Renal disease

lecture 2

What are the four kinds of renal disease?

1. glomerular

2. tubular

3. interstitial

4. vascular

What is the main immunologic cause of glomerular disease?

deposition of immune complexes onto the membrane

What is the main non-immunologic cause of glomerular disease?

exposure to chemicals and toxins

What is glomerulonephritis?

inflammation of the glomerulus

What is acute post streptococcal glomerulonephritis?

acute glomerulonephritis that is caused by immune complex depositing by group A strep and its M protein

What are the symptoms of acute post-streptococcal glomerulonephritis?

fever, edema around eyes, fatigue, hypertension, oliguria, hematuria

What kinds of cells, molecules, and casts can we find from acute post-streptococcal glomerulonephritis?

cells: RBC, WBC

molecules: protein

casts: hyaline and granular

What is rapidly progressive glomerulonephritis?

aka crescentic glomerulonephritis

• a more serious form of acute glomerulonephritis that results in renal failure and permanent damage

What are the symptoms of rapidly progressive glomerulonephritis?

deposition of immune complexes by SLE, macrophage damage to walls that release plasma into bowmans space, crescentic formations

What cells, molecules, and casts can we find in rapidly progressive glomerulonephritis?

cells: RBC

molecules: tons of protein

casts: RBC casts

very low GFR

What is Good Pasture syndrome?

morphology change to the glomerulus due to an autoimmune disorder (cytotoxic)

Goodpasture syndrome is what kind of disease?

autoimmune

How can goodpasture syndrome arise?

viral respiratory infection

What are the symptoms of good pasture syndrome?

hemoptysis (coughing up blood), dyspnea, hematuria

What cells, molecules, and casts are found in good pasture syndrome?

cells: RBC

molecules: protein

casts: RBC casts

What is Wegener’s granulomatosis?

a granuloma that produces inflammation of the small blood vessels in the kidney and respiratory system

How do we diagnose Wegener’s?

anti-neutrophilic cytoplasmic antibody

In Wegener’s disease, what pattern do ethanol stained neutrophils make?

perinuclear

In Wegener’s disease, what pattern do formaldehyde stained neutrophils make?

granular

What are symptoms of Wegener’s?

hemoptysis, renal failure

What are three renal diseases that involve pulmonary issues?

Wegener’s, good pasture syndrome, Henoch-Schonlein

What cells, molecules, and casts are found in Wegener’s?

cells: RBC

molecules: protein

casts: RBC casts

What is Henoch-Schonlein?

a common disease in children after an upper respiratory infection, raised red patches on the skin

What are symptoms of Henoch-Schonlein?

red patches on skin, blood in sputum and stools, renal issues

What cells, molecules, and casts are found in Henoch-Schonlein?

cells: RBCs

molecules: protein

casts: RBC casts

What is membranous glomerulonephritis?

thickening of the glomerular membrane due to IgG deposition complexes of the autoimmune nature

What is membranoproliferative glomerulonephritis?

alterations of specific cellularity in the glomerulus and peripheral capillaries

What is IgA nephropathy?

aka Berger disease

• IgA complexes deposit after a mucosal infection

What are symptoms of IgA nephropathy?

macroscopic hematuria, elevated IgA levels

continual damage of the glomerulus leads to what disease?

chronic glomerulonephritis

What are symptoms of chronic glomerulonephritis?

fatigue, anemia, hypertension, edema, oliguria

What is nephrotic syndrome?

a filtration disease where proteins and lipids are in the urine

What causes nephrotic syndrome?

systemic shock

What cells, molecules, and casts do we see in nephrotic syndrome?

cells: RTE cells

molecules: fat, cholesterol crystals, protein

casts: fatty and waxy casts

What kind of damage is done to the glomerular membrane in nephrotic syndrome?

increased permeability, damaged podocytes

What is minimal change disease?

aka lipid nephrosis → resembles nephrotic syndrome

When does minimal change disease occur?

after allergies, immunization

What damage is done to the glomerular membrane in minimal change disease?

little damage, only a small amount of cellular change

Focal segmental glomerulosclerosis (FSGS) is caused by what Ig complex deposition?

IgM

Which glomerular disorder associates with heroin and analgesic (tylenol) abuse?

FSGS

The biggest analyte difference in acute glomerulonephritis and nephrotic syndrome is?

presence of lipids in nephrotic syndrome

What are two causes of renal tubular acidosis?

ischemia: shock, trauma, surgery

toxins: aminoglycosides, antifungal agents, radiographic due

What cell is indicative of renal tubular damage?

RTE cells and their casts

What are some tubular disorders?

Fanconi, alport, uromodulin associated kidney disease, diabetic nephropathy, nephrogenic diabetes insipidus

What is fanconi syndrome?

a PCT resorption disorder where we cannot absorb glucose, protein, amino acids, bicarbonate, etc.

What are characteristic labs of fanconi syndrome?

glycosuria with cystine crystals

What is alport syndrome?

inherited tubular disorder of collagen production that affects the glomerular membrane

What is renal glycosuria?

failure to resorb glucose, but we have normal blood glucose and glucose in the urine

What is diabetic nephropathy?

damage to the glomerular membrane through deposition of glycosylated proteins

What is nephrogenic diabetes insipidus?

low levels of ADH that cause excessive urination

What is the most common renal disease?

UTI

In a upper UTI, what cells and casts do we see?

RBC, WBC, casts, bacteria

In acute interstital nephritis, what cells and casts do we see?

RBC, WBC, casts, NO BACTERIA

What is cystitis?

infection of the bladder

What cells, molecules, and casts do we see in cystitis?

cells: WBC, bacteria

molecules: protein

casts: NONE

What is acute pyelonephritis?

infection of the upper urinary tract

What cells, molecules, and casts are seen in acute pyelonephritis?

cells: WBC, bacteria, RBC

molecules: protein

casts: WBC cast, bacteria cast

a chronic infection of the urinary tract can lead to what disease and what symptoms?

chronic pyelonephritis

• symptoms: structural abnormalities that cause decreased urine concentration and flow

What is acute interstitial nephritis?

inflammation of the renal interstitium and tubules

What are symptoms of acute interstitial nephritis?

oliguria, edema, decreased renal conc. ability, dec. GFR

What kind of inflammation is seen in acute interstitial nephritis?

allergic, so we see eosinophils

What is renal failure?

loss of renal function marked by dec. GFR, azotemia (Cr and BUN in blood), electrolyte imbalance, watery urine

What can cause post renal failure?

calculi, tumors

What can cause renal failure?

acute glomerulonephritis, tubular necrosis, pyelonephritis, interstitial nephritis

What can cause pre renal failure?

decreased blood pressure, hemorrhage, burns, surgery

What is hydronephrosis?

a consequence of urinary obstruction above the bladder, causes swelling of the renal pelvis

What is renal lithiasis?

renal calculi (kidney stones)

What causes renal calculi formation?

pH, chemical concentration, urinary flow