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renal diseases


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what are GLOMERULAR diseases?
diseases that cause direct injury to the glomerulus.
What symptoms are present in GLOMERULAR diseases?
-decr. GFR
Which of these symptoms is almost always present?
What 5 basic reactions are associated with GLOMERULAR diseases?
1. Immune-complex
2. Proliferation of cells
3. Thickening of Basemt memb.
4. Infiltration of PMNs/macroph
5. Sclerosis scars
Which basic reaction is most often seen?
Immune-complex associated.
How do immune complexes cause glomerular disease?
By depositing IgA or IgG complexes in the glomeruli.
What symptoms appear with Acute Glomerulonephritis?
-edema, headaches, low back pain, oliguria.
What infection is AGN associated with?
Group A streps
What pathological process occur in AGN?
-Immune complexes deposit
-Mesangial cells proliferate and WBCs infiltrate.
-Glomerulus dmg allows protein and blood into filtrate.
What are the lab findings seen in AGN?
-Many RBCs - hematuria.
-RBC casts
-Hyaline/granular casts
-maybe WBCs
What 4 conditions must be present for casts to form?
1. Acidic pH
2. Protein
3. Stasis
4. Salt (high sp gr)
What is "Crescentic RPGN"?
Rapidly Progressive Glomerulo-nephritis. The progression of AGN.
What pathological processes occur in RPGN?
1. Immune complexes deposit in glomerulus.
2. Macrophages dmg capillary walls.
3. Leaked cells/fibrin form in Bowman's space, damage it.
What is worse: RPGN or AGN? Why?
RPGN; usually ends in renal failure. APGN can recover.
What type of disorder is Goodpastures?
Who is it seen in?
Young males.
What are the complications that occur in goodpasture's, and why?
Renal and pulmonary.
B/c an antibody develops against alveolar and basement membranes.
What is the prognosis of Goodpastures?
Poor - usually progresses to CGNor renal failure.
What is the main pathology in Membranous Glomerulonephritis?
Diffuse thickening of the basement membrane.
Why is MGM bad?
(2 reasons)
1. Vessels get obliterated and glomerulus can't function.
2. Major cause of Nephrotic syndrome in adults.
What are the lab findings in MGM?
What is the name of the most common cause of GN?
Bergers Disease - IgA Nephropathy
What lab findings accompany berger's disease?
-Episodes of macrohematuria
-Asymptomatic microhematuria
-Varied degrees of proteinuria.
What is focal proliferative Glomerulonephritis?

In what age group?
Increased mesangial cells but only in SOME nephrons.

16-35 yr olds
What makes minimal change disease so... minimal?
the glomerulus looks NORMAL but the podocyte pores are enlarged.
What are the 2 characteristic symptoms of minimal change disease?
MASSIVE protein.
Why is minimal change disease important to diagnose?
It is the major cause of nephrotic syndrome in children.
What is the definition of "Nephrotic Syndrome"?
the protein losing kidney.
What pathologically causes nephrotic syndrome?
Damaged membrane has increased permeability of capillary walls; Electric charges in podocytes altered, protein/lipids escape into filtrate.
What are the 4 lab symptoms of general nephrotic syndrome?
1. Severe proteinuria
2. Hypoalbuminemia
3. General edema
4. Hyperlipidemia
What major microscopic lab finding is seen with Nephrotic syndrome but NOT GN?
Oval Fat Bodies
What disease most often causes nephrotic syndrome?
immune complex
What is chronic glomerulonephritis?
-Continual/permanent dmg
-80% have previous disorder
What are the lab findings in chronic glomerulonephritis in
Blood: increased creat/BUN, decreased Ca.
Urine: RBCs, protein, ALL casts, WBCs, ISOSTHENURIC sp gr.
What is the sp gr seen in CGN?
How does vascular disease cause kidney damage?
Atherosclerosis - intrarenal arteries have reduced blood flow
What lab findings accompany renal vascular disease?
-Slight/mod protein
-NOTHING on micro
-May see RBC casts LATER when in renal failure.
What 3 things cause TUBULAR DISEASE?
What is the main pathologic occurence in ATN?
Loss of large numbers of RTE cells.
What are causes of ATN?
-Renal ischemia
-Exogenous toxins
-Endogenous toxins
what are the 3 stages of ATN?
1. Oliguric
2. Diuretic
3. Recoveru
What are the 3 types of interstitial nephritis?
1. acute pyelonephritis
2. chronic pyelonephritis
3. acute interstitial nephritis
what is acute pyelonephritis?
An infection caused by the ascention of bacteria in the lower UT, or carried by the bloodstream.
what are clinical symptoms of acute pyelonephritis?
sudden onset of fever, chills, nausea, polyuria, urinary frequency.
what are lab findings of acute pyelonephritis?
WBCs, WBC CASTS!!!!! clumps, RBCs, RTEs.
what would be a common cause of acute pyelonephritis?
GNB - ecoli
how do wbc casts form?
diapedesis - response to inflammation.
How does chronic pyelonephritis develop?
From recurrent/chronic infections - cause chronic inflammation, renal scarring.
What are lab findings seen in chronic pyelonephritis?
-Incr. bun/creat
-Decr. GFR
-Minimal proteinuria*
-WBCs*** and some casts.
What causes acute interstial nephritis?
What lab findings are associated with acute interstial nephritis?
-STERILE leukocyturia - no bacteria.
What is the definition of Cystitis?
Inflammation of the bladder and ureters.
What usually causes cystitis?
-Bacteria from lower UTI
What are lab findings in Cystitis?
-WBCs (mostly) -RBCs
-Some protein but from inflammation, not leakage.
-Bacteria -NO CASTS!!
What types of Urinary calculi can form?
What is the most common type of primary calculi to form?
Calcium oxalate
What are secondary calculi?
stones that form around a focus of necrotic tissue or other things.
What is ARF?
Acute suppression of renal function with an associated decrease in the GFR.
What are the 3 types of ARF?
What is pre-renal ARF?
Decreased GFR b/c general blood flow is decreased - usually from cardiac output problem.
What causes intra-renal ARF?
Glomerular, tubular, or vascular disease.
What causes post-renal ARF?
What is affected in Chronic renal failure? wHY?
from the pathophysiology of uremia.
what lab findings are seen in CRF in regard to blood?
-Increased BUN/CREAT
-Acidosis w/ incr. K, P, Sulfate
-Decreased Ca2+ and protein
What lab findings are seen in CRF in regard to urine?
what are 2 types of kidney tumors?

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