71: Urinary System-Clincal Consideration Flashcards

1
Q

A hereditary disorder of basement membrane collagen- defective alpha chains.

A

Alport syndrome

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2
Q

The clinical manifestations of Alport Syndrome:

A
  • Hematuria
  • Progressive renal failure
  • Neurosensory hearing loss (deaf by 25 years)
  • Ocular abnormalities
  • Lens, fundus are affected
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3
Q

Alport Syndrome causes splitting and damage of the basement membrane that leads to leakage of….. and ………. - Hematuria - Proteinuria - Pedal edema
- Eventual renal failure by 50 years

A

Proteins and RBCs

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4
Q

Goodpasture Syndrome

A

Autoantibody reacts with type IV collagen of glomerular & alveolar capillary basement membrane

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5
Q

Goodpasture Syndrome affects …….. and ……… and causes intra-alveolar hemorrhage, atrophy of the glomerulus, and epithelial crescent fills Bowman’s space.

A

Affects kidney and lungs

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6
Q

Immune mediated disease where sub-epithelial deposition of antigen-antibody complexes in the GBM and uniform thickening of GBM.

A

Membranous Glomerulonephritis

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7
Q

Membranous glomerulonephritis causes …….trigger the synthesis & liberation proteases and oxygen radical by podocytes, mesangial cells, and endothelial cells which disrupts the integrity of GBM

A

Membrane complexes

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8
Q

Membranous glomerulonephritis causes ……….. which leads to massive proteinuria, hypoalbuminemia, and anasarca (generalized body swelling)

A

Leaky Barriers

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9
Q

Recurrent painless macroscopic hematuria following viral illness (24 - 48 hours) that results in the predominant deposition of IgA and complement complexes in glomerular mesangial matrix following RTI or GI infection

A

IgA Nephropathy

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10
Q

IgA Nephropathy causes ……….. due to swelling of the renal capsule. Leukocyte infiltration and cytokine release will stimulate mesangial proliferation and hypercellularity

A

Flank Pain

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11
Q

Complement activation in IgA nephropathy leads to damage of ………………surface leading to hematuria

A

Glomerular filtration

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12
Q

Clinical Manifestations of IgA Nephropathy:

A
  • Enlarged, hypercellular glomeruli.
  • Hyperplasia of epithelium & endothelium.
  • Inflammatory cells.
  • Collapsed capillaries > obstruction to blood flow.
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13
Q

Proliferation of epithelial cells and monocytic phagocytes within Bowman’s capsule.

A

Rapidly progressive glomerulonephritis

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14
Q

Signs of Glomerulonephritis (GN):

A

Rapid decline in renal function

Hallmark - “ cellular crescents”

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15
Q

Diabetic glomerulosclerosis:

A
  • Kimmelsteil-Wilson Lesion involves atherosclerosis of larger vessels & hyalinization of arterioles
  • Deposits of hyaline material in the mesangium of the renal corpuscles
  • Diffuse infiltration of glomerular tuft with eosinophic material & also focal deposits
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16
Q

Untreated ……….. is one of the principle causes of renal failure

A

Hypertension

17
Q

Increased tension in the vessels due to hypertension lead to ……….. of the walls and reduction in the caliber of the vessel

A

Hyalinization (H)

18
Q
  • Autosomal recessive PKD-the cysts are dilated elongations of the collecting tubules and radially arranged
  • Fatal in first few months of life
  • Protein affected-fibrocystin
A

Congenital Polycystic Kidney Disease

19
Q

Autosomal dominant disease where cysts of the kidney are not usually present at birth, but develop slowly over time causing renal failure in middle age.
• Defective protein-polycystin

A

Adult Polycystic Kidney Disease

20
Q

Characteristics of Adult Polycystic Kidney Disease:

A
  • Assoc. with HTN, haematuria & cardiac abnormalities
  • No normal tubules
  • Thinned out tubules
  • Glomeruli appear normal
  • 77% -suffer renal failure
21
Q

All of the following can cause …………
•Medications
•Iodine containing contrast agents
• Metals – lead, mercury, cadmium, copper, gold, arsenic
•Toxins
•Infections
•Ischemia and hypovolemic shock •Mechanical obstruction

A

Acute tubular injury

22
Q

The most common cause of………. is acute ischemia due to hypotension and ……… is a common cause of acute renal failure..

A

Acute Tubular Necrosis

23
Q
Acute Tubular Necrosis mostly affects the .............and causes:
• Dilated  tubule 
• Flattened epithelium 
• Loss of brush border and infoldings
• Anuria/oliguria & renal failure
A

Proximal Convoluting Tubule

24
Q

During acute tubular necrosis, most of ……….. is destroyed & sloughed into the lumen. Surviving cells attempt to repair and are lined by flat, elongated cells

A

Epithelium

25
Q

Acute suppurative bacterial infection

•Common in : benign prostatic hyperplasia & in pregnancy

A

Acute pyelonephritis

26
Q

Acute pyelonephritis is neutrophil infiltration of the renal interstitium causing …………… and obstruction of the drainage system (calyces, ureters) may result in hydronephrosis & hydroureters.

A

Chronic inflammation

27
Q

The following is characteristic of ………….. pyelonephritis.
• Bacterial infection of kidney from the bladder
• Caused by E.coli, Proteus etc
• Destruction of tubules>glomeruli
• *Epithelium -swollen & granular
• **Tubule full of pus & lost their epithelial lining
• Large amount of polymorphs

A

Acute Pyelonephritis

28
Q

The following is characteristic of ………….. pyelonephritis.
• Kidneys are reduced in size & scarred
• Follows recurrent acute episodes
• Glomeruli are completely fibrosed & avascular
• Crowding of hyalinised glomeruli
• Tubules are dilated and have casts
• Heavy infiltration of lymphocytes & plasma cells

A

Chronic Pyelonephritis

29
Q

Embolus and Sickle Cell Crisis can cause …….. in the kidney.

A

Renal infarctions

  • Embolus:-Can cause focal or global infarct
  • Sickle cell crisis- Slit-like infarcts
30
Q

Major cause of ……… is atheromatous plaques which leads to hypertension (due to increased production of renin and subsequent circulation of angiotensin II)

A

Renal Artery Stenosis

31
Q

Angiotensin I activated to angiotensin II by ……..

A

Pulmonary endothelial cells

32
Q

Functions of Angiotensin II:

A

– potent vasoconstrictor
– stimulates aldosterone secretion from adrenal cortex
– aldosterone stimulates reabsorption of Na+ and secretion of K+ by connecting tubules and collecting ducts

33
Q

Risk factors for Renal cell carcinoma:

A

Risk: Male, 60-70yrs, smoking, obesity, hypertension

34
Q

Signs and Symptoms of Renal cell carcinoma:

A

Classic Triad: • Hematuria 50% of cases • Flank pain • Abdominal mass

35
Q

Renal cell carcinoma originate from………

A

Renal tubular epithelial cells (adenocarcinoma)

36
Q

Transitional cell (urothelial) carcinoma:

A

Cancer of the transitional cells of the bladder