Urinary Disease & Findings Flashcards
congenital anatomical variations affecting urinary tract (3)
duplicate set of ureters
horseshoe kidney
vesicoureter reflux
acquired anatomical variations affecting urinary tract (2)
- accidents/injuries damaging kidney or urinary tract
- benign prostatic hyperplasia (BPH)
MC renal congenital abnormality
duplicated ureter
additional ureter may result in
ureterocele (distal ureter balloons) or ectopic ureter
congenital anatomical variations MC affect ______ and could be important predisposing factor for
females (around 4th week of fetus development)
UTIs in newborn or children
renal fusion or super kidney that affects 1 in 400 people
horseshoe kidney
horseshoe kidney is MC seen with (2) disorders
Turner Syndrome
Trisomy 18
genetic disorder seen in GIRLS, where all or part of X chromosome is absent or has abnormalities
Turner Syndrome
___ % of girls with Turner Syndrome aka _____ have horseshoe kidney;
15%
45, X0
serious chromosomal abnormality characterized by defects in nearly all organs and systems, develops horseshoe kidney in ___% of kids affected
trisomy 18
20%
in horseshoe kidney, the isthmus is found at ___ level
L4/L5
(2) characteristics of horseshoe kidney
MC in men
usually asymptomatic
horseshoe kidney increases risk for development of (5) as result of POOR DRAINAGE
kidney obstruction hydronephrosis pyelonephritis urolithiasis kidney cancer
abnormal retrograde movement of urine from bladder to ureters; can be primary or secondary
vesicoureteral reflux
vesicourteral reflux may result in (2)
hydronephrosis
pyelonephritis
MC hospital acquired infection
UTI
UTI affects
bladder- cystitis
kidneys- pyelonephritis
female-male ratio for UTI and age range
female to male 4:1
ages 16-35
etiology of BACTERIAL UTI, (can also be a viral or fungal infection)
- E.Coli = 80-85%
- other gram - rods
- staphylococcus epidermis
risk factors for UTI
- urinary tract obstruction in pregnancy, urolithiasis, prostate enlargement, or tumors
- catheterization
- diabetes mellitus
- congenital anatomical abnormalities
2 ways that bacteria can reach kidney in UTI’s
- from lower urinary tract (ascending infection usually due to cystitis) = MC
- through blood stream
signs of acute cystitis
dysuria increased frequency of urination increased urinary urgency lower abdominal pain (RARELY causes systemic symptoms)
signs of pyelonephritis
- causes systemic symptoms (fever, chills, nausea)
- flank pain
- dysuria
urinalysis of UTI includes:
increases leukocytes (neutrophils) positive leukocyte esterase bacteria MAY have positive nitrite WBC casts- maybe (indicate kidney infection)
urinary tract stone formation is called
urolithiasis
kidney stones are common cause of _____ obstruction; can cause severe pain called ______
UPPER urinary tract
ureteral (renal) colic
classic presentation for acute ureteral colic
sudden onset of severe pain originating in flank, back and radiating inferior and anteriorly towards groin
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
urinalysis of ureteral colic includes:
hematuria
WBC, leukocyte esterase
crystals
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
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
hyaline arteriosclerosis/benign nephrosclerosis leads to (3)
tubular atrophy
interstitial fibrosis
glomerular alterations
urinalysis of HTN nephropathy shows:
multiple hyaline casts
cell casts
proteinuria
hematuria
in HTN nephropathy, there is decrease in GFR –> blood ELEVATION of (2)
creatinine
blood urea nitrogen
diabetes mellitus is manifested by (7)
polyuria polydipsia malaise fatigue micoangiopathies (small blood vessels of body injured) diabetic nephropathy peripheral neuropathy
diabetic nephropathy characterized by (3) and is OFTEN manifested by ____ syndrome
glomerular lesions
renal angiopathy
pyelonephritis
nepHROTIC syndrome
changes in urine w/ diabetic nephropathy
polyuria increased specific gravity glycosuria ketonuria albuminuria lipiduria cell, fatty, and waxy casts
if diabetic nephropathy is complicated by pyelonephritis, urinalysis includes (4)
gross hematuria
pyuria
bacteriruai
trace albuminuria
nephritic and nephrotic syndrome are present in people with
glomerular diseases
glomerular diseases are associated with (2); can be genetic or acquired, acute or chronic
immunopathological processes
AI diseases
_____ is associated with paradoxical increased permeability of glomeruli for RBCs and REDUCED permeability for water
nephRITIC syndrome
signs and symptoms of nephRITIC syndrome
hematuria oliguria azotemia HTN proteinuria
immunopathological condition- type III hypersensitivity, that may arise 14-21 days after exposure to BETA-HEMOLYTIC GROUP A STREPTOCOCCUS
acute proliferative glomerulonephritis
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
in acute proliferative glomerulonephritis, immune complexes become lodged btwn _____ and ______ below the podocyte foot processes; complement _____ leads to destruction
magnesium
glomerular basement membrane
activation
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
changes in urine for acute proliferative glomerulonephritis are typical for _____ syndrome; including (4)
nepHRITIC hematuria oliguria edema cast cells (may be HTN or azotemia)
kidney disorder characterized by rapid loss of renal fxn, acute renal failure, and death within months
rapidly progressive (crescentic) glomerulonephritis
rapidly progressive (crescentic) glomerulonephritis may develop with (4) AI diseases:
goodpasture’s syndrome
systemic lupus
wegener granulomatosis
polyarteritis nodosa
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
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
AI disease characterized by formation of antibodies against glomerular and alveolar basement membranes
goodpasture’s syndrome
in goodpasture syndrome, (2) organs affected; ______ could occur within 2 weeks
lungs and kidneys
renal failure
symptoms in lungs for goodpasture’s syndrome
hemoptysis
dyspnea
hypoxia of tissue
symptoms in kidneys for goodpasture’s syndrome
hematuria RBC casts oliguria HTN proteinuria azotemia
disease that is characterized by deposition of IgA and IgA immune complexes into misangium with distraction of GBM
Berger’s Disease (IgA Nephropathy)
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
berger’s disease turns into _____ in 25-30% of patients
chronic glomeronephritis
______ is MC cause of glomerulonephritis world-wide
IgA nephropathy
syndrome associated with increased permeability of glomeruli for PROTEINS, predominately albumins
nephROTIC syndrome
signs and symptoms for nephROTIC syndrome
heavy proteinuria (> 3.5 g/d) HYPOalbuminemia generalized edema lipidemia and lipiduria fat goblets and casts
MC disease associated with nephROTIC syndrome in adults; characterized by _______
membranous glomerulonephritis
diffuse thickening of glomerular capillary wall
signs and symptoms of membranous glomerulonephritis (5)
proteinuria hematuria edema mild HTN nocturia
characterized by thickening of glomerular basement membrane and leukocyte infiltration, usually present with nePHROTIC syndrome,
membranoproliferative glomerulonephritis
50% of membranoproliferative glomerulonephritis develops into
chronic renal failure
signs and symptoms of membranoproliferative glomerulonephritis
proteinuria edema hematuria dark urine- tea/cola colored HTN oliguria
relatively benign disorder that is MC cause of nephrOTIC syndrome in KIDS; peak btwn 2-6 y.o.
minimal change disease (lipoid nephrosis)
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)
minimal change disease is clinically associated with
respiratory infections
prophylactic immunization
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
_____ are very effective with minimal change disease
corticosteroids
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
focal segmental glomerulosclerosis is frequently accompanied by
nephROTIC syndrome or heavy protein uria
electron microscopy for focal segmental glomerulosclerosis shows:
pronounced focal detachment of visceral epithelial cells with denudation of underlying GBM
focal segmental glomerulosclerosis affects ____ with better prognosis, and has higher incidence in ___ & ____
kids
males
african americans
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
progression of chronic renal failure varies from ____ to ___ ; tested using
several months to several years
GFR
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
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
genetic condition characterized by kidney disease, loss of hearing before 30 y.o., eye abnormalities, affects mostly MALES
alport syndrome
destruction of tubular epithelial cells of nephron, present with acute toxic kidney injury and ischemia
acute tubular necrosis
acute tubular necrosis is USUALLY ______; lab findings include:
reversible reduced GFR increased blood levels of BUN and creatinine severe oliguria hematuria casts
diseases (genetic, congenital, or acquired) of PROXIMAL renal tubules of kidneys with inadequate reabsorption of AA, uric acid, glucose, phosphates, bicarbonates
Fanconi’s syndrome
urinalysis of Fanconi’s syndrome
mild proteinuria/aminoaciduria
glycosuria
hyperuricosuria
(may result in renal tubular acidosis)
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
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
kidney tubules defect that affects ability to respond to ADH
nephrogenic diabetes insipidus
nephrogenic diabetes insipidus is in contrast to _______, which is caused by INSUFFICIENT levels of ADH
central/neurogenic diabetes inspidus
patient passes LARGE volume of urine with LOW specific gravity; usually affects MEN
nephrogenic diabetes insipidus
autosomal recessive disorder that involves inadequate reabsorption of glucose due to proximal tubules dysfunction; ketones are NEVER present; renal histology is normal
renal glycosuria
form of nephritis affecting interstitium of kidneys surrounding tubules; interferes with kidney function
acute interstitial nephritis
acute interstitial nephritis results from (3)
allergic reactions to meds
infection
intoxication
acute interstitial nephritis is manifested by
hematuria increased WBCs in urine fever rash increased or decreased urine output mental status changes nausea, vomiting
acute onset in patients with severe liver diseases; progressively intense VASOCONSTRICTION which leads to oliguria, elevated BUN, creatinine and renal failure
hepatorenal failure
urinary findings for hepatorenal failure
oliguria dark color urine increased specific gravity low sodium no proteinuria or abnormal crystals
autosomal recessive diseases occurring rarely; due to non-production of enzyme phenyalanine hydrolase, blockage of normal conversion to tyrosine
phenylketonuria (PKU)
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
___ tests detect PKU early; people affected usually have ___ skin and ___ hair
blood
pale skin
blonde hair
autosomal recessive disorder, in which there is a lack of enzyme homogentisic acid oxidase in tyrosine pathway –> accumulation of homogentisic acid in tissues
alkaptonuria
color of urine with alkaptonuria
black
accumulation of homogentisic acid in cartilage results in its degeneration- this is called:
ochronosis
rare, inherited metabolic disorder in which patients cannot breakdown leucine, isoleucine or valine; AA and their ketone-acids are excreted
maple syrup urine disease
maple syrup urine disease can be controlled if detected before the _____
11th day after birth
symptoms of maple syrup urine disease
brain damage cataracts jaundice enlarged liver kidney damage
inherited disease that is characterized by inadequate reabsorption of AA in PROXIMAL convoluted tubules
cystinosis (cystine disorders)
cystinuria exists in 2 forms in cystinosis
- lysine, arginine, ornithine, and cystine cannot be reabsorbed
- only lysine or cystine cannot be reabsorbed
inherited disorders in which clusters of noncancerous cysts develop primarily within the kidney
polycystic kidney disease (PKD)
PKD is associated with
aortic aneurysms
brain aneurysms
cysts in liver, pancreas and testes
diverticula of colon
______ PKD often develops btwn 30-40 yo; only one parents needs to have disease, MC
autosomal dominant
_____ PKD appears shortly after birth, both parents must have it, less common
autosomal recessive
symptoms of PKD
high BP back pain headache increase in size of abdomen lood in urine frequent urination kidney failure UTIs
