5 major categories of renal diseases
- Glomerular (damage to glomeruli)
- Tubular (infection/toxin destroys cells)
- Interstitial (infections)
- Vascular (disruption to blood supply)
- Others
6 glomerular diseases
- Acute Post-Streptococcal
- Glomerulonephritis
- Acute GN, Chronic GN
- Membranoproliferative GN
- Focal segmental GN
- Rapidly progressive GN
Acute Post-Streptococcal Glomerulonephritis
- Specific causative bacteria
Group A Beta hemolytic strep
Acute Post-Streptococcal Glomerulonephritis
- How immune complexes causes the disease
Cellular infiltrates deposit on glomerular basement membrane
Acute Post-Streptococcal Glomerulonephritis
- Anatomic structure in the glomerulus is damaged
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Acute Post-Streptococcal Glomerulonephritis
- 6 typical urinalysis findings
- Gross hematuria
- Proteinuria
- Red cell casts
- Hypertension
- Edema
- Transient oliguria w/ reduced GFR
Acute Post-Streptococcal Glomerulonephritis
- Pathognomonic finding for the disease
Red cell casts
Acute Post-Streptococcal Glomerulonephritis
- Two chemistry lab findings
↑ BUN and creatinine
Acute Post-Streptococcal Glomerulonephritis
- One immunological finding
Positive test for streptococcal Abs (Abs of M proteins)
List 3 symptoms for chronic glomerulonephritis
- Edema
- Hypertension
- Oliguria
Pathognomonic urinalysis findings for chronic glomerulonephritis
Broad and waxy casts
2 categories of tubular diseases
- Acute Tubular Necrosis (ischemic and toxic)
- Renal Tubular Acidosis
Describe tubular damage caused by trauma, shock, or sepsis, in ischemic acute tubular necrosis
The damage leads to ↓ renal perfusion. Reduced oxygen disrupts tubular basement membrane function
List typical toxic agents that cause toxic acute tubular necrosis and the specific part of the nephron that becomes damaged
- Heavy metals, ethylene glycol, organic solvents, drugs, mushrooms
- Causes damage and death to PT
6 typical urinalysis findings of acute tubular necrosis
- Mild proteinuria
- Hematuria
- Low specific gravity
- Renal epithelial cells, renal epithelial cell casts, granular casts
- Oliguria
- ↑ BUN
Pathognomonic findings for acute tubular necrosis
Renal epithelial cell casts
Explain the pathogenesis of renal tubular acidosis
Tubules can’t secrete hydrogen ions to acidify urine, ↓ blood pH, causing acidosis
5 tubulointerstitial diseases
- Pyelonephritis (acute and chronic)
- Cystitis
- Urethritis
- Acute tubulointerstitial nephritis
- Acute tubulointerstitial necrosis
Pyelonephritis
- 3 predisposing factors
- UTI
- Pregnancy
- Diabetes mellitus
Pyelonephritis
- 3 common routes of infection
- Ascending from bladder
- 3% from bloodstream
- From lymphatic system
Acute pyelonephritis
- 6 typical urinalysis findings
- > 5 WBCs/hpf (clumps)
- Bacteria
- Mild proteinuria
- Positive blood
- Positive nitrate
- WBC casts
Acute pyelonephritis
- Pathognomonic finding
WBC casts
Chronic pyelonephritis
- Most common cause of chronic pyelonephritis
Backward flow of urine up ureters
Chronic pyelonephritis
- 7 typical urinalysis findings
- ↑ protein
- WBCs in clumps
- Low specific gravity
- Macrophages
- Granular casts
- Waxy casts
- Broad casts
Chronic pyelonephritis
- 2 pathognomonic findings
Waxy and broad casts
Cystitis
- 4 typical symptoms
- ↑ frequency and urgency of urination
- Pain in pelvic/abdominal region
- Fever and chills
- Burning sensation on urination
Cystitis
- 2 common bacterial causes
- E. coli
- Staphylococcus saprophyticus
Cystitis
- 5 common urinalysis findings
- Positive blood
- Positive leukocyte esterase
- Positive nitrite (if bacteria produce nitrite)
- WBCs
- Bacteria (1/3 will be neg)
NO CASTS
Nephrotic syndrome
- 4 disease processes that may lead to the syndrome
- Glomerulonephritis
- Systemic Lupus Erythematosus (SLE)
- Diabetes mellitus
- Sickle cell anemia
Nephrotic syndrome
- Renal damage that leads to symptoms and lab findings
Glomerular basement membrane becomes highly permeable to plasma proteins and lipids
Nephrotic syndrome
- 2 clinical symptoms
- Edema
- Hypertension
Nephrotic syndrome
- 3 typical chemistry findings
- Hypoproteinemia
- ↑ cholesterol
- ↑ triglycerides
Nephrotic syndrome
- 4 urinalysis findings
- Massive proteinuria
- Microscopic hematuria
- Oval fat bodies
- Fatty casts and waxy casts
Nephrotic syndrome
- Pathognomonic findings
- Oval fat bodies
- Fatty casts
- Waxy casts
4 vascular renal disease
- Hypertension
- Benign nephrosclerosis
- Renal artery stenosis
- Microangiopathies
Why can vascular disease lead to renal disease?
The kidneys receive 20-25% of cardiac output so anything that interferes w/ blood flow impacts kidney function
Why can hypertension lead to renal disease?
↑ pressure changes the structure of vascular walls which ↑ the risk for renal failure
What is the lab marker for renal disease caused by hypertension?
Microaluminuria
Hemolytic Uremic Syndrome (HUS)
- Bacterial causative agent and what food is it found in?
E. coli found in ground meat
Hemolytic Uremic Syndrome (HUS)
- Why the toxin causes hemolysis and thrombosis
Toxin binds to RBCs, affects platelet function, and causes ↑ adhesion of WBCs to endothelium
Hemolytic Uremic Syndrome (HUS)
- Processes that lead to vasoconstriction
The toxin causes ↑ production of endothelia and loss of endothelial nitric oxide favors vasoconstriction, this in presence of blood clots, occludes vessels, causes necrosis, and thickening of capillary walls
Nephrolithiasis
- 4 factors that favor stone formation
- ↑ concentration of stone constituent in urine
- changes in urine pH
- ↓ urine flow
- Presence of bacteria
Nephrolithiasis
- 4 categories of kidney stones
- Calcium salts
- Triple phosphate (struvite)
- Uric acid
- Cystine
Nephrolithiasis
- 3 symptoms
- Severe flank pain
- Nausea
- Vomiting
Nephrolithiasis
- 3 typical urinalysis findings
- Hematuria
- Bacteriuria
- Crystals
Nephrolithiasis
- 2 typical chemistry findings
↑ BUN and creatinine
Abrupt ↓ in renal function sufficient to ↑ plasma creatinine and BUN
“Acute renal failure”
Pre-renal causes of acute renal failure
- Extracellular fluid loss
- ↓ cardiac output
- Sepsis/shock
Renal causes of acute renal failure
- Vascular disorders (DIC)
- Glomerulonephritis
- Tubular necrosis
Post-renal causes of acute renal failure
Obstructions
Acute renal failure
- 3 chemical findings
- Hyperkalemia
- ↑ plasma phosphorus
- ↓ blood pH
Acute renal failure
- 2 urinalysis findings
- Positive blood and protein in urine
- Oliguria
Acute renal failure
- 1 hematological finding
Anemia
What is the GFR associated w/ chronic renal failure?
GFR < 15mL/minute
What specific part of the nephron becomes damaged in toxic acute tubuler necrosis?
Proximal tubules
