Renal Pathophysiology

Question 1

Presentation of renal disease:

Answer 1

azotemia
uremia
proteinuria
hematuria
altered naturesis (leading to HTN)
edema
circulatory congestion

Question 2

Azotemia:

Answer 2

elevated blood urea nitrogen and creatinine level

decreased glomerular filtration rate

Question 3

uremia:

Answer 3

excess of urea and other nitrogenous waste in the blood

• failure of renal excretory function, host of metabolic and endocrine altercation
• secondary gastrointestinal, neuromuscular, and cardiovascular involvement

Question 4

Acute kidney disease/injury/failure

Answer 4

-abrupt decrease in GFR or creatinine clearance
-RIFLE classification
-based on anatomical area of injury or malfunction:
prerenal
intrinsix
postrenal

Question 5

RIFLE

Answer 5

-risk, injury, failure, loss of kidney function, and end-stage kidney disease

Question 6

prerenal

Answer 6

decreased renal blood flow

Question 7

intrinsic

Answer 7

structure within kidney damaged

Question 8

postrenal

Answer 8

obstruction present within the urine collection system

Question 9

chronic kidney disease

Answer 9

progressive loss of function over several months to years

gradual replacement of normal kidney with parenchymal fibrosis

Question 10

hemodialysis

Answer 10

• perfusion of blood and dialysate on opposite side of semipermeable membrane
• substances removed by diffusion or convection
• excess water removed via ultrafiltration

Question 11

peritoneal dialysis

Answer 11

instillation of dialysate into peritoneal cavity by permanent peritoneal catheter

• substances removed from blood across peritoneum via diffusion and ultrafiltration
• excess water removed by ultrafiltration created by osmotic pressure generated by various dextrose or icodextrin concentrations

Question 12

drug-induced kidney disease

Answer 12

drug causes immune reaction, inflammation causes damage to structures of kidney

• antibiotics
• NSAIDs (analgesic nephropathy)

Question 13

chronic glomerulonephritis

Answer 13

• most common causes of renal failure in humans

- divided into primary and secondary

Question 14

secondary GN

Answer 14

associated with a number of systemic disease:

• SLE (systemic lupus erythrometitis-attack joints, skin lesions, kidney and spleen))
• diabetes (diabetic neuropathy)
• etc.

Question 15

antibody-mediated glomerular injury (3)

Answer 15

1) immune complex (antibody/antigen) deposition- sub endothelial deposit, deposit in basement membrane:protein and blood leak out
2) anti-GBM (glomerular basement membrane) antibody
3) antibody against glomerular antigen (membranous nephropathy)

Question 16

cell mediated

Answer 16

T-cell immune reaction: macrophages, mesangial cells

Question 17

nephrotic syndrome

Answer 17

protein leakage only:

• proteinuria
• hypoalbuminemia
• edema
• hyperlidemia and lipiduria

Question 18

nephritic syndrome

Answer 18

protein and RBC leakage

• hematuria
• oliguria (not enough urine)
• azotemia
• HTN

Question 19

3 major glomerular syndrome

Answer 19

• nephrotic syndrome
• nephritic syndrome
• chronic glomerulonephritis

Question 20

Chronic glomerulonephritis

Answer 20

• nephrosis

- nephritis

Question 21

nephrosis

Answer 21

1) nephropathy (any disease of the kidney)

2) degeneration of renal tubular epithelium

Question 22

nephritis

Answer 22

inflammation of the kidney

Question 23

acute pyelonephritis pathways

Answer 23

1) hematogenous infection-bacterial spread (staphylococcus, E.coli)
2) ascending infection :urinary bladder infection, vesicoureterial reflux, intrarenal reflux

Question 24

APKD acronym

Answer 24

autosomal dominant (adult) polycystic kidney disease

Question 25

APKD definition

Answer 25

multiple expanding cyst of both kidneys, destroys intervening parenchyma

Question 26

APKD pathogenesis

Answer 26

inherited mutation of PKD1 or PKD2 gene in renal tubular cells
-abnormal cyst formation in both kidneys
intermittent gross hematuria
HTN and urinary infection
ultimately fatal
renal transplantation necessary

Question 27

Autosomal recessive (childhood) PKD pathogenesis

Answer 27

autosomal recessive inheritance

mutation in PKHD1-fibrocystin (polyductin)

Question 28

Autosomal recessive PKD clinical features

Answer 28

• serious manifestation usually present at birth
• young infants dies quickly from pulmonary or renal failure
• patients who survive infancy develop liver cirrhosis (HTN)