Kidney Disorders Flashcards
Infectious inflammatory disease of the renal parenchyma and pelvis
that usually ascends from the lower urinary tract
Complication of lower UTI – can ascend and affect one or both
kidneys
Pyelonephritis
What are the most common organisms that cause Pyelonephritis?
gram negative organisms:
E. coli
Proteus
Klebsiella
Enterobacter
Pseudomonas
What is a complication of pyelonephritis in diabetics that you should be aware of?
Emphysematous pyelonephritis
What type of organisms cause emphysematous pyelonephritis?
gas producing organisms
Why is emphysematous pyelonephritis so concerning?
Nephrotic, gangrenous
May be lift threatening
What condition presents as the following:
Dysuria
Fever
tachycardia
Shaking chills/rigors
Flank pain
NVD
Costovertebral tenderness
Back pain
Sepsis with shock
Pyelonephritis
List some complications of pyelonephritis
Sepsis with shock
Emphysematous pyelonephritis in diabetics
Scarring or chronic pyelonephritis
Abscess formation
Glomerular inflammation and damage resulting in microscopic or gross hematuria
5% of intrinsic renal failure
Usually children
Glomerulonephritis
What condition presents as the following:
Gross hematuria with or without systemic symptoms (tea colored urine)
Asymptomatic hematuria
Periorbital and scrotal edema
HTN
RBC casts and positive ASO titer
Glomerulonephritis
What is a common predisposing factor of glomerulonephritis, especially in children?
s/p Group A strep infection within 1-3 weeks
If a child had appropriate strep infection treatment, does that mean you can rule out glomerulonephritis?
No - glomerulonephritis can still happen even if the strep infection was treated appropriately
What type of glomerulonephritis is associated with extensive
glomerular crescent formation?
Rapidly-Progressive Glomerulonephritis
In rapidly-progressive glomerulonephritis, what indicates a poor prognosis?
Associated with extensive glomerular crescent formation
What are some causes of rapidly-progressive glomerulonephritis?
Infectious
Anti-GBM disease
Idiopathic (common)
What type of glomerulonephritis presents as the following:
Patients with idiopathic type note a preceding viral-like illness
Nephrotic or non-nephrotic proteinuria
Active urinary sediment with hematuria and RBC casts, leukocytes
Oliguria may be present
rapidly-progressive glomerulonephritis
In rapidly-progressive glomerulonephritis, what on urinalysis warrant
rapid diagnosis and treatment?
RBC casts
Prognosis in poor in rapidly-progressive glomerulonephritis when treatment is begun with a creatinine greater than what or when what is present?
6mg/dL or when oliguria is present
What type of glomerulonephritis presents as the following:
Proteinuria
Glomerular hematuria - Usually asymptomatic except for hematuria
Usually follows a group A beta-hemolytic strep infection by
1-3 weeks
Usually self-limiting (95%) and resolves spontaneously
No therapy required unless febrile
Post-Infectious Glomerulonephritis
What is the most common prior infection to post-infectious glomerulonephritis?
Post streptococcal is the most common
What age range is the greatest incidence to see post-infectious glomerulonephritis?
ages 2-5
What time frame post infection is it most likely to see post-infectious glomerulonephritis?
10-14 days post infection
What testing is used to diagnosis Post-Infectious Glomerulonephritis?
Confirm with ASO titer
What is the most common chronic nephritis in children?
IgA Nephropathy
What condition presents as the following:
Cause unknown
Present with asymptomatic gross hematuria
Initial onset usually 1-2 days after febrile URI
IgA Nephropathy
How is IgA nephropathy diagnosed?
Made by biopsy showing IgA deposits in glomeruli
What percentage of IgA nephropathy patients progress to hypertension and renal failure?
10%
What are the two classifications for glomular disease?
Nephritic and Nephrotic Syndromes
Which syndrome of glomular disease is described below?
Think acute glomerulonephritis
Inflammatory process causing renal dysfunction over days to weeks
May or may not resolve
Can cause permanent damage to nephrons, glomeruli, progresses to ESRD
Classified by edema, HTN, hematuria
Possible RBC casts and dysmorphic RBCs
“urinating blood”
Nephritis syndrome
Which syndrome of glomular disease is described below?
Think chronic system disease with glomerular involvement
33% have DM, amyloidosis, SLE, 66% idiopathic
Classified by proteinuria, hypoalbuminemia, peripheral edema
Hypercoagulability
Oval fat bodies in urine
“urinating protein”
Nephrotic syndrome
Nephritis syndrome is classified by what?
hematuria
Nephrotic syndrome is classified by what?
proteinuria
What is the most common cause of nephrotic syndrome?
idiopathic
What is the hallmark sign for nephrotic syndrome?
> 3.5 gram/day proteinuria
Seeing lipid bodies showing a “maltese cross” appearance in polarized light are called what? And what disorder should you consider?
Oval fat bodies
nephrotic syndrome
The majority of kidney stones are comprised of what?
calcium
What are reasons to admit a patient with nephrolithiasis?
Presence of a fever
Intractable nausea, vomiting, or pain
What are the five major types of urinary stones?
Calcium oxalate
Calcium phosphate
Struvite (magnesium ammonium phosphate)
Uric acid
Cystine
What high intake of these two items may be important factors in the
development of urinary stones?
High protein
high salt
What are the risk factors for developing a kidney stone?
Male gender
Dietary
Genetic
What type of stone is most commonly seen in women?
Struvite
Sudden onset of severe pain originating in the flank and radiating inferiorly and anteriorly (classic presentation)
Renal or ureteral colic – intermittent, can’t sit still
At least 50% of patients will have nausea
and vomiting
May present with gross hematuria
Back pain, Abdominal pain, Flank pain radiating to groin
Nephrolithiasis
What is the test of choice for suspected nephrolithiasis?
CT scan without contrast
What size of kidney stone is unlikely to pass spontaneously and
require some type of surgical procedure?
7mm or larger stone
When to refer in cases of nephrolithiasis?
Evidence of urinary obstruction
Anatomic abnormalities or solitary kidney
Concomitant pyelonephritis
Swelling of one or both kidneys
Occurs when a blockage somewhere in the urinary tract causes a
backup into the kidneys
Hydronephrosis
One of the most common fetal problems seen during a prenatal
ultrasound
Hydronephrosis
What are the causes of fetal hydronephrosis?
Posterior urethral valves
Vesicourethral reflux
Pelvic junction obstruction
Severe cases of fetal hydronephrosis require what intervention?
a shunt to be placed in the bladder to relieve pressure
Corrective surgery recommended in fetal hydronephrosis cases
if it doesn’t resolve within what time frame?
the first two years of life
Born without one or both kidneys
Renal Agenesis
Multiple cysts found on the kidney
Autosomal dominant or recessive
50% of patients will have ESRD by age 60
Polycystic Kidney Disease
What ultrasound finding is seen in polycystic kidney disease?
“honeycomb” appearance
What is the imaging of choice in polycystic kidney disease?
Ultrasound of kidneys
What are some associated findings in patients with polycystic kidney disease?
hepatic, splenic, pancreatic cysts
Mitral valve prolapse – 25%
Aneurysm in Circle of Willis – 10%
Renal calculi – 20%
Condition where protein accumulates in various organs
Amyloid deposits in the kidney
Pathology - Glomeruli filled with amorphous deposits that stain with Congo red (Bence-Jones proteins) showing green bifringence
Amyloidosis
In patients with amyloidois with kidney involvement, how long until they typically progress to ESRD?
in 2-3 years
Glomeruli filled with amorphous deposits that stain with Congo red
(Bence-Jones proteins) showing green bifringence should alert you to what disorder?
Amyloidosis
One of the most common solid tumors in children
Wilm’s Tumor
Most common abdominal neoplasm in children
Wilm’s Tumor
nephroblastoma
Usually occurs before age 4
Mixed tumor of embryonic and mesenchymal tissues
Can occur in any part of the kidney
Usually is sharply demarcated with variable encapsulation
Wilm’s Tumor
Wilm’s Tumor is also associated with what other findings?
Sporadic aniridia
Hemihypertrophy
GU malformations
What condition presents with the following clinical presentation?
Large abdominal mass
Hypertension
Abdominal pain
+/- vomiting
Wilm’s Tumor
What imaging is used to confirm the diagnosis of Wilm’s Tumor?
CT scan to confirm
Originates in the proximal tubule cells
Not common: 2-3% of all adult cancers
M>F = 2:1
Biggest risk factor is smoking
Renal Cell Carcinoma
What is the biggest risk factor for renal cell carcinoma?
smoking
What is the most common presentation in renal cell carcinoma?
Gross or microscopic hematuria – 60%
On a kidney ultrasound, if a complex cyst is identified, what must be ruled out?
renal cell carcinoma
What is the imaging of choice for renal cell carcinoma?
CT abdomen/pelvis (best)
What condition presents with the following clinical presentation?
Gross or microscopic hematuria – 60%
Flank pain/abdominal mass – 30%
Cough and bone pain in 20-30% of patients at presentation
renal cell carcinoma
What is the gold standard treatment for renal cell carcinoma?
Radical nephrectomy
Why is a radical nephrectomy the gold standard treatment for renal cell carcinoma?
No effective chemo regimen!
