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Renal/Metabo Disease

MEDT 208 Renal & Metabolic Disease Correlation study objectives

What are the clinical features associated with glomerular disease? Hematuria, Proteinuria, Oliguria, Azotemia, Edema, Hypertension
What factors affect the presence and severity of the clinical features of glomerular disease? Number of glomeruli involved, Mechanism of injury, Rapidity of disease onset
Clinical presentation: Acute, fever, malaise, nausea, oliguria, hematuria, edema, hypertension. RBC, WBC, RTE, casts, (RBC, HGb, granular occasional WBC and renal cell)  Acute glomerulonephritis
Clinical presentation: Acute onset. Main cause of nephrotic syndrome. Membranous glomerulonephritis
Clinical presentation: Proteinuria, Hematuria, ↓ GFR, Nephrotic syndrome Focal segmental glomerulonephritis
Clinical presentation: Slow, progressive . Varied presentation: hematuria to nephrotic syndrome Membranoproliferative glomerulonephritis
Clinical presentation: Hyalinized, acelular glomeruli. Slow and silent; hypertension, edema, proteinuria, azotemia. Chronic glomerulonephritis
Clinical presentation: Fever, malaise, nausea, oliguria, hematuria, edema, hypertension. Rapidly progressive glomerulonephritis
Clinical presentation: Loss of podocyte foot process in glomeruli. Nephrotic syndrome. Immune mediated. Minimal Change disease
Clinical presentation: Glomerular inflammation, cellular proliferation, Nephritic syndrome. Focal proliferative glomerulonephritis
Clinical presentation:Increased mesangial cellularity due to IgA deposits in mesangium; Slow + progressive; Recurrent hematuria + proteinuria. IgA Nephropathy
What is the pathology of SLE? Autoimmune disease causes lesions on glomerulus.
What is the pathology of diabetes mellitus? Lack of insulin or insulin resistance causes glycosylation & sclerosis in glomerulus.
What is the pathology of amyloidosis? Amyloid protein deposits in glomerulus causes sclerosis.
Presentation of systemic disease: Recurrent hematuria + Nephritic syndrome OR Nephrotic syndrome SLE
Presentation of systemic disease: Proteinuria + Hyperglycemia Diabetes mellitus
Presentation of systemic disease: Heavy proteinuria + Nephrotic syndrome +RTE casts/cells + Misc casts. Amyloidosis
RTE's are seen in only what two conditions? (1) Nephrotic Syndrome, (2) Glomerulonephritis
What are at least five clinical features that characterize the nephrotic syndrome? (1) Heavy proteinuria >3.5 g/day, (2) Hypoproteinemia (3) Hyperlipidemia, (4) Lipiduria, (5) Edema
Which four glomerular inflammatory diseases are associated with nephrotic syndrome? (1) Minimal Change Disease, (2) Membranous glomerulonephritis, (3) Focal Segmental Glomerulonephritis, (4) Membranoproliferative Glomerulonephritis
What is the clinical presentation of acute tubular necrosis (destruction of renal tubules)? Oliguria + acute renal failure
Ischemic acute tubular necrosis means? Destruction of renal tubules following a hypotensive event.
Toxic acute tubular necrosis means? Destruction of renal tubules due to nephrotoxic agents.
The dysfunction in Fanconi's Syndrome is? Loss of proximal tubular function (can't reabsorb stuff)
What are the clinical features of Fanconi's syndrome? Low amino acids, Dehydration, Hypoglycemia, Hypophosphatemia, Hypokalemia , Hypo-calcium
What is the dysfunction in Renal Glycosuria? Reduced tubular reabsorptive capacity (Tm) for glucose.
What are the clinical features of Renal Glycosuria? Hypoglycemia, Normal Ca, Normal phosphate
What is the dysfunction in Renal Phosphaturia? Rare hereditary disorder; Inability to reabsorb phosphate in the distal tubules; Decreased proximal tubular response to hypophosphatemia
What are the clinical features of Renal Phosphaturia? Hypophosphatemia; Normal glucose; Normal Ca
What is the dysfunction in Renal Tubular Acidosis? Tubules can't excreted H+. ; Type I - distal ; Type II - proximal; Type III - combined
What are the clinical features of Renal Tubular Acidosis? Acidemia ; Urine pH > 5.3
Acute Pyelonephritis is caused by an ascending infection characterized by flank pain, groin pain, dysuria, frequency, urgency, fever, nausea, headache, malaise, and mental confusion. What are the typically urinary findings? Leukocytes, Inflammatory cells, Casts, Mild hematuria, Proteinuria, Low SG
Chronic Pyelonephritis is caused by reflux nephropathies characterized by persistent scarring and inflammation in the kidneys, hypertension & renal failure. What are they typical urinary findings? LE +, Low SG, Moderate proteinuria, WBC, macropages; Casts: granular, waxy, broad, few WBC/renal cells
Lower UTI's are caused by bacteria from the GI tract entering the UT (usually E. coli). Characterized by cystitis , dysuria (Pain/burning), Urgency, Fever and Cramping. What are the typical urinary findings? Increased WBC, Bacteria, RBC & Transitional epis. Chemical: Protein: small, Blood +, LE +, Nitrite +
Yeast infections are caused by fungus (Candida) proliferating after a disruption of normal flora (catheters). Causes itching, burning, urgency. What are the typical urinary findings? Yeas + pseudohyphae
What is the effect of vascular disease on renal function? Since renal function directly dependent on renal vasculature, any kidney-blood-supply altering diseases directly affect renal function, such as renal ischemia (insufficient blood flow), & hypertension.
What is the physiological mechanism of cystinosis? Lysosomal storage disease: cellular deposition of lysosome of cells. Accumulated cystine crystallizes w/in cells, causes damages and disrupting cellular functions.
What are the clinical features of cystinosis? Fanconi's syndrome, Growth retardation, Rickets, Polyuria, Polydispis, Dehydration, Acidosis, Light sensitivity
What urinalysis finding will diagnosis cystinosis? Cystine crystals
What is the physiological mechanism of cystinuria? Autosomal recessive disorder: nephrons unable to reabsorb aa's.
What are the clinical features of cystinuria? Cystine excretion, AA excretion (arginine, lysine, ornithine), Renal calculi +
What urinalysis finding will diagnosis cystinuria? Cystine crystals + pH < 8
Homogentisic acid (alkaptonuria) is caused by? What color does urine turn? Liver enzyme deficiency: excretion of large amounts of homogentisic acid. Black.
Describe the urine of a phenylketonuria patient? Mousy, musty urine odor.
Phenylketonuria is caused by? An enzyme deficiency resulting in increased urinary excretion of phenylpyruvic acid.
What are the clinical symptoms of phenylketonuria? Severe mental retardation, aminoaciduria, delayed development, feeding difficulties, severe vomitng, light pigmentation
What is the cause of tyrosinuria? Metabolic pathway defect. Large amounts of tyrosine in plasma.
What are the clinical symptoms of tyrosinuria? High tyrosine levels, liver damage, renal disease, aminoaciduria, death in 1st decade
What is the preferred method for tyrosinuria diagnosis? Ion exchange chromatorgraphy
Melanuria is caused by? Inherited defective melanin production or malignant neoplasm.
What is the urinary indicator of melanuria? Darkening of urine
What two mechanisms cause diabetes mellitus? (1) Defective insulin production. (2) Defective insulin action.
What is diabetes mellitus? Impaired ability to utilize glucose.
What are the clinical features of diabetes mellitus? Chronic hyperglycemia, chronic glycosuria, polyuria, polydipsia, ketonuria, rapid weight loss
What is the characteristic urinary finding for diabetes mellitus? Glucose in urine
What is galactosuria? Galactose in urine caused by defective enzyme in galactose metabolic pathway. Leads to galactose accumulation in blood exceeding renal threshold.
What are the clinical symptoms of galactosuria? Failure to thrive, vomitng, jaundice, liver disease, diarrhea, cataracts.
What is the purpose of urinary test for galactose? Screening only
What is diabetes insipidus caused by? Defective ADH production or response. Neurogenic is low ADH. Nephrogenic is normal ADH + defective renal tubular response.
What are the clinical features of diabetes insipidus? Polyuria, glycosuria, polydipsia.
What are the urinary findings in diabetes insipidus? Dilute specimen + low SG
What are porphyrins caused by? Inherited or acquired enzyme deficiency or inhibition during heme biosynthesis. OR lead poisoning.
Are porphyrins are neurotoxins? yes
What are the clinical symptoms of porphyrin? Light sensitivity + neurologic symptoms
What are the urinary findings in porphyrins? Porphyrins + red blood
 Which of the following is a characteristic feature of  type 2 diabetes mellitus?   usually presents first in adults
Diabetes insipidus is not characterized by _________  increased vasopressin
Testing for reducing substances in infants is important to detect a carbohydrate disorder with galactosemia. These infants may present with all of these features except ______________ polyuria
Galactose is a metabolic product of ____? lactose
What condition results in the accumulation homogentisic acid? Alkaptonuria
A urine sample exposed to air developed a brown-black color. This indicates the sample may contain ? melanin
Which of the following are related to tyrosine metabolism or production? Tyrosinuria, melanuira, phenylketonuria, alkaptonuria. All of them
Which of the following can lead to severe mental retardation if not detected early in life? Phenylketonuria, Maple syrup disease, glactosuria, alkaptonuria. Phenylketonuria, Maple syrup disease, glactosuria.
Which of the following regarding porphyrins and their precursors is true?  (1) porphyria can be inherited or induced; (2) Porphyrin precursors are neurotoxins; (3) Porphyrins can be dark red or purple; (4) Porphyrin precursors cause skin photosensitivity. (1) porphyria can be inherited or induced; (2) Porphyrin precursors are neurotoxins; (3) Porphyrins can be dark red or purple;
What specific characteristic of the organism causing Acute post streptococcal glomerulonephritis is causing sore throat? M protein
What is the significance of dysmorphic RBCs? Glomerular bleeding
What is the prognosis of acute post-streptococcal glomerulonephritis? Full recovery with treatment
Which laboratory result is most helpful in diagnosing IgA Nephropathy? Serum IgA level
A positive result for urine glucose generically means? tubular damage
What are waxy casts associated with? Chronic tubular damage with oliguria
What physiologic mechanism causing massive proteinuria? Basement membrane injury
What is the relationship between proteinuria and edema? Decreased capillary oncotic pressure
What mechanism produces oval fat bodies? Tubular reabsorption of filtered lipids
State two additional procedures that can be performed to verify the presence of the ovalfat bodies and the fatty casts. Polarized microscopy and Sudan III staining
Minimal change disease usually presents in ? children
What two population are most at risk for developing cystitis? Pregnant women and female children
What disorder will develop if cystis is not treated? acute pyelonephritis
RTE cells indicate? tubular damage
Crenated RBCs will appear in urine with a low SG or high SG? High SG
The most common crystal in renal calculi is? Ca oxalate
Identify the disorder:A patient with severe lower back pain and microscopic hematuria is scheduled for lithotripsy. Renal calculi
Identify the disorder: A patient who tested positive for human immunodeficiency virus exhibits mild symptoms resembling the nephrotic syndrome. Focal segmental glomerulonephritis
Identify the disease: A 40-year-old patient diagnosed with systemic lupus erythematosus develops macroscopic hematuria, proteinuria, and the presence of RBC casts in the urine sediment. Rapidly progressive glomerulonephritis
Identify the disease:A 50-year-old patient diagnosed with systemic lupus erythematosus exhibits symptoms of gradually declining renal function and increasing proteinuria membranous glomerulonephritis
Identify the disease: A patient who has taken outdated tetracycline develops glycosuria and a generalized aminoaciduria Fanconi's syndrome
Identify the disease: A patient known to form renal calculi develops oliguria, edema, and azotemia Acute renal failure
Identify the disease: A patient has a normal blood glucose and mild glucosuria Nephrogenic diabetes insipidus
What are the four morphological changes in glomeruli during glomerular damage? (1) Cellular proliferation, (2) Leukocyte infiltration, (3) Glomerular basement membrane thickening, (4) Hyalinization (sclerosis) of glomeruli
Created by: 100002485764648