Class 4 chapter 25

Question 1

Glomerulonephritis

Answer 1

Inflammatory process
2nd leading cause of kidney failure
Categorized by appearance
1. Proliferative (Infiltration of WBC and proliferation of glomerular cells)
2. Membranous (Thickening of glomerular capillary wall)
3. Sclerotic (Increased extracellular matrix)
4. Diffuse/focal/segmental (Ex mesangial (involves only mesangial cells)

Question 2

Glomerulonephritis causes

Answer 2

Hereditary
Other disease process (DM, HTN, toxins)
Immunologic (usual process)
1. Injury from antibodies reacting with antigens in glomeruli
2. Injury from circulating antibody/antigen complexes lodging in glomeruli

Question 3

Types of Glomerular Disease

Answer 3

Acute Nephritic syndrome
Rapidly progressive glomerulonephritis
Nephrotic syndrome
Asymptomatic hematuria or proteinuria
Chronic glomerulonephritis

Question 4

Acute Nephritic Syndrome

Answer 4

Inflammatory response damaging glomerular capillary wall

Question 5

Treatment of Nephritic syndrome

Answer 5

Symptomatic
Possible permanent kidney damage
Children often have spontaneous recovery

Question 6

Rapidly Progressive Glomerulonephritis

Answer 6

Signs of severe glomerular injury without specific cause
Rapid (over a few months)
Proliferation of glomerular cells, with monocytes & macrophages destroy Bowman space
Goodpastures Syndrome (rare, autoimmune)

Question 7

Nephrotic syndrome

Answer 7

Integrity of glomerular membrane is affected
1. Medication
2. Neoplasms
3. Inflammation 
Increased GFR
Massive proteinuria
Hypoalbuminemia
Edema (anasarca - massive edema)
Lipidurea/hyperlipidemia

Question 8

Asymptomatic Hematuria or Proteinuria

Answer 8

IgA nephropathy (Berger disease)
IgA complex deposits d/t inflammation
Alport syndrome (hereditary)

Question 9

Chronic Glomerulonephritis

Answer 9

Acute forms either resolve or progress

Small kidneys, sclerosed glomeruli etc

Question 10

Acute Pyelonephritis cause

Answer 10

Bacterial infection of upper UT with intrarenal reflux

Question 11

Acute Pyelonephritis contributing factors

Answer 11

Outflow obstruction (enlarged prostate)
Catheterization/urinary instrumentation
Vesicoureteral reflux (urine going in opposite direction as it should)
Pregnancy
Neurogenic bladder

Question 12

Acute Pyelonephritis manifestations

Answer 12

Usually rapid progression
Chills, fever
Aches/pain unilateral or bilateral (costovertebral angle)
Dysuria, frequency, urgency
Nausea, abdominal pain radiating to the back

Question 13

Acute Pyelonephritis treatment

Answer 13

Symptomatic pain relief
Fluids to aid dysuria
Antibiotics

Question 14

Acute Nephritic Syndrome manifestations

Answer 14

Hematuria
Decreased GFR
Azotemia (nitrogenous waste in the blood)
Oliguria
Fluid retention (edema and htn)
SOB

Question 15

Chronic Pyelonephritis

Answer 15

Scarring and deformation of renal calyces and pelvis, with atrophy and thinning of cortex
Primarily affects proximal and distal tubules

Question 16

Chronic Pyelonephritis causes

Answer 16

Recurrent or persistent infection

Intrarenal reflux

Question 17

Toxin-Related Nephropathies effect dependent on

Answer 17

Action of drugs/toxins
Number of toxins involved
Existence of pre-renal issues that decrease blood flow to kidney
Formation of crystals
Hypersensitivity response

Question 18

Polycystic Kidney Disease

Answer 18

Inherited autosomal dominant
Generally older population; progresses slowly
Fluid-filled cysts in kidney and liver (less so spleen, pancreas)
Deformity of epithelial cell interfere with fluid absorption/cellular maturation resulting in cyst formation (Inflammatory mediators accumulate and renal tubular cells are destroyed, Kidneys enlarge)

Question 19

Polycystic Kidney Disease manifestations

Answer 19

Pain
Hematuria
Infected cysts – UTI
Htn

Question 20

Polycystic Kidney Disease complications

Answer 20

Nephrolithiasis (15-20% of PKD)
Valvular deformities
Cerebral artery aneurysm (10-30% of PKD pts) - subarachnoid hemorrhage

Question 21

Obstructive Disorders of the Kidneys

Answer 21

Sudden, or develop slowly
One or both kidneys
Partial or complete

If acute obstruction is caught early, effects are reversible
If not, damage/atrophy/chronic

Question 22

Obstructive Disorders Where and Why?

Answer 22

1. Renal pelvis
   Calculi, necrosis
2. Ureter
   Calculi, pregnancy, tumours, stricture, congenital origins
3. Bladder and ureter
   Calculi, neurogenic bladder, cancer, BPH and strictures

Question 23

Damage from Obstructive Disorders

Answer 23

1. Stasis of urine
   Causes UTI (common), stone formation
2. Progressive dilation of renal collecting ducts & tubular structures
   Causes destruction and atrophy of renal tissue
3. Hydronephrosis
   Urine-filled dilation of renal pelvis and calyces d/t obstruction of outflow, leading to atrophy of kidney

Question 24

Manifestations of Urinary Obstructions

Answer 24

1. Recurrent UTIs
2. Minimal to severe pain
   Dependent on level and degree of obstruction
3. Complete obstruction
   Oliguria/anuria
   Renal failure

Question 25

Renal Calculi (nephrolithiasis)

Answer 25

``` Most common cause of upper UT obstruction Usually develop in kidney (May travel down without damage, may stay in kidney or lodge elsewhere) “Supersaturation” + crystal aggregation Contributing factors (Type of stone dependant on cause, see chart pg 633) ```

Question 26

Types of Renal Calculi (Kidney stones)

Answer 26

``` 1. Calcium (oxalate or phosphate) D/t immobilization, hyperparathyroidism, diffuse bone disease 2. Magnesium ammonium phosphate Struvite/staghorn D/t UTIs 3. Uric acid D/t gout, high purine diet 4. Cystine (rarer/children) Inherited ```

Question 27

Manifestations of Nephrolithiasis

Answer 27

``` 1. Pain Ureter stone - severe flank and upper abdominal quadrant with radiation Renal pelvis stone - less severe 2. NV 3. Pallor and diaphoresis 4. Frequency and burning 5. Fever and chills (with infection) 6. Hematuria ```

Question 28

Treatment of kidney stones

Answer 28

``` Analgesics, Anti-spasmotics Allopurinol (changes pH to decrease acidity) Increased fluids to produce 2 liter/day Strain urine Diet modification Extracorporeal shockwave lithotripsy (ESWL) Ureteroscopic removal Percutaneous nephrolithotomy ```

Question 29

Renal Malignancy

Answer 29

1. Wilms Tumor (nephroblastoma) Most common malignant abdominal tumor in children (usually 3 to 5 years) Usually encapsulated Associated with other congenital anomalies Symptoms - abdominal mass, htn, abdominal pain, vomiting 2. Renal cell carcinoma Symptoms - Hematuria, flank pain, mass, silent disorder in early stages High risk factor - smoking Treatment - surgery, chemotherapy, radiation (good survival rate)