Renal Disorders

Question 1

Define Glomerulonephritis

Answer 1

inflammatory damage to glomeruli (tiny network of blood vessels that are the “cleaning unit” of the kidney)

caused by: immune responses, toxins/medications, vascular disorders, system diseases

Damage to the filtration membrane makes it more permeable– leads to proteinuria and hematuria

Glomerular scarring leads to decreased GFR

Question 2

Polycystic kidney disease

Answer 2

an autosomal dominant genetic disorder that causes the nephron epithelial tubular cells to proliferate, form outpouchings filled with filtrate

this leads to mechanical compression of other nephron structures-> chronic kidney damage-> chronic renal failure->death

Question 3

Describe acute kidney injury

Answer 3

-a sudden reduction in blood flow to the kidneys or exposure to nephrotoxic agents
-manifestations are caused by decreased GFR and accumulated nitrogenous waste products (Azotemia) in the blood
-symptoms include decreased urine output (Oliguria), fluid overload, electrolyte imbalance and metabolic acidosis
-if untreated, can lead to kidney failure, cardiovascular disease and death

Question 4

Describe chronic kidney disease

Answer 4

-manifestations are caused by decreased GFR and accumulated nitrogenous waste products (Azotemia) in the blood
-progressive and irreversible renal disorder that develops over a long period of time
-CKD can be caused by diabetes, hypertension or damaged kidneys
-manifestations include fatigue, nausea, vomiting, edema, anemia, and Oliguria

Question 5

Define Glomerular filtration rate (GFR)

Answer 5

is a measure of how effectively the kidneys are filtering waste products from the blood. A reduced GFR may indicate the kidney dysfunction or disease

Question 6

What are the 3 phases of AKI pathogenesis? Describe each phase

Answer 6

1. Initiation
   –> injury triggers the cascade events that lead to kidney dysfunction (ex. Ischemia, toxins, infection, dehydration, urinary obstruction, autoimmune disorders)
2. Maintenance (oliguric phase)
   –> Ongoing kidney dysfunction – Inflammatory response, tubular dysfunction (can lead to electrolyte imbalances, fluid retention, and metabolic acidosis), renal ischemia and hypoxia, activation of RAAS
3. Recovery
   –> kidneys start to regain their normal function, injury heals, regeneration of nephrons, restoration of renal blood flow, normalization of urine output and electrolytes – this phase features polyuria (yay)

Question 7

What are the clinical features of the Maintenance Phase (AKI)

Answer 7

-decreased glomerular filtration rate (GFR)
-oliguria
- azotemia
-uremia
-fluid and electrolyte imbalance
-hypertension

Question 8

What is an example of a prerenal acute kidney injury?

Answer 8

renal hypoperfusion (reduced blood flow to the kidneys)
any condition that reduces renal blood flow can cause prerenal AKI, including: hypovolemia, inadequate cardiac output, restricted renal blood flow

Question 9

What are the three main types of Intrarenal acute kidney injuries?

Answer 9

1. acute tubular necrosis
2. acute interstitial nephritis
3. glomerulonephritis

clinical features may include:
-proteinuria
-hematuria

Question 10

Define acute tubular necrosis (ATN)

Answer 10

ischemic or nephrotoxic damage to renal tubules

Question 11

Define acute interstitial nephritis

Answer 11

the spaces between the kidney tubules (interstitial tissue) become swollen (inflamed)

Question 12

Describe Nephrotic Syndrome

Answer 12

a condition characterized by the excessive loss of protein in the urine due to damage to the glomeruli

manifestations: hyperproteinuria, hypoalbuminea, hyperlipidemia, and edema

exact cause is unknown but key factors include: immune dysfunction, genetic predisposition, and environmental factors

Question 13

Nephritic Syndrome

Answer 13

manifestations: hematuria, RBC casts, azotemia/uremia, and HTN

occurs primarily with the infection-related glomerulonephritis

Question 14

Describe the CKD etiology

Answer 14

-gradual decline in renal function (+3 months)
-decreased GFR
-oliguria
-azotemia–> uremia

-irreversible and potentially life-threatening

Question 15

Describe the pathogenesis of CKD

Answer 15

Early stage– normal urine output, very little signs if any due to the healthy nephrons increasing their filtration rates to compensate (glomerular hyperfiltration)

Late stage– decreased GFR and urine output, uremia, systemic clinical manifestations

Question 16

Define glomerular hyperfiltration

Answer 16

the compensatory mechanism in which healthy nephrons increase their filtration rate to make up for the damaged nephrons

Question 17

Define glomerular sclerosis

Answer 17

damage done to the healthy nephrons during extended glomerular hyperfiltration– they harden and die– which only furthers the cycle of nephron loss

leads to late-stage CKD

Question 18

Describe the progression from HTN to CKD

Answer 18

HTN causes blood vessels to thicken
Thickened blood vessels are narrower
Narrow renal blood vessels cause ischemia and glomerulosclerosis
Irreversible nephron loss
<GF
CKD

Question 19

Describe the progression from diabetic nephropathy to CKD

Answer 19

Blood vessel wall glycation which makes them thicker and narrows the arterioles
Glomerular HTN
Hyperfiltration
Glomerulosclerosis
Irreversible nephron loss
<GFR
CKD

Question 20

Define nonezymatic glycation

Answer 20

excess glucose in the blood that sticks to proteins in the blood vessel walls– leads to thicker walls and narrower blood vessels

Question 21

What are the clinical manifestations of CKD?

Answer 21

azotemia/uremia
Fluid and electrolyte imbalances
seizures and coma
HTN and cardiac dysrhythmia
renal osteodystrophy
bleeding