CHAPTER 8: RENAL DISEASE

Question 1

Deposition of immune complexes, in conjunction with streptococcal Infection, on the glomerular membrane

Answer 1

Acute or Post-streptococcal
Glomerulonephritis

Question 2

Deposition of immune complexes from systemic immune disorders on the glomerular membrane

Answer 2

Rapidly Progressive Glomerulonephritis

Question 3

Attachment of a cytotoxic antibody formed during viral respiratory infections to glomerular and alveolar
basement membranes

Answer 3

Goodpasture’s Syndrome

Question 4

Binding of antineutrophilic cytoplasmic antibody to neutrophils in vessel walls

Answer 4

Wegener’s Granulomatosis

Question 5

Disruption of vascular integrity
following viral respiratory infections

Answer 5

Henoch-Schonlein Purpura

Question 6

Deposition of IgA on the glomerular membrane resulting from increased levels of serum IgA

Answer 6

IgA Nephropathy

Question 7

Thickening of the glomerular membrane following IgG immune complex deposition associated with systemic disorders

Answer 7

Membranous Glomerulonephritis (MGN)

Question 8

Type of MPGN that displays increased cellularity in the subendothelial cells of the mesangium (interstitial area of Bowman capsule), causing thickening of the capillary walls

Answer 8

Type 1 Membranoproliferative glomerulonephritis (MPGN)

Question 9

Type of MPGN that displays extremely dense deposits in the glomerular basement membrane, tubules, and Bowman capsule

Answer 9

Type 2 Membranoproliferative glomerulonephritis (MPGN)

Question 10

Type of MPGN that is characterized by both subepithelial and subendothelial deposits

Answer 10

Type 3 Membranoproliferative glomerulonephritis (MPGN)

Question 11

Refers to a sterile, inflammatory process that affects the glomerulus and is associated with the finding of blood, protein, and casts in the urine

Answer 11

Glomerulonephritis

Question 12

Marked by the sudden onset of symptoms consistent with damage to the glomerular membrane

Answer 12

Acute glomerulonephritis (AGN)

Question 13

Symptoms usually occur in children and young adults after respiratory infections caused by certain strains of group A β-hemolytic streptococci that contain M protein in the cell wall

Answer 13

Acute glomerulonephritis (AGN)

Question 14

Primary urinalysis findings include marked hematuria, proteinuria, and oliguria, accompanied by red blood cell (RBC) casts, dysmorphic RBCs, hyaline and granular casts, and white blood cells (WBCs)

Answer 14

Acute glomerulonephritis (AGN)

Question 15

These are a hallmark characteristic of acute glomerulonephritis

Answer 15

RBC casts

Question 16

Formerly called Wegener granulomatosis

Answer 16

Granulomatosis with polyangiitis (GPA)

Question 16

This autoantibody can be detected in a patient’s serum

Answer 16

Antiglomerular basement membrane antibody

Question 17

Initial laboratory results are similar to AGN but become
more abnormal as the disease progresses, including protein levels that are markedly elevated and glomerular filtration rates
that are very low

Answer 17

Rapidly Progressive (or crescentic) Glomerulonephritis (RPGN)

Question 18

Key to the diagnosis of GPA is the
demonstration of?

Answer 18

Antineutrophilic cytoplasmic antibody (ANCA) in the patient’s serum

Question 19

If the neutrophils are fixed in ethanol, the antibodies form a perinuclear pattern which is called?

Answer 19

p-ANCA

Question 19

This includes incubating the patient’s serum with either ethanol or formalin/formaldehyde-fixed neutrophils and examining the preparation using indirect immunofixation to detect the serum antibodies attached to the neutrophils

Answer 19

ANCA for GPA

Question 20

This disease occurs primarily in children after upper respiratory infections.

Answer 20

Henoch-Schönlein Purpura

Question 20

When the neutrophils are fixed with formalin/formaldehyde, the pattern is granular
throughout the cytoplasm and is referred to as

Answer 20

c-ANCA

Question 21

Cellular proliferation affecting the capillary walls or the glomerular basement membrane

Answer 21

Membranoproliferative Glomerulonephritis

Question 22

A **marked decrease in renal function** resulting from ***glomerular damage*** precipitated by other renal disorders

Answer 22

Chronic Glomerulonephritis

Question 23

Disruption of the **electrical charges** that produce the tightly fitting podocyte barrier resulting in a massive loss of protein and lipids

Answer 23

Nephrotic Syndrome

Question 24

Disruption of podocytes in certain areas of glomeruli associated with heroin and analgesic abuse and with HIV and hepatitis viruses

Answer 24

Focal Segmental Glomerulosclerosis

Question 25

Disruption of the podocytes that occurs primarily in children after allergic reactions and immunizations; dysfunction of T-cell immunity

Answer 25

Minimal Change Disease (MCD)

Question 26

Ascending bacterial infection of the bladder

Answer 26

Cystitis

Question 27

Complete recovery with normal renal function is seen in more than 50% of patients. In other patients, progression to a more serious form of glomerulonephritis and renal failure may occur

Answer 27

Henoch-Schönlein Purpura

Question 28

Its predominant characteristic is a pronounced thickening of the glomerular basement membrane resulting from the deposition of immunoglobulin G immune complexes

Answer 28

Membranous Glomerulonephritis

Question 29

Their presence is often seen in chronic glomerulonephritis that progresses to ESRD

Answer 29

Broad casts

Question 30

Also known as Berger disease

Answer 30

IgA nephropathy

Question 31

The most common cause of glomerulonephritis.

Answer 31

IgA nephropathy

Question 32

Marked by massive proteinuria (greater than 3.5 g/day), low levels of serum albumin, high levels of serum lipids, and pronounced edema

Answer 32

Nephrotic syndrome

Question 33

Genetic disorder showing lamellated and thinning glomerular basement membrane

Answer 33

Alport syndrome

Question 33

Acute onset after systemic shock Gradual progression from other glomerular disorders and then to renal failure

Answer 33

Nephrotic syndrome (NS)

Question 33

Frequent complete remission after **corticosteroid treatment**

Answer 33

Minimal change disease (MCD)

Question 33

It may resemble nephrotic syndrome (NS) or minimal change disease (MCD)

Answer 33

Focal segmental glomerulosclerosis (FSGS)

Question 33

**Slow progression** to nephrotic syndrome (NS) and end-stage renal disease

Answer 33

Alport syndrome

Question 33

Hemoptysis and dyspnea followed by hematuria

Answer 33

Goodpasture syndrome

Question 33

Their presence in the urine sediment is characteristic for ATN

Answer 33

RTE cell casts and RTE cells

Question 33

Demonstration of positive results of these tests provides evidence that the disease is of streptococcal origin (2pts)

Answer 33

Anti–group A streptococcal enzyme tests (antistreptolysin O [ASO] and Antideoxyribonuclease-B antibody [anti-DNase B]) *These are under the Acute Poststreptococcal Glomerulonephritis*

Question 33

This may be elevated during the acute stages of AGN, but, like the urinalysis, returns to normal

Answer 33

Blood Urea Nitrogen (BUN)

Question 33

Since the development of this, which can be performed in a physician’s office, urgent care facility, or emergency department, the incidence of acute poststreptococcal glomerulonephritis has declined.

Answer 33

rapid anti–group A streptococcal enzyme tests

Question 33

Secondary complications of AGN

Answer 33

Hypertension and Electrolyte imbalance

Question 33

Morphological changes to the glomeruli resembling those in rapidly progressive glomerular nephritis are seen in conjunction with?

Answer 33

the autoimmune disorder termed **Goodpasture syndrome**

Question 34

Initial pulmonary complaints are **hemoptysis and dyspnea**, followed by the development of hematuria

Answer 34

Goodpasture syndrome

Question 34

Urinalysis results include proteinuria, hematuria, and the presence of RBC casts. Progression to chronic glomerulonephritis and end-stage renal failure is common

Answer 34

Goodpasture syndrome

Question 34

Initial symptoms include the appearance of **raised, red patches on the skin**

Answer 34

Henoch-Schönlein purpura

Question 34

Causes a granuloma-producing inflammation of the small blood vessels, primarily of the kidney and respiratory system

Answer 34

Granulomatosis with polyangiitis (GPA)

Question 34

**Renal involvement** is the most serious complication of this disorder and may range from mild to heavy proteinuria and hematuria with RBC casts

Answer 34

Henoch-Schönlein Purpura

Question 34

Respiratory and gastrointestinal symptoms, including blood in the sputum and stools, may be present

Answer 34

Henoch-Schönlein Purpura

Question 35

Disorders associated with the development of this disease include SLE, Sjögren syndrome, secondary syphilis, hepatitis B, gold and mercury treatments, and malignancy.

Answer 35

Membranous Glomerulonephritis (MGN)

Question 36

In MGN, about 75% of cases, the etiology is?

Answer 36

Unknown

Question 37

This disease has a tendency toward thrombosis.

Answer 37

Membranous Glomerulonephritis (MGN)

Question 38

Laboratory findings include microscopic hematuria and elevated urine protein excretion that may reach concentrations similar to those in nephrotic syndrome. **RBC casts are rare**, but microscopic hematuria is common

Answer 38

Membranous Glomerulonephritis (MGN)

Question 39

In MPGN, Type 1 patients progress to? While Type 2 patients experience symptoms of?

Answer 39

Type 1: Nephrotic syndrome Type 2: Chronic glomerulonephritis

Question 40

Progression of glomerulonephritis from one form to another:

Answer 40

Rapidly progressive glomerulonephritis > chronic glomerulonephritis > nephrotic syndrome > renal failure

Question 41

There is a high incidence of recurrence of this disease after renal transplant

Answer 41

Membranoproliferative glomerulonephritis (MPGN)

Question 41

Its laboratory findings vary, but hematuria, proteinuria, and decreased serum complement levels are usual findings. There appears to be an association with autoimmune disorders, infections, and malignancies.

Answer 41

Membranoproliferative glomerulonephritis (MPGN)

Question 42

Except for periodic episodes of macroscopic hematuria, a patient with this disorder may remain essentially asymptomatic for 20 years or more; however, there is a gradual progression to chronic glomerulonephritis and ESRD

Answer 42

IgA nephropathy

Question 43

A glomerular filtration rate that is markedly decreased is present in conjunction with increased BUN and creatinine levels and electrolyte imbalance

Answer 43

Chronic Glomerulonephritis (CGN)

Question 43

Primary urinary results in the early stages of IgA nephropathy

Answer 43

Macroscopic or microscopic hematuria

Question 44

Primary urinary results in the late stages of IgA nephropathy

Answer 44

Chronic glomerulonephritis (CGN)

Question 44

Damage to renal tubular cells caused by ischemia or toxic age

Answer 44

Acute tubular necrosis (ATN)

Question 45

**Acute onset of renal dysfunction** usually resolved when underlying cause is corrected

Answer 45

Acute tubular necrosis (ATN)

Question 46

Inherited in association with cystinosis and Hartnup disease or acquired through exposure to toxic agents

Answer 46

Fanconi syndrome

Question 47

Generalized defect in **renal tubular reabsorption** requiring supportive therapy

Answer 47

Fanconi syndrome

Question 48

Inherited defect in the production of normal uromodulin by the renal tubules and increased uric acid causing gout

Answer 48

Uromodulin-associated kidney disease

Question 49

Continual monitoring of renal function for progression to renal failure and possible kidney transplantation

Answer 49

Uromodulin-associated kidney disease

Question 50

Inherited defect of tubular response to ADH or acquired from medications

Answer 50

Nephrogenic diabetes insipidus (DI)

Question 50

Requires supportive therapy to prevent dehydration

Answer 50

Nephrogenic diabetes insipidus (DI)

Question 51

Benign disorder

Answer 51

Renal glucosuria

Question 51

Inherited **autosomal recessive trait**

Answer 51

Renal glucosuria

Question 52

Acute onset of urinary frequency and burning; resolved with antibiotics

Answer 52

Cystitis

Question 53

Infection of the renal tubules and interstitium related to interference of urine flow to the bladder, reflux of urine from the bladder, and **untreated cystitis**

Answer 53

Acute pyelonephritis

Question 54

**Recurrent infection** of the renal tubules and interstitium caused by structural abnormalities affecting the flow of urine

Answer 54

Chronic pyelonephritis

Question 55

Acute onset of urinary frequency, burning, and **lower back pain**; resolved with antibiotics

Answer 55

Acute pyelonephritis

Question 56

Frequently diagnosed in children; requires correction of the underlying structural defect Possible progression to renal failure

Answer 56

Chronic pyelonephritis

Question 57

Allergic inflammation of the renal interstitium in response to certain medications

Answer 57

Acute interstitial nephritis (AIN)

Question 58

**Acute onset of renal dysfunction** often accompanied by a ***skin rash*** Resolves after discontinuation of medication and treatment with corticosteroids

Answer 58

Acute interstitial nephritis (AIN)

Question 59

Renal calculi (kidney stones) may form in the:

Answer 59

- calyces and pelvis of the kidney - ureters - bladder

Question 60

In this condition, the calculi vary in size from barely visible to large, staghorn calculi resembling the shape of the renal pelvis and smooth, round bladder stones with diameters of 2 or more inches.

Answer 60

Renal Lithiasis

Question 61

Conditions favoring the formation of renal calculi are similar to those favoring the formation of urinary crystals, including:

Answer 61

- pH - chemical concentration - urinary casts

Question 62

Broad casts are often referred to as?

Answer 62

Renal failure casts

Question 63

A procedure using high-energy shock waves, can be used to break stones located in the upper urinary tract into pieces that then can be passed in the urine.

Answer 63

Lithotripsy

Question 64

This has little importance in predicting calculi formation

Answer 64

crystals

Question 64

This has been noted during the summer months in people known to form renal calculi

Answer 64

Increased crystalluria

Question 65

Approximately 75% of the renal calculi are composed of?

Answer 65

calcium oxalate or calcium phosphate

Question 66

These are the other primary calculi constituent

Answer 66

- Ammonium magnesium phosphate (struvite/ triple phosphate) - Uric acid - cystine

Question 67

Frequently this is associated with **metabolic calcium and phosphate disorders** and, occasionally, diet

Answer 67

calcium calculi

Question 68

May be associated with an increased intake of foods with high purine content and uromodulin-associated kidney disease.

Answer 68

Uric acid

Question 69

Identify if pre, renal, or postrenal causes of ARF: - Acute glomerulonephritis (AGN) - Acute tubular necrosis (ATN) - Acute pyelonephritis - Acute interstitial nephritis (AIN)

Answer 69

Renal

Question 70

Identify if pre, renal, or postrenal causes of ARF: - Renal calculi - Tumors

Answer 70

Postrenal

Question 71

Identify if pre, renal, or postrenal causes of ARF: - Decreased blood pressure/cardiac output - Hemorrhage - Burns - Surgery - Septicemia

Answer 71

Prerenal

Question 72

It exists in both acute and chronic forms.

Answer 72

Renal failure

Question 72

In contrast to chronic renal failure, this exhibits a sudden loss of renal function and frequently is reversible

Answer 72

Acute Renal Failure (ARF)

Question 73

Renal calculi is also known as?

Answer 73

Kidney stones

Question 74

Its urinalysis findings include glycosuria with normal blood glucose and possible mild proteinuria. Urinary pH can be very low due to the failure to reabsorb bicarbonate

Answer 74

Fanconi syndrome

Question 75

The disorder associated with **tubular dysfunction** most frequently is?

Answer 75

Fanconi syndrome

Question 76

The syndrome can be inherited as a sex-linked or autosomal genetic disorder. Males inheriting the X-linked gene are affected more severely than females inheriting the autosomal gene.

Answer 76

Alport Syndrome

Question 77

Can be inherited as a sex-linked recessive gene or acquired from medications, including lithium and amphotericin B. It also may be seen as a complication of polycystic kidney disease and sickle cell anemia.

Answer 77

Nephrogenic DI

Question 78

This affects only the reabsorption of glucose

Answer 78

Renal Glycosuria

Question 79

This is significant for differentiating between cystitis and pyelonephritis.

Answer 79

WBC casts

Question 80

Their presence in the urine sediment is characteristic for AIN

Answer 80

Eosinophil casts and eosinophils

Question 81

General characteristics of ARF:

Answer 81

decreased glomerular filtration rate, oliguria, edema, and azotemia.

Question 82

Provides a more comprehensive analysis of Renal Lithiasis

Answer 82

X-ray crystallography