Flashcards in Diseases of the Renal System 1 Deck (64):
1
What are the 4 main functions of the kidney
Eliminate metabolic waste products
Regulate fluid and electrolyte balance
Acid-base balance
Produce some hormones (renin, erythropoietin)
2
What are the 2 main types of mechanisms of glomerular damage?
Immunological
Non-immunological
3
Give 4 conditions whcih cause damage to the glomerulus by immune complexes being deposited in the glomerulus
Lupus
IgA nephropathy
Henoch Schonlein Purpura
Membranous purpura
4
Give 2 examples of conditions that cause damage to the basement membrane through the deposition of antibodies
Anti glomerular basement membrane disease (goodpasture's syndrome)
Post infective glomerulonephritis
5
5 mechanisms of vascular damage in the kidneys
Thrombotic microangiopathy
Vasculitis
Hypertension
Diabetes
Atheroma e.g. renal artery stenosis
6
Thrombi in capillaries and small arterioles, due to damaged endothelium (bacterial toxins, drugs) or abnormalities in clotting e.g haemolytic uraemic syndrome
Thrombotic microangiopathy
7
Give an example of vasculitis that can affect the kidney
Wegener's granulomatosis
8
Nephrotic syndrome is due to damage of what part of the renal system?
Glomerulus
9
What are the signs of nephrotic syndrome
Hypoalbuminaemia
Proteinuria
Oedema
+/-hypertension
+/-hyperlipidaemia
10
Complciations of nephrotic syndrome
Infections, thrombosis
11
4 causes of nephrotic syndrome
Membranous neuropathy
Focal segmental glomerulosclerosis (FSGS)
Minimal change disease
Diabetes, lupus nephritis, amyloid
12
Most common cause of nephrotic syndrome
Membranous neuropathy
13
Primary glomerular disorder of unknown cause. 30-60yrs, 20-30% progress to end stage renal failure
Membranous neuropathy
14
A pattern of kidney damage affecting the podocytes, with various possible causes (idiopathic, genetic, heroin use, HIV)
Focal segmental glomerulosclerosis
15
Which causes of nephrotic syndrome are more common in males than females?
Membranous neuropathy
Focal segmental glomerulosclerosis
16
In children, what are the most common causes of nephrotic syndrome?
Minimal change disease, or FSGS (less common)
17
What are the 5 signs of acute nephritis
Oedema
Proteinuria
Acute renal failure
Haematuria
Hypertension
Both nephrotic syndrome and nephritis OPAHH
18
4 main causes of acute nephritis
Post infective glomerulonephritis
IgA nephropathy
Vasculitis
Lupus
19
Typically occurs a few weeks after streptococcoal throat infection; common cause of acute nephritis
post infective glomerulonephritis
20
Most common primary glomerular disease- teenagers and young adults iwth haematuria
IgA nephropathy
21
What proportion of people with IgA nephropathy will progress to renal failure over 20 years
20-50%
22
Cause of nephritic syndrome; presents with fever, generally unwell, rash, myalgia, arthralgia
Vasculitis
23
Autoimmune disease commonly affecting women, that can be a cause of acute nephritis
Lupus
24
What are the 3 most common causes of nephritis in children?
Post infective glomerulonephritis
IgA nephropathy
hencoch-schonlein purpura
haemolytic-uraemic syndrome
25
A specific type of IgA nephropathy that is more common in males than females- arthralgia ,abdo pain, rash and haematuria and acute renal failure
Henoch schonlein purpura
26
Typically affects children with E.coli 0157 enteritis
Haemolytic uraemic syndrome
27
What are the 3 signs of haemolytic uraemic syndrome
Acute nephritis, haemolysis and thrombocytopenia
28
What 3 things must be present for a diagnosis of acute renal failure
Anuria/oliguria
High plasma creatinine levels
High plasma Urea
29
What are the 3 classes of causes for acute renal failure
pre-renal
renal
post-renal
30
Give 2 examples of pre renal causes of acute kidney failure
Severe dehydration
Hypotension e.g. bleeding, septic shock, LV failure
31
Give 3 examples of post renal causes of acute kidney failure
Tumours
bladder stones
prostatic enlargement
32
Give 4 examples of renal causes of acute renal failure
Vasculitis
Acute interstitial nephritis
33
Give 3 examples of renal causes of acute renal failure in children
Henoch schonlein purpura
Hameolytic uraemic syndrome
acute interstitial nephritis
34
5 complications of acute kidney disease
Cardiac failure
Arrythmias
GI bleeding
Jaundice
Infection
35
Which might cardiac failure results from acute kidney failure?
Fluid overload
36
Treatment for acute kidney disease
Short term dialysis
Treat underlying cause
37
Permanently decreased GFR and less nephrons
Chronic renal failure
38
Briefly outline the stages of chronic renal failure
1-2 no treatment
3-moderate reduction in GFR
4- severe reduction in GFR
5-end stage kidney failure
39
3 causes of chronic renal failure
Diabetes
Glomerulonephritis
Reflux nephropathy
40
Chronic reflux of urine up the ureter leading to repeated infections and scarring
Reflux nephropathy
41
What does a renal biopsy tell you in chronic renal failure?
Scarring, no evidence of initial cause
42
4 effects of chronic renal failure
Decreased excretion of water and electrolytes-oedema and hypertension
decreased excretion of toxic metabolites
decreased production of erythropoietin- anaemia
renal bone disease
43
elderly patient with acute renal failure
acute interstitial nephritis (drug reactions)
myeloma-tumour of the plasma cells, secrete immunoglobulins
44
Young male with haematuria and rash
Henoch Schonlein Purpura
45
Teenager/young adult with haematuria
Post infective glomerulonephritis
IgA nephropathy
46
Adult with acute renal failure, fever and myalgia
Vasculitis
47
Young woman with haematuria and facial butterfly rash
Lupus
48
Adult with nephrotic syndrome
Membranous neuropathy
49
Child with nephrotic syndrome
Minimal change
50
Imaging of the urinary tract
Cytoscopy
51
Causes of isolated haematuria
IgA nephropathy
Thin basemement membrane disease
Alport type hereidtary nephropathy
52
Inherited abnormalities of collagen type 4 causing abnormal basement membrane in the glomerulus- renal failure +/- deafness +/-occular problems May be autosomal or X linked
Alport type hereditary nephropathy
53
Commonest 3 causes of isolated proteinuria in adults
FSGS
Diabetes
Lupus
54
Commonest 2 causes of isolated proteinuria in children
Henoch Schonlein purpura
FSGS
55
Causes of acute pyelonephritis
Diabetes
Structural abnormalities of urinary tract
56
Complications of pyelonephritis
Abscess formation
57
What is the cause of chronic pyelonephritis
Associated iwth obstruction of urinary tract and reflux of urine up reter, leading to scarring of the kidney and can lead to renal failure
58
Complications of chronic pyelonephritis
Scarring of kidney
Chronic renal failure
59
What is the result of renal artery stenosis
Ischemia of affected kidney
Activation of renin-angiotensin-aldosterone system leads to hypertension
60
Thrombus blocks the capillary within the glomerulus. Inflammatory cells surround an artery which has fibrin in the wall indicating damage
Vasculitis
61
How does hypertension cause damage to the kidney
Thickening of vessel walls-decrease in size of the lumen-chronic hypoxia-loss of renal tubules-decrease in renal function, decreased blood flow activates RAA system
62
Commonest cause of end stage renal failure?
Diabetes
63
How does diabetes affect the kidney?
hyperglycaemia damages the basement membrane- becomes thicker, glomerulus produces excess extracellular matrix which forms nodules. Also affects small vessels leading to ischaemia and damage to renal tubules
64