Ch. 8 - Renal Disease Flashcards
0
Q
What are the different classifications of renal disease based on the area of the kidney primarily affected?
A
Glomerular
Tubular
Interstitial
1
Q
What is the major function of the kidneys?
A
Filtration of the blood to remove waste products
2
Q
Most of the disorders associated with the glomerulus are of _____ origin.
A
Immune
3
Q
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.
A
Immune complexes
4
Q
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.
A
Complement Neutrophils Lymphocytes Monocytes Cytokines
5
Q
Give a non-immunologic source for glomerular damage
A
Exposure to chemicals and toxins
6
Q
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.
A
Glomerulonephritis
7
Q
This is a disease marked by the sudden onset of symptoms consistent with damage to the glomerular membrane
A
Acute Glomerulonephritis
8
Q
What are the symptoms of the Acute glomerulonephritis (AGN)?
A
Fever Edema, most noticeable around the eyes Fatigue Hypertension Oliguria Hematuria
9
Q
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.
A
Acute Streptococcal Glomerulonephritis
10
Q
What disease exhibits these primary urinalysis findings: Marked hematuria Proteinuria Oliguria, accompanied by RBC casts Dysmorphic RBCs Hyaline and Granular casts White blood cells
A
Acute Glomerulonephritis
11
Q
What enzyme test can provide evidence that the acute glomerulonephritis is of streptococcal origin?
A
Demonstration of an elevated serum antistreptolysin-O (ASO) titer or anti-group A streptococcal test
12
Q
This is a more serious form of acute glomerulonephritis and has a much more poorer prognosis, often terminating in renal failure.
A
Rapidly Progressive (or Crescentic) glomerulonephritis
13
Q
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
A
Permanent
14
Q
The lab results of Acute glomerulonephritis is similar to the rapidly progressive glomerulonephritis (T/F)
A
True
15
Q
An autoimmune disorder, seen in conjunction with RPGN
A
Goodpasture syndrome
16
Q
In good pasture syndrome, what are the initial pulmonary complaints?
A
Hemoptysis - caughing up blood
Dyspnea
Followed by development of hematuria
17
Q
What disease exhibits these urinalysis results:
Proteinemia
Hematuria
Presence of RBC casts
Progression to chronic glomerulonephritis and end-stage renal failure is common
A
Goodpasture syndrome
18
Q
This disease causes a granuloma-producing inflammation of the small blood vessels of primarily the kidney and respiratory
A
Wegener’s granulomatosis
19
Q
What is the key to the diagnosis of Wegener’s granulomatosis?
A
Demonstration of antineutrophilic cytoplasmic antibody (ANCA) in the patients serum
20
Q
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
A
Wegener’s granulomatosis
21
Q
This is a disease occurring primarily in children following upper respiratory infection
A
Henoch-Schönlein pupura
22
Q
What are the initial symptoms of Henoch-Schönlein pupura
A
Appearance of raised, red patches on the skins.
Blood in the sputum and stool may be present
24
Q
Renal involvement is the most serious complication of this disorder and may range from mild to heavy proteinuria and hematuria with RBC casts
A
Henoch-Schönlein pupura
25
The predominant characteristic of this disease is a pronounced thickening of the glomerular basement membrane resulting from the deposition of IgG complexes.
Membranous Glomerulonephritis
26
Enumerate some disorders associated with the development of membranous glomerulonephritis.
```
Systemic lupus erythemtaosus
Sjogren syndrome
Secondary syphilis
Hepatitis B
Gold and mercury treatments
Malgnancy
```
27
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)
28
This disease is marked by two different alterations in the cellularity of the glomerulus and peripheral capillaries.
Membranoproliferative glomerulonephritis (MPGN)
29
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
30
This type of Membranoproliferative glomerulonephritis (MPGN) displays extremely dense deposits in the glomerular basement membrane.
Type 2
31
What are the usual laboratory findings for Membranoproliferative glomerulonephritis (MPGN)?
Hematuria
Proteinuria
Decreased serum complement levels
32
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)
33
In chronic glomerulonephritis, (increased/decreased) glomerular filtration rate is present in conjuction with increased BUN and creatinine levels and electrolyte imbalance
Decreased
34
This is also known as the Berger disease
Immunoglobulin A nephropathy
35
This is a disease wherein immune complexes containing IgA are deposited in the glomerular membrane.
Immunoglobulin A nephropathy (Berger disease)
36
This is the most common cause of glomerulonephritis.
Immunoglobulin A nephropathy (Berger disease)
37
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
38
Patients suffering from this disorder usually present with an episode of macroscopic hematuria following an infection or strenuous exercise.
Immunoglobulin A nephropathy (Berger disease)
39
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)
40
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
41
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
42
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
```
43
This disorder is also known as lipid nephrosis.
Minimal Change disease
44
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)
45
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
46
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
47
This disorder responds well to corticosteroids.
Minimal Change disease (Lipid nephrosis)
48
This disorder affects only certain numbers and areas of glomeruli, and the others remain normal.
Focal Segmental Glomerulosclerosis (FSGS)
49
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)
50
In this disorder, IgM and C3 are a frequent finding and can be seen in undamaged glomeruli.
Focal Segmental Glomerulosclerosis (FSGS)
51
What immune deposits can be frequently seen in a patien suffering from Focal Segmental Glomerulosclerosis (FSGS)?
IgM and C3
52
What are the most consistent urinalysis findings in patients suffering from Focal Segmental Glomerulosclerosis (FSGS)?
Moderate to heavy proteinuria
| Microscopic hematuria
53
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
54
Alport syndrome more frequently affects (males than females/females than males).
Males than females
55
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
56
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
57
This is also known as Kimmelstiel-Wilson disease
Diabetic nephropathy
58
This is currently the most common cause of end-stage renal disease.
Diabetic nephropathy (Kimmelstiel-Wilson disease)
59
Diabetic nephropathy (Kimmelstiel-Wilson disease) causes damage to this membrane as a result of glomerular membrane thickening and increased proliferation of mesanglial cells
Glomerular
60
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)
61
The vascular structure of the glomerulus also develops sclerosis in patients suffering from this disorder.
Diabetic nephropathy (Kimmelstiel-Wilson disease)
62
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)
63
This is the primary disorder associated with damage to the renal tubules.
Acute tubular necrosis (ATN)
64
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
65
What disorders can cause ischemic Acute tubular necrosis (ATN)?
Shock
Trauma (such as crushing injuries)
Surgical procedures
66
This is a general term indicating a severe condition that decreases the flow of blood throughout the body.
Shock
67
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
```
68
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
69
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
70
In patients diagnosed with Acute tubular necrosis (ATN), what other casts may be present due to the tubular damage?
Hyaling
Granular
Waxy
Broad
71
The disorder most frequently associated with tubular dysfunction.
Fanconi syndrome
72
This syndrome consists of a generalized failure of tubular reabsorption in the proximal convoluted tubule.
Fanconi syndrome
73
What are the substances most noticeably affected by the Fanconi syndrome?
```
Glucose
Amino acids
Phosphorus
Sodium
Potassium
Bicarbonate
Water
```
74
(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)
75
What are the urinalysis finding for Fanconi syndrome?
Glycosuria
| Possible mild proteinuria
76
Urine concentration is regulated in what part of the renal system?
Distal convoluted tubule and collecting ducts
77
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
78
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
79
Nephrogenic Diabetes Insipidus can be inherited as a sex-linked recessive gene or acquired from what medications?
Lithium
| Amphotericin B
80
What are the urinalysis findings associated with Diabetes Insipidus?
Low specific gravity
Pale yellow color
Possible false-negative results for chemical tests.
81
This syndrome exhibits a generalized failure to reabsorb substances from the glomerular filtrate.
Fanconi syndrome
82
This syndrome exhibits a failure to reabsorb glucose from the glomerular filtrate.
Renal glycosuria
83
Renal glycosuria is inherited as a/an (autosomal/sex-linked) recessive trait.
Autosomal
84
In Renal glycosuria, the number of glucose transporters in the tubules is (increased/decreased).
Decreased
85
In Renal glycosuria, the affinity of the transporters for glucose is (increased/decreased).
Decreased
86
(T/F) Disorders affecting the interstitium also affects the tubules
T (Results in commonly used term Tubulointerstitial disease)
87
What is the most common renal disease?
UTI
88
The term used to define infection of the bladder. If untreated, can progress to a more serious upper UTI.
Cytitis
89
Cytitis is seen (more/less) often in women and children who present with symptoms of urinary frequency and burning.
More
90
What are the urinalysis results associated with cystitis?
Presence of numerous WBCs and bacteria
Mild proteinuria and hematuria
Increased pH
91
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
92
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
93
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
94
This is the reflux of urine from the bladder back into the ureters.
Visicoureteral reflux
95
(T/F) There is a relatively high correlation between Acute Pyelonephritis and bacteremia
T
96
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
97
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)
98
The presence of this elements in the urine differentiates pyelonephritis from cytitis.
WBC casts
99
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
100
This is the most frequent cause of chronic pyelonephritis.
Congenital urinary structural defects producing a reflux nephropathy
101
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
102
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
103
This disorder is marked by inflammation of the renal intersitium followed by inflammation of the renal tubules.
Acute Interstitial Nephritis (AIN)
104
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)
```
105
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)
106
Enumerate drugs associated with Acute Interstitial Nephritis (AIN).
```
Penicillin
Methicillin
Ampicillin
Cephalosporines
Sulfonamides
NSAIDs
Thiazide diuretics
```
107
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
108
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)
109
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
110
In the progression of renal failure to end-stage renal disease, serum BUN and creatinine values (increase/decrease)
Increase (Azotemia)
111
In the progression of renal failure to end-stage renal disease, this results in the production of isothenuric urine.
Lack of renal concentrating ability
112
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
113
This type of renal failure exhibit a sudden loss of renal function and is frequently reversible
Acute renal failure (ARF)
114
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)
115
What are the prerenal causes of Acute renal failure (ARF)?
Sudden decrease in blood flow to the kidney
116
What are the renal causes of Acute renal failure (ARF)?
Acute glomerular and tubular disease
117
What are the postrenal causes of Acute renal failure (ARF)?
Renal calculi or tumor obstructions
118
What are the general symptoms/characteristics of patients with Acute renal failure (ARF)?
Decreased GFR
Oliguria
Edema
Azotemia
119
These may form in the calyces and pelvis of the kidney, ureters, and bladder.
Renal calculi (Kidney stones)
120
Small calculi may be passed in the urine, subjecting the patient to severe pain radiating from the _____ to the _____.
Lower back
| Legs
121
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
122
Aprroximately 75% of the renal calculi are composed of what compounds?
Calcium oxalate or phosphate
123
Aside from Calcium oxalate or phosphate, what are the other primary calculi constituents?
Magnesium ammonium phosphate (Stuvite)
Uric acid
Cystine
124
This calculi constituent may be associated with increased intake of foods with high purine content.
Uric acid calculi
125
The urine of patients suffering from renal calculi is (basic/acidic).
Acidic (higher than 7.0)
126
These calculi constituents are seen in conjunction with hereditary disorders of cystine metabolism.
Cystine calculi
127
These calculi constituents are frequently associated with metabolic calcium and phosphate disorders and occasionally diet.
Calcium calculi
128
These calculi constituents are frequently accompanied by urinary infections involving urea-splitting bacteria
Magnesium ammonium phosphate (Stuvite)
129
What is the primary urinalysis finding for patients with Renal lithiasis?
Microscopic hematuria resulting from irritation to the tissues by the moving calculus.
