L1. Renal syndromes and renal biopsy Flashcards
The 3 fucntional categories of renal disease
- Pre-renal disease
- Post renal disease
- Intrinsic renal disease
Define pre-renal disease and give ex. of common causes (6)
Pre-renal = Due to reduced renal perfusion
- Volume depletion: GI, renal, skin losses
- Heat failure: reduction in cardiac output
- Cirrhosis: Splanchnic vessel pooling
- NSAID: renal vasoconstriction
- Renal artery stenosis
- Shock: sepsis, fluid loss
Define post-renal disease and give ex. of common causes
Post-renal = Urinary tract obstruction
- Prostatic disease
- Pelvi retroperitoneal malignancy
- Renal or uretic calculi
- Congenital abnormalities
Define instrinsic renal disease and common causes
Instrinsic renal disease = problem w/ components of kidney
- Glomerular disease
- Tubular disease
- Vascular disease
- Interstitial disease
Common glomerular disease
- Glomerulopathies
- Glomerulonephritis
Common Vascular diseases
- Nephrosclerosis
- Systemic vasculitis
- Thrombotic microangiopathy
Common tubular disease
- Acute tubular necrosis
- Myeloma kideney
- Hypercalcemia
- Polycystic kidney disease
Common interstitial disease
- Acute pyelonephritis
- Chronic pyelonephritis
- Drug-induced nephritis
- Analgesic nephropathy
Why increase glomerular permeability leads to 1.Thromboembolism,
- Tubular dysfunction,
- hypoalbuminemia,
- edema,
- Hyperlipoproteinemia,
- lipiduria,
- Malnutrition,
- increased infections
- Thromboembolism –>Alteration in coagulation factors
- Tubular dysfunction –> Increased tubular reabsorption of filtered protein
- hypoalbuminemia: Albumin wasting
- edema: Decrease oncotic pressure due to Dec. albumin
- Hyperlipoproteinemia: Increase hepatic synthesis of lipoproteins in response to protein wasting
- lipiduria: Due to hyperlipoproteinemia
- Malnutrition: Due to albuminuria
- increased infections: Altered turnover rates of immunoglobins
NEPHOTIC SYNDROME
- Mechanisms
- Effects: Protein, albumin, lipidemia, peripheral fluid
- Mechanisms
GMB or mesangial abnormality –> increased glomerular permeability
- Effects
Heavy proteinuria (>3.5), hypoalbuminemia, edema, hyperlipidemia
ASYMPTOMATIC OR GROSS HEMATURIA
- Mechanisms
- Effects
- Mechanisms
Glomerular abnormality
- Effects: hematuria –> dysmorphic RBC in urine
NEPHRITIC SYNDROME
- Mechanisms
- Effects: Protein, albumin, lipidemia, peripheral fluid
NEPHRITIC SYNDROME
- Mechanisms
Glomerular cellular proliferation –> Decreased glomerular perfusion
- Effects:
Hematuria, oliguria, increased serum creatinine and BUN, hypertension and proteinuria
ACUTE RENAL FAILURE
- Mechanisms
- Effects: Protein, albumin, lipidemia, peripheral fluid
- Mechanisms
Acute tubular or interstitial damage, acute glomerular perfusion failure
- Effects:
Oliguria/anuria, increased serum creatinine and BUN, acidosis, hyperkalemia
CHRONIC RENAL FAILURE
- Mechanisms
- Effects: Protein, albumin, lipidemia, peripheral fluid
- Mechanisms
Chronic irrevesible nephron destruction
- Effects:
Uremia = increased creatinine and BUN, and multiple organ disorders (anemia, endocrine defects and osteodystrophy)
Why anemia, endocrine defects and osteodystrophy in chronic renal failure
Kidney produces EPO –> regulates erythropoiesis, Renin –> angiotensin system (regulated), Important in the regulation of Ca and PO4 absorption and wasting for bone remodeling
