T1: Renal Diseases Flashcards
5 major categories of renal diseases
- Glomerular (damage to glomeruli)
- Tubular (infection/toxin destroys cells)
- Interstitial (infections)
- Vascular (disruption to blood supply)
- Others
6 glomerular diseases
- Acute Post-Streptococcal
- Glomerulonephritis
- Acute GN, Chronic GN
- Membranoproliferative GN
- Focal Segmental GN
- Rapidly Progressive GN
Acute Post-Streptococcal Glomerulonephritis
- specific causative bacteria
Group A Beta hemolytic strep
Acute Post-Streptococcal Glomerulonephritis
- How immune complexes causes the disease
cellular infiltrates deposit on glomerular basement membrane
Acute Post-Streptococcal Glomerulonephritis
- Six typical urinalysis findings
- Gross hematuria
- Proteinuria
- Red cell casts
- Hypertension
- Edema
- transient oliguria with reduced GFR
Acute Post-Streptococcal Glomerulonephritis
- Pathognomonic finding for the disease
Red cell casts
Acute Post-Streptococcal Glomerulonephritis
- two chemistry lab findings
increased BUN and Creatinine
Acute Post-Streptococcal Glomerulonephritis
- one immunological finding
positive test for streptococcal antibodies (antibodies of M proteins)
Three symptoms for chronic glomerulonephritis
edema, hypertension, oliguria
Pathognomonic urinalysis finding for chronic glomerulonephritis
Broad and waxy casts
two tubular diseases
- Acute Tubular Necrosis (Ischemic and Toxic)
2. Renal Tubular Acidosis
Describe tubular damage caused by trauma, shock, or sepsis, in ischemic acute tubular necrosis
the damage leads to decreased renal perfusion. Reduced oxygen disrupts tubular basement membrane function
6 typical urinalysis findings of acute tubular necrosis
- mild proteinurea
- Hematuria
- Low Specific gravity
- renal epithelial cells, renal epithelial cell casts, granular casts
- Oliguria
- Increased BUN
Pathognomonic findings for acute tubular necrosis
Renal epithelial cell casts
Explain the pathogenesis of renal tubular acidosis
Tubules can’t secrete hydrogen ions to acidify urine, decreases blood pH, causing acidosis
Five tubulointerstitial diseases
- Pyelonephritis (acute and chronic)
- Cystitis
- Urethritis
- Acute Tubulointerstitial Nephritis
- Acute Tubulointerstitial Necrosis
Pyelonephritis
- three predisposing factors
- Urinary tract infection
- Pregnancy
- Diabetes mellitus
Pyelonephritis
- three common routes of infection
- Ascending from bladder
- 3% from bloodstream
- From lymphatic system
Acute Pyelonephritis
- six typical findings
- > 5 WBC’s/hpf (clumps)
- Bacteria
- Mild proteinuria
- Positive blood
- Positive nitrite
- WBC casts
Acute Pyelonephritis
- pathognomonic finding
WBC casts
Chronic Pyelonephritis
- most common causes of chronic pyelonephritis
Backward flow of urine up ureters
Chronic Pyelonephritis
- seven typical urinalysis findings
- increased protein
- WBC’s in clumps
- low specific gravity
- macrophages
- granular casts
- waxy casts
- Broad casts
Chronic Pyelonephritis
- pathognomonic finding
waxy and broad casts
Cystitis
- 4 typical symptoms
- increased frequency and urgency of urination
- Pain in pelvic/abdominal region
- Fever and chills
- Burning sensation on urination
Cystitis
- Two common bacterial causes
- E. coli
2. Staph saprophyticus
Cystitis
- Five common urinalysis findings
- Positive blood
- Positive leukocyte esterase
- Positive nitrite (if bacteria produce nitrite)
- WBC’s
- Bacteria (1/3 will be neg)
NO CASTS
Nephrotic Syndrome
- 4 disease processes that may lead to the syndrome
- Glomerulonephritis
- Systemic lupus erythematosus
- Diabetes mellitus
- sickle cell anemia
Nephrotic Syndrome
- The renal damage that leads to symptoms and lab findings
Glomerular basement membrane becomes highly permeable to plasma proteins and lipids
Nephrotic Syndrome
- Two clinical symptoms
- Edema
2. Hypertension
Nephrotic Syndrome
- Three typical chemistry findings
- Hypoproteinemia
- Increased cholesterol
- Increased triglycerides
Nephrotic Syndrome
- Four urinalysis findings
- Massive proteinuria
- Microscopic hematuria
- oval fat bodies
- Fatty casts and waxy casts
Nephrotic Syndrome
- Pathognomonic findings
oval fat bodies, fatty casts and waxy casts
Four vascular real diseases
- Hypertension
- Benign Nephrosclerosis
- Renal Artery Stenosis
- Microangiopathies
Why can vascular disease lead to renal disease?
The kidneys receive 20-25% of cardiac output so anything that interferes with blood flow impacts kidney function
Why can hypertension lead to renal disease?
incresed pressure changes the structure of vascular walls which increased the risk for renal failure
What is the lab marker for real disease caused by hypertension?
microalbuminuria
Hemolytic Uremic Syndrome (HUS)
- bacterial causative agent and what food is it found in?
- E. coli
- ground meat
Hemolytic Uremic Syndrome (HUS)
- Why the toxin causes hemolysis and thrombosis
Toxin binds to RBC’s, affects platelet function, and causes increased adhesion of WBC’s to endothelium
Hemolytic Uremic Syndrome (HUS)
- Processes that lead to vasoconstriction
The toxin causes increased production of endothelia and loss of endothelial nitric oxide favors vasoconstriction, this in presence of blood clots, occludes vessels, causes necrosis, and thickening of capillary walls
Nephrolithiasis
- four factors that favor stone formation
- increased concentration of stone constituent in urine
- changes in urine pH
- decreased urine flow
- presence of bacteria
Nephrolithiasis
- Four categories of kidney stones
- calcium salts
- triple phosphate (struvite)
- Uric acid
- Cystine
Nephrolithiasis
- Three symptoms
- severe flan pain
- nausea
- vomiting
Nephrolithiasis
- Three typical urinalysis findings
- Hematuria
- Bacteriuria
- crystals
Nephrolithiasis
- Two typical chemistry findings
- Increased BUN
2. Increased creatinine
Abrupt decreased in renal function sufficient to increase plasma creatinine and BUN
Definition of “acute renal failure”
Pre-renal causes of acute renal failure
- Extracellular fluid loss
- decreased cardiac output
- sepsis/shock
Renal causes of acute renal failure
- vascular disorders (DIC)
- glomerulonephritis
- tubular necrosis
Post-renal causes of acute renal failure
- obstructions
Acute Renal Failure
- three chemical findings
- Hyperkalemia
- Increased plasma phosphorus
- Decresed blood pH
Acute Renal Failure
- two urinalysis findings
- Positive blood and protein in urine
- Oliguria
Acute Renal Failure
- one hematological finding
anemia
What glomerular filtration rate is associated with chronic renal failure
GFR < 15 mL/min
Typical toxic agents that cause toxic acute tubular necrosis (5)
Heavy metals, ethylene glyco, organic solvents, drugs, and mushrooms
Specific part of the nephron that is damaged in toxic acute tubular necrosis
proximal tubules
