Urogenital - renal patho Flashcards
causes of chronic renal failure
- Diabetic nephropathy
- Glomerulonephritis
- Hypertensive nephrosclerosis
- Interstitial nephritis
- Chronic urinary outflow tract obstruction
- Pyelonephritis (kidney inflammation)
- Polycystic kidney disease
- congenital kidney diseases / malformations
- tumours
complications of end-stage renal disease (ESRD) (7)
- dehydration, anemia, hyperkalemia, metabolic acidosis
- hyperphosphataemia, hypocalcemia, hyperparathyroidism, renal osteodystrophy
Systems:
- cardiopulmonary: HTN, HF, Cardiomyopathy, Pulmonary oedema, uraemic pericarditis
- GIT: Nausea and vomiting, bleeding, esophagitis, gastritis, colitis
- neuromuscular: myopathy, peripheral neuropathy, encephalopathy
- skin: dermatitis, pruritus (itch)
treatment for chronic renal failure (3)
- Hemodialysis: removal of solutes across a semi-permeable membrane within a dialysis machine
3x a week, requires pt to go down to NKF - peritoneal dialysis: removal of solutes across the peritoneal membrane into peritoneal dialysate fluid
- renal transplant
pt needs to be on immunosuppressive therapy for rest of life to prevent organ rejection
chronic renal failure
- gross and micro appearance
- clinical presentation
- BILATERAL small contracted kidneys
- Widespread glomerulosclerosis, tubular atrophy and interstitial fibrosis
- polyuria - cause tubules cannot concentrate the filtrate
acute renal failure
- clinical presentation
- oliguria/ anuria = decrease/ absence of urine production
- azotaemia = rise in serum creatinine
acute renal failure causes
- pre-renal, renal, post-renal
- pre-renal (blood supply TO kidney is poor)
HTN, hemorrhage, dehydration, shock, heart disease, liver failure - renal (kidney disease)
- Glomerulonephritis
- Acute tubular necrosis (due to drugs, toxins, pigment)
- Acute interstitial nephritis
- Haemolytic uraemic syndrome (HUS)
- vasculitis
- severe infections (pyelonephritis)
- post-renal (exit renal system)
Acute urinary tract outlet obstruction (due to blood clots, stones, tumour)
Acute atonia, hypotonia (loss of muscle tone) of the bladder to the nerve damage (neurogenic bladder) -> lack of bladder control
renal failure investigations (4)
- Blood tests: Urea, Creatinine, Electrolytes
- Urine tests: Protein, RBCs, WBCs, Haemoglobin, Myoglobin
- Imaging studies: IVU, Ultrasound of the Kidneys, CT urogram, CT / MRI
- kidney biopsy: light/electron microscopy, IF
clinical presentation of glomerular disease
glomerulus becomes leaky/ cannot filter through
presentations:
- Nephrotic syndrome: leaky filters
- Nephritic syndrome: some glomeruli leaky, some unable to filter
- Microscopic haematuria: mild leak
- ARF: sudden development of inability to filter
- CRF: slow development of inability to filter
nephrotic syndrome**
- pathology + causes (5)
- clinical manifestations (4)
- leaky filter, w/o inflammation
causes
- Minimal change disease
- Idiopathic focal segmental glomerulosclerosis (FSGS)
- Membranous glomerulonephritis
- Membranoproliferative glomerulonephritis
- IgA nephropathy
- heavy proteinuria: 3.5g of protein loss/ day
- hypoalbunemia: liver cannot produce enough albumin to maintain normal serum levels
- Anasarca: generalized edema due to decrease in serum oncotic pressure -> starling’s forces
- lipiduria
nephrotic syndrome
- clinical symptoms (2)
- generalised edema: face (eyelids), abdomen (ascites), ankle
- Large urine volumes with frothy urine
cause of high protein levels in urine -> decrease surface tension of liquid -> bubbling
clinical consequence of nephrotic syndrome affecting diff age groups
- differential diagnosis
- affects response to steroidal therapy
children usually more sensitive to steroids
nephritic syndrome
- pathology
- clinical manifestations (6)
- damaged glomeruli: some cannot filter, some leaky
- Oliguria: decrease in urine volume, because of poor filtration
- Azotaemia: elevation of serum creatinine level
- Oedema: due to fluid retention (but not as prominent as in nephrotic syndrome)
- HTN: due to fluid retention
- Gross hematuria: presence of RBCs in the urine, often with red cells found in urine microscopy
- Proteinuria
largely caused by IVDA
glomerulonephritis
definition
includes diseases characterized by increased glomerular cellularity caused by proliferation of indigenous cells and/or leucocyte infiltration
glomerular injury caused by antibodies
- In situ formation of Ag-Ab Complexes
against native antigen (Anti-GBM = Goodpasture’s disease - autoimmune against lungs/kidneys)
against planted antigen that localises in glomerulus (HBV) - Circulating immune complexes (lupus nephritis)
- Antineutrophil Cytoplasmic Antibodies (ANCA)
stimulate inflammatory response in the glomeruli -> glomerular injury
diagnosis of immune complexes (3 methods)
- Immunofluorescence: Granular staining seen when immune complex is present
Allows determination of what types of antibody and complement involved
-> C3 = proteinuria, hematuria
-> IgM/ IgG - Electron microscopy:
Allows more precise localisation of immune complexes
identification of ultrastructural pathology (GBM abnormalities) - light microscopy