Gen Path - Class 14

Front 1

What are four requirements for the normal formation and excretion of urine?

Back 1

(1)Must be anatomically normal, (2)Must have normal blood flow and adequate body hydration, (3)Must have normal hormone regulation, (4)Ureters and bladder must be clear of obstruction

Front 2

What are three hormones involved in the normal formation and excretion of urine?

Back 2

(1)Antidiuretic hormone, (2)Atrial natriuretic hormone, (3)Aldosterone

Front 3

What is renal failure?

Back 3

Failure of the urinary tract to produce normal amounts of urine. Defined as pre-renal, renal or post-renal.

Front 4

What are five unique risks for the urinary system?

Back 4

(1)Extremely susceptible to bacterial infections, (2)Glomeruli capillaries are targets for antibodies, (3)Systemic conditions can effect that renal arteries or glomeruli capillaries and cause irreparable damage, (4)Renal tubules are composed of specialized cells that are very sensitive to lack of oxygen and to toxins, (5)Urinary tract consists of mitotic cells that may under gomalignant transformation

Front 5

What are two examples of bacterial infections?

Back 5

(1)Bacteria in circulation – enter kidneys, (2)Bacteria from urethra – d/t the anatomical proximity of the urethra to the vaginal and rectal openings.

Front 6

Describe how glomeruli capillaries can be infected.

Back 6

Glomerulonephritis. High amounts of blood being filtered. Easy for autoantigens to cause issues

Front 7

What are two examples systemic conditions can effect that renal arteries or glomeruli capillaries?

Back 7

(1)HTN, (2)DM

Front 8

How are renal tubules at risk for infection?

Back 8

Their filtering function puts these cells at risk

Front 9

What are eight age related changes that can affect the urinary system?

Back 9

(1)Gradual dcr in blood flow to the kidneys & dcr in nephrons, (2)Incr in renal vasoconstriction, made worse with stress/exercise, or with some diseases (i.e. CHF), (3)Impaired Na regulation-Elderly more at risk for hyponatremia, (4)Dcr’d bladder capacity, incr’d freq. of urination, (5)Incr’d nocturia, (6)Hormone changes in women can be a factor in pelvic floor disorders, (7)TIA’s & strokes can dcr muscle tone in the pelvic floor, (8)Higher risk for UTI’S – b/cof medications, & catheterizations in hospitals

Front 10

What are eight examples of local symptoms of urinary pathology symptoms?

Back 10

(1)Polyuria, (2)Dysuria, (3)Oliguria, (4)Anuria, (5)Proteinuria, (6)Glucosuria, (7)Hematuria, (8)Pyuria

Front 11

What is polyuria?

Back 11

Increased amount of urine

Front 12

What is dysuria?

Back 12

Painful urination

Front 13

What is oliguria?

Back 13

Decreased daily output of urine

Front 14

What is anuria?

Back 14

State where no urine is produced

Front 15

What is proteinuria?

Back 15

Increased excretion of protein in urine

Front 16

What is Glucosuria?

Back 16

Increased excretion of glucose in urine

Front 17

What is hematuria?

Back 17

Blood present in urine – visible or not

Front 18

What is pyuria?

Back 18

Pus in urine – may appear turbid

Front 19

What are four examples of systemic symptoms of urinary pathology symptoms?

Back 19

(1)Depends on condition, (2)Fever, shivering, (3)Malaise, (4)Uremia – poisoning with urine (Retention of water and minerals, uric acid, ammonia)

Front 20

What are three classifications of renal failure?

Back 20

(1)Prerenal, (2)Intrarenal, (3)Postrenal

Front 21

What is prerenal failure?

Back 21

Shock, heart failure. Before the kidney. Usually reversible. Normal renal function is restored.

Front 22

What is intrarenal failure?

Back 22

Tubular necrosis

Front 23

What is postrenal failure?

Back 23

Prostate disease, kidney stones in bladder

Front 24

What is acute renal failure?

Back 24

Sudden oliguria (extreme diminishment of urine production)

Front 25

What is the etiology of acute renal failure?

Back 25

acute tubular necrosis = mcc of ARF. Usually d/t renal ischemia

Front 26

How does renal ischemia result in acute renal failure?

Back 26

(1)can be caused by hypotension: dcr’d cardiac output, incr’d renal artery resistance, (2)also ureter obstruction [i.e. stone], bladder obstruction, acute glomerulonephritis, liver failure, or drug rxn

Front 27

What is the pathogenesis of acute renal failure?

Back 27

suppression of blood flow -- ischemia -- necrosis -- oliguria -- azotemia -- damage

Front 28

What are four clinical manifestations of acute renal failure?

Back 28

(1)edema, (2)acidosis, (3)hyperkalemia (high potassium), (4)hypercalcemia

Front 29

What are four potential outcomes of acute renal failure?

Back 29

(1)cardiac arrest, (2)ongoing dialysis, (3)transplant, (4)death

Front 30

What is chronic renal failure?

Back 30

Alteration of kidney function or structure for 3 months or longer. Destruction of nephrons = irreversible progressive decline

Front 31

What are the three most common causes of chronic renal failure?

Back 31

(1)Diabetes (44%), (2)Hypertension (27%), (3)Glomerulonephritis (8%)

Front 32

What is end stage renal disease (ESRD)?

Back 32

End Stage Renal Disease (ESRD) is the final stage = complete loss of kidney function requiring dialysis or transplant

Front 33

What are four other causes of chronic renal failure?

Back 33

(1)Polycystic kidneys, (2)repeated kidney infections, (3)SLE, (4)overuse ofNSAIDS

Front 34

How many stages of chronic renal failure are there?

Back 34

5

Front 35

What are the five stages of chronic renal failure?

Back 35

(1)Renal damage but normal or mildly incr’d GFR, (2)Mildly dcr’d GFR 60-89 ml/min, (3)Moderately dcr’d GFR 30-59 ml/min; incr’d nitrogen and creatinine build up in blood, (4)Severely dcr’d GFR; oliguria, (5)Kidney failure (ESRD)

Front 36

What is Polycystic Kidney Disease?

Back 36

Both kidneys are enlarged and contain a lot of cysts. Weigh 3000 – 4000 g (normal is 150 – 200g) = 20X normal! Unknown reason – cysts are formed by obstructed tubules. Cysts form anywhere along nephron

Front 37

What is the etiology of polycystic kidney disease?

Back 37

autosomal dominant

Front 38

What is the pathogenesis of polycystic kidney disease?

Back 38

cysts form from the epithelium of renal tubule

Front 39

What are seven clinical manifestations of polycystic kidney disease?

Back 39

often asymptomatic or: (1)pain (abdominal or flank), (2)hematuria, (3)fever, (4)HTN, (5)May have enlarged kidney, easily palpable through the abdomen, (6)Hematuria may only be microscopic – would be macroscopic if cyst ruptures, (7)Liver cysts common

Front 40

How is polycystic kidney disease diagnosed?

Back 40

ultrasound – at least 2 cysts on one kidney must be present; also CT or MRI. Usually check with family history.

Front 41

What are four types of glomerular disease?

Back 41

(1)Immunological Diseases, (2)Metabolic Diseases, (3)Circulatory Disorders, (4)Multiple Mechanism

Front 42

What is glomerular disease?

Back 42

Group of diseases that affect the kidneys filtering units (glomeruli)

Front 43

What is the most common type of glomerular disease?

Back 43

Glomerulonephritis

Front 44

What are clinical features of multiple mechanism glomerular disease?

Back 44

glomerular diseases can present with a set of symptoms which are recognized as syndromes

Front 45

What are four syndromes that can be classified as multiple mechanism glomerular disease?

Back 45

(1)Acute renal failure, (2)Nephritic Syndrome, (3)Nephrotic Syndrome, (4)Isolated Glomerular Hematuria

Front 46

What is acute renal failure?

Back 46

rapidly progressive glomerulonephritis – loss of renal excretory function over several weeks. Hematuria -- oligouria -- anuria

Front 47

What is another name for nephrotic syndrome?

Back 47

Nephrosis

Front 48

What is a key feature of nephrotic syndrome/nephrosis?

Back 48

Proteinuria

Front 49

What is nephrotic syndrome?

Back 49

Generalized edema, massive proteinuria, hypoalbunemia, and Byperlipidemia/lipiduria (high lipids in blood & urine). MCC – Diabetes

Front 50

What are three clinical manifestations of nephritoc syndrome/nephrosis?

Back 50

(1)edema d/t hypoalbuminemia, (2)incr’d lipids [liver’s response to low protein in the blood], (3)coagulation abnormalities

Front 51

What nephritic syndrome?

Back 51

Generalized edema, HTN, hematuria, proteinuria, hypoalbuminemia. Most common causes: Acute = Post Strep Chronic= SLE

Front 52

What is another name for nephritic syndrome?

Back 52

Nephritis

Front 53

What is a key feature of nephritic syndrome/nephritis?

Back 53

Hematuria d/t Inflammatory rupture of capillaries

Front 54

What is the etiology of nephritic syndrome/nephritis?

Back 54

Lupus; IgA nephropathy; acute diffuse proliferative glomerulonephritis; group Abeta-hemolytic streptococcus

Front 55

What are three clinical manifestations of nephritic syndrome/nephritis?

Back 55

(1)hematuria (macro), (2)oliguria, (3)HTN

Front 56

What is isolated glomerular hematuria?

Back 56

Immune mediated

Front 57

What are immunologic glomerular diseases?

Back 57

Type II or Type III hypersensitivity reaction. Deposits of immunoglobulins in the glomeruli (If causes an inflammatory reaction – glomerulonephritis). Seen in Systemic Lupus Erythematosus, Good pastures, etc.

Front 58

What are five immunologic glomerular diseases?

Back 58

(1)good pasture's disease, (2)Acute Glomerulonephritis, (3)Crescentic Glomerulonephritis, (4)Chronic Proliferative Glomerulonephritis, (5)End stage Glomerulopathy

Front 59

What is good pasture's disease?

Back 59

Autoimmune disease with autoantibodies against the glomerular basement membrane(Anti-glomerular basement membrane antibodies). Type II hypersensitivity.

Front 60

What is Acute Glomerulonephritis?

Back 60

immune mediated inflammation 1-2 weeks after acute infection. MC is streptococcal infection. Generally short lived disease•Good outcome. In 1-2% Acute renal failure --Chronic GN orEnd stage KD Dz

Front 61

What are four clinical features of Acute Glomerulonephritis?

Back 61

(1)Nephritic syndrome, (2)Basement membrane of glomeruli becomes permeable -- proteinuria and hematuria, (3)Reduced blood flow -- Oliguria, (4)Edema, headaches (d/t brain edema), HTN

Front 62

What is Crescentic Glomerulonephritis?

Back 62

severe glomerular injury and formation of exudate in glomerular urinary space around Bowman’s capsule

Front 63

What is the pathogenesis of Crescentic Glomerulonephritis?

Back 63

Macrophages travel through damaged glomerular capillaries into urinary space, then they are replaced by fibroblasts -- secrete collagen -- scaring and destruction of glomerulus

Front 64

What is the cause of Crescentic Glomerulonephritis?

Back 64

Good pasture’s syndrome – autoimmune dz attacking basement membrane. Other Less common causes as well – PSGN etc.

Front 65

What is Chronic Proliferative Glomerulonephritis?

Back 65

Caused by any autoimmune disease affecting the glomerulus that do not respond to treatment and lead to end-stage kidney disease. Eg. IgA nephropathy or systemic AI conditions like SLE

Front 66

What are three clinical features of Chronic Proliferative Glomerulonephritis?

Back 66

(1)Nephrotic syndrome, (2)Nephritic syndrome, (3)Hematuria

Front 67

What is End stage Glomerulopathy?

Back 67

Most immune-mediated (autoimmune dz) glomerular diseases progress to end-stage kidney disease. Kidneys appear shrunken (d/t scarring) and granular,

Front 68

What is an example of a metabolic glomerular disease?

Back 68

Diabetes Mellitus

Front 69

Describe diabetes mellitus.

Back 69

Polyuria. Glycosuria. Chronic renal failure – 5-10% patients. Causes changes in basement membrane -- thickened and glomerulosclerotic (thickened, scarred). Lose their semipermeability.

Front 70

What is diabetic neuropathy?

Back 70

Leading cause of Chronic renal failure in the UnitedStates and other Western societies. Diabetes is responsible for 30-40% of all end-stage renal disease (ESRD) cases in the United States.

Front 71

Diabetic nephropathy is a clinical syndrome characterized by the following three conditions present in the setting of diabetes:

Back 71

(1)Persistent albuminuria (>300 mg/d or >200 μg/min) that is confirmed on at least 2 occasions 3-6 months apart, (2)Progressive decline in the glomerular filtration rate (GFR), (3)Elevated arterial blood pressure

Front 72

What is the pathogenesis of diabetic nephropathy?

Back 72

The key change in diabetic glomerulopathy is augmentation of extracellular matrix. Three major histologic changes occur in the glomeruli of persons with diabetic nephropathy.

Front 73

What are the three major histologic changes occur in the glomeruli of persons with diabetic nephropathy?

Back 73

(1)Mesangial expansion is directly induced by hyperglycemia, (2)Thickening of the glomerular basement membrane(GBM) occurs, (3)Glomerular sclerosis.

Front 74

Describe circulatory glomerular diseases.

Back 74

Atherosclerosis of renal arteries. Hypoper fusion due to malignant hypertension (systolic, >220) can cause necrosis of the glomerular capillaries. Microthrombi may also form in glomerular capillaries

Front 75

What are two circulatory glomerular diseases?

Back 75

(1)Acute tubular necrosis, (2)Hypertension

Front 76

What is acute tubular necrosis?

Back 76

Caused by sudden decrease in arterial pressure -- acute hypoperfusion of the kidneys. Often after myocardial infarction, massive bleeding. Affects the kidney cortex more than the medulla. Proximal tubules most effected. Most common cause of acute renal failure.

Front 77

What is hypertension?

Back 77

Affects intrarenal arteries/arterioles -- contraction which when sustained -- thickening of walls. Arteries become multilayered and fibrotic. Arterioles undergo hyalinization (i.e. extra ECM).

Front 78

What is malignant hypertension?

Back 78

Malignant hypertension – arterioles don’t have time to adjust -- necrosis. Thickened arterial walls -- ischemia of the renal parenchyma -- renal failure. Renal ischemia stimulates the release of Renin -- worsening of the hypertension.

Front 79

What are three bacterial urinary system diseases?

Back 79

(1)Urinary tract infection, (2)Acute Pyelonephritis, (3)Chronic Pyelonephritis

Front 80

What are urinary tract infections?

Back 80

Most common urinary tract disorder. 2nd most common type of infection (1st = URTI). Usually the bladder (=cystitis) and the urethra(=urethritis). Advancement to the upper urinary tract – [the kidneys]=pyleonephritis. Uncomplicated -- no other dz’s -- easily treated. Complicated -- with diabetes, pregnancy, men, immunosuppression, infants, kidney dz, etc.

Front 81

What are four signs of a UTI?

Back 81

(1)Urinary frequency and/or urgency, (2)Dysuria (painful urination) – “burning with urination”, (3)Nocturia, (4)May have cloudy and/or foul-smelling urine, (5)pyleonephritis

Front 82

What are six signs of pyleonephritis?

Back 82

(1)Pain – not just urethra, but also low back, pelvis, abdomen, shoulder (with kidney infection, diaphragm can become irritated…. Refers to shoulder), (2)Costovertebral tenderness and hyperesthesia of dermatomes, (3)Fever/chills – and any other typical signs of any infection, (4)Hematuria, (5)Pyuria, (6)Dyspareunia (pain after intercourse)

Front 83

What is the incidence/prevalence of UTI's?

Back 83

Majority = women (due to urethra length and location),and elderly (both men and women) (especially in nursing homes and hospitals). Recurrence very common in children who have had oneUTI. Frequently recurrent in women as well.

Front 84

What is the etiology of UTI's?

Back 84

bacteria – e.coli [80-90% of the time]

Front 85

What are eight risk factors of UTI's?

Back 85

(1)Being female (short urethra & proximity to vaginal & rectal bacteria), (2)Intercourse for women (rarely for men), (3)Previous UTI, (4)Pregnancy, (5)Age (decreased self-care, aging tissue, weakened immune function, Post-menopausal increase due to atrophic vaginitis, (6)Catheterization, (7)Diabetes (higher amounts of sugar in the urine; also neuropathy can make voiding difficult), (8)Anatomical abnormalities

Front 86

What is the pathogenesis of UTI's?

Back 86

Bacteria = E.coli. Bacteria adheres to mucosa -- colonizes. Most common route to bladder = urethra. Occasionally blood or lymph can be routes of infection, but also very rare.

Front 87

What is Acute Pyelonephritis?

Back 87

Infectious – usually from a bladder infection (often several) + immuno-compromise.

Front 88

What is the pathogenesis of Acute Pyelonephritis?

Back 88

urine reflux up ureters carrying infectious pathogen

Front 89

What are five clinical manifestations of Acute Pyelonephritis?

Back 89

(1)sudden onset fever, (2)hematuria, (3)chills, (4)flank pain, (5)+Murphy’s

Front 90

What is Chronic Pyelonephritis?

Back 90

May evolve from acute pyelonephritis. Chronic pyelonephritis is characterized by renal inflammation and fibrosis induced by recurrent or persistent renal infection, vesicoureteral reflux, or other causes of urinary tract obstruction. It occurs almost exclusively in patients with major anatomic anomalies.

Front 91

What are three characteristic of urinary tract neoplasms?

Back 91

(1)Most often malignant than benign, (2)Affect elderly, (3)Men more than women

Front 92

What is the most common urinary tract neoplasms?

Back 92

Bladder tumours

Front 93

Where are three other locations that urinary tract neoplasms can occur?

Back 93

(1)Kidneys/renal pelvis – most are renal cell carcinoma, (2)Ureters (rare), (3)Urethra (rare)

Front 94

What is renal cell carcinoma?

Back 94

Men 2x more likely than female, avg age is 55 years old. 3-4% of all cancers.

Front 95

What is the etiology of renal cell carcinoma?

Back 95

Unknown. Risk factors – may have some link with smoking but not strong.

Front 96

What is the pathology of renal cell carcinoma?

Back 96

Look like nodules or masses that are encapsulated from surrounding kidney tissue. Large tumours may extend into peritoneal fat and near by organs.

Front 97

What are two clinical features of renal cell carcinoma?

Back 97

(1)Often found by mistake on CT scans (50%), (2)Typical triad is only in 10% of people (LBK pain, hematuria, palpable abdominal mass)

Front 98

What is a Wilm's tumour?

Back 98

Also known as nephroblastoma. Often present at birth – affect 1 in 10,000 children. Discovered between 2-4 years old. Defect in tumour suppressor gene.

Front 99

What is the pathology of a Wilm's tumour?

Back 99

Renal mass that replaces the Kidney to a large extent. Cells resemble developing fetal kidney.

Front 100

What are two clinical features of Wilm's tumour?

Back 100

Usually discovered accidentally during routine exam or by parents. Abdominal pain and abnormally large abdomen.

Front 101

Describe carcinoma of the urinary bladder.

Back 101

Most common UT Cancer. Peak incidence in 60-70 yoa; 3x more common in men than women. Present with early symptoms, are less prone to metastasis and respond better to treatment than Renal Cell Carcinoma.

Front 102

What is the etiology of carcinoma of the urinary bladder?

Back 102

Unknown. Risk factors: cigarette smoking, industrial carcinogens.

Front 103

What is the pathology of carcinoma of the urinary bladder?

Back 103

Wart like protrusions or thickenings of bladder mucosa. May invade into muscular layer of the bladder. Metastasis to pelvic lymph nodes initially.

Front 104

What are three clinical features of carcinoma of the urinary bladder?

Back 104

(1)Hematuria, (2)Dysuria, (3)Lower abdominal pain

Front 105

What is renal calculi (kidney stones)?

Back 105

Stones can be in the kidney (most common) or ureter a.k.a. nephrolithiasis. MC type = calcium (oxalate and phosphate). Other types: struvite, uric acid, cystine. Uric acid stones common with gout. More common in men. More common in industrialized countries. Highest rate in hot summers (d/t dehydration).

Front 106

What is the etiology of renal calculi (kidney stones)?

Back 106

Anything which leads to over excretion and hyper-saturation of calcium or oxalate

Front 107

What are risk factors for renal calculi (kidney stones)?

Back 107

(1)Acidic pH of the urine, (2)chronic dehydration, (3)obesity, (4)high dietary calcium, sugar, and/or animal proteins, (5)deficiency of calcium and potassium, (6)high dietary intake of oxalate-rich foods

Front 108

What is the pathogenesis of renal calculi (kidney stones)?

Back 108

super saturation of urine with stone forming constituents(calcium, oxalate, uric acid) -- ions from the super saturated urine form microscopic crystalline structures -- resulting calculi give rise to symptoms when they become impacted within the ureter as they pass toward the urinary bladder

Front 109

What is are signs of renal calculi (kidney stones)?

Back 109

acute ‘renal colic’, N/V, may be UTI –type sx’s. Similar to presentation of pyelonephritis but diagnostically negative for infection.

Front 110

Describe renal colic.

Back 110

Severe flank pain, radiating to lower abdomen, groin, and perineal areas (scrotum or labia) with hematuria. Pain is generated by the dilation, stretching, and spasm d/t acute ureteral obstruction.

Front 111

What are neurogenic bladder disorders?

Back 111

Voiding dysfunction assoc’d with a neurological pathology. Most often a combination of sensory and motor abnormalities.

Front 112

What is the etiology of neurogenic bladder disorders?

Back 112

CVA’s (stroke); dementia; Parkinson’s; MS; brain tumours; spinal cord injury; herniated discs; spinal cord tumours; vascular lesions; myelitis. Also 2° to local pelvic irritation, causing spasm of the external bladder sphincter = spastic bladder i.e. vaginitis, perineal inflammation, urethral inflammation, chronic prostatitis. Flaccid bladder can be 2° to spina bifida, DM

Front 113

What is the pathogenesis of a neurogenic bladder?

Back 113

depends on underlying dz

Front 114

What are four clinical manifestations of a neurogenic bladder?

Back 114

(1)Urinary retention (partial or complete), (2)Incontinence, (3)Urgency and/or frequent urination, (4)Suprapubic pain

Front 115

What is urinary incontinence?

Back 115

Involuntary loss of urine, when bladder pressure exceeds sphincter resistance

Front 116

What the four types of urinary incontinence?

Back 116

(1)Functional, (2)Stress, (3)Urge, (4)Overflow

Front 117

Describe functional urinary incontinence?

Back 117

Normal bladder, has functional difficulties getting to toilet

Front 118

Describe stress urinary incontinence?

Back 118

Increased abdominal pressure (lifting, sneezing)

Front 119

Describe urge urinary incontinence?

Back 119

Hyperreflexive – sudden uncontrollable urge

Front 120

Describe overflow urinary incontinence?

Back 120

Constant leaking; full bladder that can’t empty

Front 121

What are nine risk factors for urinary incontinence?

Back 121

(1)post-surgery, (2)detrusor-sphincter pathology, (3)post-partum (esp. after several babies or severe tearing), (4)age, (5)diuretic medications; other medications (i.e. sedatives), (6)estrogen deficiency, (7)high caffeine intake, (8)chronic constipation (contributing to bladder prolapse), (9)Obesity