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Clinical Chemistry (CC 1) > (F) L4: Renal Function (Part 3: Diseases) > Flashcards

(F) L4: Renal Function (Part 3: Diseases) Flashcards

1
Q

These may be secondary to infection, autoimmune diseases, or genetic diseases leading to the dysfunction of filtration causing the presence of cells and proteins in urine

A

Glomerular Disorders

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2
Q

Give the 13 Glomerular Disorders

A
  1. Acute Glomerulonephritis (AGN)
  2. Rapidly Progressive/Crescentic Glomerulonephritis (RPGN)
  3. Goodpasture Syndrome
  4. Granulomatosis with Polyangiitis or Wegener’s Granulomatosis (GPA)
  5. Henoch-Schonlein Purpura
  6. Membranous Glomerulonephritis (MGN)
  7. Chronic Glomerulonephritis
  8. Berger’s Disease
  9. Nephrotic Syndrome
  10. Minimal Change Disease
  11. Focal Segmental Glomerulosclerosis
  12. Alport Syndrome
  13. Diabetic Nephropathy
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3
Q

Glomerular Disorders

  • aka Post Streptococcal Nephritis (secondary to S. pyogenes)
  • Deposition of immune complexes for the Group A (pyogenes) Strep infection on the glomerular membrane
  • Presents with macroscopic hematuria, proteinuria, RBC and granular casts, and oliguria
A

Acute Glomerulonephritis (AGN)

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4
Q

Glomerular Disorders

This test involves the complement with the activation of the membrane attack complex (the lysis antigen)

A

Antistreptolysin O (ASO) for Acute Glomerulonephritis (AGN)

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5
Q

Glomerular Disorders

  • Hematuria and proteinuria (albumin < 3g/day causes edema)
  • Decreased GFR with sodium retention (hypertension)
  • Presence of RBC casts (pathognomonic to this disease)
  • Associated with a recent infection yet idiopathic
A

Acute Glomerulonephritis (AGN)

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6
Q

Glomerular Disorders

  • The deposition of immune complexes from systemic immune disorders on the glomerular membranes caused by systemic autoimmune diseases such as SLE
  • Presents with macroscopic hematuria, proteinuria, and RBC casts
A

Rapidly Progressive/Crescentic Glomerulonephritis (RPGN)

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7
Q

Glomerular Disorders

  • Has an anti-glomerular basement membrane antibody
  • A cytotoxic antibody attaches to the glomerular and alveolar basement membrane (lungs and kidneys are affected)
  • Presents with macroscopic hematuria, proteinuria, and RBC casts
A

Goodpasture Syndrome

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8
Q

Glomerular Disorders

What 3 diseases are characterized by the presence of antibodies against the glomerular basement membrane?

A
  1. Acute Glomerulonephritis (AGN)
  2. Rapidly Progressive/Crescentic Glomerulonephritis (RPGN)
  3. Goodpasture Syndrome
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9
Q

Glomerular Disorders

  • Has an antineutrophilic cytoplasmic autoantibody
  • Is also associated with primary sclerosing cholangitis
  • Binds to neutrophils in vascular walls producing damage to small vessels in the lungs and glomerulus
  • Presents with macroscopic hematuria, proteinuria, and RBC casts
A

Granulomatosis with Polyangiitis or Wegener’s Granulomatosis (GPA)

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10
Q

Glomerular Disorders

Goodpasture Syndrome and Granulomatosis with Polyangiitis or Wegener’s Granulomatosis (GPA) are almost identical except for their antibodies, which are those?

A

Goodpasture: Anti-Glomerular Basement Membrane Ab
GPA: Anti-Neutrophilic Cytoplasmic AutoAb

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11
Q

Glomerular Disorders

  • Common in children following a viral respiratory infection
  • Presents with decreased platelets and vasculitis (IgA vasculitis; inflammation of BVs due to IgA deposition)
  • Every BV is affected because of the deposition
  • Presents with macroscopic hematuria, proteinuria, and RBC casts
A

Henoch-Schonlein Purpura

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12
Q

Glomerular Disorders

What 5 conditions present with macroscopic hematuria, proteinuria, and RBC casts?

A
  1. Acute Glomerulonephritis (AGN)
  2. Rapidly Progressive/Crescentic Glomerulonephritis (RPGN)
  3. Goodpasture Syndrome
  4. Granulomatosis with Polyangiitis or Wegener’s Granulomatosis (GPA)
  5. Henoch-Schonlein Purpura

First 5 on the list basically

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13
Q

Glomerular Disorders

  • There is thickening of the Glomerular Basement Membrane (GBM) due to IgG deposition
  • Since IgG is triggered, the complement is also triggered which causes cell lysis
  • Presents with macroscopic hematuria and elevated proteins
A

Membranous Glomerulonephritis (MGN)

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14
Q

Glomerular Disorders

  • There is a marked decrease in renal function resulting from glomerular damage precipitated by other renal disorders
  • Is secondary to chronic diseases like hypertension and uncontrolled diabetes (hyperglycemia)
  • Presents with hematuria, proteinuria, glucosuria, and casts (cellular, granular, waxy, and broad)
A

Chronic Glomerulonephritis

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15
Q

Glomerular Disorders

  • Aka IgA nephropathy
  • The most common cause of glomerulonephritis
  • Increased serum IgA levels cause a depositioning of IgA on the GBM
  • Predominantly affects the kidneys of adults and young adults
A

Berger’s Disease

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16
Q

Glomerular Disorders

Deposition of IgA
A. Henoch-Schonlein Purpura
B. Berger’s Disease
C. Both
D. Neither

A

C. Both

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17
Q

Glomerular Disorders

Early or Late Stage Berger’s Disease?
1. Macroscopic and microscopic hematuria
2. Hematuria, proteinuria, glucosuria, and casts (cellular, granular, waxy, and broad)

A
  1. Early stage
  2. Late stage
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18
Q

Glomerular Disorders

  • There is a disruption of the shield of negativity and damage to the tightly fitting podocytes resulting in massive loss of proteins and lipids
  • There is excessive proteinuria (3.5 to 20 g/day) and hypoalbuminemia (which causes edema)
  • Also manifests as hyperlipidemia and lipiduria
  • Presents with heavy proteinuria, microscopic hematuria, RTE, oval fat bodies, and fatty and waxy casts
A

Nephrotic Syndrome

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19
Q

Glomerular Disorders

In nephrotic syndrome, in a patient’s SERUM, what are the levels of albumin and A2-macroglobulin?

A
  • Albumin - decreased (excreted out due to impaired shield of negativity)
  • A2-Macroglobulin - increased (unable to pass due to a MW of 700,000 Da)
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20
Q

Glomerular Disorders

In nephrotic syndrome, in a patient’s URINE, what are the levels of albumin and A2-macroglobulin?

A
  • Albumin - increased (excreted out due to impaired shield of negativity)
  • A2-Macroglobulin - decreased (unable to pass due to a MW of 700,000 Da)
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21
Q

Glomerular Disorders

  • Aka Lipoid nephrosis
  • Mostly idiopathic however it may be secondary to allergic reactions and immunization
  • T-cells release cytokines that can damage the podocytes
  • There is little cellular change in the glomerulus but less tightly fitting podocytes
  • Presents with heavy proteinuria, edema, transient hematuria, fat droplets, and normal NPNs
A

Minimal Change Disease

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22
Q

Glomerular Disorders

There is a disruption of podocytes in certain areas of the glomeruli associated with heroin and analgesic abuse & AIDS

A

Focal Segmental Glomerulosclerosis

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23
Q

Glomerular Disorders

  • An inherited disorder showing a lamellated & thinning GBM caused by a defect in the gene that codes for type 4 collagen
  • Primary urinalysis results are that of nephrotic syndrome: heavy proteinuria, microscopic hematuria, RTE, oval fat bodies, and fatty and waxy casts
A

Alport Syndrome

24
Q

Glomerular Disorders

Patients with Alport Syndrome have a genetic defect on the gene that codes for what?

A

Type 4 Collagen

25
Q

Glomerular Disorders

  • Aka Kimmelstiel-Wilson Disease
  • The most common cause of end stage renal disease
  • There is GBM thickening and an accumulation of solid substances around the capillary tuft due to a deposition of glycosylated proteins
  • Primary urinalysis results are that of chronic glomerunonephritis: hematuria, proteinuria, glucosuria, and casts (cellular, granular, waxy, and broad)
A

Diabetic Nephropathy

26
Q

Glomerular Disorders

Thickening of the GBM
A. Alport Syndrome
B. Diabetic Nephropathy
C. Both
D. Neither

A

B. Diabetic Nepropathy (Alport is thinning)

27
Q

Glomerular Disorders

Microscopic hematuria
A. Nephrotic Syndrome
B. Alport Syndrome
C. Chronic Glomerulonephritis
D. A and B
E. B and C
F. A and C

A

D. A and B

28
Q

Disorders that decrease the efficacy of reabsorption and secretion

A

Tubular Disorders

29
Q

Give the 7 tubular disorders

A
  1. Acute Tubular Necrosis (ATN)
  2. Fanconi Syndrome
  3. Uromodulin-associated Kidney Disease
  4. Nephrogenic DI
  5. Renal Tubular Acidosis (RTA)
  6. Renal Tubular Infection (E. coli)
  7. Renal Tubular Obstruction
30
Q

Tubular Disorders

  • There is damage to the renal tubular cells caused by ischemia (lack of oxygenation) or toxic agents
  • Presents with microscopic hematuria, proteinuria, RTE, and casts (RTE, hyaline, granular, waxy, and broad)
A

Acute Tubular Necrosis (ATN)

31
Q

Tubular Disorders

  • A generalized defect in renal tubular reabsorption
  • Is inherited in association with cystine disorders and Hartnup disease or acquired through exposure to toxic agents (heavy metals)
  • Is secondary to multiple myeloma or renal transplantation
A

Fanconi Syndrome

32
Q

Tubular Disorders

  • An inherited defect in the production of normal uromodulin (aka Tamm-Horsfall protein) by RTEs
  • Increased uric acid causes gout
A

Uromodulin-Associated Kidney Disease

33
Q

Tubular Disorders

An inherited defect of tubular response to ADH or acquired from medications

A

Nephrogenic DI

34
Q

Tubular Disorders

Tubules are unable to secrete acids leading to acidic blood pH

A

Renal Tubular Acidosis (RTA)

35
Q

Tubular Disorders

Infection of the upper urinary tract (pyelonephritis)

A

Renal Tubular Infection (E. coli)

36
Q

Tubular Disorders

Tumors, renal calculi, and stones

Note: Calcium oxalate is the most common

A

Renal Tubular Obstruction

37
Q

Diseases that result in tissue inflammation that may affect the kidneys

A

Interstitial Diseases

38
Q

Give the 3 interstitial diseases

A
  1. Cystitis
  2. Pyelonephritis
  3. Acute Interstitial Nephritis (AIN)
39
Q

Interstitial Diseases

Infection of the bladder

40
Q

Interstitial Diseases

  • Infection of the renal tubules, interstitium, and renal pelvis
  • May be acute or chronic
A

Pyelonephritis

41
Q

Interstitial Diseases

How do you differentiate Cystitis and Pyelonephritis?

A

Pyelonephritis has WBC casts

42
Q

Interstitial Diseases

  • Allergic inflammation of the interstitium secondary to medications
  • We expect elevated eosinophils
A

Acute Interstitial Nephritis (AIN)

43
Q

The most severe disease that is aka end stage renal disease

A

Renal Failure

44
Q

Give the 2 types of renal failure

A
  1. Acute
  2. Chronic
45
Q

Renal Failure

  • Sudden loss of renal function
  • May be a toxic or hypoxic insult to the kidney
  • Signs include: oliguria, azotemia, onset of uremic syndrome or ESRD, peripheral edema, hypertension, metabolic acidosis, and CHF
  • There is reduced GFR (< 10mL/min) which is caused by decreased tubular secretion
A

Acute Renal Failure

46
Q

Renal Failure

  • Secondary to chronic renal disease like chronic glomerulonephritis and diabetic nephropathy
  • A gradual decline in renal operation
  • There is scarring of the collecting tubules
  • Prevents salt and water reabsorption (polyuria)
A

Chronic Renal Failure

47
Q

Give the stage of chronic kidney disease

Description: At increased risk
GFR (mL/min per 1.73m2): ≥ 90 (with risk factors)

48
Q

Give the stage of chronic kidney disease

Description: Kidney damage with normal or unequal GFR
GFR (mL/min per 1.73m2): > 90

Manual: silent deterioration of renal status

49
Q

Give the stage of chronic kidney disease

Description: Kidney damage with normal or decreased GFR
GFR (mL/min per 1.73m2): 60-89

Manual: 50% reduction in normal functioning

50
Q

Give the stage of chronic kidney disease

Description: Moderately decreased GFR
GFR (mL/min per 1.73m2): 30-59

Manual: impending renal failure (anemia systemic acidosis)

51
Q

Give the stage of chronic kidney disease

Description: Severely decreased GFR
GFR (mL/min per 1.73m2): 15-29

Manual: uremic syndrome

52
Q

Give the stage of chronic kidney disease

Description: Kidney failure
GFR (mL/min per 1.73m2): < 15

53
Q

Additional Diseases

  • Aka Diabetic nephropathy
  • Manifests 15-20 years after diagnosis
  • There are heavy demands made by the kidney to diurese
  • Microalbuminuria (10-15 years) with increased pores
A

Diabetes Mellitus

54
Q

Additional Diseases

  • Decreased perfusion
  • Increased hypernatremia
  • Stimulation of the RAAS
A

Renal Hypertension

55
Q

Tubular Disorders

Inherited conditions
A. Acute Tubular Necrosis
B. Uromodulin-associated Kidney Disease
C. Both
D. Neither

A

B. Uromodulin-associated Kidney Disease

The inherited conditions are:
1. Fanconi
2. Uromodulin-associated
3. Nephrogenic DI

56
Q

Glomerular Disorders

Autoimmune disorders
A. Acute Glomerulonephritis
B. Rapidly Progressive (Crescentic) Glomerulonephritis
C. Both
D. Neither

A

B. Rapidly Progressive (Crescentic) Glomerulonephritis

Other autoimmune disorders:
- Goodpasture Syndrome
- Granulomatosis with Polyangiitis/Wegener’s Granulomatosis (GPA)

Clinical Chemistry (CC 1) (33 decks)

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