Renal Diseases Prt. 3

Question 1

•Pathophysiology: Excessive ADH secretion or action

Answer 1

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Question 2

•Clinical Features: Headache, nausea, confusion, seizures

Answer 2

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Question 3

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

• Laboratory Findings:

• Hyponatremia
•Concentrated urine despite hypotonicity
• Urine sodium_____
•Normal renal, adrenal, and thyroid function
• Euvolemia

Answer 3

> 20 mEq/L

Question 4

-URINARY TRACT INFECTION
•Lower UTI: (2)

(pain or burning sensation on urination, frequent urge to urinate)

Answer 4

urethritis and cystitis

Question 5

-URINARY TRACT INFECTION

•Upper UTI: (2)

(fever, back or flank pain)

Answer 5

pyelitis and pyelonephritis

Question 6

Urinalysis findings: WBCs, bacteria, mild proteinuria and hematuria, increased pH

Answer 6

UTI

Question 7

UTI

______times more common in females
• Short___ with proximity to the vagina and the rectum
•___ that enhance bacterial adherence to mucosa
• Absence of____ and its antibacterial action
• ‘Milking’ of bacteria up the urethra during

Answer 7

10

urethra

Hormones

prostatic fluid

Question 8

85% of UTI is caused by…

Answer 8

Gram-negative rods

Klebsiella
Enterobacter
E. coli
Proteus
Pseudomonas

Question 9

UTI

Gram-positive agents include

Answer 9

S. faecalis
S. saprophyticus
S. aureus

Question 10

• Conditions that interfere with the downward flow of urine

• Renal calculi, catheterization, sepsis, pregnancy, DM, immunosuppressive therapy
• Vesicoureteral reflux

Answer 10

“ACUTE PYELONEPHRITIS

Question 11

• Most frequently occurs because of the ascending movement of bacteria from a lower UTI into the tubules and interstitium

• May also be due to hematogenous infection

Answer 11

“ACUTE PYELONEPHRITIS

Question 12

• Urinalysis findings
• WBCs, bacteria, WBC casts (pathognomonic of upper UTI)

Answer 12

Acute Pyelonephritis

Question 13

• Bacteria multiply in the interstitium and cause acute inflammation

• Tubular necrosis

• Bacterial toxins and leukocyte enzymes cause the formation of abscess

Answer 13

“ACUTE PYELONEPHRITIS

Question 14

• Persistent inflammation of renal tissue and causes permanent scarring

• Mostly due to congenital urinary structural defects producing reflux nephropathy (vesicoureteral reflux and intrarenal reflux) and chronic urinary tract obstruction

Answer 14

‘CHRONIC PYELONEPHRITIS

Question 15

• Note: INCREASED NUMBER OF EOSINOPHILS in differential analysis

Answer 15

-ACUTE INTERSTITIAL NEPHRITIS

Question 16

• Major cause: allograft rejection of transplanted kidney

• Other causes: antibiotics, NSAIDs (NO EOSINOPHILURIA), antiepileptic agents, diuretics, and certain diseases

Answer 16

-ACUTE INTERSTITIAL NEPHRITIS

Question 17

• Cell-mediated immune response that causes damage to the interstitium and renal tubular epithelium (3-21 days after exposure to the offending agent)

Answer 17

ACUTE INTERSTITIAL NEPHRITIS

Question 18

Urinalysis findings

• Hematuria, proteinuria, WBCs, WBC casts without bacteria

Answer 18

ACUTE INTERSTITIAL NEPHRITIS

Question 19

•YEAST INFECTIONS
• More common in women
• Yeasts like_____ are normal flora in the Gl tract and vagina and kept in check by the bacterial flora

Answer 19

Candida albicans

Question 20

• Occurs when the bacterial flora is disrupted by antibiotics or pH changes

Answer 20

Yeast infections

Question 21

• Renal calculi or kidney stones

• Vary in size from barely visible to large, staghorn calculi

• When urine becomes supersaturated with insoluble material because excretion rates are excessive and/or because water conservation is extreme, crystals form and may grow and aggregate to form a stone

Answer 21

NEPHROLITHIASIS

Question 22

PATHOGENESIS OF STONES
•Conditions favoring the formation of renal calculi:

Answer 22

• Chemical concentration or supersaturation of chemical salts in urine
• Optimal pH
• Urinary stasis
• Nucleation or initial crystal formation

Question 23

______: constant and unchanging urine ph
______: less soluble in neutral or alkaline urine
______: less soluble in acidic urine
• Urea-splitting organisms

Answer 23

Isohydruria

Inorganic salts

Organic salts

Question 24

75-85% of calculi are…

Answer 24

calcium oxalate
calcium phosphate

Question 25

: medication for HIV patients; poor solubility in physiologic pH

Answer 25

• Indinavir

Question 26

: in conjunction with hereditary disorders of cystine metabolism

Answer 26

• Cystine (1%)

Question 27

: food rich in purine and with uromodulin-associated kidney disease

Answer 27

• Uric acid (5-10%)

Question 28

: accompanied by chronic urinary infections involving urea-splitting bacteria, usually Proteus species

Answer 28

• Magnesium ammonium phosphate/struvite/staghorn (5%)

Question 29

•Urinalysis findings • Crystals in urine, microscopic hematuria

Answer 29

NEPHROLITHIASIS

Question 30

• May be a gradual progression from the original disorder to chronic renal failure or end-stage renal disease

Answer 30

RENAL FAILURE

Question 31

Sudden loss of renal function caused by: • sudden decrease in renal blood flow (25%) • acute glomerular and tubular disease (65%, 99% of cases is due to ATN), or • renal calculi or obstructions (10%, high BCHP equates to low GFR)

Answer 31

Acute Renal Failure • Now known as acute kidney injury

Question 32

ACUTE RENAL FAILURE IN CHILDREN •________ • One of the most common causes of acute renal failure in children • Commonly occurs after ingestion of meat infected with verocytotoxin-producing E. coli, most often serotype______ • The toxin damages the endothelium, reducing nitric oxide, promoting vasoconstriction and necrosis, and promoting thrombosis

Answer 32

HEMOLYTIC-UREMIC SYNDROME Serotype 0157: H7

Question 33

RENAL FAILURE • Progressive loss of renal function caused by an irreversible and intrinsic renal disease and progresses to end-stage renal disease

Answer 33

Chronic Renal Failure

Question 34

RENAL FAILURE • Marked decrease in GFR, slow but continuous (< 25 ml/min) • Steadily rising serum BUN and creatinine values • Electrolyte imbalance • Isosthenuric urine • Proteinuria and glycosuria • Abundance of granular, waxy, and broad casts (telescoped urine sediment)

Answer 34

Chronic Renal Failure