Renal Patho

renal agenesis, horseshoe kidney, multi-cystic renal dysplasia, PCKD

Developmental disorders of the kidneys

renal agenesis

A developmental disorder where one or both kidneys don’t form at all

Horseshoe kidney

A developmental disorder where the tissue of the kidneys join, and the kidneys are unable to rise into the pelvis. Patients are prone to stones, infection, and physical damage.

PCKD (polycystic kidney disease)

Which developmental disorder of the kidneys is due to abnormal chromosomes and always affects both kidneys?

autosomal dominant

PCKD that is adult onset

autosomal recessive

PCKD that is infantile (aka present at birth)

acute renal failure, nephritis syndrome, nephrotic syndrome, isolated hematuria/proteinuria, chronic renal failure

Immune mediated glomerular diseases

antigen-antibody complexes (Type III)

Immune mediated glomerular diseases are mediated by

acute renal failure

What type of Immune mediated glomerular disease results in destruction in minutes to hours, is crescentic, drops the GFR, and increases creatine and BUN

Nephritic syndrome

What type of Immune mediated glomerular disease is the result of inflammatory processes, associated with SLE, and the damage occurs in epithelial cells and the basement membrane?

Nephrotic syndrome

What type of Immune mediated glomerular disease results in noninflammatory damage to the podocytes

isolated hematuria/proteinuria

Immune mediated glomerular diseases associated with Berger’s disease and lupus?

chronic renal failure

If any Immune mediated glomerular diseases is left untreated it can progress to

nephritic syndrome

A 55 y/o patient presents to the ER for hematuria. The patient has hypertension and generalized edema. After a urine sample is sent to the lab you discover RBC casts, non-nephrotic range proteinuria (<3.5). The patient also reports that he hasn’t been urinating a lot either. Diagnosis?

oliguria

Decreased urine output (at least 500 ccs a day)

anuria

No or very little urine output, less than 100 ccs

Nephrotic syndrome

A patient presents to the clinic with generalized edema. Blood work shows hypoalbuminemia amd hyperlipiemia. A urine sample shows proteinuria exceeding 3.5 and lipid casts. The patient reports that he was recently in the hospital for a DVT and has just gotten over a cold. Diagnosis?

ESRD (endstage glomerulopathy)

The progression of immune-mediated glomerulopathies, AKA “Chronic glomerulonephritis” basically the kidney damages is so bad we cannot function

diabetic nephropathy, urinary stones

Metabolic diseases of the kidneys

glomerulopathy, tubular atrophy, pyelonephritis, papillary ischemia/necrosis

Forms of diabetic nephropathy

arterioles

Tubular atrophy tends to affect the

Kimmelstiel wilson (KW)

The expansion of the mesnagial matrix of the kidneys in diabetes leads to the formation of nodules which is typical of what?

rarely

Does diabetic nephropathy ever result in acute renal failure?

calcium, struvite, uric acid, cystine

Types of urinary stones

calcium oxalate/phosphate

Most common type of urinary stone (75%)

struvite stones

A 55 y/o women reports to the ER for symptoms of an UTI. She states that for the last year she has had 2 UTIs a month. What could be an underlying problem?

bladder

Cystitis is an infection of the

kidneys

pyelonephritis is an infection of the

ascending infections

Most UTIs are

E.coli

What is the most common bacteria involved in an UTI

staph/strep

If the UTI is hematogenous in nature what is most likely the bacteria present?

renal arteries

Nephroangiosclerosis is more commonly affecting the

Activate RAS leading to vasoconstriction and increasing blood volume

What do the kidneys do as a result of hypertension

older men due to smoking, obesity, and job exposure

What is the typical patient population for renal tumors?

epithelial cells

Renal cell cancers originate from

transitional cells

Bladder cancers typically originate from

renal cell caricinoma

A patient presents to the clinic for blood in their urine. They also report flank pain that waxes and wanes. On a physical exam you notice a larger abdominal mass. Blood work shows amyloidosis, hypercalcemia, and erythrocytosis. Diagnosis?

bladder cancer

Most common cancer of the the whole urinary tract

renal cell carcinoma

Most common renal adult tumor

cytoscopy biopsy

Patient presents to the clinic for hematuria and burning on urination. They also report abdominal pain. To rule out urinary bladder cancer, what do you need to order?

Wilms tumor

A childhood cancer caused by the deletion on the WT-1 or 2 that is composed of immature renal blastema cells.

wilms tumor, one side of body is bigger than the other

Hemihypertrophy/hemi-hyperplasia components

wilms tumor, microcephaly, macroglossia, umbilical hernia

Beckwith-wiedermann syndrome components

wilms tumor, aniridia, GU abnormalities, mental retardation

WAGR syndrome

wilms tumor, glomerular disease, GU abnormality

Denys-Drash Syndrome components