71: Urinary System-Clincal Consideration

Question 1

A hereditary disorder of basement membrane collagen- defective alpha chains.

Answer 1

Alport syndrome

Question 2

The clinical manifestations of Alport Syndrome:

Answer 2

• Hematuria
• Progressive renal failure
• Neurosensory hearing loss (deaf by 25 years)
• Ocular abnormalities
• Lens, fundus are affected

Question 3

Alport Syndrome causes splitting and damage of the basement membrane that leads to leakage of….. and ………. - Hematuria - Proteinuria - Pedal edema
- Eventual renal failure by 50 years

Answer 3

Proteins and RBCs

Question 4

Goodpasture Syndrome

Answer 4

Autoantibody reacts with type IV collagen of glomerular & alveolar capillary basement membrane

Question 5

Goodpasture Syndrome affects …….. and ……… and causes intra-alveolar hemorrhage, atrophy of the glomerulus, and epithelial crescent fills Bowman’s space.

Answer 5

Affects kidney and lungs

Question 6

Immune mediated disease where sub-epithelial deposition of antigen-antibody complexes in the GBM and uniform thickening of GBM.

Answer 6

Membranous Glomerulonephritis

Question 7

Membranous glomerulonephritis causes …….trigger the synthesis & liberation proteases and oxygen radical by podocytes, mesangial cells, and endothelial cells which disrupts the integrity of GBM

Answer 7

Membrane complexes

Question 8

Membranous glomerulonephritis causes ……….. which leads to massive proteinuria, hypoalbuminemia, and anasarca (generalized body swelling)

Answer 8

Leaky Barriers

Question 9

Recurrent painless macroscopic hematuria following viral illness (24 - 48 hours) that results in the predominant deposition of IgA and complement complexes in glomerular mesangial matrix following RTI or GI infection

Answer 9

IgA Nephropathy

Question 10

IgA Nephropathy causes ……….. due to swelling of the renal capsule. Leukocyte infiltration and cytokine release will stimulate mesangial proliferation and hypercellularity

Answer 10

Flank Pain

Question 11

Complement activation in IgA nephropathy leads to damage of ………………surface leading to hematuria

Answer 11

Glomerular filtration

Question 12

Clinical Manifestations of IgA Nephropathy:

Answer 12

• Enlarged, hypercellular glomeruli.
• Hyperplasia of epithelium & endothelium.
• Inflammatory cells.
• Collapsed capillaries > obstruction to blood flow.

Question 13

Proliferation of epithelial cells and monocytic phagocytes within Bowman’s capsule.

Answer 13

Rapidly progressive glomerulonephritis

Question 14

Signs of Glomerulonephritis (GN):

Answer 14

Rapid decline in renal function

Hallmark - “ cellular crescents”

Question 15

Diabetic glomerulosclerosis:

Answer 15

• Kimmelsteil-Wilson Lesion involves atherosclerosis of larger vessels & hyalinization of arterioles
• Deposits of hyaline material in the mesangium of the renal corpuscles
• Diffuse infiltration of glomerular tuft with eosinophic material & also focal deposits

Question 16

Untreated ……….. is one of the principle causes of renal failure

Answer 16

Hypertension

Question 17

Increased tension in the vessels due to hypertension lead to ……….. of the walls and reduction in the caliber of the vessel

Answer 17

Hyalinization (H)

Question 18

• Autosomal recessive PKD-the cysts are dilated elongations of the collecting tubules and radially arranged
• Fatal in first few months of life
• Protein affected-fibrocystin

Answer 18

Congenital Polycystic Kidney Disease

Question 19

Autosomal dominant disease where cysts of the kidney are not usually present at birth, but develop slowly over time causing renal failure in middle age.
• Defective protein-polycystin

Answer 19

Adult Polycystic Kidney Disease

Question 20

Characteristics of Adult Polycystic Kidney Disease:

Answer 20

• Assoc. with HTN, haematuria & cardiac abnormalities
• No normal tubules
• Thinned out tubules
• Glomeruli appear normal
• 77% -suffer renal failure

Question 21

All of the following can cause …………
•Medications
•Iodine containing contrast agents
• Metals – lead, mercury, cadmium, copper, gold, arsenic
•Toxins
•Infections
•Ischemia and hypovolemic shock •Mechanical obstruction

Answer 21

Acute tubular injury

Question 22

The most common cause of………. is acute ischemia due to hypotension and ……… is a common cause of acute renal failure..

Answer 22

Acute Tubular Necrosis

Question 23

Acute Tubular Necrosis mostly affects the .............and causes:
• Dilated  tubule 
• Flattened epithelium 
• Loss of brush border and infoldings
• Anuria/oliguria & renal failure

Answer 23

Proximal Convoluting Tubule

Question 24

During acute tubular necrosis, most of ……….. is destroyed & sloughed into the lumen. Surviving cells attempt to repair and are lined by flat, elongated cells

Answer 24

Epithelium

Question 25

Acute suppurative bacterial infection | •Common in : benign prostatic hyperplasia & in pregnancy

Answer 25

Acute pyelonephritis

Question 26

Acute pyelonephritis is neutrophil infiltration of the renal interstitium causing ............... and obstruction of the drainage system (calyces, ureters) may result in hydronephrosis & hydroureters.

Answer 26

Chronic inflammation

Question 27

The following is characteristic of .............. pyelonephritis. • Bacterial infection of kidney from the bladder • Caused by E.coli, Proteus etc • Destruction of tubules>glomeruli • *Epithelium -swollen & granular • **Tubule full of pus & lost their epithelial lining • Large amount of polymorphs

Answer 27

Acute Pyelonephritis

Question 28

The following is characteristic of .............. pyelonephritis. • Kidneys are reduced in size & scarred • Follows recurrent acute episodes • Glomeruli are completely fibrosed & avascular • Crowding of hyalinised glomeruli • Tubules are dilated and have casts • Heavy infiltration of lymphocytes & plasma cells

Answer 28

Chronic Pyelonephritis

Question 29

Embolus and Sickle Cell Crisis can cause ........ in the kidney.

Answer 29

Renal infarctions * Embolus:-Can cause focal or global infarct * Sickle cell crisis- Slit-like infarcts

Question 30

Major cause of ......... is atheromatous plaques which leads to hypertension (due to increased production of renin and subsequent circulation of angiotensin II)

Answer 30

Renal Artery Stenosis

Question 31

Angiotensin I activated to angiotensin II by ........

Answer 31

Pulmonary endothelial cells

Question 32

Functions of Angiotensin II:

Answer 32

– potent vasoconstrictor – stimulates aldosterone secretion from adrenal cortex – aldosterone stimulates reabsorption of Na+ and secretion of K+ by connecting tubules and collecting ducts

Question 33

Risk factors for Renal cell carcinoma:

Answer 33

Risk: Male, 60-70yrs, smoking, obesity, hypertension

Question 34

Signs and Symptoms of Renal cell carcinoma:

Answer 34

Classic Triad: • Hematuria 50% of cases • Flank pain • Abdominal mass

Question 35

Renal cell carcinoma originate from.........

Answer 35

Renal tubular epithelial cells (adenocarcinoma)

Question 36

Transitional cell (urothelial) carcinoma:

Answer 36

Cancer of the transitional cells of the bladder