Patho Kidney Flashcards
What is a term that describes renal pain?
Nephralgia
Do kidneys have pain receptors?
Not in kidney- but in capsule
What will urine look like with decreased renal function?
Dark, strong smelling
What are 2 types of congenital renal disorders?
Renal Agenesis
Polycystic kidney disease
What is the absence of one or both kidneys?
Renal agenesis
What type of agenesis is usually fatal?
Bilateral
What is potter syndrome associated with?
Bilateral renal agenesis
Bescides kidney problems, what else is associated with Potter syndrome?
Facial and respiratory abnormalities
What is the result of multiple dilations of collecting ducts?
Polycystic kidney disease
When is ARPKD diagnosed?
In infants and young children (recessive versision)
When is ADPKD diagnosed?
Adulthood (dominant)
Where is the genetic defect in ARPKD?
Chromosome 6
What also accompanies ARPKD?
hepatic fibrosis
Why can ARPKD affect chlidren differently?
Depends on the number of collecting ducts affected (more affected- worse survivability)
What chromosomes are defected in ADPKD?
Chromosome 16 (95%)
Chromosome 4 (5%)
What is the primary pathological cause of ADPKD?
Tubular epithelial cell hyperplasia
Can involve the entire nephron
What part of the kidney can ADPKD affect?
Entire neprhon
What ages does ADPKD normally appear?
30-50 years
What symptoms appear with ADPKD?
UTIs
back or flank pain
heamturia
hypertension
What is a big protector of the urinary tract?
The acidic nature of urine
What is the most common infectious agent of the urinary tract?
E. Coli
What is pyelonephritis?
Infection of the upper urinary tract (renal pelvis) and interstitium
How do infections get from the bladder to the kidney?
Reflux from the bladder
There are no spinchter so urine can go from bladder back into kidney
Where is a hematogenous infection in the kidney found?
Thoughout the kidney
If an infection is caused by reflux, where is it normally found
More concentrated locaitons in the kidney (focal regions)
What are 3 pathways of pyelonephritis?
Hematogenous
Lymphatic
Urinary
Where is acute pyelonephritis found?
Pelvic
Calyces
Medulla
What cells are damaged by inflammatory mediators in actue pyelonephritis?
Tubule cells
What is chronic pyelonephritis?
Presistent or recurring episodes of acute pyelonephritis that leads to shrunken, fibortic kidney
With obstructive disorders, what do changes in the tract depend on?
Degree of osbstruction
Duration
Timing
What happens proximal to the obstruction in an obstructive renal disorder?
Hydrostatic pressure increase proximal
dilation of proximal tract
urine stasis
What is hydroureter?
An accumulation of fluid behind the ureter
Creates pressure in renal pelvis and tubules
What is postobstructive diuresis
Production and excretion of more urine than normal after obstruction has been cleared
Gets rid of waste materials due to obstruction
What is the proper name for a kidney stone?
Renal calculus
What is nephrolithiasis?
Presence of stone (calculus) anywhere in the tract
What type of cells are found in the urteters?
Transitional squamous
What 3 factors influence renal calculus formation?
Supersturation (calcium)
Anormal urine pH
Low urine volume
What is Ureteral colic ?
Pain when there is a renal calculus in ureter
Ureter distends behind stone
What are the three types of renal tumors?
Benign
Primary Neoplasm
Secondary Neoplasm
What is a genetic, slow growing, benign tumor?
Oncocytoma
What is a benign conential tumor of infancy in the kidney?
Mesoblastic nephroma
What is a benign renal tumor that is caused by an excess of somethign that doesn’t belong on the kidney?
renal angiomyolipomas (hemartoma)
What is a renal neoplasm of low malignant potential that may be a pre-malignant version of renal adenocarcinoma?
Renal adenoma
What is a renal tumor found mostly in older adult males, with occupation exposure, high protein diet, mostly in developed countries
Renal Cell Carcinoma (renal adenocarcinoma)
What is the triad of symptoms of renal adenocarcinoma ?
Heamturia
flank pain
mass
Where do renal cell carcinomas normally start?
epithelium of PCT
Where are urothelial tumors found?
Lining of renal pelvis, calyces, ureter, bladder (in transitional cell epithelium)
What type tumor is mostly found in children and is due to a defect on chromosome 11?
Nephroblastoma (Wilms tumor)
What is glomerulonephritis?
Inflammation of glomerulus
Most common cause of chronic renal disease and end-stage renal failure
What causes acute glomerulonephritis?
Inflammation due to group A post-streptococccal infection
Where is cellular proliferation found in rapidly-progressing glomerulonephritis?
Bowman’s Capsule
What type lesions are found in rapidly progressing glomerulonephritis
Crescent
What is an anti-glomerular basement membrane disease?
Goodpasture syndrome
WHat do the antibodies form against in goodpasture syndrome?
Capillaries
What is the name for several glomerular diseases that lead to chronic renal failure?
Chronic glomerulonephritis
What are the 3 pathological changes associated with chronic glomerulonephritis?
Tubular dilation and atrophy
Tubulointerstitial injury
Proliferation of mesangial cells
What are the two changes to the urine in chronic glomerulonephritis?
Proteinuria
Hematuria
What is the excretion of 3.5 gram or more of protein in urine per day?
Nephrotic syndrome
In nehprotic syndrome, what is edema caused by?
Hypoalbuminemia
What other symptoms are seen in nephrotic syndrome?
Lipiduria
Hypocalcemia
Hypercoagulability
What is a decline in renal function to 25% of normal?
Renal insufficiency
What is end-stage renal failure?
Less than 10% of normal kidney function left
What term describes the whole syndrome of renal failure?
Uremia
What is an increase serum urea levels (nitroenous wastes, usually increased creatinine levels)
Azotemia
What is an abrupt reduction in renal function with elevated BUN and creatinine levels?
Actue Renal Failure
What are the three classification of ARF?
Prerenal (blood supply before it gets to kidney)
Intrarenal
Posternal (urinary tract)
What do all prerenal ARF share?
Decreased blood flow and decreased cardiac output
What is required for postrenal ARF?
Bilateral outflow obstruction
If blood volume of BP is not restored in prerenal ARF what cna happen?
Acute tubular necrosis
Acute cortical necrosis
What is the most common cause of intrarenal ARF?
Acute tubular necrosis
WHat are the two caues of ATN (actue tubular necrosis) ?
Postichemic or nephrotoxic
*ischemic form most often after surgery
Where does necorsis occur with ischemia ?
Any part of the neprhon
Patchy necrosis
What is nephrotoxic ATN caused by?
Numerous antibiotics
Drugs accumulate in cortex
In nephrotoxic ATN where does necrosis occur?
Only in proximal tubules- necrosis is uniform
What are 3 reasons GFR is reduced in ARF?
Tubular obstruction
Tubular back-leak
Alternations in renal blood flow
In postrenal ARF, what leads to a decrease in GRF?
Increase in intraluminal pressure proximal to obstruction
WHat are the three phases of ARF?
Initiation phase
Maintenance phase
Recovery phase
In which stage of ARF is urine output lowest?
Maintenance phase
In which stage of ARF do serum creatinine and BUN increase ?
Maintenance phase
What is an irreversible loss of renal function?
Chronic renal failure
What does chornic renal failure affect?
All organ systems
WHat are the most common causes of chronic renal failure?
Diabetes mellitus
Hypertension
What is when GFR is reduced to 50% and BUn is elevated (no clinical symtpoms)
Reduced renal reserve
What is a near complete absence of GFR?
End stage renal disease
What is azotemia, acidosis, impaired urien dilution, severe anemia, electrolyte imbalances associated with?
Renal failure
As GFR falls, plasma creatine levels _____
increase
What are urea levels highly tied to?
A peron’s diet (specifically protein), this is why it is not as acurate of an indicator as creatinine
It becomes difficult to conserve sodium after GFR is…
<25%
What does PTH do?
Increases levels of Ca in system, needs Vitamin D to work
What is potassium normally mediated by?
Aldosterone
When does metabolic acidosis occur?
When GFR is <30-40%
Where is there hypocalcemia and bone disease in renal failure?
Lack of Vitamin-D
With renal failure, what cardiovascular system organ effect will there be?
Hypertension due to increased Na
What is dyslipidemia caused by in individuals in renal failiure?
Increase in fluid volume
What are some neural function alterations due to renal failure?
sleep disorders, memory loss
hiccups, muscle scramps
asterixis, seizures, coma
In renal failure, what happends in the endocrine/ reproductive systems?
Drop in circulating sex steroids
Hyperinsulinemia (diabetes get better as kidneys fail)
What are hematologic alternations associated with renal failure?
Anemia due to lack of EPO
normochromic, normocytic
What immunologic dysregulation is associated with renal failure?
Suppression of chemotaxi, phagocytosis, antibody production, cellular immunity
What are 2 GI problems in people with renal failure (only 25% of patients)?
Gastroenteritis
Uremic fetor (bad breath from nitrogenous waste, urea being excreted)
What causes a person in renal failure to have a negative nitrogen balance?
Proteinuria and catabolic state
Why is there glucose interolerance in someone with renal failure?
Increased amount of glucose in blood stream due to decreased filtration
