Disease Correlations: Tubular Diseases Flashcards
Acute Tubular Necrosis (ATN)
2 types, leads to?
RTE destruction, aschemic ATN: blood flow loss, sheets of RTE, casts
Toxic ATN: proximal tubules
Leads to acute renal failure, damage can be reversed
Acute Tubular Necrosis: Correlations
Positive blood
Low SG
WBCs
Increased RTEs
Casts: renal cell, granular, waxy, broad
Tubular Dysfunction: General
Normal glomerular filtration
- Affects only one portion of renal tubule
- One solute or many are affected
- Genetic abnormality vs. metabolic buildup
- Can be primary or secondary
Fanconi’s Syndrome
what is it, can be caused by
Loss of proximal tubule function: stubstances that are reabsorbed still get released in urine
Can be caused by: inherited metabolic disease, toxin exposure, glomerulonephritis
Renal Glucosuria
what is it
Inherited: autosomal recessive
- Decreased reabsorption of glucose: ends up in urine
- Benign, normal blood glucose levels
Nephrogenic Diabetes Insipidus
what is it
Tubule is nonresponsive to ADH
- Release a lot of urine
- Dilute urine, decreased water retention, increase plasma osmalarity
Genetic or acquired, excessive thirst
Renal Tubular Acidosis (RTA)
And systemic metabolic acidosis
Tubules can’t secrete H+ ions OR can’t absorb bicarb
Inherited: autosomal dominant
Secondary to tissue damage
Systemic metabolic acidosis: paralysis, renal failure with neutral or basic urine
Cystinuria
what is it, what does it cause
Tubular disease
Tubules can’t absorb cystine/amino acids
- Inherited
- Increased risk of kidney stones
Cystinosis
what is it, age?
Metabolic Disease
Cystine deposits throughout body: can cause Fanconi’s
- Inherited: typically in infancy
Renal Phosphaturia
what, symptoms
Rare inherited: sex linked
Distal tubules unable to reabsorb inorganic phosphorus
Low serum phos levels, decreased bone growth
Interstitial Diseases
3 types
- Tubulointerstitial
- UTI
- Acute interstitial Nephritis
Urinary Tract Infections
locations, risk, causes
Lower: urethra, bladder
Upper: ureter, renal pelvis, interstitium
Increased risk in women: urethra length, hormones, intercourse, no prostatic fluid
Causes?
Usually sterile urine, but bacteria in distal parts of urethra
- 85% are endogenous
- Some hospital-acquired
Lower UTI
what is it, UA, symptoms
Bladder infection
- Pain, burning at urination, incomplete and infrequent voids
UA:
- WBCs, bacteria, nitrite, culture with >100,000 colinies/mL
- Possible low protein, blood, transitional epis
Acute Pyleonephritis (AP)
what is it, what does it cause, where
Bacteria proliferate in interstitium: toxins, WBC damage in tubules, recurrence
Upper UTI/kidney infection
Causes: reflux, obstructions, stones, blood infection, infection from lower going up the tract
AP/Upper UTI: Correlations
UA
- Bacteria, WBC, nitrite
- __Casts__
- Protein, blood variable
- RTE, transitional
- Low SG
Other
- Sudden
- Flank pain
- Urgency
- Fever nausea, malaise, etc.
Chronic Pyelonephritis
what is it, what does it causes
Permanent scarring of renal tissue
Causes: untreated/repeat infections, reflux nephropathies, chronic obstruction
- Renal calyces dilated and deformed, 10-15% lead to CRF and dialysis
Acute Interstitial Nephritis (AIN)
what is it
Response to drug or toxin
- Allergic, toxic, drug abuse
- High WBC infiltrate, PMNs or eos
- Remove drug or toxin, sometimes irreversible
Acute Interstitial Nephritis Correlations
UA
- Hematuria, mild proteinuria, “sterile” leukocyturia
- Eosinophils (microscopic only)
- WBC casts
Urolithiasis
what does it cause, crystals (4)
“Kidney stones”, renal calculi: solid aggregates of chemicals
Mostly in renal calyces and pelvis
- Mostly calcium, triple phosphate, uric acid, cystine
Stones: Formation & Correlation
- Increase in chemical salt concentration
- Changes in pH
- Urinary stasis
- Foreign body seed
Correlation: pain, hematuria, crystal
Acute Renal Failure
Sudden drop in glomerular filtration rate: can’t remove waste (azotemia), can’t concentrate urinem oliguria
- Reversible but can be fatal
- Can be renal or non-renal causes
Acute Renal Failure Causes
pre, renal, post
Pre-renal
- Loss of blood flow
- Ateriole BP < 80 mmHg
- Hepatorenal syndrome
- Increased serum Na
Renal
- Any renal disease, especially acute
- Renal/glomerular damage
Post-renal
- Obstruction
Chronic Renal Failure
- Irreversible and progressive (months/years) loss of renal function
- Mostly because of glomerular disease
- Progresses to end stage renal disease eventually, based on %GF and symptoms
Chronic Renal Failure Correlations
SG special
UA
- Low and fixed SG = 1.010
- Chronic proteinuria
- Hemoglobinuria, waxy and broad casts
Other
- Azotemia, acid/base issues, abnormal electrolytes
- Oliguria, hypertension, edema
End Stage Renal Disease (ESRD)
- <5% of normal GFR
- Glomerular scarring
- Reduced capillaries
- Tubular atrophy
- Renal fibrosis
- Reduced kidney mass
Dialysis/transplant required
Aminoaciduria
3 of them, inherited vs secondary
Overflow, no-threshold, or renal causes
Inherited
- Defective/defic. enzyme, error of metabolism
- Tubular dysfunction
Secondary
- Other primary renal disease or generalized tubular dysfunction like Fanconi’s
Overflow Aminoaciduria
Increased plasma levels spill into urine
- IEMs
- Phenylketonuria (PKU)
- Maple syrup urine disease
- Tyrinsosis
No-Threshold Aminoaciduria
No normal renal mechanism for reabsorption
- Metabolic stage is not normal form because of IEM
- Don’t need ecessive levels in plasma to see in urine
- Homocystinuria
Renal-Transport Aminoaciduria
Abnormal protein responsible for reabsorption decreases the tubular function
- Normal plasma and metabolism
- Cystinuria
Other Metabolic Conditions
Porphyrins
- Inherited or acquired from lead poison
- Wine colored urine, skin marks
Carb Disorders
- Galactosuria: enzyme defic. serious
- Purine disorders: excessive uric acid
