Renal Disease

Question 1

Renal disease aetiology: glomerular diseases

Answer 1

Glomerulonephritis - inflammation of the glomeruli accounts for 10-15% of glomerular diseases. Over time can lead to glomerulosclerosis- scarring of the glomeruli. Most GNs are
Immune mediated
Type of immune mediated glomerulonephritis
1. Anti- glomerular basement membrane- Abs attack glom. Basement membrane.
2. Immune complex GN- immune complexes get stuck in the glomerular capillary. Most common type. Abs bind to Ags forming immune complexes. Small immune complexes formed in blood get trapped in capillary walls.
3. T cell GN - T lymphocytes injure the glomeruli?
4. Idiopathic (immune mediated)

Question 2

Glomerulonephritis

Answer 2

Inflammation causes leaky capillaries
Proteinuria (albumin)
Heamaturia

Eg. Post- streptococcal glomerulonephritis

• haematuria
• oliguria
• peri orbital oedema
• mild hypertension
• dark urine
• leads to the nephrotic syndrome (an acute GN)

Question 3

Glomulosclerosis

Answer 3

Persistent inflammation leads to widespread scarring and chronic renal failure
Ie. Hardening of Glomerular

Question 4

Nephrotic syndrome - glomerular diseases

Answer 4

1. Massive proteinuria- 3.5 grams/ day mainly albumin
2. Hypoalbuminaemia
3. Oedema
4. Hyperlipkdeamia (increased risk of atherosclerosis?)
   Other proteins lost in urine:
   Anti coagulants, incr thrombosis

Question 5

Renal disease aetiology: interstitial tissue injury

Answer 5

Kidney infections are pyelonephritis
Predisposing factors:
- obstruction: blockage of urinary react from scarring, stones, tumours, enlarged prostate, pregnancy; leads to oliguria, Aniuria
- catheter, surgery
- immune depression
Renal failure can be caused by- accumulation of heavy metals, drugs; adoring, antibiotics and myoglobin.
Crush injuries, trauma lead to rhabdomyolysis: breakdown of skeletal muscle, releases myoglobin, myoglobin plugs in renal tubules, leads to acute renal failure.
Polycystic kidney disease:
Multiple cysts in kidneys, can cause obstruction, bleeding leading to infection, hypertension, pain, reduced renal function, anaemia

Question 6

Renal disease aetiology: obstructive disorders

Answer 6

Obstruction to urine flow- some congenital abnormalities can lead to obstructive nephropathy.
Inflammations, infections, scarring, cancer.
Pregnancy.
Stasis of urine flow - UTI, stone formation, atrophy of kidneys, hypertension

Question 7

Clinical effects of renal failure

Answer 7

Caused by diseases beginning in the blood vessels, glomeruli, interstitial tissue, of obstructive diseases can ultimately lead to chronic renal failure.

Uraemia- signs and symptoms seen in renal failure:

• caused by metabolic toxic waste products (urea and other wastes), and failure to remove any exogenous toxins.
• electrolyte imbalance
• metabolic acidosis due to inability to remove excess H+
• releases angiotensin to increase blood pressure and cause hypertension
• decreased WBC Activity causing increased risk of infection. - decreased chemotactic and phagocytosis
• renal osteodystrophy- decreased activation of vit D and absorption of Ca2+- bone issues
• uraemic encephalopathy- sensory neuropathy(pins and needles, pain, burning sensation), then motor(cramps, muscle weakness, atrophy), usually affects lower limbs.

Question 8

Gastrointestinal manifestations in the uraemic patient

Answer 8

Anorexia, nausea, vomitting, formation of ulcers, gastro-oesophageal reflux disease

Anaemia- decrease in EPO- production of erythropoietin. Ulcers form and bleed in the GI tract
RBC have decreased survival in renal failure- acidosis? Toxin in uraemia?

Question 9

Renal disease aetiology: vascular disorders

Answer 9

Hypertension- causes atherosclerosis in renal artery, Arteriolosclerosis (narrowing of arterioles) in kidney arterioles, leading to widespread Ischaemia and necrosis in the kidney, nephrosclerosis
Emboli- can arise from arteries. Most of the cardiogenic arise from the venous circulation.