Selected Renal and Metabolic Diseases

Question 1

ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS
- Classify the disorder
a. Describe the etiology of the disease
b. Identify the symptoms
c. Identify prominent urine and blood laboratory values and explain their
relationship to the renal disorder
d. Identify prognosis (when provided in notes)

Answer 1

• Glomerular disorder
  a. Immune complexes deposit on the glomerular membrane following Group A
  Strep infection
  b. Rapid onset of hematuria and edema*
  Fever, hypertension
  Oliguria to anuria
  c. Urinalysis results
  
  • Marked hematuria*
  • Proteinuria
  • RBC Casts*
  • Hyaline Casts
  • Granular Casts
  • WBCs
    Blood results
  • Increased serum BUN
    d. Permanent kidney damage seldom occurs

Question 2

RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS
- Classify the disorder
a. Describe the etiology of the disease
b. Identify the symptoms
c. Identify prominent urine and blood laboratory values and explain their
relationship to the renal disorder
d. Identify prognosis (when provided in notes)

Answer 2

• Glomerular disorder
  a. Deposition of immune complexes in glomerulus leading to the formation of crescentic structures in Bowman’s space composed of macrophages, fibrin, and fibroblasts
  b. NONE LISTED IN LECTURE NOTES
  c. Urinalysis
  
  • Hematuria
  • Low GFR
  • Proteinuria
    d. Progresses to chronic glomerulonephritis and eventually end-stage renal
    failure

Question 3

GOODPASTURE SYNDROME
- Classify the disorder
a. Describe the etiology of the disease
b. Identify the symptoms
c. Identify prominent urine and blood laboratory values and explain their
relationship to the renal disorder
d. Identify prognosis (when provided in notes)

Answer 3

• Glomerular disorder
  a. Anti-glomerular basement membrane autoantibody formed after viral
  respiratory infection or inhalation of chemicals causing pulmonary injury
  b. Pulmonary: hemoptysis and dyspnea
  c. Urinalysis
  
  • Proteinuria
  • Hematuria
  • RBC casts
    d. Progresses to chronic glomerulonephritis and eventually end-stage renal
    failure

Question 4

CHRONIC GLOMERULONEPHRITIS
- Classify the disorder
a. Describe the etiology of the disease
b. Identify the symptoms
c. Identify prominent urine and blood laboratory values and explain their
relationship to the renal disorder
d. Identify prognosis (when provided in notes)

Answer 4

• Glomerular disorder
  a. Marked decrease in renal function resulting from glomerular damage
  precipitated by other renal disorders
  b. Fatigue, anemia, hypertension, edema, markedly decrease GFR, increased
  BUN and creatinine, electrolyte imbalance
  c. Urinalysis
  
  • Hematuria
  • Proteinuria
  • Glucosuria
  • RBC and WBC casts
  • Granular casts
  • Waxy and broad casts*
    d. Kidney failure

Question 5

NEPHROTIC SYNDROME
- Classify the disorder
a. Describe the etiology of the disease
b. Identify the symptoms
c. Identify prominent urine and blood laboratory values and explain their
relationship to the renal disorder
d. Identify prognosis (when provided in notes)

Answer 5

• Glomerular disorder
  a. Glomerular damage coupled with the disruption of the electrical charge of
  the tubular epithelium results in a leaky tubular epithelium
  b. Edema
  c. Lab results
  
  • Serum hypoproteinemia
  • Serum hyperlipidemia
  • Low immunoglobulins
  • Low coagulation factors
  • Azotemia
  • Hypertension
    Urinalysis results
  • Proteinuria*
  • Hematuria
  • Lipiduria
  • Oliguria
  • Fatty casts*
  • Waxy casts
  • Renal tubular casts
    d. Kidney failure

Question 6

ACUTE TUBULAR NECROSIS
- Classify the disorder
a. Describe the etiology of the disease
b. Identify the symptoms
c. Identify prominent urine and blood laboratory values and explain their
relationship to the renal disorder
d. Identify prognosis (when provided in notes)

Answer 6

• Tubular disorder
  a. Damage to the renal tubular cells caused by ischemia, toxic agents
  b. NONE LISTED IN LECTURE NOTES
  c. Lab results
  
  • Low hemoglobin
  • Low hematocrit
  • Elevated cardiac enzymes
    Urinalysis results
  • Hematuria
  • Proteinuria
  • Renal tubular epi cells in sheets*
  • Renal tubular epi cell casts
  • Variety of casts
    d. Variable dependent on underlying cause

Question 7

FANCONI’S SYNDROME
- Classify the disorder
a. Describe the etiology of the disease
b. Identify the symptoms
c. Identify prominent urine and blood laboratory values and explain their
relationship to the renal disorder
d. Identify prognosis (when provided in notes)

Answer 7

• Tubular disorder
  a. Failure of reabsorption in the PCT
  b. NONE LISTED IN LECTURE NOTES
  c. Lab results
  
  • abnormal serum electrolytes
  • abnormal amino acid chromatography
  • normal blood glucose
    Urinalysis results
  • glucose
  • cystine crystals

Question 8

CYSTITIS
- Classify the disorder
a. Describe the etiology of the disease
b. Identify the symptoms
c. Identify prominent urine and blood laboratory values and explain their
relationship to the renal disorder
d. Identify prognosis (when provided in notes)

Answer 8

• Interstitial disorder
  a. Bladder infection (usually E. coli)
  b. Pain and burning during urination, increased frequency of urination, mental
  confusion
  c. Urine values: LE+, Nitrite+, Urine culture +, Bacteria +