Renal/GU taxonomy (pathophys)

prerenal

-before the kidney

-hypoperfusion (volume depletion, 3rd spacing, restricted renal arterial blood flow)

-drop in blood pressure

pre renal disease

prerenal azotemia

prerenal azotemia

-most common acute kidney injury

-most common cause of renal failure (inpatient patients)

-most commonly caused by dehydration

intrarenal

direct damage to the kidneys (inflammation, toxins, drugs, infection, reduced blood supply)

categories of intrarenal diseases

-vascular

-glomerular

-tubular

-interstitial

types of vascular diseases (intrarenal)

-vasculitis

-malignant HTN

-scleroderma

-thromboembolic

types of glomerular diseases (intrarenal)

-acute glomerulonephritis

-chronic glomerulonephritis

types of acute glomerulonephritis (intrarenal, glomerular)

-Anti-GM-associated acute GN

-Goodpasture's syndrome

-IgA nephropathy (Berger's disease)

-Crescentic GN

-post streptococcal GN

types of chronic glomerulonephritis (intrarenal, glomerular)

-diabetic neuropathy

-lupus nephritis

-membranous nephropathy

-focal segmental glomerular sclerosis

-minimal change disease

-membranoproliferative GN

types of tubular disease (intrarenal)

-acute tubular

-chronic tubular

types of acute tubular disease (intrarenal, tubular)

-acute tubular necrosis

-multiple myeloma

-uric acid nephropathy

types of chronic tubular disease (intrarenal, tubular)

-polycystic kidney disease

-medullary sponge kidney

types of interstitial disease (intrarenal)

-acute

-chronic

-renal neoplasias

types of acute interstitial disease (intrarenal, interstitial)

-interstitial nephritis

-acute pyelonephritis

types of chronic interstitial disease (intrarenal, interstitial)

-chronic pyelonephritis

-analgesic nephropathy

-chronic interstitial nephritis

types of renal neoplasias (intrarenal, interstitial)

-renal adenomas

-renal transition cell carcinoma

-renal cell carcinoma

postrenal

-after the kidneys

-obstructive (renal damage by back pressure)

types of post renal disease

-obstructive uropathy

-bladder disorders

-lower urinary tract obstructions

types of obstructive uropathy (postrenal)

-kidney stones

-infection/inflammation

types of bladder disorders (postrenal)

-functional uropathy

-overactive bladder syndrome

-bladder tumors

types of lower urinary tract obstruction (postrenal)

-UTI

-prostate enlargement

-urethral stricture

-severe pelvic organ prolapse

-low bladder wall compliance

how is UTI determined by type:

-complicated (recurrent, difficult to treat)

-uncomplicated (most common)

how is UTI determined by location:

-Urethritis (inflammation in urethra)

-Prostatitis (inflammation in prostate)

-Cystitis (bladder inflammation)

-interstitial cystitis (cystitis with negative urine cultures)

-pyelonephritis (inflammation of upper urinary tract)

vasculitis

-vascular, intrarenal

-inflammation, immune mediated (ANCA)

malignant HTN

-vascular, intrarenal

-thickened, degraded arterioles/tubules/glomeruli from increased pressure in kidneys

scleroderma

-vascular, intrarenal

-systemic disease, progressive

-renal degradation, obliterative vasculopathy

-collagen overproduction, connective tissue disorder

thromboembolic disease

-vascular, intrarenal

-arterial embolus blocks flow to at least a portion of kidney

-local or distant thromboembolitic events

acute glomerulonephritis

-glomerular, intrarenal

-immune mediated

-uncommon

-nephritic or nephrotic

Anti-GBM associated acute glomerulonephritis

-glomerular (acute), intrarenal

-antibodies attack glomerular basement membrane

-variety of disorders associated with it

goodpasture's syndrome

-anti-GBM (acute GN, glomerular, intrarenal)

-sequela of lung infection

-antibodies simultaneously attack lung and kidney basement membrane

IgA nephropathy (Berger's disease)

-IgA associated (acute GN, glomerular, intrarenal)

-most common type

- abnormal IgA to mesangial cells* in the glomerulus, activating a complement pathway → injury and mesangial proliferation

crescentic glomerulonephritis

-may be anti-GBM associated (acute GN, glomerular, intrarenal)

-proliferation of glomerular capillary cells

-rapid loss of renal function

post-streptococcal glomerulonephritis

-anti-GBM associated (acute GN, glomerular, intrarenal)

-rarer now due to testing and antibiotics

-immune mediated

-follows group A strep infection

nephritic

-blood in the urine and LITTLE protein

-immune mediated inflammation

-usually less significant

-leads to mild HTN

nephrotic

-blood in the urine with LOTS of protein

-noninflammatory damage

-leads to hyperlipidemia

-usually very serious

diabetic nephropathy

-chronic GN, glomerular, intrarenal

-podocyte injury leads to thickening of glomerular basement membrane

-most common type of chronic GN

lupus nephritis

-chronic GN, glomerular, intrarenal

-systemic condition

-formation of autoantibodies against double stranded DNA

-deposition of immune complexes on GBM

focal segmental glomerular sclerosis

-chronic GN, glomerular, intrarenal

-involves some or parts of glomeruli hardening

-autoimmune plus drugs, infection, Sickle Cell causes

minimal change disease

-chronic GN, glomerular, intrarenal

-most common nephrotic condition in kids

-idiopathic and without major tissue changes

membranoproliferative GN

-chronic GN, glomerular, intrarenal

-abnormal activation of complement cascade in kids and young adults

-can cause renal deposits in eye

-characteristic kidney lesions

acute tubular necrosis

-acute, tubular, intrarenal

-most common cause of intrarenal AKI

-from ischemia, toxins, sepsis (majority= dehydration)

-muddy brown casts

multiple myeloma

-acute, tubular, intrarenal

-large numbers of ineffective antibodies

-can be toxic or obstructive to tubules

-myeloma in kidney= 25% of MM patients

-Bence Jones proteins found in urine

uric acid nephropathy

-acute, tubular, intrarenal

-uric acid overproduction and crystallization causes obstruction

-uric acid= reversible cause of acute renal failure

polycystic kidney disease

-chronic, tubular, intrarenal

-widespread cyst formation from genetic disorders

-can progress to ESRD

medullary sponge kidney

-chronic, tubular, intrarenal

-rare congenital disorder

-small tubular cysts

-usually benign without symptoms

interstitial nephritis

-acute, interstitial, intrarenal

-immune mediated

-often drug induced

-eosinophils in the urine

acute pyelonephritis

-acute, interstitial, intrarenal

-infective

-in blood or upward from bladder

-white blood cell casts

chronic pyelonephritis

-chronic, interstitial, intrarenal

-can become chronic and lead to chronic kidney failure

-persistent, recurrent infections of kidneys

analgesic nephropathy

-chronic, interstitial, intrarenal

-iatrogenic

-chronic use of high dose NSAIDS

-mostly women over age 30

-frequent urinary tract infections

chronic interstitial nephritis

-chronic, interstitial, intrarenal

- immune-mediated, generally drug-induced

-sx:  fever, maculopapular rash, eosinophils in urine

-from failure to resolving acute version (drug-induced (NSAIDS, antibiotics, diuretics, allopurinol)

-nonspecific, diagnosed by exclusion

renal adenomas

-renal neoplasia, interstitial, intrarenal

-benign glandular tumor

renal transition cell carcinoma

-renal neoplasia, interstitial, intrarenal

-malignant and rare

renal cell carcinoma

-renal neoplasia, interstitial, intrarenal

-most common type of neoplasia

-malignant

-genetic mutation of tumor suppressor gene (VHL)

kidney stones

-obstructive uropathy, postrenal

-renal calculi or urolithiasis

-Ca oxalate is most common crystal composition

-Staghorn calculi (large, filling calyces, non-obstructive)

functional uropathy

-bladder disorder, postrenal

-neurogenic bladder

-from upper or lower motor neuron defects

overactive bladder syndrome

-bladder disorder, postrenal

-detrusor overactivity

-urinary urgency and urodynamic testing

bladder tumors

-bladder disorder, postrenal

-urothelial transition carcinoma (most common)

-painless microscopic hematuria

urinary tract infection

causes:

-epithelial inflammation (pathogen or not)

-retrograde flow into urethra and bladder

-local obstruction, ascending infection, infective implications

-classified by type (complicated vs uncomplicated)

-classified by location

urethritis

inflammation of urethra

prostatitis

inflammation of prostate

cystitis

bladder inflammation

interstitial cystitis

cystitis with negative urine cultures

pyelonephritis

inflammation of upper urinary tract

other causes of lower urinary tract obstructions

-prostate enlargement

-urethral stricture

-severe pelvic organ prolapse

-low bladder wall compliance

stage 1 kidney disease

-kidney damage with normal or increased GFR

-GFR > or equal to 90

stage 2 kidney disease

-kidney damage with mildly decreased GFR

-GFR= 60-89

stage 3 kidney disease

-moderately decreased GFR

-GFR= 30-59

stage 4 kidney disease

-severely decreased GFR

-GFR= 15-29

stage 5 kidney disease

-kidney failure

GFR < 15 (dialysis)

chronic kidney disease

-defined as either kidney damage or GFR < 60 for 3 months or longer

-kidney damage defined as pathological abnormalities/markers of damage (including urine/blood tests, imaging studies)

what is normal urine flow?

1.2-2 liters/day

adult urine production

0.5-1 mL/kg/hr

polyuria

-excessive urination

more than 2 liters/day

oliguria

-decreased urine output

-less than 500 mL/day

anuria

-absence of urine

-less than 100 mL/day