Diseases of the Kidney

Question 1

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

Answer 1

The cortex receives 90%

Question 2

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

Answer 2

Supplies the glomeruli by dividing into capillary loops

Question 3

Capillary loops exit as?

Answer 3

Efferent arterioles

Question 4

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

Answer 4

Cortical and medullary tubules

Question 5

How much interference is required to cause medullary necrosis?

Answer 5

Only minor interference

Question 6

What are glomeruli?

Answer 6

Anastomosing network of capillaries

Question 7

What lines the glomeruli?

Answer 7

Fenestrated epithelium

Question 8

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

Answer 8

Visceral epithelium

Question 9

Where does filtrate collect?

Answer 9

Bowman’s capsule

Question 10

What kind of epithelium lines the Bowman’s capsule?

Answer 10

Parietal epithelium

Question 11

What type of cells support the glomerular tuft?

Answer 11

Mesangial cells

Question 12

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

Answer 12

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

Question 13

What maintains the barrier?

Answer 13

Visceral epithelial cells

Question 14

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

Answer 14

2/3

Question 15

Proximal tubules are highly susceptible to?

Answer 15

Ischemic necrosis and chemical injury

Question 16

What is the interstitium composed of?

Answer 16

Fenestrated peritubular capillaries and cells

Question 17

What are the two overarching functions of the kidney?

Answer 17

Urine production and endocrine

Question 18

What are the 4 functions of the kidney that fall under urine production?

Answer 18

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

Question 19

What hormones are produced by the kidney?

Answer 19

Renin, erythropoeitin, and 1,25-dihydroxycholecalciferol

Question 20

What cells produce renin?

Answer 20

Juxtomedullary cells

Question 21

1,25-dihydroxycholecalciferol is involved with metabolism of?

Answer 21

Calcium

Question 22

What are treatments for renal failure?

Answer 22

Dialysis and transplantation

Question 23

The glomerulus is highly susceptible to what type of injury?

Answer 23

Immunologically mediated

Question 24

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

Answer 24

Toxic, infectious, drug overdoses

Question 25

Urinalysis looks for what 3 things?

Answer 25

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

Question 26

Which of those 3 is often diagnostic?

Answer 26

The extent of hematuria

Question 27

Pyuria is associated with?

Answer 27

infection

Question 28

Glomerular disease is indicated by?

Answer 28

High levels of proteinuria and hematuria

Question 29

What is hyposthenuria and what causes it?

Answer 29

Hypotonic urine caused by inability of the tubules to concentrate

Question 30

What is oliguria?

Answer 30

A decrease in the amount of urine, 400

Question 31

What is anuria?

Answer 31

A lack of urine production, less than 200

Question 32

Azotemia refers to increased levels of? Caused by?

Answer 32

Creatinine and BUN. Caused by decreased glomerular filtration rate

Question 33

What are the 3 congenital kidney disorders we studied?

Answer 33

Ectopic kidney, renal hypoplasia, polycystic kidney disease

Question 34

What is renal hypoplasia?

Answer 34

Failure of the kidney to develop completely, usually unilateral

Question 35

An ectopic kidney is?

Answer 35

When nephrons develop in abnormal positions

Question 36

What is adult polycystic disease?

Answer 36

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

Question 37

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

Answer 37

Liver

Question 38

Those with polycystic disease often develop?

Answer 38

Hypertension or UTI

Question 39

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

Answer 39

Transplant, death due to uremia or hypertensive crisis

Question 40

What happens in acute nephritic syndrome?

Answer 40

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

Question 41

Describe the pathogenesis of acute nephritic syndrome

Answer 41

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

Question 42

What happens in the early stages of renal failure?

Answer 42

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

Question 43

What happens in acute renal failure?

Answer 43

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

Question 44

What causes chronic renal failure?

Answer 44

Gradual onset irreversible | End result of all chronic renal diseases

Question 45

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

Answer 45

Uremic frost

Question 46

What 3 conditions can occur due to chronic renal failure?

Answer 46

Osteodystrophy, secondary hyperparathyroidism, and metastatic calcifications

Question 47

What is the overarching cause of glomerular kidney diseases?

Answer 47

Immune injury

Question 48

What causes the immune injury in glomerular kidney diseases?

Answer 48

Antibodies within the glomerulus reacting with intrinsic antigens or extrinsic antigens Deposition of soluble circulating antigen-antibody complexes (seen in SLE, Hep B, HIV)

Question 49

What is the most common glomerular diagnosis?

Answer 49

IgA nephropathy or Berger disease

Question 50

IgA nephropathy is a common cause of?

Answer 50

Gross/microscopic hematuria

Question 51

IgA deposits itself in?

Answer 51

Mesangium leading to proliferation and matrix increase

Question 52

What types of UTI's are often asymptomatic?

Answer 52

Chronic

Question 53

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

Answer 53

Cystitis

Question 54

UTI's that go the kidney are called?

Answer 54

Pyelonephritis

Question 55

Pyelonephritis is typically caused by what bacteria?

Answer 55

Gram negatives like E coli

Question 56

How do the bacteria gain entry to the kidney?

Answer 56

Vesicoureteral Valves don't function properly and allow relfux from bladder up the ureter, catheter, or

Question 57

What symptoms are typical of acute pyelonephritis?

Answer 57

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

Question 58

What is the gross appearance of the kidney in acute?

Answer 58

Necrosis with superficial abscesses and suppration

Question 59

How is acute pyelonephritis treated? However what remains even after treatment and what further precautions must be taken?

Answer 59

Antibiotics, however the kidney remains scarred. It can be recurrent if the causative factors are not addressed

Question 60

Chronic pyelonephritis can lead to what if not treated?

Answer 60

End stage renal disease

Question 61

How does chronic pyelonephritis manifest itself?

Answer 61

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

Question 62

Describe the appearance of the kidney affected by chronic pyelonephritis?

Answer 62

Shrunken and irregularly scarred

Question 63

The tubules of the cortex become _____ in chronic pyelonephritis?

Answer 63

They become dilated with thyroidization

Question 64

What is the most common UT obstruction?

Answer 64

Kidney stone or renal calculi

Question 65

Why does acute obstruction cause pain?

Answer 65

Distention of collecting system or renal capsule

Question 66

Unrelieved obstruction always leads to?

Answer 66

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

Question 67

If obstruction is below the bladder it causes?

Answer 67

Bladder distention

Question 68

If obstruction is unilateral the symptoms are?

Answer 68

Silent because the other kidney can maintain renal function

Question 69

Partial bilateral obstruction leads to?

Answer 69

Unable to concentrate urin, polyuria and nocturia

Question 70

Complete bilateral obstruction leads to?

Answer 70

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

Question 71

Why does GFR persist even with complete obstruction?

Answer 71

Persists initially due to back diffusion of filtrate into renal interstitium

Question 72

What is hydronephrosis?

Answer 72

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

Question 73

When does bilateral and unilateral hydronephrosis occur?

Answer 73

Bilateral when below, uni when above

Question 74

Renal calculi occurs more often in men or women? Where do most arise? Are big or small stones better?

Answer 74

Men, kidney, big is better because they stay in place and don't enter the urethra causing bleeding and pain

Question 75

What causes renal calculi?

Answer 75

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

Question 76

What is the most common malignant renal tumor? What does it develop from and in whom?

Answer 76

Renal cell carcinoma Tubule epithelial cells of the cortex in older male smokers

Question 77

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

Answer 77

Costovertebral fullness or pain in back, hematura, palpable mass

Question 78

Where does renal cell carcinoma often metastasis to?

Answer 78

Lung or bone

Question 79

Where does filtered urine collect?

Answer 79

Renal pelvis

Question 80

The kidney stains how in chronic pyelonephritis?

Answer 80

Eosinophilic

Question 81

What are cellular casts?

Answer 81

WBC/RBC trapped in the renal tubules

Question 82

What are non-cellular casts?

Answer 82

Precipitated proteins

Question 83

How do the kidneys appear in childhood polycystic disease?

Answer 83

Bilaterally enlarged kidneys with a smooth appearance

Question 84

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

Answer 84

Renal or pulmonary failure. Congenital hepatic fibrosis

Question 85

Nephrotic syndrome involves?

Answer 85

Severe proteinuria, hypoalbuminemia, hyperlipidemia, and lipiduria

Question 86

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

Answer 86

Kidney disease and systemic disease respectively

Question 87

What is rapidly progressive glomerulonephritis? What causes it? How is it treated?

Answer 87

Disease with rapid loss of kidney function and oliguria, immune mediated. Treated with steroids and cytotoxic agents

Question 88

Rapidly progressive is AKA?

Answer 88

Crescentric

Question 89

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

Answer 89

Lipoid nephrosis, children

Question 90

Minimal change disease often follows?

Answer 90

Viral infection or routine prophylaxis

Question 91

Minimal change disease responds to?

Answer 91

Corticosteroid therapy