Ch. 8 - Renal Disease Flashcards
What are the different classifications of renal disease based on the area of the kidney primarily affected?
Glomerular
Tubular
Interstitial
What is the major function of the kidneys?
Filtration of the blood to remove waste products
Most of the disorders associated with the glomerulus are of _____ origin.
Immune
These are formed as a result of immune reactions and increased serum immunoglobulins (ex. IgA). These circulate the bloodstream and are deposited in the glomerular membranes.
Immune complexes
Enumerate the components of the immune system that are attracted to the site of attachment of the immune complexes and produces changes and damages to the membrane.
Complement Neutrophils Lymphocytes Monocytes Cytokines
Give a non-immunologic source for glomerular damage
Exposure to chemicals and toxins
This term refers to a sterile, inflammatory process that affects the glomerulus and is associated with the finding of blood, protein, and casts in the urine.
Glomerulonephritis
This is a disease marked by the sudden onset of symptoms consistent with damage to the glomerular membrane
Acute Glomerulonephritis
What are the symptoms of the Acute glomerulonephritis (AGN)?
Fever Edema, most noticeable around the eyes Fatigue Hypertension Oliguria Hematuria
Symptoms of this disease usually occur in children and young adults following respiratory infections caused by certain strains of group A streptococcus that contain M protein in the cell wall.
Acute Streptococcal Glomerulonephritis
What disease exhibits these primary urinalysis findings: Marked hematuria Proteinuria Oliguria, accompanied by RBC casts Dysmorphic RBCs Hyaline and Granular casts White blood cells
Acute Glomerulonephritis
What enzyme test can provide evidence that the acute glomerulonephritis is of streptococcal origin?
Demonstration of an elevated serum antistreptolysin-O (ASO) titer or anti-group A streptococcal test
This is a more serious form of acute glomerulonephritis and has a much more poorer prognosis, often terminating in renal failure.
Rapidly Progressive (or Crescentic) glomerulonephritis
In rapidly progressive glomerulonephritis, damage by macrophages to the capillary walls releases cells and plasma into Bowman’s capsule; this cause (temporary/permanent) damage to the capillary tufts
Permanent
The lab results of Acute glomerulonephritis is similar to the rapidly progressive glomerulonephritis (T/F)
True
An autoimmune disorder, seen in conjunction with RPGN
Goodpasture syndrome
In good pasture syndrome, what are the initial pulmonary complaints?
Hemoptysis - caughing up blood
Dyspnea
Followed by development of hematuria
What disease exhibits these urinalysis results:
Proteinemia
Hematuria
Presence of RBC casts
Progression to chronic glomerulonephritis and end-stage renal failure is common
Goodpasture syndrome
This disease causes a granuloma-producing inflammation of the small blood vessels of primarily the kidney and respiratory
Wegener’s granulomatosis
What is the key to the diagnosis of Wegener’s granulomatosis?
Demonstration of antineutrophilic cytoplasmic antibody (ANCA) in the patients serum
Patients with this disease usually presents first with pulmonary symptoms and later develop renal involvement, including hematuria, proteinuria, RBC casts and elevated serum creatinine and BUN
Wegener’s granulomatosis
This is a disease occurring primarily in children following upper respiratory infection
Henoch-Schönlein pupura
What are the initial symptoms of Henoch-Schönlein pupura
Appearance of raised, red patches on the skins.
Blood in the sputum and stool may be present
Renal involvement is the most serious complication of this disorder and may range from mild to heavy proteinuria and hematuria with RBC casts
Henoch-Schönlein pupura
The predominant characteristic of this disease is a pronounced thickening of the glomerular basement membrane resulting from the deposition of IgG complexes.
Membranous Glomerulonephritis
Enumerate some disorders associated with the development of membranous glomerulonephritis.
Systemic lupus erythemtaosus Sjogren syndrome Secondary syphilis Hepatitis B Gold and mercury treatments Malgnancy
What are the laboratory findings from a patient suffering from membranous glomerulonephritis?
Microscopic hematuria
Elevated urine protein excretion (May reach concentrations similar to nephrotic syndrome)
This disease is marked by two different alterations in the cellularity of the glomerulus and peripheral capillaries.
Membranoproliferative glomerulonephritis (MPGN)
This type of Membranoproliferative glomerulonephritis (MPGN) displays increased cellularity in the subendothelial cells of the mesangium (interstitial area of Bowman’s capsule), causing thickening of the capillary walls.
Type 1
This type of Membranoproliferative glomerulonephritis (MPGN) displays extremely dense deposits in the glomerular basement membrane.
Type 2
What are the usual laboratory findings for Membranoproliferative glomerulonephritis (MPGN)?
Hematuria
Proteinuria
Decreased serum complement levels
Examination of the urine sample of a patient suffering from chronic glomerulonephritis would exhibit what conditions?
Hematuria, Proteinuria, Glucosuria as a result of tubular dysfunction
Many varieties of casts (including broad casts)
In chronic glomerulonephritis, (increased/decreased) glomerular filtration rate is present in conjuction with increased BUN and creatinine levels and electrolyte imbalance
Decreased
This is also known as the Berger disease
Immunoglobulin A nephropathy
This is a disease wherein immune complexes containing IgA are deposited in the glomerular membrane.
Immunoglobulin A nephropathy (Berger disease)
This is the most common cause of glomerulonephritis.
Immunoglobulin A nephropathy (Berger disease)
In Immunoglobulin A nephropathy (Berger disease), patients have increased serum levels of IgA, which may be a result of what type of infection?
Mucosal infection
Patients suffering from this disorder usually present with an episode of macroscopic hematuria following an infection or strenuous exercise.
Immunoglobulin A nephropathy (Berger disease)
A patient with this disorder may remain essentially asymptomatic for 20 years or more; however, there is a gradual progression to chronic glomerulonephritis and end-stage renal disease.
Immunoglobulin A nephropathy (Berger disease)
This disorder is marked by massive proteinuria (greater than 3.5g/dL), low levels of serum albumin, high levels of serum lipids, and pronounced edema.
Nephrotic syndrome
In a patient suffering from Nephrotic syndrome, what is the primary protein depleted from the circulation? This decrease stimulates the increased production of lipids by the liver.
Albumin
What would be observed from patients suffering from Nephrotic syndrome?
Marked proteinuria Urinary fat droplets Oval fat bodies Renal tubular epithelial (RTE) cells Epithelial, fatty, and waxy casts Microscopic hematuria
This disorder is also known as lipid nephrosis.
Minimal Change disease
This disease produces little cellular change in the glomerulus, although the podocytes appear to be less tightly fitting, allowing for the increased filtration of protein.
Minimal Change disease (Lipid nephrosis)
Patients, usually children, who suffer from Minimal Change disease (Lipid nephrosis), present what clinical findings?
Edema
Heavy proteinuria
Transient hematuria
NORMAL BUN and Creatinine results
Aside from allergic reaction and recent immunization, this antigen has also been associated with Minimal Change disease (Lipid nephrosis).
Human leukocyte antigen-B12 (HLA-B12) antigen
This disorder responds well to corticosteroids.
Minimal Change disease (Lipid nephrosis)
This disorder affects only certain numbers and areas of glomeruli, and the others remain normal.
Focal Segmental Glomerulosclerosis (FSGS)
The symptoms of this disorder may be similar to Nephrotic syndrome and Minimal Change disease (Lipid nephrosis) owing to the damaged podocytes; it is often associated with abuse of heroine and analagesics and with AIDS
Focal Segmental Glomerulosclerosis (FSGS)
In this disorder, IgM and C3 are a frequent finding and can be seen in undamaged glomeruli.
Focal Segmental Glomerulosclerosis (FSGS)
What immune deposits can be frequently seen in a patien suffering from Focal Segmental Glomerulosclerosis (FSGS)?
IgM and C3
What are the most consistent urinalysis findings in patients suffering from Focal Segmental Glomerulosclerosis (FSGS)?
Moderate to heavy proteinuria
Microscopic hematuria
This is an inherited disorder affecting the glomerular basement membrane and it can be inherited as a sex-linked or autosomal genetic disorder.
Alport syndrome
Alport syndrome more frequently affects (males than females/females than males).
Males than females
Males suffering from this disorder, before the age of 6, may exhibit macroscopic hematuria and continue to exhibit microscopic hematuria during respiratory infections.
Alport syndrome
Patients suffering from this disorder will exhibit glomerular basement membrane that has a lamellated appearance with areas of thinning; no evidence of glomerular antibodies are present.
Alport syndrome
This is also known as Kimmelstiel-Wilson disease
Diabetic nephropathy
This is currently the most common cause of end-stage renal disease.
Diabetic nephropathy (Kimmelstiel-Wilson disease)
Diabetic nephropathy (Kimmelstiel-Wilson disease) causes damage to this membrane as a result of glomerular membrane thickening and increased proliferation of mesanglial cells
Glomerular
In Diabetic nephropathy (Kimmelstiel-Wilson disease), there is an (increase/decrease) deposition of cellular and noncellular material within the glomerular matrix.
Increase (Results in accumulation of solid substances around the capillary tufts)
The vascular structure of the glomerulus also develops sclerosis in patients suffering from this disorder.
Diabetic nephropathy (Kimmelstiel-Wilson disease)
To detect the onset of Diabetic nephropathy (Kimmelstiel-Wilson disease), early monitoring of persons diagnosed with this disease is important.
Diabetes mellitus (For the presence of microalbuminuria)
This is the primary disorder associated with damage to the renal tubules.
Acute tubular necrosis (ATN)
In patients suffering from Acute tubular necrosis (ATN), what can cause damage to the RTE cells?
Decreased blood flow that causes a lack of oxygen presentation to the tubules
Presence of toxic substances in the urinary filtrate
What disorders can cause ischemic Acute tubular necrosis (ATN)?
Shock
Trauma (such as crushing injuries)
Surgical procedures
This is a general term indicating a severe condition that decreases the flow of blood throughout the body.
Shock
Enumerate some nephrotoxic agents/substances that can damage and affect the function of the RTE cells.
Aminoglycoside antibiotics Antifungal agent amphotericin B Cyclosporine Radiographic dye Organic solvents such as ethylene glycol, heavy metals, and toxic mushrooms
What is the treatment done for Acute tubular necrosis (ATN) which is followed effective management of the accompanying symptoms of acute renal failure.
Correction of ischemia
Removal of toxic substances
What are the urinalysis findings for patients suffering from Acute tubular necrosis (ATN)?
Mild proteinuria
Microscopic hematuria
Presence of RTE cells and RTE cell casts containing tubular fragments consisting of three or more cells
In patients diagnosed with Acute tubular necrosis (ATN), what other casts may be present due to the tubular damage?
Hyaling
Granular
Waxy
Broad
The disorder most frequently associated with tubular dysfunction.
Fanconi syndrome
This syndrome consists of a generalized failure of tubular reabsorption in the proximal convoluted tubule.
Fanconi syndrome
What are the substances most noticeably affected by the Fanconi syndrome?
Glucose Amino acids Phosphorus Sodium Potassium Bicarbonate Water
(T/F) Fanconi syndrome cannot be inherited but can be acquired through exposure to toxic agents, including heavy metals and outdated tetracycline, or as a complication of multiple myeloma and renal transplant.
F (Can also be inherited in association with cytinosis and Hartnup disease)
What are the urinalysis finding for Fanconi syndrome?
Glycosuria
Possible mild proteinuria
Urine concentration is regulated in what part of the renal system?
Distal convoluted tubule and collecting ducts
This type of diabetes insipidus is caused by the disruption of ADH by the inability of the renal tubules to respond and causes an excessive amount of urine to be excreted.
Nephrogenic Diabetes Insipidus
This type of diabetes insipidus is caused by the disruption of ADH due to the failure of the hypothalamus to produce ADH and causes an excessive amount of urine to be excreted.
Neurogenic Diabetes Insipidus
Nephrogenic Diabetes Insipidus can be inherited as a sex-linked recessive gene or acquired from what medications?
Lithium
Amphotericin B
What are the urinalysis findings associated with Diabetes Insipidus?
Low specific gravity
Pale yellow color
Possible false-negative results for chemical tests.
This syndrome exhibits a generalized failure to reabsorb substances from the glomerular filtrate.
Fanconi syndrome
This syndrome exhibits a failure to reabsorb glucose from the glomerular filtrate.
Renal glycosuria
Renal glycosuria is inherited as a/an (autosomal/sex-linked) recessive trait.
Autosomal
In Renal glycosuria, the number of glucose transporters in the tubules is (increased/decreased).
Decreased
In Renal glycosuria, the affinity of the transporters for glucose is (increased/decreased).
Decreased
(T/F) Disorders affecting the interstitium also affects the tubules
T (Results in commonly used term Tubulointerstitial disease)
What is the most common renal disease?
UTI
The term used to define infection of the bladder. If untreated, can progress to a more serious upper UTI.
Cytitis
Cytitis is seen (more/less) often in women and children who present with symptoms of urinary frequency and burning.
More
What are the urinalysis results associated with cystitis?
Presence of numerous WBCs and bacteria
Mild proteinuria and hematuria
Increased pH
The term used to denote the infection of the upper urinary tract, including both the tubules and interstitium and can occur in both acute and chronic forms.
Pyelonephritis
This type of pyelonephritis most frequently occurs as a result of ascending movement of bacteria from a lower UTI into the renal tubules and interstitium.
Acute Pyelonephritis
In acute pyelonephritis, what are the factors that enhances the ascending movement of bacteria from the bladder?
Conditions that interfere with the downward flow of urine from the ureters to the bladder
Complete emptying of the bladder during urination
This is the reflux of urine from the bladder back into the ureters.
Visicoureteral reflux
(T/F) There is a relatively high correlation between Acute Pyelonephritis and bacteremia
T
What are the urinalysis results associated with acute pyelonephritis ?
Presence of numerous WBCs and bacteria
Mild proteinuria and hematuria
Additional finding of WBC casts, signify infection within tubules
This urinalysis result is of primary diagnostic value for both acute and chronic pyelonephritis.
Additional finding or presence of WBC casts (signify infection within tubules)
The presence of this elements in the urine differentiates pyelonephritis from cytitis.
WBC casts
This type of pyelonephritis is a more serious disorder that can result in permanent damage to the renal tubules and possibly progression to chronic renal failure.
Chronic pyelonephritis
This is the most frequent cause of chronic pyelonephritis.
Congenital urinary structural defects producing a reflux nephropathy
What are the urinalysis results associated with chronic pyelonephritis in the early stages?
Presence of numerous WBCs and bacteria
Mild proteinuria and hematuria
Additional finding of WBC casts, signify infection within tubules
What are the urinalysis results associated with chronic pyelonephritis during its later stages?
Presence of granular, waxy and broad casts
Increased proteinuria and hematuria
Decreased renal cconcentration
This disorder is marked by inflammation of the renal intersitium followed by inflammation of the renal tubules.
Acute Interstitial Nephritis (AIN)
What are the symptoms of patients with Acute Interstitial Nephritis (AIN)?
Oliguria Edema Decreased renal concentrating ability Possible decrease in glomerular filtration rate Fever and skin rash (Initial symptoms)
This type of nephritis is associated with an allergic reaction to medications that occur within the renal intersitium, possibly caused by the binding of the medication to the interstitial protein.
Acute Interstitial Nephritis (AIN)
Enumerate drugs associated with Acute Interstitial Nephritis (AIN).
Penicillin Methicillin Ampicillin Cephalosporines Sulfonamides NSAIDs Thiazide diuretics
What are the urinalysis results associated with Acute Interstitial Nephritis (AIN)?
Hematuria, possibly macroscopic
Mild to moderate proteinuria
Numerous WBCs
WBC casts without the presence of bacteria
These are characteristics of the progression of renal failure to end-stage renal disease.
Marked decrease in the glomerular filtration rate; less than 25 mL/min
Rising serum BUN and creatinine values (Azotemia)
Electrolyte imbalance
Lack of renal concentrating ability (Produces isothenuric urine)
Proteinuria
Renal glycosuria
Abundance of granular, waxy, and broad casts (referred to as telescoped urine sediment)
In the progression of renal failure to end-stage renal disease, there is a marked decrease in the glomerular filtration rate; less than ___ mL/min
25
In the progression of renal failure to end-stage renal disease, serum BUN and creatinine values (increase/decrease)
Increase (Azotemia)
In the progression of renal failure to end-stage renal disease, this results in the production of isothenuric urine.
Lack of renal concentrating ability
In the progression of renal failure to end-stage renal disease, this is often referred to as “telescoped urine sediment.”
Abundance of granular, waxy, and broad casts
This type of renal failure exhibit a sudden loss of renal function and is frequently reversible
Acute renal failure (ARF)
What are the primary causes of Acute renal failure (ARF)?
Sudden decrease in blood flow to the kidney (Prerenal)
Acute glomerular and tubular disease (Renal)
Renal calculi or tumor obstructions (Postrenal)
What are the prerenal causes of Acute renal failure (ARF)?
Sudden decrease in blood flow to the kidney
What are the renal causes of Acute renal failure (ARF)?
Acute glomerular and tubular disease
What are the postrenal causes of Acute renal failure (ARF)?
Renal calculi or tumor obstructions
What are the general symptoms/characteristics of patients with Acute renal failure (ARF)?
Decreased GFR
Oliguria
Edema
Azotemia
These may form in the calyces and pelvis of the kidney, ureters, and bladder.
Renal calculi (Kidney stones)
Small calculi may be passed in the urine, subjecting the patient to severe pain radiating from the _____ to the _____.
Lower back
Legs
This is a procedure, using high-energy shock waves, that can be used to break stones located in the upper urinary tract into pieces that can be passed in the urine.
Lithotripsy
Aprroximately 75% of the renal calculi are composed of what compounds?
Calcium oxalate or phosphate
Aside from Calcium oxalate or phosphate, what are the other primary calculi constituents?
Magnesium ammonium phosphate (Stuvite)
Uric acid
Cystine
This calculi constituent may be associated with increased intake of foods with high purine content.
Uric acid calculi
The urine of patients suffering from renal calculi is (basic/acidic).
Acidic (higher than 7.0)
These calculi constituents are seen in conjunction with hereditary disorders of cystine metabolism.
Cystine calculi
These calculi constituents are frequently associated with metabolic calcium and phosphate disorders and occasionally diet.
Calcium calculi
These calculi constituents are frequently accompanied by urinary infections involving urea-splitting bacteria
Magnesium ammonium phosphate (Stuvite)
What is the primary urinalysis finding for patients with Renal lithiasis?
Microscopic hematuria resulting from irritation to the tissues by the moving calculus.
