Renal diseases

Question 1

What is erythropoietin, and how is it related to anemia in chronic kidney disease?

Answer 1

Erythropoietin is a glycoprotein produced by kidney fibroblasts that stimulates red blood cell production in the bone marrow. In chronic kidney disease, decreased erythropoietin production leads to anemia due to reduced red blood cell formation.

Question 2

What tests are used to assess renal function?

Answer 2

Blood tests (urea, phosphate, creatinine) and urine analysis (proteinuria, hematuria). Imaging techniques (US, CT, MRI) assess structure and obstructions. Creatinine clearance and eGFR estimate glomerular filtration rate.

Question 3

What is glomerulonephritis?

Answer 3

It is inflammation of the glomeruli leading to impaired kidney function and renal failure.

Question 4

What are the etiologies of glomerulonephritis?

Answer 4

Causes include autoimmune diseases (SLE), infections, IgA nephropathy, and genetic disorders

Most cases of primary and many cases of secondary glomerular disease probably have an immune origin

Question 5

Explain the pathophysiology of glomerulonephritis.

Answer 5

Autoimmune or inflammatory processes damage glomerular capillaries, leading to reduced filtration efficiency, hematuria, proteinuria, and reduced GFR. Changes include proliferation, membranous thickening, and sclerosis.

Question 6

What are two types of immune mechanisms that have been implicated in the development of glomerular disease

Answer 6

1. Injury resulting from antibodies reacting with (fixed) glomerular antigens (or antigens planted within the glomerulus)
2. Injury resulting from circulating antigen–antibody complexes that become trapped in the glomerular membrane

Question 7

What are the clinical manifestations of glomerulonephritis?

Answer 7

Symptoms include hematuria, proteinuria, edema, hypertension, fatigue, and reduced urine output.

Question 8

What kind of cellular changes occur with glomerular disease?

Answer 8

It increases in glomerular or inflammatory cell number (proliferative or hypercellular), (basement) membrane thickening (membranous), and changes in noncellular glomerular components (sclerosis and fibrosis).

Question 9

Define nephrotic syndrome.

Answer 9

A condition characterized by proteinuria (>3.5 g/day), hypoalbuminemia, edema, hyperlipidemia, and lipiduria.

Question 10

What is the pathophysiology of nephrotic syndrome?

Answer 10

Increased glomerular permeability causes protein loss, hypoalbuminemia, and edema. Hyperlipidemia occurs due to compensatory lipid synthesis.

Question 11

List clinical manifestations of nephrotic syndrome.

Answer 11

Massive proteinuria, hypoalbuminemia, generalized edema, hyperlipidemia, dyspnea, and increased infection risk.

Question 12

What is chronic kidney disease (CKD)?

Answer 12

Chronic kidney disease (CKD) is a progressive decline in kidney function because of the permanent loss of nephrons. CKD is defined as either kidney damage or a low glomerular filtration rate GFR

Progressive loss of kidney function over >3 months, often leading to end-stage renal failure.

Question 13

What causes CKD?

Answer 13

Main causes are Hypertension and diabetic kidney disease.

Question 14

Describe the pathophysiology of CKD.

Answer 14

Gradual nephron loss leads to compensatory hypertrophy of remaining nephrons, eventually resulting in irreversible damage, waste buildup, and fluid imbalance.

Question 15

What are the symptoms of CKD?

Answer 15

Early stages are asymptomatic. Later stages show anemia, uremia, hypertension, fluid retention, bone disease, and cardiovascular issues.

Question 16

What is Polycystic Kidney Disease (PKD)

Answer 16

A genetic disorder causing fluid-filled cysts in kidneys, leading to enlarged kidneys and impaired function.

Question 17

Differentiate between ADPKD and ARPKD.

Answer 17

ADPKD appears in adulthood (mutations in PKD1/PKD2); ARPKD appears in childhood (mutations in PKHD1).

Question 18

What are the clinical manifestations of PKD?

Answer 18

Hypertension, flank pain, hematuria, kidney stones, infections, and progressive renal failure.

Question 19

What is hydronephrosis?

Answer 19

Kidney swelling due to urine buildup from obstruction, causing renal damage.

Question 20

What are the symptoms of hydronephrosis?

Answer 20

Pain, reduced urine output, infections, hypertension, and kidney failure.

Question 21

What causes urinary obstruction?

Answer 21

Kidney stones, tumors, enlarged prostate, pregnancy, and strictures.

Question 22

What are the clinical effects of urinary obstruction?

Answer 22

Urine stasis, infections, stone formation, hydronephrosis, and renal failure.

Question 23

What are kidney stones?

Answer 23

Aggregates of minerals and crystals forming in the urinary tract.

Question 24

What causes kidney stones?

Answer 24

High concentrations of stone-forming substances, low inhibitors of crystallization, and urine stasis.

Question 25

What are the symptoms of kidney stones?

Answer 25

Renal colic (severe pain), nausea, vomiting, hematuria, and non-colicky dull pain.

Question 26

What is dialysis?

Answer 26

A treatment for renal failure that removes waste and excess fluid when kidneys can't function properly.

Question 27

Describe the types of dialysis.

Answer 27

Hemodialysis (blood filtered outside the body) and peritoneal dialysis (fluid exchange through the abdomen).

Question 28

What are common bladder and urethral disorders?

Answer 28

Obstructions, urinary stasis, incontinence, and cancers.

Question 29

What causes urinary incontinence?

Answer 29

Weak pelvic muscles, nerve damage, bladder overactivity, or obstruction.

Question 30

What are symptoms of bladder cancer?

Answer 30

Hematuria, frequent urination, and pelvic pain.

Question 31

What causes urinary and kidney infections?

Answer 31

Bacteria (E. coli most common), urinary stasis, catheter use, or obstructions.

Question 32

What are the symptoms of infections in the kidney?

Answer 32

Dysuria, urgency, frequency, fever, flank pain, and cloudy or foul-smelling urine.

Question 33

Define nephritic syndrome.

Answer 33

A condition characterized by hematuria, oliguria, hypertension, and mild proteinuria (<3.5 g/day).

Question 34

What is the pathophysiology of nephritic syndrome?

Answer 34

Inflammation and damage to the glomerular capillary walls result in reduced filtration, leading to hematuria, oliguria, and fluid retention.

Question 35

List clinical manifestations of nephritic syndrome.

Answer 35

Hematuria (cola-colored urine), oliguria, hypertension, edema, mild proteinuria, and azotemia.

Question 36

How do nephrotic and nephritic syndromes differ?

Answer 36

Nephrotic Syndrome: High proteinuria (>3.5 g/day), hypoalbuminemia, generalized edema, hyperlipidemia, lipiduria, and increased thrombotic risk. Nephritic Syndrome: Hematuria, oliguria, hypertension, mild proteinuria (<3.5 g/day), edema, and azotemia.