rest of renal objective 7 (renal problems)

Question 1

What is chronic glomerulonephritis?

Answer 1

A long-term, progressive disease leading to renal failure, affecting both adults and children, often linked to chronic diseases. It can be idiopathic or caused by secondary conditions like diabetic nephropathy and lupus.

Question 2

Common secondary causes of chronic glomerulonephritis?

Answer 2

Diabetic nephropathy (uncontrolled diabetes) and lupus erythematosus.

Question 3

What are the manifestations of chronic glomerulonephritis?

Answer 3

Proteinuria, hypercholesterolemia.

Question 4

How is chronic glomerulonephritis diagnosed?

Answer 4

History & Physical (H&P), urinalysis, serum creatinine, creatinine clearance.

Question 5

What is nephrotic syndrome?

Answer 5

A condition characterized by the excretion of 3.5 grams or more of protein in the urine due to damage to the glomerulus.

Question 6

Etiologies of nephrotic syndrome?

Answer 6

Genetic causes, diabetes mellitus, lupus, amyloidosis, medication-related, HIV, leukemia, lymphoma, vascular disorders.

Question 7

Manifestations of nephrotic syndrome?

Answer 7

Hypoalbuminemia (<3 mg/dL), edema, foamy urine, hyperlipidemia.

Question 8

How is nephrotic syndrome diagnosed?

Answer 8

Serum albumin level, 24-hour urine protein test, lipid panel.

Question 9

What is nephritic syndrome?

Answer 9

A syndrome associated with an intraglomerular inflammatory process causing hematuria and low proteinuria (less severe than nephrotic syndrome).

Question 10

Etiologies of nephritic syndrome?

Answer 10

Post-infectious glomerulonephritis, IgA nephropathy, lupus nephritis.

Question 11

Manifestations of nephritic syndrome?

Answer 11

Hematuria, proteinuria (<3.5 grams), edema, oliguria, hypertension.

Question 12

How is nephritic syndrome diagnosed?

Answer 12

H&P, serum albumin level, 24-hour urine test.

Question 13

What is azotemia?

Answer 13

Increased serum urea levels and creatinine levels, indicating renal insufficiency or failure.

Question 14

What is uremia?

Answer 14

A condition where elevated BUN and creatinine levels cause symptoms such as neurologic changes, fatigue, anorexia, nausea, vomiting, and pruritus.

Question 15

Difference between azotemia and uremia?

Answer 15

Azotemia is elevated BUN/creatinine without symptoms, while uremia includes elevated BUN/creatinine with symptomatology.

Question 16

What is chronic renal failure?

Answer 16

Irreversible loss of renal function associated with systemic diseases, progressing to less than 25% of normal renal function.

Question 17

Factors that advance chronic renal failure?

Answer 17

Proteinuria, angiotensin II, and hyperfiltration leading to glomerular damage and leaky glomerulus.

Question 18

Complications of chronic renal failure?

Answer 18

Sodium/water imbalance, phosphate/calcium imbalance (leading to bone alterations), hyperkalemia (dysrhythmias), metabolic acidosis, hypertension, anemia, alterations in protein, carbs, and lipids.

Question 19

Manifestations of chronic renal failure?

Answer 19

Nausea, poor appetite, neurologic changes (uremia), oliguria to anuria.

Question 20

How is chronic renal failure diagnosed?

Answer 20

H&P, BUN/creatinine, 24-hour creatinine clearance.

Question 21

What is hypospadias?

Answer 21

Urethral meatus is located on the ventral (underside) of the penis.

Question 22

What is epispadias?

Answer 22

In males, the urethral opening is on the dorsal surface of the penis; in females, a cleft along the ventral urethra extends to the bladder neck.

Question 23

How common is epispadias in males vs. females?

Answer 23

It affects boys twice as often as girls.

Question 24

What is exstrophy of the bladder?

Answer 24

Herniation of the bladder through the abdominal wall due to failure of abdominal muscles, pelvic ring, and pelvic floor to fuse.

Question 25

When should exstrophy of the bladder be repaired?

Answer 25

Ideally, before the infant is 72 hours old.

Question 26

What is ureteropelvic junction obstruction?

Answer 26

Blockage where the renal pelvis transitions into the ureter, causing a backup of fluid into the renal pelvis/calyces.

Question 27

What causes bladder outlet obstruction?

Answer 27

Urethral valves, urethral polyps, or urethral atresia (absence of urethra).

Question 28

What is renal aplasia?

Answer 28

Kidneys are “absent” or underdeveloped.

Question 29

What are hypoplastic kidneys?

Answer 29

Small kidneys with a decreased number of nephrons, leading to poor filtration.

Question 30

What is renal dysplasia?

Answer 30

Abnormal differentiation of kidney tissues, including primitive glomeruli, tubules, cysts, and non-renal tissues (e.g., cartilage).

Question 31

What is renal agenesis?

Answer 31

Absence of one or both kidneys.

Question 32

What is unilateral renal agenesis?

Answer 32

One kidney (usually the left) is absent, and the remaining kidney hypertrophies.

Question 33

What is Potter syndrome?

Answer 33

A rare, fatal disorder involving bilateral renal agenesis, associated with specific facial anomalies (wide-set eyes, parrot-beak nose, low-set ears, receding chin).

Question 34

What is polycystic kidney disease (PKD)?

Answer 34

An autosomal dominant disorder causing cyst formation in the kidneys, related to mutations in PKD-1 (chromosome 16) and PKD-2 (chromosome 4).

Question 35

What does PKD lead to?

Answer 35

Cyst formation, renal obstruction, destruction of renal parenchyma, interstitial fibrosis, and loss of functional nephrons.

Question 36

What is autosomal recessive PKD (ARPKD)?

Answer 36

Cystic changes in the kidney, liver, and pancreas, often found in adults and related to a gene mutation.

Question 37

What are the manifestations of PKD?

Answer 37

Asymptomatic for decades, hematuria, flank pain, hypertension, heart valve defects, aneurysm formation.

Question 38

How is PKD diagnosed?

Answer 38

History & Physical (H&P), renal ultrasound.

Question 39

What is hemolytic-uremic syndrome?

Answer 39

An acute disorder characterized by hemolytic anemia, fibrinolysis, and renal failure.

Question 40

Mechanism of hemolytic-uremic syndrome?

Answer 40

RBCs break down, microthrombi form, and the glomerulus becomes swollen and occluded, leading to decreased GFR.

Question 41

Common etiology of hemolytic-uremic syndrome?

Answer 41

Often occurs 1-2 weeks after bacterial (especially E. Coli) or viral infections, most common in children < 4 years old.

Question 42

What are the manifestations of hemolytic-uremic syndrome?

Answer 42

Asymptomatic for 1-5 days, pallor, ecchymosis, purpura, mental status changes, seizures, oliguria, metabolic acidosis, hyperkalemia, and hypertension.

Question 43

How is hemolytic-uremic syndrome diagnosed?

Answer 43

H&P, urine, and blood analysis by microscope.

Question 44

What is Wilms tumor?

Answer 44

An embryonal tumor of the kidney, most common in children between 1 and 5 years old.

Question 45

Mechanism of Wilms tumor?

Answer 45

Arises from the proliferation of abnormal renal stem cells, related to the “two-hit” hypothesis involving mutations in the WT1 and WT2 genes on chromosome 11.

Question 46

Manifestations of Wilms tumor?

Answer 46

An enlarging, firm, non-tender, smooth upper abdominal mass, vague abdominal pain, hematuria, fever, and hypertension.

Question 47

How is Wilms tumor diagnosed?

Answer 47

H&P.