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Renal Pathology


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Kidneys have several important fuctions
produce EPO , hormone that stimulates blood cell production; manage electrolyte levels in the blood; concentrate urine; manage overll fluid levels
Glomerulonephritis [ aka Nephritic Syndrome ]
a relatively rare but serious situation involving inflammation and scarring of the glomeruli [ microscopic knots of epithelial tissue that are surrounded by capsules ]
Treatment of Glomerulonephritis
depends on cause and generally is geared toward symptom control; ACE inhibitors to control high blood pressure; antiboides for general infection; steriods if autoimmune; Cystotoxic drugs used to inhibit damaging effects of immune system attack against kidneys
Negatrive Feedback Loop
Compression that impairs fucntion which decrease blood flow which result in necrosis which cause compression that impairs fucntion,etc
increase in nitrogeous waste
Treatment of Kidney Stones
Percutaneous Nephrolithotomy; Uteroscophic stone removal; extracorporeal shockwave lithotriposy; surgey to remove parathroid glands; meds to regulate metabolism; dietary adjustment and adequate hydration; limit caffeine. alcohol and oxalate rich foods [dark leafy vegetables, nutes & chocolate]
Mesagial glomerulonephritis
involves immune system abnormalities and the loss of erthrocytes into the urine [ assocatied with HIV/AIDs, mononuclesosis, celiac disease & cirrhosis ]
Nephrotic Characteristics
lead to increased permeability of glomerulus and Bowman's caplsules to protein; diesease affecting filtrations membrane; massiave protein urea [ lots of proteins in urine/filtrate]; increase in pressure along with large leakage; lipidurea; loss of albumiomas; proteins "dam things up"
Pott's Syndrome
associated with an agenesis of sort; facial structure is different and limbs defects
Kidney Stones [ aka renal calculi; nephrolithaises]
are crystals that sometimes develop in the renal pelvis
Acute Renal Failure
identified when kidney function suddenly drops to 50% or less of normal levels, this may takes place over several hours or days
Demographics of Glomerulonephritis
different age groups are at risk for different types; children may experience as a complication of a streptococal infection; adult may experience as a spontaneous event or part of an automimmune disorder, allergy or rection to toxic exposures
Primary Nephritic Syndrome
IgA nephropathy; most common in North America; genetic weakness; results increase levels of IgA in blood; disposition of antiboitics compliment in glomerous; hemauria; 50% will have reoccuring singular episodes; 50% will have gradual progression of the disease
Chronic Renal Fialure GFR
under 30 mL/ minute
End- Stage Renal diesaese GFR
under 10 mL/ minute
relatively rate; 2%; directly related to a genetic dysfunction with the metabolism of cystine [ an amino acid ]
Renal Colic
if big enough to disrupt kidney function may lead to chronc/acute liver failure; retrograde build up of urine increase in presure, swollen and necrosis
Things that occur with Cystic Disease (of Kidney)
Tubular Obstruction; Changes in Basement Membrane
sharp decrease in urine output
Etiology of Interstitial Cystitis
fragments of WBCs or pahtogens indicate an infection somewhere in the urinary system; occurs when the inner lining of the bladder no longer protects the orgn from urine; develop pin point hemorrhages; muscular walls of bladder become fibrotic and ineslatic
Treatment of Bladder Cancer
depends on stage; cystoscope to remove abnormal tissue; men may lose prostate gland; woem may lose the uterus , ovaries & parts of the vaginal wall
Higher UTI
kidney; pyelitis; much more serious; can cause renal damage
Predispotion for UTIs
female; obstructive diseases; pregnant; elderly; immonocomprised; diabetes mellitus; catherized; bedridden, immobilized and paradilizied;
Early Sign & Symptoms of Glomerulonephritis
early symptoms are abnormalities in the urine; high protein levels of RBCs; Hematuria as dark or rust coloured urine; hypertension, doesn't respond to normal interventions
Late Signs & Symptoms of Glomerulonephritis
are indicators of renal failure; including general malaise, skin discolouration, itching , fatigue, anemia [erythorpetri is affected], low urine output, systemic edema & in very severe severe cases , lethary , confusion & coma
Treatment of Pyelonephritis
most clear up with antibiotic therapy
cause compression of the developing fetus and is often associated with impaired development of fetal structures
Obstructive Disorders
toxins in urine, remain in body, inadequate elimination of waste; urine become alkaline; chronic stricuture will dilate and try to move it, blood vessels will start to compressl result ischemica; with ischemic blow pressure increase insanely, massive production of renin; hypoxic monitor by kidneys
Etiology of Bladder Cancer
involve epithelial cells transitional eptihelium that lines the urinary bladder, constant reptitive damage to this epithlium causes the matures cells to die and stimulates rapid replication in the basal layer and soon new colonies of immature cells migrate to the surface; the new cellsare easily disrupted by genetic mutations and may become malignant groths that causes bleeding into the bladder
kidney stone stuck in ureter
Membraneous Glomerulonephropathy associated with
Hep B; Thryoidititis; certain drugs [street drugs]
Signs & Symptoms of Bladder Cancer
hematuira, reddened or rust coloured urine [earliest sign]; secondary symptoms bladder irritabilty; compression on the rectum, pelvic lymph nodes & other structures
fats going through
Interstitial Cystitis
a condition in which the urinary bladder becomes small and inelastic
Prognosis of Glomeruolnephritis
Short term acute infection with complete recovery; Long term progressive condition in which the kidneys are slowly destroyed, leading to end-stage renal failure and dependance on dialysis
Contributing Factors for Bladder Cancer
exposure to aromatic amines [ chemicals used in dry cleaning fluid, hairdressing, chemical, textile and rubber industries]
Chronic insufficieny [silent condition] GFR
30 - 70 mL/ minute
Risk Factors of UTIs
Spermicides; Diaphragm use; Pregnancy; Diabetes; Neurogenic Bladder
Signs & Symptoms of Acute Pyelonephritis
rapid onset with urinary infection; fever; buring; frequency of urination; cloudy urine; extreme back pain; fatigue; nausea & vomiting; develop over a 1-2 day period
increase of lipids in urine due toe metabolic hyperlipidedma [ increase of lipid in the body]; fat floating through body; atherliosclerosis
During a specific immune system attack against an invader, a variey of things can happen
one mechanism involves the formation of immune complexes sticky bites of antigens & antibodies, often accompanied by complement [a series of immune system chemical that are meant to aid in the destruction of invading pathogens]
Tubular Obstuction
increase in tubular pressure; almost like herination; get buldge than twist to close then , volia , a cyst
Signs & Symptoms of Chronic Renal Failure
decrease urine output; systemic edema from salt & water; arrhythmia from potassium retention; anemia from lack of EPO ; osteomalacia [bone thinning] from lack of vitamin D; rashes & skin discolouration from rentention of toxic pigements; lethargy; fatigue; headaches; loss of sensation in hands & feet; tremors; seizures; bruising; bleeding; muscle cramps; chnge in mental and emotional states
Cystic Disease
a cyst is a fluid filled sac; singular or multiple variety
Size of Kidney Stones
varies widely , depending on how long they have been developing and type; range between size of grains of sand to approximately 1 inch diameter
Semipermeable Membranes
that separate the circulatory capillaries from the nephrons act as filter to keep vital blood components in the bloodstream while allowing water and waste to exit into the urinary [renal] system
Types of Kidney Stones
Calciumoxalate or Calcium phosophate; Struvite; Uric Acid; Cystine; Coral
Kidney fuction is measure in
terms of GFR [ glomerular filtration rate]; how efficiently fluid moves from the glomeruli into the nephrons
Causes of Acute Renal Failure
Prerenal Problems; Intrarenal Problems & Postrenal Problems
Etiology of Pyelonephritis
complication of Escherichia coli [E coli ] infection in urinary tract that travels up ureters; can also develop from more obscure pathogens; related to diabetes & pregnancy; neurogenic bladder; surgery or medical instrutment [catheters or cystoscopes]; can be a complication of kidney stones or enlarged prostate
blood posioning; life theatening situation
Chronic Renal Failure
an impairment in kidney function that may persist for months or yers before it causes any symptoms
infection of the nephrons in kidney, although the renal pelvis may also be involved
Honeymoon Cystitis
refers to inflammation and subsequent infection brought abour by repeated friction and irritation of the urthera from sexual activity
Focal Sclerosis
focal collogen deposited; into some of the glomeruli [not all but enough to cause an issue]; idiopahtic; may lead to renal failure; unsure how to treat
How is hypertension both a symptom and complication of most chronic kidney disorder
because a disruption in urine outputcauses fluid retention and external pressure on all blood vessesl
Calciumoxalate or Calcium Phosophate Stones
75-85%; assocaited with parathroid dysfuntion; too much vitamin D; abnormally high rate of Calcium absoprtion
Demographics of Urinary Tract Infection (UTIs)
20-50% of all woemn will have atleast one; women's disoder since the urthra is so short & located close to the anus
Approximately 10% of patients with Interstitial Cystitis develop a particular lesion called
Hunner's ulcer
Secondary Nephritic Syndrome
acute porliferative glomerural nephritites [strep]; most comon respone to beta hemolytic strep [strep throat]; may have other infections
Primary Nephrotic Syndrome
Minimal Change Disease: Focal Sclerosis; Membraneous Glomerulonephropathy
Uric Acid
form in kidneys of people whose blood is abnormally acidic; 5-15%; assocaited with a diet high in meat and prines
Signs & Symptoms of UTIs
painful burning urination; frequent need to urinate; reduced bladder capacity; urgency; hematuria; cloudy urine; pelvic , abdominal or low back pain may occur; severe flank or back pain; [men] pain in penis or scotum;
Causes of UTIs
E coli [90% of cases]; certain variet os staphyloccus, kelbsiella, chlamydia and mycoplasma; stress
Renal Hypotrophy
kidney doesn't develop to normal size; only effect one kidney [ can affect bot in rare case]
Complications of Pyelonephritis
if recurrent can cause scarring and long lasting kidney damage; insufficient kidney leads to hypertension and renal failure; sepsis from an acute infection;
Signs & Symptoms of Chronic Pyelonephritis
[in adults] situation in which an acute infection has been incompletely treated; silent; no symptoms but damage accumulates in the kidney; [in children] related to a strucural anomaly at the vesicoureteral valve {aka Vesicoureteral reflux } allows urine to back up into the kidney
Descending UTIs
spread by blood; hemogenitions
White Blood Cells
Diabetes Glomerulosclerosis
major component of diabetes mellitus; similair to glomerual nephronitis; but without inflammation
Treatment of UTIs
drink lots, pee it out!; antibiotics
Children and UTIs
5% of girls; 2% boys; 80% will have reoccurences; increase with premature babies; immunosuppresed
Prerenal Problems
something prevents blood flow into the kidney; glomerula and nephrons essentially collapse from lack of fluid volume; decrease blood volume; low blood pressure from septicemia; traumatic shock; extreme dehydration; embolism that blocks renal artery
Intrarenal Problems
pathologic conditions within the kidneys themselves; glomerulonephrtis; an embolism caught inside kidney; E coli infection that produces tissue damaging [ Hemolytic uremic syndrome ]; drugs reactions
Cause of Interstitial Cystitis
unkown; maybe autoimmune diesease or allergy that weakens the protective mucous membrance of bladder's epithelium; pathologic thinning of the mucous membrane bladder walls is another factor; causative agent
staghorn stones; worse kind!; due to cycel of urease [urea-amonium]; fill entire kidney with stones; disruption of physical and physiology structure of kidney; health problem; usually unilateral
Membraneous Glomerulonephropathy
adult form; unkown/idiopathic; difussed thickening of glomuerular basement membrane; due to depoist of immune complex into the membrane; progresses to end stage renal failure
Wilm's tumours
nephroblastoma; malignant tumour, very rare
Signs & Symptoms of Interstitial Cystitis
chronic pelvic pain; pain & buring on urination; increase frequency; increase urgency; painful intercourse; get progressively worsen for about 5 years and then stabilize; flare and remission; although others find that their daily experiences
Minimal Change Disease
loss of podocytes [pedicules]; structural abnormality; cause is unknown; might be linke with immunization & upper tract infection; doesn't progress to renal failure; malnutrtion & immune system dysfunctions
Why Females for UTIs
proximity to vagina: yeast infections; hormonal flactulations; 15-25 years old going through structural changes allows for opportunstic basteria; honey moonitits
Risk factors for developing chronic renal failure are;
having chronic hypertension; diabtes or glomerulonephritis; race African Americans are far more likely to experience both chronic high blood pressure and chronic renal failures that caucasians; environmental toxins; 20 million Americans are in early stages, usually undiagnosed
Subgroups of Glomerulonephritis
Acute Postinfectious Glomerulonephritis & Mesangial Glomerulonephritis
Postrenal Problems
fluid is prevented from leaving the kidneys; damage to nephrons can accumulate to dangerous levels; kidney stones; enlarged prostate; tumors
Complications of UTIs
infection in bladder [cycstitis] uf ubcjecked my move into ureters & kidney; chronic UTIs may contribute to chronic renal failure; sepsis; can cause permanent damage to kidneys or even death
Bladder Cancer
development of malignant cells in the urinary bladder
Characterisitcs of Pott's Syndrome
eyes wider apart; broad flat nose; receeding chin; unilateral agensis; incapable of life
Normal GFR
120 mL/ minute
Causes of Chronic Renal Failure
most common cause is Diabetes Mellitus; followed by chronic hypertension. glomerulonephritis and others
Elderly and UTIs
15-30% in retirement homes reoccurent infections; 5-20% at home will get reoccurent infections; ascending more predominant; rate between sexes are equal;drink lots
Rapidly Progressive Glomerulonephritis
no specific cause; can be primary; happens within months; monocytes in Bowman's Capsule
Increased Risk for developing Bladder Cancer
person who have undergone pelvic radiotion; chronic infections; bladder stones ; catheter use; approximately half of all bladder cancer cases are believed to be related to cigarette smoking
Demographics of Bladder Cancer
common, 4th leading cancer among men & 8th among women; disease of older people; average age is 68 years old
Lower UTI
cystitis; bladder is inflammed
Causes of Focal Sclerosis
AIDs; herione abuse; NSAIDs; drugs used by mother
Prevention of Pyelonephritis
Acute is almost always related to bacteria that enters the body at the urethral opening "Let this be a lesson ladies; always wipe front to back"
Obstructive Disorders
caused by a stone
Etiology of UTIs
foriegn mircoorangisms are introduced into the urethra, cling to the mucous lining of the urthera or bladder and set up an infection
Nephrotic Syndrome
grouping of some sort; less specific than a disease
Changes in Basement Membrane
predisoposition to cyst; occurs in breast; genetic; fluid accumulation leads to preceeded growth; compresses blood flow in renal system
Treatment of Chronic Renal Failure
determinde by whatever pathologic conditions; control symtpoms; prevent further complications; slow progession of disease
Prevention of UTIs
drinking lots of water & acidic juices; urinate whenever needed; wiping from back to front; showers rather than baths; emptying the bladder; pee after sex; avoid femine hygiene sprays
Renal Failure
means that for various reasons the kidneys are not functioning adequately; kidneys are still working but unble to keep up with body's demand
Characteristics of Nephritic Syndrome
hematuria; olguria; azotemic; decrease glomerular filtrate; hypertension; no or little edema due to loss of plasma proteins
Prognosis of Bladder Cancer
5 year survival rate is 76% for causasians & 55% for African Americans
Chronic Inflammation
decrease in kindey function may lead to renal failure can change in strucutre, change in hemodynamics , can be primary and seconday
Renal Colic
passing of a stone; pain with it
Red Blood Cells
Ascending UTIs
female; proximity to anus; ureters are short & wider; more bacteria entering
Why Pregnant for UTIs
hormonal changes; mechincal and antomical changes; decrease perstatlsis [ureters]; stasis [chance for bacteria infection]; physical change in organce because body pushes them out of the way; drink acidic juices
Treamtment of interstitial Cystitis
no known cause , no known cure; generally aimed at symptomatic relifer and development of coping skills
complete failure of an organ to develop
blood in the urine
Demographics of Kidney Stones
form in absence of adequate fluids; commo in tropical environments; men affect more then women 3:1; 10% of americans will pass a stone at sometime; first get between 20-30 years old; 75% will experience at least one repeast
Demographics of Interstitial Cystitis
700, 000 to 1 million Americans have it; 90% women , 10% men; rare in children; women at risk between 20-50 years oldl average onset is 43 years old
associated with chronic urinary tract infection; 5-15%
Acute Postinfectious Glomerulonephritis
situation that follows a few week after an infection [ usually with some type of streptaccoues, as seen with strep throat or impetigo ]
Urinary Tract Infection
infection that may occur anywhere in the urinary system, from the kidneys to the bladder to the urethra
Complications of Kidney Stones
if big enough cause exruciating pain; may lead to chroinc or acute renal failure;
large stones removed surgically; ultrasounds; dislodge it; meds; hydration , gallon of water per day; dietary adjustments
failure of an organ to develop normally
Signs & Symptoms of Kidney Stones
most are completely silent; 85% pass through ureters without pain; grabbing pain; can cause renal colic; pain is sudden onset; comes & goes; nausea and vomiting; pain refers into the groin area
Etiology of Glomerulonephritis
acute or crhonic inflmmatory reaction in the semipermeable membrances can compromise their effectiveness and allow important substance to leave the body through the urine, while allowing toxins to accumulate in the bloodstream

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