RENAL DISEASES Flashcards by Ssherwyn Lavarias

What are the 3 renal diseases?

GLOMERULAR, TUBULAR, TUBULOINTERSTITIAL

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Majority are of immune origin
Exposure to chemicals and toxins

GLOMERULAR

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Disruption of the electrical membrane charges
Deposition of amyloid material from systemic disorders

GLOMERULAR

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Basement membrane thickening

GLOMERULAR

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It refers to a sterile, inflammatory process that affects the glomerulus and is associated with the finding of blood, protein, and casts in the urine

glomerulonephritis

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Immune-mediated and have symptoms of Hypertension and Oliguria?

NEPHRITIC SYNDROME

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Deposition of immune complexes formed in response to Group A Streptococcal infection

ACUTE POST-STREPTOCOCCAL GLOMERULONEPHRITIS

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Contains M protein in the cell wall which is deposited in the glomerulus

ACUTE POST-STREPTOCOCCAL GLOMERULONEPHRITIS

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Under Glomerular, what disease that has signs and symptoms:

edema (eyes), fever, fatigue, hypertension

ACUTE POST-STREPTOCOCCAL GLOMERULONEPHRITIS

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Deposition of immune complexes from systemic immune disorders (ex: SLE) on the glomerular membrane

RAPIDLY PROGRESSIVE/CRESENTIC GLOMERULONEPHRITIS

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Under RAPIDLY PROGRESSIVE glomerulonephritis:

a cellular proliferation of EC inside the Bowman’s capsule which forms crescents

Crescentic:

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More serious form of acute glomerular disease

RAPIDLY PROGRESSIVE/CRESENTIC GLOMERULONEPHRITIS

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Deposition of antiglomerular basement membrane antibody to glomerular and alveolar basement membranes.

GOODPASTEUR SYNDROME

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Under Glomerular, what disease that has signs and symptoms:

hemoptysis and dyspnea

GOODPASTEUR SYNDROME

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Causes a granuloma-producing inflammation of the small blood vessels of primarily the kidney and respiratory system

WEGENER’S GRANULOMATOSIS

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WEGENER’S GRANULOMATOSIS disease is?

(+) Antineutrophilic cytoplasmic antibody (ANCA)

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Occurs in children following viral respiratory infections

HENOCH-SCHONLEIN PURPURA

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Allergic purpura that causes decrease in the number of platelets and affects vascular integrity

HENOCH-SCHONLEIN PURPURA

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A pronounced thickening of the glomerular basement membrane resulting from the deposition of IgG immune complexes

MEMBRANOUS GLOMERULONEPHRITIS

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Seen in SLE, Sjogren’s syndrome, secondary syphilis and hepatitis B infection

MEMBRANOUS GLOMERULONEPHRITIS

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Develop and increase the tendency to thrombosis

MEMBRANOUS GLOMERULONEPHRITIS

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Cellular proliferation affecting capillary walls or the glomerular basement membrane

MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS (MPGN)

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The glomerular disease that has type 1 and 2?

MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS (MPGN)

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What MPGN Type that:

Displaced increased cellularity in the sub-endothelial cells of the mesangium that progresses to nephrotic syndrome

Type 1

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What MPGN Type that: - Extremely dense deposits in the glomerular basement membrane which is a chronic glomerulonephritis

Type 2

Gradual worsening of symptoms leading to loss of kidney function

CHRONIC GLOMERULONEPHRITIS

Progression to renal failure and end stage renal disease may also occur

CHRONIC GLOMERULONEPHRITIS

Under Glomerular, what disease that has signs and symptoms: fatigue, anemia, hypertension, edema, and oliguria

CHRONIC GLOMERULONEPHRITIS

Most common cause of glomerulonephritis

IgA NEPHROPATHY / BERGER’S DISEASE

Frequent in adults and children and IgA deposition on the glomerular membrane leading to thickening

IgA NEPHROPATHY / BERGER’S DISEASE

Disruption of the electrical charges of the basement membrane leading to massive loss of proteins and lipids

NEPHROTIC SYNDROME

Glomerular disease that has chronic or acute?

NEPHROTIC SYNDROME

Chronic in NEPHROTIC SYNDROME characteristics?

Less painful, Long-lasting, Irreversible

Acutein NEPHROTIC SYNDROME characteristics?

Painful, Sudden onset, Reversible

Genetic disorder showing lamellated and thinning of glomerular basement membrane

ALPORT SYNDROME

Inherited sex-linked or autosomal genetic disorder

ALPORT SYNDROME

Also known as Lipid nephrosis

MINIMAL CHANGE DISEASE

This is little cellular changes and there is a shield of negativity which increases the filtration of CHON

MINIMAL CHANGE DISEASE

MINIMAL CHANGE DISEASE is associated with what 3 things?

allergic reaction, recent immunization, human leukocyte Ag-B12

Responds to corticosteroids

MINIMAL CHANGE DISEASE

Disruption of podocytes occurring primarily in children following allergic reactions and immunizations

MINIMAL CHANGE DISEASE

Disruption of the podocytes in certain areas of the glomerulus; others remain normal

FOCAL SEGMENTAL GLOMERULOSCLEROSIS

FOCAL SEGMENTAL GLOMERULOSCLEROSIS is associated with?

heroin and analgesic abuse, and AIDS

Most common cause of end-stage renal disease

DIABETIC NEPHROPATHY / KIMMELSTIEL-WILSON

Glomerular membrane thickening and Increased proliferation of mesangial cells

DIABETIC NEPHROPATHY / KIMMELSTIEL-WILSON

Increased deposition of cellular and noncellular materials

DIABETIC NEPHROPATHY / KIMMELSTIEL-WILSON

Deposition of glycosylated proteins on the glomerular basement membranes caused by poorly controlled blood glucose levels

DIABETIC NEPHROPATHY / KIMMELSTIEL-WILSON

This type of cell is modulate glomerular capillary blood flow and plays a role in the ultra-filtration surface area. In addition, it is both a source and target for vaso-active molecules, growth factors and extracellular matrix CHONs

Mesangial cells

Actual damage to the tubules and those in which ametabolic or hereditary disorder affects the intricate functions of the tubules.

TUBULAR

Damage to the renal tubular epithelial cells due to ischemia and exposure to nephrotoxic (antibiotic & anti-fungal) agents

ACUTE TUBULAR NECROSIS

Odorless urine

ACUTE TUBULAR NECROSIS

Failure of tubular reabsorption in the PCT (glucose, amino acids, phosphorus, sodium, potassium, bicarbonate and water)

FANCONI’S SYNDROME

FANCONI’S SYNDROME 2 diseases?

Cystinosis; Hartnup disease

Under FANCONI’S SYNDROME: what type of disease is amino acid disorder; accumulation of cystine

Cystinosis

Under FANCONI’S SYNDROME: What disease is tryptophan metabolism

Hartnup

DIABETES INSIPIDUS types?

Neurogenic DI and Nephrogenic DI

type of DI that is failure of hypothalamus to produce ADH

Neurogenic DI

type of DI that is renal tubules fail to respond to ADH

Nephrogenic DI

Inherited defect in the production of uromodulin by the renal tubules

UROMODULIN-ASSOCIATED KIDNEY DISEASE (UKD)

- Increased uric acid causing gout - Normal uromodulin is replaced by abnormal forms that destroy the RTE cells

UROMODULIN-ASSOCIATED KIDNEY DISEASE (UKD)

Inherited autosomal recessive trait

RENAL GLYCOSURIA

Normal blood glucose

160-180 mg/dL

Increased urine glucose due to defective tubular reabsorption

RENAL GLYCOSURIA

- Disorders affecting the interstitium also affects the tubules due to their close proximity - Majority of these disorders involve infections and inflammatory conditions

TUBULOINTERSTITIAL

- Bacterial infection of the urinary bladder - Common in women and children with urinary frequency and burning sensation

CYSTITIS

- Lower UTI

CYSTITIS

Upper UTI

ACUTE PYELONEPHRITIS

- Kidney infection; begins at the urethra or bladder - Infection of the renal tubules and interstitium related to interference of urine flow to the bladder, reflux of urine from the bladder and untreated cystitis

ACUTE PYELONEPHRITIS

-Recurrent infection of the renal tubules and interstitium caused by structural abnormalities affecting the flow of urine. -May result to permanent damage

CHRONIC PYELONEPHRITIS

Allergic inflammation of the renal interstitium in response to certain medications

ACUTE INTERSTITIAL NEPHRITIS

PROGRESSION TO END-STAGE RENAL DISEASE:

RENAL FAILURE

RENAL FAILURE: Marked decreased in GFR amount is?

<25mL/min

General characteristics: - Decreased GFR - Oliguria - Edema - Azotemia

ACUTE RENAL FAILURE

Under Pre-renal is?

Decreased blood pressure/cardiac output, Hemorrhage, Burns, Surgery, Septicemia

Under RENAL?

Acute glomerulonephritis, Acute tubular necrosis, Acute pyelonephritis, Acute interstitial nephritis

Under POST RENAL?

Renal calculi, Tumors, Crystallization of ingested substances

Formation of stones in the renal calyces, renal pelvis, ureters and bladder

RENAL CALCULI / LITHIASIS

May be passed in the urine and obstruct the urinary tract

RENAL CALCULI / LITHIASIS

What are the conditions favoring the formation of renal calculi:

o pH o Chemical concentration o Urinary stasis

Major constituent of renal calculi

Calcium oxalate/phosphate (~75%)

Very hard, dark in color with rough surface May be due to metabolic disorders or diet

Calcium oxalate/phosphate (~75%)

Frequently accompanied by UTI involving urea-splitting bacteria

Magnesium ammonium phosphate

Formed in the pelvis – resembling antlers of deer

Magnesium ammonium phosphate

Associated with increased intake of foods with high purine content Yellowish to brownish red and moderately hard

Uric acid

Seen in conjunction with hereditary disorders of cysteine metabolism Yellow-brown, greasy and resembles an old soap

Cystine

Least common calculi (1-2%)

Cystine

It is a procedure using high-energy shock waves, can be used to break stones located in the upper urinary tract into pieces that can then be passed in the urine. Surgical removal also can be employed.

LITHOTRIPSY:

Findings: - Acute onset of usually grossly visible hematuria - RBC casts - Mild to moderate proteinuria

NEPHRITIC SYNDROME

Findings: Hematuria Proteinuria Oliguria WBCS, Dysmorphic RBCs RBC cast, Hyaline cast, Granular cast (+) ASO titer

ACUTE POST-STREPTOCOCCAL GLOMERULONEPHRITIS

Findings: -Hematuria -Proteinuria -Dysmorphic RBCs -RBC cast, Hyaline cast -Granular cast -WBCs

RAPIDLY PROGRESSIVE/CRESENTIC GLOMERULONEPHRITIS

Findings: Hematuria Proteinuria RBC casts

GOODPASTEUR SYNDROME

Findings: Hematuria Proteinuria RBC casts Elevated serum creatinine and BUN

WEGENER’S GRANULOMATOSIS

Findings: Red skin patches, blood in sputum and stool Proteinuria Hematuria with RBC cast

HENOCH-SCHONLEIN PURPURA

Findings: Hematuria Proteinuria

MEMBRANOUS GLOMERULONEPHRITIS

Findings: Hematuria Proteinuria Decreased serum complement

MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS (MPGN)

Findings: Hematuria Proteinuria Glucosuria (result of tubular dysfunction) Many varieties of casts Markedly decreased GFR; Increased BUN and creatinine; electrolyte imbalance

CHRONIC GLOMERULONEPHRITIS

Findings: IgA deposition on the glomerular membrane leading to thickening

IgA NEPHROPATHY / BERGER’S DISEASE

Findings: Heavy proteinuria (> 3.5 g per day) Hematuria RTE cells OFB Fat droplets Fatty and waxy casts

NEPHROTIC SYNDROME

Findings: Microalbuminuria

ALPORT SYNDROME

Findings: Heavy proteinuria Transient hematuria Fat droplets

MINIMAL CHANGE DISEASE

Findings: Proteinuria, Microscopic hematuria

FOCAL SEGMENTAL GLOMERULOSCLEROSIS

Findings: Microalbuminuria (+) Micral test

DIABETIC NEPHROPATHY / KIMMELSTIEL-WILSON

Findings: Proteinuria Hematuria RTE cells, RTE casts, Other casts: hyaline, granular, waxy, and broad cast

ACUTE TUBULAR NECROSIS

Findings: Glycosuria (but w/ normal blood glucose) - Defect is in the renal tubules Possible mild proteinuria

FANCONI’S SYNDROME

Findings: Low specific gravity Polyuria Pale yellow color of urine

DIABETES INSIPIDUS

Findings: RTE cells Hyperuricemia (increase uric acid in blood)

UROMODULIN-ASSOCIATED KIDNEY DISEASE (UKD)

Findings: Increased urine glucose due to defective tubular reabsorption

RENAL GLYCOSURIA

Findings: + WBCs + Bacteria Hematuria Mild proteinuria Increased pH

CYSTITIS

Findings: WBCs, Bacteria WBC cast, Bacterial cast Hematuria Proteinuria

ACUTE PYELONEPHRITIS

Findings: WBCs Bacteria Casts: WBC, Bacterial, Granular, Waxy, Broad Hematuria Proteinuria

CHRONIC PYELONEPHRITIS

Findings: Hematuria Proteinuria WBCs (Increased eosinophils) WBC casts NO BACTERIA

ACUTE INTERSTITIAL NEPHRITIS

Findings: Steady rise in BUN AND CREATININE (azotemia) Electrolyte imbalance Lack of renal concentrating ability producing an isosthenuric urine Proteinuria, Renal glycosuria Telescoped urine sediments - Waxy, granular and broad casts

RENAL FAILURE

Findings: Decreased GFR Oliguria Edema Azotemia

ACUTE RENAL FAILURE