T1: Renal Diseases

Question 1

5 major categories of renal diseases

Answer 1

1. Glomerular (damage to glomeruli)
2. Tubular (infection/toxin destroys cells)
3. Interstitial (infections)
4. Vascular (disruption to blood supply)
5. Others

Question 2

6 glomerular diseases

Answer 2

1. Acute Post-Streptococcal
2. Glomerulonephritis
3. Acute GN, Chronic GN
4. Membranoproliferative GN
5. Focal Segmental GN
6. Rapidly Progressive GN

Question 3

Acute Post-Streptococcal Glomerulonephritis

- specific causative bacteria

Answer 3

Group A Beta hemolytic strep

Question 4

Acute Post-Streptococcal Glomerulonephritis

- How immune complexes causes the disease

Answer 4

cellular infiltrates deposit on glomerular basement membrane

Question 5

Acute Post-Streptococcal Glomerulonephritis

- Six typical urinalysis findings

Answer 5

1. Gross hematuria
2. Proteinuria
3. Red cell casts
4. Hypertension
5. Edema
6. transient oliguria with reduced GFR

Question 6

Acute Post-Streptococcal Glomerulonephritis

- Pathognomonic finding for the disease

Answer 6

Red cell casts

Question 7

Acute Post-Streptococcal Glomerulonephritis

- two chemistry lab findings

Answer 7

increased BUN and Creatinine

Question 8

Acute Post-Streptococcal Glomerulonephritis

- one immunological finding

Answer 8

positive test for streptococcal antibodies (antibodies of M proteins)

Question 9

Three symptoms for chronic glomerulonephritis

Answer 9

edema, hypertension, oliguria

Question 10

Pathognomonic urinalysis finding for chronic glomerulonephritis

Answer 10

Broad and waxy casts

Question 11

two tubular diseases

Answer 11

1. Acute Tubular Necrosis (Ischemic and Toxic)

2. Renal Tubular Acidosis

Question 12

Describe tubular damage caused by trauma, shock, or sepsis, in ischemic acute tubular necrosis

Answer 12

the damage leads to decreased renal perfusion. Reduced oxygen disrupts tubular basement membrane function

Question 13

6 typical urinalysis findings of acute tubular necrosis

Answer 13

1. mild proteinurea
2. Hematuria
3. Low Specific gravity
4. renal epithelial cells, renal epithelial cell casts, granular casts
5. Oliguria
6. Increased BUN

Question 14

Pathognomonic findings for acute tubular necrosis

Answer 14

Renal epithelial cell casts

Question 15

Explain the pathogenesis of renal tubular acidosis

Answer 15

Tubules can’t secrete hydrogen ions to acidify urine, decreases blood pH, causing acidosis

Question 16

Five tubulointerstitial diseases

Answer 16

1. Pyelonephritis (acute and chronic)
2. Cystitis
3. Urethritis
4. Acute Tubulointerstitial Nephritis
5. Acute Tubulointerstitial Necrosis

Question 17

Pyelonephritis

- three predisposing factors

Answer 17

1. Urinary tract infection
2. Pregnancy
3. Diabetes mellitus

Question 18

Pyelonephritis

- three common routes of infection

Answer 18

1. Ascending from bladder
2. 3% from bloodstream
3. From lymphatic system

Question 19

Acute Pyelonephritis

- six typical findings

Answer 19

1. > 5 WBC’s/hpf (clumps)
2. Bacteria
3. Mild proteinuria
4. Positive blood
5. Positive nitrite
6. WBC casts

Question 20

Acute Pyelonephritis

- pathognomonic finding

Answer 20

WBC casts

Question 21

Chronic Pyelonephritis

- most common causes of chronic pyelonephritis

Answer 21

Backward flow of urine up ureters

Question 22

Chronic Pyelonephritis

- seven typical urinalysis findings

Answer 22

1. increased protein
2. WBC’s in clumps
3. low specific gravity
4. macrophages
5. granular casts
6. waxy casts
7. Broad casts

Question 23

Chronic Pyelonephritis

- pathognomonic finding

Answer 23

waxy and broad casts

Question 24

Cystitis

- 4 typical symptoms

Answer 24

1. increased frequency and urgency of urination
2. Pain in pelvic/abdominal region
3. Fever and chills
4. Burning sensation on urination

Question 25

Cystitis | - Two common bacterial causes

Answer 25

1. E. coli | 2. Staph saprophyticus

Question 26

Cystitis | - Five common urinalysis findings

Answer 26

1. Positive blood 2. Positive leukocyte esterase 3. Positive nitrite (if bacteria produce nitrite) 4. WBC's 5. Bacteria (1/3 will be neg) NO CASTS

Question 27

Nephrotic Syndrome | - 4 disease processes that may lead to the syndrome

Answer 27

1. Glomerulonephritis 2. Systemic lupus erythematosus 3. Diabetes mellitus 4. sickle cell anemia

Question 28

Nephrotic Syndrome | - The renal damage that leads to symptoms and lab findings

Answer 28

Glomerular basement membrane becomes highly permeable to plasma proteins and lipids

Question 29

Nephrotic Syndrome | - Two clinical symptoms

Answer 29

1. Edema | 2. Hypertension

Question 30

Nephrotic Syndrome | - Three typical chemistry findings

Answer 30

1. Hypoproteinemia 2. Increased cholesterol 3. Increased triglycerides

Question 31

Nephrotic Syndrome | - Four urinalysis findings

Answer 31

1. Massive proteinuria 2. Microscopic hematuria 3. oval fat bodies 4. Fatty casts and waxy casts

Question 32

Nephrotic Syndrome | - Pathognomonic findings

Answer 32

oval fat bodies, fatty casts and waxy casts

Question 33

Four vascular real diseases

Answer 33

1. Hypertension 2. Benign Nephrosclerosis 3. Renal Artery Stenosis 4. Microangiopathies

Question 34

Why can vascular disease lead to renal disease?

Answer 34

The kidneys receive 20-25% of cardiac output so anything that interferes with blood flow impacts kidney function

Question 35

Why can hypertension lead to renal disease?

Answer 35

incresed pressure changes the structure of vascular walls which increased the risk for renal failure

Question 36

What is the lab marker for real disease caused by hypertension?

Answer 36

microalbuminuria

Question 37

Hemolytic Uremic Syndrome (HUS) | - bacterial causative agent and what food is it found in?

Answer 37

- E. coli | - ground meat

Question 38

Hemolytic Uremic Syndrome (HUS) | - Why the toxin causes hemolysis and thrombosis

Answer 38

Toxin binds to RBC's, affects platelet function, and causes increased adhesion of WBC's to endothelium

Question 39

Hemolytic Uremic Syndrome (HUS) | - Processes that lead to vasoconstriction

Answer 39

The toxin causes increased 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

Question 40

Nephrolithiasis | - four factors that favor stone formation

Answer 40

1. increased concentration of stone constituent in urine 2. changes in urine pH 3. decreased urine flow 4. presence of bacteria

Question 41

Nephrolithiasis | - Four categories of kidney stones

Answer 41

1. calcium salts 2. triple phosphate (struvite) 3. Uric acid 4. Cystine

Question 42

Nephrolithiasis | - Three symptoms

Answer 42

1. severe flan pain 2. nausea 3. vomiting

Question 43

Nephrolithiasis | - Three typical urinalysis findings

Answer 43

1. Hematuria 2. Bacteriuria 3. crystals

Question 44

Nephrolithiasis | - Two typical chemistry findings

Answer 44

1. Increased BUN | 2. Increased creatinine

Question 45

Abrupt decreased in renal function sufficient to increase plasma creatinine and BUN

Answer 45

Definition of "acute renal failure"

Question 46

Pre-renal causes of acute renal failure

Answer 46

- Extracellular fluid loss - decreased cardiac output - sepsis/shock

Question 47

Renal causes of acute renal failure

Answer 47

- vascular disorders (DIC) - glomerulonephritis - tubular necrosis

Question 48

Post-renal causes of acute renal failure

Answer 48

- obstructions

Question 49

Acute Renal Failure | - three chemical findings

Answer 49

- Hyperkalemia - Increased plasma phosphorus - Decresed blood pH

Question 50

Acute Renal Failure | - two urinalysis findings

Answer 50

- Positive blood and protein in urine | - Oliguria

Question 51

Acute Renal Failure | - one hematological finding

Answer 51

anemia

Question 52

What glomerular filtration rate is associated with chronic renal failure

Answer 52

GFR < 15 mL/min

Question 53

Typical toxic agents that cause toxic acute tubular necrosis (5)

Answer 53

Heavy metals, ethylene glyco, organic solvents, drugs, and mushrooms

Question 54

Specific part of the nephron that is damaged in toxic acute tubular necrosis

Answer 54

proximal tubules