Flashcards in Renal Disorders I Deck (42)
1
Clinical symptoms of acute kidney injury
- oliguria
- elevated serum creatinine
2
Clinical signs of nephrotic syndrome
- severe proteinuria
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Clinical signs of nephritic syndrome
- hematuria
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Location of injury in acute kidney injury
- proximal tubule, sometimes distal tubule
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Location of injury in nephrotic syndrome
- glomerular capillary filtration defect (podocyte defect)
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Location of injury in nephritic syndrome
- breaks in the glomerular capillary loops
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Possible diagnoses for acute kidney injury
- acute tubular necrosis
- acute interstitial nephritis
- acute pyelonephritis
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Possible diagnoses for nephrotic syndrome
- membranous nephropathy
- FSGS
- minimal change disease
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Possible diagnoses for nephritic syndrome
- acute nephritic syndrome: crescentic glomerulonephritis, lupus nephritis, post infectious glomerulonephritis
- isolated hematuria: IgA nephropathy, alport's disease
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Clinical indicators of renal dysfunction
- edema
- decreased renal output
- foamy urine: proteinuria
- dark or red urine: hematuria (tea colored, cola colored)
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Laboratory indicators of renal dysfunction
- increased creatinine, blood urea nitrogen
- increased protein excretion (urine dipstick, urine protein/creatinine ratio, 24 hour urine protein)
- hematuria (urine dipstick, microscopic exam)
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Signs of chronic kidney disease
- Glomerular sclerosis
- interstitial fibrosis
- tubular atrophy
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Ways to assess renal biopsy
- light microscopy
- immunofluorescence microscopy
- electron microscopy
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Patterns of immunofluorescence staining in glomerulus
- linear capillary loop pattern
- granular capillary loop pattern
- mesangial pattern
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Disease associated with linear capillary loop pattern immunofluorescence stain
- Anti-GBM disease
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Diseases associated with granular capillary loop pattern immunofluorescence stain
- membranous nephropathy, lupus nephritis
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Diseases associated with mesangial pattern immunofluorescence stain
- IgA nephropathy, lupus nephritis
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Layers of basement membrane
- lamina externa
- lamina densa
- lamina interna
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Mechanisms of glomerular injury
1. immune mechanisms: immune complex mediated, T-cell mediated
2. non immune mechanisms: structural disorders
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Disorder associated with immune complex mediated glomerular injury
- membranous glomerulopathy
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Disorders associated with T-cell mediated glomerular injury
- minimal change disease
- lupus nephritis
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Disorder associated with non immune glomerular injury
- alport's syndrome
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Mutation associated with alport's syndrome
- mutation in collagen type IV gene
- leads to structural weakness in basement membrane b/c it's composed of collagen type IV
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Patient presentation and lab values seen with acute kidney injury
- decreased urinary output (oliguria), and uremia (azotemia)
- labs: increased serum creatinine, and blood urea nitrogen
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Types of acute kidney injury
- pre renal
- renal
- post renal
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Pre renal acute kidney injury causes
- cardiac shock, dehydration
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Renal acute kidney injury
- tubulointerstitial diseases
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Post renal acute kidney injury causes
- obstructive renal stone
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Causes of acute kidney injury
- acute tubular necrosis
- acute interstitial nephritis
- acute pyelonephritis
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Acute tubular necrosis prevelance
- MOST COMMON cause of acute kidney injury
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Causes of acute tubular necrosis
- injury to tubular epithelial cells
- hypovolemia, ischemia, drug toxicity
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Presentation of ATN & reversibility
- oliguria
- reversible
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Key features of ATN
- tubular dilation and flattening of tubular epithelial cells
- necrotic debris in tubular lumen
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Acute interstitial nephritis key featurs
- interstitial inflammation and tubulitis (lymphocytes in interstitium and in the tubule)
- EOSINOPHILS = drug induced (if eosinophils are present)
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Acute pyelonephritis causes
- infections of pelvicalyceal system, and renal parenchyma
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Presentation of acute pyelonephritis
- pain in cost-vertebral angle + other signs of infections
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Diagnosis of acute pyelonephritis
- pus (WBC) casts
- positive urine culture
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Key features of acute pyelonephritis
- similar to interstitial nephritis but inflammatory cells are NEUTROPHILS
- neutrophilic infiltrates and neutrophil casts in tubules are characteristic
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Prognosis of acute pyelonephritis
- benign course if treated, symptoms disappear after treatment with antibiotics
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Chronic pyelonephritis course
- may have insidious onset or a history of recurrent acute pyelonephritis
- gradual loss of renal function
- results in scarred kidney with chronic inflammation
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Key features of chronic pyelonephritis
- scarred kidneys, chronic inflammation
- severe tubular atrophy, "thyroidization" of the kidney
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