renal diseases Flashcards
Diseases that are most often immune mediated
Glomerular Diseasesq
Exposure to chemicals, toxinx, and amyloid materials
Non immunologic glomerular disease
Acute onset of grossly visible hematuria
RBC casts
Mild to moderate proteinuria
Hypertension
Oliguria
Nephritic Syndrome
Basement thickening because of the deposition of ___ materials from systemic disorder?
Glomerular disease; amyloid material
The term ____ refers to sterile, inflammatory process that affects the glomerulus and is associated with the finding of blood, protein, and casts in urine?
Glomerulonephritis
Respiratory infection caused by group A streptococcus
Acute post streptococcal glomerulonephritis
Deposition of
immune
complexes
formed in
response to
Group A
Streptococcal
infection on the _______
Acute post streptococcal glomerulonephritis; Glomerular membrane
Marked by the sudden onset of symptoms consistent with
glomerular membrane damage
Acute post streptococcal glomerulonephritis
Signs and symptoms: edema around the eyes, fever, fatigue, hypertension
Acute post streptococcal glomerulonephritis
in Acute post streptococcal glomerulonephritis there is a increase in what?
BUN and ASO titer
contains M protein in the cell wall and deposited in the glomerulus
Acute post streptococcal glomerulonephritis
More serious form of
acute glomerular
disease that involves
deposition of
immune complexes
from systemic
immune disorders
Rapidly Progressive/Crescentic Glomerulonephritis
Damaged glomeruli
allow release of cells
and fibrin into the
Bowman’s capsule
leading to
crescentic
formation and
pressure changes
/Crescentic Glomerulonephritis
more severe, there is cellular proliferation of epithelial cells insede the bowman’s capsule that forms crescent which are related to SYSTEMIC LUPUS ERYTHEMATOSUS
Crescentic Glomerulonephritis
deposition of Antiglomerular Basement Membrane
Ab which is cytotoxic to collagen leading
to complement activation and capillary
destruction
Goodpasteur Syndrome
what is deposited on Goodpasteur syndrome that is cytotoxic?
Antiglomerular Basement Membrane antibody
Goodpasteur syndrome; deposition of Antiglomerular Basement Membrane antibody in the?
Glomerular and alveolar basement membrane
deposition of Antiglomerular Basement Membrane
Ab which is cytotoxic to collagen leading
to ___ and ___?
Complement activation and capillary destruction
May lead to chronic glomerulonephritis
and end-stage renal disease
Goodpasteur Syndrome
Signs and symptoms: hemoptysis and
dyspnea
Goodpasteur Syndrome
(+) Antineutrophilic Cytoplasmic Antibody (ANCA) that targets
neutrophils in
the vascular
walls initiating
immune
response and
granuloma
formation in the
lungs and
kidneys
Wegener’s Granulomatosis
causes granuloma producing inflammation of the small blood vessels primarily of the kidneys and the respiratory system
Wegener’s Granulomatosis
Wegener’s Granulomatosis is positive for?
Antineutrophilic cytoplasmic antibody
increase of what in Wegener’s granulomatosis?
increase serum BUN and creatinine
Allergic purpura that causes decrease in the number of platelets
and affects vascular integrity
Henoch-Schonlein Purpura
Signs and symptoms: red skin patches, blood in sputum and stool
Henoch-Schonlein Purpura
this usually occurs in children after upper respiratory infection
Henoch-Schonlein Purpura
Involves IgG deposition on the glomerular membrane leading to
pronounced thickening
Membranous Glomerulonephritis
Seen in SLE, Sjogren’s syndrome, secondary syphilis and hepatitis
B infection
Membranous Glomerulonephritis
this develop and increase the tendecies for thrombosis
Membranous Glomerulonephritis
pronounce thickening of the glomerular basement membrane resulting from the deposition of IgG immune complexes
Membranous Glomerulonephritis
Cellular proliferation affecting capillary walls or the glomerular
basement membrane
. Membranoproliferative Glomerulonephritis
Membranoproliferative Glomerulonephritis other lab findings?
decreased serum complement
what type of Membranoproliferative Glomerulonephritis? increased cellularity in the sub-endothelial cells of the mesangium that may progress to nephrotic syndrome
Type 1 Membranoproliferative Glomerulonephritis
what type of Membranoproliferative Glomerulonephritis? Extremely dense deposits in the glomerular basement membrane which is a chronic glomerulonephritis
Type 2 Membranoproliferative Glomerulonephritis
Gradual worsening of symptoms leading to loss of kidney function
Chronic Glomerulonephritis
Other lab findings: increased BUN and creatinine, electrolyte
imbalance
Chronic Glomerulonephritis
may progress to renal failure and the duration of the damage of the kidney may progress to ____ and end stage renal disease may occur
Chronic Glomerulonephritis
Nephritic or nephrotic? Hypertension
Nephritic syndrome
Nephritic or nephrotic? inflammation of the glomeruli
nephritic syndrome
Nephritic or nephrotic? cola colored urine/hematuria
Nephritic
Nephritic or nephrotic? berger’s disease (IgA nephropathy)
Nephritic
BErger’s disease is also known as ?
IgA nephropathy
is the most common cause of primary glomerulonephritis
Berger’s disease
Nephritic or nephrotic? hypoalbuminemia
Nephrotic syndrome
Nephritic or nephrotic? Hyperlipidemia
Nephrotic
Nephritic or nephrotic? massive proteinuria
nephrotic
Nephritic or nephrotic? peripheral edema
Nephrotic
igA deposition on the glomerular membrane leading to thickening
IgA nephropathy/Berger’s Disease
most common cause of glomerulonephritis
IgA nephropathy/Berger’s Disease
Acute onset may occur as a result of circulatory disruption
causing systemic shock and decrease in blood pressur
. Nephrotic Syndrome
Involves membrane damage and changes in the electrical charges
of the basement membrane leading to the passage of high
molecular weight proteins and lipids into the urine
Nephrotic Syndrome
Loss of albumin causes decrease in capillary oncotic pressure and
edema
Nephrotic Syndrome
disruption of the electrical charges of the basement membrane leading to massive loss of proteins and lipids
nephrotic syndrome
Heavy proteinuria in nephrotic syndrome is?
> 3.5g/day
nephrotic syndrome Other lab findings: decreased ___, increased ____
dec serum albumin; inc serum lipids
Inherited disease that affects the glomerular basement
membrane (lamellated appearance with areas of thinning)
Alport Syndrome
inherited sex linked or autosomal genetic disorder showing lamellated and thinning of the glomerular basement membrane
Alport Syndrome
Disruption of podocytes and shield of negativity which increases the filtration of protein
occurring primarily in
children following allergic
reactions and
immunizations
minimal change disease
lipid nephrosis
minimal change disease
little cellular changes
minimal change disease
unknown etiology associations includes allergic reaction, immunizations, possession to HLA B12, and this disease responds to corticosteroids?
minimal change disease
Disruption of the
podocytes in certain areas
of the glomerulus but other parts remain normal
Focal segmental glomerulosclerosis
Associated with heroin and
analgesic abuse, and AIDS
Focal Segmental
Glomerulosclerosis
Most common cause of end-stage renal disease
Diabetic Nephropathy/Kimmelstiel-Wilson
Glomerular damage may be due capillary thickening, increase
proliferation of the mesangial cells, increase deposition of cellular
and non-cellular materials
Diabetic Nephropathy/Kimmelstiel-Wilson
glycosylated protein caused by poorly controlled blood glucose levels
Diabetic Nephropathy/Kimmelstiel-Wilso
the mesangial cells which plays a central role in glomerulat function which modulated glomerular capillary blood flow and ultrafiltration surface area and in addition, this mesangial cells are both a source and target for vasoactive molecules growth factors and extracellular matrix proteins
Diabetic Nephropathy/Kimmelstiel-Wilson
findings: microalbuminuria, (+) Micral test
Diabetic Nephropathy/Kimmelstiel-Wilson
May be due to actual tubule damage, and metabolic or hereditary disorders
TUBULAR DISEASES
results from infection and toxic substances
TUBULAR DISEASES
affects the renal tubules
TUBULAR DISEASES
Damage to the renal tubular epithelial cells due to ischemia and
nephrotoxic 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
causes cytinosis and hartnup’s disease
Fanconi’s Syndrome
cystine accumulation in the cell
cystinosis
accumulation of tryptophan in the cell
Hartnup disease
Inherited defect of tubular response to ADH or acquired from
medications
Nephrogenic Diabetes Insipidus
Nephrogenic Diabetes Insipidus findings:
Low specific gravity, polyuria, pale yellow color
failure of the hypothalamus to produce ADH
neurogenic diabetes insipidus
failure of the tubules to respond to ADH
Nephrogenic Diabetes Insipidus
inherited defect int hte productionod uromodulin by the renal tubules
uromodulin associated kidney disease
increased uric acid causing gout
uromodulin associated kidney disease
affects only the reabsorption of glucose
renal glycosuria
normal blood glucose due to defective tubular reabsorption
Renal glycosuria
Affects only the reabsorption of glucose
renal glycosuria
renal treshold of glucose?
160-180 mg/dl
Disorders affecting the
interstitium also affects the
tubules due to their close
proximity
TUBULOINTERSTITIAL DISEASES
Majority of these disorders
involve infections and
inflammatory conditions
TUBULOINTERSTITIAL DISEASES
Most
common
renal disease
that involves
the lower urinary tract (urethra and bladder) or the upper urinary
tract (renal pelvis, tubules and interstitium)
Urinary Tract
Infection
lower urinary tract
urethra and bladder
upper urinary tract
renal pelvis, tubules, and interstitium
Urinalysis: hematuria, RTE cells, RTE casts, other casts, hyaline, granular, and broad cast
Acute Tubular Necrosis
can be heriditary and metabolic disorder
Fanconi’s syndrome
uromodulin is also known as
Tamm horsfall protein- most abundant protein in urine
findings: rte cell and hyperuricemia
Uromodulin associated kidney disease
infection of the urinary bladder, lower urinary tract infection, common in woman and children
cystitis
bacterial infection of the urinary bladder
cystitis
positive for WBC, bacteria, hematuria, mild proteinuria, increased pH
cystitis
affects the renal tubules and interstitium, upper urinary tract infection
acute pyelonephritis
begins in the urethra and bladder and travels up to both of the kidneys
Acute pyelonephritis
difference cystitis and acute pyelonephritis
presence of bacterial cast in acute pyelonephritis
Allergic inflammation of the renal interstitium in response to
certain medications
Acute Interstitial Nephritis
ascending movement of bacteria
Acute pyelonephritis
infection of the renal tubules and interstitium, reflux of urine from the bladder and untreated cystitis
Acute pyelonephritis
different leukocyte couns
acute interstitial nephritis
disease that has no bacteria since allergic inflammation only
Acute Interstitial Nephritis
Formation of stones in the renal calyces, renal pelvis, ureters
and bladder
Renal Calculi/Lithiasis
more severe form of pyelonephritis that can result to permanent damage of the renal tubules
chronic pyelonephritis
recurrent infection of renal tubules and interstitium caused by structural abnormalities affecting the flow of urine
Chronic pyelonephritis
*PROGRESSION TO END-STAGE RENAL
DISEASE:
RENAL FAILURE
Marked decreased in GFR(<25mL/min)
RENAL FAILURE
*Steady rise in BUN AND CREATININE is termed?
azotemia
TELESCOPED URINE SEDIMENTS
RENAL FAILURE
*Electrolyte imbalance
* Lack of renal concentrating ability producing an
isosthenuric urine
*Proteinuria, Renal glycosuria
RENAL FAILURE
*GENERAL CHARACTERISTICS:
* Decreased GFR
* OLIGURIA
* Edema
* Azotemia
ACUTE RENAL FAILURE
due to accumulationof non-filtered substances
edema
May be passed in the urine and obstruct the urinary tract
Renal Calculi/Lithiasis
Conditions favoring the formation of renal calculi
- pH
- Chemical concentration
- Urinary stasis
Major constituent of renal calculi
Calcium oxalate/phosphate (~75%)
Primary Calculi Constituents; Very hard, dark in color with rough surface
- May be due to metabolic disorders or diet
Calcium oxalate/phosphate (~75%)
Primary Calculi Constituents; Frequently accompanied by UTI involving urea-splitting
bacteria
-
Magnesium ammonium phosphate:
Primary Calculi Constituents: Formed in the pelvis – resembling antlers of deer
Magnesium ammonium phosphate:
Primary Calculi Constituents:associated with increased intake of foods with high purine
content
Uric acid:
Primary Calculi Constituents:Yellowish to brownish red and moderately hard
Uric acid:
Primary Calculi Constituents:seen in conjunction with hereditary disorders of cysteine
metabolism
Cystine
Primary Calculi Constituents: - Yellow-brown, greasy and resembles an old soap
Cystine
Primary Calculi Constituents: Least common calculi (1-2%)
Cystine
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
which plays a central role in glomerulat function which modulated glomerular capillary blood flow and ultrafiltration surface area and in addition
Mesangial cells
It is a source and target for vasoactive molecules growth factors and extracellular matrix proteins
Mesangial cells