M5U1: RENAL DISEASES Flashcards
1
Q
This renal failure is characterized by a sudden loss of renal function with the nephron appearing normal histologically
A
Acute renal failure
2
Q
Why does acute renal failure have a higher mortality rate ?
A
due to concomitant infection and potassium intoxication
3
Q
This causes 25% of ARF cases
A
Prerenal mechanism
4
Q
What is the common cause of prerenal mechanism ?
A
decreased renal perfusion resulting to ischemia
5
Q
What conditions may be associated with prerenal mechanism ?
A
decreased cardiac output hemorrhages burns surgical procedures diarrhea vomiting
6
Q
What other clinical findings may be present in prerenal mechanism ?
A
low urine sodium
higher urine osmolality than serum
increased BUN:Creatinine ratio
7
Q
This causes majority (65%) of ARF cases
A
Renal mechanism
8
Q
This mechanism includes glomerular, tubular, and vascular diseases
A
Renal mechanism
9
Q
This causes 10% of ARF cases
A
Postrenal mechanism
10
Q
This mechanism is commonly associated with obstruction of urine flow
A
Postrenal mechanism
11
Q
The obstruction due to postrenal mechanism causes an ____
A
increase in hydrostatic pressure in tubules and bowman’s capsule resulting to damage
12
Q
This type of renal failure s characterized by irreversible progressive loss of renal function
A
Chronic renal failure
13
Q
When does the decrease in glomerular filtration rate become clinically recognizable ?
A
80-85% of normal renal function is lost (GFR=15-20 mL/min)
14
Q
What causes the slow and silent progression of CRF ?
A
This may be due to the ability of the healthy nephrons to compensate for damaged nephrons
15
Q
Where does the wear and tear principle occur in relation to renal failure ? and what does this do ?
A
CRF
the healthy nephrons become overworked and undergo hypertrophy until they lose their function as well
16
Q
What are some of the conditions that cause CRF ?
A
glomerulonephritis diabetic nephropathy chronic pyelonephritis hypertension systemic lupus erythematosus congenital abnormalities
17
Q
What may patients with CRF experience ?
A
acid-base imbalance water and electrolyte imbalance\ azotemia abnormal calcium phosphate metabolism
18
Q
What are some typical urinalysis results of patients with CRF ?
A
isosthenuria
proteinuria
hematuria
all types of casts
19
Q
___ is a vascular disease that reduce renal blood flow
A
atherosclerosis
20
Q
In relation to vascular disease, ____ causes structural changes on the arterioles and glomerular capillaries resulting to ischemia
A
hypertension polyarteritis nodosa eclampsia diabetes amyloidosis
21
Q
In relation to vascular disease, renal function depends on ____ and any condition affecting this can cause renal diseases
A
adequate renal perfusion
22
Q
In this tubulointerstitial disease you may find an increase in transitional epithelial cells in the microscopic examination ?
A
Cystitis (lower UTI)
23
Q
What tubulointerstitial disease is characterized by small amounts of protein (<0.5 g/day) found in the physical and chemical examination ?
A
Cystitis (lower UTI)
24
Q
What tubulointerstitial disease is characterized by mild amounts of protein (=1 g/day) found in the physical and chemical examination ?
A
Acute interstitial nephritis (upper UTI)
25
What tubulointerstitial disease is characterized by mild amounts of protein (<1 g/day) found in the physical and chemical examination ?
Acute pyelonephritis (upper UTI)
26
What tubulointerstitial disease is characterized by moderate amounts of protein (<2.5 g/day) found in the physical and chemical examination ?
Chronic pyelonephritis (upper UTI)
27
In this tubulointerstitial disease you may find an increase in eosinophils in the microscopic examination ?
Acute interstitial nephritis (upper UTI)
28
What may be the cause of tubular necrosis ?
decreased blood flow in the kidneys resulting to ischemia
direct damage to the tubules by toxic substances
29
What are some common tubular dysfunctions
```
Fanconi syndrome
cystinosis and cystinuria
renal glucosuria
renal phosphaturia
renal tubular acidosis
```
30
This tubular disease is characterized by reversible destruction of the renal tubular epithelium with 50% of cases resulting from surgical procedures
acute tubular necrosis (ATN)
31
Describe the onset of Renal tubular necrosis ?
abrupt after a hypotensive event
| subtle after exposure to a nephrotoxic substance
32
Renal failure of Renal tubular necrosis is ?
azotemia
hyperkalemia
metabolic acidosis
oliguria
33
Describe the recovery phase ofRenal tubular necrosis
urine output steadily increases as much as 3 liters per day
Diuresis - indicate gfr is returning to normal
continued loss of large amounts of water, sodium, and potassium until tubular function is restored and azotemia is resolved
34
What are the three phases present in Renal tubular necrosis ?
onset
renal failure
recovery phase
35
This is a focal type of tubular disease characterized by tubular basement membrane disruption resulting from the complete necrosis of tubular cells exposing the renal interstitium to the tubular luen
Ischemic Acute Renal Necrosis
36
This type of ATN has fragments of the renal epithelium in the collecting ducts visible in the microscopic examination of urine
Ischemic Acute Renal Necrosis
37
Ischemic ATN often develops ___ leading to a decrease in renal perfusion resulting to renal ischemia
following a hypotensive event
38
What are the three principal causes of Ischemic Acute Renal Necrosis ?
sepsis (bacterial infection)
shock (severe burns)
trauma (crush injuries)
39
This type of ATN is characterized by the involvement of necrosis in the PCT but not including the basement membrane
Toxic Acute Renal Necrosis
40
This type of ATN has distinctive large convoluted renal tubular epithelial cells from the PCT in the microscopic examination of urine
Toxic Acute Renal Necrosis
41
What may be the cause of Toxic Acute Renal Necrosis ?
endogenous or exogenous nephrotoxic agents
42
____ are normal substances in circulation that become nephrotoxic in higher concentrations
endogenous agents
43
These are examples of endogenous agents
hemoglobin (severe hemolytic episodes)
myoglobin (rhabdomyolysis)
uric acid (Lesch-Nyhan diseases)
immunoglobulin light chains (multiple myeloma)
44
____ are substances ingested, injected, absorbed, or inhaled
exogenous agents
45
Examples of exogenous agents may include
```
therapeutic agents (aminoglycosides)
anesthetics (enflurane)
radiographic contrast media
chemotherapeutic drugs (cyclosporin)
recreational drugs (heroin cocaine)
industrial chemicals (heavy metals)
organic solvents (carbon tetrachloride)
other poisons
```
46
An increased number and variety of casts (granular, renal tubular cell, waxy and broad casts) are commonly associated with ____
Ischemic ATN
47
This tubular dysfunctions is characterized by generalized loss of function of PCT
Fanconi syndrome
48
____ is an autosomal dominant disorder resulting to the inability of the tubules to produce an acid urine despite adequate hydrogen ions for secretion and a normal GFR
Renal Tubular Acidosis (RTA)
49
What are the characteristics of RTA Type I ?
inability to maintain the normal hydrogen gradient
increases the secretion of ammonia to compensate
50
What are the characteristics of RTA Type II ?
decreased reabsorption of bicarbonates in the PCT
utilization of hydrogen ions to reabsorb bicarbonates in the DCT instead of being eliminated in urine
51
What are the characteristics of RTA Type III ?
combination of type I and type II
52
What are the characteristics of RTA Type VI ?
impaired ability to exchange sodium for potassium and hydrogen in the dsital tube
53
This is an autosomal recessive disorder resulting to cystinuria
Cystinosis
54
This is a benign inherited condition that lowers the maximal tubular reabsorptive capacity of the tubules
Renal glucosuria
55
This is a rare dominant sex-linked disorder
Renal phosphaturia/familial hypophosphatemia
56
What is the characteristic of renal phosphaturia ?
inability of the DCT to reabsorb inorganic phosphoporus
57
How is renal phosphaturia appeared to be a two-folded defect ?
DCT is hypersensitive to the parathyroid hormone
increasing phosphate excretion
decrease PCT response to hypophosphatemia
58
This renal tubular disease may have mild protein (<1 g/day) findings in the physical and chemical examination of urine
ATN
cystinuria and cystinosis
59
This renal tubular disease may have mild protein (<2.5 g/day) findings in the physical and chemical examination of urine
Fanconi syndrome
60
This renal tubular disease may have positive glucose findings in the physical and chemical examination of urine
Fanconi syndrome
61
This renal tubular disease may have pH findings of >pH 5.5 in the physical and chemical examination of urine
Renal tubular acidosis
62
This renal tubular disease may have cystine crystals visible in the microscopic examination of urine
cystinuria and cystinosis
63
What is the cause for a disease in the renal tubules inevitably affecting the renal interstitium and vice versa ?
the proximity and interconnectedness in function of the renal tubules and renal interstitium
64
What conditions are capable of causing tubulointerstitial diseases ?
infections (pyelonephritis or interstitial nephritis)
toxins
metabolic diseases
vascular diseases
neoplasms
multiple myeloma
drugs
irradiation
transplant rejection
65
___ is closely related to tubulointerstitial diseases as the former presents the mechanism leading to the development of acute pyelonephritis
UTI
66
Lower UTI may involve the ___, ___ or both
urethra (urethritis)
| bladder (cystitis)
67
Upper UTI can involve the ___ and/or ___
```
renal pelvis (pyelitis)
interstitium (pyelonephritis)
```
68
Which portion of the urethra has normal flora ?
distal portion
69
How does the normal flora remain isolated in the urethra ?
due to continual flushing during voiding
70
UTI is commonly caused by ___
bacteria from GI tract
71
Why is UTI more common among females than males ?
anatomy - shorter urethra with close proximity to the vagina and rectum
hormones - enhance bacterial adherence to the mucosa of the urethra
absence of prostatic fluid - has antibacterial action is not secreted by women
"milking" of bacteria up the urethra during sexual intercourse
72
____ are the normal flora in the GI tract and vagina
Candida species (e.g., Candida albicans)
73
When the bacterial flora is adversely disrupted by ____, yeasts proliferate and may cause an infection
antibiotics or pH changes
74
What are the common signs and symptoms of UTI ?
painful urination (dysuria)
frequent urge to urinate (urgency)
occasional low-grade fever
cramping
geriatric patients: mental confusion or distress
75
This type of infection involves the renal tubules, interstitium and renal pelvis as a result of ascending infection or hematogenous infection
acute pyelonephritis
76
What is ascending infection in acute pyelonephritis
movement of bacteria from the lower urinary tract to the kidneys
77
What is hematogenous infection ?
localization of bacteria from the bloodstream in the kidneys
78
What is the common cause in acute pyelonephritis ?
ascending UTI from gram-negative organisms that are normal intestinal flora
79
In acute pyelonephritis, the presence of bacteria in the interstitium results to ___ and ___
acute inflammation
| tubules becoming necrotic
80
In acute pyelonephritis, the presence of bacterial toxins and leukocytic enzymes results to the ____
formation of abscesses
81
Predisposing factors to acute pyelonephritis include ____
conditions or procedures that causes the proliferation and movement of bacteria to the upper urinary tract
82
In acute pyelonephritis, this refers to the abnormal movement of urine from the bladder to the ureter as a result of an inherited congenital defect
Vesicoureteral reflux
83
What conditions may be seen in relation to acute pyelonephritis ?
vesicoureteral reflux
catheterization
Urinary tract obstruction
sepsis
pregnancy
diabetes mellitus
immunosuppression
84
Patients with ___ experience acute pain in their flank, back or groin and nocturia together with typical UTI (dysuria and urgency to urinate) and in some cases they may experience ____
acute pyelonephritis
```
high fever
chills
nausea
headache
generalized malaise
```
85
What are the characteristics of chronic pyelonephritis ?
persistent inflammation of the renal tissue resulting to fibrosis and scarring of the renal calyces and renal pelvis
86
What is the common cause of chronic pyelonephritis ?
reflux nephropathies: vesicoureteral reflux, urinary tract obstruction and intrarenal reflux
87
____ is the movement of urine back to the collecting duct and as far as the renal cortex due to a structure abnormality
intrarenal reflux
88
Patients with chronic pyelonephritis may experience
hypertension
polyuria
nocturia
renal failure (in 10-15% of cases)
89
What are the causes of acute interstitial nephritis ?
allergic response in the interstitium of the kidney, usually from an acute allograft rejection after kidney transplant
antibiotic
NSAIDs
antipileptics
allopurinol
90
Allergic reactions to antibiotic, NSAIDs, antipileptics and allopurinol usually induce ___
cell-mediated immune responses causing damage to the interstitium (edema and infiltration) and tubules (necrosis)
91
Clinical features associated with drug-induced acute interstitial nephritis
fever
skin rash
eosinophilia
92
What is the effect of glomerular diseases on urinary system ?
immune-mediated causing deposition of immune complexes on the glomerulus or antibodies directly reacting to glomerular tissue thereby resulting to inflammation or damage
93
Vascular diseases affect ___ in the kidneys to which normal renal function is dependent
renal perfusion
94
In glomerular diseases, these ___ are trapped in the glomerular tuft and may activate the ___ resulting to cell lysis of cells in the glomerulus
immune complexes
complement system
95
What are the three phases of deposition of immune complexes in the pathogenesis of glomerular diseases ?
immune complex formation
immune complex deposition
immune complex-mediated inflammation
96
____ refers to a group of clinical findings indicative of glomerular damage resulting from an inflammatory process
nephritic syndrome
97
Nephritic syndrome is characterized by
hematuria
hypertension
oliguria
azotemia
mild proteinuria
mild edema
98
In nephritic syndrome, the severity of the symptoms shown depends on ___, ___ and ___
number of glomeruli involved
the mechanism of injury
onset of disease
99
____ indicates adverse glomerular changes brought about by non-inflammatory mechanisms
Nephrotic syndrome
100
Nephrotic syndrome is characterized by
proteinuria (>3.4 mg/day)
hypoalbuminemia
generalized edema
hyperlipidemia
lipiduria
101
In nephrotic syndrome, due to an increase in glomerular permeability substances such as ___ become elevated in urine
albumin
immunoglobulins
complement cofactors
coagulation factors
lipids
102
Albumin is the predominant protein lost in urine from nephrotic syndrome, this results to ___
hypoalbuminemia
proteinuria
103
The patient becomes ___ due to loss of immunoglobulins, complement cofactors, and coagulation factors
susceptible to infections and thrombotic complications
104
In nephrotic syndrome, ___ and ___ result from the increased lipid synthesis in the liver and a decreased lipid catabolism
hyperlipidemia
lipiduria
105
TGC, cholesterol, phospholipids, and VLDL are able to pass throughout the glomerulus and are found freely floating in urine, withing ___ or withing ___
renal tubular cells
renal casts
106
What is the primary cause of generalized edema ?
sodium retention associated with the increased reabsorption of sodium and water in the DCT
107
How does hypoalbuminemia play a minor role in causing edema ?
loss of proteins in plasma reduces oncotic pressure eventually causing the movement of fluid into the interstitial tissues
108
Soft and pitting edema is commonly observed where ?
eyes or legs
109
Aside from glomerular diseases, nephrotic syndrome can also be observed in patients with ___ and those who ___
systemic diseases
have taken nephrotoxic agents
110
In sever cases of generalized edema, ___ and ___ may manifest
pleural effusions
ascites
111
What is leukocyte infiltration characterized by
infiltration of neutrophils and macrophages as form of chemotactic response
112
Leukocyte infiltration is commonly observed in some types of ____
acute glomerulonephritis
113
Cellular proliferation is characterized by
increase in the number of:
endothelial cells
mesangial cells
podocytes
in the glomerular tuft
114
Define segmental cellular proliferation
involves only a part of each glomerulus
115
Define focal cellular proliferation
involves only a certain number of glomeruli in the kidney
116
Define diffuse cellular proliferation
involves all glomeruli in the kidneys
117
What is the cause of glomerular basement membrane thickening ?
deposition of immune complexes or fibrin in the basement membrane
118
The cause of glomerular basement membrane thickening is true in most cases, but in ____ the basement membrane thickens without any evidence of deposition of materials
diabetic glomerulosclerosis
119
Hyalinization is characterized by
accumulation of a homogenous eosinophilic material in the glomeruli resulting to a loss of its structure detail
