RENAL DSE Flashcards
CLASSIFICATIONS OF RENAL DISEASE
o Majority are of immune origin (immune complexes, IgG, IgA)
o Common: proteinuria, hematuria, casts
Glomerular disorders
GLOMERULAR DISORDERS
“WHARG - CIMMM - FADN”
Wegener’s Granulomatosis
Henoch Schönlein Purpura
Acute Post-Streptococcal Glomerulonephritis
Rapidly Progressive (Crescentic) Glomerulo
Goodpasture Syndrome
Chronic Glomerulonephritis
IgA Nephropathy (Berger’s Disease)
Membranous Glomerulonephritis (MGN)
Membranoproliferative Glomerulo (MPGN)
Minimal Change Disease, MCD
Focal Segmental Glomerulosclerosis
(FSGS)
Alport Syndrome
Diabetic Nephropathy
Nephrotic Syndrome
GLOMERULAR DISORDERS
- Group A Streptococcus (S. pyogenes) infection
on the glomerular membranes
Acute Post-Streptococcal Glomerulonephritis
–along with RHD
GLOMERULAR DISORDERS
Findings:
- Macroscopic hematuria, proteinuria, dysmorphic RBCs/glomerular membrane damage, RBC casts, granular casts
- (+) ASO titer and anti-DNAse B
Acute Post-Streptococcal Glomerulonephritis
GLOMERULAR DISORDERS
- Deposition of immune complexes from
systemic immune disorders (ex: SLE) on the glomerular membrane - Cellular proliferation of epithelial cells
inside the Bowman’s capsule form “crescents” - MURAG MOON SA HISTO SLIDE
Rapidly Progressive (Crescentic) Glomerulonephritis
GLOMERULAR DISORDERS?
Findings:
- Macroscopic hematuria
- Proteinuria
- RBC casts
“RGWH”
- Rapidly Progressive (Crescentic)
Glomerulonephritis - Goodpasture Syndrome
- Wegener’s Granulomatosis
- Henoch Schönlein Purpura
GLOMERULAR DISORDERS
Deposition of antiglomerular basement
membrane antibody- IgG to glomerular and
alveolar basement membranes
Goodpasture Syndrome
GLOMERULAR DISORDERS
- Anti-neutrophilic cytoplasmic auto-antibody (ANCA)
-(perinuclear-ANCA) forms when neutrophils are fixed in ethanol
- (cytoplasmic-ANCA) forms when neutrophils are fixed with formalin
Wegener’s Granulomatosis
NOW CALLED: Granulomatosis with Polyangitis-GPA
GLOMERULAR DISORDERS
- Occurs in children following viral
respiratory infections - Decrease in platelets disrupts vascular
integrity
Henoch Schönlein Purpura
GLOMERULAR DISORDERS
- Thickening of glomerular membrane
following IgG immune complex
deposition associated with systemic
disorders
Membranous Glomerulonephritis (MGN)
GLOMERULAR DISORDERS
- Cellular proliferation affecting the
capillary walls or the glomerular
basement membrane, possibly
immune-mediated
Membranoproliferative Glomerulonephritis (MPGN)
GLOMERULAR DISORDERS
- Disruption of podocytes in certain
numbers and areas of glomeruli,
others remain normal - IgM and C3 are evident on the sclerotic areas (using IF)
Focal Segmental Glomerulosclerosis
(FSGS)
—FOCAL means certain areas only ang affected
GLOMERULAR DISORDERS?
findings:
- Proteinuria
- Hematuria
“MMF”
-Membranous Glomerulonephritis (MGN)
-Membranoproliferative Glomerulonephritis (MPGN)
-Focal Segmental Glomerulosclerosis
(FSGS)
GLOMERULAR DISORDERS
- Marked decrease in renal function
resulting from glomerular damage
precipitated by other renal disorders - Progression to renal failure
- long term, less painful and irreversible
Chronic Glomerulonephritis
GLOMERULAR DISORDERS
FINDINGS:
- Hematuria
- Proteinuria, Glucosuria
- Cellular & granular casts
- WAXY AND BROAD CASTS
Chronic Glomerulonephritis
GLOMERULAR DISORDERS
Deposition of lgA on the glomerular
membrane resulting from increased
levels of IgA
IgA Nephropathy (Berger’s Disease)
GLOMERULAR DISORDERS
FINDINGS:
- Early stages: Hematuria
- Late stages: waxy and broad casts
IgA Nephropathy (Berger’s Disease)
GLOMERULAR DISORDERS
- Little cellular changes in the
glomerulus
-Disruption of podocytes primarily in
children following allergic reactions &
immunizations - Associated with HLA-B12 antigen
Minimal Change Disease, MCD or
(Nil Disease/Lipoid Nephrosis)
GLOMERULAR DISORDERS
findings:
- Heavy proteinuria
- Transient hematuria
- Fat droplets
Minimal Change Disease, MCD
(Nil Disease/Lipoid Nephrosis)
GLOMERULAR DISORDERS
- Most common cause of ESRD
- Deposition of glycosylated proteins on
the glomerular basement membranes
caused by poorly controlled blood
glucose levels
Diabetic Nephropathy (KimmelstielWilson Disease)
GLOMERULAR DISORDERS
findings:
- Microalbuminuria
- + Micral test
Diabetic Nephropathy (KimmelstielWilson Disease)
GLOMERULAR DISORDERS
- Genetic disorder showing lamellated
and thinning of glomerular basement
membrane - with GIANT PLATELETS
Alport Syndrome
GLOMERULAR DISORDERS
- Disruption of the electrical charges/shield of negativity that produce the tightly fitting podocyte barrier resulting in massive loss of proteins & lipids deposited in urine
Occurs in patients with MCD (in children), MGN (in adults), FSGS and
MPGN
Nephrotic Syndrome
GLOMERULAR DISORDERS
Urinalysis Findings:
- Albumin, a1, B, gamma-globulins
- (-) a2-macroglobulin
- Oval fat bodies
- Fatty casts
- Waxy casts
- ↑ Albumin
- ↑ Lipase
- ↑ Lipids
Serum Findings:
- Albumin, α1, gamma - globulins
- α2-macroglobulin
- β-globulin (LDL)
- ↓ Albumin
- ↓ Lipase
- ↑ Lipids
- ↑ Apo B100
- ↑ LDL and
VLDL - ↑ Chole &
TAG
Nephrotic Syndrome
TUBULAR DISORDERS?
“FADUR”
Fanconi Syndrome
Acute Tubular Necrosis
Diabetes Insipidus
Uromodulin-associated Kidney Disease
(UKD)
Renal Glucosuria
TUBULAR DISORDERS
- Damage to renal tubular cells caused by ischemia/blockage in BL so Oxygen can’t pass, results to hypoxia and results to cyanosis
- Urine odor = “odorless”
Acute Tubular Necrosis
TUBULAR DISORDERS
findings:
- Microscopic hematuria,
proteinuria
- RTE cells, RTE casts
- Hyaline, granular, waxy
and broad casts
Acute Tubular Necrosis
TUBULAR DISORDERS
- 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 the RTE cells
Uromodulin-associated Kidney Disease
(UKD)
TUBULAR DISORDERS
findings:
- RTE cells
- Hyperuricemia
-waxy and broad casts
Uromodulin-associated Kidney Disease
(UKD)
TUBULAR DISORDERS
-Generalized failure of tubular reabsorption
in the proximal convoluted tubule
Fanconi Syndrome
TUBULAR DISORDERS
findings:
- Glucosuria
- Possible cystine
crystals (amino acid)
Fanconi Syndrome
TUBULAR DISORDERS
- Neurogenic DI = hypothalamus fails to
produce ADH - Nephrogenic DI = renal tubules fail to
respond to ADH
Diabetes Insipidus
TUBULAR DISORDERS
findings:
- Low specific gravity
- Polyuria (>15 L/day
Diabetes Insipidus
TUBULAR DISORDERS
- (N) Blood glucose = ↑ Urine glucose
- Defective tubular reabsorption of glucose
Renal Glucosuria
INTERSTITIAL DISORDERS?
“CACA”
Cystitis (Lower UTI)
Acute Pyelonephritis (Upper UTI)
Chronic Pyelonephritis
Acute Interstitial Nephritis
INTERSTITIAL DISORDERS
- Ascending bacterial infection of
the urinary bladder - Acute onset of urinary
frequency and burning
Cystitis (Lower UTI)
INTERSTITIAL DISORDERS
FINDINGS:
- WBCs, Bacteria, NO CAST
- Microscopic hematuria
- Mild proteinuria, increased pH
Cystitis (Lower UTI)
INTERSTITIAL DISORDERS
- Infection of the renal tubules &
interstitium
-reflux of urine from the
bladder (vesicoureteral reflux)
& untreated cystitis
Acute Pyelonephritis (Upper UTI)
INTERSTITIAL DISORDERS
FINDINGS:
- WBCs, Bacteria
- WBC casts, bacterial casts,
- Microscopic hematuria
Acute Pyelonephritis (Upper UTI)
INTERSTITIAL DISORDERS
- Recurrent infection of the renal
tubules & interstitium caused
by structural abnormalities
affecting the flow of urine
Chronic Pyelonephritis
INTERSTITIAL DISORDERS
FINDINGS:
- WBCs, Bacteria, WBC casts,
Bacterial casts, granular casts - Waxy and broad casts
- Hematuria, proteinuria
Chronic Pyelonephritis
INTERSTITIAL DISORDERS
- Allergic inflammation of the
renal interstitium in response to
certain medications
Acute Interstitial Nephritis
INTERSTITIAL DISORDERS
FINDINGS:
- Hematuria, proteinuria
- WBCs (↑ eosinophils, >1%)
- WBC casts, NO BACTERIA
Acute Interstitial Nephritis
“CAGIS”
- Casts = (cellular, coarsely granular, finely granular, waxy) variety of casts seen in the same specimen
- Azotemia (↑ BUN & Creatinine)
- ↓ Glomerular filtration rate (< 25 mL/min)
- Isosthenuria = (-) renal concentrating ability
- increased telescoped Sediments
RENAL FAILURE / END STAGE RENAL DISEASE -ESRD
- May form in the calyces and pelvis of the kidney, ureters, and bladder
- Lithotripsy uses high-energy shock waves to break kidney stones into pieces
-BEST: SURGERY
RENAL CALCULI/RENAL LITHIASIS
RENAL CALCULI/RENAL LITHIASIS
Conditions Favoring the Formation of Renal Calculi:
“PChemU”
pH
Chem concentration
Urinary stasis
Primary UA Finding RENAL CALCULI/RENAL LITHIASIS?
Microscopic hematuria, why?
bc gina damage ang lining sa bladder, syempre mga bato, labi na mga large calculi, magasgas si bladder
RENAL CALCULI
- Major constituent of renal calculi
- Very hard, dark in color with rough surface
-CHUCO MUCHO IN CLUMPS
Calcium oxalate calculi
RENAL CALCULI
- Associated w/ increased intake of foods w/ high purine content, and w/ UKD
- Yellowish to brownish red & moderately hard
-HOT SHOTS OF KFC
Uric acid & Urate calculi
RENAL CALCULI
-Yellow-brown, greasy & resembles an old soap
- Least common calculi
- SMALLER THAN A COIN
Cystine calculi
RENAL CALCULI
- Pale & friable
- MARUPOK/POP-CORN
Phosphate calculi
RENAL CALCULI
common in DRUGS
Sulfonamide calculi
RENAL CALCULI
- Accompanied by urinary infections involving ureasplitting bacteria (Proteus vulgaris)
- Branching/staghorn calculi resembling antlers of a deer — pelvis of kidney nga na form
-MURAG MENTOS
Triple phosphate calculi
RENAL CALCULI
frequency of Calcium calculi?
75%
RENAL CALCULI
frequency of Cystine calculi?
2%
METHODS FOR CALCULI ANALYSIS?
“ORIEM”
o Optical crystallography
o Radiograph diffraction
o Infrared spectroscopy
o Electron beam analysis
o Mass spectroscopy
tram track appearance of the glomerulus
Membranoproliferative glomerulonephritis (MPGN)
