Ch. 25 Renal Disorders Flashcards
What is glomerulonephritis?
An inflammatory process that is the second leading cause of kidney failure.
What are the causes of glomerulonephritis?
Hereditary
Other disease process
Immunologic
What are the two immunologic causes of glomerulonephritis?
- Injury from antibody reacting with antigens in glomeruli
2. Injury from circulating antibody/antigen complexes that lodge in the glomeruli
How are the types of glomerulonephritis categorized?
By appearance.
What are the four categories of glomerulonephritis?
Proliferative, membranous, sclerotic, diffuse/focal/segmental
What are the types of glomerular disease?
Acute Nephritic syndrome Rapidly progressive glomerulonephritis Nephrotic syndrome Asymptomatic hematuria or proteinuria Chronic glomerulonephritis
What is acute nephritic syndrome?
Inflammatory response damaging glomerular capillary wall.
What are the manifestations of acute nephritic syndrome?
Hematuria Decreased GFR Azotemia Oliguria Fluid retention
What is proliferative glomerulonephritis?
Infiltration of WBC and proliferation of glomerular cells.
What is membranous glomerulonephritis?
Thickening of glomerular capillary wall.
What is sclerotic glomerulonephritis?
Increased extracellular matrix.
What is the treatment for nephritic syndrome?
Symptomatic
Possible permanent kidney damage
Children often have spontaneous recovery
What is rapidly progressive glomerulonephritis?
Signs of severe glomerular injury without specific cause. It is rapid. It involves proliferation of glomerular cells, with monocytes and macrophages that destroy Bowman space
What is Goodpasture’s Syndrome?
A rare autoimmune type of rapid progressive glomerulonephritis.
What is nephrotic syndrome?
Integrity of the glomerular membrane is affected.
What are three causes of nephrotic syndrome?
Medication
Neoplasms
Inflammation
What are the results of nephrotic syndrome on the blood and urine?
Increased GFR Massive proteinuria Hypoalbuminemia Edema (anascara) Lipidurea Hyperlipidemia
What is asymptomatic hematuria or proteinuria? (Two examples of this disorder)
IgA nephropathy (Berger's disease) Alport syndrome (hereditary)
What is IgA nephropathy? (Berger’s disease)
IgA complex deposits due to inflammation.
What is chronic glomerulonephritis? (What does it look like)
Acute forms either resolve or progress.
Small kidneys, sclerosed glomeruli.
What causes acute pyelonephritis?
Bacterial infection of upper urinary tract with intrarenal reflux.
What are factors that contribute to acute pyelonephritis?
Outflow obstruction Catheterization/urinary instrumentation Vesicoureteral reflux Pregnancy Neurogenic bladder
What is intrarenal reflux?
Urine moving in the wrong direction within the kidney.
What is vesicoureteral reflux?
Urine going back up the ureters from the bladder into the kidney
What are the manifestations of acute pyelonephritis?
Rapid, chills, fever Ache/pain unilateral or bilateral (costovertebral angle) Dysuria, frequency, urgency Nausea and vomiting, abdominal pain radiating to the back.
What are the treatment methods for acute pyelonephritis?
Symptomatic pain relief
Fluids to aid dysuria
Antibiotics
What is chronic pyelonephritis?
Scarring and deformation of renal calyces and pelvis, with atrophy and thinning of cortex.
What part of the kidney does chronic pyelonephritis primarily affect?
Primarily affects proximal and distal tubules.
What are the causes of chronic pyelonephritis?
Recurrent or persistent infection, intrarenal reflux.
What factors determine the effect of toxin-related nephropathies?
Action of drugs/toxins Number of toxins involved Existence of pre-renal issues that decrease blood flow to kidney Formation of crystals Hypersensitivity response
What is polycystic kidney disease?
Fluid filled cysts in kidney (and liver, and sometimes other organs) An inherited autosomal dominant disease. It is generally in the older population and progresses slowly.
What is the pathophysiology behind polycystic kidney disease?
Deformity of epithelial cell interfere with fluid absorption/cellular maturation resulting in cyst formation
Inflammatory mediators accumulate, and renal tubular cells are destroyed
Kidneys enlarge
What are the manifestations of polycystic kidney disease?
Pain
Hematuria
Infected cysts (UTI)
Hypertension
What are the complications of polycystic kidney disease?
Nephrolithiasis (kidney stones)
Valvular deformities
Cerebral artery aneurysm - subarachnoid hemorrhage
What are obstructive problems that occur in the renal pelvis?
Calculi, necrosis
What are obstructive problems that occur in the ureter?
Calculi, pregnancy, tumors, stricture, congenital origins
What are obstructive problems that occur in the bladder and ureter?
Calculi, neurogenic bladder, cancer, benign prostatic hypertrophy, strictures
What are some kinds of damage that can result from obstructive disorders?
Stasis of urine
Progressive dilation of renal collecting ducts and tubular structures
Hydronephrosis
What does stasis of urine cause?
UTI
Stone formation
What does progressive dilation of renal collecting ducts and tubular structures result in?
Causes destruction and atrophy of renal tissue.
What does hydronephrosis mean?
Urine-filled dilation of renal pelvis and calyces due to obstruction of outflow, leading to atrophy of kidney
What are the manifestations of urinary obstructions?
Recurrent UTIs
Minimal to severe pain (dependent on level and degree of obstruction)
Complete obstruction
What are some results of complete urinary obstruction?
Oliguria/anuria
Renal failure
What is the most common cause of upper urinary tract obstruction?
Renal calculi (nephrolithiasis)
What are the four most common materials that kidney stones are made of?
Calcium (oxalate or phosphate)
Magnesium ammonium phosphate
Uric acid
Cysteine
Why does hyperparathyroidism cause kidney stones?
High levels of parathyroid hormone causes osteoclasts to break down bone tissue.
What are the causes of calcium kidney stones?
Due to immobilization, hyperparathyroidism, diffuse bone disease
What causes magnesium ammonium phosphate stomes?
Due to UTIs
Which kidney stones are struvite/staghorn shape? (weird shaped)
Magnesium ammonium phosphate
What are the causes of uric acid kidney stones?
Gout, high purine diet
What are the causes of cystine kidney stones?
These are inherited and are rarer (usually in children)
What are the manifestations of nephrolithiasis? (kidney stones)
Pain Nausea and vomiting Pallor and diaphoresis Frequency and burning Fever and chills (with infection) Hematuria
What are the treatments for kidney stones?
Analgesics, Anti-spasmotics Allopurinol Changes pH to decrease acidity Increased fluids to produce 2 liter/day Strain urine Diet modification Extrancoporeal shockwave lithotripsy (ESWL) Ureteroscopic removal Percutaneous nephrolithotomy
What is Wilms Tumor (nephroblastoma)?
Most common malignant abdominal tumor in children. It is usually encapsulated and associated with other congenital abnormalities.
What are the symptoms of Wilms Tumor (nephroblastoma)?
Abdominal mass
Hypertension
Abdominal pain
Vomiting
What is renal cell carcinoma characterized by?
Hematuria, flank pain, mass
Silent disorder in early stages
What is a risk factor for renal cell carcinoma?
Smoking
What is the treatment for renal cell carcinoma?
Surgery, chemotherapy, radiation
