Renal Pathology Flashcards
What are the warning signs of kidney disease?
A Cr and BUN outside the normal range, GFR less than 60, blood and/or protein in the urine, HTN, more frequent urination particularly at night (difficult or painful urination), puffiness around the eyes, swelling of the hands and feet
What are the principle fluid and electrolyte manifestations of acute or chronic kidney dysfunction?
dehydration, edema, hyperkalemia, metabolic acidosis
What are the principle Ca, phosphate and bone manifestations of acute or chronic kidney dysfunction?
Hyperphosphatemia, hypocalcemia, secondary hyperparathyroidism, renal osteodystrophy
What are the principle hematologic manifestations of acute or chronic kidney dysfunction?
anemia, bleeding diathesis
What are the principle cardiopulmonary manifestations of acute or chronic kidney dysfunction?
HTN, CHF, cardiomyopathy, pulmonary edema, uremic pericarditis
What are the principle GI manifestations of acute or chronic kidney dysfunction?
N/V, bleeding, esophagitis/gastritis/colitis
What are the principle neuromuscular manifestations of acute or chronic kidney dysfunction?
myopathy, peripheral neuropathy, encephalopathy
What are the principle dermatologic manifestations of acute or chronic kidney dysfunction?
sallow color, pruritus, dermatitis
What is the ideal ratio of BUN to Cr?
Between 10 to 1 and 20 to 1
What is usually a manifestation of subtle or mild glomerular abnormalities?
asymptomatic hematuria or proteinuria, or a combination of these two
What causes pre-renal azotemia?
CHF, burns, hemorrhage in GIT, shock and stress, dehydration
What causes renal azotemia?
glomerulonephritis, pyelonephritis, DM, nephrotoxic drugs, renal failure, anabolic steroids use
What causes post renal azotemia?
urinary tract obstruction (stones, neoplasms, bladder or urethral abnormality, bladder outlet obstruction)
What are the 3 sites where constrictions in the ureters normally appear?
at the ureteropelvic junction, crossing the external iliac A and/or pelvic brim, as the ureter traverses the bladder wall
What can cause tubulointersitial nephritis?
Infections (acute or chronic bacterial pyelonephritis, other infections), toxins, metabolic disease (urate nephropathy, nephrocalcinosis, oxalate nephropathy), physical factors (chronic urinary tract obstruction, neoplasms, multiple myeloma), immunologic reactions, vascular diseases
What is the empiric treatment for an uncomplicated UTI caused by proteus?
outpatient treatment with either a 3 day course of trimethoprim/sulfamethoxazole (TMP/SMZ) or an oral fluoroquinolone (ciprofloxacin)
What is the treatment for a pt presenting with complicated UTI (e.g. pt with an underlying condition that may increase the risk of failure of therapy)?
May be treated in an outpatient setting with oral abx for 10-21 days as log as they receive adequate follow up
Acute uncomplicated pyelonephritis can be treated on an outpatient basis with what abx?
Fluoroquinolone although a regimen of 7-14 days is recommended; an alternative to this treatment is a one time dose of ceftriaxone or gentamicin followed by either TMP/SMZ, an oral fluoroquinolone or cephalosporin for 7-14 days
What is the function of uromodulin (Tamm-Horsfall protein)?
Multifunctional protein critical for modulating renal ion channel activity, salt/water balance, renal and systemic inflammatory responses, intertubular bacterial adhesion
Mutations in Tamm-Horsfall cause what?
a group of inherited kidney diseases and altered THP expression is associated with increased risks of UTI, kidney stones, HTN, hyperuricemia, and acute/chronic kidney disease
What is hepatorenal syndrome?
A form of renal failure occurring in individuals with liver failure in whom there is no intrinsic morphologic or functional cause for kidney dysfunction
The onset of hepatorenal syndrome is marked by what?
a drop in urine output and increasing levels of urea and Cr in the blood
What is the triggering event of hepatorenal syndrome?
Portal HTN and secondary increased production of vasodilators such as NO by endothelial cells in the splanchnic vasculature which leads to systemic vasodilation and diminished renal perfusion which is sensed by the kidney provoking activation of RAAS –> renal failure
