Gen Path Exam 3 - Urinary System Flashcards
1
Q
Increased blood urea nitrogen (BUN) and creatinine, due to decreased GFR
A
Azotemia
2
Q
Progression of azotemia to clinical level with failure of renal excretory function and systemic problems
A
Uremia
3
Q
What are the 4 secondary effects of uremia?
A
GI -> gastroenteritis
Neuromuscular -> peripheral neuropathy
Cardiovascular -> pericarditis
Oral -> severe ulcers
4
Q
Inflammation that leads to mesangial and/or BM thickening, which causes barrier dysfunction
A
Glomerulonephritis
5
Q
What are the 2 major clinical presentations of glomerulonephritis?
A
Nephrotic syndrome
Nephritic syndrome
6
Q
Nephrotic or nephritic syndrome?
Pathogenesis = alteration of glomerular capillary walls, causing permeability to plasma proteins
A
Nephrotic syndrome
7
Q
Nephrotic or nephritic syndrome?
Massive proteinuria
A
Nephrotic syndrome
8
Q
Nephrotic or nephritic syndrome?
Hypoalbuminemia
A
Nephrotic syndrome
9
Q
Nephrotic or nephritic syndrome?
Generalized edema
A
Nephrotic syndrome
10
Q
Nephrotic or nephritic syndrome?
Hyperlipidemia and lipiduria
A
Nephrotic syndrome
11
Q
What happens to the podocytes in nephrotic syndrome?
A
Effacement
Detachment
12
Q
Nephrotic or nephritic syndrome?
Pathogenesis = inflammatory rxn injures glomerular capillaries, RBCs go into urine, decreased GFR
A
Nephritic syndrome
13
Q
Nephrotic or nephritic syndrome?
Hematuria with dysmorphic RBCs
A
Nephritic syndrome
14
Q
Nephrotic or nephritic syndrome?
Decreased GFR, oliguria, azotempia
A
Nephritic syndrome
15
Q
Nephrotic or nephritic syndrome?
Increased blood urea nitrogen (BUN)
A
Nephritic syndrome
16
Q
Nephrotic or nephritic syndrome?
Hypertension due to renin release
A
Nephritic syndrome
17
Q
Nephrotic or nephritic syndrome?
Mild proteinuria/edema (not as severe)
A
Nephritic syndrome
18
Q
The causes of glomerulonephritis are most often _____________
A
immune-mediated
19
Q
Generalized edema
A
Anasarca
20
Q
What is an example of a primary cause of glomerulonephritis?
A
Post-strep glomerulonephritis
21
Q
Nephrotic or nephritic syndrome?
Post-strep glomerulonephritis
A
Nephritic syndrome
22
Q
What are 6 examples of secondary causes of glomerulonephritis?
A
Hypertension
Diabetes
Amyloidosis
Lupus
Goodpasture syndrome
Granulomatosis w/ polyangititis (GPA)
23
Q
Nephrotic or nephritic syndrome?
Diabetes
A
Nephrotic syndrome
24
Q
Nephrotic or nephritic syndrome?
Amyloidosis
A
Nephrotic syndrome
25
Nephrotic or nephritic syndrome?
Lupus
Nephrotic or nephritic syndrome
26
Primary or secondary cause of glomerulonephritis?
Kidney is only or predominant organ
Primary
27
Primary or secondary cause of glomerulonephritis?
Systemic disease leads to glomerular damage
Secondary
28
Decreased urination
Oliguria
29
What disease?
Antibody bound to strep proteins causes proliferation of glomerular cells and activates complement, leading to infiltration of leukocytes
Post-step glomerulonephritis
30
What disease?
Gross hematuria (smoky brown)
Post-step glomerulonephritis
31
What disease?
Most kids recover completely
In adults, 15-50% develop end-stage renal disease (over years-decades)
Post-step glomerulonephritis
32
Describe the Type III hypersensitivity immune injury mechanism in glomerulonephritis
Circulating antigen/AB complexes in glomerulus
33
What are 2 diseases that use the Type III hypersensitivity immune injury mechanism in glomerulonephritis?
Post-strep
Lupus
34
Describe the Type II hypersensitivity immune injury mechanism in glomerulonephritis
ABs bind to glomerular antigens in the glomerulus
35
What is 1 disease that uses the Type II hypersensitivity immune injury mechanism in glomerulonephritis?
GPA (effects kidney and lung)
36
What disease?
Diagnosed by urinalysis showing either nephrotic syndrome or nephritic syndrome
Glomerulonephritis
37
Nephrotic or nephritic syndrome?
Excessive proteins
Nephrotic syndrome
38
Nephrotic or nephritic syndrome?
Excessive RBCs
Nephritic syndrome
39
What disease?
Diagnosed by circulating autoantibodies in blood
Glomerulonephritis
40
What disease?
Diagnosed by renal biopsies like light microscopy, immunofluorescence, or electron microscopy
Glomerulonephritis
41
Tests pt tissue directly for presence of autoantibodies
Direct immunofluorescence
42
Tests pt blood for presence of autoantibodies in 3 different cells
Indirect immunofluorescence
43
What are the 3 different cells used when looking for autoantibodies in indirect immunofluorescence?
HEp-2 cell lines
Specific tissues
Granulocytes
44
Useful for wide range of antinuclear antibodies (ANA) and cytoplasmic components
HEp-2 cell lines
45
Use a similar animal epithelium as a substrate
Specific tissues
46
Antineutrophil cytoplasmic antibodies (ANCA) involve antibodies that display perinuclear (pANCA) or cytoplasmic (cANCA) staining
Granulocytes
47
Most forms of tubular injury also involve the ___________
interstitium
48
What disease?
Caused by bacterial or non-bacterial etiologies
Tubulointerstitial nephritis
49
What are some causes of non-bacterial reasons for Tubulointerstitial nephritis?
Drugs
Metabolic disorder
Physical injury
Viral infection
Immune rxn
50
Tubulointerstitial nephritis caused by bacteria is called what?
Pyenlonephritis
51
Tubulointerstitial nephritis NOT caused by bacteria is called what?
Interstitial nephritis
52
What disease?
Common manifestation of extension from lower UTI
Acute pyelonephritis
53
Acute pyelonephritis usually involves what bacteria?
Gram negative (E. coli)
54
How is acute pyelonephritis spread?
Ascending infection (most common)
Hematogenous (ex: septicemia)
55
What disease?
More common in females due to shorter urethra, close proximity to anus, and pregnancy
Acute pyelonephritis
56
What disease?
Predisposing factor = urinary obstruction (BPH) or bladder dysfunction leads to stasis, favoring bacterial growth
Acute pyelonephritis
57
What disease?
Predisposing factor = instrumentation of urinary tract, like catheterization
Acute pyelonephritis
58
What disease?
Predisposing factor = vesicoureteral reflux
Acute pyelonephritis
59
What disease?
Predisposing factor = diabetes due to increased susceptibility to infection and neurogenic bladder dysfunction
Acute pyelonephritis
60
What disease?
Predisposing factor = immunosuppression and immunodeficiency
Acute pyelonephritis
61
What disease?
Abrupt onset of costovertebral angle pain
Acute pyelonephritis
62
What disease?
Fever, chills, malaise, nausea, vomiting, pus in urine, bacteria in urine
Acute pyelonephritis
63
Pus in urine
Pyuria
64
Bacteria in urine
Bacteriuria
65
What disease?
Urethral irritation, dysuria, increased frequency/urgency
Acute pyelonephritis
66
Pain when urinating like burning, stinging, itching
Dysuria
67
What disease?
Symptoms last 1 week without tx
Acute pyelonephritis
68
What disease?
Usually unilateral -> renal failure does NOT occur
Acute pyelonephritis
69
What disease?
Histologically = patchy neutrophilic infiltration of interstitium
Acute pyelonephritis
70
What disease?
Histologically = glomeruli intact, but tubules spread apart and necrotic
Acute pyelonephritis
71
What disease?
Histologically = collecting tubules filled with pus, passes out in urine
Acute pyelonephritis
72
What disease?
Damages tubules, calyces, and pelvis, leading to scarring
Chronic pyelonephritis
73
What disease?
Related to obstruction or vesicoureteral reflux
Chronic pyelonephritis
74
What disease?
May be asymptomatic until polyuria and hypertension and renal failure occur and/or urinalysis shows WBCs
Chronic pyelonephritis
75
Scarring, atrophy, inflammation around tubules from a non-bacterial cause
Interstitial nephritis
76
What type of interstitial nephritis?
IgE or T cell-mediated immune rxn to drug
Drug-induced interstitial nephritis
77
What type of interstitial nephritis?
Interstitial mononuclear inflammation w/ eosinophils
Drug-induced interstitial nephritis
78
What disease?
Clinicopathologic entity- damaged tubular epithelial cells with acute decline of renal function (decreased GFR)
Acute Tubular Injury (ATI)
79
What is the most common cause of renal failure?
Acute tubular injury (ATI)
80
What are the 2 types of acute tubular injury (ATI)?
Ischemic
Nephrotoxic
81
Ischemic or nephrotoxic ATI?
Occurs when marked decrease in
blood flow to kidney (trauma, acute pancreatitis, or septicemia leading to shock)
Ischemic ATI
82
Ischemic or nephrotoxic ATI?
Exposure to toxins- poison, heavy metals; drugs- antibiotics
Nephrotoxic ATI
83
What disease?
Ischemia or toxic injury causes tubule cells to be shed (casts seen in urine).
This blocks urine output, increases interstitial pressure, and decreases GFR.
Acute tubular injury (ATI)
84
What disease?
Oliguria leads to uremia
Acute tubular injury (ATI)
85
What disease?
Reversible when caught early--death is
circumvented thru dialysis and maintaining electrolytes
Acute tubular injury (ATI)
86
What disease?
Abrupt onset of renal dysfunction within 48 hrs
Acute renal failure
87
What disease?
Increased serum creatinine
Oligouria or anuria
Azotemia
Acute renal failure
88
What are the 3 potential causes of acute renal failure?
Prerenal
Intrarenal
Postrenal
89
Which cause of acute renal failure?
Decreased blood flow to kidneys (ex: cardiac failure)
Prerenal
90
Which cause of acute renal failure?
ATI = most common cause, but also acute glomerular, interstitial or vascular disease
Intrarenal
91
Which cause of acute renal failure?
Obstruction of urinary tract, distal to kidney
Postrenal
92
What is an oral manifestation that is due to acute renal failure?
Uremic stomatitis
93
What disease?
Azotemia slowly progresses to uremia which causes oral ulcers, gastroenteritis, pericarditis, peripheral neuropathy
Chronic renal failure
94
What disease?
Symptoms = hypertension and some degree of proteinuria
Chronic renal failure
95
What disease?
Caused by chronic kidney disease that leads to severe progressive scaring
Chronic renal failure
96
What disease?
Also called benign nephrosclerosis
Arterionephrosclerosis
97
What disease?
Thickening, luminal obstruction of arteries/arterioles associated with benign hypertension + diabetes
Arterionephrosclerosis
98
What disease?
Causes parenchymal ischemia, resulting in small foci of parenchymal loss and fibrosis
Arterionephrosclerosis
99
What disease?
Kidney = small, contracted, grain leather surface
Arterionephrosclerosis
100
What disease?
Small vessels show hyaline deposition (arterioloscerlosis), thickened wall with narrowed lumen
Arterionephrosclerosis
101
What disease?
Uncommon, 5% of pts with hypertension, or may arise de novo
Malignant hypertension
102
What is the BP reading in malignant hypertension?
> 200/120
103
What disease?
Symptoms:
Increased intracranial pressure (headache, nausea, vomiting, visual impairment)
Proteinuria
Hematuria
Renal failure later on
Malignant hypertension
104
What disease?
Medical emergency - requires aggressive antihypertensive therapy
Malignant hypertension
105
Describe the pathogenesis of malignant hypertension
1. Chronic hypertension
2. vascular damage
3. narrows lumen of afferent arteriole
4. ischemia
5. increased renin
6. angiotensin II
7. vasoconstriction
8. increased renin even more
9. really increased BP
106
What disease?
Can obstruct/damage tubules and hinder renal function
Tubular precipitations
107
What disease?
Causes are urolithiasis (most common) and multiple myeloma
Tubular precipitations
108
Which cause of tubular precipitations?
Can cause:
Bence-Jones casts in tubules
Hypercalcemia
Amyloidosis
Tumor deposits
Multiple myeloma
109
Urinary tract stones/kidney stones
Urolithiasis/Nephrolithiasis
110
What disease?
Precipitations of different compounds due to increased urinary concentration of stone's components (supersaturation)
Urolithiasis/Nephrolithiasis
111
What disease?
Large stones collect in calcyes; may remain silent or cause obstruction with hematuria
Urolithiasis/Nephrolithiasis
112
What disease?
Small stones lodge in ureters where they cause intense renal colic, ulceration, hematuria
Urolithiasis/Nephrolithiasis
113
Excruciating flank pain
Renal colic
114
In urolithiasis/nephrolithiasis, what do large and small stones predispose to?
Infection
115
What disease?
Tx = surgery, chemical dissolution, ultrasound lithotripsy
Urolithiasis/Nephrolithiasis
116
What disease?
Cause is not always clear, usually high urine levels of components
Urolithiasis/Nephrolithiasis
117
What are kidney stones composed of?
Calcium oxalate
Calcium phosphate (most common)
118
Overabsorption from gut or renal reabsorption defect
Hypercalciuria
119
Caused by hypercalcemia due to hyperparathyroidism, myeloma, sarcoidosis, bone destroying tumors, too much calcium or vitamin D in diet
Hypercalciuria
120
If ureters, calyces, or urethra are __________, urine backs up and causes infection of kidney or pressure atrophy of renal parenchyma
obstructed
121
Pressure atrophy of renal parenchyma
Hydronephrosis
122
What do the following cause?
Congenital/secondary strictures
Kidney stones
Prostate enlargement
Tumors
Bladder atony
Obstruction
123
What are these symptoms related to?
Bilateral hydronephrosis causes anuria, can quickly be corrected
Obstruction
124
What are these symptoms related to?
Unilateral hydronephrosis is asymptomatic, causes loss of renal function
Obstruction
125
Benign tumor of tubular epithelium
Renal adenoma
126
What disease?
Well demarcated yellow, lipid filled nodules in upper pole of cortex and measures < 2.5 cm
Renal adenoma
127
What disease?
No reliable way to differentiate from kidney cancers, so should be treated as if it could be cancer
Renal adenoma
128
What disease?
Malignant tumor of renal tubular cells resembling the adenoma grossly and histologically but are larger (> 3 cm)
Renal cell carcinoma
129
What disease?
Signs and symptoms:
– Dull flank pain
– Palpable abdominal mass
– Painless hematuria (most common)
– Polycythemia – tumor makes
erythropoietin
Renal cell carcinoma
130
What is the most common sign/symptom of renal cell carcinoma?
Painless hematuria
131
Where does renal cell carcinoma spread?
Lungs + bone
132
What disease?
Unpredictable course, usually fatal
Renal cell carcinoma
