4 - Kidney, UT Disorders Flashcards
Kidney
-basic physiology
One of the most highly differentiated organs in the body (~30 diff cell types)
Kidney and UT Disorders - basic types
-acute kidney injury
—describe
—epidemiology
Impairment of kidney filtration/excretory function over days-weeks -> retention of nitrogenous and other waste products
5-7% of acute care admissions
Up to 30% for the ICU
Kidney and UT Disorders - basic types -acute kidney injury —causes —dx —presentation —prognosis
Heart problems, infection, ischemia, toxins
- large variations in causes
- e.g. NSAID use, venomous caterpillar bites
Incr serum creatinine (toxic if not excreted) or decr urine output
Ranges: transient, rapidly fatal, etc.
Significantly incr risk of in-hospital and long-term mortality
Kidney and UT Disorders - basic types -chronic kidney disease —describe —staging —epidemiology
Spectrum of pathology processes assoc with abnormal kidney function and progressive decline in GFR
1-5 based on estimates of GFR and albuminuria
- stage 5 = end-stage
- albuminuria indirectly measures amount of blood filtered thru kidney
At least 6% of adults stages 1-2
4.5% stages 3-4
Kidney and UT Disorders - basic types -chronic kidney disease —causes —dx —presentation
Most commonly caused by DM2
-DM1 can also cause
HTN other main cause
Both DM and HTN can be causes or consequences
Est chronicity
Address specific causes, reduce intraglomerular HTN/proteinuria to decr progression = renal replacment therapy
Renal replacement therapy
- describe
- 2 types and descriptions
With end-stage renal failure, accumulation of toxins, fluid, electrolytes leads to death unless removed
Dialysis
- typically in-center hemodialysis
- replaces only a small fraction of filtration
- 5 year survival rate of 40%
Transplantation
- TOC for chronic renal failure
- improved lifestyle and expenctancy vs dialysis
Alport syndrome
- type of defect
- genetics
- signs/symptoms
Defect in genes encoding for collagen T4
-affects glomerular BM, cochlea, retina, lens capsule, cornea (Descemet’s and BM)
XL > AR»_space; AD
Kidney disease hematuria and proteinuria -> progressive renal failure
Sensorineural deafness
Ocular: retinopathy, anterior lenticonus, post polymorphous corneal dystrophy > RCE
Alport syndrome
-retina
Retinal findinds most common for Alport (70-80%)
Dot-fleck retina
Dull macular reflex
Usually not a whole lot of vision problems, just distinctive fundus
Alport syndrome
-len
Bulge in capsule (lenticonus) in ~25%
Can lead to cataract
Alport syndrome
-cornea
Corneal changes less common
Polymorphous dystrophy
Endothelial dysfunction -> edema
Fabry disease
- type of disease/describe
- genetics
Alpha-galactosidase A deficiency
- enzyme that breaks down certain types of fats in the body (hence spingolipidosis)
- defect -> accumulation (considered lysosomal storage disease)
XL
Fabry disease
- pathophys
- classic early symptoms (3)
Enzyme deficiency -> accumulation -> damage to vascular endothelium
-affects heart, brain, kidneys
Acroparesthesias - burning pain in hands/feet, tingling, “abnormal sensations in far periphery”
Angiokeratoma - splotchy blood-like spots on body, esp thighs
Hypohydrosis
Fabry disease
- key for ODs
- treatment
Early detection
-one of earliest changes is whorl/vortex keratopathy
HRT and newer oral drug
Von Hippel-Lindau (VHL)
- type of disease
- genetics
- dx
Mutation -> tumor of brain, eye, kidney, etc
-VHL gene’s job is to prevent tumor proliferation
AD
Genetic testing
Von Hippel-Lindau (VHL)
-tx of tumors as needed
—ocular
—systemic screening
Exudation/gliosis -> RD, etc.
-most serious (exud = exud RD, glio = tractional RD)
Eye tx mainly with photocoagulation (smaller lesions) and cryotherapy (larger)
Blood, urine, ultrasound
