- phenylacetic acid
Phenylketonuria
Increased formation of phenylalanine metabolites resulting from
deficiency of phenylalanine hydroxylase
In alkaptonuria there is lack of
homogentisic acid oxidase
in the tyrosine pathway
homogentisic acid oxidase lack leads to accumulation of
homogentisic acid in tissues
Accumulation of homogentisic acid in cartilage results in
the cartilage degeneration (ochronosis)
Maple Syrup Urine Disease aka
branched-chain ketoaciduria
Maple syrup urine disease (MSUD) etiology
inherited metabolic disorder
Maple Syrup Urine Disease
Patients with this condition cannot break down:
leucine
isoleucine
valine
Cystinuria etiology
inherited disease
Cystinuria (cystinosis) is It is characterized by
inadequate reabsorption of amino acids in the proximal convoluted tubules
Cystine Disorders patients are more likely to have in their urine?
cystine crystals and cystine renal stones
Polycystic kidney disease (PKD) is
inherited disorder in which clusters of cysts develop primarily within kidneys
what are the 2 types of PKD?
- Autosomal dominant polycystic kidney disease
- Autosomal recessive polycystic kidney disease
Autosomal dominant PKD effects patiets at what age?
30’s and 40’s, but can happen in children
in Autosomal dominant PKD, does both parents needs to carry the disease?
No
only one parent is needed to carry the disease
Autosomal recessive PKD developes at what age?
shortly after birth
Does Autosomal recessive PKD require both parents to have the disease?
Yes
Which type of PKD is more common?
Autosomal dominant PKD
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
