Diseases of the Kidney Flashcards Preview

Systemic Pathology Test 2 > Diseases of the Kidney > Flashcards

Flashcards in Diseases of the Kidney Deck (91):
1

What part of the kidney receives most of the renal circulation and how much?

The cortex receives 90%

2

The main renal artery supplies what part of the kidney by dividing into?

Supplies the glomeruli by dividing into capillary loops

3

Capillary loops exit as?

Efferent arterioles

4

Glomerular disease that affects capillary blood flow affects what parts of the kidney?

Cortical and medullary tubules

5

How much interference is required to cause medullary necrosis?

Only minor interference

6

What are glomeruli?

Anastomosing network of capillaries

7

What lines the glomeruli?

Fenestrated epithelium

8

What type of epithelium is part of the intrinsic capillary wall?

Visceral epithelium

9

Where does filtrate collect?

Bowman's capsule

10

What kind of epithelium lines the Bowman's capsule?

Parietal epithelium

11

What type of cells support the glomerular tuft?

Mesangial cells

12

The glomerular filtration barrier has high permeability to? Low permeability to?

High permeability to water and small solutes. Low to large, negatively charged proteins

13

What maintains the barrier?

Visceral epithelial cells

14

How much of filtered solutes are absorbed by proximal tubular cells?

2/3

15

Proximal tubules are highly susceptible to?

Ischemic necrosis and chemical injury

16

What is the interstitium composed of?

Fenestrated peritubular capillaries and cells

17

What are the two overarching functions of the kidney?

Urine production and endocrine

18

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

19

What hormones are produced by the kidney?

Renin, erythropoeitin, and 1,25-dihydroxycholecalciferol

20

What cells produce renin?

Juxtomedullary cells

21

1,25-dihydroxycholecalciferol is involved with metabolism of?

Calcium

22

What are treatments for renal failure?

Dialysis and transplantation

23

The glomerulus is highly susceptible to what type of injury?

Immunologically mediated

24

The tubules and interstitial are susceptible to what type of injury?

Toxic, infectious, drug overdoses

25

Urinalysis looks for what 3 things?

Proteinuria- protein in urine due to glomerular or tubular damage
Hematuria- blood in urine
Pyuria- pus in urine

26

Which of those 3 is often diagnostic?

The extent of hematuria

27

Pyuria is associated with?

infection

28

Glomerular disease is indicated by?

High levels of proteinuria and hematuria

29

What is hyposthenuria and what causes it?

Hypotonic urine caused by inability of the tubules to concentrate

30

What is oliguria?

A decrease in the amount of urine, 400

31

What is anuria?

A lack of urine production, less than 200

32

Azotemia refers to increased levels of? Caused by?

Creatinine and BUN. Caused by decreased glomerular filtration rate

33

What are the 3 congenital kidney disorders we studied?

Ectopic kidney, renal hypoplasia, polycystic kidney disease

34

What is renal hypoplasia?

Failure of the kidney to develop completely, usually unilateral

35

An ectopic kidney is?

When nephrons develop in abnormal positions

36

What is adult polycystic disease?

Expanding cysts of both kidneys lead to renal failure and destruction of the parenchyma

37

In polycystic disease, cysts are often found in what other organ?

Liver

38

Those with polycystic disease often develop?

Hypertension or UTI

39

How is polycystic disease treated and what is the usual cause of death?

Transplant, death due to uremia or hypertensive crisis

40

What happens in acute nephritic syndrome?

Acute onset of severe hematuria, moderate proteinuria, oliguria. See fluid retention and renin release from ischemic kidneys

41

Describe the pathogenesis of acute nephritic syndrome

Proliferation of cells in glomeruli, WBC infiltrate, capillary wall drainage, low GFR

42

What happens in the early stages of renal failure?

Can't concentrate urine and conserve water, sodium loss, and dehydration

43

What happens in acute renal failure?

Rapid onset, reversible
Caused by glomerular, interstitial, or vascular injury

44

What causes chronic renal failure?

Gradual onset irreversible
End result of all chronic renal diseases

45

What happens to the skin as a result of chronic renal failure?

Uremic frost

46

What 3 conditions can occur due to chronic renal failure?

Osteodystrophy, secondary hyperparathyroidism, and metastatic calcifications

47

What is the overarching cause of glomerular kidney diseases?

Immune injury

48

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)

49

What is the most common glomerular diagnosis?

IgA nephropathy or Berger disease

50

IgA nephropathy is a common cause of?

Gross/microscopic hematuria

51

IgA deposits itself in?

Mesangium leading to proliferation and matrix increase

52

What types of UTI's are often asymptomatic?

Chronic

53

UTI's confined to the bladder and urethra are called?

Cystitis

54

UTI's that go the kidney are called?

Pyelonephritis

55

Pyelonephritis is typically caused by what bacteria?

Gram negatives like E coli

56

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

57

What symptoms are typical of acute pyelonephritis?

Sudden onset with patin at cost vertebral angle, fever, malaise, dysuria. Frequent and urgent urination

58

What is the gross appearance of the kidney in acute?

Necrosis with superficial abscesses and suppration

59

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

60

Chronic pyelonephritis can lead to what if not treated?

End stage renal disease

61

How does chronic pyelonephritis manifest itself?

Lower back pain, fever, pyuria, or clinically silent, hypertension

62

Describe the appearance of the kidney affected by chronic pyelonephritis?

Shrunken and irregularly scarred

63

The tubules of the cortex become _____ in chronic pyelonephritis?

They become dilated with thyroidization

64

What is the most common UT obstruction?

Kidney stone or renal calculi

65

Why does acute obstruction cause pain?

Distention of collecting system or renal capsule

66

Unrelieved obstruction always leads to?

Enlarged kidneys, interstitial inflammation, and permanent cortical and medullary atrophy

67

If obstruction is below the bladder it causes?

Bladder distention

68

If obstruction is unilateral the symptoms are?

Silent because the other kidney can maintain renal function

69

Partial bilateral obstruction leads to?

Unable to concentrate urin, polyuria and nocturia

70

Complete bilateral obstruction leads to?

Anuria, oligura. This is not compatible with survival, patient becomes uremic (urea in the blood)

71

Why does GFR persist even with complete obstruction?

Persists initially due to back diffusion of filtrate into renal interstitium

72

What is hydronephrosis?

Dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to outflow obstruction of urine

73

When does bilateral and unilateral hydronephrosis occur?

Bilateral when below, uni when above

74

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

75

What causes renal calculi?

Urine supersaturated with certain mineral which then precipitates as a solid crystal

76

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

77

What is the triad of classic symptoms for renal cell carcinoma?

Costovertebral fullness or pain in back, hematura, palpable mass

78

Where does renal cell carcinoma often metastasis to?

Lung or bone

79

Where does filtered urine collect?

Renal pelvis

80

The kidney stains how in chronic pyelonephritis?

Eosinophilic

81

What are cellular casts?

WBC/RBC trapped in the renal tubules

82

What are non-cellular casts?

Precipitated proteins

83

How do the kidneys appear in childhood polycystic disease?

Bilaterally enlarged kidneys with a smooth appearance

84

Those with childhood polycystic die from? If they survive infancy they have?

Renal or pulmonary failure. Congenital hepatic fibrosis

85

Nephrotic syndrome involves?

Severe proteinuria, hypoalbuminemia, hyperlipidemia, and lipiduria

86

In those under 15 nephrotic syndrome is due to? Adults?

Kidney disease and systemic disease respectively

87

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

88

Rapidly progressive is AKA?

Crescentric

89

Minimal change disease is AKA? It is the most common nephrotic syndrome in?

Lipoid nephrosis, children

90

Minimal change disease often follows?

Viral infection or routine prophylaxis

91

Minimal change disease responds to?

Corticosteroid therapy