27 Intrarenal Disorders

Question 1

Intrarenal Disorders

Answer 1

occurs within kidney

-potential to result in renal insufficiency or failure

Question 2

5 types of Intrarenal Disorders

Answer 2

1 Congenital
2 Neoplastic
3 Infectious
4 Obstructive
5 Glomerular

Question 3

Nephralgia

Answer 3

kidney/renal pain

• generally felt at COSTOVERTEBRAL ANGLE
• –recorded as CVA tenderness or flank pain

Question 4

nephralgia is due to…

Answer 4

distention/inflammation of renal capsule

Question 5

dermatome

Answer 5

area of skin innervated by a specific spinal cord segment

Question 6

nephralgia is transmitted to T10 + L1 via…

Answer 6

sympathetic afferent neurons

-mat be felt throughout dermatomes

Question 7

Urinalysis

Answer 7

• DIPSTICK + MICROSCOPIC URINALYSIS

- –results provide clues to intrarenal pathologies

Question 8

Abnormal Urinalysis Findings

Answer 8

dark, strong smell: DECR RENAL FUNCTN

cloudy, pungent: INFECTIOUS PROCESS

Question 9

Diagnostic/Imaging Tests

Answer 9

1 KUB
2 Renogram/Renal Scan
3 Ultrasonography
4 CT/MRI

Question 10

KUB

Answer 10

ID gross abnormalities related to size, position, + shape

-may show renal calculi

Question 11

Renogram/Renal Scan

Answer 11

reveals renal vasculature + tumors

Question 12

Ultrasonography

Answer 12

differentiates bw diff tissue characteristics

Question 13

CT/MRI

Answer 13

detailed info about vasculature + tissue

Question 14

Renal Agenesis

Answer 14

kidneys don’t dvlp in fetus

-either bilateral or unilateral

Question 15

BILATERAL AGENESIS of kidney

Answer 15

NOT COMPATIBLE W LIFE

Question 16

unilateral agenesis of kidney

Answer 16

compensatory hypertrophy of functional kidney

Question 17

Renal Hypoplasia

Answer 17

some fetal kidney dvlpt

• can lead to pediatric end-stage renal failure
• SINGLE NORMAL KIDNEY CAN MAINTAIN NORMAL RENAL FUNCTION
• requires lifelong kidney monitoring

Question 18

Cystic Kidney Disease

Answer 18

genetically transmitted renal disorder

• results in FLUID-FILLED CYSTS that can expand + disrupt urine formation + flow
• may be localized to one area or affect both
• can lead to renal failure
• may require dialysis or transplant in late stage

Question 19

2 types of Cystic Kidney Disease

Answer 19

1 Autosomal RECESSIVE: at birth

2 Autosomal DOM: later in life

Question 20

Renal Carcinoma

Answer 20

• metastatic disease

- ASYMPTOMATIC until advanced

Question 21

Hematuria

Answer 21

• presence of blood in urine
• a sign of renal carcinoma, nephroblastoma (Wilms Tumor), or bladder cancer
• sometimes in chronic glomerulonephritis

Question 22

Renal Carcinoma

S/S + staging

Answer 22

ASYMPTOMATIC until advanced

• CVA tenderness
• hematuria
• palpable mass

Staging: I-IV

Question 23

Renal Carcinoma

treatment

Answer 23

• NEPHRECTOMY

- resistant to radiatoin, immunotherapy, + chemotherapy (p53 mutation)

Question 24

Nephroblastoma

Answer 24

aka Wilms Tumor

-most common kidney cancer in children

Question 25

Nephroblastoma | clinical manifestation

Answer 25

- palpable abdominal mass - abdominal pain - HYPERTENSION - hematuria

Question 26

Nephroblastoma | treatment

Answer 26

- nephrectomy - radiatoin - chemotherapy * **excellent cure rate!

Question 27

Pyelonephritis

Answer 27

infection of the kidney

Question 28

most common Pyelonephritis

Answer 28

ascending infection fr lower urinary tract -effective preventative measure is early removal of caterers

Question 29

Acute Pyelonephritis

Answer 29

infection of renal pelvis or parenchyma | --usually fr ascending UTI

Question 30

Renal Cell Carcinoma | risk factors

Answer 30

familial pattern: | smoking, obesity, hypertension

Question 31

Acute Pyelonephritis | clinical manifestations

Answer 31

- CVA tenderness - fever - chills - N/V - anorexia

Question 32

Acute Pyelonephritis | diagnosis

Answer 32

presence of WBC casts | --indicative of upper UTI

Question 33

Acute Pyelonephritis | treatment

Answer 33

antimicrobials avoids decreased renal function

Question 34

classic sign of Acute Pyelonephritis

Answer 34

CVA tenderness

Question 35

anorexia in acute pyelonephritis will...

Answer 35

increase fever-induced hydration

Question 36

Obstruction

Answer 36

conditions that interfere w the flow of urine

Question 37

Urine Stasis

Answer 37

predisposes to infections + structural damage | -caused by renal obstruction

Question 38

Obstruction | common causes

Answer 38

1 Stones 2 Tumors 3 Prostatic Hypertrophy 4 Strictures of the ureters or urethra

Question 39

Stones

Answer 39

most common cause of renal obstruction | -composed of Ca crystals, uric acid, struvite, cystine

Question 40

Complete renal obstruction results in

Answer 40

``` 1 Hydronephrosis 2 Decreased GFR 3 Ischemic kidney damage 4 Acute Tubular Necrosis 5 Chronic Kidney Disease ```

Question 41

how does complete renal obstruction cause ischemic kidney damage?

Answer 41

because of increased intraluminal pressure

Question 42

Acute Tubular Necrosis

Answer 42

intrarenal acute renal failure | ---self limiting disorder

Question 43

Acute Glomerulonephritis

Answer 43

immune response to variety of potential triggers | -attraction of immune cells to area of inflammation results in LYSOSOMAL DEGRADATION OF THE BASEMENT MEMBRANE

Question 44

In acute glomerulonephritis, why might GFR fail?

Answer 44

contraction of mesangial cells results in decreased surface area for filtration

Question 45

what happens when immune cells come to an area of inflammation (acute glomerulonephritis)?

Answer 45

lysosomal degradation of basement membrane

Question 46

Acute Glomerulonephritis | clinical manifestations

Answer 46

1 proteinura 2 oliguria + azotemia 3 edema + hypertension

Question 47

Acute Glomerulonephritis | treatment

Answer 47

1 steroids 2 plasmapheresis 3 supportive measures (diet + fluid) 4 mgmt of systemic + renal hypertension

Question 48

Chronic Glomerulonephritis

Answer 48

- progressive course that ultimately dvlps to END-STAGE RENAL DISEASE - sclerosis + fibrosis of kidney

Question 49

Chronic Glomerulonephritis | clinical manifestation

Answer 49

- persistent PROTEINURA - w/ w/o hematuria - slowly declining renal function

Question 50

Chronic Glomerulonephritis | treatment

Answer 50

dialysis or kidney transplant is necessary | -supportive interventions throughout course of disease

Question 51

Nephrotic Syndrome

Answer 51

occurs due to INCREASED flomerular permeability to proteins | -urinary loss of 3-3.5g of protein/day

Question 52

proteinuria leads to...

Answer 52

1 HYPOALBUMINEMIA 2 generalized EDEMA 3 decr blood colloid osmotic pressure

Question 53

increase in liver activity can cause...

Answer 53

1 Hyperlipidemia | 2 Hypercoagulability

Question 54

most common finding in nephrotic syndrome?

Answer 54

Edema

Question 55

Nephrotic Syndrome | clinical manifestation

Answer 55

``` 1 proteinuria (3-3.5g) 1a hypoalbuminemia 1b edema 1c decr blood colloid osmotic pressure 2 incr liver activity 2a hyperlipidemia 2b hypercoagulability ```

Question 56

Nephrotic Syndrome | treatment

Answer 56

``` conservative symptom mgmt 1 diuretics 2 lipid-lowering agents 3 antihypertensives 4 immunosuppression/immunomodulation ``` - mgmt of underlying process when IDd - may resolve spontaneously or progress to end-stage renal disease

Question 57

child w hypertension is a sign of

Answer 57

nephroblastoma/wilm tumor

Question 58

types of kidney infections

Answer 58

``` acute pyelonephritis (pelvic/parenchyma infection, FEVER, WBC cast) acute glomerulonephritis (immune, infection, inflammation, lysosomal degradation) ```

Question 59

wbc cast

Answer 59

acute pyelonephritis

Question 60

hydronephrosis

Answer 60

build-up of urine in kidney from backflow due to obstruction below.