Week 6 Objectives (Pathophysiology)

Chapter 27 - Intrarenal Disorders (cards 1-62), Chapter 28 - Acute Kidney Injury (62-113)

What are the 5 categories in renal insufficiency/failure?

Congenital, Neoplastic, Infectious, Obstructive, Glomerular

What are the common manifestations of pain in kidney disease?

nephralgia, CVA tenderness, flank pain, dull constant pain to T10 and L1

What are the CAUSES for pain in kidney disease?

distension/inflammation of renal capsule, pain transmitted by sympathetic afferent neurons

What are the abnormal urinalysis findings of kidney disease describing the urine?

Dark and strong smelling, cloudy pungent

What does dark, strong-smelling urine indicate?

decreased renal function

What does cloudy pungent urine indicate?

infectious process

What does KUB identify?

size, position, shape

What does a renogram/renal scan show?

vasculature, tumors

What does ultrasonography differentiate?

Tissue characteristics

What does CT/MRI provide detailed information on?

vasulature, tissue

What are the diseases/disorders associated with congential abnormaities of the kindey?

Renal agenesis, renal hypoplasia, cystic kidney disease

What type of renal agenesis is NOT compatible with life?

Bilateral

Which TYPE of renal agenesis casues compensatory hypertrophy of the functional kidney?

Unilateral

What condition is characterized by the kidneys NOT developing in the fetus?

Renal agenesis

What is the condition where there is ONLY SOME kidney development?

Hypoplasia

What are some complications/affects of Hypoplasia?

pediactric end-stage renal failure, lifelong monitoring

(T/F) A single normal kidney can NOT maintain normal renal function.

F (False)

What disease is a genetically transmitted renal disease resulting in fluid-filled cysts that can expand and distrupt urine formation and flow?

Cystic Kidney Disease

Which form of cycstic kidney disease forms AT BIRTH

Autosomal recessive

Which form of cycstic kidney disease forms LATER IN LIFE

Autosomal dominant

(T/F) Cystic kidney disease can lead to renal failure, requiring dialysis or transplatation at late stage.

T (True)

What are the diseases/disorders associated with neoplasms of the kindey?

renal cell carcinoma, nephroblastoma (Wilms Tumor)

Which neoplastic disorder associated with the kidney has a familial pattern?

renal cell carcinoma

What are the risk factors for renal cell carcinoma?

smoking, obesity, hypertension, family history

What is the treatment of renal cell carcinoma?

nephrectomy

What are the symptoms of renal cell carcinoma?

CVA tenderness, hematuria, palpable mass

Metastases from renal cell carcinoma would be resistant to which types of treatment?

radiation, immunotherapy, chemotherapy

What kind of mutation is associated with renal cell carcinoma and its metastases?

p53 mutation

What neoplastic kidney disease/disorder is most common in children?

Nephroblastoma (Wilms Tumor)

What is another name for nephroblastoma?

Wilms Tumor

What are the clinical manifestations of Nephroblastoma?

palpable abdominal mass, abdominal pain, hypertension, hematuria

What are the treatments for nephroblastoma?

nephrectomy, radiation therapy, chemotherapy

(T/F) Wilms Tumor has an excellent cure rate.

T (True)

(T/F) Nephroblastoma has a poor cure rate.

F (False)

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Infection
Infection of the kidney: pyelonephritis (what would be the expected S/S in clinic?)
Most common: ascending infection from the lower urinary tract
Most effective preventive measure: early removal of catheters
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ADD SOMETHING ABOUT THE INFECTION SECTION FOR NEPHROBLASTOMA AFTER ATTENDING OFFICE HOURS

What are the diseases/disorders associated with infection of the kindey?

acute pyelonephritis

What structured are infected with acute pyelonephritis?

renal plevis, renal parenchyma

What is the cuase of acute pyelonephritis?

ascending UTI

What is the classic sign of acute pyelonephritis?

CVA tenderness

What are the clinical manifestations of acute pyleonephritis?

CVA tenderness, fever, chills, anorexia, fever-induced dehydration

What is a diagnostic sign of acute pyelonephritis?

presence of WBC casts inidicative of UTI

What is the treatment of acute pyleonephritis?

anitmicrobials

What are the common causes associated with obstruction of the kindey?

stones, tumors, prostatic hypertrophy, strictures of ureters or urethra

What is the purpose of treating acute pyelonephritis promptly with antimicrobials?

avoid decreased renal function

What are the outcomes/results associated with the complete obstruction of the kindey?

hydronephrosis, decreased GFR, ischemic kidney damage, acute tubular necrosis, chronic kidney disease

What is the cause for ischemic kidney damage in the kidney due to complete obstruction?

increased inraaluminal pressure

What are the diseases/disorders associated with glomerular disorders of the kindey?

Acute glomerulonephritis, chronic glomerulonephritis, nephrotic syndrome

What disease is associated with an immune response that causes the attraction of immune cells to the area of inflammation resulting in lysosomal degradation of the basement membrane?

acute glomerulonephritis

Why may GFR fall in acute glomerulonephritis?

contraction of mesangial cells (decreased surface area for filtration)

What are the clinical manifestations of acute glomerulonephritis?

proteinuria, oliguria, azotemia, edema, hypertension

What is the treatment of acute glomeronephritis?

Steroids, plasmapheresis, dietary and fluid management, systematic and renal hypertension

What disease is assumes a progressive course ulitmately developoing into end-stage renal disease, sclerosis, and fibrosis of kidney.

chronic glomerulonephritis

What clinical maifestations are present with chronic glomerulonephritis?

persistent proteinuria, heamturia, declining renal function

What condition is associated with increased glomerular permeability to proteins?

Nephrotic Syndrome

What are the clinical manifestations of Nephrotic Syndrome?

proteinuria, increased liver activity, edema

What is the urinary loss of protein per day (in grams) for someone with nephrotic syndrome?

3 to 3.5

What can proteinuria lead to?

hypoalbuminenia, edema, decreased blood colloid osomtic pressure

What is the most common finding in nephrotic syndrome?

edema

What can increased liver activity cause?

hyperlipidemia, hypercoagulability

What is the treatment of nephrotic syndrome?

diuretics, liquid-lowering agents, antihypertensives, immunosuppression (immunomodulation), management of underlying process

(T/F) Nephrotic syndrome can NOT resolve spontaneously

F (False)

(T/F) Nephrotic syndrome can progress to end stage renal failure.

T (true)

What conditions is associated with a sudden reduction of kidney function

Acute Kidney Injury

What does acute kidney injury cause?

Decreased GFR, decreased urine output, retention of nitrogen waste, increased serum creatinine, disruptions in fluid balance, electrolyte balance, acid-base balance

How is renal funcation monitored in acute kidney injury?

serum creatinine, calculated GFR

What does BUN allow us to monitor?

retention of metabolic waste(s)

What are the metabolic wastes being monitored by the BUN when suspecting acute kidney injury?

azotemia, uremia

What are the 3 sites of disruption associated with acute kidney injury?

prerenal (renal perfusion), postrenal (urine flow distal to the kidney), infrarenal (intrinsic) (circumstances within the kidney blood vessels, tubules, glomeruli, or interstitium)

What type of kidney injury is characterized by low GFR, oliguria, high urine specific gravity and osmolality, and low urine sodium?

Prerenal (kidney injury)

What are the causes of prerenal kidney injury?

conditions that diminish perfusion of the kidney, hypovolemia, hypotension, heart failure, renal artery obstruction, fever, vomiting, diarrhea, burns, overuse of diuretifcs, edema, ascites, ace inhibitors, angiotensin II blockers, NSAID

Prolonged prerenal acute renal failure leads to ...

acute tubular necrosis (intrinsic)

What condition is due to obstruction within the urinary collecting system distal to the kidney; elevated pressure in Bowman capsule; impedes glomerular filtration

Postrenal Kidney Injury

What are the cuases of postrenal kidney injury?

obstruction within urinary collecting system, elevated pressure in Bowman capsule

What are the clinical findings for postrenal kidney injury based on?

duration of obstruction

What can prolonged postrenal acute renal failure lead to?

acute tubular necrosis, irreversible kidney damage

What condition is due to a primary dysfunction of the nephrons and the kidney itself?

intrarenal (intrinsic) kidney injury

What is the most common problem associated with intrarenal/intrinsic kidney injury?

within renal tubules

What are the interstitial etiologies associated with intrinsic/intrarenal kidney injury?

within the renal tubules, glomerular, vascular

What are the pathophysiological processes associated with intrarenal/intrinsic kidney injury?

vascular, tubular

What is the VASCULATURE pathophysiological process associated with intrinsic/intrarenal kidney injury?

decreased renal blood flow, hypoxia, vasoconstriction

What is the TUBULAR pathophysiological process associated with intrinsic/intrarenal kidney injury?

inflammation and reprefusion injury, causes casts, obtructs urine flow, tubular backleak

(T/F) Intrinsic/Intrarenal disease is self-limiting (can repair itself).

T (True)

What are the 3 phases of the clinical presentation of acute tubular necrosis?

prodromal, oliguric, post-oliguric

What laboratory test can be used to differentiate between prerenal from intrinsic/intrarenal kidney injury?

BUN, urine sodium concentration, fractional excretion of sodium (FENa), urine osmolality, urinalysis (UA)

What is the condition associated by outcome of progressive and irrevocable loss of functional nephrons?

Chronic Kidney Disease

What is the progressive progress of chronic kidney disease? (use "-" between each condition in order [early-middle-late])

Chronic kidney disease-Chronic renal failure-End-stage renal disease (CKD-CRF-ESRD)

Which of the following requires dialysis: Chronic kidney disease (CKD), Chronic renal failure (CRF), End-stage renal disease (ESRD)

End-stage renal disease (ESRD)

What are some comorbidities linked with chronic kidney disease?

hypertension, diabetes (mellitus)

What condition is defined as decreased kidney function or kidney damage of 3 months’ duration based on blood tests, urinalysis, and imaging studies?

Chronic Kidney Disease

What condition is defined as GFR <60 ml/minute/1.73 m² for 3 months with or without indication of damage to the kidney?

Chronic Kidney Disease

What are the risk factors for chronic kidney disease?

diabetes, hypertension, recurrent pyelonephritis, glomerulonephritis, polycystic kidney disease, family history, old age, ethnicity

(T/F) The pathophysiology of progression of chronic kidney disease is NOT progressive and IS reversable.

False

What condition describes the pathophysiology of the progression when there is a GFR reduction with nephron loss and the kidneys compensate until 75% to 80% of nephrons are damaged/nonfunctional?

Chronic kidney disease

What are ALL the complications of chronic kidney disease?

Hypertension, cardiovascular disease, uremic syndrome (nephrotic syndrome), metabolic acidosis, electrolyte imbalances, bone and mineral disorder, malnutrition, anemia, pain, depression

What processes/conditions are involved in the pathogenesis of HYPERTENSION AND CARDIOVASCULAR DISEASE in chronic kidney disease?

hypervolemia, escalated atherosclerotic process, heightened RAAS and SNS activity

What processes/conditions are involved in the pathogenesis of UREMIC SYNDROME (nephrotic syndrome) in chronic kidney disease?

Retention of metabolic wastes, impaired healing, pruritus (itching), dermatitis, uremic frost

What processes/conditions are involved in the pathogenesis of METABOLIC ACIDOSIS in chronic kidney disease?

retention of acidic waste products, hyperkalemia, kidneys lose ability to secrete H+ ions and bicarbonate

What processes/conditions are involved in the pathogenesis of ELECTROLYTE IMABLANCE in chronic kidney disease?

retained potassium, phosphorous, and magnesium

What processes/conditions are involved in the pathogenesis of BONE AND MINERAL disorders in chronic kidney disease?

elevated phosphorous and PTH, inability to produce active vitamin D (results in inability for the small intestine to reabsorb calcium)

What processes/conditions are involved in the pathogenesis of MALNUTRITION in chronic kidney disease?

uremic syndrome (decreased intake), depression, dietary limitations, changes in taste, protein-energy wasting, negative nitrogen balance