Renal diseases Flashcards
Majority of glomerular disorders are of what origin?
Immune origin (IgG, IgA)
What are the classifications of renal disease?
Glomerular disorder, tubular disorder, interstitial disorder
What causes Acute post Streptococcal glomerulonephritis?
Deposition of immune complexes formed in conjunction with Group A streptococcus on glomerular membranes
What is rapidly progressive (crescentic) glomerulonephritis characterized by?
Deposition of immune complexes from systemic immune disorders (SLE); cellular proliferation of epithelial cells inside the Bowman’s capsule forming crescents
What is Goodpasture syndrome?
Deposition of anti-glomerular basement membrane antibody to glomerular and alveolar basement membranes
What causes Wegener’s granulomatosis (Granulomatosis with polyangiitis)?
Anti-neutrophilic cytoplasmic auto-antibody (ANCA) binds to neutrophils in vascular walls, damaging small vessels in the lungs and glomerulus
What is p-ANCA?
Perinuclear ANCA that forms when neutrophils are fixed in ethanol
What is c-ANCA?
Cytoplasmic ANCA that forms when neutrophils are fixed in formalin
What is Henoch-Schonlein Purpura?
A condition in children following viral respiratory infections with decreased platelets disrupting vascular integrity
What is Membranous Glomerulonephritis (MGN)?
Thickening of the glomerular membrane due to IgG immune complex deposition associated with systemic disorders
What is Membranoproliferative Glomerulonephritis (MPGN)?
Cellular proliferation affecting the capillary walls or glomerular membrane; possibly immune-mediated
What is Type 1 MPGN?
Increased vascular cellularity in the subendothelium
What is Type 2 MPGN?
Extremely dense deposits in the glomerular basement membrane (GBM), tubules, etc.
What is Type 3 MPGN?
Both subepithelial and subendothelial deposits in the glomeruli
What is Chronic Glomerulonephritis?
Marked decrease in renal function due to glomerular damage, potentially progressing to renal failure
What is IgA Nephropathy (Berger’s Disease)?
Deposition of IgA on the glomerular membrane resulting from increased IgA levels
What is Minimal Change Disease (MCD)?
Little cellular change in the glomerulus, loss of podocyte foot processes; associated with HLA-B12 antigen
What is Focal Segmental Glomerulosclerosis (FSGS)?
Disruption of podocytes in certain glomeruli, others remain normal; IgM and C3 deposition in sclerotic areas
What is Diabetic Nephropathy (Kimmelstiel-Wilson Disease)?
Most common cause of ESRD, caused by deposition of glycosylated proteins on the glomerular basement membranes due to poorly controlled blood glucose
What is Nephrotic Syndrome?
Disruption of podocyte electrical charges, leading to massive protein and lipid loss
What is the rate of proteinuria in Nephrotic Syndrome?
> 3.5g/day
Which conditions are associated with Nephrotic Syndrome?
MCD (children), MGN (adults), FSGS, and MPGN
What are the serum findings in Nephrotic Syndrome?
Decreased albumin, a1-gammaglobulin; increased a2-macroglobulin, b-globulin (LDL)
What are the urinalysis findings in Nephrotic Syndrome?
Increased albumin; a-1,b-,y-globulins; negative for a2-macroglobulin; oval fat bodies, fatty casts, waxy casts
What are the findings in Acute Post-Streptococcal Glomerulonephritis?
Macroscopic hematuria, proteinuria, dysmorphic RBCs, RBC casts, granular casts, (+) ASO titer and anti-DNASE B
What are the findings in rapidly progressive (crescentic) glomerulonephritis and Goodpasture syndrome?
Macroscopic hematuria, proteinuria, RBC casts
What condition is associated with decreased platelet count?
Henoch-Schonlein Purpura
What are the findings in Membranous Glomerulonephritis (MGN) and Membranoproliferative Glomerulonephritis (MPGN)?
Hematuria (microscopic MGN) and proteinuria
What are the findings in Chronic Glomerulonephritis?
Hematuria, proteinuria, glycosuria, cellular and granular casts, waxy broad casts
What are the findings in Berger’s Disease (IgA Nephropathy)?
Early stages: hematuria; Late stages: similar to chronic glomerulonephritis
What are the findings in Minimal Change Disease (MCD)?
Heavy proteinuria, transient hematuria, fat droplets
What are the findings in Focal Segmental Glomerulosclerosis (FSGS)?
Proteinuria and hematuria
What are the findings in Diabetic Nephropathy?
Microalbuminuria (positive Micral test)
What is the hallmark of Alport syndrome?
Similar with nephrotic syndrome findings
Damage to renal tubular cells caused by ischemia or toxic agents; odorless urine
Acute tubular necrosis
Findings in acute tubular necrosis
Microscopic hematuria, proteinuria, RTE cells, RTE casts, hyaline, granular, waxy and broad casts
Inherited defect in the production of normal uromodulin by the renal tubules and increased uric acid causing gout; normal uromodulin is replaced by abnormal forms that destroy RTE cells
Uromodulin-associated Kidney Disease (UKD)
Findings in UKD
Early stages: RTE cells; Late stages: See chronic GN; Hyperuricemia
Generalized failure of tubular reabsorption in proximal convoluted tubule
Fanconi syndrome
Fanconi syndrome findings
Possible cystine crystals, glucosuria
Diabetes insipidus: hypothalamus fails to produce ADH
Neurogenic DI
Diabetes insipidus: renal tubules fail to respond to ADH
Nephrogenic DI
Findings in DI
Low specific gravity, Polyuria (>15 L/day)
Renal glycosuria glucose levels
Urine: increased, Blood: normal
Defective tubular reabsorption of glucose
Renal glycosuria
Findings in Renal glycosuria
Glucosuria
Ascending bacterial infection of urinary bladder; acute onset of urinary frequency and burning
Cystitis (lower UTI)
Infection of renal tubules and interstitium; interference of urine flow to bladder, reflux of urine from bladder, untreated cystitis
Acute pyelonephritis (upper UTI)
Recurrent infection of renal tubules and interstitium
Chronic pyelonephritis
Allergic inflammation of renal interstitium; possibly caused by medication binding to interstitial protein
Allergic interstitial nephritis
Findings: WBCs, bacteria, no casts, microscopic hematuria, mild proteinuria, increased pH
Cystitis (lower UTI)
Findings: WBCs, bacteria, WBC casts, bacterial casts, microscopic hematuria
Acute pyelonephritis (upper UTI)
Findings: WBCs, bacteria, WBC casts, bacterial casts, granular casts, waxy and broad casts, hematuria, proteinuria
Chronic pyelonephritis
Findings: Hematuria, proteinuria, increased WBCs (eosinophils), WBC (eosinophil casts), no bacteria
Acute interstitial nephritis
Decreased glomerular filtration rate (<25 mL/min), azotemia (increased BUN, creatinine), electrolyte imbalance, decreased renal concentration ability, proteinuria, renal glycosuria, telescoped sediment
Renal failure/ESRD findings
Telescoped sediment
Variety of casts seen in same specimen
Formation in calyces, pelvis, ureters, bladder; lithotripsy breaks stones with high-energy shock waves
Renal calculi/renal lithiasis
Conditions favoring renal calculi formation
pH, chemical concentration, urinary stasis
Primary finding in renal calculi
Microscopic hematuria
Major constituent of renal calculi; very hard, dark, rough surface
Calcium oxalate
Associated with high purine intake, UKD; yellowish-brown/red, moderately hard
Uric acid/urate
Seen in hereditary metabolism disorders; yellow-brown, greasy, resembles old soap, least common
Cystine
Pale, friable renal lithiasis
Phosphate
Accompanied by urinary infections with urea-splitting bacteria; branching/staghorn calculi
Triple phosphate
Triamterene calculi
Mustard-colored stones from insoluble diuretic
Adenine calculi
Inherited enzyme deficiency, hyperuricemia
Xanthine calculi
Genetic disorder, absence of xanthine oxidase
Renal calculi with highest composition
Calcium
Magnesium ammonium phosphate in renal calculi percentage
0.15
Cystine frequency in renal calculi
0.02
Uric acid frequency in renal calculi
0.06
Calcium with phosphate frequency in renal calculi
0.15
