pathology exam 3

What can cause a calcium stone?

hypoparathyroidism/vitamin D, dehydration, prolonged immobilization, decreased renal calcium absorption, and high intake of calcium

What can cause a uric acid stone?

gout leads to a buildup of uric acid which causes stones

What can cause a struvite stone?

magnesium-ammonia-phosphate, infection, and alkaline urine

What is the main pathology of any kidney stone?

stones obstruct the urinary tract causing a backup of urine

What are the main clinical manifestations of kidney stones?

radiating high pain, hematuria, and n/v

What can kidney stones cause?

connective tissue deposits or scarring, inability to urinate --> hydroureters --> hydronephrosis --> glomeruli damage --> tubular damage

What is glomerulonephritis?

type 3 hypersensitivity that causes inflammation of the glomeruli

What can cause glomerulonephritis?

Group A beta-hemolytic strep and staph

What occurs during glomerulonephritis?

specialized cells in the basement membrane are damaged causing the filter to not work and things we want end up being excreted

What clinical manifestations would you see with glomerulonephritis?

proteinuria, hematuria, edema, low RBCs, anemia, poor perfusion, hypertension, low urine output, high BUN and creatinine, low GFR, and metabolic acidosis

What is nephrotic syndrome?

damage to the basement membrane causes excess excretion of protein

What clinical manifestations would you see with nephrotic syndrome?

proteinuria, low albumin, edema, and hyperlipidemia

What is hyperlipidemia?

when there is low protein, the body activates a reactive response and produces lipoproteins

What is nephritic syndrome?

damage to the glomerulus causes GFR permeability and leakage of RBCs into the urine

What are clinical manifestations of nephritic syndrome?

hematuria, dark colored urine, low GFR, high BUN, and high creatinine

Which kidney hormones increase renal blood flow/perfusion?

ADH and aldosterone

What does ADH do in the kidneys?

high ADH causes high fluid volume and diluted sodium so hyponatremia

What does aldosterone do in the kidneys?

high aldosterone causes high fluid volume and high excretion of potassium so hypokalemia

Which kidney hormones decrease renal blood flow/perfusion?

Natriuretic peptides

What are the two kinds of natriuretic peptides?

atrial and brain; atria and ventricles

What do natriuretic peptides do?

high nat. peptides inhibit sodium and water absorption and aldosterone secretion causing vasodilation/low BP, high urine output, and low blood volume

What other hormones are involved in the kidneys?

EPO and vitamin D

What does EPO do in the kidneys?

low oxygen to the kidneys cause high EPO and low EPO causes anemia

What does vitamin D do in the kidneys?

hyperPTH causes hypocalcemia and low vitamin D which causes risk of fracture/osteomalacia

What are the types of UTIs?

cystitis and pyelonephritis

What is cystitis?

bladder infection

What s/sx would you see with cystitis?

suprapubic pain, frequent, urgent, painful urination, and cloudy urine

What is pyelonephritis?

kidney infection

What s/sx would you see with pyelonephritis?

CVA/flank pain and fever

What are common causes of UTIs?

E. coli, diabetes, and being a female

What is the pathology of prerenal AKI?

inadequate perfusion to the kidney; low perfusion causes hypoxia and cell injury

What are the causes of prerenal AKI?

hypotension from any cause and renal artery stenosis/blockage/constriction

What s/sx would you see with prerenal AKI?

low GFR, activates RAAS system, aldosterone release, high BUN and creatinine

What is the pathology of intrarenal AKI?

necrosis due to damage of renal structures; direct damage to kidney

What can cause intrarenal AKI?

nephrotoxic drugs, infection/inflammation, and oxidative stress/free radicals formed after hypoxia from prerenal AKI

What are nephrotoxic drugs?

NSAIDS, certain antibiotics and antifungals, ACE inhibitors, and contrast dye

What is an example of intrarenal AKI?

acute glomerulonephritis

What is the pathology of postrenal AKI?

occurs due to urinary tract obstruction

What is the characteristic finding with postrenal AKI?

flank pain

What can occur from postrenal AKI?

hydroureters, hydronephrosis, damage to glomeruli and tubules, and scarring of kidney

What are the phases of AKI?

Initiation, Maintenance, Recovery

What is the initiation phase of AKI?

regular urination; initial damaging event is occuring

What is the maintenance phase of AKI?

lowest/no urination; initial damaging event has resolved; high electrolytes; metabolic acidosis

What is the recovery phase of AKI?

too much urination; damage is over; low electrolytes

What can CKD result in?

poor waste excretion, poor electrolyte and fluid regulation, and poor kidney hormone regulation

What would you see due to poor waste excretion in CKD?

high urea --> confusion/drowsiness, n/v, anorexia, itchiness, and neuropathy

What would you see due to poor electrolyte regulation in CKD?

can't make bicarb so metabolic acidosis

What would you see due to poor fluid regulation in CKD?

edema and lots of heart problems like high cardiac workload and high BP

What would you see for poor kidney hormone regulation in CKD?

poor EPO causing anemia and can't make vitamin D so hypocalcemia and secondary hyperPTH causes brittle bones

What is the normal range for BUN?

6-20 mg/dL

What is the normal range for creatinine?

0.6-1.2 mg/dL

What is the normal range of GFR?

90-120 mL/min

What is the normal range for WBCs?

4500-11000

What is the normal range for RBCs?

4-5.5 million

What is the normal range for hemoglobin?

12-17.4

What is the normal range for hematocrit?

36%-52%

What is the normal range for platelets?

150,000-450,000

What are the types of anemia?

quantity RBC and quality RBC

What can cause a quantity RBC anemia?

inadequate number of RBCs due to low RBC production or low hemoglobin

What is an example of quantity RBC anemia?

iron deficiency anemia which is caused by blood loss or low iron intake

What are the risk factors for quantity RBC anemia?

blood loss, inadequate iron intake like a vegan diet, GI problems cause poor absorption, children/pregnancy, and lead poisoning

What are the s/sx of quantity anemia?

SOB, pallor, fatigue, dizziness, and spoon nails

How might the body compensate for anemia?

increased HR, increased CO, and capillary dilation; high RR, dyspnea; high EPO, RAAS, high NA and H2O retention --> high extracellular fluid

What is quality RBC anemia?

size, shape, or problem in RBCs

What are the types of macrocytic-normochromic anemia?

pernicious anemia and folate deficiency anemia

What are the risk factors for pernicious anemia?

congenital or autoimmune B12 deficiency

What s/sx would you see with pernicious anemia?

neuro: paresthesia, weakness, fatigue, difficult walking, sore tongue, and neuronal death; vague: loss of appetitie, abdominal pain, weight loss

What are the risk factors for folate deficiency anemia?

food fortification and alcoholism

What s/sx would you see with folate deficiency anemia?

gut: mouth/stomach ulcer, dysphagia, flatulence, watery diarrhea and stomatitis

What is an example of normocytic-normochromic anemia?

Sickle Cell disease

What is sickle cell disease?

autosomal recessive mutation of hemoglobin that causes RBCs to have crescent shape Hgb called HbS

What are the risk factors for sickle cell disease?

sickle cell crisis: dehydration, exposure to low O2 or high altitude, and extreme temps

What s/sx would you see with sickle cell disease?

pallor, fatigue, jaundice, irritability, and pain

What is polycythemia?

overproduction of RBCs cause increased viscosity and volume of blood

What would someone with polycythemia be at risk for?

vessel occlusion causing ischemia and infarction or necrosis

What are the types of polycythemia?

relative and absolute (primary and secondary)

What can cause relative polycythemia?

dehydration so can be resolved with fluid administration

What can cause primary absolute polycythemia?

problem in hemopoietic stem cells in bone marrow that are responsible to produce RBC

What is an example of primary absolute polycythemia?

polycythemia vera

What can cause secondary absolute polycythemia?

too much RBC production due to underlying conditions like hypoventilation, COPD, and medications

What can occur from too little clotting?

hemophilia, thrombocytopenia, and low vitamin K

What is hemophilia?

mutation of clotting factors 8 or 9 that causes impaired coagulation cascade and bleeding

What are the s/sx of hemophilia?

unexplained and excessive bleeding in joints, after vaccination, or in urine/stool

What is thrombocytopenia?

low platelets

What are the s/sx of thrombocytopenia?

petechiae and purpura

What are the types of thrombocytopenia?

HIT and ITP

What is heparin induced thrombocytopenia (HIT)?

antibodies see heparin as a foreign body and attack platelets

What is immune thrombocytopenia purpura (ITP)

autoimmune disorder causes platelet destruction and bleeding

What occurs with low vitamin K?

slow blood clotting

What can occur from too much clotting?

thrombocythemia and the Virchow's Triad

What is disseminated intravascular coagulation (DIC)?

a systemic inflammatory response due to sepsis, burn, cancer, trauma

What are some examples where DIC could occur?

bleeding from IV, nose bleed, or GI bleed

What can occur from DIC?

increased tissue factors or the body uses all the platelets and clotting factors

What happens if the body uses all of the plts and clotting factors?

thrombocytopenia and low clotting factors cause bleeding

What happens if there is an increase in tissue factors?

high fibrin deposition and clot formation that block blood vessels causing tissue hypoxia and organ failure

What is hemostasis?

controlling the bleeding through vasoconstriction, platelet activation via the von Willebrand factor, and the coagulation cascade

Describe the effects of WBC alterations on WBC differential

there could be a left shift or a greater percentage of immature WBCs

When would you see a left shift?

in acute leukemias

What is mononucleosis?

viral infection of B lymphocytes caused by EBV

What are the risk factors for mononucleosis?

transmitted by saliva