Intrarenal Disorders Flashcards
What type of neoplasms are found in the kidneys?
benign and malignant tumors or result from metastases from extrarenal sites
What is benign renal neoplasms?
several benign neoplasms found in the kidneys, developing from renal cortex, medulla or capsule
How are benign renal neoplasms detected?
they are typically detected incidentally during abdominal imaging for other reasons
SI/Sx of benign renal neoplasms
abdominal palpation, produce flank pain, and hematuria
Treatment for benign renal neoplasms
nephrectomy- removal of kidney because they are space-occupying lesions
Renal Cell Carcinoma (RCC) Etiology
genetic factors, and greater risk if a first-degree relative has the disease
Risk factors of RCC
Obesity, cigarette smoking, and hypertension, diabetes
Most common subtype of RCC
clear cell RCC
Clear Cell RCC
tumors originate in the renal cortex from cells of the proximal tubules and are usually unilateral and random in occurrence with rare cases of familial patterns
Papillary RCC
Evolve from cells of the distal tubule. this type may be sporadic or hereditary
Chromophobe RCC
originates from the renal parenchyma: slow growth and infrequent metastasis
Medullary and Collect Duct Carcinomas
occur in younger patients and associated with sickle anemia trait
Treatment of RCC
Nephrectomy and is unresponsive to cytotoxic chemotherapy
Who is affected most by Nephroblastoma (Wilms Tumor)
pediatric malignancy and most common childhood kidney cancer
Nephroblastoma etiology
develop from embryonic pluripotent kidney precursor cells
Nephroblastoma pathogenesis
typically large, well-encapsulated tumors that grow rapidly. they undergo hemorrhage and cystic changes, necrosis, renal pelvis compresses
Clinical Manifestations of Nephroblastoma
abdominal pain, hypertension, hematuria, tumor thrombus in inferior vena cava, decreased venous return, lower extremity edema
Pyelonephritis
infection of the kidney or upper urinary tract infection
What is affected pyelonephritis?
renal parenchyma, pelvis and calices
How are infectious organisms responsible for upper urinary tract?
delivered to the kidney via bloodstream or lymphatic system most common reached to the kidneys as an ascending infections from the lower urinary tract
In pregnant women what type of infection is most common?
acute polynephritis because of the physiologic alterations that occur in the urinary tract
In nonpregnant women, men, and children what are the most common risk factors for acute pyelonephritis?
diabetes mellitus, anatomic abnormalities of the urinary tract and obstructive causes
In which kidney is acute pyelonephritis most affected?
right kidney and unilateral
Si/Sx of acute pyelonephritis
sudden onset, fever, chills and CVA tenderness, dysuria, urgency and frequency, nausea, vomiting, and anorexia `
Urosepsis
describes organisms in the bloodstream originating from a UTI
Chronic Pyelonephritis
small atrophied kidneys with diffuse scarring and blunting of the calices secondary to persistent or recurrent infection of the kidneys
What is the typical cause of chronic pyelonephritis?
reflux of infected urine into the renal pelvis
Pathogenesis of chronic pyelonephritis
bacteriuria associated with obstructive disorders
What is chronic pyelonephritis a potential cause of?
chronic kidney disease
The presence of what is the indicative of an upper urinary tract infection as opposed to a lower UTI?
presence of WBC
What is the classic symptom of Pyelonephritis?
CVA tenderness
Obstructive disorders of the Urinary tract
interfere with the flow of urine (urine stasis), which predisposes to infection and structural damage
What are the common causes of obstruction?
stones, tumors, prostatic hypertrophy and strictures of the ureters or urethra
What is the number one cause of obstruction?
renal stones
T/F the more proximal to the kidney the obstruction is located the less dilation is seen.
False, the more distal
hydroureter
complete obstruction of a ureter
hydronephrosis
enlarged kidney
What occurs after complete obstruction?
hydrophonephorsis, decreased GFR, and ischemic kidney damage because of increased intraluminal pressure
Renal calculi (Nephrolithiasis)
crystal aggregates composed of organic and inorganic material located within the urinary tract. these calculi are thought to form within the kidney (tubules or collecting duct) and may migrate to more distal structures
What is the common name for renal calculi?
kidney stones
Under what conditions do crystals form in the urinary tract?
solute supersaturation, low urine volume, and abnormal urine pH
What is an essential requirement for stone formation?
urinary supersaturation
besides crystalline formation what is the other formation of stones?
matrix: protein, sugar, glucosamine, bound water, and organic ash
What is the most common component of stones?
Calcium-oxalate: idiopathic
Glomerulopathies
glomerular disorders result from alterations in the structure and function of the glomerular capillary circulation
Primary Glomerulopathies
disease states in which the kidney is the only or predominant organ involved
Secondary Glomerulopathies
result from drug exposure, infection, or glomerular injury in the setting of multisytem or vascular abnormalities
What can Glomerulopathies result in?
proteinuria, hematuria, abnormal urinary casts, decreased GFR, and hypertension
Nephrotic Syndrome
characterized by a protein loss >3.5 in 24 hours
Nephritic Syndrome
reflection of inflammation and RBC casts are present in the sediment
Glomerulonephritis
due to an immune response to a variety of potential triggers and may have a primary or secondary etiology
Acute Glomerulopathies
triggered by infection
Crescentic Glomerulopathies
idiopathic but may be secondary to other diseases such as Goodposture Syndrome
Chronic Glomerulopathies
progress to chronic kidney disease
treatment of Glomerulopathies
steroids, plasmapheresis and supportive measures
What causes Nephrotic Syndrome
increases glomerular permeability to proteins which results in urinary loss of 3-3.5g of protein or more
Treatment of Nephrotic Syndrome
conservative, consisting of management of symptoms
