Chapter 41: Disorders of Renal Function Flashcards
disorders of kidney
-subject to many of the same types of disorders that affect other body structures \+developmental defects \+infections \+altered immune responses \+neoplasms
fetal anomalies
+most common: anomalies in shape and position
+less common: a decrease in renal mass (i.e agenesis, hypogensis) & a change in renal structure (i.e renal cysts)
organ development
+dysgenesis: failure of an organ to develop normally
+agenesis: the complete failure of an organ to develop
potter syndrome
+characteristic facial features of newborns with renal agenesis
- the eyes are widely separated and have epicanthic
- ears are low set
- the nose is broad and flat
- the chin is receding
- lim defects often are present
Causes of neonatal renal failure with potter phenotype
+cystic renal dysplasa
+obstructive uropathy
+autosomal recessive polycystic disease
+unilateral agenesis (uncommon)
cystic disease of the kidney
+definition: fluid filled sacs or segments of dialated nephron
+causes:
-tubular obstruction that increase intratubular pressure
- changes in the basement membrane of the renal tubules that predispose to cystic dilatation
types of cystic disease of the kidney
-simple and acquired renal cysts
-medullary cystic disease
-polycystic kidney disease
+autosomal recessive polycystic kidney disease
+autosomal dominant polycystic kidney disease
causes of urinary tract obstruction
- developmental defects
- calculi (stones)
- pregnancy
- benign prostatic hyperplasia
- scar tissue resulting from infection and inflammation
- tumors
- neurologic disorders such as spinal cord injury
Damaging effects of urinary obstruction
+stasis of urine
- predisposes to infection and stone formation
+ development of back pressure
- interferes with renal blood flow and destroys kidney tissue
Kidney stones
+def: crystalline structure that form from components of the urine
+requirements for formation
-a nidus to form
-a urinary environment that supports continued crystallization of stone components
Factors influencing the formation of kidney stones
+ the concentratin of stone compenents in the urine
+the ability of stone components to complex and form stones
+the presence of substances that inhibit stone formation
types of kidney stones
\+calcium stones -oxalate or phosphate \+magnesium ammonium phosphate stones \+uric acid stones \+cystine stones
Kidney stone treatment
+preventative (dietary restrictionm calcium salt supplementation, thiazide diuretics, cellulose phosphate)
+treatment for pain
+antibiotic for infection
+removing stones: Ureteoscopic removal, percutaneous removal, extracorporeal lithotripsy
+diagnosis
-urialysis, radiography, intravenous pyelography, ultrasonography
Types of Urinary tract infections (A.S.L.U)
- asymptomatic bacteriuria
- symptomatic infections
- lower UTIs: cystitis
- upper UTIs: pyelonephritis
causes of UTIs
- most uncomplicated UTIs is cause by Escherichia coli
- other uropathis pathogens include: Staphylocococcus sapophyticus in uncomplicated UTIs, Both non-E.coli from-negative rods, Gram-positive cocci in complicated UTIs
- most cause by bacteria that enter through the urethra
Causes of UTIs associated with stasis of urine flow
\+anatomic obstructions -urinary tract stones - prostatic hyperplasia - pregnancy -malformations of the ureterovesical juncton \+ increase pressure resulting in reflux \+functional obstructions -neurogenic bladder -infrequent voiding - detrusor (bladder) muscle instability -constipation
protective mechanisms
- washout phenomenon
- mucin layer
- local immune responses
- normal flora of the periurethral area in women
- prostate secretions in men
Characteristics of acute episode of cystitis
- frequency of urination (as often as every 20 minutes)
- lower abdominal or back discomfort
- burning and pain on urination (dysuria)
- cloudy and foul smelling urine on occasion
Special considerations of UTI patients
- sexually active women
- pregnant women
- age related effects
diagnosis and treatment of UTIs
- diagnosis based on symptoms and on examination of the urine for the presence of microorganisms
- X-ray films, ultrasonography, and CT and renal scans are used to identify contributing factors
- urine dipstick
- treatment of UTI is based on the pathogen causing the infection
Characteristics of Glomerylonephritis
+immune mechanisms
-glomerular antibodies
- circulating antigen-antibody complexes
+characteristics
-hematuria with red blood cell casts
-a diminished glomerular filtration rate (GFR)
-azotemia presence of nitrogenous wastes in the blood
-oliguria
-hypertension
Causes of glomerulonephritis
+disease that provoke a proliferative inflammatory response of the endothelial, mesangial, or epithelial cells of the glomeruli
+the inflammatory process:
- damages the capillary wall
-permits red blood cells to escape into the urine
-produces hemodynamic changes that decrease the GFR
Cellular changes in Glomerular Disease
\+proliferative: endothelial, mesangial, leukocyte, crescent formation \+ basement membrane thickening \+sclerosis \+fibrosis \+diffuse glomerular changes \+focal glomerular changes \+segmental glomerular changes \+mesangial changes
urinary changes in glomerulonephritis
\+proteinuria \+hematuria \+pyuria \+oliguria \+edema \+hypertension \+azotemia
Types of Glomerular disease
\+acute proliferative glomerulonephritis \+rapidly progressive " " \+Nephrotic syndrome \+ membranous glomerulonephritis \+minial change disease (lipoid nephrosis_ \+focal segmental glomerulosclerosis \+IgA nephropathy \+chronis glomerulonephritis
Tubulointerstitial disorders
+damage to the proximal, loop, or distal portion of the nephron
- acute tubular necrosis
- renal tubular acidosis
- pyelonephritis
- the effects of drugs and toxins
Proximal and distal tubular acidosis
- renal tubular acidosis
- proximal tubular disorders that affect bicarbonate re absorption
- distal tubular defects that affect the secretion o fixed metabolic acids
Major groups of renal neoplasms
\+embryonic kidney tumors occurring during childhood -wilms tumor -onset 3-5 years -in one or both kidney -WT1 mutation on chromosome 11 \+ adult kidney cancers -renal cell carcinoma
