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D2 Fall > Gen Path Exam 3 - Urinary System > Flashcards

Gen Path Exam 3 - Urinary System Flashcards

1
Q

What does the kidney excrete?

A

Urea
Uric acid

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2
Q

What is the end product of protein metabolism?

A

Urea

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3
Q

What is the end product of purine and pyrimidine metabolism?

A

Uric acid

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4
Q

What does the kidney regulate?

A

Electrolytes, minerals, BP, pH

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5
Q

What does the kidney secrete?

A

Erythropoietin
Active form of vitamin D

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6
Q

What does the kidney eliminate?

A

Solute

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7
Q

What does the kidney conserve?

A

Protein

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8
Q

What does the Renal Panel measure?

A

Electrolytes
Minerals
Albumin
Waste products
Glucose
Calculated values (includes estimated GFR)

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9
Q

What electrolytes are measured on a renal panel?

A

Na+
K+
Cl-
HCO3-

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10
Q

What minerals are measured on a renal panel?

A

Ca2+
Phosphorus

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11
Q

What waste products are measured on a renal panel?

A

Urea
Creatinine

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12
Q

Consists of 3 components or examinations: physical, chemical, microscopical

A

Urinalysis

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13
Q

Which part of urinalysis?

Describes volume, color, clarity, odor, gravity

A

Physical

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14
Q

Which part of urinalysis?

Identifies pH, RBCs, WBCs, proteins, glucose, urobilinogen, bilirubin, ketone bodies, leukocyte esterase, nitrites

A

Chemical

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15
Q

Which part of urinalysis?

Detects casts, cells, crystals, microorganisms

A

Microscopic

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16
Q

What are the 4 main parts of the kidney that are affected by disease?

A

Glomerulus
Tubules
Interstitium
Blood vessels

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17
Q

What type of disease affects the glomerulus?

A

Immunologic

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18
Q

What type of agents affect the tubules and interstitium?

A

Toxic/infectious agents

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19
Q

The 4 main parts of the kidney affected by disease (glomerulus, tubules, interstitium, blood vessels) are ______________

A

interdependent

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20
Q

What does it mean that the 4 main parts of the kidney are interdependent?

A

Effects on one part effect all other parts

(eventually leads to end stage kidney disease)

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21
Q

What part of the glomerulus?

Lined by parietal epithelium on outside and visceral epithelium on inside

A

Bowman’s space

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22
Q

What part of the glomerulus?

Mostly made by type IV collagen

A

Glomerular BM

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23
Q

What part of the glomerulus?

Separates podocytes

A

Filtration slits

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24
Q

What part of the glomerulus?

Support the glomerulus

A

Mesangial cells

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25
Q

The glomerulus has a ___________ endothelium

A

fenestrated (means it has little holes)

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26
Q

In the glomerulus, podocytes are bridged by a slit diaphragm made of what?

A

Nephrin

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27
Q

The kidney is highly permeable to what?

A

Water + small solutes

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28
Q

The kidney is impermeable to what?

A

Large molecules/proteins + anions

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29
Q

What does the filtration slit diaphragm prevent?

A

Backflow of water

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30
Q

What does the filtration slit diaphragm normally act as?

A

Diffusion barrier for proteins

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31
Q

What does a loss of the filtration slit diaphragm lead to?

A

Protein leakage -> nephrotic syndrome

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32
Q

Increased blood urea nitrogen (BUN) and creatinine, due to decreased GFR

A

Azotemia

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33
Q

Progression of azotemia to clinical level with failure of renal excretory function and systemic problems

A

Uremia

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34
Q

What are the 4 secondary effects of uremia?

A

GI -> gastroenteritis
Neuromuscular -> peripheral neuropathy
Cardiovascular -> pericarditis
Oral -> severe ulcers

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35
Q

Inflammation that leads to mesangial and/or BM thickening, which causes barrier dysfunction

A

Glomerulonephritis

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36
Q

What are the 2 major clinical presentations of glomerulonephritis?

A

Nephrotic syndrome
Nephritic syndrome

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37
Q

Nephrotic or nephritic syndrome?

Pathogenesis = alteration of glomerular capillary walls, causing permeability to plasma proteins

A

Nephrotic syndrome

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38
Q

Nephrotic or nephritic syndrome?

Massive proteinuria

A

Nephrotic syndrome

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39
Q

Nephrotic or nephritic syndrome?

Hypoalbuminemia

A

Nephrotic syndrome

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40
Q

Nephrotic or nephritic syndrome?

Generalized edema

A

Nephrotic syndrome

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41
Q

Nephrotic or nephritic syndrome?

Hyperlipidemia and lipiduria

A

Nephrotic syndrome

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42
Q

What happens to the podocytes in nephrotic syndrome?

A

Effacement
Detachment

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43
Q

Nephrotic or nephritic syndrome?

Pathogenesis = inflammatory rxn injures glomerular capillaries, RBCs go into urine, decreased GFR

A

Nephritic syndrome

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44
Q

Nephrotic or nephritic syndrome?

Hematuria with dysmorphic RBCs

A

Nephritic syndrome

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45
Q

Nephrotic or nephritic syndrome?

Decreased GFR, oliguria, azotempia

A

Nephritic syndrome

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46
Q

Nephrotic or nephritic syndrome?

Increased blood urea nitrogen (BUN)

A

Nephritic syndrome

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47
Q

Nephrotic or nephritic syndrome?

Hypertension due to renin release

A

Nephritic syndrome

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48
Q

Nephrotic or nephritic syndrome?

Mild proteinuria/edema (not as severe)

A

Nephritic syndrome

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49
Q

The causes of glomerulonephritis are most often _____________

A

immune-mediated

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50
Q

Generalized edema

A

Anasarca

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51
Q

What is an example of a primary cause of glomerulonephritis?

A

Post-strep glomerulonephritis

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52
Q

Nephrotic or nephritic syndrome?

Post-strep glomerulonephritis

A

Nephritic syndrome

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53
Q

What are 6 examples of secondary causes of glomerulonephritis?

A

Hypertension
Diabetes
Amyloidosis
Lupus
Goodpasture syndrome
Granulomatosis w/ polyangititis (GPA)

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54
Q

Nephrotic or nephritic syndrome?

Diabetes

A

Nephrotic syndrome

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55
Q

Nephrotic or nephritic syndrome?

Amyloidosis

A

Nephrotic syndrome

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56
Q

Nephrotic or nephritic syndrome?

Lupus

A

Nephrotic or nephritic syndrome

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57
Q

Primary or secondary cause of glomerulonephritis?

Kidney is only or predominant organ

A

Primary

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58
Q

Primary or secondary cause of glomerulonephritis?

Systemic disease leads to glomerular damage

A

Secondary

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59
Q

Decreased urination

A

Oliguria

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60
Q

What disease?

Antibody bound to strep proteins causes proliferation of glomerular cells and activates complement, leading to infiltration of leukocytes

A

Post-step glomerulonephritis

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61
Q

What disease?

Gross hematuria (smoky brown)

A

Post-step glomerulonephritis

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62
Q

What disease?

Most kids recover completely
In adults, 15-50% develop end-stage renal disease (over years-decades)

A

Post-step glomerulonephritis

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63
Q

Describe the Type III hypersensitivity immune injury mechanism in glomerulonephritis

A

Circulating antigen/AB complexes in glomerulus

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64
Q

What are 2 diseases that use the Type III hypersensitivity immune injury mechanism in glomerulonephritis?

A

Post-strep
Lupus

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65
Q

Describe the Type II hypersensitivity immune injury mechanism in glomerulonephritis

A

ABs bind to glomerular antigens in the glomerulus

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66
Q

What is 1 disease that uses the Type II hypersensitivity immune injury mechanism in glomerulonephritis?

A

GPA (effects kidney and lung)

67
Q

What disease?

Diagnosed by urinalysis showing either nephrotic syndrome or nephritic syndrome

A

Glomerulonephritis

68
Q

Nephrotic or nephritic syndrome?

Excessive proteins

A

Nephrotic syndrome

69
Q

Nephrotic or nephritic syndrome?

Excessive RBCs

A

Nephritic syndrome

70
Q

What disease?

Diagnosed by circulating autoantibodies in blood

A

Glomerulonephritis

71
Q

What disease?

Diagnosed by renal biopsies like light microscopy, immunofluorescence, or electron microscopy

A

Glomerulonephritis

72
Q

Tests pt tissue directly for presence of autoantibodies

A

Direct immunofluorescence

73
Q

Tests pt blood for presence of autoantibodies in 3 different cells

A

Indirect immunofluorescence

74
Q

What are the 3 different cells used when looking for autoantibodies in indirect immunofluorescence?

A

HEp-2 cell lines
Specific tissues
Granulocytes

75
Q

Useful for wide range of antinuclear antibodies (ANA) and cytoplasmic components

A

HEp-2 cell lines

76
Q

Use a similar animal epithelium as a substrate

A

Specific tissues

77
Q

Antineutrophil cytoplasmic antibodies (ANCA) involve antibodies that display perinuclear (pANCA) or cytoplasmic (cANCA) staining

A

Granulocytes

78
Q

Most forms of tubular injury also involve the ___________

A

interstitium

79
Q

What disease?

Caused by bacterial or non-bacterial etiologies

A

Tubulointerstitial nephritis

80
Q

What are some causes of non-bacterial reasons for Tubulointerstitial nephritis?

A

Drugs
Metabolic disorder
Physical injury
Viral infection
Immune rxn

81
Q

Tubulointerstitial nephritis caused by bacteria is called what?

A

Pyenlonephritis

82
Q

Tubulointerstitial nephritis NOT caused by bacteria is called what?

A

Interstitial nephritis

83
Q

What disease?

Common manifestation of extension from lower UTI

A

Acute pyelonephritis

84
Q

Acute pyelonephritis usually involves what bacteria?

A

Gram negative (E. coli)

85
Q

How is acute pyelonephritis spread?

A

Ascending infection (most common)
Hematogenous (ex: septicemia)

86
Q

What disease?

More common in females due to shorter urethra, close proximity to anus, and pregnancy

A

Acute pyelonephritis

87
Q

What disease?

Predisposing factor = urinary obstruction (BPH) or bladder dysfunction leads to stasis, favoring bacterial growth

A

Acute pyelonephritis

88
Q

What disease?

Predisposing factor = instrumentation of urinary tract, like catheterization

A

Acute pyelonephritis

89
Q

What disease?

Predisposing factor = vesicoureteral reflux

A

Acute pyelonephritis

90
Q

What disease?

Predisposing factor = diabetes due to increased susceptibility to infection and neurogenic bladder dysfunction

A

Acute pyelonephritis

91
Q

What disease?

Predisposing factor = immunosuppression and immunodeficiency

A

Acute pyelonephritis

92
Q

What disease?

Abrupt onset of costovertebral angle pain

A

Acute pyelonephritis

93
Q

What disease?

Fever, chills, malaise, nausea, vomiting, pus in urine, bacteria in urine

A

Acute pyelonephritis

94
Q

Pus in urine

A

Pyuria

95
Q

Bacteria in urine

A

Bacteriuria

96
Q

What disease?

Urethral irritation, dysuria, increased frequency/urgency

A

Acute pyelonephritis

97
Q

Pain when urinating like burning, stinging, itching

A

Dysuria

98
Q

What disease?

Symptoms last 1 week without tx

A

Acute pyelonephritis

99
Q

What disease?

Usually unilateral -> renal failure does NOT occur

A

Acute pyelonephritis

100
Q

What disease?

Histologically = patchy neutrophilic infiltration of interstitium

A

Acute pyelonephritis

101
Q

What disease?

Histologically = glomeruli intact, but tubules spread apart and necrotic

A

Acute pyelonephritis

102
Q

What disease?

Histologically = collecting tubules filled with pus, passes out in urine

A

Acute pyelonephritis

103
Q

What disease?

Damages tubules, calyces, and pelvis, leading to scarring

A

Chronic pyelonephritis

104
Q

What disease?

Related to obstruction or vesicoureteral reflux

A

Chronic pyelonephritis

105
Q

What disease?

May be asymptomatic until polyuria and hypertension and renal failure occur and/or urinalysis shows WBCs

A

Chronic pyelonephritis

106
Q

Scarring, atrophy, inflammation around tubules from a non-bacterial cause

A

Interstitial nephritis

107
Q

What type of interstitial nephritis?

IgE or T cell-mediated immune rxn to drug

A

Drug-induced interstitial nephritis

108
Q

What type of interstitial nephritis?

Interstitial mononuclear inflammation w/ eosinophils

A

Drug-induced interstitial nephritis

109
Q

What disease?

Clinicopathologic entity- damaged tubular epithelial cells with acute decline of renal function (decreased GFR)

A

Acute Tubular Injury (ATI)

110
Q

What is the most common cause of renal failure?

A

Acute tubular injury (ATI)

111
Q

What are the 2 types of acute tubular injury (ATI)?

A

Ischemic
Nephrotoxic

112
Q

Ischemic or nephrotoxic ATI?

Occurs when marked decrease in
blood flow to kidney (trauma, acute pancreatitis, or septicemia leading to shock)

A

Ischemic ATI

113
Q

Ischemic or nephrotoxic ATI?

Exposure to toxins- poison, heavy metals; drugs- antibiotics

A

Nephrotoxic ATI

114
Q

What disease?

Ischemia or toxic injury causes tubule cells to be shed (casts seen in urine).

This blocks urine output, increases interstitial pressure, and decreases GFR.

A

Acute tubular injury (ATI)

115
Q

What disease?

Oliguria leads to uremia

A

Acute tubular injury (ATI)

116
Q

What disease?

Reversible when caught early–death is
circumvented thru dialysis and maintaining electrolytes

A

Acute tubular injury (ATI)

117
Q

What disease?

Abrupt onset of renal dysfunction within 48 hrs

A

Acute renal failure

118
Q

What disease?

Increased serum creatinine
Oligouria or anuria
Azotemia

A

Acute renal failure

119
Q

What are the 3 potential causes of acute renal failure?

A

Prerenal
Intrarenal
Postrenal

120
Q

Which cause of acute renal failure?

Decreased blood flow to kidneys (ex: cardiac failure)

A

Prerenal

121
Q

Which cause of acute renal failure?

ATI = most common cause, but also acute glomerular, interstitial or vascular disease

A

Intrarenal

122
Q

Which cause of acute renal failure?

Obstruction of urinary tract, distal to kidney

A

Postrenal

123
Q

What is an oral manifestation that is due to acute renal failure?

A

Uremic stomatitis

124
Q

What disease?

Azotemia slowly progresses to uremia which causes oral ulcers, gastroenteritis, pericarditis, peripheral neuropathy

A

Chronic renal failure

125
Q

What disease?

Symptoms = hypertension and some degree of proteinuria

A

Chronic renal failure

126
Q

What disease?

Caused by chronic kidney disease that leads to severe progressive scaring

A

Chronic renal failure

127
Q

What disease?

Also called benign nephrosclerosis

A

Arterionephrosclerosis

128
Q

What disease?

Thickening, luminal obstruction of arteries/arterioles associated with benign hypertension + diabetes

A

Arterionephrosclerosis

129
Q

What disease?

Causes parenchymal ischemia, resulting in small foci of parenchymal loss and fibrosis

A

Arterionephrosclerosis

130
Q

What disease?

Kidney = small, contracted, grain leather surface

A

Arterionephrosclerosis

131
Q

What disease?

Small vessels show hyaline deposition (arterioloscerlosis), thickened wall with narrowed lumen

A

Arterionephrosclerosis

132
Q

What disease?

Uncommon, 5% of pts with hypertension, or may arise de novo

A

Malignant hypertension

133
Q

What is the BP reading in malignant hypertension?

A

> 200/120

134
Q

What disease?

Symptoms:
Increased intracranial pressure (headache, nausea, vomiting, visual impairment)
Proteinuria
Hematuria
Renal failure later on

A

Malignant hypertension

135
Q

What disease?

Medical emergency - requires aggressive antihypertensive therapy

A

Malignant hypertension

136
Q

What % of pts survive 5 years after malignant hypertension diagnosis?

A

50%

137
Q

Describe the pathogenesis of malignant hypertension

A
  1. Chronic hypertension
  2. vascular damage
  3. narrows lumen of afferent arteriole
  4. ischemia
  5. increased renin
  6. angiotensin II
  7. vasoconstriction
  8. increased renin even more
  9. really increased BP
138
Q

What disease?

Can obstruct/damage tubules and hinder renal function

A

Tubular precipitations

139
Q

What disease?

Causes are urolithiasis (most common) and multiple myeloma

A

Tubular precipitations

140
Q

Which cause of tubular precipitations?

Can cause:
Bence-Jones casts in tubules
Hypercalcemia
Amyloidosis
Tumor deposits

A

Multiple myeloma

141
Q

Urinary tract stones/kidney stones

A

Urolithiasis/Nephrolithiasis

142
Q

What disease?

Precipitations of different compounds due to increased urinary concentration of stone’s components (supersaturation)

A

Urolithiasis/Nephrolithiasis

143
Q

What disease?

Large stones collect in calcyes; may remain silent or cause obstruction with hematuria

A

Urolithiasis/Nephrolithiasis

144
Q

What disease?

Small stones lodge in ureters where they cause intense renal colic, ulceration, hematuria

A

Urolithiasis/Nephrolithiasis

145
Q

Excruciating flank pain

A

Renal colic

146
Q

In urolithiasis/nephrolithiasis, what do large and small stones predispose to?

A

Infection

147
Q

What disease?

Tx = surgery, chemical dissolution, ultrasound lithotripsy

A

Urolithiasis/Nephrolithiasis

148
Q

What disease?

Cause is not always clear, usually high urine levels of components

A

Urolithiasis/Nephrolithiasis

149
Q

What are kidney stones composed of?

A

Calcium oxalate
Calcium phosphate (most common)

150
Q

Overabsorption from gut or renal reabsorption defect

A

Hypercalciuria

151
Q

Caused by hypercalcemia due to hyperparathyroidism, myeloma, sarcoidosis, bone destroying tumors, too much calcium or vitamin D in diet

A

Hypercalciuria

152
Q

If ureters, calyces, or urethra are __________, urine backs up and causes infection of kidney or pressure atrophy of renal parenchyma

A

obstructed

153
Q

Pressure atrophy of renal parenchyma

A

Hydronephrosis

154
Q

What do the following cause?

Congenital/secondary strictures
Kidney stones
Prostate enlargement
Tumors
Bladder atony

A

Obstruction

155
Q

What are these symptoms related to?

Bilateral hydronephrosis causes anuria, can quickly be corrected

A

Obstruction

156
Q

What are these symptoms related to?

Unilateral hydronephrosis is asymptomatic, causes loss of renal function

A

Obstruction

157
Q

Benign tumor of tubular epithelium

A

Renal adenoma

158
Q

What disease?

Well demarcated yellow, lipid filled nodules in upper pole of cortex and measures < 2.5 cm

A

Renal adenoma

159
Q

What disease?

No reliable way to differentiate from kidney cancers, so should be treated as if it could be cancer

A

Renal adenoma

160
Q

What disease?

Malignant tumor of renal tubular cells resembling the adenoma grossly and histologically but are larger (> 3 cm)

A

Renal cell carcinoma

161
Q

What disease?

Signs and symptoms:
– Dull flank pain
– Palpable abdominal mass
– Painless hematuria (most common)
– Polycythemia – tumor makes
erythropoietin

A

Renal cell carcinoma

162
Q

What is the most common sign/symptom of renal cell carcinoma?

A

Painless hematuria

163
Q

Where does renal cell carcinoma spread?

A

Lungs + bone

164
Q

What disease?

Unpredictable course, usually fatal

A

Renal cell carcinoma

D2 Fall (37 decks)

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