Unit 5 - Renal, Endocrine, Male GU, Lower Urinary Tract Flashcards
Conjoined kidneys usually connected at lower pole
Horseshoe Kidney
What does the horseshoe kidney get caught on during its ascent from pelvis to abdomen?
Inferior mesenteric artery
Absent kidney formation
Renal agenesis
What does unilateral renal agenesis lead to?
Hypertrophy of existing kidney, increased risk of renal failure later in life
What does bilateral renal agenesis lead to?
Potter sequence [oligohydramnios with lung hypoplasia, flat face with low set ears, developmental defects of extremities]
What is a dysplastic kidney?
Noninherited congenital abnormality of renal parenchyma characterized by cysts and abnormal tissue
Inherited defect leading to bilateral enlarged kidneys with cysts in renal cortex and medulla
Polycystic Kidney Disease
In PKD, autosomal ____ form presents in infants and autosomal ____ form presents in young adults
Recessive; dominant
Presentation and associations of PKD in infant
Worsening renal failure and hypertension
Associated with congenital hepatic fibrosis and hepatic cysts
Presentation and associations of PKD in young adult
Hypertension, hematuria, worsening renal failure
Associated with berry aneurysm, hepatic cysts, mitral valve prolapse
What is medullary cystic kidney disease and how does it present?
Inherited defect leading to cysts in medullary collecting ducts
Presents as shrunken kidneys and worsening renal failure
What is azotemia?
Increased BUN and creatinine
Prerenal azotemia is caused by ______, postrenal azotemia is caused by _______
Decreased blood flow to kidneys; Obstruction of urinary tract downstream from kidneys
Most common cause of acute renal failure
Acute Tubular Necrosis
What causes decreased GFR in acute tubular necrosis?
Necrotic cells that plug tubules –> see brown granular casts in urine
Lab findings with acute tubular necrosis
Serum BUN:Cr ratio
Two main causes of Acute Tubular Necrosis
Ischemic damage - Proximal tubule and medullary segment of thick ascending limb
Nephrotoxic agents - proximal tubule
Drug induced hypersensitivity involving interstitium and tubules that results in acute renal failure
Acute Interstitial Nephritis
Clinical features of Acute Interstitial Nephritis
Oliguria, fever, rash days to weeks after starting drug
Eosinophils may be seen in urine
Drugs that can cause Acute Interstitial Nephritis
NSAIDs, penicillin, diuretics
How does renal papillary necrosis present?
Gross hematuria and flank pain
Causes of Renal Papillary Necrosis
Chronic analgesic abuse, diabetes mellitus, sickle cell disease/trait, severe acute pyelonephritis
Nephrotic syndromes are characterized by _____ resulting in _____, _____, _____, and ________
Characterized by proteinuria
Hypoalbuminemia - pitting edema
Hypogammaglobulinemia - risk of infection
Hypercoagulable state
Hyperlipidemia/hypercholesterolemia - fatty casts in urine
What is Minimal Change Disease?
Most common cause of nephrotic syndrome in children, usually idiopathic (may be associated with Hodgkins Lymphoma)
Results of H&E, EM, and immunofluorescence in Minimal Change Disease
H&E - normal glomeruli, may see lipid
EM - effacement of foot processes
Negative immunofluorescence
What is Focal Segmental Glomerulosclerosis?
Most common cause of nephrotic syndrome in Hispanics and African Americans
Usually idiopathic, may be associated with HIV, heroin use, sickle cell disease
H&E, EM and immunofluorescence results in Focal Segmental Glomerulosclerosis
H&E - focal and segmental sclerosis
EM - effacement of foot processes
Negative IF
Most common cause of nephrotic syndrome in Caucasian adults, may be associated with Hep B or C, solid tumors, SLE, or drugs
Membranous Nephropathy
Results of H&E, EM, and IF for membranous nephropathy
H&E - thick glomerular basement membrane
EM - subepithelial immune complex deposits with spike and dome appearance
IF - positive, granular
What are the 2 types of Membranoproliferative Glomerulonephritis and their associations?
Both types can cause nephritic, nephrotic, or both syndromes Type I (subendothelial) - associated with HBV, HCV Type II (intramembranous) - associated with C3 nephritic factor
H&E and IF results for Membranoproliferative Glomerulonephritis
H&E - tram track appearance due to immune complex deposition
Positive granular IF
How does Diabetes Mellitus cause nephrotic syndrome?
Hyaline arteriosclerosis affects efferent arteriole more than afferent - high GFR pressure
Injury leads to microalbuminuria
Eventually progresses to nephrotic syndrome
Results of H&E stain for Diabetic Nephropathy
Sclerosis of mesangium, formation of Kimmelstiel-Wilson nodules
How does systemic amyloidosis cause nephrotic syndrome?
Amyloid deposits in mesangium
Nephritic Syndromes are characterized by _____ and _____, leading to _____, ______, ______, and _____
Characterized by glomerular inflammation and bleeding
Leads to limited proteinuria
oliguria/azotemia
salt retention with periorbital edema/HTN
RBC casts/dysmorphic RBCs in urine
