Renal Disorders Flashcards
What is Glomerulonephritis and its causes
- Inflammatory process of the kidneys
- 2nd leading cause of kidney failure
Causes
- Hereditary
- Other disease process (DM, HPTN, toxins)
- Immunologic (usual process)
1. Injury from antibodies reacting with antigens in glomeruli
2. Injury from circulating antibody/antigen complexes lodging in glomeruli
How is Glomerulonephritis categorized?
Categorized by appearance Proliferative - Infiltration of WBC & proliferation of glomerular cells Membranous - Thickening of glomerular capillary wall Sclerotic - Increased extracellular matrix Diffuse/focal/segmental e.g. mesangial - Involves only mesangial cells
What are Different Types of Glomerular Disease?
- Acute Nephritic syndrome
- Rapidly progressive glomerulonephritis
- Nephrotic syndrome
- Asymptomatic hematuria or proteinuria
- Chronic glomerulonephritis
Acute Nephritic Syndrome
Inflammatory response damaging glomerular capillary wall
Manifestations
- Hematuria
- Decreased GFR
- Azotemia (nitrogenous based waste)
- Oliguria (poor to no urine output)
- Fluid retention (d/t decreased urine output)
Fluid retention causes edema and hypertension!
Treatment of Nephritic syndrome
Symptomatic
Possible permanent kidney damage
Children often have spontaneous recovery
Rapidly Progressive Glomerulonephritis
- Signs of severe glomerular injury without specific cause
- Rapid (over a few months)
- Proliferation of glomerular cells, with monocytes & macrophages destroy Bowman space
Goodpasture’s Syndrome
- rare, autoimmune
Nephrotic Syndrome Causes & Signs & Symptoms
> Integrity of glomerular membrane is affected
- Medication
- Neoplasms
- Inflammation
- Increased GFR
- Massive proteinuria
- Hypoalbuminemia
- Edema (anasarca)
- Lipidurea/hyperlipidemia
Asymptomatic Hematuria or Proteinuria
- IgA nephropathy (Berger disease)
- IgA complex deposits d/t inflammation - Alport syndrome (hereditary)
Chronic Glomerulonephritis
- Acute forms either resolve or progress
2. Small kidneys, sclerosed glomeruli, etc.
Acute Pyelonephritis Cause and Contributing factors
Cause
- Bacterial infection of upper UT with intrarenal reflux (UTI infection moves up to the kidney)
> Contributing factors
- Outflow obstruction
- Catheterization/urinary instrumentation
- Vesicoureteral reflux (urine backtracking up ureter and to the kidney)
- pregnancy (large body pushing/creating increased pressure)
- Neurogenic bladder (disfunction nerve supply to bladder)
Acute Pyelonephritis Manifestations & Treatment
Manifestations
- Usually rapid progressing
- Chills, fever
- Aches/pain unilateral or bilateral
- Dysuria, frequency, urgency
- Nausea, vomiting, abd. pain radiating to the back
Treatment
- Symptomatic pain relief
- Fluids to aid dysuria
- Antibiotics
Chronic Pyelonephritis
- Scarring and deformation of renal calyces and pelvis, with atrophy and thinning of cortex
- Primarily affects proximal and distal tubules
Causes:
- Recurrent or persistent infection
- Intrarenal reflux
Toxin-Related Nephropathies: Effect dependent on…
- Action of drugs/toxins
- Number of toxins involved
- Existence of pre-renal issues that decrease blood flow to kidney
- Formation of crystals
- Hypersensitivity response
Polycystic Kidney Disease
- Inherited autosomal dominant
- Generally older population; progresses slowly
- Fluid-filled cysts in kidney and liver
(Less so the spleen or pancreas)
> Deformity of epithelial cell interfere with fluid absorption/cellular maturation resulting in cyst formation
- Inflammatory mediators accumulate, and renal tubular cells are destroyed
- Kidneys enlarge
Polycystic Kidney Disease (PKD) Manifestations & Complications
Manifestations
- Pain
- Hematuria
- Infested cysts- UTI
- Hypertension
Complications
- Nephrolithiasis (15-20% of PKD) (kidney stones)
- Valvular deformities (d/t other infection)
- Cerebral artery aneurysm (10-30% of PKD patients)
Subarachnoid hemorrhage occurs d/t cerebral aneurysm