Renal Disease Study Guide: Terms & Definitions for Medicine

Autosomal Dominant Polycystic Kidney Disease

-a lot of cyst formaion that causes parenchymal distortion & dysfunction

-can lead to renal failure

-hereditary (autosomal dominant)

-APKD gene mutation

-in adults

-can cause HTN due to increases renin and a berry aneurysm

Simple Renal Cyst

-most common renal mass

-usually asymptomatic

What is Acute Kidney Injury?

-rapid loss (

What are the 3 causes of Acute Kidney Injury?

1. Prerenal

2. Intrarenal

3. Postrenal

Pre-Renal AKI

-decreased renal blood flow (hypotension)

-kidney is not getting enough blood

-ex. hypovolemia, CHF, shock, lesions, drugs

-most common

-can progress to intrarenal

Intra-Renal AKI

-direct damage to glomerulus or tubules

-kidney is not filtering blood well

EX.

-Acute tubular necrosis (rhabdo, drugs, ischemia)

-Inflammatory diseases (glomerulonephritis)

Post-Renal AKI

-urinary tract obstructions

EX. kidney stones, tumors

-least common

Pre-Renal v. Intra-Renal BUN/Creatinine Ratio

Pre-Renal: >20:1 (BUN increases more than creatinine)

Intra-Renal:

Acute Tubular Injury/Necrosis

-tubular injury due to ischemia or toxicity (myoglobin)

-the critical events in both ischemic and nephrotoxic ATI are believed to be 1) tubular injury and 2) persistent severe disturbances in blood flow

How are the stages of renal disease and GFR related?

as renal disease progresses the GFR decreases

What is an early sign of renal disease?

microalbumoinurea

What increases the risk of morbidity and mortality in renal disease?

1) decreased GFR

2) increased albuminuria

What is a normal GFR value for ages 20-29?

120mL /min

What is a normal GFR value for someone in their 70s?

70mL/min

Chronic Kidney Disease

-progressive loss of renal function of a perioed of months to years

Signs:

-Uremia (increased BUN)

-glomerulosclerosis (caused by HTN)

-irreversible loss of nephrons

Causes:

****DM

- also HTN

Effects of CKD

1. Uremia

-uremic frost

-increased nitrogenous waste in blood can affect heart and other systems

2. Renal Osteodystrophy

-kidneys affect phosphate/Ca2+ balance and activate Vitamin D

-if damaged can degenerate bone tissue

3. Renal anemia

-lack of EPO leads to anemia

4. Metabolic Acidosis

-kidneys remove acids and generate bicarbonate

-failure leads to acidosis

5. Hyperkalemia

-kidney is responsible for removing extra K+

-failure leads to high levels of K+ in blood

How is CKD treated?

Hemodialysis

Kidney Stones

-precipitation of crystals in the urinary tract that can cause acute occlusion to the passage of urine

-calculus (stone)

-urolithiasis (stone in GU tract)

-nephrolithiasis (kidney stone)

-ureterolithiasis (stone in ureter)

Renal calculi

-kidney stone

-made of crystallized calcium

-large stones can block ureter creating colicky pain

Causes:

-dehydration, infection

Treatment:

-lithotripsy

What is the main symptom of a kidney stone?

colicky pain!

(comes and goes in waves)

Urine Outlet Obstruction

-intrinsic or extrinsic obstruction to urinary system

-urinary stasis increases risk of infection

-obstruction causes increased pressure in the nephron that can reduce GFR and lead to kidney injury if not treated

Causes:

-calculi, tumors

What should NOT be in the filtrate after leaving the glomerulus?

-cells

-proteins

-things boud to proteins

What are the 2 Glomerular Diseases?

1. Nephrotic Syndrome

2. Nephritic Syndrome

What are the main indicators of Nephrotic Syndrome?

proteinuria (> 3.5 g/24 hrs)

hyperlipidemia

edema (due to hypoalbuminemia)

**non-inflammatory

What are the 3 pathologies associated with Nephrotic Syndrome?

1. Diabetic glomerulosclerosis

2. Renal amyloidosis

3. Minimal change disease

Nephrotic Syndrome: Diabetic Glomerulosclerosis

"christmas ball disease"

-increases hydrostatic pressure of capillaries which increases permeability of the basement membrane

-allows for albumin to enter the urine

-causes hyaline arteriolosclerosis in afferent and efferent arterioles (decreased blood flow)

What is the leading cause of end-stage renal disease in the US?

diabetes

Nephrotic Syndrome: Renal Amyloidosis

-abnormal deposition of amyloid protein in the kidneys

-caused by abnormal folding of proteins

-can lead to proteinuria and progressive renal failure

Nephrotic Syndrome: Minimal Change Disease

-most common cause of nephrotic syndrome in children

-electron microscopy reveals fusion of podocytes

-caused by cytokines from T-cells

-treat wih steroids

What is the most common cause of nephrotic syndrome in children?

minimal change disease

What are the 3 major causes of of Nephritic Syndrome?

Systemic Lupus Erythematosus

IgA nephropathy (Berger Disease)

Acute postinfectious glomerulonephritis (CHILDREN)

What are the main indicators of Nephritic Syndrome?

-Inflammatory glomerlopathy

-Hematuria (RBC cast)

-Oliguria

-low GFR

Nephritic Syndrome: Acute Postinfectious (Poststreptococcal) Glomerulonephritis

-steptococcus pyogenes

-immune complexes (activate inflammation, causes proliferation)

-most common in children

-causes inflammation & hypercellularity

Nephritic Syndrome: Systemic Lupus Erythematosus

-autoimmune disease

-renal deposition of immune complexes

-antibodies become trapped in glomeruli and trigger an immune response

Nephritic Syndrome: IgA Nepropathy (Berger Disease)

-glomerulonephritis due to immune complex deposition of IgA

-usually occurs after a URI

-most common

Hypertensive (benign) Nephrosclerosis

Cause: DM & HTN

-chronic HTN creates hardens renal arterioles

-leads to decreased renal function

-cortex thins and scars

-medial and intimal thickening

-hyalinization of arteriolar walls

Malignant Nephrosclerosis

-sudden accelerated spike in blood pressure

-petechiae

-fibrosis and necrosis of arter

vessel damage --> fibrosis -->ateriolosclerosis -->dec BP -->increased HTN

Renal Artery Stenosis/Renal Vascular Hypertension

-hypertension is secondary to renal artery stenosis

-caused by production of renin from ischemic kidney

Acute Pyelonephritis

-bacterial infection of the kidney

-leads to inflammation

-upper UTI

-usually caused by E. coli traveling up from the bladder

-WBC casts

-high fever

-flank pain

Cystitis

-urinary bladder inflammation

-usually from spread of E.coli from colon

Triad:

-frequent urination

-lower abdominal pain

-dysuria

Abnormal Urine Constituents

-pyuria (WBC)

-casts (clumps of WBC-->pyelonephritis)

-nitrites (produced by bacteria)

Drug-induced Tubulointerstitial Nephritis

-sterile pyuria

-caused by NSAIDS, ABX, PPI

Nephroblastoma (Wilms tumor)

-common in children

-malignant neoplasm of embryonic nephrogenic elements

What is the most common kidney growths in children?

Wilms Tumor (nephroblastoma)

Renal Cell Carcinoma

-most common adult renal cancer

-cigarette smoking

-painless hematuria

-yellow orange mass

-cells with clear cytoplasm

Bladder Cancer

-carcinoma from transitional epithelium

-cigarette smoking

Benign Prostatic Hyperplasia (BPH)

noncancerous enlargement of the prostate

-helped with alpha blockers that relax smooth muscle

-very common

-related to DHT growth factors

-causes urinary obstruction

Prostate Carcinoma

-adenocarcinoma is most common form of cancer in men

-tends to grow on posterior --> digital rectal exam

-elevated levels of serine protease

Testicular Tumors

-most common: germ cell tumors

-most common tumor of young men (15-34)

2 Groups:

1. Seminomatous tumors (resemble germ cells)

-remain localized

-most common

2. Nonseminomatous tumors (resemble stem cells)

-more aggressive

What does the teste descend through?

Inguinal canal

Cryptochidism

-teste does not descend

-increased risk of testicular cancer

Neurogenic bladder

-spastic and flaccid bladder

-caused by neurogenic damage

-can be overactive or underactive

-more likely to get UTI

What is important for proper bladder function?

coordination of detrusor muscle and sphincter

2 Types of Neurogenic Bladder

1. Spastic

-involuntary contractions

-sphincter relaxation and bladder control are uncoordinated

-damage from brain or spinal cord above T12

2. Flaccid

-contractions are absent

-damage to peripheral nerves or S2-S4 spinal cord

-overflow incontinence

What is urinary incontinence?

involuntary loss of urine

What are 3 types of urinary incontinence?

Overflow

-BPH

-poor stream, imcomplete emptying

Stress

-multiple births

-small volume loss when you cough, sneez

Urge

-bladder thinks its full but its not

-urgency and frequency