Lesson 5: Renal Disease Flashcards
It is a “sudden onset” of symptoms consistent with damage to the glomerular membrane
Acute glomerulonephritis (AGN)
This disease usually occurs after respiratory infection caused by certain strains of group A (Beta-hemolytic streptococci) that contains M protein in the cell wall
Acute poststreptococcal glomerulonephritis
Primarily urinalysis findings include:
marked hematuria
proteinuria
oliguria
RBC cast
dysmorphic RBC
hyaline, granular cast
WBC cast
Acute glomerulonephritis
What tests provide evidence that the glomerulonephritis is of streptococcal origin?
Positive anti-group A streptococcal enzyme test:
1. anti-streptolysin O (ASO)
2. antideoxyribonuclease-B antibody (anti-DNase B)
Technical Tip: RBC casts are a hallmark characteristic of acute glomerulonephritis
YIPPIE ESNUPI!
A more serious form of acute glomerular disease and has a much more poorer prognosis, often terminating in renal failure
Rapidly progressive (or crescentic) glomerulonephritis (RPGN)
Symptoms of this disease are initiated by deposition of “immune complexes in the glomerulus”, often as a complication of another form of glomerulonephritis or a disorder of the immune system such as, “SLE” or Systemic Lupus Erythematosus
Rapidly Progressive (Crescentic) Glomerulonephritis
A cytotoxic “autoantibody” can appear against the glomerular and alveolar basement membranes after viral respiratory infections
Goodpasture syndrome
Granulomatosis with polyangiitis (GPA) is formerly called as?
Wegener granulomatosis
It has morphological changes to the glomeruli resembling those in RPGN and seen in conjunction with autoimmune disorder termed as?
Goodpasture Syndrome
What antibody in the patient’s serum is a key diagnostic indication of Granulomatosis with Polyangiitis (GPA)?
Antineutrophilic cytoplasmic antibody (ANCA)
What antibody is related to Goodpasture Syndrome?
Anti-glomerular Basement Membrane Antibody
It causes a granuloma-producing inflammation of the small blood vessels, primarily of the kidney and respiratory system
Granulomatosis with polyangiitis (GPA)
ANCA is associated with what disease?
Granulomatosis with Polyangiitis
Testing for ANCA includes incubating the patient’s serum with either ________/________ and examining the preparation using indirect immunofixation to detect the serum antibodies attached to the neutrophils
Ethanol or Formalin/Formaldehyde-fixed neutrophils
ANCA binds with what WBCs located in the vascular walls that may initiate an immune response?
Neutrophils
When neutrophils are fixed with “ethanol”, the antibodies form a perinuclear pattern called?
p-ANCA
When neutrophils are fixed with “formalin/formaldehyde”, the pattern is granular throughout the cytoplasm and is referred to as?
c-ANCA
It is marked by different alteration in the cellularity of the glomerulus and peripheral capillaries
Membranoproliferative glomerulonephritis (MPGN)
Its initial symptoms include the appearance of raised, “red patches” on the skin
Henoch-Schonlein purpura
Complete recovery with normal renal function is seen more than ___ of patients in cases of Henoch-Schonlein Purpura
50%
Disorders associated with membranous glomerulonephritis development include?
SLE
Sjogren syndrome
Secondary syphilis
Hepatitis B
Gold and Mercury treatments
Malignancy
Type 1, Type 2, or Type 3 Membranoproliferative Glomerulonephritis (MPGN)
Also called as “dense deposit disease” and displays extremely dense deposits in the glomerular basement membrane, tubules, and Bowman capsule
Type 2 MPGN
This disorder is associated with a tendency towards “Thrombosis”
Membranous Glomerulonephritis
Predominant characteristic of this disease is a pronounced thickening of the glomerular basement membrane resulting from the deposition of “Immunoglobulin G” or IgG
Membranous Glomerulonephritis (MGN)
Type 1, Type 2, or Type 3 Membranoproliferative Glomerulonephritis (MPGN)
Displays increased cellularity in the subendothelial cells of the “mesangium” (interstitial area of Bowman capsule), causing thickening of the capillary walls
Type 1 MPGN
Type 1, Type 2, or Type 3 Membranoproliferative Glomerulonephritis (MPGN)
Characterized by “both” subepithelial and subendothelial deposits
Type 3 MPGN
Many patients are children, and the disease has a poor prognosis. Type 1 (MPGN) patients progress to what disease?
Nephrotic syndrome
Many patients are children, and the disease has a poor prognosis. Type 2 (MPGN) patients progress to what disease?
Chronic Glomerulonephritis
Acute glomerular disease may progress into (2)?
Chronic Glomerulonephritis (CGN)
End-Stage Renal Disease (ESRD)
Technical Tip: The presence of broad casts is often seen in chronic glomerulonephritis that progresses to ESRD
YEEEEEEEEEEEEEEEEEEEEEEEE
Immune complexes containing IgA are deposited on the glomerular membrane, and is the most common common cause of glomerulonephritis
IgA nephropathy
IgA nephropathy is also known as?
Berger disease
A patient with IgA nephropathy may remain essentially asymptomatic for how many years?
20 years or more
This disorder is seen most frequently in children and young adults
Immunoglobulin A nephropathy
What is damaged in cases of Nephrotic Syndrome that causes the passage of high-molecular-weight proteins and lipids and negatively charged albumin into the urine.
Damaged shield of negativity and podocytes that produces a barrier
In nephrotic syndrome, what is the primary protein depleted from the circulation?
Albumin
Minimal Change Disease (MCD) is also known as?
Lipid nephrosis or nil disease
This is a disease marked by:
massive proteinuria (>3.5 g/day)
low levels of serum albumin
high levels of serum lipids
pronounced “edema”
Nephrotic Syndrome
Primary disorder associated with damage to the renal tubules?
Acute Tubular Necrosis (ATN)
Since both tubular and glomerular damage occurs, nephrotic syndrome may progress to?
Chronic Renal Failure
Produces little cellular change in the glomerulus, except for some damage to the podocytes and shield of negativity, allowing for increased protein filtration
Minimal Change Disease
What antigen is associated with Minimal Change Disease (MCD)?
Human leukocyte antigen-B12 (HLA-B12)
Patients of this disease are usually:
Children who present with edema
Heavy proteinuria
Transient hematuria
Normal BUN and Creatinine
Minimal Change Disease (MCD)
It is the most common cause of nephrotic syndrome in children (85-95%)
But only (10-15%) in adults
Minimal Change Disease (MCD)
It is a disorder of T cells, which release a cytokine that injures the glomerular epithelial foot processes.
Minimal Change Disease (MCD)
Minimal Change Disease (MCD) is usually treated with?
Corticosteroids
It is one of the most common causes of primary glomerular disease in adults
It affects only certain numbers and area of glomeruli and the others remain normal
Focal Segmented Glomerulosclerosis (FSGS)
A disease seen in association with abuse of “heroin” and “analgesics” and with HIV and Hepatitis virus
FSGS (Focal Segmental Glomerulosclerosis)
Immune deposits, primarily immunoglobulin M (IgM) and C3, are a frequent finding and can be seen in undamaged glomeruli
Focal Segmental Glomerulosclerosis (FSGS)
Damage to the RTE cells may be produced by decreased blood flow that causes a lack of oxygen presentation to the tubules in Acute Tubular Necrosis which is called?
Ischemia
Exposure to substances like:
Aminoglycoside antibiotics
Antifungal agents (amphotericin B)
Cyclosporine
Radiographic dye
Ethylene glycol
Heavy metals
Toxic mushrooms
These are substances that are considered as?
Nephrotoxic agents
This disorder may be inherited in association “Cystinosis” and “Hartnup Disease”, acquired through exposure to toxic agents, including heavy metals and outdated tetracycline, or seen as a complication of multiple myeloma or renal transplant
Fanconi Syndrome
It is a general term indicating a severe condition that decreases the flow of blood throughout the body
Shock
It is a glycoprotein and is the only protein produced by the kidney (in the PCT and DCT)
Uromodulin
It is an inherited disorder of “collagen production” affecting the glomerular basement membrane.
Can be sex-linked or autosomal genetic disorder.
Alport Syndrome
This disease shows abnormalities in hearing and vision.
Alport syndrome
This disorder associated with tubular dysfunction most frequently is?
Fanconi syndrome
The syndrome consists of a generalized failure of tubular reabsorption in the PCT.
Therefore, substances affected most noticeably include glucose, amino acids, phosphorous, sodium, potassium, bicarbonate, and water
Fanconi Syndrome
Technical Tip: RTE cell casts and the presence of RTE cells in the urine sediment are characteristic for ATN
Strasingpurrrrr!!
Technical Tip: Uromodulin forms the matrix of urinary casts seen in many renal disorders. The defective gene is not associated with other renal disorders
FWAEHHH!
It is primarily an inherited disorder caused by an autosomal mutation in the “gene that produces uromodulin”
Decreased production of normal uromodulin and replaced with abnormal form
Uromodulin-Associated Kidney Disease
It is the most common cause of ESRD (End-Stage Renal Disease)
Diabetic Nephropathy
Nephrogenic Diabetes Insipidus can be acquired from medication of?
Lithium and Amphotericin B
Early monitoring of people diagnosed with diabetes mellitus for the presence of __________ is important to detect the onset of diabetic nephropathy
Microalbuminuria
Polycystic kidney disease and sickle cell anemia are complications seen in?
Nephrogenic Diabetes Insipidus
Most frequently encountered UTI is the infection of the?
Bladder (Cystitis) (Lower UTI)
What is the difference in reabsorption function between Fanconi Syndrome and Renal Glycosuria?
Fanconi Syndrome = Generalized failure to reabsorb substances from the Glomerular Filtrate
Renal Glycosuria = Affects only reabsorption of Glucose
Upper urinary tract infections affect the ____, ______, and _____
renal pelvis, tubules, and interstitium
Considering the close proximity between renal tubules and the renal interstitium, disorders affecting the interstitium also affect the tubules, resulting in the condition called as?
Tubulointerstitial Disease
Most common renal disease
UTI (Urinary Tract Infection)
Lower urinary tract infections affect the _____ and _______
urethra and bladder
Infection of the Upper Urinary Tract, including both the tubules and interstitium is termed as?
Pyelonephritis
It is associated primarily with an allergic reaction to medications that occurs within the renal interstitium, possibly caused by the medication binding to the interstitial protein
Acute Interstitial Nephritis (AIN)
It occurs most frequently as a result of ascending movement of bacteria from a lower UTI into the renal tubules and interstitium
Acute Pyelonephritis
Congenital urinary structural defects producing reflux nephropathy are the most frequent cause of?
Chronic Pyelonephritis
Reflux of urine from the bladder back into the ureters is termed as?
Vesicoureteral reflux (VUR)
Technical Tip: The presence of WBC casts is significant for differentiating between cystitis and pyelonephritis
LEZGOOO!
Which is reversible, Acute Renal Failure or Chronic Renal Failure?
Acute Renal Failure
Primary causes of Acute Renal Failure
Prerenal: sudden decrease in blood flow to the kidney
Renal: Acute glomerular and tubular disease
Postrenal: Renal calculi or tumor obstructions
YAY!!!
It is marked by the inflammation of the renal interstitium followed by inflammation of the renal tubules
Acute Interstitial Nephritis (AIN)
Medications commonly associated with AIN include:
Penicillin
Methicillin
Ampicillin
Cephalosporins
Rifampin
Sulfonamides
NSAIDs
Thiazide diuretics
Indinavir
Proton pump inhibitors
Allopurinol
5-aminosalicylates
Diuretics
Cimetidine
YIPPIE ESNUPI!
The progression to ESRD is characterized as follows:
- Marked decrease in the glomerular filtration rate (less than 25 mL/min)
- Steadily rising serum BUN and creatinine values (azotemia)
- Electrolyte imbalance
- Lack of renal concentrating ability, producing an isosthenuric urine
- Proteinuria
- Renal glycosuria
- Abundance of granular, waxy, and broad casts, often referred to as a telescoped urine sediment
Thanks for the info!
Technical Tip: The presence of eosinophil casts and eosinophils in the urine sediment are characteristic for AIN (Acute interstitial nephritis)
ESNUPIIIII!
These may form in the calyces and pelvis of the kidney, ureters, and bladder. They vary in size from barely visible to large.
Renal calculi
Technical Tip: Broad casts are often referred to as “Renal Failure Casts”
LAMAOW!
These are renal calculi resembling the shape of the renal pelvis and smooth, round bladder stones with diameters of 2 or more inches
Staghorn calculi
A procedure using high-energy shock waves, can be used to break stones located in the upper urinary tract into pieces that then can be passed in the urine
Lithotripsy
