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Pathophysiology > Module 8: Renal System > Flashcards

Module 8: Renal System Flashcards

1
Q

Formation of Kidney stones

A

Nephrolithiasis

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2
Q

Formation of stones in the Urinary tract

A

Urolithiasis

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3
Q

Formation of stones in the “Duct”

A

Lithiasis

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4
Q

Account for 80% of all stones
Small, hard Stones (1-3mm)
Stones have sharp edges
Radio-Opaque

A

Calcium Stones

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5
Q

Large Stones (Molds to Renal Pelvis/Calyces) ʹ Hence Staghorn͘
Chronic Irritation of Epithelium surrounding
Stone > Squamous Metaplasia

A

Triple Phosphate/Struvite/ “Staghorn” Stones

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6
Q

Clinical Features:
- Usually, Unilateral o Painful Hematuria ʹ
Macro/Micro
- Writhing in pain͕ pacing about and unable
to lie still͟
- Hydronephrosis > Stretching of Renal
Capsule > Flank Pain & Tenderness.

A

Lithiasis (Clinical features of Lithiasis)

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7
Q

Deep flank pain. No radiation.
Distension of the Renal Capsule

A

Stone in Ureteropelvic Junction

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8
Q

Intense, Colicky
Pain (Loin > Inguinal Region >
Testes/Vulva) + N/V

A

Stone in Ureter

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9
Q

Dysuria, Frequency, + Tip of penis
pain

A

Stone in Ureterovesical Junction

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10
Q

Management: Daily Na-Bicarbonate, (ESWL) Extracorporeal Shock-Wave Lithotripsy, Surgical

A

Lithiasis (Management of Lithiasis)

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11
Q

What Location?
- may cause flank discomfort, recurrent
infection or persistent hematuria
- may remain asymptomatic for years and
not require treatment

A

calyx

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12
Q

What Location?
- tend to cause UPJ obstruction renal pelvis
and one or more calyces

A

pelvis

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13
Q

What Location?
- often associated with infection
- infection will not resolve until stone
cleared

A

staghorn calculi

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14
Q

What Location?
- 5 mm diameter will pass spontaneously in
75% of patients the three narrowest
passage points for upper tract stones
include: UPJ, pelvic brim, UVJ

A

ureter

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15
Q

Factors promoting stone formation?

A

(INC Ca, Uric, Oxalate) CUO
hypercalciuria
increased oxalate
increased uric acid

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16
Q

Ca2+ oxalate most common, followed by
Ca2+ phosphate description
- grey or brown due to hemosiderin from
bleeding
- radiopaque

A

Calcium Stones

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17
Q

Female patients affected twice as often as
male patients
- account for 10% of all stones
- contribute to formation of staghorn
calculi
- consist of triple phosphate (calcium,
magnesium, ammonium)

A

Struvite Stones

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18
Q

Account for 10% of all stones
- orange colored gravel, needle
shaped crystals
- radiolucent on x-ray
- filling defect on IVP
- Radiopaque on CT scan
- Visualized with ultrasound

A

Uric Acid Stones

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19
Q

Autosomal recessive defect in small bowel
mucosal absorption and renal tubular
absorption of dibasic amino acids
- Seen in children and young adults
- Aggressive stone disease

A

Cystine Stones

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20
Q

hexagonal on urinalysis
o yellow, hard
o radiopaque (ground glass)
o staghorn or multiple
o decreased reabsorption of “COLA”

A

Cystine Stones

21
Q

COMMON INFECTIONS OF THE URINARY
SYSTEM: Infection of the renal parenchyma with local and systemic manifestations of infection
- may be classified as uncomplicated or
complicated

A

Acute Pyelonephritis

22
Q

Usually ascending microorganisms, most
often bacteria. causative microorganisms are usually E. coli, Klebsiella, Proteus, Serratia, Pseudomonas, Enterococcus, and S. aureus

A

Acute Pyelonephritis

23
Q

Laboratory Investigations of Pyelonephritis?

A

Urine dipstick, Microscopy, Gram negative rods, Gram positive cocci, Culture: > 105 colony forming units

24
Q

Type of Acute Pyelonephritis: in the absence of
conditions predisposing to anatomic
or functional impairment of urine
flow

A

uncomplicated

25
Q

Type of Acute Pyelonephritis: occurring in the setting of renal or ureteric stones,
structures, prostatic obstruction
(hypertrophy or malignancy),
vesicoureteral reflux, neurogenic
bladder, catheters, DM, sickle-cell
hemoglobinopathies, polycystic
kidney disease, immunosuppression,
and post-renal transplant

A

complicated

26
Q

Treatment of Pyelonephritis

A

TMP/SMX, fluoroquinolone, third generation
cephalosporin, start broad spectrum IV antibiotics

27
Q

A form of chronic tubulointerstitial nephritis
of bacterial origin
- Cortical scarring, tubulointerstitial damage,
and calyceal deformities seen

A

Chronic Pyelonephritis

28
Q

Characterized by significant proteinuria, hypoalbuminemia, edema, and hyperlipidemia, Normal GFR

A

Nephrotic syndrome

29
Q

Characterized by hematuria, proteinuria, and variable degrees of decreased glomerular filtration rate (GFR)

A

Nephritic syndrome

30
Q

THE Childhood cause of Nephrotic
Syndrome (1-8yrs)
Etiology:
- Post-Infective (URTI)

A

MCD (Minimal Change Disease) / Foot Process
Disease/ Nil Disease)

31
Q

> 50% of Adult Nephrotic Syndrome:
Etiology
- Autoimmune - Ag : Ab Complex Deposition

A

MGN (Membranous Glomerulonephrosis)

32
Q

<35% of Adult Nephrotic Syndrome
- Vey similar to MCD but in adults
Etiology: Same as MCD
- Often a recent history of an URTI
- Nephrotic Syndrome
- +++ Selective Proteinuria
- Prognosis – Poor: 30% Remission; 50% CKD
and 20% RPGN

A

FSGS (Focal Segmental Glomerulosclerosis)

33
Q

THE Childhood cause of Nephritic
Syndrome (3-15yrs). Post-Infective (GABH-Streptococcal
Pharyngitis) Ag:Ab Complex Deposition

A

PSGN (Post-Strep Glomerulonephritis)

34
Q

IgA-Nephropathy = THE Adult (15-30yrs)
Cause of Nephritic Syndrome.
-Autoimmune - Ag:IgA Complex Deposition
in Glomerulus
- 30% > Slowly Progressive
- 10% > Renal Failure

A

IgA Nephropathy (Berger’s Disease)

35
Q

NOT a Separate Disease; ANY
Glomerulonephritis can > RPGN
Etiology:
- Progression of any Glomerulonephritis
(Autoimmune)
- Rapidly Progressing Glomerulonephritis >
Renal Failure within Weeks
- Poor: Quickly progresses to ESRF (end stage renal failure)

A

RPGN (Rapidly Progressive Glomerulonephritis)

36
Q

Rapid loss of kidney function
Clinical features: Uremia, Hyperkalemia, Fluid Retention, Hematuria, Flank pain

A

Acute Renal Failures

37
Q

Before the Blood Reaches the Kidney (Ie.
Dec. Glomerular Perfusion)
o Hypovolemia (Eg. Blood Loss)
o Decreased cardiac output (Eg. Heart
Failure)
o Renal artery obstruction (Eg.
Embolism)

A

Pre-Renal Failure

38
Q

The kidney itself is damaged
- Acute glomerular nephritis
- Tubular diseases e.g., acute tubular necrosis
- Interstitial diseases e.g., auto immune
disorders such as SLE
- Vascular diseases e.g., polyarteritis nodosa

A

Intra-Renal Failure

39
Q

Due to outflow obstruction from the
kidneys
o Cancer - Bladder / Prostate /
Ureteric / Cervical
o Blood clot
o Calculi (Kidney stones - Bilateral)
o Accidental surgical ligation

A

Post-Renal Failure

40
Q

What Stage of Chronic Renal Failure?

> 90 ml/min GFR (Normal) plus other signs of renal disease

A

Stage 1

41
Q

What Stage of Chronic Renal Failure?

90-60 ml/min GFR

A

Stage 2

42
Q

What Stage of Chronic Renal Failure?

60-30 ml/min GFR

A

Stage 3

43
Q

What Stage of Chronic Renal Failure?

30-15 ml/min GFR

A

Stage 4

44
Q

What Stage of Chronic Renal Failure?

<15 ml/min GFR

A

Stage 5

45
Q

DEC Blood Urea: Creatinine Ratio (Infection/toxin/Ischemia/Hypoxia)

A

Intra Renal Failure

46
Q

INC Blood Urea: Creatinine Ratio

A

Pre Renal (Hypotension/
Dehydration /Normal Kidney)

OR

Post Renal (BPH/Bladder Stone/Normal Kidney)

47
Q
  • Continuum of progressive nephron loss and declining renal function
  • Asymptomatic until severe insufficiency
    develops
    -Frequently patients present at end-stage
    with small, contracted kidneys, unknown
    etiology
A

Chronic Renal Failure

48
Q

Types of classifications of Chronic Renal failures are…

A

glomerular, tubulointerstitial disease, vascular, hereditary

Pathophysiology (7 decks)

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