Diseases of the kidney and Urinary tract
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| What are the causes of Renal Failure? | 1. Pre-renal (septic shock, dehydration, hemorrhage, heart failure)
2. Renal (acute tubular necrosis, acute glomerulonephritis
3. Post Renal (UTO)
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| What are the Manifestations of kidney failure | 1. Inability to excrete fluid (edema)
2. Inability to excrete excess electrolytes
3. Inability to regulate blood pH (MA)
4. Inability to excrete nitrogenous wastes
5. Decreased EPO synthesis
6. Hypertension
7. Bone disease
8. Accumulation of wast
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| What is the difference between acute and chronic kidney failure? | Acute
- Reversible if underlying cause can be treated
Chronic
- Can result from conditions that cause permenant loss of the glomeruli such as
o Uncontrolled HTN, chronic UTO, disorders of the glomeruli (eg. SLE)
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| What is Cystic Kidney Disease? What are some important manifestations? | Cystic disease is the formation of masses called cysts, and some are/can:
- Major cause of chronic renal failure
- Can occasionally be confused with malignant tumors
- Some forms are hereditary
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| What is Polycystic Kidney disease? How is it acquired? | Termed so because of formation of numerous cysts. It is a hereditary condition
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| What is the difference between adult and juvenile polycystic kidney disease? | Adult polycystic is autosomal dominant while juvenile is autosomal recessive. Adult polycystic is most common cause of renal failure. Loss of this protein probably results in altered growth and differentiation of tubular cells, with cyst forming
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| What two classifications are there of diseases of the glomerulus? | Primary glomerulopathies: diseases which affect the glomerlus primarily or exclusively.
Secondary glomerulopathies: diseases which affect multiple organs, including the kidney.
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| What is the prognosis of the glomerlopathies? | Most of the glomerular diseases are result of an abnormal immune reaction = despostion of antibodies or antigen-antibody immunce complexes in the glomerular basement membrane. Leads to glomerlus' ability to filter blood being impaired.
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| What is acute tubular necrosis? | Diseases that affect the tubules preferentially.
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| What are the tubules sensitive to? | sensitive to lack of oxygen or exposure to toxins
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| What are the roles of the tubules? | Needed for salt and water regulation.
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| What results in acute tubular necrosis? What is the prognosis of dysfunctioning tubules? | Major trauma, shock, burns, infections, nephrotoxic drugs or poisons result in ATN. Inability to regulate concentrations of salt and inability to regulate fluid balance.
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| How does pyelonephritis occur? | Begins as an acute bacterial infection of the kidneys
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| What are some symptoms of pyelonephritis? | Fever
Flank
pain
flu like symptoms
bladder irritation: pain on urination
increased frequency and feeling of urgency
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| What are some risk factors of pylonephritis? | obstruction
instrumentation
urine influx
female gender
diabetes
suppressed immune system
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| What is chronic pylonephritis? | Chronic pyelonephritis: longstanding obstruction, urine reflux or repeated infections result in scaring of the kidney with distortion of the pelvis and blunting of the renal papillae
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| How does atherosclerosis impair the kidney functions? | Narrowing arteries to the kidney result in decreased blood flow, atrophy of the kidney and chronic kidney failure.
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| What happens when atheromatous plaques in the heart, aorta or renal artery break off? What is this termed? | They lodge in smaller arteries of the kidney impairing blood flow to that area of th kidney. Termed renal cortical infarct (RCI).
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| Where can kidney stones form? Where are they most common? | May form at any level of the urinary tract, but is most common in the kidney.
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| Is there a hereditary predisposition to Kidney Stones? | Yes
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| What percent of kidney stones contain calcium salts? | 75%
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| What other substances, other than calcium salts, are in kidney stones? What percentage of kidney stones are these? | other substances include magnesium ammonium phosphate, uric acid, and cystine. They make up 25% of the stone types.
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| How do kidney stones occur? (pathogenesis) | increased urinary concentration of the salt's constituents, which form a supersaturated solution that crystalizes in the urinary tract.
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| What is the most common kidney tumor termed? | Renal cell carcinoma.
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| What is the epidemiology of renal cell carcinoma? | Occur more often in people age 60-70. Twice as common in males (2-3:1 ratio to women)
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| What are the risk factors of renal cell carcinoma? | Smoking is the major one. Others include:
obesity
exposure to certain petroleum products
Industry chemicals and heavy metals
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| What are the signs and symptoms of renal cell carcinoma? | blood in the urine
flank pain
palpable mass
weight loss
loss of appetite
fever
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| Obstruction of the urinary tract can be _____ or ____? | Intrinsic or extrinsic
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| What are the causes of intrinsic renal obstructions? | Stones
congenital acquired strictures
tumors, mainly of the ureters, bladder and prostate
Loss of normal neural pathways that control bladder
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| What are the causes of extrinsic urinary obstructions? | 1. Pregnancy - compression of the ureters by enlarged uterus
2. Inflammation & scarring of surrounding organs
3. tumors arising in adjacent pelvic or abdominal organs
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| What are the signs and symptoms of a UTO? | (blank)
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| What is the most common type of cancer in teh urinary tract? | transitional cell carcinoma
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| What is the epidemiology for TCC? | White, elderly males.
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| What are risk factors for TCC? | Strong link to smoking...
2. occupational exposure to industrial chemicals
3. Drugs (rarely)
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| What are the signs and symptoms of TCC? | Painless hematuria (blood in urine.
Urinary irritations like: frequency, burning & urgency are seen in 20% of the cases.
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| What are the two broad groups of TCC? What are the components of each? | Low Grade & High grade.
Low grade - progresses slowly, monotonous looking, small risk for metastasis.
High Grade - high rate of recurrence, flat & nodular, high risk for invasion
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| What is the treatment for TCC? | Low grade - conservative monitoring or progression is adequate. High grade - chemo, BCG immunology
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