Patho Final
Terms
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- what is Wilms' tumor?
-
A neoplasm of the kidneys that typically occurs in children.
Most cases present with abdominal mass, hematuria, and fever - What is renal tubular acidoses (RTAs)?
- They are a group of disorders in which there is a failure of the kidney to either resorb bicarbonate or excrete hydrogen ions. They are a cause of a normal anion gap acidosis.
- which syndrome is characterized by massive loss of protein(>3.5 g/day)and lipiduria along with an assoc. hypoalbuminemia in the urine?
- nephrotic syndrome
- what is the leading cause of chronic renal failure accounting for 50% of pts with end-stage renal desease?
- Glomerulonephritis
- What is azotemia?
- presence of nitrogenous wates in the blood
- What is the nephritic syndrome characterized by?
-
hematuria
<GFR
azotemia
oliguria
HTN - what causes glomerulonephritis?
-
It is caused by diseases that provoke an inflammatory response (usually immune origin) of the endothelial, mesangial or epithelial cells of the glomeruli
SLE and strep are often assoc. - how are most UTIs acquired?
- they ascend from the urethra and bladder
- what is the second most common type of bacterial infection seen?
- UTIs
- who is at increased risk for UTIs?
-
urinary obstruction and reflux
impaired bladder emptying
women who are sexually active
use of diaphragm as contraceptive
postmenopausal women
men with prostate disease
elderly persons - what organism is assoc. with uncomplicated UTIs?
-
E. coli
others: Staph saprophyticus - which type of kidney stone is assoc. with UTIs?
- magnesium ammonium phosphate(struvite) stones
- what are the 4 types of kidney stones?
-
Calcium (oxalate and phosphate)
magnesium ammonium phosphate(struvite)
uric acid
Cystine - what is the most common cause of upper UTIs?
- kidney stones
- what are the most causative agents of pyelonephritis?
-
E. coli
Proteus
Klebsiella
Enterobacter
Pseudomonas - what are the 2 major groups of renal neoplasms?
-
Embryonic (Wilm's Tumor)
Renal cell carcinoma - Name the causes of prerenal failure
-
Hypovolemia
< vascular filling (shock)
Heart failure
< renal perfusion due to drugs - Name causes of intrarenal failure
-
Acute tubular necrosis
renal ischemia
exposure to nephrotoxic drugs
Intratubular obstruction - Name causes of postrenal failure
-
Bilaterial ureteral obstruction
Bladder outlet obstruction - How is end-stage renal disease defined?
- when the GFR is less than 5% of normal
- what is one of the earliest symptoms of renal insufficiency? (GFR at 20% to 50% of normal)
- Isosthenuria or polyuria with urine that is almost isotonic with plasma
- what are some causes of metabolic acidosis?
-
M- methanol poisoning
U- Uremia
D- Diabetic ketoacidosis
S- Salicylate poisoning
L- Lactic acidosis
I-
D- Dehydration
E- - define metabolic acidosis
- a decrease in plasma bicarb and pH caused by an excess production or accumulation of fixed acids or loss of bicarb.
- define metabolic alkalosis
- an increase in plasma bicarb and pH that is caused by excess H+ ion loss or bicarb gain
- how do you calculate the anion gap?
- Na+ - (Cl + HCO3)
- Characteristics of diabetes insipidous
- excessive urine production due to low ADH
- what are the osmotically active particles in ECF?
-
Na+
Cl-
HCO3-
These account for 95% of osmotic pressure.
BUN and Glucose 5% - name some causes of edema
-
Increased capillary pressure
(increased vascular volume; ie HF, kidney failure, Na retention)
Decreased colloidal osmotic pressure
(loss of plasma proteins, protein losing renal diseases, burns)
Increased capillary permeability
obstruction to lymphatic flow - what does edema represent?
- an increase in interstitial fluid volume
- What does atrophic gastritis cause?
- causes a deficiency on intrinsic factor production
- which type of DM is related to an autoimmune process
- Type I DM- not enough insulin is produced due to immune complexes
- what is type II DM?
- obstruction of insulin to the cells, mainly due to life style factors
- what is anasarca?
- Generilized edema
- S/Sx of Nephrotic syndrome
-
Gen. Edema
Xerosis-due to loss of protein
loss of protein >3.5 g/day
hypoalbuminemia < 3 g/dl
Cholesterol >300 mg/dl - what is acute tubular necrosis
- ischemia and inflammation leading to necrosis of the glomerulus
- what are the causes of metabolic acidosis?
-
M- methanol
U- uremia
D- diabetic ketoacidosis
S- salicylates
L- lactic acidosis
I- infections
D- dehydration/diarrhea
E- ethanol - what are some manifestations of kidney failure?
- azotemia and uremia
- what is the respiratory compensation in metabolic acidosis
- hyperventilation to decrease PCO2
- what is the renal compensation in metabolic acidosis
- if no renal disease, increased H+ excretion and increased HCO3 reabsorption
- what is the primary disturbance in metabolic acidosis
- Decrease in bicarbonate
- Name 4 things that cause metabolic acidosis
-
1.increased production of nonvolatile metabolic acids
2.decreased acid secretion by the kidneys
3.excessive loss of bicarb
4.an increase in chloride - what are some causes of UT obstruction
-
renal calculi
papillary necrosis
pregnancy
tumors that compress the ureter - what are the S/Sx of pyelonephritis
- abrupt onset with chills, fever headache, back pain, CVAT, general malaise, dysuria
- the most common presenting signs in Wilm's tumor
-
large abdominal mass
hypertension - what characterizes prerenal failure
- a decrease in renal blood flow due to a depletion of vascular volume
- what are some conditions that cause prerenal failure
-
hemorrhage
heart failure
shock - what are some causes fo postrenal failure
- obstruction of renal outflow due to calculi, structures, tumors, BPH
- what causes intrinsic renal faiulure
-
ischemia
acute tubular necrosis (MC)
acute glomerulonephritis
pyelonephritis - what does the axial skeleton consist of?
- The axial skeleton forms the central axis of the body. It consists of the skull, the vertebral column, the ribs and the sternum or breastbone
- what is the physiologic role of Vit D
- increases calcium absorption in the GI tract and helps regulate calcium deposition in bone
- what is osteoarthritis
- degeneration and progressive loss of cartilage within the joints
- what is podagra
- condition in gout in which uric acid crystals are deposited i the big toe
- what is the HPA axis?
- it plays a primary role in the body's reactions to stress by balancing hormone releases from the adrenaline-producing adrenal medulla, and from the corticosteroid-producing adrenal cortex.
- in which disease is PND most commonly seen?
- PND is a sign of severe heart failure, it is most common with CHF
- Describe Hemophilia
- Hemophilia is an X-linked disorder affecting blood clotting
- what form from the ectoderm?
- skin and nervous system
- what forms from the endoderm
- glandular tissue of the liver and pancreas
- name 2 common second messengers
- cAMP and Calcium
- what is the function of the rought ER?
- manufacturing and transporting proteins
- what are the 4 basic types of tissue
-
epithelial
connective
muscle
nerve - what is the major cell involved in cell-mediated immunity?
-
T-cell
B-cell in Humoral-mediated immunity - what do megakaryocytes differentiate into?
- platelets
- what regulates blood cell production?
- cytokines and growth factors