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Urogenital > Urogenital 3 > Flashcards

Urogenital 3 Flashcards

1
Q

What are 10 causes of chronic renal failure?

A
  1. Diabetic Nephropathy
  2. Glomerulonephritis
  3. Hypertension
  4. Interstitial Nephritis
  5. Chronic urinary outflow tract obstruction
  6. Pyelonephritis
  7. Polycystic Kidney Disease
    8 Congenital Kidney Diseases
  8. Tumours
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2
Q

What are systemic manifestations/complications of end stage renal disease?

A
  1. Fluid and Electrolytes
    - dehydration
    - anemia
    - hyperkalemia
    - metabolic acidosis
  2. Calcium, Phosphate Bone
    - Hyperphosphatemia
    - Hypocalcemia
    - secondary hyperparathyroidism
    - renal osteodystrophy
  3. hematologic
    - anemia
    - bleeding diathesis
  4. Cardio-pulmonary
    - hypertension
    - heart failure
    - cardiomyopathy
    - pulmonary edema
    - uremic pericarditis
  5. GIT
    - nausea and vomitting
    - bleeding
    - esophagitis, gastritis, colitis
  6. neuromuscular
    - myopathy
    - peripheral neuropathy
    - encephalopathy
  7. Skin
    - dermatitis
    - pruritus
    - sallow colour
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3
Q

How to treat chronic renal failure?

A
  1. Hemodialysis
  2. Peritoneal Dialysis - removal of solute across the peritoneal membrane into peritoneal dialysate fluid (1.5-3l/time)
  3. Renal Transplantation - pt needs to be on immunosuppression rest of life
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4
Q

What are the consequences of chronic renal failure? 1 gross, 1 histo, 2 clinical feature

A
  1. Bilateral small contracted kidneys
  2. Widespread glomerulosclerosis, tubular atrophy, interstitial fibrosis
  3. Urine volume may be normal initially or may even have polyuria as tubules cannot concentrate glomerular filtrate
  4. Terminal oliguria when no function nephrons left
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5
Q

TWO signs of acute renal failure?

A
  1. Oliguria
  2. Azotaemia (rise in creatinine)
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6
Q

6 pre-renal causes of acute renal failure?

A
  1. hypotension
  2. hemorrhage
  3. severe dehydration
  4. shock
  5. heart disease
  6. liver failure
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7
Q

6 renal causes of acute renal failure?

A
  1. glomerulonephritis
  2. acute tubular necrosis (due to drugsm toxins, pigment etc)
  3. acute interstitial nephritis
  4. hemolytic uremic syndrome
  5. vasculitis
  6. severe infections (pyelonephritis etc)
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8
Q

2 post-renal causes of acute renal failure?

A
  1. acute urinary tract outlet obstruction (due to blood clots, stones, tumours)
  2. Acute atonia, hypotonia of bladder due to nerve damage (neurogenic bladder)
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9
Q

What investigations can be done for renal failure?

A

Blood Tests: Urea, Creatinine, Electrolytes

Urine Tests: Protein, RBCs, WBCs. Hemoglobin, Myoglobin

Imaging Studies: IVU, Ultrasound of the Kidneys, CT Urogram, CT/MRI etc

Kidney Biopsy

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10
Q

3 broad categories of renal diseases can lead to acute and chronic renal failure. What are these 3 diseases?

A
  1. Glomerular Disease
  2. Tubulo-interstitial disease
  3. Vascular Disease
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11
Q

How can glomerular disease present?

A
  1. Nephrotic syndrome
  2. Nephritic Syndrome
  3. Micriscopic Hematuria
  4. Acute Renal Failure
  5. Chronic Renal Failure
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12
Q

What does nephrotic syndrome cause? How does it present?

A
  1. Heavy proteinuria
  2. Hypoalbuminaemia
  3. Anasarca - edema due to loss of serum oncotic pressure
  4. lipiduria
  5. hyperlipidaemia

body swelling (face, eyelids, abdomen, ankles)
large urine volumes with frothy urine

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13
Q

Note: some nephrotic syndrome patients may be classified as steroid sensitive or steroid resistant; children are usually ____?

A

Sensitive to steroids. If child does not respond to treatment a renal biopsy will be performed.

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14
Q

How does nephritic syndrome manifest?

A
  1. Oligura
  2. Azotaemia
  3. Edema
  4. Hypertension
  5. Gross Hematuria
  6. Proteinura
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15
Q

How does microscopic hematuria present?

A

Hematuria detected by urinalysis (not visible to naked eye), pt is clinically well

some degree of proteinuria

no change in urine volume

no htn

no azotaemia

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16
Q

What is glomerulonephritis?

A

Includes diseases characterised by increased glomerular cellularity caused by proliferation of indigenous cells and/or leukocyte infiltration

other forms of glomerular disease may be termed ‘glomerulopathy’

17
Q

State and explain 3 antibody-mediated mechanisms of glomerular injury.

A
  1. In-situ formation of Ag-Ab complexes: against native antigen (ie Anti-GBM disease aka Goodpasture’s Disease) or against planted antigen that localises in glomerulus ie HBV, Lupus
  2. Circulating Immune Complexes
    - antigen in excess of antibody = small circulating complexes that fiernout in glomeruli ie lupus nephritis
  3. Antineutrophil Cytoplasmic Antibodies (ANCA)
    - interact with neutrophils in glomeruli [IF negative]
18
Q

Where do immune deposits deposit in the glomerulus
a) post strep
b) SLE, MPPGN
c) anti-GBM

A

a) subepithelial
b) mesangium, subendothelum
c) along basal membrane

19
Q

3 common and 2 uncommon causes of nephrotic syndrome

A
  1. Minimal Change Disease
  2. Focal Segmental Glomerulosclerosis
  3. membranous glomerulonephritis
  4. Membranoproliferative glomerulonephritis
  5. IgA nephropathy
20
Q

Imaging of minimal change disease
a) Light microscopy
b) IF
c) EM

A

a) no histologic abnormality
b) no immune deposits
c) fusion of foot processes and detachment from basement membrane

21
Q

pathogenesis of focal segmental glomerulosclerosis

A

podocyte injury with loss of pdocytes

22
Q

imaging of focal segmental glomerulosclerosis

A

LM - some glomeruli show segmental sclerosis
IF - sclerotic lesions stain with IgM and C3

23
Q

What is the effects of Diabetic Nephropathy?

A
  1. Glomeruli
    - GBM thickeniung (seen on EM
    - Mesangial widening (increase in matrix and cells); may become nodular as disease progresses (Kimmelstiel-Wilson nodules)
    - Hyalinosis lesions (protein insudation)
    - Microaneurysms of glomerular capillary lesions
    -eventually, glomerular sclerosis
  2. Interstitium
    - interstitial fibrosis
  3. tubules
    - thickened tubular basement membranes
    - tubular atrophy
  4. Vessels
    - arteriorlar hyalinosis
    - arteriosclerosis (a/w hypertension)
  5. Other findings
    - pyelonephritis predisposition
24
Q

presentation of hypertensive nephrosclerosis?

A
  1. proteinuria (low grade but if secondary FSGS develops, may be in nephrotic range)
  2. impaired renal function
  3. arterioles hyalinosis +/- muscular thickening
  4. Arteriosclerosis
  5. In malignantr htn, fibrinoid necrosis of arterioles and glomeruli and mucoid intimal thickning of arteries
25
Q

What is amyloidosis inkidney?

A

extracellular accumulation of fibrillary proteins

26
Q

Stains for amyloidosis?

A
  1. Congo Red Stain
  2. Apple Green birefringence under polarised light examination
27
Q

What gives the proteins its staining properties?

A

Antiparallel beta-pleated sheets

28
Q

What type of patients get amyloidosis?

A
  1. Plasma cell dyscrasia (AL amyloid)
  2. Chronic Inflammatory Diseases or Neoplasms (AA amyloid)
29
Q

Where are protein deposits found in amyloidosis?

A

glomeruli, interstitium, blood vessel

30
Q

what does amyloidosis cause?

A

proteinuria, nephrotic range

31
Q

histologic appearance of amyloidosis?

A

amorphous material in glomerulus, arteriole and interstitium (grey-blue)

32
Q

Key feature of Anti-GBM (Goodpasture’s Syndrome)?

A

crescenteric glomerulonephritis

Urogenital (3 decks)

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