renal 2

Question 1

is diabetic nephropathy common?

Answer 1

about 5 to 10% of all diabetic in the US have some degree of renal problem that involve the glomeruli blood vessels and the interstitium

Question 2

what are the changes in the glomeruli in diabetic nephropathy?

Answer 2

thickening and increase permeability of the basement membrane of the glomerul and theres an increased amount of mesangial matrix

Question 3

which disorder is Diffuse Glomerulosclerosis associated with?

Answer 3

diabetic nephropathy

Question 4

in diabetic nephropathy mesangial matrix expansion leads to

Answer 4

Nodular Glomerulosclerosis or Kimmelstiel-Wilson Disease, which is the formation of nodules in the glomerular tuft.

Question 5

Increase permeability of the basement membrane causes what?

Answer 5

proteinuria

considered massive if it exceeds 3 gms of protein/day which causes Nephrotic syndrome.

Question 6

in patients with diabetes when does proteinuria usually develop?

Answer 6

about 10 to 20 years after the onset

Question 7

once proteinuria becomes severe in diabetic patients what are the results?

Answer 7

renal function deteriorates and chronic renal failure usually develops over a five year period

Question 8

describe the vascular changes in diabetic patients

Answer 8

the vascular changes are most prominent in arterioles, hyalinosis and thickening of the vessel walls occur and narrowing of the vascular lumen

Question 9

hyalinosis and thickening of the vessel walls occur and narrowing of the vascular lumen of the arterioles lead to

Answer 9

ischemia and tubular atrophy, which may progress to papillary necrosis of the pyramids

Question 10

necrotic papillae as a result of papillary necrosis may detach and do what?

Answer 10

occlude the ureter causing obstruction

Question 11

diabetic patients are prone to what type of (viral/ bacterial) infections related to the kidneys

Answer 11

bacterial infections

pyelonephritis is an important complication

Question 12

Recurrent episodes of interstitial bacterial pyelonephritis in diabetic patients may do what?

Answer 12

destroy the kidneys leading to the development uremia and require dialysis or renal transplantation

Question 13

urinary stones – calculi formation
more common in who?
4 chemical structure groups?

Answer 13

MC in men, 20 to 30 years old

4 groups: Calcium, Struvite, Uric Acid, and Cysteine stones

Question 14

calcium stones are composed of what, and make up what percent of stones

Answer 14

calcium oxalate or phosphate, 75%

Question 15

calcium stones are associated with

Answer 15

with hyperexcretion of calcium in patients who have abnormal calcium metabolism

Question 16

examples of abnormal calcium metabolism

Answer 16

hyperparathyroidism and diffuse bone disease

Question 17

struvite stones are composed of what, and make up what percent of stones

Answer 17

ammonia phosphate or triple stones, 15%

Question 18

struvite stones are associated with

Answer 18

UTI complications due to the formation of ammonia from urea

Question 19

which infection may lead to struvite stones

Answer 19

Proteus

Question 20

large stuvite stones are known as what? what are they associated with? and how large can they grow

Answer 20

staghorn calculi, associated with infection, can grow to fill the entire pelvis

Question 21

uric acid stones are associated with which conditions

Answer 21

hyperuricemia, Gout, Leukemia

Question 22

which factor of leukemia makes it associated with uric acid stones

Answer 22

leukemia involves rapid cell turnover

Question 23

which stones are radiolucent

Answer 23

uric acid stones

Question 24

cysteine stones are found in patient with which condition? describe this condition

Answer 24

cystinosis

cystinosis is an inborn error of amino acid metabolism

Question 25

where are most stones found

Answer 25

renal pelvis or urinary bladder

Question 26

what symptoms may a patient with stones present with?

Answer 26

hematuria urinary colic due to spasmotic pain caused by the contraction of an obstructed ureter renal colic presenting as flank pain radiating towards the groin

Question 27

how are stones removed?

Answer 27

small stones may be peed out (symptoms should then be resolved) larger stones may require surgery or mechanical extraction

Question 28

what is lithotripsy?

Answer 28

breaking of stones into small pieces by ultrasonic targeting

Question 29

Urinary Tract Obstructions increases a patients susceptibility to what? (3)

Answer 29

infection stone formation permanent renal atrophy

Question 30

what is Hydronephrosis

Answer 30

permanent renal atrophy | dilation of renal pelvis and calyces

Question 31

where are 90% of obstructions are located below? why is this significant?

Answer 31

the level of the glomeruli and therefore cause obstructions to urine flow.

Question 32

Obstructive Lesions of the Urinary Tract at level of the pelvis

Answer 32

calculi tumors ureteropelvic stricture

Question 33

Obstructive Lesions of the Urinary Tract in ureter that are intrinsic

Answer 33

calculi tumors sloughed papillae inflammation

Question 34

Obstructive Lesions of the Urinary Tract in ureter that are extrinsic

Answer 34

pregnancy tumors retroperitoneal fibrous

Question 35

Obstructive Lesions of the Urinary Tract in bladder

Answer 35

calculi tumors functional disorders

Question 36

Obstructive Lesions of the Urinary Tract intrastate

Answer 36

hyperplasia carcinoma prostatitis

Question 37

Obstructive Lesions of the Urinary Tract in urethra

Answer 37

posterior valve stricture | tumors, but they are rare

Question 38

Hydronephrosis is secondary to what

Answer 38

obstruction of urine flow

Question 39

the progressive pressure and dilation from Hydronephrosis leads to

Answer 39

collection ducts and cortical regions become affected and compress the renal vasculature affecting GFR

Question 40

Hydronephrosis and interstitial inflammatory reaction | secondary to? mediated by? leads to?

Answer 40

an obstruction can also trigger an interstitial inflammatory reaction mediated by leukocytes, eventually leading to interstitial fibrosis

Question 41

servere hydronephrosis causes what changes in the kidney

Answer 41

thin-walled cystic structure with parenchymal atrophy, obliteration of the pyramids and thinning of the cortex.

Question 42

hydronephrosis symptoms

Answer 42

colic-type pain due to distention of the collecting system

Question 43

Bilateral partial hydronephrosis leads to

Answer 43

inability to concentrate urine, reflected by polyuria and nocturia, leading to a nephritis

Question 44

Bilateral complete hydronephrosis leads to

Answer 44

oliguria or anuria, incompatible with long survival, due to irreversible kidney damage

Question 45

3 facts about neoplasms of the urinary tract

Answer 45

be malignant more often than benign, affects older patients, and more common in men

Question 46

Renal Cell Carcinoma comprise __ % of all kidney tumors. Transitional Cell Carcinoma of the renal pelvis comprise another __%, and Wilms Tumor, __%.

Answer 46

85, 8, 5

Question 47

in the renal lecture which tumors are benign tumors that are of no significance

Answer 47

renal cortical ademomas or fibromas

Question 48

what are Renal Cell Carcinoma composed of

Answer 48

cuboidal cells reminiscent of renal tubules

Question 49

Renal Cell Carcinoma patients typically present with

Answer 49

hematuria, dull flank pain, palpable abdominal mass other non-specific symptoms: weight loss, long-standing fever, or HTN

Question 50

labs found in Renal Cell Carcinoma (rare)

Answer 50

hypercalcemia and Polycythemia (hematocrit elevated)

Question 51

treatment and survival rate for RCC

Answer 51

Surgical treatment | 5 yr. survival of 35%.

Question 52

Transitional Cell Carcinoma are

Answer 52

papillary neoplasms

Question 53

Transitional Cell Carcinoma patients typically present with

Answer 53

hematuria or urinary obstruction early in course

Question 54

treatment and survival rate for TCC

Answer 54

surgically for grade 1 and 2 lesions 5 yr. survival of 70% Grade 3 lesions are less favorable

Question 55

what is the most common of solid tumors in infants and children

Answer 55

Wilms Tumor | affect 1 in 10,000

Question 56

``` Wilms Tumor present at? presents as? malignant or benign? composed of ```

Answer 56

present at the time of birth presents as a solitary or multinodular abdominal mass that replaces the kidney highly malignant composed of plastic or immature cells

Question 57

Wilms tumor treatment and prognosis

Answer 57

Good prognosis with surgery and chemo, with 85% with complete cures