Renal Disease Flashcards by Liz Haywood

5 major categories of renal diseases

Glomerular (damage to glomeruli)
Tubular (infection/toxin destroys cells)
Interstitial (infections)
Vascular (disruption to blood supply)
Others

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6 glomerular diseases

Acute Post-Streptococcal
Glomerulonephritis
Acute GN, Chronic GN
Membranoproliferative GN
Focal segmental GN
Rapidly progressive GN

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Acute Post-Streptococcal Glomerulonephritis

- Specific causative bacteria

Group A Beta hemolytic strep

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Acute Post-Streptococcal Glomerulonephritis

- How immune complexes causes the disease

Cellular infiltrates deposit on glomerular basement membrane

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Acute Post-Streptococcal Glomerulonephritis

- Anatomic structure in the glomerulus is damaged

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Acute Post-Streptococcal Glomerulonephritis

- 6 typical urinalysis findings

Gross hematuria
Proteinuria
Red cell casts
Hypertension
Edema
Transient oliguria w/ reduced GFR

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Acute Post-Streptococcal Glomerulonephritis

- Pathognomonic finding for the disease

Red cell casts

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Acute Post-Streptococcal Glomerulonephritis

- Two chemistry lab findings

↑ BUN and creatinine

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Acute Post-Streptococcal Glomerulonephritis

- One immunological finding

Positive test for streptococcal Abs (Abs of M proteins)

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List 3 symptoms for chronic glomerulonephritis

Edema
Hypertension
Oliguria

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Pathognomonic urinalysis findings for chronic glomerulonephritis

Broad and waxy casts

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2 categories of tubular diseases

Acute Tubular Necrosis (ischemic and toxic)

- Renal Tubular Acidosis

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Describe tubular damage caused by trauma, shock, or sepsis, in ischemic acute tubular necrosis

The damage leads to ↓ renal perfusion. Reduced oxygen disrupts tubular basement membrane function

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List typical toxic agents that cause toxic acute tubular necrosis and the specific part of the nephron that becomes damaged

Heavy metals, ethylene glycol, organic solvents, drugs, mushrooms
Causes damage and death to PT

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6 typical urinalysis findings of acute tubular necrosis

Mild proteinuria
Hematuria
Low specific gravity
Renal epithelial cells, renal epithelial cell casts, granular casts
Oliguria
↑ BUN

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Pathognomonic findings for acute tubular necrosis

Renal epithelial cell casts

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Explain the pathogenesis of renal tubular acidosis

Tubules can’t secrete hydrogen ions to acidify urine, ↓ blood pH, causing acidosis

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5 tubulointerstitial diseases

Pyelonephritis (acute and chronic)
Cystitis
Urethritis
Acute tubulointerstitial nephritis
Acute tubulointerstitial necrosis

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Pyelonephritis

- 3 predisposing factors

UTI
Pregnancy
Diabetes mellitus

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Pyelonephritis

- 3 common routes of infection

Ascending from bladder
3% from bloodstream
From lymphatic system

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Acute pyelonephritis

- 6 typical urinalysis findings

> 5 WBCs/hpf (clumps)
Bacteria
Mild proteinuria
Positive blood
Positive nitrate
WBC casts

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Acute pyelonephritis

- Pathognomonic finding

WBC casts

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Chronic pyelonephritis

- Most common cause of chronic pyelonephritis

Backward flow of urine up ureters

Chronic pyelonephritis

- 7 typical urinalysis findings

↑ protein
WBCs in clumps
Low specific gravity
Macrophages
Granular casts
Waxy casts
Broad casts

Chronic pyelonephritis | - 2 pathognomonic findings

Waxy and broad casts

Cystitis | - 4 typical symptoms

- ↑ frequency and urgency of urination - Pain in pelvic/abdominal region - Fever and chills - Burning sensation on urination

Cystitis | - 2 common bacterial causes

- E. coli | - Staphylococcus saprophyticus

Cystitis | - 5 common urinalysis findings

- Positive blood - Positive leukocyte esterase - Positive nitrite (if bacteria produce nitrite) - WBCs - Bacteria (1/3 will be neg) NO CASTS

Nephrotic syndrome | - 4 disease processes that may lead to the syndrome

- Glomerulonephritis - Systemic Lupus Erythematosus (SLE) - Diabetes mellitus - Sickle cell anemia

Nephrotic syndrome | - Renal damage that leads to symptoms and lab findings

Glomerular basement membrane becomes highly permeable to plasma proteins and lipids

Nephrotic syndrome | - 2 clinical symptoms

- Edema | - Hypertension

Nephrotic syndrome | - 3 typical chemistry findings

- Hypoproteinemia - ↑ cholesterol - ↑ triglycerides

Nephrotic syndrome | - 4 urinalysis findings

- Massive proteinuria - Microscopic hematuria - Oval fat bodies - Fatty casts and waxy casts

Nephrotic syndrome | - Pathognomonic findings

- Oval fat bodies - Fatty casts - Waxy casts

4 vascular renal disease

- Hypertension - Benign nephrosclerosis - Renal artery stenosis - Microangiopathies

Why can vascular disease lead to renal disease?

The kidneys receive 20-25% of cardiac output so anything that interferes w/ blood flow impacts kidney function

Why can hypertension lead to renal disease?

↑ pressure changes the structure of vascular walls which ↑ the risk for renal failure

What is the lab marker for renal disease caused by hypertension?

Microaluminuria

Hemolytic Uremic Syndrome (HUS) | - Bacterial causative agent and what food is it found in?

E. coli found in ground meat

Hemolytic Uremic Syndrome (HUS) | - Why the toxin causes hemolysis and thrombosis

Toxin binds to RBCs, affects platelet function, and causes ↑ adhesion of WBCs to endothelium

Hemolytic Uremic Syndrome (HUS) | - Processes that lead to vasoconstriction

The toxin causes ↑ production of endothelia and loss of endothelial nitric oxide favors vasoconstriction, this in presence of blood clots, occludes vessels, causes necrosis, and thickening of capillary walls

Nephrolithiasis | - 4 factors that favor stone formation

- ↑ concentration of stone constituent in urine - changes in urine pH - ↓ urine flow - Presence of bacteria

Nephrolithiasis | - 4 categories of kidney stones

- Calcium salts - Triple phosphate (struvite) - Uric acid - Cystine

Nephrolithiasis | - 3 symptoms

- Severe flank pain - Nausea - Vomiting

Nephrolithiasis | - 3 typical urinalysis findings

- Hematuria - Bacteriuria - Crystals

Nephrolithiasis | - 2 typical chemistry findings

↑ BUN and creatinine

Abrupt ↓ in renal function sufficient to ↑ plasma creatinine and BUN

"Acute renal failure"

Pre-renal causes of acute renal failure

- Extracellular fluid loss - ↓ cardiac output - Sepsis/shock

Renal causes of acute renal failure

- Vascular disorders (DIC) - Glomerulonephritis - Tubular necrosis

Post-renal causes of acute renal failure

Obstructions

Acute renal failure | - 3 chemical findings

- Hyperkalemia - ↑ plasma phosphorus - ↓ blood pH

Acute renal failure | - 2 urinalysis findings

- Positive blood and protein in urine | - Oliguria

Acute renal failure | - 1 hematological finding

Anemia

What is the GFR associated w/ chronic renal failure?

GFR < 15mL/minute

What specific part of the nephron becomes damaged in toxic acute tubuler necrosis?

Proximal tubules