Renal Pathology

Question 1

1. describe 4 common symptoms of kidney disease

2. what are symptoms of kidney disease due to? (3)

Answer 1

1. hypertension
   kidney pain
   kidney mass
   bleeding from uro-epithelium
2. loss of excretory function
   loss of regulation of salt and water retention
   endocrine dysfunction

Question 2

1. what is loin pain?
2. what is the term given to blood in the urine?
3. name sources of this bleeding

Answer 2

1. pain in the flank (unilateral or bilateral) that may radiate to the groin/testicle. Can be a presentation of renal pathology
2. haematuria
3. kidney cysts
   tumours or stones in the urinary tract
   cystitis
   glomerulonephritis
   blood vessel problems

Question 3

1. What are the two types of symptoms of lower urinary tract pathology?
2. Give examples of each of these types

Answer 3

OBSTRUCTIVE VOIDING SYMPTOMS

• hesitancy
• delay in initiation
• weak stream
• straining to void
• incomplete emptying
• terminal dribbling

STORAGE SYMPTOMS

• urinary frequency
• nocturia
• urgency
• incontinence
• bladder pain
• dysuria

Question 4

what are the manifestations of, and the causes of:

1. nephrotic syndrome
2. nephritic syndrome

Answer 4

1. proteinuria (with peripheral oedema, hypoalbuminaemia and hypercholesterolaemia). Caused by structural or functional changes in the filtration membrane
2. proteinuria and haematuria (with hypertension, acute kidney injury, oliguria and oedema secondary to oliguria). Usually caused by inflammation (complement) which damages the basemembr membrane

Question 5

Name the methods used to visualise the kidneys, and the order in which they would be considered

Answer 5

ultrasound
CT scan
MRI
angiography
intravenous urography
nuclear medicine
biopsy

Question 6

1. how does haemodialysis work?
2. how does peritoneal dialysis work?
3. name some impacts of dialysis on the patient

Answer 6

1. patient’s blood is exposed to partially permeable membrane of dialyser. Dialysis solution is on the other side of the membrane. Water and wastes move between the two solutions (under the influence of negative pressure)
2. a sterile glucose containing solution is run through a tube into the peritoneal cavity. peritoneal membrane acts as a partially permeable membrane for the removal of fluids and wastes

3. often have multiple medical problems
frequent hospital admissions
psychiatric illness common
heavy burden on time
limitation of travel because of treatment
restrictions on fluid intake and diet
employment difficulties
cost to healthcare provider

Question 7

define the following:

1. prerenal disease
2. renal disease
3. postrenal disease

Answer 7

1. pathology before the kidney
2. pathology within the kidney
3. pathology after the kidney (e.g. lower urinary tract)

Question 8

NEPHROTIC SYNDROME

1. describe the underfill model of oedema
2. describe the overfill model of oedema
3. name 2 causes of primary nephrotic syndrome
4. name 5 causes of secondary nephrotic syndrome

Answer 8

1. reduced plasma oncoric pressure promotes the movemebt of fluid from vascular to extracellular fluid compartment. Reduction in plasma volume stimulates RAAS. Increased capillary hydrostatic pressure
2. defect of Na excretion in the distal nephrin - sodium retention leads to hypervolaemia > oedema
3. minimal change disease
   focal segmental glomerular sclerosis

4. membranous glomerulonephritis
    IgA nephropathy
    diabetic neuropathy
    lupus
    amyloidosis

Question 9

1. name 3 causes of nephritic syndrome in children
2. name 4 causes of nephritic syndrome in adults
3. Describe the following mechanisms of inflammation causing nephritic syndrome:
   a) immune complex trapping
   b) in situ antigens
   c) implanted antigen
   d) endothelial cell injury

Answer 9

1. haemolytic uremic syndrome
   henoch-schonlein purpurn
   post streptococcal glomerulonephritis
2. goodpastures
   ANCA associated vasculitis
   lupus
   primary or secondary mesangiocapillary glomerulonephritis

3a) antigen-antibody complexes present in the blood get stuck in the basement memnrane and cause complement activation (classical pathway) - lupus
b) antigen is present in the basement membrane. Formation of antibody-antigen complex and activation of complement - goodpastures
c) bacterial antigen becomes implanted in basement membrane as a consequence of bacteremia - post infectious glomerulonephritis
d) endotoxins activate both classical and alternate complement pathways > endothelial damage

Question 10

1. what is azotemia?
2. name presentations of acute renal failure
3. name causes of:
   a) acute prerenal failure (4)
   b) acute renal failure (3)
   c) acute postrenal failure (2)

Answer 10

1. high levels of nitrogen products (urea, creatinine) in the blood
2. oliguria or anuria with recent onset azotemia
   3a) hypovolaemia, hypotension, heart failure, decreased renal perfusion
   3b) glomerular injury, tubulo-interstitial injury, vascular injury
   3c) ureteral/bladder obstruction
   kidney/bladder stones

Question 11

1. what is chronic kidney disease defined by?

2. name 8 consequences of chronic kidney disease

Answer 11

1. estimated GFR
2. uremia (abnormal levels of urea in blood)
   fluid, electrolyte and acid base disturbance
   abnormalities in calcium, phosphate and bone metabolism
   cardiopulmonary abnormalities
   haematopoeitic manifestations
   GI signs and symptoms
   dermatological changes
   neuromuscular disturbances