Term
| explain the barriers to nephron filtration 5 |
|
Definition
mesangium: supports vessels
endothelium: interior vessel size barrier
basement membrane: neg charge barrier
podocytes: visceral epithelium size barrier
nephrin: keeps podocytes spaced for size barrier, negative charge barrier |
|
|
Term
| explain the 4 ways the kidney is damaged |
|
Definition
antigens: get stuck subepithelial
circulating immune complexes: get stuck subendothelial
Ig attack IV collagen: attack BM, complement follows
Complement damage: induces epithelial and endothelial release of proteases, GF, and cytokines which destory BM and kill cells. cause hypocomplementemia |
|
|
Term
| what are the 3 ways we can look at a kidney biopsy, what do each show us |
|
Definition
electron microscope: location of immune complexes
light microscope: fibrosis, collagen, BM structure (stained with silver, PAS, trichrome)
immunoflourescence: tells type if Ig and Ag, exact location, and pattern (linear or granular) |
|
|
Term
| define uremia, what are the symptoms 6 |
|
Definition
illness with kidney failure
fatigue, weakness, nausea, itch, confusion, pericarditis, coma |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what are the 3 types of azotemia, how do they occur |
|
Definition
pre-renal: dec CO causes hypoperfusion in glomeruli and dec GFT which allows BUN to reabsorb into blood more (BUN:CR>15)
post-renal azotemia: UT obstruction below kidney increases pressure and dec GFR allowing BUN to be resorbed more (BUN:CR>15)
renal intrinsic azotemia: kidney damage won't allow BUN back into blood (BUN:CR<15, RBC cast, protien in urine) |
|
|
Term
| 7 characteristics of nephritic syndromes |
|
Definition
protein <3.5g/d (<+2)
little edema
oliguria
HTN due to protein
asotemia
hematuria: RBC casts
dysmorphic RBC |
|
|
Term
| 7 characteristics of nephrotic syndromes |
|
Definition
protein <3.5g/d (>+3)
general dependent edema
hypoalbumenia
hyperlipidemia
lipiduria (maltease cross)
fat thromboembolism
endothelial dammage (inflamm and clots)
dec plasma: ions, vitamins, hormones, drugs |
|
|
Term
| why is the hyperlipidemia, lipiduria, and fat thromboembolism in nephrotic syndromes |
|
Definition
| proteinuria causes liver to try and make more and it always sends protein out with fats so fats seen in blood and in urine as fatty casts. extra fats in blood give risk of thromboembolism |
|
|
Term
| what is the final stage of many glomerular diseases |
|
Definition
| chronic glomerulonephritis |
|
|
Term
| what renal diseases commonly end in chronic glomerulonephritis 3 |
|
Definition
|
|
Term
| symptoms of chronic glomerulonephritis 4 |
|
Definition
uremia; protein, azotemia
anemia
anorexia |
|
|
Term
| urinalysis 1, LM trichrome signs of chronic glomerulonephritis 6 |
|
Definition
waxy casts
fibrosis, dead cells, hyalinization, interstitial fibrosis, lymphocytic infiltrate, scaring |
|
|
Term
| prognosis and tx of chronic glomerulonephritis |
|
Definition
| death without dialysis and transplant |
|
|
Term
| what are the 4 nephritic diseases |
|
Definition
acute proliferative (post-strep) GN
rapid proliferative (crecentric) GN
IgA nephropathy
hereditary nephritis - alport syndrome |
|
|
Term
| what are the age/most commons for the 4 nephritic diseases |
|
Definition
acute proliferative (post-strep) GN: more commonin kids
rapid proliferative (crecentric) GN: male > female 20-40yo
IgA nephropathy: more common in kids, most common GN, most common hematuria
hereditary nephritis - alport syndrome: AD, AR, X linked. 20-40yo |
|
|
Term
| what is the pathological cause of acute proliferative glomerulonephritis 2 |
|
Definition
immune complexes with antigens to GBS 1-4wk after infection
immune complexes to SLE (lupus nephritis) |
|
|
Term
| what is the patholgical causes of the 3 rapid progressive (crecentric) GN |
|
Definition
1. good pastures: anti-IgG to type IV collagen in glomeruli BM and aleolar capillary that recruits C3
2. anti-IgG to SLE, IgA nephropathy, PGN that attacks nephron
3. serum ANCA attacks nephron in microscopic polyangitis, weagner's granulomatosis, or idiopathic pacui-immune type GN |
|
|
Term
| what do the vessels look like the goodpastures |
|
Definition
parietal cells and monocytes cause crescent shape and push bowmans and cell tuft decreasing flow and killing cells
anti-IgG to IV collagen on GBM and pulmonary BM (1st) in LINEAR pattern |
|
|
Term
| symptoms of goodpastures 5 |
|
Definition
pulmonary hemorrhage
hemoptysis
plasma phoresis: removes Ab
oliguria
azotemia |
|
|
Term
| what do the vessels look like in type 2 rapid progressive glomerulonephritis |
|
Definition
parietal cells and monocytes cause crescent shape and push bowmans and cell tuft decreasing flow and killing cells
anti- IgG from SLE/PGN/IgAN in granular pattern |
|
|
Term
| what do the vessels look like in type 3 rapid progressive glomerulonephritis |
|
Definition
parietal cells and monocytes cause crescent shape and push bowmans and cell tuft decreasing flow and killing cells
ANCA |
|
|
Term
| prognosis and treatment of rapid progressive (crescentric) GN (all three types) |
|
Definition
rapid progression to renal failure
<80% crescent cells is better prognosis
dialysis and transplant needed to death |
|
|
Term
| what is the cause of IgA nephropathy |
|
Definition
genetic abnormality in IgA production or clearance
IgA is made to respiratory or GI infection then attacks the glomeruli |
|
|
Term
| what other conditions is IgA nephropathy associated with 3 |
|
Definition
cleaiac disease
liver disease
henoch-scholein purpura (probablly a varient of it) |
|
|
Term
| what does the LM, EM, and IF show in IgA nephropathy |
|
Definition
LM: mesangial proliferation
EM: electron dense deposits in mesangium
IF: IgA in mesangium, C3 alternate compliment pathway activation and recruitment |
|
|
Term
| symptoms of IgA nephropathy 2 |
|
Definition
hematuria 1-2d post respiratory, GI, or urinary infection that reoccurs every few months
LOIN PAIN |
|
|
Term
| prognosis of IgA nephropathy |
|
Definition
| can sometimes progress to chronci renal failure in 20y |
|
|
Term
|
Definition
| GBM type IV collagen mutation |
|
|
Term
| what does the vessel look like in aloprt syndrome 3 |
|
Definition
thin BM
LM trichrome: sclerosis, fibrosis |
|
|
Term
| signs of alport syndrome 5 |
|
Definition
nerve deafness
lens dislocation
posterior cataract
cornea dystrophy
carriers: hematuria |
|
|
Term
| prognosis of alport syndrome |
|
Definition
|
|
Term
| what are the 4 nephrotic diseases |
|
Definition
minimal change diesease
membranous glomerulonephritis
focal segmental glomerulonephritis
membranous proliferative GN |
|
|
Term
| what are the ages or common epidemology of the 4 nephrotic diseases |
|
Definition
minimal change disease: most common nephrotic syndrome in kids
membranous glomeruonephritis: most common nephrotic syndrome in adults (30-50)
focal segmental GN: in all ages, more in AA, HIV, IV drugs
membranous proliferative Gn: nephritic, nephrotic, or mixed |
|
|
Term
| what is the cause of minimal change disease |
|
Definition
| T cells induce IL-8 and TNF which attacks the nephron |
|
|
Term
| what are the EM, IF, and LM changes in the glomerulus in minimal change disease |
|
Definition
EM: loss of slit pores, damage to podocytes
IF: no complexes seen
LM: PCT filled with lipoprotein causes NECROSIS |
|
|
Term
| what is the clinical presentation of minimal change disease |
|
Definition
previously healthy kid (1-7) gets respiratory infection or vaccine and activates this immune response
selective proteinuria (albumin) |
|
|
Term
| what disorders is minimal change disease associated with |
|
Definition
|
|
Term
| prognosis and tx of minimal change disease |
|
Definition
>90% respond to steroids
<5% have renal failure in 25y
change is reversible |
|
|
Term
| what is the cause of membranous glomerulonephritis 3 |
|
Definition
exogenous: Hep B, hep B, malaria, syphillis, penicillin, NSAID, gold, murcery lodge in the kidney and body sends antibodies to attack them
endogeous: SLE, malignant carcinoma from lung or colon (ANTI-CEA), melanoma, or DM cause auto-antibodies to the kidney
both induce C5-C9 MAC to cause endothelial and mesangial cells to release protease and oxidants that cause damage |
|
|
Term
| what are the LM, EM, and IF changes in membranous glomerulonephritis |
|
Definition
LM: thick BM and spikes
EM: subepithelial deposits, spikes, podocyte loss
IM: C3, IgG along BM
DIFFUSE THICKENING OF CAPILLARIES
NECROSIS of kidney |
|
|
Term
| clinical signs of membranous glomerulonephritis |
|
Definition
non-selective proteinuria
NECROSIS of kidney |
|
|
Term
| prognosis of membraneous glomerularnephritis |
|
Definition
40% renal failure in 2-10y
10-30% benign/partial remission/full remission |
|
|
Term
| what is the cause of focal segmental glomerulonephritis 3 |
|
Definition
evolution from other glomerular nephritis
agressive form of minimal change disease
curculating mediators (IgM/C3) |
|
|
Term
| what are the LM, IF, EM changes in focal segmental GN |
|
Definition
SEGMENTAL
LM: tubular atrophy, sclerosis, hyalinization, interstitial fibrosis
IF: IgM, C3
BM: broken, displaced, obliderated podocytes |
|
|
Term
| clinical signs of focal segmental GN |
|
Definition
hx glomerulonephritis (esp IgA nephropathy)
non-selective proteinuria
hematuria
HTN |
|
|
Term
| prognosis of focal segmental GN |
|
Definition
poor
kids > adults
50% renal failure in 10y |
|
|
Term
| cause of membranous proliferative GN 2 |
|
Definition
immune complexes lodge in kidney and recruit C3: HapB, HepC, SLE, AV shunt infection, CLL)
C3 nephritic factor (C3nF) activates alternate complement pathway stabilizing C3 convertase causing hypocomplementemia (except C1, 2, 4) and causing complement damage to glomeruli |
|
|
Term
| EM, IM, LM changes in membranous proliferative GN type 1 |
|
Definition
EM: subentotheloal deposits
IM: IgG, C1q, C4, GRANULAR
LM: lobular glomeruli, proliferation of mesangial cells, infiltrative WBC, TRAIN TRACK BM |
|
|
Term
| EM, IM, LM changes in membranous proliferative GN type 2 |
|
Definition
EM: deposits inside BM and subendothelial, GRANULAR
IF: C3 in BM and mesangium
LM: lobular glomeruli, proliferation of mesangial cells, infiltrative WBC, TRAIN TRACK BM |
|
|
Term
| clinical signs of membranous proliferative GN |
|
Definition
|
|
Term
| prognosis of membranous proliferative GN |
|
Definition
slowly progressive (inc proteinuria) until renal failure
type 2 is worse |
|
|
Term
| what are the 4 systemic diseases that cause glomerulonephritis |
|
Definition
diabetic glomeruloapthy
SLE
renal amyloidosis
multiple myeloma kidney disease |
|
|
Term
| what is the most common cause of renal failure in the uS |
|
Definition
|
|
Term
| what are the 3 risk factors for diabetic glomerulopathy |
|
Definition
poor glycemic control
HTN
diabetic reinopathy - high correlation |
|
|
Term
| what are the changes to the vessels and golmeruli in diabetic glomerulopathy 7 |
|
Definition
non-enzymatic glycosulation causes athlerosclerosis and haline formation which cause hyperfiltration and increase GFR, and causes damage
glycosylation and endothelil damage cause sorbital activation which causes hyperfiltration, increases GFR, and causes damage
type IV collagen increases
proteinuria due to compormised layers
protein and type IV collagen deposits in mesangium
papillary necrosis: infarction of renal papillae cause puss in calyx, black papillae, death of papilae, and sloughing off |
|
|
Term
| what are the clinical signs of diabetic glomerulopathy 2 |
|
Definition
| poor glycemia for 10d leads to microalbuminea |
|
|
Term
| what are people with diabetic glomerulopathy at risk for |
|
Definition
|
|
Term
| how does SLE cause glomerulonephritis |
|
Definition
immune complexes stick in mesangium, BM, capillaries
diffuse proliferation of glomeruli |
|
|
Term
| how does renal amyloidosis cause glomerulonepheitis |
|
Definition
| depostits of amyloid in glomeruli (esp in dialysis), BM, vessels |
|
|
Term
| how is renal amyloidosis diagnosed |
|
Definition
| congo red shows yellow green bifringent amyloid in polarized light |
|
|
Term
| how does multiple myeloma kidney disease cause glomerulonephritis |
|
Definition
| Ig causes tubular casts and urinary obstruction |
|
|
Term
| what are the two types of renal vessel diseases |
|
Definition
benign nephrosclerosis
malignant nephrosclerosis |
|
|
Term
| what is the cause of benign nephrosclerosis |
|
Definition
| renal changes due to benign h |
|
|
Term
| what are the two types of renal vessel diseases |
|
Definition
benign nephrosclerosis
malignant nephrosclerosis |
|
|
Term
| what is the cause of benign nephrosclerosis |
|
Definition
| renal changes due to benign HTN causes hayline arteriosclerosis |
|
|
Term
| what is the cause of malignant nephrosclerosis |
|
Definition
| renal change due to malignant HTN causes hyperplastic arteriolosclerosis |
|
|
Term
| how does the external kidney look in benign nephrosclerosis |
|
Definition
| atrophy: grain leather, granular surface |
|
|
Term
| what changes in the arteries in benign nephrosclerosis |
|
Definition
| pink haylinethickening of vessels |
|
|
Term
| how does the kidney function change in benign nephrosclerosis |
|
Definition
decreased GFR
decreased concentrating abilities |
|
|
Term
| how do the large arteries change in malignant nephrosclerosis |
|
Definition
| hyperplastic arteriolosclerosis (onion skin) |
|
|
Term
| how does the external kidney change in malignant nephrosclerosis |
|
Definition
| flea bitten kidney: pinpoint petechial hemorrhages on surface |
|
|
Term
| how do the small arteries change in malignant nephrosclerosis 3 |
|
Definition
fibroid necrosis
granular eosinophillia
necrotizing arteriolitis (inflammatory cells)
necrotizing glomerulitis: arteriolitis in glomeruli |
|
|
Term
| what are the clinical signs of malignant nephrosclerosis 6 |
|
Definition
diastolic >120 EMERGENCY
papilledema
encephalopathy
cardiovascular abnormalities
renal failure: proteinuria, hematuria |
|
|
Term
| what is the prognosis of malignant nephrosclerosis 3 |
|
Definition
QUICKLY progresses to renal failure
50% survive 5y
90% that die die from uremia |
|
|
Term
| what are the two types of kidney infections |
|
Definition
acute pyelonephritis
chronic pyelonephritis |
|
|
Term
| what are the three types of kidney toxicities |
|
Definition
acute tubular necrosis
acute drug induced nephritis
analgesic nephropathy |
|
|
Term
| who usually gets acute pyelonephritis |
|
Definition
| more commoni n females (short urethra, damage with sex) |
|
|
Term
| what microbes usually cause pyelonephritis 4 |
|
Definition
#1 E.colo
klebsiella
proteus
enterobacterium |
|
|
Term
| what are ways that microbes can get to the kidney 11 |
|
Definition
infection ascention
colonization and spread
insturmentation
vesicurorectal reflex incompetence
flaccid pladder (spinal injury)
hematogenous
outflow obstruction
stasis
incomplete voiding
benign prostatic hypertrophy
uterine prolapse |
|
|
Term
| where does pyrlonephritis infect the kidney |
|
Definition
pelvis
tubules
interstitium
NOT glomeruli |
|
|
Term
| 4 signs in kidney of pleonephritis |
|
Definition
yellow external abscess
suppurative interstitial and tubular necrosis and abscess
pyonephrosis: exudate
papillary necrosis of pyramid tips |
|
|
Term
| what are 7 signs of pyelonephritis |
|
Definition
fever
chills
CVA tenderness
WBC casts
dysuria
urgency
pyuria |
|
|
Term
| what is the most common cause of acute renal failure |
|
Definition
|
|
Term
| what are the two types of acute tubular necrosis, give examples of what could cause each |
|
Definition
ischemic
nephrotoxic: AMINOGLYCOSIDES, IV RADIOCONTRAST, MYOBLOBIN VIA CRUSH INJURY, Mu, Ag, Pb, CCl3, ethylene glycol, mushrooms, pesticides |
|
|
Term
| what are 4 signs of ischemic acute tubular necrosis |
|
Definition
BM rupture: cell dies and cannot regenerate
tubular necrosis
generalized edema of interstitium
tubular casts wash into urine |
|
|
Term
| what are 4 signs of nephrotixic acute tubular necrosis |
|
Definition
some BM in tact
tubular necrosis
tubular casts in urine
generalized interstitial edema |
|
|
Term
| prognosis of acute tubular necrosis |
|
Definition
reversible if survive the other symptoms of the toxicity
excellent prognosis |
|
|
Term
| signs of acute tubular necrosis in urinalysis |
|
Definition
oliguria
dec BUN/CR (high in serum)
basic (acidic blood)
low k (high in blood)
dirty brown tubular casts |
|
|
Term
| what is the cause of chronic pleonephritis |
|
Definition
| recurrent infection due to chronic obstruction or reflux |
|
|
Term
| 3 signs in kidney of chronic pleonephritis |
|
Definition
scaring and fibrosis cause blunt calyces and retracted pelvis
fibrosis of interstitial tubules with PAS positive colloid casts |
|
|
Term
| what is seen on a pyelogram and biopsy of a kidney with chronic pleonephrosis |
|
Definition
calyces and pelvis retraction
may see FSGN |
|
|
Term
| clinical signs of chronic pleonephrosis 2 |
|
Definition
unoticed until renal failure
HTN due to inflammation |
|
|
Term
| cause of acute drug induced nephritis |
|
Definition
| hypersensitivity to drug 15d after exposure (antibiotic, thiazide, NSAID) binds kidney elements OR look similar to kidney causing cross reactivity |
|
|
Term
| signs in kidney of acute drug induced nephritis 3 |
|
Definition
|
|
Term
| clinical signs of acute drug induced nephritis 7 |
|
Definition
fever
eosinophilia
rash
hematuria
leukocytouria
serum CR increase
oliguria esp in elderly |
|
|
Term
| tx and prognosis for acute drug induced nephritis |
|
Definition
| remove drug, recovery in months |
|
|
Term
| cause of analgesic nephropathy |
|
Definition
| analgesic + (phenacetin, aspirin, tyalnol, caffiene, codine) x long time |
|
|
Term
| how does aspirin damage kidney |
|
Definition
| stops prostaglandin synthesis, decreases vasodilation, causes papilla ischemia, necrosis, and shriveling |
|
|
Term
| how does tyanol causes kidney damage |
|
Definition
| binds and causes ROS damage |
|
|
Term
| how does phenacetin cause kidney damage |
|
Definition
| phenacetin breakdown cause yellow lipofuscion like exudate |
|
|
Term
| what is a sign of analgesic nephropathy in kidney no matter the cause |
|
Definition
| pas positive BM thickening of small papillae vessels |
|
|
Term
| clinical signs of analgesic nephropathy 3 |
|
Definition
|
|
Term
| what are the three kidney cyst diseases |
|
Definition
simple cysts
AD polycystic kidney disease
AR polycystic kidney disease |
|
|
Term
| who gets the three kidney cyst diseases |
|
Definition
simple cysts - dialysis pt in end stage disease or long term dialysis, idiopathic
AD polycistic kidney disease - adults 40yo
AR polycstic kidney disease - rare, in kids, perinatal/neonatal/infantile/juveline |
|
|
Term
|
Definition
1-5cm
in cortex
clear
filled with fluid |
|
|
Term
| why do we care about simple cysts if they dont do anything |
|
Definition
| they can differentiate into adenoma/adenocarcinoma |
|
|
Term
| what is the cause of AD polycystic kidney disease |
|
Definition
| AD polycistin (PKD) mutation (90% PKD1) of protein that is like other proteins that cause cell-cell-matrix adhesions |
|
|
Term
| clinical signs of AD polcystic kindey disease 5 |
|
Definition
flank pain
large palpable 4kg kidneys
HTN
hematuria
UTI |
|
|
Term
| signs in kidney of AD polycystic kidney disease 2 |
|
Definition
kidney failure
2-4cm cysts all over outside of kidney push on it and cause ischemia and atrophy |
|
|
Term
| signs outside kidney of AD polycystic kidney disease 3 |
|
Definition
berry anurysm in circle of willis
subarachnoid hemorrhage
asymptomatic liver cysts |
|
|
Term
| tx and prognosis of AD polycystic kidney disease |
|
Definition
10% cohronic renal failure (>50yo)
SLOW progression
tx: transplant |
|
|
Term
| cause of AR polycystic kidney disease |
|
Definition
| 2 mutated fibrocystin genes (PKhD1) to receptors on CD and biliary differentiating cells |
|
|
Term
| signs of AR polycystic kidney disease 3 |
|
Definition
cysts in cortex and medulla that spread from CD
sponge like kidney
cysts in liver and portal bile ducts |
|
|
Term
| prognosis of AR polycstic kidney disease |
|
Definition
perinatal and neonatal die from pulmonary and respiratory failure
liver chirrhosis |
|
|
Term
|
Definition
|
|
Term
| general cause of urolithiasis |
|
Definition
| supersaturation of substance allows for percipitation |
|
|
Term
| size and location of urlithiasis |
|
Definition
80% unilateral
usually 2-3 cm |
|
|
Term
| clinical signs of urolithiasis 4 |
|
Definition
flank pain towards groin (uteral colic)
gross hematuria
infections
hydronephrosis |
|
|
Term
| 4 compounds causing renal stones, which is most common |
|
Definition
Ca oxylate 70%
Mg ammonium phosphate
uric acid
cysteine |
|
|
Term
| how do Ca oxylate stones form |
|
Definition
hypercalcuria without hypercalcemia (Ca goes right from GI to bladder)
renal wont absorb the Ca and uric acid wont enter because its too concentrated (so it cant break it up) so it percipitates |
|
|
Term
| why would someone have hypercalcuria and hypercalcemia in ueolithiasis 2 |
|
Definition
hyperparathyroidism
sarcoidosis |
|
|
Term
| how are Mg ammonium phosphate crystals formed, aka |
|
Definition
struvite
bacteria poo out urea and it percipitates |
|
|
Term
| how do uric acid crystal form |
|
Definition
| gout increases uric acid or leukemia turns over cells and it spills out and gets high and then it is high in pee and percipitates when urine pH <5.5 |
|
|
Term
| how do cysteine crystals form |
|
Definition
| genetic deficit in renal AA transporter for cys back into blood so it is stuck in pee in high concentration and percipitates |
|
|
Term
| what is a staghorn calculi |
|
Definition
| struvute in branches in casts of tubules |
|
|
Term
| what causes hydronephrosis |
|
Definition
| prostate enlargement, tumor, stone, anything that blocks the urine |
|
|
Term
| what are the changes in the kidney in hydronephrosis 6 |
|
Definition
BIG kidney
dilation of pelvis and calyces
obliterated papulae
flat pyramids
parenchyma compression, necrosis, and atrophy
coagulative necrosis (when acute) |
|
|
Term
| clinical signs of hydronephrosis 3 |
|
Definition
anuridia
polyruidia (decreased concentrating ability)
if unilateral may be asymptomatic for longer |
|
|
Term
| prognosis of hydronephrosis |
|
Definition
| reversible if un-obstructed within a few weeks |
|
|
