Renal Physiology Flashcards
Most commonrenal developmental disorder
Renal cystic dysplasia
-abnormal differention of renal structures during embryonic period, with cyst formation
Are adult polycystic kidney disease unilateral or bilateral?
bilateral
- Serous or purulent-filled cysts that destroy parenchyma
- Cysts form from obstructed tubules
- Dull, aching pain in abdomen or back
- Hematuria
- Liver cysts (also common)
Adult polycystic kidney disease
- non-functional kidney, bilaterally at birth
- sponge-like
- cysts from collecting ducts
- Autosomal recessive
Childhood polycystic kidney disease
Most common infective agents of acute pyelonephritis
gram negative - E.coli**, (also Klebsiella, Enterobacter, pseudomonas, serritia, proteus)
Fever, chills, malaise, sudden sharp costovertebral pain
Acute pyelonephritis
Complication of acute pyelonephritis seen with diabetics.
-Ischemia + necrosis at renal pyramid tip
Renal papillary necrosis
- Scarring involving pelvis and/or calyces leading to papillary blunting and calyceal deformities
- Dialated tubules contain pink, glassy colloid casts (thyroidization)
Chronic pyelonephritis
Proteinaceous casts in distal tubules and collecting ducts–> Tamm-Horsfall protein
Acute tubular necrosis
Most common cause of acute renal failure
Acute tubular necrosis
Causes of Acute Tubular necrosis
-reduction in blood flow that affects the cortex of the kidney
When?: after MI, cardiac arrect, hypotensive shock
Is Acute tubular necrosis reversible?
yes
Diabetic nephropathy (2 microscopic findings/urinalysis finding)
- basement membrane thickens and becomes more permeable
- Nodules in the glomerular tuft (Kimmelsteil-Wilson dx)
- Proteinuria (massive if >3 gms a day)
Vascular changes (2) in diabetic nephropathy
- Narrowing of lumen (thickening of vessel walls)
2. Ischemia–>papilary necrosis of pyramids, detach and cause ureter obstruction
Location of urinary stones (2)
- renal pelvis
2. Urinary bladder
Hematuria, urinary colic, renal colic, flank pain radiating to the groin
urolithiasis
Most common urinary stone
Calcium stone (calcium oxalate or calcium phosphate)
causes: hyperparathyroidism, diffuse bone disease
Urea splitting bacteria: Proteus causes this type of stone
Struvite
ex. Staghorn calculi (largest type of stones)
- Radiolucent stones
- complication of gout or leukemia (hyperuricemia)
Uric Acid stone
Stone from inborn error of amino acid metabolism
Cysteine stone
Causes of urinary tract obstruction
- Developmental defect
- Urinary calculi
- Pregnancy
- BPH
- Prostate cancer
- Infection/inflammation
- Uterine prolapse
- Dilation of renal pelvis and calyces with progressive atrophy of the kidney due to obstruction to the outflow of urine
- Compress blood supply of kidney (lowers GFR)
Hydronephrosis
Hydronephrosis (gross kidney appearance)
enlarged, dilation of pelvis and calyces with interstitial inflammation (latter leads to fibrosis)
Which type of bilateral hydronephrosis has inability to concentrate urine (polyuria and nocturia)?
partial hydronephrosis
Which type of hydronephrosis does not produce urine (oliguria or anuria?
complete hydronephrosis
-irreversible damage
Renal cell carcinoma risk factors
-Older men who smoke
Which renal cancer arises from either the lower or upper pole?
Renal cell carcinoma
Gross appearance of renal cell carcinoma
- nodules, sharply demarcated
- upper or lower pole
- yellow, bosselated
- encapsulated
Where does RCC like to metastasize to?
- lung
2. bone (hypercalcemia, polycythemia)
Classic triad of Renal cell carcinoma
- Hematuria
- Dull flank pain
- Palpable abdominal mass
Cuboidal cells with clear or granular cytoplasm, filled with glycogen and lipids are histological features of what?
Renal cell carcinoma
Treatment for RCC?
surgery
Papillary neoplasms of the renal pelvis that resemble carcinomas of the urinary bladder
Transitional Cell Carcinoma
Most common solid kidney tumor in infants/children
Wilms tumor
Kidney tumor of childhood that is highly malignant and comprised of blastic or immature cells
- palpable
- manifests around age 2-4
Wilms tumor
Most common type of urinary bladder cancer?
Transitional cell carcinoma
Risk factors of urinary bladder cancer
- Cigarette smoking
- Azo dyes
- Rubber industry chemicals
- Schistosoma haematobium infection (Egypt) [very rare squamous cell CA)
Sudden onset _____ may cause fibrinoid necrosis of glomerular capillaries
Hypertension
Rapid, reversible deterioration in renal function. Sudden onset, loss of excretory function (oliguria or anuria)
Acute Renal Failure
Most common nephrotic syndrome in children
Minimal change disease (Nils Disease)
Acute Post-streptococcal glomerulonephritis
- nephritic
- hypocomplementemia (gets stuck in the kidney)
- immune complexes in basement membrane (humps)
- marked hypercellularity of the glomerulus
- smoky colored urine, oliguria
- Red cells casts in urine
- periorbital edema (recurring each morning)
- Autoimmune, abo to bm collagen type 4
- injury to lungs
- linear deposits in glomerulus
- Kidneys don’t survive this, will need dialysis/transplant
Good Pasture’s Syndrome
Fusion of visceral epithelial foot processes
complete remission
Treatment: steroids
Minimal Change Disease (Nils) Disease
Membranous glomerulonephritis
-nephrotic
-adults
-bm thickening due to immune complexes
-granularity of deposits
TX: steroids
