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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