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AUBF LEC > M5U1: RENAL DISEASES > Flashcards

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

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2
Q

Why does acute renal failure have a higher mortality rate ?

A

due to concomitant infection and potassium intoxication

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3
Q

This causes 25% of ARF cases

A

Prerenal mechanism

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4
Q

What is the common cause of prerenal mechanism ?

A

decreased renal perfusion resulting to ischemia

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5
Q

What conditions may be associated with prerenal mechanism ?

A 
decreased cardiac output
hemorrhages
burns
surgical procedures
diarrhea
vomiting
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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

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7
Q

This causes majority (65%) of ARF cases

A

Renal mechanism

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8
Q

This mechanism includes glomerular, tubular, and vascular diseases

A

Renal mechanism

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9
Q

This causes 10% of ARF cases

A

Postrenal mechanism

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10
Q

This mechanism is commonly associated with obstruction of urine flow

A

Postrenal mechanism

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11
Q

The obstruction due to postrenal mechanism causes an ____

A

increase in hydrostatic pressure in tubules and bowman’s capsule resulting to damage

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12
Q

This type of renal failure s characterized by irreversible progressive loss of renal function

A

Chronic renal failure

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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)

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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

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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

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16
Q

What are some of the conditions that cause CRF ?

A 
glomerulonephritis
diabetic nephropathy
chronic pyelonephritis
hypertension
systemic lupus erythematosus
congenital abnormalities
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17
Q

What may patients with CRF experience ?

A 
acid-base imbalance
water and electrolyte imbalance\
azotemia
abnormal calcium
phosphate metabolism
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18
Q

What are some typical urinalysis results of patients with CRF ?

A

isosthenuria
proteinuria
hematuria
all types of casts

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19
Q

___ is a vascular disease that reduce renal blood flow

A

atherosclerosis

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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
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21
Q

In relation to vascular disease, renal function depends on ____ and any condition affecting this can cause renal diseases

A

adequate renal perfusion

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22
Q

In this tubulointerstitial disease you may find an increase in transitional epithelial cells in the microscopic examination ?

A

Cystitis (lower UTI)

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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)

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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)

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25
Q

What tubulointerstitial disease is characterized by mild amounts of protein (<1 g/day) found in the physical and chemical examination ?

A

Acute pyelonephritis (upper UTI)

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26
Q

What tubulointerstitial disease is characterized by moderate amounts of protein (<2.5 g/day) found in the physical and chemical examination ?

A

Chronic pyelonephritis (upper UTI)

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27
Q

In this tubulointerstitial disease you may find an increase in eosinophils in the microscopic examination ?

A

Acute interstitial nephritis (upper UTI)

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28
Q

What may be the cause of tubular necrosis ?

A

decreased blood flow in the kidneys resulting to ischemia

direct damage to the tubules by toxic substances

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29
Q

What are some common tubular dysfunctions

A 
Fanconi syndrome
cystinosis and cystinuria
renal glucosuria
renal phosphaturia
renal tubular acidosis
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30
Q

This tubular disease is characterized by reversible destruction of the renal tubular epithelium with 50% of cases resulting from surgical procedures

A

acute tubular necrosis (ATN)

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31
Q

Describe the onset of Renal tubular necrosis ?

A

abrupt after a hypotensive event

subtle after exposure to a nephrotoxic substance

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32
Q

Renal failure of Renal tubular necrosis is ?

A

azotemia
hyperkalemia
metabolic acidosis
oliguria

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33
Q

Describe the recovery phase ofRenal tubular necrosis

A

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

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34
Q

What are the three phases present in Renal tubular necrosis ?

A

onset
renal failure
recovery phase

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35
Q

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

A

Ischemic Acute Renal Necrosis

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36
Q

This type of ATN has fragments of the renal epithelium in the collecting ducts visible in the microscopic examination of urine

A

Ischemic Acute Renal Necrosis

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37
Q

Ischemic ATN often develops ___ leading to a decrease in renal perfusion resulting to renal ischemia

A

following a hypotensive event

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38
Q

What are the three principal causes of Ischemic Acute Renal Necrosis ?

A

sepsis (bacterial infection)

shock (severe burns)

trauma (crush injuries)

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39
Q

This type of ATN is characterized by the involvement of necrosis in the PCT but not including the basement membrane

A

Toxic Acute Renal Necrosis

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40
Q

This type of ATN has distinctive large convoluted renal tubular epithelial cells from the PCT in the microscopic examination of urine

A

Toxic Acute Renal Necrosis

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41
Q

What may be the cause of Toxic Acute Renal Necrosis ?

A

endogenous or exogenous nephrotoxic agents

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42
Q

____ are normal substances in circulation that become nephrotoxic in higher concentrations

A

endogenous agents

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43
Q

These are examples of endogenous agents

A

hemoglobin (severe hemolytic episodes)
myoglobin (rhabdomyolysis)
uric acid (Lesch-Nyhan diseases)
immunoglobulin light chains (multiple myeloma)

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44
Q

____ are substances ingested, injected, absorbed, or inhaled

A

exogenous agents

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45
Q

Examples of exogenous agents may include

A 
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
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46
Q

An increased number and variety of casts (granular, renal tubular cell, waxy and broad casts) are commonly associated with ____

A

Ischemic ATN

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47
Q

This tubular dysfunctions is characterized by generalized loss of function of PCT

A

Fanconi syndrome

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48
Q

____ 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

A

Renal Tubular Acidosis (RTA)

49
Q

What are the characteristics of RTA Type I ?

A

inability to maintain the normal hydrogen gradient

increases the secretion of ammonia to compensate

50
Q

What are the characteristics of RTA Type II ?

A

decreased reabsorption of bicarbonates in the PCT

utilization of hydrogen ions to reabsorb bicarbonates in the DCT instead of being eliminated in urine

51
Q

What are the characteristics of RTA Type III ?

A

combination of type I and type II

52
Q

What are the characteristics of RTA Type VI ?

A

impaired ability to exchange sodium for potassium and hydrogen in the dsital tube

53
Q

This is an autosomal recessive disorder resulting to cystinuria

A

Cystinosis

54
Q

This is a benign inherited condition that lowers the maximal tubular reabsorptive capacity of the tubules

A

Renal glucosuria

55
Q

This is a rare dominant sex-linked disorder

A

Renal phosphaturia/familial hypophosphatemia

56
Q

What is the characteristic of renal phosphaturia ?

A

inability of the DCT to reabsorb inorganic phosphoporus

57
Q

How is renal phosphaturia appeared to be a two-folded defect ?

A

DCT is hypersensitive to the parathyroid hormone

increasing phosphate excretion

decrease PCT response to hypophosphatemia

58
Q

This renal tubular disease may have mild protein (<1 g/day) findings in the physical and chemical examination of urine

A

ATN

cystinuria and cystinosis

59
Q

This renal tubular disease may have mild protein (<2.5 g/day) findings in the physical and chemical examination of urine

A

Fanconi syndrome

60
Q

This renal tubular disease may have positive glucose findings in the physical and chemical examination of urine

A

Fanconi syndrome

61
Q

This renal tubular disease may have pH findings of >pH 5.5 in the physical and chemical examination of urine

A

Renal tubular acidosis

62
Q

This renal tubular disease may have cystine crystals visible in the microscopic examination of urine

A

cystinuria and cystinosis

63
Q

What is the cause for a disease in the renal tubules inevitably affecting the renal interstitium and vice versa ?

A

the proximity and interconnectedness in function of the renal tubules and renal interstitium

64
Q

What conditions are capable of causing tubulointerstitial diseases ?

A

infections (pyelonephritis or interstitial nephritis)

toxins

metabolic diseases

vascular diseases

neoplasms

multiple myeloma

drugs

irradiation

transplant rejection

65
Q

___ is closely related to tubulointerstitial diseases as the former presents the mechanism leading to the development of acute pyelonephritis

A

UTI

66
Q

Lower UTI may involve the ___, ___ or both

A

urethra (urethritis)

bladder (cystitis)

67
Q

Upper UTI can involve the ___ and/or ___

A 
renal pelvis (pyelitis)
interstitium (pyelonephritis)
68
Q

Which portion of the urethra has normal flora ?

A

distal portion

69
Q

How does the normal flora remain isolated in the urethra ?

A

due to continual flushing during voiding

70
Q

UTI is commonly caused by ___

A

bacteria from GI tract

71
Q

Why is UTI more common among females than males ?

A

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
Q

____ are the normal flora in the GI tract and vagina

A

Candida species (e.g., Candida albicans)

73
Q

When the bacterial flora is adversely disrupted by ____, yeasts proliferate and may cause an infection

A

antibiotics or pH changes

74
Q

What are the common signs and symptoms of UTI ?

A

painful urination (dysuria)

frequent urge to urinate (urgency)

occasional low-grade fever

cramping

geriatric patients: mental confusion or distress

75
Q

This type of infection involves the renal tubules, interstitium and renal pelvis as a result of ascending infection or hematogenous infection

A

acute pyelonephritis

76
Q

What is ascending infection in acute pyelonephritis

A

movement of bacteria from the lower urinary tract to the kidneys

77
Q

What is hematogenous infection ?

A

localization of bacteria from the bloodstream in the kidneys

78
Q

What is the common cause in acute pyelonephritis ?

A

ascending UTI from gram-negative organisms that are normal intestinal flora

79
Q

In acute pyelonephritis, the presence of bacteria in the interstitium results to ___ and ___

A

acute inflammation

tubules becoming necrotic

80
Q

In acute pyelonephritis, the presence of bacterial toxins and leukocytic enzymes results to the ____

A

formation of abscesses

81
Q

Predisposing factors to acute pyelonephritis include ____

A

conditions or procedures that causes the proliferation and movement of bacteria to the upper urinary tract

82
Q

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

A

Vesicoureteral reflux

83
Q

What conditions may be seen in relation to acute pyelonephritis ?

A

vesicoureteral reflux

catheterization

Urinary tract obstruction

sepsis

pregnancy

diabetes mellitus

immunosuppression

84
Q

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 ____

A

acute pyelonephritis

high fever
chills
nausea
headache
generalized malaise
85
Q

What are the characteristics of chronic pyelonephritis ?

A

persistent inflammation of the renal tissue resulting to fibrosis and scarring of the renal calyces and renal pelvis

86
Q

What is the common cause of chronic pyelonephritis ?

A

reflux nephropathies: vesicoureteral reflux, urinary tract obstruction and intrarenal reflux

87
Q

____ is the movement of urine back to the collecting duct and as far as the renal cortex due to a structure abnormality

A

intrarenal reflux

88
Q

Patients with chronic pyelonephritis may experience

A

hypertension

polyuria

nocturia

renal failure (in 10-15% of cases)

89
Q

What are the causes of acute interstitial nephritis ?

A

allergic response in the interstitium of the kidney, usually from an acute allograft rejection after kidney transplant

antibiotic

NSAIDs

antipileptics

allopurinol

90
Q

Allergic reactions to antibiotic, NSAIDs, antipileptics and allopurinol usually induce ___

A

cell-mediated immune responses causing damage to the interstitium (edema and infiltration) and tubules (necrosis)

91
Q

Clinical features associated with drug-induced acute interstitial nephritis

A

fever
skin rash
eosinophilia

92
Q

What is the effect of glomerular diseases on urinary system ?

A

immune-mediated causing deposition of immune complexes on the glomerulus or antibodies directly reacting to glomerular tissue thereby resulting to inflammation or damage

93
Q

Vascular diseases affect ___ in the kidneys to which normal renal function is dependent

A

renal perfusion

94
Q

In glomerular diseases, these ___ are trapped in the glomerular tuft and may activate the ___ resulting to cell lysis of cells in the glomerulus

A

immune complexes

complement system

95
Q

What are the three phases of deposition of immune complexes in the pathogenesis of glomerular diseases ?

A

immune complex formation

immune complex deposition

immune complex-mediated inflammation

96
Q

____ refers to a group of clinical findings indicative of glomerular damage resulting from an inflammatory process

A

nephritic syndrome

97
Q

Nephritic syndrome is characterized by

A

hematuria

hypertension

oliguria

azotemia

mild proteinuria

mild edema

98
Q

In nephritic syndrome, the severity of the symptoms shown depends on ___, ___ and ___

A

number of glomeruli involved

the mechanism of injury

onset of disease

99
Q

____ indicates adverse glomerular changes brought about by non-inflammatory mechanisms

A

Nephrotic syndrome

100
Q

Nephrotic syndrome is characterized by

A

proteinuria (>3.4 mg/day)

hypoalbuminemia

generalized edema

hyperlipidemia

lipiduria

101
Q

In nephrotic syndrome, due to an increase in glomerular permeability substances such as ___ become elevated in urine

A

albumin

immunoglobulins

complement cofactors

coagulation factors

lipids

102
Q

Albumin is the predominant protein lost in urine from nephrotic syndrome, this results to ___

A

hypoalbuminemia

proteinuria

103
Q

The patient becomes ___ due to loss of immunoglobulins, complement cofactors, and coagulation factors

A

susceptible to infections and thrombotic complications

104
Q

In nephrotic syndrome, ___ and ___ result from the increased lipid synthesis in the liver and a decreased lipid catabolism

A

hyperlipidemia

lipiduria

105
Q

TGC, cholesterol, phospholipids, and VLDL are able to pass throughout the glomerulus and are found freely floating in urine, withing ___ or withing ___

A

renal tubular cells

renal casts

106
Q

What is the primary cause of generalized edema ?

A

sodium retention associated with the increased reabsorption of sodium and water in the DCT

107
Q

How does hypoalbuminemia play a minor role in causing edema ?

A

loss of proteins in plasma reduces oncotic pressure eventually causing the movement of fluid into the interstitial tissues

108
Q

Soft and pitting edema is commonly observed where ?

A

eyes or legs

109
Q

Aside from glomerular diseases, nephrotic syndrome can also be observed in patients with ___ and those who ___

A

systemic diseases

have taken nephrotoxic agents

110
Q

In sever cases of generalized edema, ___ and ___ may manifest

A

pleural effusions

ascites

111
Q

What is leukocyte infiltration characterized by

A

infiltration of neutrophils and macrophages as form of chemotactic response

112
Q

Leukocyte infiltration is commonly observed in some types of ____

A

acute glomerulonephritis

113
Q

Cellular proliferation is characterized by

A

increase in the number of:
endothelial cells
mesangial cells
podocytes

in the glomerular tuft

114
Q

Define segmental cellular proliferation

A

involves only a part of each glomerulus

115
Q

Define focal cellular proliferation

A

involves only a certain number of glomeruli in the kidney

116
Q

Define diffuse cellular proliferation

A

involves all glomeruli in the kidneys

117
Q

What is the cause of glomerular basement membrane thickening ?

A

deposition of immune complexes or fibrin in the basement membrane

118
Q

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

A

diabetic glomerulosclerosis

119
Q

Hyalinization is characterized by

A

accumulation of a homogenous eosinophilic material in the glomeruli resulting to a loss of its structure detail

AUBF LEC (10 decks)

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