1 - Renal Patho Flashcards by Joanna Brown

What is the most common types of urinary dysfunction?

Infection (duh)

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What is obstructive uropathy?

Anatomic changes in the urinary system caused by obstruction

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Define the following

hydroureter

hydronephrosis

ureterohydronephrosis

accumulation of urine in the ureter

enlargement of renal pevlis and calyces

dilation of both ureter and pelvicaliceal system

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What causes tubulointerstitial fibrosis?

Imbalance between cytokines (causing breakdown) and growth factors (causing rebuilding)

Fibroblasts deposit an excessive amount of extracelullar matrix, leading to fibrosis of the tubule

Angiontensin II and aldosterone are involved in creating this imbalance

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Relief of a urinary tract obstruction of one kidney is usually followed by ________

a brief period of diuresis

postobstructive diuresis

Can sometimes be extreme and require intervention

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What is nephrolithiasis?

Kidney stones, renal calculi

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Why is the prevalence of stones dependent on geographic location?

average temperature, humidity, rainfall influence fluid intake and dietary patterns

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Most stones are made up of:

70-85% are calcium oxalate or phosphate

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Which tends to cause calcium phosphate stone formation: Urine that is alkaline or acidic

Alkaline

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Which tends to cause uric acid stones: Urine that is alkaline or acidic

acidic

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Name four crystal growth inhibiting substances:

Uromodulin
K citrate
pyrophosphate
magnesium

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Stones smaller than _______ have a 50% chance of passing spontaneously.

Stones larger than ______ will never pass spontaneously.

5mm

1cm

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What is renal colic?

moderate to severe pain flank pain that radiates depending on where the obstruction is

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Prevention of stones includes drinking enough water to result in ________ L of urine per day

2.5

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What substance in soda causes stones?

phosphoric acid

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Lower motor neuron disorders may cause ______

Upper motor neuron disorders may cause _______

detrusor hyperreflexia

detrusor areflexia

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What is the difference between overactive bladder syndrome and underactive bladder syndrome?

OAB results from detrusor overactivity, but the detrusor isn’t strong enough to empty the bladder, resulting in urinary retention. It causes symptoms of urgency.

UAB is caused by bladder contractions that aren’t strong enough to totally empty the bladder. They can initiate, but they can’t pee completely.

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What usually causes bladder outlset obstruction in women with pelvic organ prolapse?

A cystocele

Due to decreased vaginal tone, the back of the bladder collapses below the neck of the bladder, causing difficulty emptying the bladder, and weakening the detrusor muscle

The detrusor muscle hypertrophies, which initially compensates but ultimately leads to poor bladder wall compliance

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What is the most common renal neoplasm?

Renal cell carcinoma

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What is the most common bladder malignancy?

urothelial carcinoma

appears on the inner lining of the bladder

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What constitutes recurrent UTIs?

thre or more in 12 months

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The pathogen most commonly responsible for UTI is:

E Coli (80-85%)

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________ mechanisms are the major cause of acute glomerulonephritis

immune

Most common: Type III hypersensitivity 2/2 deposition of circulating immune complexes in the glomerulus

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Nephrotic syndrome is characterized by _______

Nephritic syndrome is characterized by _______

Both are features of different types of _________

gross proteinuria and lipid sediments

red blood cells escaping through the membrane and proteinuria (less severe)

glomerulonephritis

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Severe glomerular disease causes: (3)

oliguria hypertension renal failure

Why does diabetic nephropathy occur?

1. Accumulation of glycosylated end products 2. Inflammatory growth factors 3. vascular changes 2/2 hyperglycemia

Why does lupus cause nephritis?

glomerular deposition of immune complexes complement activation

What causes nephrotic syndrome?

disturbances in the glomerular basement membrane and podocyte injury leads to loss of negative charged proteins and increased permeability

Nephrotic syndrome most often occurs with \_\_\_\_\_\_\_\_ Nephritic syndrome most often occurs with \_\_\_\_\_\_\_\_\_

minimal-change nephropathy (more common in kids) infection-related glomerulonephritis, RPCG, lupus

Nephrotic syndrome is treated by consuming a moderate _________ diet

protein restricted low fat salt restricted

# Define the following: Renal Insufficiency Renal Failure ESRD

25% of renal function / GFR \< 25-30 significant loss of renal function 10% of renal function

Both _____ and _____ refer to indications of accumulated nitrogenous waste products in the blood

uremia azotemia

An AKI has a mortality rate of \_\_\_\_\_\_\_

50-80%

The most common cause of AKI is:

reduced perfusion (pre-renal)

prerenal AKI can result from renal vasocontriction caused by:

NSAIDs Contrast

When renal perfusion is compromised, the kidney can initially maintain the GFR by afferent _______ and efferent \_\_\_\_\_\_\_

dilation constriction

\_\_\_\_\_\_ antibiotics are particularly likely to cause nephrotoxic ATN

aminoglycosides (getnamicin, neomycin, tobramycin)

Which tubule is most susceptible to injury? Why?

proximal Designed to be highly reabsorptive with a high surface area and thick brush border tends to absorb the majority of nephrotoxic things

Which AKI is associated with complete anuria?

postrenal obstruction

What are the symptoms of uremia?

hypertension anorexia n/v/d or constipation malnutrition and weight loss pruritis edema anemia CV/neuro/skeletal issues etc

Why does renal disease cause hypocalcemia?

impaired renal synthesis of calcitriol leads to decreased intestinal absorption of calcium phosphate excretion is reduced, so phosphate binds to calcium and further reduces serum calcium levels decreased calcium levels spark increased PTH secretion, which results in bone breakdown (secondary hyperPTH)

Why does renal disease cause dyslipidemia?

uremia causes a deficiency in lipoprotein lipase and hepatic triglyceride lipase Causes dysregulation of HDL and LDL levels

Is the urine of infants more or less dilute? Why?

More dilute Very low concentrating ability The medulla is highly perfused and the loops are short The immature kidney isn't as responsive to vasopressin

Why is urea excretion low in infants?

They are in a high anabolic states and use pretty much any available proteins for growth no proteins are getting broken down, so no urea is formed

Compared to adults, the percentage of ECV in the newborn is \_\_\_\_\_\_

nearly double!

Glomerulonephritis begins with the deposition of _______ in the glomerulus

antigen-antibody complexes of IgG and C3 complement

Glomerulonephritis in children usually follows a ______ infection

Group A beta hemolytic streptococcal

Symptoms of glomerulonephritis generally begin _______ weeks after a URI and ______ weeks after a skin infection

1-2 weeks up to 6 weeks

What percentage of children with PSGN develop end stage renal disease?

1% 95% have a complete recovery

What is the most common form of glomerulonephritis in children worldwide?

IgA nephropathy

What percentage of children with IgA require dialysis or transplantation?

20-40%

What causes IgA nephropathy?

abnormal IgA is produced by the bone marrow, which can activate compliment and spark an immune inflammatory reaction The ensuing complex is deposited in the glomerulus

What is the most common community acquired cause of acute renal failure in young children

Hemolytic Uremic Syndrome

What is Hemolytic Uremic Syndrome?

hemolytic anemia that leads to renal impairment

What causes hemolytic uremic syndrome?

verotoxin from E. Coli is absorbed from the intestines into the blood It binds to leukocytes and is transported to the kidney In the kidney, inflammatory cascade leads to lysis of glomerular capillary endothelial cells which ends up clotting the glomerular arterioles glomerular filtration decreases Narrowed vessels damage red blood cells, hence the hemolytic anemia

HUS is usually preceeded by:

A GI diarrheal infection

Approximately 95% of cases of nephrotic syndrome in children occur without \_\_\_\_\_\_\_

a history of systemic or pre-existing renal disease

What is a Wilms Tumor?

Nephroblastoma abnormal proliferation of renal stem cells

How do most Wilms tumors manifest?

90% are an asymptomatic enlarging upper abdominal mass in a health, thriving child

Why would an increase in efferent arteriolar resistance cause increased reabsorption in the peritubular capillaries?

Decreased flow through the efferent arteriole means decreased flow through the peritubular capillaries this means decreased hydrostatic pressure in the peritubular capillaries, which means increased reabsorption