UA unit 2.2

what are the classifications of renal disease?

glomerular, tubular, or interstitial

what are glomerular immunologic disorders?

increased serum immunoglobulins are deposited on the glomerular membranes

-complement migrate and produce change and damage to membrane

what are the majority of glomerular disorders?

immunologic

what is nonimmunologic glomerular disorder?

chemicals and toxins, electrical charge interference, deposition of amyloid material and acute phase reactants, membrane thickening

what is glomerulonephritis?

general term for sterile, inflammatory process affecting the glomerulus

what causes blood, protein, and casts in urine?

glomerulonephritis

what can glomerulonephritis progress through?

acute glomerulonephritis → nephrotic syndrome → renal failure

what is acute poststreptococcal glomerulonephritis (AGN)?

immune complexes deposit on glomerular membrane

what are the symptoms of acute poststreptococcal glomerulonephritis?

fever, edema around the eyes, fatigue, nausea, hypertension, oliguria, proteinuria, and hematuria

what do you see in the urine for AGN?

hematuria, proteinuria, oliguria

-RBC casts and dysmorphic RBCs

-hyaline and granular casts

-WBCs

how do you test AGN?

anti-group A streptococcal enzyme test

what is rapidly progressive (Crescentic) glomerulonephritis?

systemic immune disorders: macrophages damage capillary walls and fibrin

-more serious than acute form; can lead to renal failure

what is the urinalysis like for rapidly progressive (crescentic) glomerulonephritis?

similar to AGN but progress to more abnormal, elevated protein, low glomerular filtration rate (GFR)

what is fibrin?

permanent damage to capillary tufts

what can rapidly progressive glomerulonephritis have increase amounts of?

fibrin degradation products (FDP), cryoglobulins, and IgA immune complex depositions

What is goodpasture’s syndrome?

autoimmune disorder against glomerular and alveolar basement membranes

-morphological changes resembling crescentic GN,

Goodpasture’s syndrome is cytotoxic antibody ___________

following viral respiratory disease

what is common in goodpasture’s syndrome?

chronic glomerulonephritis to end-stage renal failure

what are the symptoms of goodpasture syndrome?

hemoptysis, dyspnea, proteinuria, hematuria, RBC casts

what is granulomatosis with polyangitis?

inflammation and granulomas in small blood vessels of kidney and respiratory system

-neutrophils initiate immune response, producing granulomas

what is the key to diagnosis of granulomatosis with polyangitis?

antineutrophilic cytoplasmic antibody (ANCA)

what are the symptoms of granulomatosis with polyangitis?

pulmonary symptoms first, then hematuria, proteinuria, RBC casts, elevated BUN and creatinine levels

what are the tests for granulomatosis with polyangitis?

immunofixation for p-ANCA/ c-ANCA

what population do you see henoch-schonlein purpura?

children following upper respiratory infections

what are the symptoms of henoch-schonlein purpura?

raised, red patches on skin; blood in sputum and stools; proteinuria and hematuria; RBC casts

what is the most serious complication of henoch-schonlein purpura?

renal involvement

-proteinuria and hematuria, RBC casts

what is membranous glomerulonephritis?

IgG immune complexes cause pronounced thickening on glomerular basement membrane

what can cause membranous glomerulonephritis?

lupus, sjogren’s syndrome, secondary syphilis, hepatitis B, gold and mercury treatments, malignancy

what is seen in the urine of membranous glomerulonephritis?

microscopic hematuria, very high protein

how does membranous glomerulonephritis progress?

slow progression, possible remission, nephrotic syndrome frequently develops

what is type 1 membranoproliferative glomerulonephritis (MPGN)?

increased cellularity in the subendothelial cells of the mesangium

-thickening of capillary walls

what is type 2 membranoproliferative glomerulonephritis (MPGN)?

extremely dense deposits in the glomerular basement membrane

-poor prognosis

what is type 3 membranoproliferative glomerulonephritis (MPGN)?

subepithelial and subendothelial deposits

what does the labs look like in membranoproliferative glomerulonephritis (MPGN)?

hematuria, proteinuria, decrease in serum complement

what are the symptoms of chronic glomerulonephritis?

fatigue, anemia, hypertension, edema, oliguria gradually worsening

what is there a marked decrease in for chronic glomerulonephritis?

GFR

what does the urine look like in chrinic glomerulonephritis?

hematuria, proteinuria, glycosuria (tubular dysfunction), many types of casts including broad casts

what is immunoglobulin A nephropathy (Berger’s disease)?

IgA complexes on glomerular membrane

-increased serum levels of IgA

what is the most common cause of glomerulonephritis?

immunoglobulin A nephropathy (Berger’s disease)

what is immunoglobulin A nephropathy (Berger’s disease) mostly frequently seen in

children and young adults

what is the progression of immunoglobulin A nephropathy?

possibly asymptomatic for 20 years or more: gradual progression to chronic glomerulonephritis and ESRD

what is the early macroscopic of immunoglobulin A nephropathy (Berger’s disease)?

hematuria from exercise or infection with spontaneous recovery

what is nephrotic syndrome?

acute onset from systemic shock (low blood pressure) or glomerulonephritis complication

-glomerular membrane damage and changes in podocyte electrical charges

-tubular damage

what happens to the protein in nephrotic syndrome?

protein passes through membrane; albumin depleted, causing increased lipid production

what is the urinalysis in nephrotic syndrome?

marked proteinuria; fat droplets, oval fat bodies, renal epithelial cells, fatty and waxy casts, and microscopic hematuria

what is minimal change disease (lipid nephrosis or nil disease)?

heavy proteinuria, edema, transient hematuria, normal BUN and creatinine levels

-most common cause of nephrotic syndrome

what is minimal change disease?

allergic reactions, immunization, HLA-B12

who usually gets minimal change disease (lipid nephrosis or nil disease)?

children

what is focal segmental glomerulonephritis?

similar to nephrotic syndrome by affects only certain numbers and areas of glomeruli; podocytes are damaged

-IgM and C3 immune deposits

what can cause focal segmental glomerulophritis?

heroin and analgesic abuse, HIV and hepatitis

what does the urine look like in focal segmental glomerulonephritis?

moderate to heavy proteinuria; microscopic hematuria

what is acute tubular necrosis?

the ischemia causes severe decrease in blood flow

how can you get acute tubular necrosis?

shock, trauma, surgery, surgical procedures

what is the treatment for acute tubular necrosis?

remove cause and manage symtoms

what do you see in the urine of acute tubular necrosis?

RTE cells and casts and RTE fragments; hyaline, granular, waxy, broad casts

what is fanconi syndrome?

generalized proximal convoluted tubule reabsorption failure

what is most affected with fanconi syndrome?

glucose, amino acids, phosphorus, sodium, potassium, bicarbonate, water

what are the complications of fanconi syndrome?

multiple myeloma, renal transplant

what do you see in the urine of fanconi syndrome?

glycosuria and mild proteinuria

what is fanconi syndrome inherited with?

cystinosis and hartnup disease

how can you acquire fanconi syndrome?

heavy metals, outdated tetracycline

what is alport’s syndrome?

inherited sex-linked and autosomal disorder affecting basement membrane

-membrane laminated with thinning; no immune complexes

what gender is more severely affected by alport’s syndrome?

males

what are the symptoms of alport’s syndrome?

macroscopic hematuria with respiratory infections by age 6 years

what does the urine look like in alport’s syndrome?

mild to persistent hematuria, proteinuria, and renal insufficiency in later life due to nephrotic syndrome and ESRD

what is uromodulin associated kidney disease (UMKD)?

inherited disorder that results in an abnormal buildup of uromodulin the the tubular cells causing their destruction

what do the labs look like in uromodulin associated kidney disease (UMKD)?

elevated serum uric acid and gout at an early age

-occurs before renal symptoms

what is diabetic nephropathy?

glomerular basement membrane thickening; increased proliferation of mesangial cells; increased deposition of cellular and acellular material within glomerular matrix

what is the most common cause of end-stage renal disease?

diabetic nephropathy

what are the cellular and acellular depositions associated with in diabetic nephropathy?

glycosylated proteins from poorly controlled diet

what is nephrogenic diabetes insipidus?

failure of tubules to respond to ADH

what is neurogenic diabetes insipidus?

failure to produce ADH

how can someone get nephrogenic DI?

inherited sex-linked recessive gee, medications like lithium and amphotericin B

what does the urine look like in diabetes insipidus?

low specific gravity, pale yellow color, possible false neg results for over test

what is renal glycosuria?

affects only the reabsorption of glucose, decreased number of glucose transporters in tubules, decreased affinity of transporters for glucose

how can someone get renal glycosuria?

inherited as autosomal recessive

what does the labs look like in renal glycosuria?

glycosuria with normal blood glucose level

what can happen in untreated bystitis?

progresses to more serious upper urinary tract

what does the urine look like in cystitis?

many WBCs, bacteria, increased pH, mild proteinuria, hematuria

when is cystitis commonly seen?

in women and children

what is acute pyelonephritis?

ascending movement of bacteria; conditions affecting emptying of bladder

-calculi, pregnancy, reflux of urine from bladder to ureters

what are the symptoms of acute pyelonephritis?

rapid onset, urinary frequency, burning, lower back pain

what is the urinalysis of acute pyleonephritis?

similar to cystitis with presence of WBC casts

what is chronic pyelonephritis?

congenital structural defects causing reflux

-damage to tubules; possible renal failure

when is chronic pyelophephritis often diagnosed?

in children

what does the urinalysis look like in chronic pyelonephritis?

similar to acute pyelonephritis early on; later on granular, waxy, and broad casts; increased protein, hematuria, decrease in renal concentration

what is acute interstitial nephritis?

allergic reaction causing inflammation of interstitium

what medication can cause allergic reaction happen in acute interstitial nephritis?

medication allergy, penicillin, methicillin, cephalosporins, rifampin, sulfonamides, NSAIDS, thiazide diuretics

what does the urine look like in acute interstitial nephritis?

urinalysis, hematuria, proteinuria, increase in WBCs, WBCs cast, no bacteria

-should stain for eosinophils

what are the forms of renal failure?

acute and chronic

what is chronic renal failure?

progression from original disorders to end-stage renal disease

what do the labs look like in chronic renal failure?

GFR <25 mL/min, increase in BUN and creatinine levels, electrolyte imbalance, isosthenuria, proteinuria, renal glycosuria, increase in granular, waxy and broad casts

what is the symptoms of acute renal failure?

sudden onset, often reversible

how can you tell where acute renal failure is caused by?

decreased blood flow → prerenal

acute disease → renal

renal calculi and tumors → post renal

what does the urinalysis look like in acute renal failure?

RTE cells → decreased blood flow

RBCs → glomerular injury

WBCs and casts → infection/inflammation

urothelial cells → possible malignancy

what are the causes of prerenal acute renal failure?

decreased blood pressure/cardiac output, hemorrhage, burns, surgery, septicemia

what are the causes of renal acute renal failure?

acute glomerulonephritis, acute tubular necrosis, acute pyelonephritis, acute interstitial nephritis

what are the causes of post renal acute renal failure?

renal calculi, tumors

what is renal lithiasisi?

kidney stones in calyces and pelvis of kidney, ureters, bladder

what are the symptoms of renal lithiasis?

severe back pain radiating from lower back to legs when passes through urine