Urinary Disease & Findings Flashcards
1
Q
congenital anatomical variations affecting urinary tract (3)
A
duplicate set of ureters
horseshoe kidney
vesicoureter reflux
2
Q
acquired anatomical variations affecting urinary tract (2)
A
- accidents/injuries damaging kidney or urinary tract
- benign prostatic hyperplasia (BPH)
3
Q
MC renal congenital abnormality
A
duplicated ureter
4
Q
additional ureter may result in
A
ureterocele (distal ureter balloons) or ectopic ureter
5
Q
congenital anatomical variations MC affect ______ and could be important predisposing factor for
A
females (around 4th week of fetus development)
UTIs in newborn or children
6
Q
renal fusion or super kidney that affects 1 in 400 people
A
horseshoe kidney
7
Q
horseshoe kidney is MC seen with (2) disorders
A
Turner Syndrome
Trisomy 18
8
Q
genetic disorder seen in GIRLS, where all or part of X chromosome is absent or has abnormalities
A
Turner Syndrome
9
Q
___ % of girls with Turner Syndrome aka _____ have horseshoe kidney;
A
15%
45, X0
10
Q
serious chromosomal abnormality characterized by defects in nearly all organs and systems, develops horseshoe kidney in ___% of kids affected
A
trisomy 18
20%
11
Q
in horseshoe kidney, the isthmus is found at ___ level
A
L4/L5
12
Q
(2) characteristics of horseshoe kidney
A
MC in men
usually asymptomatic
13
Q
horseshoe kidney increases risk for development of (5) as result of POOR DRAINAGE
A
kidney obstruction hydronephrosis pyelonephritis urolithiasis kidney cancer
14
Q
abnormal retrograde movement of urine from bladder to ureters; can be primary or secondary
A
vesicoureteral reflux
15
Q
vesicourteral reflux may result in (2)
A
hydronephrosis
pyelonephritis
16
Q
MC hospital acquired infection
A
UTI
17
Q
UTI affects
A
bladder- cystitis
kidneys- pyelonephritis
18
Q
female-male ratio for UTI and age range
A
female to male 4:1
ages 16-35
19
Q
etiology of BACTERIAL UTI, (can also be a viral or fungal infection)
A
- E.Coli = 80-85%
- other gram - rods
- staphylococcus epidermis
20
Q
risk factors for UTI
A
- urinary tract obstruction in pregnancy, urolithiasis, prostate enlargement, or tumors
- catheterization
- diabetes mellitus
- congenital anatomical abnormalities
21
Q
2 ways that bacteria can reach kidney in UTI’s
A
- from lower urinary tract (ascending infection usually due to cystitis) = MC
- through blood stream
22
Q
signs of acute cystitis
A
dysuria increased frequency of urination increased urinary urgency lower abdominal pain (RARELY causes systemic symptoms)
23
Q
signs of pyelonephritis
A
- causes systemic symptoms (fever, chills, nausea)
- flank pain
- dysuria
24
Q
urinalysis of UTI includes:
A
increases leukocytes (neutrophils) positive leukocyte esterase bacteria MAY have positive nitrite WBC casts- maybe (indicate kidney infection)
25
urinary tract stone formation is called
urolithiasis
26
kidney stones are common cause of _____ obstruction; can cause severe pain called ______
UPPER urinary tract
| ureteral (renal) colic
27
classic presentation for acute ureteral colic
sudden onset of severe pain originating in flank, back and radiating inferior and anteriorly towards groin
28
with urolithiasis, change of position _________; at least 50% of patients will also have (2)
- does NOT relieve pain
- systemic symptoms
- dysuria due to obstruction of urinary tract
29
urinalysis of ureteral colic includes:
hematuria
WBC, leukocyte esterase
crystals
30
chemical substances that form stones
- calcium oxalate with combination of calcium phosphates (75% of all stones)
- Magnesium ammonium phosphate ( aka Triple Phosphate, Struvites)
- Uric acid
- Cystine
31
HTN resulting in damage of blood vessels of kidney is called ______: ____ accumulates in wall of small arterioles producing the thickening of their walls and narrowing of lumen causing ischemia -->
benign nephrosclerosis
hyaline
reduction of renal function
32
hyaline arteriosclerosis/benign nephrosclerosis leads to (3)
tubular atrophy
interstitial fibrosis
glomerular alterations
33
urinalysis of HTN nephropathy shows:
multiple hyaline casts
cell casts
proteinuria
hematuria
34
in HTN nephropathy, there is decrease in GFR --> blood ELEVATION of (2)
creatinine
| blood urea nitrogen
35
diabetes mellitus is manifested by (7)
```
polyuria
polydipsia
malaise
fatigue
micoangiopathies (small blood vessels of body injured)
diabetic nephropathy
peripheral neuropathy
```
36
diabetic nephropathy characterized by (3) and is OFTEN manifested by ____ syndrome
glomerular lesions
renal angiopathy
pyelonephritis
nepHROTIC syndrome
37
changes in urine w/ diabetic nephropathy
```
polyuria
increased specific gravity
glycosuria
ketonuria
albuminuria
lipiduria
cell, fatty, and waxy casts
```
38
if diabetic nephropathy is complicated by pyelonephritis, urinalysis includes (4)
gross hematuria
pyuria
bacteriruai
trace albuminuria
39
nephritic and nephrotic syndrome are present in people with
glomerular diseases
40
glomerular diseases are associated with (2); can be genetic or acquired, acute or chronic
immunopathological processes
| AI diseases
41
_____ is associated with paradoxical increased permeability of glomeruli for RBCs and REDUCED permeability for water
nephRITIC syndrome
42
signs and symptoms of nephRITIC syndrome
```
hematuria
oliguria
azotemia
HTN
proteinuria
```
43
immunopathological condition- type III hypersensitivity, that may arise 14-21 days after exposure to BETA-HEMOLYTIC GROUP A STREPTOCOCCUS
acute proliferative glomerulonephritis
44
acute proliferative glomerulonephritis is manifested by ______, develops MC in ____ with high rate of recovery, elevated _____ found in blood
nephrRITIC syndrome,
kids
anti-streptolysin O titre
45
in acute proliferative glomerulonephritis, immune complexes become lodged btwn _____ and ______ below the podocyte foot processes; complement _____ leads to destruction
magnesium
glomerular basement membrane
activation
46
molecular size of glomerular basement membrane pores in kids is ____ nm, and the streptococcus- antibody complex is ___ nm which makes it easy for complex to be lodged into GBM pore
2-3 nm
| 15 nm
47
changes in urine for acute proliferative glomerulonephritis are typical for _____ syndrome; including (4)
```
nepHRITIC
hematuria
oliguria
edema
cast cells
(may be HTN or azotemia)
```
48
kidney disorder characterized by rapid loss of renal fxn, acute renal failure, and death within months
rapidly progressive (crescentic) glomerulonephritis
49
rapidly progressive (crescentic) glomerulonephritis may develop with (4) AI diseases:
goodpasture's syndrome
systemic lupus
wegener granulomatosis
polyarteritis nodosa
50
morphologically, rapidly progressive glomerulonephritis crescents develop from proliferation of ______ and then crescents eventually __________
parietal epithelial cells of bowman's capsule
| obliterate Bowman's space and compress glomerular tuft
51
rapidly progressive (crescentic) glomerulonephritis is manifested by _____ syndrome with symptoms such as (6); but may also manifest with symptoms similar to _____ syndrome with symptoms such as ____
```
nephrITIC syndrome
- severe hematuria
- dark, smoky colored urine
- RBC casts
- oliguria, anuria
- proteinuria less than 3 g/d
- HTN
nephrOTIC syndrome
- heavy proteinuria
- generalized edema
```
52
AI disease characterized by formation of antibodies against glomerular and alveolar basement membranes
goodpasture's syndrome
53
in goodpasture syndrome, (2) organs affected; ______ could occur within 2 weeks
lungs and kidneys
| renal failure
54
symptoms in lungs for goodpasture's syndrome
hemoptysis
dyspnea
hypoxia of tissue
55
symptoms in kidneys for goodpasture's syndrome
```
hematuria
RBC casts
oliguria
HTN
proteinuria
azotemia
```
56
disease that is characterized by deposition of IgA and IgA immune complexes into misangium with distraction of GBM
Berger's Disease (IgA Nephropathy)
57
Berger's diseases begins 1-2 days within (3) and is manifested by ________ which subsides in several days spontaneously and ____
```
acute respiratory
acute GI
UTI
gross hematuria
nepHRITIC syndrome
```
58
berger's disease turns into _____ in 25-30% of patients
chronic glomeronephritis
59
______ is MC cause of glomerulonephritis world-wide
IgA nephropathy
60
syndrome associated with increased permeability of glomeruli for PROTEINS, predominately albumins
nephROTIC syndrome
61
signs and symptoms for nephROTIC syndrome
```
heavy proteinuria (> 3.5 g/d)
HYPOalbuminemia
generalized edema
lipidemia and lipiduria
fat goblets and casts
```
62
MC disease associated with nephROTIC syndrome in adults; characterized by _______
membranous glomerulonephritis
| diffuse thickening of glomerular capillary wall
63
signs and symptoms of membranous glomerulonephritis (5)
```
proteinuria
hematuria
edema
mild HTN
nocturia
```
64
characterized by thickening of glomerular basement membrane and leukocyte infiltration, usually present with nePHROTIC syndrome,
membranoproliferative glomerulonephritis
65
50% of membranoproliferative glomerulonephritis develops into
chronic renal failure
66
signs and symptoms of membranoproliferative glomerulonephritis
```
proteinuria
edema
hematuria
dark urine- tea/cola colored
HTN
oliguria
```
67
relatively benign disorder that is MC cause of nephrOTIC syndrome in KIDS; peak btwn 2-6 y.o.
minimal change disease (lipoid nephrosis)
68
diffuse loss of foot processes of podocytes that cannot be detected by light microscopy, but can be found by electron microscopy
minimal change disease (lipid nephrosis)
69
minimal change disease is clinically associated with
respiratory infections
| prophylactic immunization
70
minimal change disease has symptoms similar to adult ______ syndrome, but with much better prognosis; symptoms include
```
nephrOTIC syndrome
massive proteinuria
hypoalbuminemia
generalized edema
no HTN
no hematuria
```
71
_____ are very effective with minimal change disease
corticosteroids
72
lesion that is characterized by sclerosis of some, but not all glomeruli and in affected glomeruli only a portion of capillary tuft is involved
focal segmental glomerulosclerosis
73
focal segmental glomerulosclerosis is frequently accompanied by
nephROTIC syndrome or heavy protein uria
74
electron microscopy for focal segmental glomerulosclerosis shows:
pronounced focal detachment of visceral epithelial cells with denudation of underlying GBM
75
focal segmental glomerulosclerosis affects ____ with better prognosis, and has higher incidence in ___ & ____
kids
males
african americans
76
end stage of glomerular disease; results from continued glomerular inflammation, worsening destruction of glomeruli, and progressive loss of kidney fxn leading to kidney failure (usually develops in years or decades)
chronic glomerulonephritis
77
progression of chronic renal failure varies from ____ to ___ ; tested using
several months to several years
| GFR
78
4 stages of chronic renal failure
1 diminished renal failure apprx 50% normal GFR
2 renal insufficiency 20-50% normal GFR
3 renal failure GFR less than 20% normal
4 End stage less than 5% normal
79
signs/symptoms of chronic renal failure
```
oliguria
nausea, vomiting
loss of appetite
anemia
fatigue, weakness
sleep problems
decreased mental sharpness
easy bruising
muscle twitching/cramping
feet/ankle swelling
persistent itching
chest pain
shortness of breath
high BP
```
80
genetic condition characterized by kidney disease, loss of hearing before 30 y.o., eye abnormalities, affects mostly MALES
alport syndrome
81
destruction of tubular epithelial cells of nephron, present with acute toxic kidney injury and ischemia
acute tubular necrosis
82
acute tubular necrosis is USUALLY ______; lab findings include:
```
reversible
reduced GFR
increased blood levels of BUN and creatinine
severe oliguria
hematuria
casts
```
83
diseases (genetic, congenital, or acquired) of PROXIMAL renal tubules of kidneys with inadequate reabsorption of AA, uric acid, glucose, phosphates, bicarbonates
Fanconi's syndrome
84
urinalysis of Fanconi's syndrome
mild proteinuria/aminoaciduria
glycosuria
hyperuricosuria
(may result in renal tubular acidosis)
85
group of disorders involving either decreased ability to secrete hydrogen ions in distal tubules or decreased ability to reabsorb bicarbonate in proximal tubules
renal tubular acidosis
86
renal tubular acidosis may result in chronic metabolic acidosis including:
```
potassium depletion and wasting
muscle weakness
calcium loss in bones
elevated urine calcium
kidney stones
renal failure
```
87
kidney tubules defect that affects ability to respond to ADH
nephrogenic diabetes insipidus
88
nephrogenic diabetes insipidus is in contrast to _______, which is caused by INSUFFICIENT levels of ADH
central/neurogenic diabetes inspidus
89
patient passes LARGE volume of urine with LOW specific gravity; usually affects MEN
nephrogenic diabetes insipidus
90
autosomal recessive disorder that involves inadequate reabsorption of glucose due to proximal tubules dysfunction; ketones are NEVER present; renal histology is normal
renal glycosuria
91
form of nephritis affecting interstitium of kidneys surrounding tubules; interferes with kidney function
acute interstitial nephritis
92
acute interstitial nephritis results from (3)
allergic reactions to meds
infection
intoxication
93
acute interstitial nephritis is manifested by
```
hematuria
increased WBCs in urine
fever
rash
increased or decreased urine output
mental status changes
nausea, vomiting
```
94
acute onset in patients with severe liver diseases; progressively intense VASOCONSTRICTION which leads to oliguria, elevated BUN, creatinine and renal failure
hepatorenal failure
95
urinary findings for hepatorenal failure
```
oliguria
dark color urine
increased specific gravity
low sodium
no proteinuria or abnormal crystals
```
96
autosomal recessive diseases occurring rarely; due to non-production of enzyme phenyalanine hydrolase, blockage of normal conversion to tyrosine
phenylketonuria (PKU)
97
in PKU, several intermediates are excreted in large amounts in urine and sweat (3) and cause ____ odor
phenylpyruvic acid
phenylactic acid
phenylacetic acid
musty/mousy odor
98
___ tests detect PKU early; people affected usually have ___ skin and ___ hair
blood
pale skin
blonde hair
99
autosomal recessive disorder, in which there is a lack of enzyme homogentisic acid oxidase in tyrosine pathway --> accumulation of homogentisic acid in tissues
alkaptonuria
100
color of urine with alkaptonuria
black
101
accumulation of homogentisic acid in cartilage results in its degeneration- this is called:
ochronosis
102
rare, inherited metabolic disorder in which patients cannot breakdown leucine, isoleucine or valine; AA and their ketone-acids are excreted
maple syrup urine disease
103
maple syrup urine disease can be controlled if detected before the _____
11th day after birth
104
symptoms of maple syrup urine disease
```
brain damage
cataracts
jaundice
enlarged liver
kidney damage
```
105
inherited disease that is characterized by inadequate reabsorption of AA in PROXIMAL convoluted tubules
cystinosis (cystine disorders)
106
cystinuria exists in 2 forms in cystinosis
1. lysine, arginine, ornithine, and cystine cannot be reabsorbed
2. only lysine or cystine cannot be reabsorbed
107
inherited disorders in which clusters of noncancerous cysts develop primarily within the kidney
polycystic kidney disease (PKD)
108
PKD is associated with
aortic aneurysms
brain aneurysms
cysts in liver, pancreas and testes
diverticula of colon
109
______ PKD often develops btwn 30-40 yo; only one parents needs to have disease, MC
autosomal dominant
110
_____ PKD appears shortly after birth, both parents must have it, less common
autosomal recessive
111
symptoms of PKD
```
high BP
back pain
headache
increase in size of abdomen
lood in urine
frequent urination
kidney failure
UTIs
```
