Path-1 Flashcards
MCC of CRF (chronic renal failure)/ ESRD (end stage renal dz). Other causes?
DM
Other causes include autoimmune dz (IgA nephropathy; lupus)
Average kidney size?
Weight: 120-150 g
Length: 10-12 cm
Width: 6 cm
Thickness: 3 cm
Where does renal colic pain begin and where does it g?
Begins at renal angle )between lower 12th rib border and lateral border of Erector Spinae), travels down and forwards to groin.
Why is R kidney lower?
Because of the liver
What structures are anterior to the L kidney?
Suprarenal gland Spleen Stomach Pancreas Left colic flexure Jejunum
What structures are posterior to the L kidney?
Diaphragm
11th and 12th ribs
Psoas major, quadratus lumborum and transversus abdominis
Subcostal, iliohypogastric and ilioinguinal nerves
What structures are anterior to the R kidney?
Suprarenal gland
Liver
Duodenum
Right colic flexure
What structures are posterior to the R kidney?
Diaphragm
12th rib
Psoas major, quadratus lumborum and transversus abdominis
Subcostal, iliohypogastric and ilioinguinal nerves
How do surgeons divide the retroperitoneum to treat a retroperitoneal hemorrhage/neoplasm?
Into three zones!
Zone I
Called the central midline retroperitoneum.
Contains:
- abdominal aorta
- IVC
- root of the mesentery
- portions of the pancreas and duodenum
Zone II
Zone II is the lateral retroperitoneum
Contains:
- kidneys
- adrenal glands
- renal vasculature
- ascending and descending colon
Zone III
Called the pelvic retroperitoneum
Are the kidneys always paired?
NO
How do most kidney issues present?
- Hematuria, proteinuria, oliguria, anuria
- HTN
- Edema
- Labs: Increased serum/urine Cr, decreased Cr clearance, increased serum BUN
- Can be asx
Most important Q to ask a pt suspected of having renal dz?
Have you ever had this before? B/c there is a big difference between acute and chronic kidney injury.
What is the “gatekeeper” of the cell?
Cell membrane becuase it provides cellular structure, protects cytosolic contents, and allows cells to be specialized. Phospholipid bilayer is responsible for keeping homeostasis.
Compartments of the kidney?
Glomeruli, tubules, interstitium, vessels
What compartment does DM primarily affect?
Glomeular (microvasculature)
But still could have tubulointerstitial features
What compartment does systemic HTN primarily affect?
Vascular (arteriolar)…so this is a tubulointerstitial dz
What is the general category of glomerular disorders due to?
Immunologic disorders…could be primary or secondary
What causes the long term complications of DM?
Persistent hyperglycemia aka glucotoxicity
What are the prototypes of the compartmental renal dz processes?
- Glomeruli = glomerulonephritis
- Tubules = Bence-Jones proteinuria
- Interstitium = fibrosis, inflammation, or edema
- Vessels = vasculitis, nephrosclerosis
Azotemia
- def
- lab values
- result of?
- Biochemical abnormality
- BUN and Cr elevation due to a decreased GFR
- Result of renal disorders but could also come from extra-renal insults (pre-renal or post-renal)
Prerenal azotemia
- Happens after hypoperfusion of kidneys (hemorrhage, shock, volume depletion, CHF) –> leads to impaired renal fx
- Impaired renal fx in absence of primary renal parenchymal damage
Postrenal azotemia
-Obstruction! Distal to calyces and renal pelvis. Remove obstruction corrects the azotemia.
Uremia definition
Azotemia + clinical sx resulting from renal damage
What kind of sx does a uremia pt have?
Usually nonspecific. Get worse over time.
Metabolic abnorms in uremia?
Anemia
Acidemia
Electrolyte abnormlaities
How could a diabetic pt present if they have uremia?
- May have better glycemic control as renal fx declines but they’ll have more hypoglycemic episodes.
- This is paradoxical due to increased insulin secretion and prolongation of its t1/2
What systems are affected (and their sx) in uremia?
Cardio: HTN, atherosclerosis, valvular stenosis, CHF, angina
GI: occult GI bleed; NV; uremic fetor breath
Neuro: fatigue, weakness, HA, amyloid deposits –> medial nerve neuropathy, carpal tunnel, or other nerve entrapments
Cutaneous: fluid retention, edema; calcium phosphate deposition and nail atrphy
What do most uremic pt’s also present w/?
Peripheral neuropathy
What are the general clinical signs of a pt w/ uremia?
- NV, WL, faigue, anorexia
- Pruritus
- Polydipsia
- Electrolyte issues –> muscle cramps
- Encephalopathy
- Bleeding –> due to platelet dysfx and anemia
- Pericarditis
- Pleuritis/ pleural diffusion
Normal GFR?
90-120 mL/min/1.73 m^2
Clinical sx of AKI
- Rapid decline of GRF
- Oliguria or anuria
- Due to glomerular, interstitial, vascular, or acute tibular injury such as acute tubular necrosis
- Reversible but can progress to CKD
Clinical sx of CKD
- Mild or silent
- If severe –> uremia
- Persistently decreased GFR (<60 mL/min for at least 3 months due to any cause)
- Persistent albuminuria
- Irreversible
Clinical sx of ESRD
GFR <5% normal
End stage of uremia
What are more characteristic of glomerular dz?
- Nephritic and Nephrotic
- Asx hematuira or proteinuria
- Chronic Renal Failure
- Acute Renal Failure
What are more characteristic of tubulointerstitial dz?
- UTI
- Obstruction
- Renal tumor
- Nephrolithiasis
Nephrotic Syndrome
- Severe PROTEINURUA
- Hypoalbuminemia
- Severe edma
- Hyperlipidemia
- Lipiduria
Nephritic Syndrome
- Acute onset HEMATURIA
- Mild–> mod. proteinuria
- HTN
- May also have edema but is less common
Rapidly progressive glomerulonephritis
Nephritic syndrome signs + rapid decline in GFR
What do you see w/ isolated urinary abnormalities?
Glomerular hematuria and/or subnephrotic proteinuria
What could cause a glomerulus to be hypercellular?
Increased nuclei due to:
- Endothelial cells
- Mesangial cells
- VIsceral epithelia
- Inflammatory cell infiltrate
- Crescents (if you see this –> rapidly progressing glomerulonephritis)
Histomorphologic features of glomerulopathies?
- Hypercellularity
- Basement membrane thickening and deposits
- Hyalinosis (glassy)
- Sclerosis (obliterative)
- Issue w/ visceral epithelial cells could lead to an issue w/ the barrier
