Urinalysis Chap 8 Flashcards Preview

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Flashcards in Urinalysis Chap 8 Deck (43):
0

MOST ALL ARE “IMMUNE” ORIGIN
MEANING THAT THEY ARE ANTIBODYANTIGEN COMPLEXES DEPOSITED INTO THE GLOMERULUS OF THE KIDNEY
SOME ARE NON-IMMUNE FROM CHEMICALS, TOXINS, ETC

GLOMERULAR DISORDERS

1

DEPOSITS INTO THE GLOMERULUS CAUSES BLOOD, PROTEIN, AND CASTS TO APPEAR IN THE URINE

GLOMERULONEPHRITIS

2

PROGRESSION: ACUTE TO CHRONIC TO NEPHROTIC SYNDROM TO RENAL FAILURE

Glomerular nephritis

3

ALTHOUGH MOST ACUTE GLOMERULONEPHRITIS RESOLVES WITHOUT PROGRESSION

Glomerular nephritis

4

What indicates GLOMERULONEPHRITIS?

RBC cast

5

CALLED “CRESCENTIC” BECAUSE of DEPOSITS OF MACROPHAGES, FIBROBLASTS, FIBRIN ARE CRESCENT SHAPED
RESULT OF AUTOIMMUNE SYSTEMIC DISEASE LIKE SYSTEMIC LUPUS ERYTHEMATOSIS (SLE)PROGRESSES RAPIDLY TO RENAL FAILURE

RAPIDLY PROGRESSIVE
GLOMERULONEPHRITIS

6

AUTOIMMUNE DISEASE
ANTIBODY TO BASEMENT MEMBRANE
AFFECTS LUNGS AND KIDNEY
HEMOPTYSIS AND HEMATURIA

GOODPASTURE’S SYNDROME

7

ANTIBODY TO STREPTOCOCCAL “M” PROTEIN ANTIBODY+ANTIGEN (BACTERIA) DEPOSITS
INTO KIDNEY
FOLLOWS THROAT OR SKIN INFECTION
OCCURS MOSTLY IN CHILDREN
ANTI-STREPTOLYSIN “O” TEST TO DETERMINE RECENT INFECTION

ACUTE POSTSTREPTOCOCCAL
GLOMERULONEPHRITIS

8

AFFECTS LUNGS AND KIDNEY LIKE
GOODPASTURES
HEMOPTISIS AND HEMATURIA
ANTIBODY TO CYTOPLASM OF NEUTROPHILS
“ANTINEUTROPHILIC CYTOPLASMIC
ANTIBODY”
GRANULOMAS FORM IN KIDNEY

WEGNER’S GRANULOMATOSIS

9

CHILDREN FOLLOWING RESPIRATORY ILLNESS
PURPURA; BLOOD IN SPUTUM AND STOOL
50% RECOVER COMPLETELY

HENOCH-SHONLEIN PURPURA

10

IgG IMMUNE COMPLEXES CAUSE THICKENING
OF BASEMENT MEMBRANE
• SLE, SJOGREN’S, SYPHILIS, HEPATITIS B, GOLD
AND MERCURY, MALIGNANCY
• SLOW PROGRESSION, SOMETIMES COMPLETE
RECOVERY, SOMETIMES PROGRESSION TO
NEPHROTIC SYNDROME

MEMBRANOUS
GLOMERULONEPHRITIS

11

GRADUALLY WORSENING SYMPTOMS
• PROTEINURIA AND HEMATURIA
• NO RBC CASTS
• MANY KINDS OF CASTS INCLUDING WAXY AND
BROAD CASTS

CHRONIC GLOMERULONEPHRITIS

12

IgA IMMUNE COMPLEXES
• MOST COMMON CAUSE OF
GLOMERULONEPHRITIS
• MOST FREQUENT IN CHILDREN AND YOUNG
ADULTS FOLLOWING MUCOSAL INFECTION
• SPONTANEOUS RECOVERY IN MOST PATIENTS
• SOME PROGRESS OVER 20 YEARS TO CHRONIC
GLOMERULONEPHRITIS

BERGER’S DISEASE

13

HEAVY PROTEINURIA -- >3.5 GRAMS/DAY
• LOW LEVELS OF SERUM ALBUMIN
(HYPOPROTEINEMIA)
• HIGH LEVELS OF SERUM LIPIDS
• PRONOUNCED EDEMA DUE TO LOW ALBUMIN
• OVAL FAT BODIES, FATTY AND WAXY CASTS,
RTE CELLS, RENAL TUBULAR EPITHELIAL CASTS

NEPHROTIC SYNDROME

14

INCREASED PROTEIN DUE TO CHANGES IN
PODOCYTES
• AS NAME IMPLIES “MINIMAL” LITTLE CHANGE
IN THE GLOMERULUS
• PRIMARILY IN CHILDREN AFTER ALLERGIC
REACTION,IMMUNIZATION, (ALSO HLA-B12)
• MILD HEMATURIA, NORMAL BUN AND
CREATININE TESTS
• PATIENTS GET WELL WITH STEROIDS

MINIMAL CHANGE DISEASE

15

SIMILAR TO NEPHROTIC SYNDROME BUT
• ONLY A PORTION OF THE KIDNEY IS AFFECTED
(SEGMENTAL)
• IgM AND C3 IMMUNE DEPOSITS
• ASSOCIATED WITH HEROIN ABUSE, ANALGESIC
ABUSE, HIV

FOCAL SEGMENTAL
GLOMERULONEPHRITIS

16

INHERITED DISORDER OF BASEMENT
MEMBRANE
• THINNING OF BASEMENT MEMBRANE
• NO IMMUNE COMPLEXES
• MACROSCOPIC HEMATURIA WITH
RESPIRATORY INFECTIONS

ALPORT’S SYNDROME

17

MOST COMMON CAUSE OF END-STAGE RENAL
DISEASE
• DEPOSITS OF GLYCOSYLATED PROTEINS
CAUSES SCLEROSIS OF VASCULAR STRUCTURE
IN GLOMERULUS
• MICROALBUMIN TESTING TO HELP FOLLOW
PATIENTS
• CONTROLLING BLOOD GLUCOSE PREVENTS
THIS COMPLICATION

DIABETIC NEPHROPATHY

18

NECROSIS OF RENAL TUBULES DUE TO LOW
BLOOD FLOW TO THE KIDNEY
• LACK OF OXYGEN TO THE TISSUE CAUSES
DEATH OF RENAL TUBULAR CELLS
• SHOCK, TRAUMA, SURGICAL PROCEDURES,
CARDIAC FAILURE, SEPTICEMIA,
ANAPHYLAXIS, HEMORRHAGE, ETC.
• RTE CELLS AND RTE CASTS ALONG WITH
HYALINE, GRANULAR, WAXY, AND BROAD

ACUTE TUBULAR NECROSIS

19

FAILURE OF
REABSORPTION BY THE PROXIMAL TUBULE
• INHERITED ALONG WITH CYSTINOSIS
• CAN BE ACQUIRED DUE TO HEAVY METALS,
OUTDATED TETRACYCLINE, MULTIPLE
MYELOMA, RENAL TRANSPLANT

Faconi's syndrome

20

POLYURIA, NOCTURIA, LOW SP. GRAVITY
• FAILURE TO RESPOND TO ADH

NEPHROGENIC DIABETES INSIPIDUS

21

UNABLE TO
REABSORB GLUCOSE IN PROXIMAL TUBULE
• DECREASED NUMBER OF GLUCOSE
TRANSPORTERS IN TUBULES

RENAL GLYCOSURIA

22

INFECTIONS AND INFLAMMATIONS
AFFECTING THE INTERSTITIUM AND THE
TUBULES

CYSTITIS
• B. ACUTE PYELONEPHRITIS
• C. CHRONIC PYELONEPHRITIS
• D. ACUTE INTERSTITIAL NEPHRITIS

23

BOTH ACUTE AND CHRONIC ARE BACTERIAL
INFECTIONS OF THE KIDNEY CHARACTERIZED
BY WBC CASTS

PYELONEPHRITIS

24

RAPID ONSET, TREATMENT WITH
ANTIBIOTICS PREVENTS TUBULAR DAMAGE

acute pyelonphritis

25

MORE SERIOUS, POSSIBLE
PROGRESSION TO CHRONIC RENAL FAILURE,
PROGRESSION TO GRANULAR, BROAD AND
WAXY CASTS

Chronic pyleonephritis

26

INFECTION BELOW THE KIDNEY
(BLADDER, URETHRA)

cystitis

27

INFECTION WITHIN THE
KIDNEY

pyleonephritis

28

WBC’S IN URINE

pyuria

29

SUDDEN LOSS OF KIDNEY
FUNCTION AND FREQUENTLY REVERSIBLE
• DUE TO LOW BP, OBSTRUCTION, ACUTE
GLOMERULONEPHRITIS, ETC. (TABLE 8-7)

acute renal failure

30

PROGRESSION FROM ORIGINAL
RENAL DISORDER

Chronic renal failure

31

what is renal calculi

Kidney stones

32

75% FROM CALCIUM OXALATE OR CALCIUM
PHOSPHATE
• ALSO URIC ACID, MAGNESIUM AMMONIUM
PHOSPHATE, CYSTINE
• LITHIASIS – HIGH ENERGY SHOCK WAVES
BREAK UP STONE
• PATIENT HYDRATION, DIET, pH MAINTENANCE

renal Calculi

33

Which glomerulonephritis is caused by antibody to basement membrane cells?

Good Pasture's Syndrome

34

Which glomerulonephritis is caused by antibody to M protein of Streptococci?

Acute Poststreptococcal Glomerulonephritis

35

Which renal disease causes excretion of large amounts of protein, elevated serum lipids, and causes excretion of oval fat bodies in the urine?

Nephrotic Syndrome

36

What type of cast would generally indicate a glomerulonephritis as opposed to a tubular disorder?

RBC cast

37

What disease is the most common cause of glomerulonephritis and is due to IgA immune complexes?

Berger's disease

38

Which renal disease is an inherited disorder that causes thinning of the basement membrane of the nephrons?

Alport's membrane

39

What is the difference between cystitis and pyelonephritis?

Cystitis is below the kidney
pyelonephritis is with in the kidney

40

Which cellular cast is indicative of pyelonephritis?

WBC cast

41

Which disease presents with hemoptyosis and hematuria and has antibody to the cytoplasm of neutrophils?

Wegner's granulomatosis

42

Which renal disease is caused by a failure of the tubules to respond to ADH hormone or by a lack of ADH hormone production?

Nephrogenic Diabetes insipidus