Renal Disorders I

Question 1

Clinical symptoms of acute kidney injury

Answer 1

• oliguria

- elevated serum creatinine

Question 2

Clinical signs of nephrotic syndrome

Answer 2

• severe proteinuria

Question 3

Clinical signs of nephritic syndrome

Answer 3

• hematuria

Question 4

Location of injury in acute kidney injury

Answer 4

• proximal tubule, sometimes distal tubule

Question 5

Location of injury in nephrotic syndrome

Answer 5

• glomerular capillary filtration defect (podocyte defect)

Question 6

Location of injury in nephritic syndrome

Answer 6

• breaks in the glomerular capillary loops

Question 7

Possible diagnoses for acute kidney injury

Answer 7

• acute tubular necrosis
• acute interstitial nephritis
• acute pyelonephritis

Question 8

Possible diagnoses for nephrotic syndrome

Answer 8

• membranous nephropathy
• FSGS
• minimal change disease

Question 9

Possible diagnoses for nephritic syndrome

Answer 9

• acute nephritic syndrome: crescentic glomerulonephritis, lupus nephritis, post infectious glomerulonephritis
• isolated hematuria: IgA nephropathy, alport’s disease

Question 10

Clinical indicators of renal dysfunction

Answer 10

• edema
• decreased renal output
• foamy urine: proteinuria
• dark or red urine: hematuria (tea colored, cola colored)

Question 11

Laboratory indicators of renal dysfunction

Answer 11

• increased creatinine, blood urea nitrogen
• increased protein excretion (urine dipstick, urine protein/creatinine ratio, 24 hour urine protein)
• hematuria (urine dipstick, microscopic exam)

Question 12

Signs of chronic kidney disease

Answer 12

• Glomerular sclerosis
• interstitial fibrosis
• tubular atrophy

Question 13

Ways to assess renal biopsy

Answer 13

• light microscopy
• immunofluorescence microscopy
• electron microscopy

Question 14

Patterns of immunofluorescence staining in glomerulus

Answer 14

• linear capillary loop pattern
• granular capillary loop pattern
• mesangial pattern

Question 15

Disease associated with linear capillary loop pattern immunofluorescence stain

Answer 15

• Anti-GBM disease

Question 16

Diseases associated with granular capillary loop pattern immunofluorescence stain

Answer 16

• membranous nephropathy, lupus nephritis

Question 17

Diseases associated with mesangial pattern immunofluorescence stain

Answer 17

• IgA nephropathy, lupus nephritis

Question 18

Layers of basement membrane

Answer 18

• lamina externa
• lamina densa
• lamina interna

Question 19

Mechanisms of glomerular injury

Answer 19

1. immune mechanisms: immune complex mediated, T-cell mediated
2. non immune mechanisms: structural disorders

Question 20

Disorder associated with immune complex mediated glomerular injury

Answer 20

• membranous glomerulopathy

Question 21

Disorders associated with T-cell mediated glomerular injury

Answer 21

• minimal change disease

- lupus nephritis

Question 22

Disorder associated with non immune glomerular injury

Answer 22

• alport’s syndrome

Question 23

Mutation associated with alport’s syndrome

Answer 23

• mutation in collagen type IV gene

- leads to structural weakness in basement membrane b/c it’s composed of collagen type IV

Question 24

Patient presentation and lab values seen with acute kidney injury

Answer 24

• decreased urinary output (oliguria), and uremia (azotemia)

- labs: increased serum creatinine, and blood urea nitrogen

Question 25

Types of acute kidney injury

Answer 25

- pre renal - renal - post renal

Question 26

Pre renal acute kidney injury causes

Answer 26

- cardiac shock, dehydration

Question 27

Renal acute kidney injury

Answer 27

- tubulointerstitial diseases

Question 28

Post renal acute kidney injury causes

Answer 28

- obstructive renal stone

Question 29

Causes of acute kidney injury

Answer 29

- acute tubular necrosis - acute interstitial nephritis - acute pyelonephritis

Question 30

Acute tubular necrosis prevelance

Answer 30

- MOST COMMON cause of acute kidney injury

Question 31

Causes of acute tubular necrosis

Answer 31

- injury to tubular epithelial cells | - hypovolemia, ischemia, drug toxicity

Question 32

Presentation of ATN & reversibility

Answer 32

- oliguria | - reversible

Question 33

Key features of ATN

Answer 33

- tubular dilation and flattening of tubular epithelial cells - necrotic debris in tubular lumen

Question 34

Acute interstitial nephritis key featurs

Answer 34

- interstitial inflammation and tubulitis (lymphocytes in interstitium and in the tubule) - EOSINOPHILS = drug induced (if eosinophils are present)

Question 35

Acute pyelonephritis causes

Answer 35

- infections of pelvicalyceal system, and renal parenchyma

Question 36

Presentation of acute pyelonephritis

Answer 36

- pain in cost-vertebral angle + other signs of infections

Question 37

Diagnosis of acute pyelonephritis

Answer 37

- pus (WBC) casts | - positive urine culture

Question 38

Key features of acute pyelonephritis

Answer 38

- similar to interstitial nephritis but inflammatory cells are NEUTROPHILS - neutrophilic infiltrates and neutrophil casts in tubules are characteristic

Question 39

Prognosis of acute pyelonephritis

Answer 39

- benign course if treated, symptoms disappear after treatment with antibiotics

Question 40

Chronic pyelonephritis course

Answer 40

- may have insidious onset or a history of recurrent acute pyelonephritis - gradual loss of renal function - results in scarred kidney with chronic inflammation

Question 41

Key features of chronic pyelonephritis

Answer 41

- scarred kidneys, chronic inflammation | - severe tubular atrophy, "thyroidization" of the kidney

Question 42

Three clinical renal syndromes

Answer 42

- acute kidney injury - nephrotic syndrome - nephritic syndrome