MIDTERM- RENAL DISEASE Flashcards
disruption of the electrical membrane charges as occurs in the
____ syndrome.
nephrotic syndrome
The term ___ refers to a sterile, inflammatory process that affects the glomerulus and
is associated with the finding of blood, protein, and
casts in the urine
glomerulonephritis
what are the components we can found in the urine of a patient with glomerulonephritis?
protein, blood, and cast
___is a
disease marked by the sudden onset of symptoms consistent
with damage to the glomerular membrane.
acute glomerulonephritis (AGN)
signs and symptoms for acute poststreptococcal glomerulonephritis
These may include
fever, edema (most noticeably around the eyes), fatigue,
hypertension, oliguria, and hematuria.
which bacteria or strains can be associated with acute poststreptococcal glomerulonephritis?
group a streptococcus with M protein
what is the primary urinalyss findings for acute post-streptococcal glumeronephritis
Primary urinalysis findings include marked
hematuria,
proteinuria, and oliguria, accompanied by red blood cell (RBC)
casts, dysmorphic RBCs, hyaline and granular casts, and white
blood cells (WBCs).
A more serious form of acute glomerular disease is called ___ and has a much
poorer prognosis, often terminating in renal failure.
rapid progressive (or crescentic) glomerulonephritis
Symptoms
are initiated by deposition of immune complexes in the glomerulus, often as a complication of another form of glomerulonephritis or an immune systemic disorder such as systemic lupus
erythematosus (SLE).
Rapidly Progressive (Crescentic) Glomerulonephritis
Damage by macrophages to the capillary
walls releases cells and plasma into Bowman’s space, and the
production of CRESCENTIC FORMATION containing macrophages, fibroblasts, and polymerized fibrin, causes permanent damage to
the capillary tufts.
Rapidly Progressive (Crescentic) Glomerulonephritis
Morphologic changes to the glomeruli resembling those in rap
idly progressive glomerular nephritis are seen in conjunction
with the autoimmune disorder termed ___
Goodpasture syndrome
A cytotoxic autoantibody can appear against the glomerular
and alveolar basement membranes after
viral respiratory infections.
Attachment of autoantibody to the basement membrane, followed by complement activation, produces the
capillary destruction. Referred to as ___ , the autoantibody can be detected in
patient serum.
antiglomerular basement membrane antibody
what are the initial pulmonary complains for Goodpasture syndrome
hemoptysis and dyspnea
urinary results commonly for Goodpasture syndrom
results include proteinuria, hematuria, and the presence of
RBC casts.
Wegener granulomatosis causes a ___of the small blood vessels primarily of the kidney
and respiratory system.
granuloma-producing INFLAMMATION
Key to the diagnosis of Wegener
granulomatosis is the demonstration of ____in the patient’s serum.
antineutrophilic
cytoplasmic antibody (ANCA)
In ANCAor anti-neutrophilic cytoplasmic antibody testing,
we fix the serum in either ethanol or formalin/formaldehyde ad examine it through immunofixation.
If the neutrophils are fixed in ethanol, the antibodies form a perinuclear pattern called ___
p-ANCA
In ANCAor anti-neutrophilic cytoplasmic antibody testing,
we fix the serum in either ethanol or formalin/formaldehyde ad examine it through immunofixation.
When the neutrophils are
fixed with formalin/formaldehyde, the pattern is granular throughout the cytoplasm called ___
c-ANCA.
fixating serum for testing anti-neutrophilic cytoplasmic antibody for the detection of wegener granulomatosis
ethanol vs formalin
ethanol: perinuclear pattern - p anca
formalin: granular patter - c anca
___ disease occurs primarily in children after upper respiratory infections. As its name implies,
initial symptoms include the appearance of raised, red patches
on the skin
Henoch-Schönlein purpura
In Henoch-Schonlein Purpura, what is the most serious complication of the disorder
Renal involvement, may range from mild to heavy proteinuria and hematuria
with RBC casts.
few of the symptoms for this type of Glomerulonephritis
Respiratory and gastrointestinal symptoms, including blood in the sputum and stools, may be present
Henoch-Schönlein Purpura
The predominant characteristic of ___ is a pronounced thickening of the glomerular
basement membrane resulting from the deposition of a specific immunoglobulin immune complexes
membranous glomerulonephritis
membranous glomerulonephritis’s distinct clinical manifestation is the thickening of the glomerular basement membrane resulting from the deposition of what immunoglobulin immune complexes?
immunoglobulin G immune complexes
Disorders associated
with membranous glomerulonephritis development include ____
Systemic lupus erythematosus, Sjögren syndrome
secondary syphilis
hepatitis B,
gold and mercury treatments
malignancy.
a glomerulonephritis which has a rule of
the disease progresses SLOWLY, with possible
REMISSION; however, nephrotic syndrome symptoms frequently develop.
membranous glomerulonephritis
a glomerulonephritis that is marked
by two different alterations in the cellularity of the glomerulus
and peripheral capillaries
Membranoproliferative glomerulonephritis (MPGN)
what are the 2 different alterations in the cellularity of the glomerulus and peripheral capillaries
Type 1 displays increased cellularity in the subendothelial cells of the mesangium (interstitial area of Bowman’s capsule)
type 2 displays extremely dense deposits in the
glomerular basement membrane. M
which type of membranoproliferative glomerulonephritis is has the possibility of developing a necrotic syndrome
Type 1
which type of membranoproliferative glomerulonephritis can experience the symptoms of chronic glomerulonephritis
type 2
laboratory findings for membranoproliferative glomerulonephritis
The laboratory findings vary, but hematuria, proteinuria, and decreased
serum complement levels are usual findings.
a type of glomerulonephritis that has tendency toward THROMBOSIS
Membranous Glomerulonephritis
laboratory findings for chronic glomerulonephritis
Examination of the urine reveals hematuria, proteinuria,
glucosuria as a result of tubular dysfunction, and many varieties of casts, including broad casts.
Gradually worsening symptoms for chronic glomerulonephritis are
fatigue, anemia, hypertension, edema, and oliguria
A markedly decreased
glomerular filtration rate is present in conjunction with increased BUN and creatinine levels and electrolyte imbalance
this significant changes is an indication of what renal disease?
Chronic Glomerulonephritis
Also known as Berger disease
Immunoglobulin A Nephropathy
IgA nephropathy, in which
___are deposited on the
glomerular membrane, is the most common cause of glomerulonephritis
immune complexes containing IgA
IgA nephropathy, Patients have increased serum levels of IgA, which
may be a result of a ___infection
mucosal
Immunoglobulin A Nephropathy disorders are frequently seen in what ages?
The disorder is most
frequently seen in children and young adults.
The ___ is marked by massive proteinuria (greater than 3.5 g/day), low levels of serum
albumin, high levels of serum lipids, and pronounced edema.
nephrotic syndrome
in order to be classified as a nephrotic syndrome, a patient must have proteinuria of around ____ g/day
3.5 g per day
Acute onset of the disorder can
occur in instances of circulatory disruption producing SYSTEMIC SHOCK that decrease the pressure and flow of blood to
the kidney.
chronic glomerulonephritis
___is the primary protein depleted from the circulation
Albumin
In chronic glomerulonephritis
Urinalysis observations include marked
proteinuria; urinary fat droplets; oval fat bodies; renal tubular epithelial (RTE)
cells; epithelial, fatty, and waxy casts; and microscopic hematuria
minimal change disease (also known as
____)
lipid nephrosis
Although the etiology is unknown at this
time, allergic reactions, recent immunization, and possession
of the human leukocyte antigen-B12 (HLA-B12) antigen have
been associated with this disease
Minimal Change Disease
Minimal Change Disease responds well
to ____, and prognosis is generally good, with
frequent complete remissions.
corticosteroids
this glomerulonephritis___ affects only certain numbers and areas of glomeruli, and the others remain normal. S
focal segmental glomerulosclerosis (FSGS)
Symptoms may be similar to the nephrotic syndrome
and minimal change disease owing to damaged podocytes
focal segmental glomerulosclerosis (FSGS)
In focal segmental glomerulosclerosis, Immune deposits, primarily ___, are
a frequent finding and can be seen in undamaged glomeruli
immunoglobulin M and C3
focal segmental glomerulonephritis is often seen in association with abuse of _
heroin and
analgesics and with AIDS.
glomerulonephritis disorders
- Acute Poststreptococcal Glomerulonephritis
- Rapidly Progressive (Crescentic) Glomerulonephritis
- Goodpasture Syndrome
- Wegener Granulomatosis
- Henoch-Schönlein Purpura
- Membranous Glomerulonephritis
- Membranoproliferative Glomerulonephritis
- Chronic Glomerulonephritis
- Immunoglobulin A Nephropathy
disorders under nephrotic syndrome
- Minimal change disease
- focal segmental glomerulosclerosis
The primary disorder associated with damage to the
renal tubules is ___
acute tubular necrosis (ATN).
Damage to the RTE cells may be produced by decreased blood flow that causes a lack of oxygen presentation to the tubules (______) or the presence of toxic
substances in the urinary filtrate.
ischemia
“____”
is a general term indicating a severe condition that decreases
the flow of blood throughout the body
Shock
Examples of conditions
that may cause shock are ___
cardiac failures, sepsis involving toxigenic bacteria, anaphylaxis, massive hemorrhage, and contact
with high-voltage electricity.
aside from ischemia what is the other reason for having a damage RTE cells
Exposure to a variety of nephrotoxic agents
what are the example of nephrotoxic agents that can damage the RTE cells
Substances include
aminoglycoside antibiotics, the antifungal agent amphotericin
B, cyclosporine, radiographic dye, organic solvents such as ethylene glycol, heavy metals, and toxic mushrooms.
aside from the chemicals and substances, what are the example of a naturally occuring component in the body that is as well nephrotoxic
filtration of large amounts of hemoglobin and
myoglobin is also nephrotoxic.
list down the Hereditary and Metabolic Tubular
Disorders
Fanconi Syndrome
Alport Syndrome
Uromodulin-Associated Kidney Disease
Diabetic Nephropathy
Nephrogenic Diabetes Insipidus
Renal Glycosuria
The disorder most frequently associated with tubular dysfunction is
Fanconi syndrome
The syndrome consists of a generalized failure of tubular reabsorption in the PROXIMAL CONVOLUTED TUBE
Fanconi Syndrome
In fanconi syndrome, since the one affected is the proximal convoluted tube, the substances that are most noticeably affected includes the
glucose, amino acids, phosphorous, sodium,
potassium, bicarbonate, and water
Tubular reabsorption may
be affected by the 3, what are they?
dysfunction of the transport of filtered substances across the tubular membranes,
disruption of cellular
energy needed for transport,
changes in the tubular membrane permeability.
Fanconi syndrome may be inherited in association with
___ disease, acquired
through exposure to toxic agents, including heavy metals and
outdated tetracycline, or seen as a complication of multiple
myeloma and renal transplant
cystinosis and Hartnup disease
hereditary and metabolic tubular disorder
is an inherited disorder of collagen production affecting the glomerular basement membrane.
Alport syndrome
The syndrome can be inherited as a ___ and ___
sex-linked or autosomal genetic
disorder.
in alport syndrome,
During
respiratory infections, males younger than age ___ years may exhibit macroscopic hematuria and continue to exhibit microscopic hematuria. Abnormalities in hearing and vision may also
develop
6 yrs old
The glomerular basement membrane has a lamellated appearance with areas of thinning
Alport Syndrome
__is a glycoprotein and is the only protein produced
by the kidney. I
Uromodulin
is primarily an
inherited disorder caused by an autosomal mutation in the
GENE that produces uromodulin
Uromodulin-associated kidney disease
a hereditary tubular disorder that is about The mutation which causes a decrease in the production of normal uromodulin that is replaced
by the abnormal form
Uromodulin-associated kidney disease
in uromodulin-associated kidney disease.
The mutation also causes an increase in serum uric acid,
resulting in persons developing ___as early as the teenage
years before the onset of detectable renal disease.
gout
is currently the most common cause of end-stage renal disease.
Diabetic nephropathy
diabetic nephropathy,
Damage to the glomerular membrane
occurs not only as a result of glomerular membrane thickening
but also because of the increased proliferation of ___
and increased deposition of cellular and noncellular material
within the glomerular matrix, resulting in accumulation of solid
substances around the capillary tufts.
mesangial cells
Diabetic Nephropathy
This glomerular damage
is believed to be associated with deposition of ____ resulting from poorly controlled blood glucose levels.
glycosylated proteins
Diabetic Nephropathy
The
vascular structure of the glomerulus also develops __
sclerosis
early monitoring of persons diagnosed with diabetes mellitus for the presence of ___ is important to detect the onset of diabetic
nephropathy.
microalbuminuria
___can be inherited as a sex-linked recessive
gene or acquired from medications, including lithium and am
photericin B
Nephrogenic DI
the disorder related to the action of ADH which is disrupted either by
the inability of the renal tubules to respond to ADH or failure of the hypothalamus to produce ADH
Nephrogenic Diabetes Insipidus
a disorder that affects only the reabsorption of glucose
Renal Glycosuria
renal glucosuria, The disorder is inherited as an __
autosomal recessive trait.
In inherited renal glucosuria either the number of glucose
transporters in the tubules is decreased or the affinity of the
transporters for glucose is decreased.
true or false
true
Considering the close proximity between the renal tubules and the renal interstitium, disorders affecting the interstitium also affect the tubules, resulting in the condition commonly called ___ disease
tubulointerstitial
The most common renal disease for tubulointerstitial disease
urinary tract infection or UTI
for interstitial disease, Most frequently encountered is infection of the bladder (____), which can progress to a more serious upper UTI if left untreated.
cystitis
Infection of the upper urinary tract, including both the
tubules and interstitium, is termed __and can
occur in both acute and chronic forms
pyelonephritis
___
most frequently occurs as a result of ascending movement
of bacteria from a lower UTI into the renal tubules and interstitium.
Acute pyelonephritis
reflux of urine
from the bladder back into the ureters (___).
vesicoureteral reflux
____ producing reflux
nephropathy are the most frequent cause of chronic
pyelonephritis
Congenital urinary structural defects
The presence of WBC casts is significant
for differentiating between ___ and ___
cystitis and pyelonephritis
is marked by
inflammation of the renal interstitium followed by
inflammation of the renal tubules.
Acute interstitial nephritis (AIN)
Patients present
with a rapid onset of symptoms relating to renal dys
function, including oliguria, edema, decreased renal concen
trating ability, and a possible decrease in the glomerular
filtration rate.
Acute Interstitial Nephritis
__ is primarily associated with an allergic reaction to medications that occurs within the renal interstitium, possibly caused
by the medication binding to the interstitial protein
AIN Acute interstitial nephritis
Medications commonly associated with AIN include ___
penicillin, methicillin, ampicillin, cephalosporins, sulfon
amides, NSAIDs, and thiazide diuretics.
The progression to _____ is
characterized by a marked decrease in the glomerular filtration
rate (less than 25 mL/min); steadily rising serum BUN and cre
atinine values (azotemia); electrolyte imbalance; lack of renal
concentrating ability producing an isosthenuric urine; protein
uria; renal glycosuria; and an abundance of granular, waxy, and
broad casts, often referred to as a telescoped urine sediment
end-stage renal disease
___, in contrast to chronic renal
failure, exhibits a sudden loss of renal function and is frequently REVERSIBLE
Acute renal failure (ARF)
renal calculi or kidney stones will form in what part of the kidney?
calyces and pelvis of the kidney, ureters, and bladder.
a procedure using
high-energy shock waves, can be used to break stones located
in the upper urinary tract into pieces that can then be passed
in the urine.
Lithotripsy
Conditions favoring the formation of renal calculi are similar to those favoring formation of urinary crystals,
including __, __, ___
pH, chemical concentration, and urinary stasis
Approximately
75% of the renal calculi are composed of what crystal?
calcium oxalate or calcium phosphate
__, __, and ___ are the other primary calculi constituents.
Magnesium ammonium phosphate (struvite),
uric acid, and cystine
which calculi are are frequently associated with metabolic calcium
and phosphate disorders and occasionally diet.
Calcium calculi
which calculi are frequently accompanied by
urinary infections involving urea-splitting bacteria
Magnesium
ammonium phosphate calculi
which calculi may be associated
with increased intake of foods with high purine content and with
uromodulin-associated kidney disease.
Uric acid calculi
which calculi are seen in conjunction with hereditary
disorders of cystine metabolism
cystine calculi
