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Systemic Pathology Test 2 > Diseases of the Kidney > Flashcards

Diseases of the Kidney Flashcards

1
Q

What part of the kidney receives most of the renal circulation and how much?

A

The cortex receives 90%

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2
Q

The main renal artery supplies what part of the kidney by dividing into?

A

Supplies the glomeruli by dividing into capillary loops

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3
Q

Capillary loops exit as?

A

Efferent arterioles

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4
Q

Glomerular disease that affects capillary blood flow affects what parts of the kidney?

A

Cortical and medullary tubules

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5
Q

How much interference is required to cause medullary necrosis?

A

Only minor interference

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6
Q

What are glomeruli?

A

Anastomosing network of capillaries

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7
Q

What lines the glomeruli?

A

Fenestrated epithelium

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8
Q

What type of epithelium is part of the intrinsic capillary wall?

A

Visceral epithelium

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9
Q

Where does filtrate collect?

A

Bowman’s capsule

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10
Q

What kind of epithelium lines the Bowman’s capsule?

A

Parietal epithelium

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11
Q

What type of cells support the glomerular tuft?

A

Mesangial cells

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12
Q

The glomerular filtration barrier has high permeability to? Low permeability to?

A

High permeability to water and small solutes. Low to large, negatively charged proteins

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13
Q

What maintains the barrier?

A

Visceral epithelial cells

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14
Q

How much of filtered solutes are absorbed by proximal tubular cells?

A

2/3

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15
Q

Proximal tubules are highly susceptible to?

A

Ischemic necrosis and chemical injury

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16
Q

What is the interstitium composed of?

A

Fenestrated peritubular capillaries and cells

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17
Q

What are the two overarching functions of the kidney?

A

Urine production and endocrine

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18
Q

What are the 4 functions of the kidney that fall under urine production?

A
  1. Maintains constancy of volume and composition of extracellular fluid
  2. Excretion of metabolic waste products
  3. Regulation of body’s concentration of salt and water
  4. Maintain acidic balance of plasma
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19
Q

What hormones are produced by the kidney?

A

Renin, erythropoeitin, and 1,25-dihydroxycholecalciferol

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20
Q

What cells produce renin?

A

Juxtomedullary cells

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21
Q

1,25-dihydroxycholecalciferol is involved with metabolism of?

A

Calcium

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22
Q

What are treatments for renal failure?

A

Dialysis and transplantation

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23
Q

The glomerulus is highly susceptible to what type of injury?

A

Immunologically mediated

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24
Q

The tubules and interstitial are susceptible to what type of injury?

A

Toxic, infectious, drug overdoses

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25
Q

Urinalysis looks for what 3 things?

A

Proteinuria- protein in urine due to glomerular or tubular damage
Hematuria- blood in urine
Pyuria- pus in urine

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26
Q

Which of those 3 is often diagnostic?

A

The extent of hematuria

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27
Q

Pyuria is associated with?

A

infection

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28
Q

Glomerular disease is indicated by?

A

High levels of proteinuria and hematuria

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29
Q

What is hyposthenuria and what causes it?

A

Hypotonic urine caused by inability of the tubules to concentrate

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30
Q

What is oliguria?

A

A decrease in the amount of urine, 400

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31
Q

What is anuria?

A

A lack of urine production, less than 200

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32
Q

Azotemia refers to increased levels of? Caused by?

A

Creatinine and BUN. Caused by decreased glomerular filtration rate

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33
Q

What are the 3 congenital kidney disorders we studied?

A

Ectopic kidney, renal hypoplasia, polycystic kidney disease

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34
Q

What is renal hypoplasia?

A

Failure of the kidney to develop completely, usually unilateral

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35
Q

An ectopic kidney is?

A

When nephrons develop in abnormal positions

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36
Q

What is adult polycystic disease?

A

Expanding cysts of both kidneys lead to renal failure and destruction of the parenchyma

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37
Q

In polycystic disease, cysts are often found in what other organ?

A

Liver

38
Q

Those with polycystic disease often develop?

A

Hypertension or UTI

39
Q

How is polycystic disease treated and what is the usual cause of death?

A

Transplant, death due to uremia or hypertensive crisis

40
Q

What happens in acute nephritic syndrome?

A

Acute onset of severe hematuria, moderate proteinuria, oliguria. See fluid retention and renin release from ischemic kidneys

41
Q

Describe the pathogenesis of acute nephritic syndrome

A

Proliferation of cells in glomeruli, WBC infiltrate, capillary wall drainage, low GFR

42
Q

What happens in the early stages of renal failure?

A

Can’t concentrate urine and conserve water, sodium loss, and dehydration

43
Q

What happens in acute renal failure?

A

Rapid onset, reversible

Caused by glomerular, interstitial, or vascular injury

44
Q

What causes chronic renal failure?

A

Gradual onset irreversible

End result of all chronic renal diseases

45
Q

What happens to the skin as a result of chronic renal failure?

A

Uremic frost

46
Q

What 3 conditions can occur due to chronic renal failure?

A

Osteodystrophy, secondary hyperparathyroidism, and metastatic calcifications

47
Q

What is the overarching cause of glomerular kidney diseases?

A

Immune injury

48
Q

What causes the immune injury in glomerular kidney diseases?

A

Antibodies within the glomerulus reacting with intrinsic antigens or extrinsic antigens

Deposition of soluble circulating antigen-antibody complexes (seen in SLE, Hep B, HIV)

49
Q

What is the most common glomerular diagnosis?

A

IgA nephropathy or Berger disease

50
Q

IgA nephropathy is a common cause of?

A

Gross/microscopic hematuria

51
Q

IgA deposits itself in?

A

Mesangium leading to proliferation and matrix increase

52
Q

What types of UTI’s are often asymptomatic?

A

Chronic

53
Q

UTI’s confined to the bladder and urethra are called?

A

Cystitis

54
Q

UTI’s that go the kidney are called?

A

Pyelonephritis

55
Q

Pyelonephritis is typically caused by what bacteria?

A

Gram negatives like E coli

56
Q

How do the bacteria gain entry to the kidney?

A

Vesicoureteral Valves don’t function properly and allow relfux from bladder up the ureter, catheter, or

57
Q

What symptoms are typical of acute pyelonephritis?

A

Sudden onset with patin at cost vertebral angle, fever, malaise, dysuria. Frequent and urgent urination

58
Q

What is the gross appearance of the kidney in acute?

A

Necrosis with superficial abscesses and suppration

59
Q

How is acute pyelonephritis treated? However what remains even after treatment and what further precautions must be taken?

A

Antibiotics, however the kidney remains scarred. It can be recurrent if the causative factors are not addressed

60
Q

Chronic pyelonephritis can lead to what if not treated?

A

End stage renal disease

61
Q

How does chronic pyelonephritis manifest itself?

A

Lower back pain, fever, pyuria, or clinically silent, hypertension

62
Q

Describe the appearance of the kidney affected by chronic pyelonephritis?

A

Shrunken and irregularly scarred

63
Q

The tubules of the cortex become _____ in chronic pyelonephritis?

A

They become dilated with thyroidization

64
Q

What is the most common UT obstruction?

A

Kidney stone or renal calculi

65
Q

Why does acute obstruction cause pain?

A

Distention of collecting system or renal capsule

66
Q

Unrelieved obstruction always leads to?

A

Enlarged kidneys, interstitial inflammation, and permanent cortical and medullary atrophy

67
Q

If obstruction is below the bladder it causes?

A

Bladder distention

68
Q

If obstruction is unilateral the symptoms are?

A

Silent because the other kidney can maintain renal function

69
Q

Partial bilateral obstruction leads to?

A

Unable to concentrate urin, polyuria and nocturia

70
Q

Complete bilateral obstruction leads to?

A

Anuria, oligura. This is not compatible with survival, patient becomes uremic (urea in the blood)

71
Q

Why does GFR persist even with complete obstruction?

A

Persists initially due to back diffusion of filtrate into renal interstitium

72
Q

What is hydronephrosis?

A

Dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to outflow obstruction of urine

73
Q

When does bilateral and unilateral hydronephrosis occur?

A

Bilateral when below, uni when above

74
Q

Renal calculi occurs more often in men or women? Where do most arise? Are big or small stones better?

A

Men, kidney, big is better because they stay in place and don’t enter the urethra causing bleeding and pain

75
Q

What causes renal calculi?

A

Urine supersaturated with certain mineral which then precipitates as a solid crystal

76
Q

What is the most common malignant renal tumor? What does it develop from and in whom?

A

Renal cell carcinoma

Tubule epithelial cells of the cortex in older male smokers

77
Q

What is the triad of classic symptoms for renal cell carcinoma?

A

Costovertebral fullness or pain in back, hematura, palpable mass

78
Q

Where does renal cell carcinoma often metastasis to?

A

Lung or bone

79
Q

Where does filtered urine collect?

A

Renal pelvis

80
Q

The kidney stains how in chronic pyelonephritis?

A

Eosinophilic

81
Q

What are cellular casts?

A

WBC/RBC trapped in the renal tubules

82
Q

What are non-cellular casts?

A

Precipitated proteins

83
Q

How do the kidneys appear in childhood polycystic disease?

A

Bilaterally enlarged kidneys with a smooth appearance

84
Q

Those with childhood polycystic die from? If they survive infancy they have?

A

Renal or pulmonary failure. Congenital hepatic fibrosis

85
Q

Nephrotic syndrome involves?

A

Severe proteinuria, hypoalbuminemia, hyperlipidemia, and lipiduria

86
Q

In those under 15 nephrotic syndrome is due to? Adults?

A

Kidney disease and systemic disease respectively

87
Q

What is rapidly progressive glomerulonephritis? What causes it? How is it treated?

A

Disease with rapid loss of kidney function and oliguria, immune mediated.

Treated with steroids and cytotoxic agents

88
Q

Rapidly progressive is AKA?

A

Crescentric

89
Q

Minimal change disease is AKA? It is the most common nephrotic syndrome in?

A

Lipoid nephrosis, children

90
Q

Minimal change disease often follows?

A

Viral infection or routine prophylaxis

91
Q

Minimal change disease responds to?

A

Corticosteroid therapy

Systemic Pathology Test 2 (10 decks)

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