Diseases of the Renal System 1 Flashcards
What are the 4 main functions of the kidney
Eliminate metabolic waste products
Regulate fluid and electrolyte balance
Acid-base balance
Produce some hormones (renin, erythropoietin)
What are the 2 main types of mechanisms of glomerular damage?
Immunological
Non-immunological
Give 4 conditions whcih cause damage to the glomerulus by immune complexes being deposited in the glomerulus
Lupus
IgA nephropathy
Henoch Schonlein Purpura
Membranous purpura
Give 2 examples of conditions that cause damage to the basement membrane through the deposition of antibodies
Anti glomerular basement membrane disease (goodpasture’s syndrome)
Post infective glomerulonephritis
5 mechanisms of vascular damage in the kidneys
Thrombotic microangiopathy Vasculitis Hypertension Diabetes Atheroma e.g. renal artery stenosis
Thrombi in capillaries and small arterioles, due to damaged endothelium (bacterial toxins, drugs) or abnormalities in clotting e.g haemolytic uraemic syndrome
Thrombotic microangiopathy
Give an example of vasculitis that can affect the kidney
Wegener’s granulomatosis
Nephrotic syndrome is due to damage of what part of the renal system?
Glomerulus
What are the signs of nephrotic syndrome
Hypoalbuminaemia Proteinuria Oedema \+/-hypertension \+/-hyperlipidaemia
Complciations of nephrotic syndrome
Infections, thrombosis
4 causes of nephrotic syndrome
Membranous neuropathy
Focal segmental glomerulosclerosis (FSGS)
Minimal change disease
Diabetes, lupus nephritis, amyloid
Most common cause of nephrotic syndrome
Membranous neuropathy
Primary glomerular disorder of unknown cause. 30-60yrs, 20-30% progress to end stage renal failure
Membranous neuropathy
A pattern of kidney damage affecting the podocytes, with various possible causes (idiopathic, genetic, heroin use, HIV)
Focal segmental glomerulosclerosis
Which causes of nephrotic syndrome are more common in males than females?
Membranous neuropathy
Focal segmental glomerulosclerosis
In children, what are the most common causes of nephrotic syndrome?
Minimal change disease, or FSGS (less common)
What are the 5 signs of acute nephritis
Oedema Proteinuria Acute renal failure Haematuria Hypertension
Both nephrotic syndrome and nephritis OPAHH
4 main causes of acute nephritis
Post infective glomerulonephritis
IgA nephropathy
Vasculitis
Lupus
Typically occurs a few weeks after streptococcoal throat infection; common cause of acute nephritis
post infective glomerulonephritis
Most common primary glomerular disease- teenagers and young adults iwth haematuria
IgA nephropathy
What proportion of people with IgA nephropathy will progress to renal failure over 20 years
20-50%
Cause of nephritic syndrome; presents with fever, generally unwell, rash, myalgia, arthralgia
Vasculitis
Autoimmune disease commonly affecting women, that can be a cause of acute nephritis
Lupus
What are the 3 most common causes of nephritis in children?
Post infective glomerulonephritis
IgA nephropathy
hencoch-schonlein purpura
haemolytic-uraemic syndrome
A specific type of IgA nephropathy that is more common in males than females- arthralgia ,abdo pain, rash and haematuria and acute renal failure
Henoch schonlein purpura
Typically affects children with E.coli 0157 enteritis
Haemolytic uraemic syndrome
What are the 3 signs of haemolytic uraemic syndrome
Acute nephritis, haemolysis and thrombocytopenia
What 3 things must be present for a diagnosis of acute renal failure
Anuria/oliguria
High plasma creatinine levels
High plasma Urea
What are the 3 classes of causes for acute renal failure
pre-renal
renal
post-renal
Give 2 examples of pre renal causes of acute kidney failure
Severe dehydration
Hypotension e.g. bleeding, septic shock, LV failure
Give 3 examples of post renal causes of acute kidney failure
Tumours
bladder stones
prostatic enlargement
Give 4 examples of renal causes of acute renal failure
Vasculitis
Acute interstitial nephritis
Give 3 examples of renal causes of acute renal failure in children
Henoch schonlein purpura
Hameolytic uraemic syndrome
acute interstitial nephritis
5 complications of acute kidney disease
Cardiac failure Arrythmias GI bleeding Jaundice Infection
Which might cardiac failure results from acute kidney failure?
Fluid overload
Treatment for acute kidney disease
Short term dialysis
Treat underlying cause
Permanently decreased GFR and less nephrons
Chronic renal failure
Briefly outline the stages of chronic renal failure
1-2 no treatment
3-moderate reduction in GFR
4- severe reduction in GFR
5-end stage kidney failure
3 causes of chronic renal failure
Diabetes
Glomerulonephritis
Reflux nephropathy
Chronic reflux of urine up the ureter leading to repeated infections and scarring
Reflux nephropathy
What does a renal biopsy tell you in chronic renal failure?
Scarring, no evidence of initial cause
4 effects of chronic renal failure
Decreased excretion of water and electrolytes-oedema and hypertension
decreased excretion of toxic metabolites
decreased production of erythropoietin- anaemia
renal bone disease
elderly patient with acute renal failure
acute interstitial nephritis (drug reactions)
myeloma-tumour of the plasma cells, secrete immunoglobulins
Young male with haematuria and rash
Henoch Schonlein Purpura
Teenager/young adult with haematuria
Post infective glomerulonephritis
IgA nephropathy
Adult with acute renal failure, fever and myalgia
Vasculitis
Young woman with haematuria and facial butterfly rash
Lupus
Adult with nephrotic syndrome
Membranous neuropathy
Child with nephrotic syndrome
Minimal change
Imaging of the urinary tract
Cytoscopy
Causes of isolated haematuria
IgA nephropathy
Thin basemement membrane disease
Alport type hereidtary nephropathy
Inherited abnormalities of collagen type 4 causing abnormal basement membrane in the glomerulus- renal failure +/- deafness +/-occular problems May be autosomal or X linked
Alport type hereditary nephropathy
Commonest 3 causes of isolated proteinuria in adults
FSGS
Diabetes
Lupus
Commonest 2 causes of isolated proteinuria in children
Henoch Schonlein purpura
FSGS
Causes of acute pyelonephritis
Diabetes
Structural abnormalities of urinary tract
Complications of pyelonephritis
Abscess formation
What is the cause of chronic pyelonephritis
Associated iwth obstruction of urinary tract and reflux of urine up reter, leading to scarring of the kidney and can lead to renal failure
Complications of chronic pyelonephritis
Scarring of kidney
Chronic renal failure
What is the result of renal artery stenosis
Ischemia of affected kidney
Activation of renin-angiotensin-aldosterone system leads to hypertension
Thrombus blocks the capillary within the glomerulus. Inflammatory cells surround an artery which has fibrin in the wall indicating damage
Vasculitis
How does hypertension cause damage to the kidney
Thickening of vessel walls-decrease in size of the lumen-chronic hypoxia-loss of renal tubules-decrease in renal function, decreased blood flow activates RAA system
Commonest cause of end stage renal failure?
Diabetes
How does diabetes affect the kidney?
hyperglycaemia damages the basement membrane- becomes thicker, glomerulus produces excess extracellular matrix which forms nodules. Also affects small vessels leading to ischaemia and damage to renal tubules
What tumour is made of plasma cells which produce excess immunoglobulins-deposit in the tubules- inflammation and fibrosis, decreased kidney function, usually irreversible
Myeloma
