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renal disease Flashcards

1
Q

what is the Globmeruli

A

network of capillaries in the kidney between afferent (bringing) and efferent (taking away) arterioles

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2
Q

what does the capillary wall of the glomeruli consist of

A

Endothelium
basement membrane
epithelium (lines urinary space)

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3
Q

what comes from the epithelial cells of the clomeruli

A

Finger like projections from cell body to contact basement membrane

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4
Q

what connects the adjacent finger processes

A

slit diaphram membrane

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5
Q

what is the importance ofthe slit diaphram membrane

A

prevents proteinuria

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6
Q

what is the capilary wall permeable to of the glomeruli

A

water

small molcules

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7
Q

what is the capillary wall

of the glomeruli impermeable to

A

Albumin

larger proteins

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8
Q

what supports the capillaries of the glomeruli to hold them together

A

Connective tissue mesagium

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9
Q

what forms the interstitum

A

Collagen

Blood vessels between the tubules and glomeruli

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10
Q

what suppliest the capillary bed around some of the tubules

A

VAsa rector

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11
Q

what is Azotemia

A

Elevated BUN(blood urea nitrogen) and creatinine

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12
Q

what causes Azotmia

A

decreased Glomerular filtration rate (less filtration

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13
Q

what is Uremia

A

Azotemia plus other symptomes

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14
Q

what are the other symptoms associated with Uremia

A 
Gastroenteritis
Peripheral neuropathy
Dermatitis
Acidosis
Pericarditis
Hyperkalemia
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15
Q

what causes Acute Nephritic syndrome

A

Results from glomerular injury

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16
Q

what are the symptoms of acute nephritic syndrome

A

acute onset of hematuria
Mild to moderate proteinuria
Azotemia
Hypertneions

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17
Q

what are the signs of nephrotic syndrome

A
  • heavy proteinuria (greater 3.5 grams per day)
  • hypoalbuminemai
  • severe edema
  • hyperlipidemia
  • lipiduria
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18
Q

what is the sudden onset of Azotemia with Oliguria/anuria

A

Acute renal failure

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19
Q

what is proteinuria

A

loss of protein

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20
Q

what is Hematuria

A

broken capillaries lead to peeing blood

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21
Q

what does severe proteinuria lead to

A

severe edema

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22
Q

what is anuria

A

no pee is made

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23
Q

how common is Autosomal dominant (adult polycycstic kidney disease

A

1 in 500-1000 people

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24
Q

how does Autosomal dominant adult polycystic kdiney disease present itself

A
  • Multiple expanding cysts in both kidneys
  • gradual onset of renal failure in adults
  • urinary tract hemorrhage (hematuria)
  • pain
  • hypertension
  • UTI
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25
what is the defective gene in autosomal dominant (adult) polycystic kidney disease
Defect PKD1 gene on chromsome 16
26
what does Autosomal dominant (adult) polycystic kidney disease code for
Polycystin-1
27
how does Autosomal dominant (adult) polycystic kidney disease affect other ogans
1/3 have cysts in liver | aneurysms develop in ciricle of willis
28
what happens to kidneys in autosomal domianny (adult) polycystic kidney disease
Very large (4kg) kidneys with many cysts in every part of the tubular system
29
where do cysts arise in autosomal dominant (adult) polycystic kidney disease
all levels of the nephron
30
what are the clinical signs of Autosomal dominant (Adult) polycystic kidney disease
``` Flank pain around 4th decade Hematuria Hypertension UTI renal failure ```
31
how common is Autosomal recessive (childhood) polycystic kidney disease
1:20,000 births
32
what mutation causes Autsomal recessive (Chidlhood) polycystic Kidney disease
PKHD1 gene muttation
33
what is the defective protein in Autosomal recessive (childhood) Polycystic kidney disease
Fibrocystin
34
when does renal failure occur in autosomal recessive (childhood) Polycystic kidney disease
Shortly after birth to serveral years of age
35
what happens to the kidney in autosomal recessive (childhood) polycystic kidney disease
Numerous unifrom-sized cysts that arise from the collecting tubules
36
what other organs may be affected by autosomal recesissive(childhood) polycystic Kidney disease
Liver cysts | progressive liver fibrosis
37
what are the mechanisms of glomerular injury
Immune complex deposites in glomerular basement membrane or mesangium leading to epithelial and endothelial cell injury
38
where can immune complexes for loerular injury come from
- circulating immune complexes that dposite in the glomerulus - circulating antibodies direct aginast glomerular compants - non-glomerular antigens "planted" in the gloerulus
39
what methods are used to evaluate Kidney biopsies
Light micrscopy Immunofluorescence Electron microscopy
40
what is used to do light micrscopy
H& E stains PAS trichrome (collagen) Jones (PAS methenamine silver) - basement membrain eval
41
what is used in immunofluorescence
Immunoglobulins and complement
42
what is Immunofluorescence used for
Identification of immune complexes
43
what is electron micrscopy used for
ID immune complexes Epithelial cell canges Basement membarne morphology others
44
how does it look when immune complex deposition occurs from ciluating growing between the endothelium and basement membrane
Bumps
45
how does it look when immune complexes grow under the foot processes
bumps
46
how does it look when immune complexes linearily aranged in the basement membrane
smooth line
47
what are the sings of Nephrotic syndrome
``` Heavy proteinuria Hypoalbuminemia Sever edema (most obvious sign) Hyperlipidemia Lipidura ```
48
what causes Nephrotic syndrome
Increased glomerular capilary permeability to plasma proteins
49
what is the most common cuase of neprotic snydrome in children
Minimal change disease (2/3 of cases)
50
how does minimal change disease look in a bioposy of the glomeruli
LM: Normal appearing glomeruli IF: no immune complex deposites EM: foot process effacement
51
how is minimal chnage disease treated
Corticosteroids | - especially in children
52
what is the common cause of adult nephrotic syndrome
Focal segmental Glomerulosclerosis
53
does focal segmental glomerulosclerosis usually exist alone
Can be primary or secondary glomerular disease | - some is Familiary
54
what does focal segmental glomerulosclerosis show in microscopes
LM: focal (some glomeruli) and segmental (part of invovled glomerulus) sclerosis wth obliteration of capillary loops IF and EM: no immune complex deposites in the primary (idopathic) form
55
how does focal segmental clomerulosclerosis respond to corticosteroid treatment
not well
56
how well does the kidney last in Focal and segmental flomerulosclerosis
renal failure in 50% after 10 years
57
who tends to get Membranous Nephropathy
Most common in adults | may affect children
58
what can cause membranous nephropathy
Primary | secondary to infection malignancy, SLE, drugs
59
how does Membranous nephropathy look in micrscop
LM: normal, thickned BM IF: immune complex depostes EM: deposties in subeitheilail side of GBM
60
how well does Membranous nephropathy respond to Corticosteroids
Poor response
61
how long does the kindey last in membranous nephropathy
40% develop renal failure in 2-20 years
62
what is the 2nd cause of death after MI for Diabetes Mellitus
Renal fialure
63
how does Diabetes Mellius show itself in a microscope
LM: nodular glomerulosclerosis IF: no immune complex deposites EM: Thick GBM
64
what are th other changes that occur in Diabetes mellitus to the kidney
Hyaline arteriolosclerosis Atherosclerosis Nephrosclerosis
65
what characterizes Nephritic syndrome
Acute onset of - Hematuria - Oliguria and Azotemia - hypertension
66
what happens to the cells of the flomeruli in Nephritic syndrome
Proliferation of cells within glomeruli and inflammatory cells
67
what does inflammation do in Nephritic syndrome
Inflammation injures capillary walls
68
injury to capillary walls leads to what in nephritic syndrome
Blood passing into urine | Reduce GFR
69
what causes Nephritic Syndrome
- Acute postinfection (poststreptococcal) glomerulonephritis | - IgA nephropathy
70
when does Acute Postinfectious glomerulonephritis occur
follows (1-4 weeks) streptococcal pharyngitis | - other infections may also cause problem (bacterial and viral)
71
who tends to get acute postinfectious glomerulonephritis
Children
72
what does a microscope show in Acute postinfectious glomerulonephritis
LM: Proliferation of endo and mesangial cells, inflammatory cells, develop cellular crescents IF: immune complex deposition, granular EM: immune complexes in GBM and sometimes mesangium
73
who tends to have acute postinfectious (poststreptococcal) glomerulonephritis progress to chronic renal disease
Adults
74
who tends to be affected by IgA nephropathy
Children and young adults
75
what are the signs of IgA nephropathy
Hematuria 1-2 days post-upper respiratory tract infection | - resolution and recurence
76
what is Henoch-Schonlein Purpura
when renal disease associated with purpuric skin rash, GI pain, arthritis in IGA nephropathy
77
what does IgA nephropathy look in a microscope
LM: variable mesangial cell proliferation | IF and EM: immune (IGA) complexes within the mesangium
78
what type of Glomerulonephritis is Rapidly Progressive Glomerulonephritis
Acute clinical syndrome, not a form of glomerulonephritis
79
what is Rapidly progressive Glomerulonephrits
PRogressive loss of renal function
80
what does the lab show in Rapidly progressive glomerulonephritis
C/w nephritic syndrome | Severe oligouria
81
what happens if Rapidly progressive glomerulonephritis is untreated
Death from renal fialure in weeks/months
82
what is the characteristic finding of Rapidly progressive Glomerulonephritis
crescentic glomerulonephritis
83
what causes Crescentic glomerulonephritis in Rapidly progressive glomerulonephritis
Proliferation of epithelial cells | Infiltration of histiocytes
84
what are the dissorders associated with Rapdily progressive Glomerulonephritis
Anti-GBM antibody disease (12% of cases) Immune complex disesase (44% of cases) Pauci immune, lack of anti-GBM or immune complexes (44% of cases)
85
what is pauci immune glomerulonephritsi
lack of immune complex deposition
86
what does untreated glomerular disease lead to
Loss of glomeruli and tubules with fibrosis
87
can you tell the OG renal disease by the time Chronic Glomerulonephritsi is diagnosed
No
88
who may get chronic Renal disease
Young and middle aged adults
89
when may chronic renal disease be detected
At a routine exam
90
what is the signs of chronic renal disease from a routine exame
Proteinuria Hypertension Azotemia
91
what is the prognosis of chronic renal disease
Poor prognosis
92
what happens to surviving glomeruli after advanced loss of tubules in glomeruli in Chronic renal disease
develop adaptive changes
93
what is the effectiveness of the adaptive changes in chronic renal disease
lead to further injury and progressive renal failure
94
what is needed in chronic renal disease treatment
Renal dialysis and kidney transplant
95
other name for acute Pyelonephritis
Tubulointerstitial nephritis
96
what is acute pyelonephritis
Suppurative(bacterial) inflammation of kidney and renal pelvis caused by bacterial infection
97
what all is affected by acute pyelonephritis
Tubules Interstitium renal pelvis
98
how does Acute Pyelonephritis spread
Ascends from bladder (most common UTI) | and spreads to kidney through blood(hematogenous)
99
how does the body respond to acute Pyelonephrits imunologically
Neutrophil infiltration of interstitium and tubules | cluster of neutrophils in the tubular lumens
100
what are clusters of neutrophils in the tubular lumens
Neutrophil casts
101
what are the predisposing conditions for acute pyelonephritis
``` Urinary tract obstruction Instrumentation Ureteral reflux Pregnancy Females Immunosuppression Diabetes Mellitus ```
102
why do females get more acute Pyelonephrtis
cuz their butthole is close to their peehole
103
what is the clinical signs of Acute pyelonephritis
Sudden onset of pain at the costovertebral angle and systemic evidence of infection - accompany dysuria, frequency and urgency
104
what is the prognosis of Acute pyelonephritis
repeated bouts of acute inflammation of cont inflammtion leading to chronic pyelonephritis - mononuclear inflammatory infiltration and irregular scarring
105
what drugs tend to cause Drug-induced interstitial nephritis
Antibiotics NSAIDS Diretics
106
what is the pathogenesis of Drug induced interstitial nephritis
Hypersensitivity | -drug binds to tubular or interstitial cells to cause immunogenic response
107
what are the clinical signs of Drug induced interstitial nephritis
Rapid onset (2-40 days) of fever eosinophilia Renal dysfuctnion with hematuria Little to no proteinuria
108
what is the body's response fo drug-induced interstitial nephritis
Interstitial mononuclear cell infiltration edema Eosinophilis with non-necrotizing granulomas
109
how does one treat Drug-inducing interstitial nephritis
Withdrawal of offending drug | Corticosteroids
110
PRognosis of Drug-induced interstitial nephritis
Good (recovering 6-8 weeks)
111
what are the clinical signs of Acute tubular necrosis
rapid onset of renal failure Reduced Urine output/decreased GFR Electrolyte imbalance ACUTE KIDNEY INJURY
112
can you heal Acute tubular necrosis
Reversible overa period of weeks as damaged tubular epithelium regenerates
113
what damage does acute tubular necrosis lead to
Injury to tubular epithlium cells from ischemia (shock) or toxin)
114
what is the pathology of Acute tubular necrosis
Dilation of tubules Interstitial edema necrosis of epithelium
115
how does Necrosis of epithlium in acute tubular necrosis look different for ischemia and toxin
Ischemia: focal and subtle Toxin: diffuse
116
treating Acute tubular necrosis
Supportive care | Dialysis
117
prognosis of Acute tubular necrosis
with no preexisting kidney disease, most fully recover renal function
118
Thickening and sclerosis of Renal arteries associated with benign hypertension
Arterionephrosclerosis
119
what gene is associated with arterionephrosclerosis
Apolipoprotein L1 gene
120
who tends to get arterionephrosclerosis
African Americans
121
what linkage does Arterionephrosclerosis share
FSGS
122
how does arterionephrosclerosis look grossly
Grossly small kidneys | Granular surface
123
what happens to kidney in arterionephrosclerosis at a tissue and micrscopic level
- Hyaline arteriolosclerosis/Fibroelastic hyperplasia - Tubular atrophy and fibrosis - Global sclerosis of glomeruli
124
what disease of arterionephrosclerosis tend to associate with
Hypertension greater than 200/120 mmhg (malignant hypertenion
125
How common is arterionephrosclerosis in essential hypertension
occurs in 5% of patients
126
what are the clinical signs of arterionephrosclerosis from malignant hypertension
Relative rapid onset of renal failure with increased intracrnail pressure - headache - nausea - vomiting - visual impairment
127
what is the pathology of arterionephrosclerosis with malignant hypertension
hyperplastic arteriolosclerosis | reduced blood flow causing necrosis of glomeruli
128
what causes thrombotic thrombocytopenia purpura(TTP)
an aquired deffect in ADAMTS 13
129
what is the action of ADAMTS 13
plasma protease that degrades vWF multimers
130
what do the vWF components activate
Platelets under certain conditions
131
what is hemolytic-uremic sndrome
endo cell injury leading to platelet activation
132
what causes Hemolytic uremic syndrome
Shiga-toxin from E. Coli | - shigella
133
what happens in thrombotic microangiopathies
Microthrombus formation in capillaries with RBC damage(schistocytes)
134
what types of disease is Thrombotic thrombocytopenia purpura and Hemolytic-uremic sydnrome
Thrombotic microangiopathies
135
what is the overal involvement in Hemolytic-uremic syndrome and thrombotic thrombocytopenia purpura
Hemolytic uremic syndrome is specific to Renal and involves children thrombotic Thrombocytopenia purpura is more widespread in organs (due to antibodies
136
what is urolithiasis
Kidney stones
137
who is affected by Urolithiasis
by 70, 11% men 6% women
138
what are the clinical signs of urolithiasis
``` Asymptomatic Obstruction intense pain Infection hematuria ```
139
types of stones
Calcium (80%( magngesium ammonium phosphate Uric acid
140
what causes calcium kidney stones
Increased Ca in urine
141
what causes magnesium ammonium phosphate kidney stones
Alkaline urine | Proteus or staph infection
142
what causes uric acid kidney stones
Gout acid urine high cell turnover
143
large kidney stones
Staghorn calculi
144
what is hydronephrosis
Dilation of renal pelvis/calyces with parenchymal atrophy secondary to obstruction
145
Causes of hydronephrosis
``` Renal stones Congenital urinary tract obstruction enlarged prostate neoplasms neurogenic bladder pregnancy ```
146
do men or female get renal cell carcinoma
2:1 male:female
147
clinical sings of renal cell carcinoma
``` Hematuria Mass Pain Fever Polycythemia Paraneoplastic syndrome ```
148
what are the risk factors of renal cell carcinoma
``` Smoking Hypertension obesity cadmium expsore Von hippel-lindau syndrome ```
149
where does renal cell carcinoma come from
Tubular epithelium
150
where does renal cell carcinoma invade
Renal vein
151
how does renal cell carcinoma look
Cells with very pale or clear cytoplasm
152
how do you treat renal cell carcinoma
Surgery +/- radiation
153
prognposis of 5 year survival of renal cell carcinoma
stage 1:81% | Stage4:8%
154
what is a wilm's tumor
abdominal mass
155
what increases risk of Wilm's tumor
Inherited syndromes
156
who tends to get wilm's tumor
2-5 year olds
157
what is the patholgy of wilms tumor
Triphasic proliferation of cell | - epithelial, stromal, and blastemal compents
158
how do we treat wilms tumor
Surgery and chemo
159
prognosis of WIlms tumor
Very good

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