Flashcards in Diseases of the Kidney Deck (91):
What part of the kidney receives most of the renal circulation and how much?
The cortex receives 90%
The main renal artery supplies what part of the kidney by dividing into?
Supplies the glomeruli by dividing into capillary loops
Capillary loops exit as?
Glomerular disease that affects capillary blood flow affects what parts of the kidney?
Cortical and medullary tubules
How much interference is required to cause medullary necrosis?
Only minor interference
What are glomeruli?
Anastomosing network of capillaries
What lines the glomeruli?
What type of epithelium is part of the intrinsic capillary wall?
Where does filtrate collect?
What kind of epithelium lines the Bowman's capsule?
What type of cells support the glomerular tuft?
The glomerular filtration barrier has high permeability to? Low permeability to?
High permeability to water and small solutes. Low to large, negatively charged proteins
What maintains the barrier?
Visceral epithelial cells
How much of filtered solutes are absorbed by proximal tubular cells?
Proximal tubules are highly susceptible to?
Ischemic necrosis and chemical injury
What is the interstitium composed of?
Fenestrated peritubular capillaries and cells
What are the two overarching functions of the kidney?
Urine production and endocrine
What are the 4 functions of the kidney that fall under urine production?
1. Maintains constancy of volume and composition of extracellular fluid
2. Excretion of metabolic waste products
3. Regulation of body's concentration of salt and water
4. Maintain acidic balance of plasma
What hormones are produced by the kidney?
Renin, erythropoeitin, and 1,25-dihydroxycholecalciferol
What cells produce renin?
1,25-dihydroxycholecalciferol is involved with metabolism of?
What are treatments for renal failure?
Dialysis and transplantation
The glomerulus is highly susceptible to what type of injury?
The tubules and interstitial are susceptible to what type of injury?
Toxic, infectious, drug overdoses
Urinalysis looks for what 3 things?
Proteinuria- protein in urine due to glomerular or tubular damage
Hematuria- blood in urine
Pyuria- pus in urine
Which of those 3 is often diagnostic?
The extent of hematuria
Pyuria is associated with?
Glomerular disease is indicated by?
High levels of proteinuria and hematuria
What is hyposthenuria and what causes it?
Hypotonic urine caused by inability of the tubules to concentrate
What is oliguria?
A decrease in the amount of urine, 400
What is anuria?
A lack of urine production, less than 200
Azotemia refers to increased levels of? Caused by?
Creatinine and BUN. Caused by decreased glomerular filtration rate
What are the 3 congenital kidney disorders we studied?
Ectopic kidney, renal hypoplasia, polycystic kidney disease
What is renal hypoplasia?
Failure of the kidney to develop completely, usually unilateral
An ectopic kidney is?
When nephrons develop in abnormal positions
What is adult polycystic disease?
Expanding cysts of both kidneys lead to renal failure and destruction of the parenchyma
In polycystic disease, cysts are often found in what other organ?
Those with polycystic disease often develop?
Hypertension or UTI
How is polycystic disease treated and what is the usual cause of death?
Transplant, death due to uremia or hypertensive crisis
What happens in acute nephritic syndrome?
Acute onset of severe hematuria, moderate proteinuria, oliguria. See fluid retention and renin release from ischemic kidneys
Describe the pathogenesis of acute nephritic syndrome
Proliferation of cells in glomeruli, WBC infiltrate, capillary wall drainage, low GFR
What happens in the early stages of renal failure?
Can't concentrate urine and conserve water, sodium loss, and dehydration
What happens in acute renal failure?
Rapid onset, reversible
Caused by glomerular, interstitial, or vascular injury
What causes chronic renal failure?
Gradual onset irreversible
End result of all chronic renal diseases
What happens to the skin as a result of chronic renal failure?
What 3 conditions can occur due to chronic renal failure?
Osteodystrophy, secondary hyperparathyroidism, and metastatic calcifications
What is the overarching cause of glomerular kidney diseases?
What causes the immune injury in glomerular kidney diseases?
Antibodies within the glomerulus reacting with intrinsic antigens or extrinsic antigens
Deposition of soluble circulating antigen-antibody complexes (seen in SLE, Hep B, HIV)
What is the most common glomerular diagnosis?
IgA nephropathy or Berger disease
IgA nephropathy is a common cause of?
IgA deposits itself in?
Mesangium leading to proliferation and matrix increase
What types of UTI's are often asymptomatic?
UTI's confined to the bladder and urethra are called?
UTI's that go the kidney are called?
Pyelonephritis is typically caused by what bacteria?
Gram negatives like E coli
How do the bacteria gain entry to the kidney?
Vesicoureteral Valves don't function properly and allow relfux from bladder up the ureter, catheter, or
What symptoms are typical of acute pyelonephritis?
Sudden onset with patin at cost vertebral angle, fever, malaise, dysuria. Frequent and urgent urination
What is the gross appearance of the kidney in acute?
Necrosis with superficial abscesses and suppration
How is acute pyelonephritis treated? However what remains even after treatment and what further precautions must be taken?
Antibiotics, however the kidney remains scarred. It can be recurrent if the causative factors are not addressed
Chronic pyelonephritis can lead to what if not treated?
End stage renal disease
How does chronic pyelonephritis manifest itself?
Lower back pain, fever, pyuria, or clinically silent, hypertension
Describe the appearance of the kidney affected by chronic pyelonephritis?
Shrunken and irregularly scarred
The tubules of the cortex become _____ in chronic pyelonephritis?
They become dilated with thyroidization
What is the most common UT obstruction?
Kidney stone or renal calculi
Why does acute obstruction cause pain?
Distention of collecting system or renal capsule
Unrelieved obstruction always leads to?
Enlarged kidneys, interstitial inflammation, and permanent cortical and medullary atrophy
If obstruction is below the bladder it causes?
If obstruction is unilateral the symptoms are?
Silent because the other kidney can maintain renal function
Partial bilateral obstruction leads to?
Unable to concentrate urin, polyuria and nocturia
Complete bilateral obstruction leads to?
Anuria, oligura. This is not compatible with survival, patient becomes uremic (urea in the blood)
Why does GFR persist even with complete obstruction?
Persists initially due to back diffusion of filtrate into renal interstitium
What is hydronephrosis?
Dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to outflow obstruction of urine
When does bilateral and unilateral hydronephrosis occur?
Bilateral when below, uni when above
Renal calculi occurs more often in men or women? Where do most arise? Are big or small stones better?
Men, kidney, big is better because they stay in place and don't enter the urethra causing bleeding and pain
What causes renal calculi?
Urine supersaturated with certain mineral which then precipitates as a solid crystal
What is the most common malignant renal tumor? What does it develop from and in whom?
Renal cell carcinoma
Tubule epithelial cells of the cortex in older male smokers
What is the triad of classic symptoms for renal cell carcinoma?
Costovertebral fullness or pain in back, hematura, palpable mass
Where does renal cell carcinoma often metastasis to?
Lung or bone
Where does filtered urine collect?
The kidney stains how in chronic pyelonephritis?
What are cellular casts?
WBC/RBC trapped in the renal tubules
What are non-cellular casts?
How do the kidneys appear in childhood polycystic disease?
Bilaterally enlarged kidneys with a smooth appearance
Those with childhood polycystic die from? If they survive infancy they have?
Renal or pulmonary failure. Congenital hepatic fibrosis
Nephrotic syndrome involves?
Severe proteinuria, hypoalbuminemia, hyperlipidemia, and lipiduria
In those under 15 nephrotic syndrome is due to? Adults?
Kidney disease and systemic disease respectively
What is rapidly progressive glomerulonephritis? What causes it? How is it treated?
Disease with rapid loss of kidney function and oliguria, immune mediated.
Treated with steroids and cytotoxic agents
Rapidly progressive is AKA?
Minimal change disease is AKA? It is the most common nephrotic syndrome in?
Lipoid nephrosis, children
Minimal change disease often follows?
Viral infection or routine prophylaxis