Micro Path Kidney diseases Flashcards
the most common inherited nephropathy
adult polycstic kidney disease (APKD)
adult polycystic kidney disease (APKD)
- autosomal __
- pathologic features
- clinical features:
- dominant
- large multicystic kidneys, liver cysts, berry aneurysms.
- hematuria (blood in urine), flank pain, UTI, renal stones, hypertension
Childhood polycystic kidney disease (CPKD)
- autosomal __
- pathologic features
- clinical features
- recessive
- enlarged, cystic kidneys at birth
- hepatic fibrosis
Name the renal cystic disease:
single/multiple cysts in NORMAL SIZED KIDNEYS, microscopic hematuria, benign and not inherited
simple cysts
Name the renal cystic disease:
autosomal dominant, SHRUNKEN KIDNEYS, coricomedullary cysts, salt wasting, polyuria. Outcome: chronic renal failure beginning in adulthood
Adult-onset medullary cystic disease
Name the renal cystic disease:
autosomal dominant
LARGE multicystic kidney, liver cysts, berry aneurisms, hematuria, flank pain, UTI, renal stones, HYPERTENTION, OUTCOME: chronic renal failure beginning at 40-60 years of age
APKD
adult polycystic kidney disease
Name the renal cystic disease:
autosomal recessive, ENLARGED CSTIC KIDNEYS AT BIRTH, HEPATIC FIBROSIS, OUTCOME: variable, DEATH IN INFANCY/CHILDHOOD
childhood polycystic kidney disease
Name the renal cystic disease:
Benign, no inheritance, medullary cysts hematuria, UTI, recurrent renal stones
OUTCOME: benign
medullary sponge kidney
Name the renal cystic disease:
autosomal recessive, corticomedullary cysts SHRUNKEN KIDNEYS, slat wasting, polyuria, growth retardation, anemia, OUTCOME: progressive renal failure beginning in childhood
familial juvenile nephronophthisis
Name the renal cystic disease:
no inheritance, cystic degeneration in END STAGE KIDNEY DISEASE, hemorrhage, erythrocytosis, neoplasia
OUTCOME: depends on dialysis
acquired renal cystic disease
name the 2 autosomal dominant renal cystic diseases
Adult polycystic kidney disease
Adult onset medullary cystic disease (Notice if it says adult it is autosomal dominant and causes chronic renal failure)
name the 2 autosomal recessive cystic renal diseases
childhood polycystic kidney disease, familial juvenile nephronophthisis, (notice if child related it is recessive)
name the 3 non inherited cystic renal diseases:
simple cysts
acquired renal cystic disease
medullary sponge kidney
which cystic renal disease is present at birth and may cause death in infancy
childhood polycystic kidney disease
cystic renal diseases causes shrunken kidneys and salt wasting
Familial juvenile nephronophthisis and adult-onset medullary cystic disease
malignant hypertension adversely affects all major organ systems. the MOST susceptible organ is the
kidneys: leads to death in 3-6 months
Nephrosclerosis ___
smallest kidney arteries (arterioles) are damaged.
3 types of nephrosclerosis:
- ____ = atrophy and scarring of kidney due to artgeriosclerotic thickenings of the walls of large branches of the renal artery
- __ renal changes associated with hypertensionin which arterioles thicken and areas undergo ischemic atrophy and interstitial fibrosis
- rapid deterioration of renal function caused by inflammation of renal arterials. this type accompanies malignant hypertension.
- arterial
- hypertension
- malignant
this is a rare but very serious form of high blood pressure that if left untreated usually leads to death in 3-6 months
Malignant hypertension
this is an ascending UTI usually caused by E.Coli that has reached the pelvis of the kidney.
Pyelonephritis
There are two kinds of pyelonephritis:
- acute pyelonephritis is an active infection of the ___
- chronic pyelonephritis is?
- renal pelvis: may be inflamed and filled with pus.
2. chronic: extensive scar tissue formed and renal failure becomes possibility
Chronic hypertension leads to reactive changes in the smaller arteries and arterioles throughout the body called
arteriosclerosis
- ____refers to the buildup of fats, cholesterol and other substances in and on your artery walls (plaques), which can restrict blood flow
2.
- Atherosclerosis: Atherosclerosis is a specific type of arteriosclerosis,
Benign arteriosclerosis: mild chronic hypertention = major change is
increase in arterial walls: HYAALINE = glassy appearance of walls caused by deposition of plasma proteins
Malignant arteriosclerosis: elevated bp = rapidly progressive vascular disease with the onset of symptoms in the
brain, heart, or kidney
Nephroliathiasis is ___
renal stones aka renal calculi
Most common type of Nephroliathiasis is:
calcium stones/struvites/cysteine/uric acid
calcium stones (80-90%) made of calcium phosphate/calcium oxalate or both
- stones in the kidneys are called
2. stones in other parts of urinary system are called
- renal calculi
2. urinary calculi
nephroliathiasis can block the urine by getting stuck in the ureter causing __
renal colic (severe pain in back/lower abdomen, groin on side of blockage)
complications associated with nephroliathiasis
obstruction of ureter, acute/chronic pyelonephritis, hydronephritis
All four types of renal stones (uric acid, calcium salts, cystine, or struvite) share the common pathogenesis of
an excessive supersaturation of the the urine with poorly soluble material.
renal calculi are more common in men or women.
men
renal calculi rarely occur in
children
predisposing factors to renal calculi
dehydration, infection, change in urine pH, obstruction of urine flow, metabolic factors HYPERPARATHYROIDISM (leads to hypercalcemis) renal acidosis, elevated uric acid, defective oxalate metabolism
hydronephrosis causes
a blood clot
scarring of ureter from injury or radiation or previous surgery
tumor in or around ureter
blockage of urinary system (present at birth - congenital)
prostate gland enlargement (benign prostatic hyperplasia), pregnancy
can hydronephrosis be caused by a bacterial infection
no! (note renal stones and pyelonephritis can)
____ occurs when the pelvis and calyces (urine collecting structures) become distended bc urine is unable to drain form the kidney down the ureters into the bladder.
hydronephrosis
hydronephrosis is not a specific disease, it is a
sign of an underlying problem
urinary calculus are associated with
gout, hyperPT, hypercalcemia, renal infection
pyelonephritis is a bacterial infection, usually ___ of the kidney ducts that carry urine away from the kidney (ureters). most often occurs as a result of a
e.coli
UTI
abscess often develop in
pyelonephritis - and if causes excessive scar tissue = renal failure possible
kidney infections are often caused by ascending/descending microorganisms
ascending from lower urinary tract
kidney infections more common in women or men?
women bc length of urinary tract
note: kidney stones more common in men, kidney infection more common in women
\_\_\_ is a glomerular disease characterized by: lipiduria hyperlipidemia severe edema heavy proteinuria HYPOalbuminemia
Neprhotic syndrome (NS) bc increased permeability of glomerular capillaries
is Neprhotic syndrome (NS) a disease
no. it results from glomerular defect and indicates renal damage.
diseases that can cause Neprhotic syndrome (NS)
DM, cancer, HIV, leukemia, lymphomas, multiple myeloma, SLE, glomerulopathies, amyloidosis
This condition clinical feature is mild to severe edema of ankles or sacrum ESPECIALLY IN CHILDREN, puffy eyelids, abdominal pain, wasting of muscles, swelling from excess salt and water retention and froth urine (high protein content)
Neprhotic syndrome (NS)
Neprhotic syndrome (NS) can occur at any age T/F
True
Neprhotic syndrome (NS) in children more common in boys or girls? in adults?
in boys
and in adults both sexes are equally affected
WBC’s are more characteristic of Neprhotic syndrome (NS) or Pyelonephritis
Pyelonephritis
- Neprhotic syndrome (NS) __ will be present in urine
2. ___may lead to the presence of fewer RBC in urine
- RBC casts (clumps)
2. infarction
- Azotemia =
(azot, “nitrogen” + -emia, “blood condition”) is a medical condition
characterized by abnormally high levels of nitrogen-containing compounds (such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds) in the blood. It is largely related to insufficient filtering of blood by the kidneys. It can lead to uremia if not controlled
Uremia
is the illness accompanying kidney failure (also called renal failure), in particular the nitrogenous waste products associated with the failure of this organ
In kidney failure, urea and other waste products, which are normally excreted into the urine, are retained in the blood
the classic presentation of acute post streptococcal glomerulonephritis is
nephritic syndrome (due to glomerular disease = visible hematuria (RBC in urine), mild to moderate proteinuria, and hypertension)
___ renal failure = oliguria or anuria (reduced or no urine flow) and recent onset of azotemia
acute
__ renal failure = prolonged symptoms and signs of uremia
chronic
subtle or mild glomerular abnormailities
asymptomatic hematuria or proteinuria
- ___ syndrome (due to glomerular disease = visible hematuria (RBC in urine), mild to moderate proteinuria, and hypertension)
- ___ syndrome: also due to glomerular disease, heavy proteinuria, hypoalbuminemia, sever edema, hyperlipidemia, and lipiduria
- nephritic
2. NephrOtic
rapid progressive glomerulonephritis
nephritic syndrome with rapid decline (hours to days) in GFR
- the dominant intrahepatic cause of hypertension is
- the dominant prehepatic cause of hypertension is
- the dominant posthepatic cause of hypertension is
- cirrhosis
- obstructive thrombosis (narrowing of portal vein before it enters liver) or massive splenomegaly
- right sided heart failure, constrictive pericarditis and hepatic vein outflow obstruction
____ accounts for most causes of portal hypertension
cirrhosis
___ is a gastroenterological term for an accumulation of fluid in the peritoneal cavity.
Ascites
4 consequences of portal hypertension
ascites
portosystemic venous shunts form
congestive splenomegaly
hepatic encephalopathy
one of most common causes of death in patients with cirrhosis associated w portal hypertension is
upper GI hemorrhage from BLEEDING ESOPHAGEAL VARICES = massive vomiting of blood occurs (hematemesis) requiring emergency treatment to control hemorrhage and prevent hypovolemic shock
___ columnar metaplasia of the esophageal epithelium that occurs with chronic reflux
Barrett’s esophagus
Iron deficiency anemia can be associated with esophageal webs this is called ___ syndrome and is rare
Plummer-Vinson syndrome
Acites is the accumulation of excess fluid in the __ cavity
peritoneal cavity
The peritoneal cavity is a potential space between the parietal peritoneum and visceral peritoneum, that is, the two membranes that separate the organs in the abdominal cavity from the abdominal wall
In 85% of cases acites is caused by
cirrhosis
Cirrhosis of liver is an __liver disease
end stage
Cirrhosis is the most common __
chronic liver disease
cirrhosis 75% of all cases caused by
alcoholism
ascites, splenomegaly, sudden onset of upper GI bleeding with MASSIVE HEMATEMESIS (vomiting of blood) and jaundice are symptoms of
jaundice
Splenomegaly indicates ___ which in turn causes __-
portal hypertention, esophageal varices
___ are the most common source of massive hematemesis in alcoholics
esophageal varices
Spider angiomas are common in
alchoholics
cholestasis
is a condition where bile cannot flow from the liver to the duodenum. The two basic distinctions are an obstructive type of cholestasis where there is a mechanical blockage in the duct system such as can occur from a gallstone or malignancy,
pruritus
Itch (Latin: pruritus) is a sensation that causes the desire or reflex to scratch
xanthoma
“yellow”, is a deposition of yellowish cholesterol-rich material in tendons or other body parts in various disease states.[1] They are cutaneous manifestations of lipidosis in which there is an accumulation of lipids in large foam cells within the skin.[1]
They are associated with hyperlipidemias,
a patient was told that her skin xanthomas and pruritis are signs of cholestasis. another likely manifestation of cholestasis is
jaundice
jaundice is excess amounts of ___ in blood stream depositing in to
bilirubin subcutaneous fat (layer of fat just beneath the skin)
causes of jaundice?
- increased destruction of RBC w rapid release of bilirubin into blood (free or unconjugated)
- obstruction of the bile ducts or damage to liver cells which results in the inability of bilirubin to be excreted into the GI tract (conjugated bilirubin)
jaundice is the leading manifestation of
liver disease.
___ is the end product of heme degradation.
bilirubin
where are RBC senescent ones broken down
liver, spleen and bone marrow
heme oxygenase located intracellular (inside cell) oxidizes heme to ____ and is rapidly reduced to free bilirubin which is released from macrophages into the plasma. The free bilirubin combines with __ and is transported thru blood and fluids
biliverdin
plasma albumin
free bilirubin is absorbed thru hepatic cell membrane where it is released from plasma albumin and soon conjugated with glucuronic acid to form bilirubin glucorinide. unconjugated bilirubin is ___
insoluble in water at physiological pH and exists in tight complexes with serum albumin. THis form cannot be extreted in the urine even when blood levels are high
high levels of unconjugated/conjugated bilirubin in the bloodstream can cause permanent damage to the brain in infants and is known as __
unconjugated
kernicterus
kernicterus can result in a form of crippling called
athetoid cerebral palsy
most common symptom of hepatocellular carcinoma (HCC) is
abdominal pain
hepatocellular carcinoma is prevalent in ___
chronic viral hepatitis (B and C) = one of most common malignancies worldwide.
chronic liver disease of any etiology is a risk factor for HCC. Hepatitis _ is now associated with HCC in 80% of cases and is almost always found in setting of cirrhosis
Hep C = hepatocellular carcinoma
Hep B may be frequently associated with HCC in the ___
absence of cirrhosis.
therefore: hepatocellular carcinoma + cirhossis = hep C
hepatocellular carcinoma -cirhossis = hep B
hepatocellular carcinoma examination may show a mass where
right upper quadrant over liver
Hepatitis C is a DNA/RNA virus with an incubation period from __ to ___
RNA, 2-6 weeks
which is milder: hep a/b/c
c
The most common reason for liver transplantation in the US is?
Hepatitis C
- Hepatitis D is a DNA/RNA that requires presence of __ for __
- Up to 40% of __ are co-infected
- partial RNA, Hepatitis B for replication.
2. IV drug users
Which hepatitis is an RNA virus transmitted by contaminated water supply
Hep E
Hep E is an endemic in
india and aisa.
incubation time for hep e
2-8 weeks
hep E is often mild/severe acute/chronic clinical/subclinical fatal?
mild, acute, subclinical
**rarely fatal except in pregnancy when mortality can reach 20%
This type of hepatitis is transmitted via fecal oral rout
Hepatitis A (remember top of your list and end of your list will be fecal/oral) = ingestion of food, milk, water, seafood from polluted water.
Acute disease of Hep A is diagnoased by
anti-HAV IgM
Immunity of Hep A is conferred by presence of
anti HAV IgG
- Hepatitis A (formerly known as infectious hepatitis) is an __ infectious disease of the liver caused by the hepatitis A virus (HAV). 2. Many cases have ___symptoms especially in the young.
- The time between infection and symptoms, in those who develop them, is between two and six weeks.When there are symptoms they typically last eight weeks and may include: nausea, vomiting, diarrhea, yellow skin, fever, and abdominal pain. is there a vaccine?
- The blood carries the virus to its target, the liver, where it multiplies within
- mortality
- acute
- little or no
- yes The hepatitis A vaccine is effective for prevention. It appears to be effective for life
- hepatocytes and Kupffer cells (liver macrophages).
- mortality is less than 0.5%
The virus spreads by the fecal–oral route and infections often occur in conditions of poor sanitation and overcrowding. Hepatitis A can be transmitted by the parenteral route but very rarely by blood and blood products. Food-borne outbreaks are not uncommon and ingestion of shellfish cultivated in polluted water is associated with a high risk of infection.[24] Approximately 40% of all acute viral hepatitis is caused by HAV.[13] Infected individuals are infectious prior to onset of symptoms, roughly 10 days following infection. The virus is resistant to detergent, acid (pH 1), solvents (e.g., ether, chloroform), drying, and temperatures up to 60 °C. It can survive for months in fresh and salt water. Common-source (e.g., water, restaurant) outbreaks are typical. Infection is common in children in developing countries, reaching 100% incidence, but following infection there is lifelong immunity
Hep A
HEPATITIS A:
- ___ antibody is only present in the blood following an acute hepatitis A infection. It is detectable from one to two weeks after the initial infection and persists for up to 14 weeks.
- The presence of __ antibody in the blood means that the acute stage of the illness is past and the person is immune to further infection. IgG antibody to HAV is also found in the blood following vaccination and tests for immunity to the virus are based on the detection of this antibody
- IgM
2. IgG
Hep B (HBV) is transmitted __
parenterally and by sexual contact
Incubation period of Hep B
6 weeks to 6 moths
Hep B risk factors
IV drug abuse, multiple sexual partners, receive blood products.
HBsAg is the first positive marker of acute infection of
hep B
the presence of anti-HbsAb denotes
immunity
- Acute disease in Hep A diagnosed by:
2, Acute disease in Hep B diagnosed by - immunity to Hep A by presence of
- immunity to Hep B by presence of
- anti-HAV IgM
- HBsAg
- anti-HAV IgG
- anti-HBsAb
there is NO ASSOCIATION OF Hepatitis __ with either cirrhosis or hepatocellular carcinoma
HAV.
Note: Hep B and C are associated
an increased level of serum __ indicates hepatocellular damage
transaminases
the presence of __ in serum indicates patient is potentially infectious for hepatitis (carrier state)
surface antigen
hepatitis virus are very __ resistant
heat (more so than aids virus)
how can u kill hepatitis
proper autoclaving
