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Renal Flashcards

1
Q

Kidney function?

A
  • filters 25% blood
  • excretes nitrogenous waste products
  • cleans blood
  • regulates water & electrolytes
  • maintains acid/base balance
  • secretes hormones
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2
Q

What hormones does the kidney secrete & what do they do?

A
  • erythropoietin: proliferative effect on bone marrow to make RBC
  • renin: BP
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3
Q

Functional unit of kidney?

A

nephron: glomeruli, convoluted tubules & collecting ducts

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4
Q

What is the function of the juxtaglomerular complex?

A

controls BP

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5
Q

How does the juxtaglomerular complex work?

A
  • JG cells in wall of afferent arteriole
  • sensitive to BP
  • drop in BP –> secrete Renin
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6
Q

What is azotemia?

A
  • elevation of blood urea nitrogen & creatine
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7
Q

What is azotemia usually related to?

A

GFR
– primary renal disorders
– some extra-renal disorders (pre vs post renal)

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8
Q

Difference between pre-renal & post-renal azotemia?

A

pre: hypoperfusion of kidneys decreases GFR in absence of parenchymal damage
post: urine flow obstructed below level of kidney

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9
Q

What is uremia?

A

progression of azotemia to produce clinical manifestations & systemic biochemical abnormalities
– failure of renal excretory function
– metabolic & endocrine alterations
– involvement of 2ndary organ systems

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10
Q

What are common organs uremia spreads to?

A
  • heart, GI, nerves
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11
Q

What is nephrotic syndrome?

A

Glomerular syndrome (non-specific)
- heavy proteinuria
- hypoalbuminemia
- severe EDEMA (puffy eyes = early)
- hyperlipidemia & lipiduria

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12
Q

What is nephritic syndrome?

A

Glomerular syndrome acute onset
- visible hematuria (brown color)**
- mild-moderate proteinuria
- azotemia
- edema
- hypertension**
**post-streptococcal glomerulonephritis

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13
Q

What is acute renal failure?

A
  • oliguria or anuria
  • recent only azotemia
    *may result from glomerular injury OR acute tubular necrosis
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14
Q

What is chronic renal failure?

A
  • prolonged symptoms & signs of uremia
    – end result of all renal disease
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15
Q

What is a UTI?

A
  • bacteremia & pyuria
  • symptomatic or asymptomatic
  • kidney (pyelonephritis) or bladder (cystitis)
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16
Q

What is nephrolithiasis?

A

kidney stones

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17
Q

What is glomerulonephritis? How is it tx?

A
  • immune mediated dx of glomeruli
  • steroids
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18
Q

What is pyelonephritis? How is it tx?

A
  • infection of kidney (not glomeruli)
  • usually by bacteria (e.coli)
  • retrograde origin (ascending infection most common)
  • antibiotics
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19
Q

What is more common glomerulonephritis or pyelonephritis?

A

pyelonephritis

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20
Q

How does acute vs chronic pyelonephritis appear on kidney specimen?

A
  • acute = abscess
  • chronic = severe scarring
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21
Q

Symptoms of nephrolithiasis (kidney stones)? Tx?

A

*common
- obstruction
- pain
- hematuria
- pyuria
- possible hypercalcemia
TX: lithotripsy = ultrasound waves for small ones

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22
Q

What is a staghorn calculus?

A
  • large, untreated kidney stones
    – cause damage & chronic kidney dx
    *ischemic kidney –> activation of RAAS
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23
Q

What is hydronephrosis?

A
  • secondary to kidney stone / obstruction leads to urine accumulation in kidney
  • calyces are dilated & thinned out
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24
Q

**Renal atrophy secondary to atherosclerosis of renal artery = hypertensive disorder

A

atrophy occurs due to ischemia

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25
Describe RAAS
- drop in BP - JG cells detect & release renin - converts angiotensinogen to angiotensin I - ACE converts to angiotensin II (active) - vasoconstriction, increase aldosterone secretion, Na & water retention - increased blood pressure
26
End organ damage & complications of hypertension?
- CV - peripheral vascular - renal - CNS - visual
27
Why can kidney levels be normal even with extreme hypertension?
- huge reservoir of glomeruli - left untreated, leads to major mulitsystem issues
28
What are the types of arteriosclerosis?
- Hyaline: benign HTN & DM --> wall grows outwards - Hyperplastic: malignant HTN --> sm. m. grows in constricting lumen --> more sinister/serious
29
What is benign nephrosclerosis?
- mostly asymptomatic - kidney slightly smaller - granular surface appearance - some glomeruli non-functional - often still functioning to high degree
30
What is malignant nephrosclerosis?
- pinpoint bleeds all over kidney - senses ischemic change more so than benign type
31
What is a simple renal cyst?
- asymptomatic (often never know) - on renal cortex - filled with clear fluid - can rupture & cause hemorrhage/some blood in urine
32
What is AD polycystic renal disease?
- more serious - multiple cysts --> enlarged immensely - uncomfortable - kidney parenchyma replaced by cysts TX: transplant or dialysis
33
What is acute transplant rejection?
- very serious - must take immunosuppressants//still can reject *entire kidney is hemorrhagic & destroyed
34
Where do renal cell carcinomas arise from?
- renal tubular epithelium
35
How do renal cell carcinomas progress?
- often silent - can grow into renal vein *metastasis: kidney is not a usual site
36
What is a Wilm's tumor?
Nephroblastoma - children <5 years - abdominal mass (very enlarged kidney) - chronic low grade fever
37
What is the histopathology of a wilm's tumor?
several cell types: some resemble abortive glomeruli & others resemble skeletal muscle
38
Survival rate for Wilm's tumor?
>90% 5-year
39
Where do urothelial carcinomas arise?
- urinary tract lining epithelium (transitional epithelium) **Bladder is most common site *bladder, ureter, calyces
40
Describe urothelial carcinomas?
- painless hematuria - clinical significance depends on histologic grade, differentiation, & depth of invasion
41
What can cause urothelial carcinomas?
- cigarette smoking - industrial solvents - chronic cystitis - schistosomiasis - drugs
42
Where is the prostate?
- lower level of bladder -- base touches bladder & apex is the point
43
Describe the zones of the prostate & the types of dx associated with them?
- central = benign hyperplasia --> experience symptoms due to pressing on urethra - peripheral = malignant --> symptoms take longer to progress
44
Three major diseases of the prostate?
- prostatitis - benign prostatic hyperplasia - adenocarcinoma of prostate
45
Describe screening for prostate dx?
- PSA: protein in serum at <4ng/mL - increased levels or velocity of change may suggest cancer
46
Function of PSA (prostate specific antigen)?
- liquefy semen to allow sperm to swim - dissolution of cervical mucous cap
47
What is prostatitis and how do you tx?
- acute bacterial dx --> potentially from habitual instrumentation (catheter) - antibiotics
48
Describe nodular (benign) prostatic hyperplasia
- obstruction to flow & urinary frequency - ascending infections - rule-out neoplasia *tx with drugs or surgery (TURP) --trans urethral resection
49
How to tell the difference between a benign & malignant prostatic nodule?
must sample lots of peripheral tissue to catch it
50
Describe adenocarcinoma of the prostate
- 70% men develop by 70-80yrs - biopsy multiple cores **wide variety of clinical behavior Use Gleason grading (microscope)
51
How to examine the prostate?
digital exam from rectum
52
Where does metastatic prostatic adenocarcinoma migrate?
* pretty much anywhere other than brain -- common in bone (intervertebral) !osteoBLASTIC lesions = bone forming!
53
What is cryptorchidism? complications/
undescended testes / absence of 1 or both in scrotum -- infertility & increased risk for neoplasia
54
What is Seminoma?
- most common germ cell tumor (malignant) - young adults - unilateral mass in testis - normally good prognosis when resected / radiation/ chemo (one of most treatable & curable cancers) - ->95% long-term survival
55
What are infections associated with the testis?
- Tuberculosis, mumps, syphilis, gonorrhea
56
Complications of mumps?
- orchitis - oophoritis & mastitis - meningitis - thyroiditis - pancreatitis - sterility - hearing loss **rare in young, more common in older people
57
What is hypospadias?
- developmental defect of urethra - abnormally placed urethral meatus opens at glans penis (most common) - can be corrected
58
What is Peyronie's disease?
- fibrous issue formation in deep penile tissue - if painful & problem with sex seek help
59
What is phimosis?
- foreskin cannot be fully retracted from head *can lead to infections & uncomfortable
60
What is priapism?
Erect penis / clitoris does not return to flaccid state despite absence of stimulation within 2 hours *medical emergency (ischemia)
61
What can cause priapism?
- hematologic diseases (sickle cell, leukemia) - trauma
62
What is erythroplakia of queret?
pre-malignant lesion / dysplastic epithelium *similar to oral erythroplakia (mucous membrane) -- must resect entirely -- HPV is most common etiology

Pathology (9 decks)

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