renal: Patho

• risk factors for acute renal dysfunction

  - hypotension

  - excessive exposure to aminoglycosides

  - hemoglobinuria + myoglobinuria

  - dehydration

  - pre-existing renal disease

  - chronic hypertension

  - exposure to radiocontrast dyes
• in acute renal dysfunction, there is sudden increase in __________ waste products

  nitrogenous

  - BUN

  - creatine

  leads to decrease in urine output
• urea nitrogen (BUN)


  from protein in diet

  range = 8-20
• creatine and its range

  from the muscle, 0.6-1.2
• < ____ ml in urine is problematic in adults

  30 mL
• prerenal dysfunction

  any condition that directly or indirectly decreases renal perfusion
• prerenal dysfunction may be due to reduced _______ output or severe _______

  cardiac output or severe hypovolemia
• intrarenal dysfunction is caused due to


  - direct damage renal tissue from

  nephrotoxic medications (aminoglycosides)

  NSAID (ibuprofen)

  
  

  - autoimmune diseases

  - untreated hypertension (MAJOR FACTOR)

  - uncontrolled diabetes
• postrenal dysfunction

  -Obstructive uropathy preventing urine outflow from the kidney

  -Kidney stones in the ureter

  -Prostate enlargement

  -Bladder cancer
• in post renal dysfunction, urine backs up leading to ______. the urine is toxic to nephron cells

  hydronephrosis
• urine _____ increases risk of infection in postrenal dysfunction

  stagnation
• acute tubular necrosis


  - with ischemia, cells slough into the tubular lumen (blocking it) , preventing fluid to flow through the lumen, reducing urine formation
• in acute tubular necrosis, the blocked lumen contributes to ______ ischemic injury of the _____ lining the tubules

  further injury; cells lining the tubules
• glomerulonephritis


  - type 3

  - immune complexes cause inflammation and membrane damage
• bacteria that causes glomerulonephritis

  beta hemolytic streptococci
• glomerulonephritis is seen ____ to ____ days after _____ infection


  7 to 21 days after strep infection
• Goodpasture's syndrome


  acute rapidly progressive form of glomerulonephritis caused by circulating antibodies to the glomerular basement membrane

  
  

  - autoimmune disease of unknown etiology
• good pasture's syndrome is a type _____ hypersensitivity reaction

  type 2

  - T cells pay a role in the initiation of the disorder
• persons with particular _____ tissue types are more susceptible to goodpasture's syndrome

  HLA tissue type
• treatment of good past

  - plasmapheresis and immunosuppressants
• nephrolithiasis


  formation of kidney stones or calculi (moving and cutting through kidney)
• _________ increases the risk of nephrolithoasis

  dehydration increases the risk of nephrolithiasis
• nephrolithiasis through things we eat

  
  

  1. _______ oxylate (75-80%)

  2. _______ (magnesium, ammonium phosphate)

  3. uric acid - 7%

  4. _____ <1%

  1. Calcium oxylate (75-80%)

  2. struvite- (magnesium, ammonium phosphate) 15%

  2. Uric acid 7%

  4. Cystine <1%
• fill in the blank for predisposing factors of nephrolithiasis

  
  

  - age >40 years, male

  - _______________ (purines, calcium, oxlate)

  - high ______ diet

  - gastric bypass surgery

  - hypercalciuria, hyperparathyroidism, hyperuricemia

  - IBS

  - ________

  - age >40 years, male

  - Dietary (purines, calcium, oxalate)

  - high sodium diet

  - gastric bypass surgery

  - hypercalciuria, hyperparathyroidism, hyperuricemia

  - IBS

  - dehydration
• in renal failure there is

  - renal insufficiency

  - renal failure

  - end stage renal failure
• Renal insufficiency decline in GFR to about _____ % of normal

  25 % of normal
• renal failure decline in GFR to about ____ to ____% of normal

  15 to 20% of normal
• end stage renal failure _____% or less of normal

  10% or less of normal GFR
• one does not see actual symptoms of renal failure until about 75 % or greater of renal function is lost .. why?

  because they still have functioning nephrons to do the job
• pyelonephritis


  - infection of renal pelvis and interstitium

  - acute or chronic
• in pyelonephritis the bacterial usually ascend from the ______ urinary tract

  lower urinary tract
• most common cause of pyelonephritis is _____ infection (E.coli, ______, pseudomonas)

  bacterial, proteus

  - all are gram negative

  - this may result from urine reflux or obstruction
• the uncontrolled acute form of pyelonephritis responds well to _____ therapy and resolves in about 2 weeks

  antibiotic
• the chronic form of pyelonephritis involves chronic


  inflammation, scarring, and fibrosis and can lead to chronic renal failure
• polycystic kidney disease


  - autosomal dominant

  - hereditary cause of renal disease

  - susceptible to disorders of other organs (liver, pancreas, and spleen)

  - may also experience heart valve problems and cerebral aneurysms
• what defect is shown in Polycystic kidney disease ?

  defect in polycystin 1- or plycystin -2
• in PKD , ______ filled cysts in both kidneys proliferate within the kidneys and fibrotic changes occur over time

  fluid filled cysts
• chronic renal failure risk factors

  - family history

  - race - african americans

  - AGE > 60

  - atherosclerosis

  - chronic glomerulonephritis

  - DIABETES

  - HYPERTENSION

  - nephrotoxic medications
• CKD/ ESRD

  - less than 15 % of kidney function

  - requires renal replacement therapy or kidney transplant (peritoneal dialysis, hemodialysis)

  - persistent itching is the big sign shown in patients
• renal cell carcinoma


  - associated with smoking, obesity

  < 10% of cases

  - 5 year survival is 60%