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