Exam 2: Renal and Urinary Tract Diseases Flashcards
Most common outpatient infection?
UTIs
-with a lifetime incidence of 50−60% in adult women
-Men start getting UTIs as they age.
UTIs can lead to pregnancy complications and about 10% of UTI lead to complications such as…
sepsis and pyelonephritis
Most common etiologic agent of UTIs?
E. coli
Main symptom of UTIs?
painful urination
lower urinary tract via the urethra and ascend the urinary tract
Ascending UTI
can arise through infections in the bloodstream seeding the kidney with organisms deposited in the upper urinary tract and descend the urinary tract.
Descending UTI
What are the typical findings associated with UTIs?
-increased neutrophils,
-presence of bacteria
-positive leukocyte esterase)
positive nitrite
infection of the kidney/ureters.
Rapid onset, urinary frequency, burning, lower back pain
Pyelonephritis
Pyelonephritis urinalysis is similar to cystitis with what three exceptions?
-protein often positive in pyelonephritis
-pyelonephritis has presence of WBC casts*
-presence of renal epithelial cells rather than transitional epithelial cells*
Most common cause of chronic pyelonephritis?
congenital structural defects
-long standing kidney infection
-can be caused by inflammation that occurs repeatedly that permanently damages the kidney and can lead to end-stage- renal disease.
Chronic pyelonephritis
chronic pyelonephritis is similar to pyelonephritis (blood, protein, WBCs) But increased…
protein, WBC, waxy and broad casts
absence of __________ may occur in later stages of chronic pyelonephritis.
bacteria
What are kidney stones called?
Calculi
Calculi are usually composed of ________but there are other kinds (e.g. uric acid)
calcium
-Fairly common. Patients will usually have blood in urine and in great pain
On UA, what is seen when calculi is present?
macro- and micro hematuria, maybe WBCs, crystals. pH can help determine type of crystal.
What are the common substances that form stones?
-Calcium oxalate (80%)
-Calcium phosphate
-Cystine
-Magnesium ammonium
-phosphate
-Uric acid
How common is CKD?
More than 1 in 7, that is 15% of US adults or 37 million people, are estimated to have CKD. As many as 9 in 10 adults with CKD do not know they have CKD.
How are changes in kidney function measured with hypertension?
-creatinine level, BUN (azotemia)
-May affect glomerular filtration rate (GFR)
-Protein on dipstick or positive microalbumin
Diabetes patients may have blood vessel damaged to the small vessels, the pt may develop ________.
edema
Kidney damage caused by diabetes can be detected by urinary…
-Protein and microalbuminuria
-creatinine level and BUN (azotemia)
-glomerular filtration rate (GFR) may be affected
Chronic kidney disease caused by obesity will have what changes?
-proteinuria
-decreased GFR
How does obesity cause CKD?
a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing CKD in the long term.
What are the two regular screening tests used for patients with diabetes and/or hypertension?
-GFR or eGFR
-urine microalbumin
Kidney disease is present at a eGFR of ______.
less than or equal to 60 mL/min
assessed by comparing the amount of micro-albumin to the urine creatinine level in a single urine sample
Urine microalbumin
disease indicated with more than ___mg of albumin per gram of creatinine, with or without a decreased eGFR.
30
What is a key sign of nephritic syndrome/ inflammation of the glomeruli?
blood in urine
What is an important marker of nephrotic syndrome?
proteinuria
Damage to glomeruli resulting in massive proteinuria and edema.
nephrotic syndrome
Difference between nephritic syndrome and nephrotic syndrome?
major difference is blood in urine
Both have proteinuria, but higher in nephrotic. Nephritic can cause some edema, but much less than nephrotic.
True or False,
BUN/creatinine is decreased with glomerular diseases?
False, increased
Causes of glomerular diseases?
-immunological processes
-can be systemic or primary origin
-can be genetic or acquired
-acute or chronic
Nephrotic syndrome/nephrosis… a set of symptoms that happen together and affect your kidneys. These include:
-Swelling in legs, ankles, or around eyes (edema)
-Large amounts of protein in urine (proteinuria). Causes foamy urine.
-Loss of protein in blood
-High levels of fat lipids in blood (high cholesterol)
-High blood pressure (in some cases)
What are possible symptoms of nephrotic syndrome/nephrosis is advanced?
symptoms may be like those ofkidney failure. People may report fatigue, a poor appetite, headache, itchy skin, shortness of breath and/or nausea.
About a week after Group A streptococcal infection (strep throat), a few individuals create antibodies to a specific component of strep cells (Protein ____). The antibody-antigen complexes accumulate at the glomeruli.
M
How can diagnosis be made for Acute Poststreptococal Glomerulonephritis (AGN)?
Test for the antibody produced, Antistreptolysin O (ASO)
What are the expected lab results for AGN?
protein, LE, and blood positive
What is the prognosis of rapidly progressive glomerulonephritis?
Spontaneous remission is rare, and 80 to 90% of untreated patients progress to end-stage renal disease within 6 months. Prognosis improves with early treatment.
Symptoms of rapidly progressive glomerulonephritis arise after…
deposition of immune complexes from anti-glomerular membrane antibody (GBM), anti-neutrophil cytoplasmic antibody (ANCA) or patient has lupus.
What is a characteristic shape/form in Bowman’s space associated with rapidly progressive GN?
crescents form
What are the typical lab results for rapidly progressive GN?
-Smoky colored urine, decrease in urine volume, edema.
-Urinalysis: protein, blood, WBCs, RBC casts
-Serologic testing available
-Visualization of crescents due to immune complex deposition but need a biopsy to visualize.
autoimmune disease caused by autoantibodies to collagen (antiglomerular basement membrane antibodies)
Goodpasteur syndrome
Looks like rapidly progressing and same poor prognosis, but here there is lung involvement so patient will have shortness of breath, cough, may cough up blood.
Goodpasteur syndrome
What are the lab results similar to for Goodpasteur syndrome?
like post streptococcal and rapidly progressive.
Pronounced thickening of the glomerular basement membrane resulting from deposition of immune complexes (IgG) leading to destruction of the glomerulus
Mebranous Glomerulunephritis (MGN)
What is the most common cause of nephrotic syndrome in adults?
Mebranous Glomerulunephritis (MGN)
What is the prognosis of Mebranous Glomerulunephritis (MGN)?
Most go on to chronic glomerulonephritis – but 1/3 resolve with treatment of underlying disorder.
Lab results for Mebranous Glomerulunephritis (MGN)?
blood and very high protein and histology
Glomeruli look normal under light microscopy, but morphologic changes are seen with electron microscopy
-No immune complex deposits, but thought to be immunologic, maybe T-cell dysfunction.
Minimal Change Disease (Lipid Nephrosis)
Minimal Change Disease (Lipid Nephrosis) is mostly seen in __________.
children
Prognosis for Minimal Change Disease (Lipid Nephrosis)?
Good prognosis, steroids, remission
Minimal Change Disease (Lipid Nephrosis):
symptoms and lab findings are like ____________, with a better prognosis.
adult nephrotic syndrome
What are significant lab findings with Minimal Change Disease (Lipid Nephrosis)?
profound proteinuria and oval fat bodies and fatty casts may be observed.
symptoms of chronic glomerulonephritis?
Fatigue, anemia, hypertension, edema, oliguria gradually worsening
Markedly decreased GFR
Chronic GN urinalysis shows…
-Dysmorphic RBCs
-protein
-Casts mix of granular, cellular, waxy, and broad.
How is kidney function monitored with chronic GN?
of BUN, creatinine, and the GFR or eGFR.
Immunoglobulin A nephropathy is called…
Berger disease
What is the most common cause of chronic glomerulonephritis.
Immunoglobulin A nephropathy
Berger’s disease may follow what type of infections?
mucosal infection (upper respiratory, GI or urinary tract) that stimulates IgA. Often begins at a younger age and develops over time
-IgA Immune complexes deposit on the glomerular membrane and serum levels of IgA are increased.
-May progress to chronic glomerulonephritis
Berger Disease
Lab findings with Berger disease?
IgA in serum, bloody urine or RBCs
Diabetic Nephropathy Continual damage to the glomerular membrane is called
Kimmelsteil-Wilson Disease
What is believed to be the main cause of Diabetic Nephropathy (Kimmelsteil-Wilson Disease)?
high blood pressure
Diabetic Nephropathy (Kimmelsteil-Wilson Disease) results in….
vascular sclerosis (thickening)***
prognosis of Diabetic Nephropathy (Kimmelsteil-Wilson Disease)?
Progresses to end stage renal disease
Thickening of the glomerular basement membrane occurs in all diabetic patients. _________ eventually develops in up to 55% of diabetic patients.
Proteinuria
Lab results for Diabetic Nephropathy (Kimmelsteil-Wilson Disease)?
persistent albinuria, progressive decline in GFR, high blood pressure
-Disease of the glomerulus with scar tissue forming on some of the glomeruli and in some areas (focal).
-Not a single disease. Often follows another glomerular disease, infection or drug abuse (Many causes).
Focal Segmental Glomerulosclerosis
Focal Segmental Glomerulosclerosis progresses to…
nephrotic syndrome and can lead to kidney failure, requiring dialysis or kidney transplant
Lab findings with Focal Segmental Glomerulosclerosis?
Moderate to heavy proteinuria; microscopic hematuria (RBCs, not casts), hyaline and broad casts
Inherited sex-linked and autosomal disorder affecting basement membrane
Males more severely affected
Alport’s Syndrome
Macroscopic hematuria with respiratory infections by age 6 years. Vision and hearing may be affected.
Membrane laminated with thinning; no immune complexes
Alport’s Syndrome
Prognosis of Alport’s syndrome?
Mild to persistent hematuria, later nephrotic syndrome, renal failure for some.
Lab findings with Alport’s syndrome?
RBCs, protein, casts, renal tubular epithelial cells (RTE)
4+ protein, RBCs, fat bodies, fatty and waxy casts, RTEs
Prognosis of Acute Tubular Necrosis (destruction of epithelial cells)
Reversible:
hydration, stop meds,
treat any resulting damage
Two types of acute tubular necrosis
-ischemic ATN
-toxic ATN
What can cause ischemic ATN?
Sepsis, shock, trauma,
dehydration
What can cause toxic ATN?
Endogenous:
myoglobin (rhabdomyolysis), hemoglobin
Exogenous: drugs, dyes and anesthetics, organic solvents
Lab findings with acute tubular necrosis?
Noticeable renal tubular epithelial (RTE) cells and muddy brown casts, hyaline, waxy, granular, broad casts
Increased BUN and creatinine
High sodium in urine
What is the specific gravity with acute tubular necrosis?
Specific gravity stays at 1.010
-Hereditary or acquired later in life due to kidney disease
-Tubular disease with inadequate reabsorption at proximal tubule due to altered influx mechanisms.
Fanconi’s Syndome
Fanconi’s Syndome:
urine accumulates…
-amino acids
-Glucose
-Bicarbonates (results in acidosis)
-phosphorus, sodium, and potassium
What could a urinalysis show with Fanconi’s syndrome?
-higher levels of substances normally reabsorbed
-abnormal crystals, in some cases
Group of disorders involving…
-either the decreased ability to secrete hydrogen ions in the distal tubule
-or a decreased ability to reabsorb bicarbonate in the proximal tubule.
Renal Tubular Acidosis
-results in chronic metabolic acidosis
How is Renal Tubular Acidosis diagnosed?
How is it treated?
blood too acidic; urine too alkaline
often drinking a bicarbonate solution
Inflammatory: Acute Interstitial Nephritis. Can be acute or chronic and is usually caused by
an allergic reaction to a drug.
Medication allergy to penicillin, methicillin, ampicillin, cephalosporins, NSAIDs, diuretics
Discontinue and use steroids to treat
What are the lab findings with acute interstitial nephritis?
Urinalysis, hematuria, proteinuria,↑ WBCs, WBC casts, no bacteria
Hansel stain for eosinophils
May also see renal tubular epithelial cells
Acute renal failure is cauterized by a sudden decrease in GFR and presence of…
azotemia and oliguria
What is the assessment of acute renal failure based on?
serum creatinine, GFR and urine output.
Prognosis for acute renal failure?
Mortality from acute renal failure is high but can start dialysis while treating underlying causes.
symptoms of acute renal failure?
Person will not feel well (nausea, edema, no urine output, chest pains, fatigue). Seizures in severe cases.
the most common causes of chronic kidney disease and kidney failure?
Diabetes and high blood pressure
Monitoring patients with diabetes for the presence of _____________ a is important for early detection of the onset of diabetic nephropathy
microalbuminuri
Bacteria may not be present in what
Chronic glomerulnephritis
Acute intestinal nephritis
Common Urinary lab finding in a patient with urithitis ( stones).
WBC casts
Chronic renal failure is a GFR below
50%
Focal segment glomerusclerosis lab diagnosis
Very high protein, blood, hyaline and broad casts (not RBC casts)
Sclerosis in some glomeruli; many causes but ass. With drug use and HIV
Diabetic nephropathy
Albinuria, low creatinine clearance/GFR
Blood: ↑glucose, ↑BUN, ↑Creatinine
Most common cause of ESRD; Sclerosis due to glucose and high blood pressure
What can increase the changes of getting a UTI
Obstruction, foreign bodies, or the presence of catheters can increase the risk of acquiring a urinary tract infection.
Nephrotic Syndrome
-Membranous GNP
-Minimal Change Disease
-Rapidly Progressive Glomerulonephritis
-Focal Seg
-Membranoproliferative GNP
-Diabetic kidney Disease
Nephritic Syndrome (I)
Primary Glomerulonephritis such as IgA
Poststreptococcal
Goodpastures
Membranoproliferative GNP
Vasculitis
Diminished renal reserve
GFR drops to about 50% of normal. Now considered to be in chronic renal failure.
Renal insufficiency
further GFR decrease, BUN and serum creatinine increase (aztemia), anemia and hypertension
Renal failure
GFR <20%, loss of urine volume and solute regulation, acidosis, edema, hyperkalemia
End stage renal disease
GFR <5%, GFR, scarring, tubular fibrosis, loss of kidney mass.
Dialysis and/or kidney transplant required for survival.
Most common cause of ESRD is
Diabetic nephropathy
Waxy and broad cast more likely in
Chronic conditions
WBC cast in
Acute renal failure
RBC cast indicate
Nephrotic syndrome ( IgA and poststreptococcal)
