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Kidney
| Question | Answer |
|---|---|
| Name for biological factors that are produced locally, act locally, and metabolized locally. | Autocoids (angiotensin, kinins, histamine, serotonin, eicosanoids) |
| 2 important fatal renal disease that typically manifest itself over many years. | 1. Chronic Glomerulonephritis 2. Chronic pyelonephritis |
| Disease of the kidney is broken down by 4 basic Morphologic Components | 1. Glomeruli 2. Tubules 3. Interstitium 4. Blood Vessels |
| Term for anatomic changes within the kidney tending to merge into a single pattern, this requires 90% destruction of the kidney before significant function impairment is seen. | "End-stage Kidneys" |
| Term for a biochemical abnormality that refers to an elevation of blood urea nitrogen and creatinine levels and is largely related to a decreased glomerular filtration rate. | Azotemia |
| When azotemia becomes associated with constellation of clinical signs and symptoms and biochemical abnormalities, what is this called. | Uremia |
| Glomerular disease that is characterized by either by acute or chronic damage to the glomerulus. | Glomerulonephritis (GN) |
| Name the two basic components of the Renal Corpuscle | 1. Visceral epithelium (podocytes) 2. Parietal epithelium which contains the Bowman's space (urinary space). |
| 3 components of the glomerular capillary wall | 1. Fenestrated Endothelial cells (70-100nm diameter) 2. Glomerular Basement Membrane (GMB) 3. Visceral Epithelial Cells (Podocytes) |
| This cell supports the GBM, have contractile properties, and are capable of proliferation, leading to collagen formation. | Mesanglial Cells |
| The Pathogenesis of Glomerular Disease follows what two immunologically mediated injury pathway. | 1. Circulating Immune Complex Nephritis 2. Immune Complex Nephritis in Situ |
| This immune pathway represents a Type III hypersensitivity (serum sickness) reaction, the source of the antigen is unknown but antigen-antibody complex lodge w/in the glomerulus causing inflammation & injury. | Circulating Immune Complex Nephritis |
| Deposition of immune complexes can occur at one of 3 sites, what are they? | 1. Between endothelial cells and the GBM (Subendothelially) 2. Between the outer surface of the GBM and the Podocytes (Subepithelially) 3. Within the Mesanglial Cells. |
| A pattern that occurs when deposits are located at more than one site, this can be seen by immunofluorescence microscopy. | Granular Pattern |
| This immune pathway is a type of injury mediated by antibodies directed against Fixed or Implanted antigens within the glomerulus. | Immune Complex Nephritis In Situ |
| In classic anti-GBM nephritis, the antibodies are directed against what in the GBM? | Fixed Antigens |
| Under Immunofluorescence, what is the pattern seen with Fixed Antigens? | Diffuse Linear Pattern |
| Term for anti-GBM antibodies that cross-reacts with the basement membrane of lung alveoli resulting in lung and kidney lesions. | Goodpasture Syndrome |
| What is the pattern seen with Implanted Antigen? (examples include systemic Lupus Erythematosus (SLE) and group A streptococcal infections) | Granular Pattern. |
| 3 Clinical Pattern of Glomerular Diseases | 1. Nephrotic Syndrome 2. Nephritic Syndrome 3. Chronic Glomerulonephritis |
| 4 Clinical complexes of Nephrotic Syndrome | 1. Massive Proteinuria (3.5g of protein or more lost in the urine) 2. Hypoalbuminemia 3. Generalized Edema (most obvious sign) 4. Hyperlipidemia & Hyperlipiduria |
| A medical condition characterized by widespread swelling of the skin due to effusion of fluid into the extracellular space, massive amounts of edematous fluid. | Anasarca |
| 2 most important primary glomerular diseases leading to Nephrotic Syndrome | 1. Minimal Change Disease 2. Membranous GN |
| A benign disorder affecting principally children, a frequent cause of Nephrotic Syndrome, This is the only form of GN in which there is no clear evidence of immune damage, although immune mediation is suspected. | Minimal Change Disease (Lipoid Nephrosis) |
| A slow progressive disease most common between age 30-50, characterized morphologically by deposition of immune complexes along GBM w/ little or no inflammation & diffuse thick capillary walls. | Membranous GN |
| This type of Glomerular Disease is usually acute in onset, characterized by HEMATURIA, FLUID RETENTION (Oliguria & Azotemia), & HYPERTENSION | Nephritic Syndrome |
| Nephritic Syndrome is commonly due to Immune Complex mediated disease, the most common cause is what? | Acute Post Streptococcal GN |
| Clinical Characteristic of Acute Post Streptococcal GN | Onset of disease tends to be more abrupt, Fever, Malaise, and Nausea followed by the onset of Nephritic Syndrome. |
| Another cause of Nephritic Syndrome is due to IgA deposited in mesangium, often seen in children and young adults, one of the most common recurrent hematuria & is most common Glemerular disease. | IgA Nephropathy |
| This pattern of Glomerular Disease is chronic and is an advanced disease characterized by destruction & extensive scarring of the glomerulus. | Chronic Glomerulonephritis (Chronic GN) |
| Clinical signs and treatment for Chronic GN | Insidious onset, diagnosed late, proteinuria, hypertension, azotemia. Treatment is Renal Transplant. |
| 2 main disease affecting Tubules & Interstitium | 1. Tubulo-interstitial Nephritis 2. Acute Tubular Necrosis (ATN) |
| This group of disease is characterized by damage primarily involving the tubules and interstitial tissue, associated with bacterial infections involving the renal pelvis (PYELONEPHRITIS). | Tubulo-interstitial Nephritis |
| 3 disease associated with Tubulo-interstitial Nephritis | 1. Acute Pyelonephritis 2. Chronic Pyelonephritis (CPN) 3. Drug-Induced Interstitial Nephritis |
| This disease is usually benign, suppurative, bacterial inflammation of the kidney and renal pelvis, extremely common disorder associated with urinary tract infection which is mainly due to E. Coli. | Acute Pyelonephritis |
| What is the pathway of Acute Pyelonephritis? | Infection that begin at the lower urinary tract and ascends from the bladder up the ureter and into the kidney. |
| The term for bacterial infection that multiply and cause inflammation of the bladder. | Cystitis |
| Cystitis that reach the renal pelvis via urine that is actively propelled up the ureters during micturition (the act of voiding urine) is called what? | Vesico-ureteral reflux (VUR) |
| Clinical signs of Acute Pyelonephritis | Sudden pain at the Costovertebral angle, fever, malaise & frequent * urgent urination with bacteriuria and pyuria (urine containing pus). |
| This type of Tubulo-interstitial nephritis is defined as a chronic renal disorder in which there is gross renal scarring associated w/ involvement of calyces and pelvis, important cause of chronic renal failure, next to Chronic GN. | Chronic Pyelonephritis (CPN) |
| Characteristics of Chronic Pyelonephritis | Interstitial fibrosis, inflammation, tubular atrophy. Most cases show few symptoms until advanced with gradual onset of renal insufficiency and hypertension. |
| The Tubulo-interstitial nephritis due to antibiotics and analgesics as the primary culprit that produced renal injury by triggering immunologic reactions by direct damage or cumulative injury. | Drug-Induced Interstitial Nephritis |
| 2 type of Drug-induced interstitial nephritis | 1. Acute Drug-induced interstitial Nephritis 2. Chronic Analgesic Nephritis (Analgesic Nephropathy) |
| This condition most frequently occurs with synthetic penicillins, other synthetic antibiotics, diuretics, nonsteroidal anti-inflammatory agents & miscellaneous drugs. | Acute Drug-induced interstitial Nephritis |
| Characteristics of Acute Drug-induced interstitial Nephritis | Fever, Eosinophilia, Rash (25% patients), renal abnormality. Both Type I & II hypersensitivity reaction are involved. |
| This Drug-induced interstitial Nephritis is caused by cumulative effect of excessive intake of analgesic mixtures including aspiring, caffeine, acetaminophen & codeine, with the biggest culprit being ASPIRIN & ACETAMINOPHEN. | Chronic Analgesic Nephritis (Analgesic Nephropathy) |
| Characteristics of Chronic Analgesic Nephritis | Necrosis of the renal papillae (PAPILLARY NECROSIS) and interstitial inflammation. |
| This disease is affecting the Tubules and Interstitium is characterized by acute renal failure resulting from destruction of tubular epithelial cells, the MOST COMMON cause of acute renal failure. | Acute Tubular Necrosis (ATN) |
| Characteristic of ATN | Urinary output falls below 400 ml/24hrs (Oliguria) |
| 2 forms of ATN | 1. Ischemic ATN 2. Nephrotoxic ATN |
| This pattern of ATN is associated with shock, results from inadequate blood flow to the kidney & other organs causing ischemia and tubular damage. | Ischemic ATN |
| This form of ATN is caused by a variety of renal poisons such as heavy metals, organic solvents, antibacterial agents, ethylene glycol, and radiographic contract agents. | Nephrotoxic ATN |
| 4 Phases of ATN | 1. Initial phase 2. Maintenance phase 3. Recovery phase 4. Final phase. |
| Characteristics of Initial phase of ATN | (1-2days post event) Mild decline in urine output |
| Characteristics of Maintenance phase of ATN | (2-6days post event) Dramatic drop in urine output (5-400 ml/day) w/ uremia & fluid overload. |
| Characteristics of Recovery phase of ATN | Increased urine output ( up to 3 liters/day). |
| Characteristics of Final phase of ATN | Gradual return of normal w/ regeneration of tubular epithelium. |
| 2 main Kidney and Vascular Disease | 1. Benign Nephrosclerosis (Aterionephrosclerosis) 2. Malignant Nephrosclerosis |
| This disease occurs secondary to benign hypertension, resulting in Hyaline arteriolosclerosis leading to reduced blood flow and ischemic damage to all renal tissue. | Benign Nephrosclerosis (Aterionephrosclerosis) |
| Term for hyalinization and thickening of the vessel wall with narrowing of the lumen. | Hyaline Arteriolosclerosis |
| This kidney and vascular disease is characterized by hypertension (BP > 200/120), but less common (5% of patients), that leads to nephrosclerosis | Malignant Nephrosclerosis |
| Malignant nephrosclerosis results in the production of "onionskin pattern" microscopically, what is this called? | Hyperplastic Arteriolosclerosis |
| 2 common forms of Cystic Diseases of the Kidney | 1. Simple Cysts 2. Autosomal Dominant Adult Polycycstic Kidney Disease (APKD). |
| This Cystic Disease are innocuous lesions that occurs as single or multiple epithelial lined cavities from 1-5cm in diameter that contain clear fluid, usually confined to the cortex of kidney & asymptomatic. | Simple Cysts |
| Radiographic sign of Simple Cysts | Smooth borders in contrast to tumors. |
| This Cystic Disease is an inherited disease characterized by multiple expanding destructive cysts of both Kidneys. 85-90% have a defective PKD1 gene. | Autosomal Dominant Adult Polycystic Kidney Disease (APKD) |
| Characteristic of APKD | Multiple 3-4 cm cysts causing enlargement, flank pain, intermittent gross hematuria, hypertension and urinary infections. |
| Term for a urinary tract obstruction that refers to calculus formation in the urinary collecting system, most frequently in the kidney. | Urolithiasis |
| What are the Predisposing conditions of renal stone formation? | Hyperparathyroidism, Cushing's syndrome, diffuse bone disease, sarcoidosis, and vit D intoxication. |
| 2 pathways most related to the renal stone formation. | 1. Hyperabsorption of calcium in the intestine w/ increased renal output 2. impairment in renal tubular reabsorption. |
| 3 Neoplasms of the Urinary bladder | 1. Renal Cell Carcinoma 2. Wilms Tumor (Nephroblastoma) 3. Carcinoma of the Urinary Bladder |
| This is the most common cancer of the kidney and occurs in the 6th & 7th decade of life and common in males, risk factors include cigarette, pipe & cigar smoking. | Renal Cell Carcinoma |
| 3 classic diagnostic features of Renal Cell Carcinoma | 1. Dull costovertebral (flank) pain 2. long-standing fever 3. hematuria. |
| Characteristic of Renal Cell Carcinoma | Tumor has a tendency to metastasize widely before giving rise to local signs and symptoms, most common metastatic site are lung and bone. |
| Most common tumor in children less than 10 yrs of age and usually arises between 1-4 yrs, arises from mesoderm. Usually presents with a large abdominal mass, hematuria, and abdominal pain. | Wilms Tumor (Nephroblastoma) |
| Unique characteristic of Wilms Tumor | Pulmonary metastases present at diagnosis, also disappear after treatment. |
| 3 basic types of Carcinoma of the Urinary Bladder | 1. Transitional Cell Carcinoma 2. Squamous Cell Carcinoma 3. Adenocarcinoma |
| Dominant clinical presentation with Carcinoma of the Urinary Bladder. | Painless Hematuria (painless blood cells in urine) |
Created by:
ddde227
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