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2H. Pathology > Renal > Flashcards

Flashcards in Renal Deck (146)
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1

The study of kidney diseases is facilitated by dividing them into those that affect the four basic
morphologic components: 

  1. glomeruli
  2. tubules,
  3. interstitium,
  4. and blood vessels

2

most glomerular diseases are _________________

immunologically
mediated 

3

whereas tubular and interstitial disorders are frequently caused by ______________

toxic or
infectious agents.

4

Disease primarily in the blood vessels, for
example, inevitably affects all the structures that depend on this blood supply.

Severe
glomerular damage impairs the flow through the peritubular vascular system and also delivers
potentially toxic products to tubules; conversely, tubular destruction, by increasing
intraglomerular pressure, may induce glomerular injury. Thus, whatever the origin, there is a
tendency for all forms of chronic kidney disease ultimately to destroy all four components of the
kidney,
culminating in chronic renal failure and what has been called____________

 end-stage kidneys

5

The
functional reserve of the kidney is large, and much damage may occur before there is evident
functional impairment. For these reasons the early signs and symptoms are particularly
important clinically.

:)

6

____________ is a biochemical abnormality that refers to an elevation of the blood urea nitrogen
(BUN) and creatinine levels, and is related largely to a decreased glomerular filtration rate
(GFR). Azotemia is a consequence of many renal disorders, but it also arises from extrarenal
disorders.

Azotemia

7

____________- is encountered when there is hypoperfusion of the kidneys (e.g.,
in hemorrhage, shock, volume depletion, and congestive heart failure) that impairs renal function in the absence of parenchymal damage.

Prerenal azotemia

8

_____________- is seen whenever urine
flow is obstructed beyond the level of the kidney. Relief of the obstruction is followed by
correction of the azotemia.

Postrenal azotemia

9

When azotemia becomes associated with a constellation of clinical signs and symptoms and
biochemical abnormalities, it is termed___________ This is characterized not only by failure of
renal excretory function
but also by a host of metabolic and endocrine alterations resulting from
renal damage
.

These patients frequently manifest secondary involvement of the
gastrointestinal system (e.g., uremic gastroenteritis), peripheral nerves (e.g., peripheral
neuropathy), and heart (e.g., uremic fibrinous pericarditis).

 uremia.

10

___________________ is due to glomerular disease and is dominated by the acute onset of
usually grossly visible hematuria
(red blood cells in urine), mild to moderate proteinuria,
and hypertension; it is the classic presentation of acute poststreptococcal
glomerulonephritis.

Nephritic syndrome

11

_________________ is characterized as a nephritic syndrome with
rapid decline (hours to days) in GFR.

Rapidly progressive glomerulonephritis

12

The _____________also due to glomerular disease, is characterized by heavy
proteinuria
(more than 3.5 gm/day), hypoalbuminemia, severe edema, hyperlipidemia,
and lipiduria
(lipid in the urine).

nephrotic syndrome, 

13

______________, or a combination of these two, is usually a
manifestation of subtle or mild glomerular abnormalities.

Asymptomatic hematuria or proteinuria

14

_______________ is dominated by oliguria or anuria (reduced or no urine flow), and
recent onset of azotemia
. It can result from glomerular, interstitial, or vascular injury or
acute tubular injury.

Acute renal failure

15

_____________, characterized by prolonged symptoms and signs of uremia, is the
end result of all chronic renal parenchymal diseases.

Chronic renal failure

16

_______________are dominated by polyuria (excessive urine formation), nocturia,
and electrolyte disorders (e.g., metabolic acidosis). They are the result of diseases that
either directly affect tubular structure
(e.g., medullary cystic disease) or cause defects in
specific tubular functions.

 

The latter can be inherited (e.g., familial nephrogenic
diabetes, cystinuria, renal tubular acidosis) or acquired (e.g., lead nephropathy).

Renal tubular defects 

17

____________ is characterized by bacteriuria and pyuria (bacteria and
leukocytes in the urine). The infection may be symptomatic or asymptomatic, and it may
affect the kidney (pyelonephritis) or the bladder (cystitis).

Urinary tract infection

18

_________- is manifested by severe spasms of pain (renal colic) and
hematuria, often with recurrent stone formation.

Nephrolithiasis (renal stones)

19

Urinary tract obstruction and renal tumors have varied clinical manifestations based on
the specific anatomic location and nature of the lesion.

Urinary tract obstruction 

20

renal failure broadly progresses through a series of four stages that merge into one another.
1. In ____________ the GFR is about 50% of normal. Serum BUN and
creatinine values are normal
, and the patients are asymptomatic. However, they are
more susceptible to developing azotemia with an additional renal insult.
2. In ______________ the GFR is 20% to 50% of normal. Azotemia appears, usually associated with anemia and hypertension. Polyuria and nocturia can occur as a result
of decreased concentrating ability. Sudden stress (e.g., with nephrotoxins) may
precipitate uremia.
3. In ________ the GFR is less than 20% to 25% of normal. The kidneys cannot
regulate volume and solute composition
, and patients develop edema, metabolic
acidosis, and hyperkalemia
. Overt uremia may ensue, with neurologic, gastrointestinal,
and cardiovascular complications.

4. In end-stage renal disease the GFR is less than 5% of normal; this is the terminal stage
of uremia.
Recent clinical classifications of chronic kidney disease, adopted in part to
better stratify patients in clinical trials, adhere to this schema of progressive injury but
divide patients into five classes based on levels of GFR.

diminished renal reserve

 renal insufficiency 

chronic renal failure 

end-stage renal disease 

21

Principal Systemic Manifestations of Chronic Kidney Disease and Uremia

 

FLUID AND ELECTROLYTES
______________

Dehydration
Edema
Hyperkalemia
Metabolic
acidosis

22

Principal Systemic Manifestations of Chronic Kidney Disease and Uremia

 

CALCIUM PHOSPHATE AND BONE
_________________________________________

Hyperphosphatemia
Hypocalcemia
Secondary
hyperparathyroidism
Renal osteodystrophy

23

Principal Systemic Manifestations of Chronic Kidney Disease and Uremia

 

HEMATOLOGIC
__________

Anemia
Bleeding
diathesis (unusual susceptibility to bleeding (hemorrhage) mostly due to hypocoagulability, in turn caused by acoagulopathy (a defect in the system of coagulation)

24

Principal Systemic Manifestations of Chronic Kidney Disease and Uremia

CARDIOPULMONARY
_____________

Hypertension
Congestive heart
failure
Cardiomyopathy
Pulmonary edema
Uremic pericarditis

25

Principal Systemic Manifestations of Chronic Kidney Disease and Uremia

 

GASTROINTESTINAL
Nausea and vomiting
Bleeding
Esophagitis, gastritis,
colitis

Nausea and vomiting
Bleeding
Esophagitis, gastritis,
colitis

26

Clinical Manifestations of Renal Diseases

Myopathy
Peripheral
neuropathy
Encephalopathy

27

Clinical Manifestations of Renal Diseases

 

DERMATOLOGIC
Sallow color
Pruritus
Dermatitis

Sallow color
Pruritus
Dermatitis

28

_______________ is one of the most common causes of chronic kidney disease in humans.
Glomeruli may be injured by a variety of factors and in the course of several systemic diseases

chronic
glomerulonephritis

29

Systemic immunological diseases such as systemic lupus erythematosus (SLE), vascular
disorders
such as hypertension, metabolic diseases such as diabetes mellitus, and some
hereditary conditions such as Fabry disease often affect the __________. These are termed
secondary glomerular diseases .

glomerulus.

30

only or predominant organ involved. The latter constitute the various types of____________ or, because some do not have a cellular inflammatory component,
glomerulopathy
. However, both the clinical manifestations and glomerular histologic changes in
primary and secondary forms can be similar.

 primary
glomerulonephritis

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