Renal Diseases

Question 1

Glomerulonephritis

Answer 1

An overactive immune system may attack the kidney, causing inflammation and some damage
Presence of blood, protein, and cast in the urine
Acute → chronic → nephrotic syndrome → renal failure

Question 2

Acute Glomerulonephritis

Answer 2

Damage to glomerular membrane
Typical urinalysis findings: protein uria, oliguria, hematuria, and dysmorphic RBCs
Varied casts - RBC, WBC, hyaline, and granular
Increased BUN
Group A streptococcus infection

Question 3

Chronic glomerulonephritis

Answer 3

Gradually worsening symptoms
Fatigue, anemia, hypertension, edema, and oliguria
Typical UA findings
Hematuria, massive proteinuria, glucosuria, dysmorphic RBCs and presence of varieties of casts including broad cast
Marked low GFR with high BUN and creatinine

Question 4

Nephrotic syndrome

Answer 4

Damage to the kidneys causes them to spill large amounts of protein into the urine

Laboratory findings:
Urine dip stick: 3+ protein
24 hour urine collection protein >3.5 g/day
Hematuria, lipiduria, fatty casts, and waxy casts, RTE casts
Oval fat bodies, fat droplets
Maltese cross formation with polarized light microscopy

Increased permeability of the glomerular membrane
Leads to damage to the shield of negativity
Podocytes that produce less tightly connected barrier

Question 5

Associated diseases with nephrotic syndrome

Answer 5

Minimal change disease
Focal segmented glomerulosclerosis (FSGS)
Membranous glomerulonephritis
Diabetic nephropathy: Diabetes melitus I/II
Amyloidosis
Lupus nephritis: Can manifest with nephritic or nephrotic symptoms

Question 6

Acute Tubular Necrosis

Answer 6

Disorder associated with damage to the renal tubules caused by ischemia or toxic agents

Urinalysis results:
Presence of large amount of hemoglobin and myoglobin
Proteinuria
Renal tubular epithelial cells
Casts may be present
Hyaline, granular, waxy, broad, and RTE

Question 7

Fanconi syndrome

Answer 7

Disorder associated with tubular dysfunction
Failure of tubular reabsorption in the proximal convoluted tubule
Urinalysis findings are glucose and may be mild protein in the urine
Inherited disorder in association with cystinosis and Hartnup disease

Question 8

Renal Glycosuria

Answer 8

Inherited disorder
Presence of glucose in the urine when blood glucose level reaches the maximum tubular reabsorption capacity
Increased urine glucose with normal blood glucose

Question 9

Cystitis (UTI)

Answer 9

The most common symptoms associated with lower UTI include dysuria or acute pain, frequent urination, urgency, and incontinence
Occasionally hematuria, cloudy urine, or foul-smelling urine

Question 10

Pyelonephritis - Acute

Answer 10

Its a result of assessing movement of bacteria from a lower UTI into the renal tubule and interstitial
Patients symptoms: Urinary frequency, burning on urination and lower back pain
The ascending movement of bacteria from the bladder interfere with the downward flow of urine
Incomplete emptying of the bladder during urination
Urinalysis results: Numerous WBC and bacteria with mild proteinuria and hematuria
Presence of WBC cast signifies infection within the tubules

Question 11

Acute interstitial nephritis

Answer 11

Its an inflammation of the renal interstitial followed by inflammation of the renal tubules
Reaction to medications

Urinalysis results:
Hematuria, protein urea, numerous WBCs and WBC cast without bacteria
Hansel stain for presence of eosinophil

Question 12

Renal lithiasis

Answer 12

75% calcium oxalate or phosphate

Others:
Magnesium ammonium phosphate (struvite)
Uric acid
Cystine
Microscopic hematuria most common lab finding
Crystals often not present

Question 13

Renal failure

Answer 13

Decreased GFR, oliguria, edema, azotemia, electrolyte imbalances

Question 14

Acute Renal Failure causes

Answer 14

Prerenal (decreased blood flow)
Renal
Postrenal (impaired outflow)

Question 15

Chronic (irreversible) Renal Failure causes

Answer 15

Hypertension
Diabetes mellitus
Glomerulonephritis