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62 Cards in this Set

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What is a cyst

a fluid filled sac

Describe in simple terms what renal cystic diseases are

diseases that are characterized by fluid filled sacs on the kidney which can either be malignant or benign

Name 6 renal cystic dieseases

-Autosomal dominant poly-cystic kidney disease


-Autosomal recessive polycystic kidney disease


-Medullary sponge kidney


-Cystic Renal dysplasia


-Acquired dialysis-related renal cystic disease


-Simple renal cysts

-Autosomal dominant poly-cystic kidney disease is most common among...

adults

Autosomal recessive polycystic kidney disease is most common among...

children

How is renal cystic dysplasia characterized pathologically

-immature tubules and (immature) glomerulus


-surrounding mesenchyme with smooth muscle and cartilage

True or False: Renal cystic dysplasia is a developmental disorder caused by abnormal metanephric differentiation

TRUE.

How and When does renal cystic dysplasia present

Presents as birth as a flank mass simulating a tumor

How do you treat unilateral renal cystic dysplasia

unilateral cases are treated by nephrectomy

True or False: Bilateral renal cystic dysplasia can be treated by bilateral nephrectomy followed by subsequent life-long dialysis

FALSE. bilateral renal cystic dysplasia is usually not compatible with life

True or False: Simple renal cysts are common amongst older patients

TRUE. 50% of people over the age of 50 have simple renal cysts

True or False: Simple renal cysts are only malignant if they are greater than 2 cm

FALSE. almost all simple renal cysts are benign

Do simple renal cysts affect renal function

NO

Name three possible causes of urinary obstruction

neoplastic obstruction


congenital obstruction (ex. urethral atresia)


calculi-obstruction



What is hydronephrosis

- distention of the renal calyces and pelvis with urine as a result of obstruction of the outflow of urine distal to the renal pelvis


- marked blunting of pyramids

What is hydroureter

-dilation of the ureter caused by obstruction distal to the ureter

What do you see histologically with hydronephrosis

the back-up of urine causes dilation of Boweman's space and dilated renal tubules

True or False: Unilateral renal obstructions always produces pain

FALSE. Unilateral (and sometimes bilateral) obstructions may be silent

Name 3 things that can happen as a result of long term (late) hydronephrosis

-tubular atrophy due to dilation


-glomerular collapse


-interstitial fibrosis

Urinary calculi are most common in which demographics

younger males



Are urinary calculi commonly bilateral or unilateral

unilateral (80% of cases)

What are stones in the kidney called (the formal medical term)

nephrolithiasis

How do urinary calculi present clinically (name 3 features)

-severe perceived abdominal pain


-hematuria


-symptoms related to obstruction



How do you diagnose and treat urinary calculi

diagnose using imaging


treat with lithotripsy (ultrasound crushing)

What are common causes of urinary stone formation (nephrolithiasis)

-Hyper-saturation (^ concentration of stone constituents)


-Low urine volume (leads to increase saturation)


-pH of urine



Name four urinary stone compositions and relative prevalence

Calcium-oxalate stones (75%)


Urate stones (10%)


Magnesium-NH3-PO4 (struvite stones) (15%)


Cystine (1%)



What conditions can "promote" the formation of Calcium stones

-hypercalcemia


-hypercalcuria (w/o hypercalcemia)


-hyperoxaluria

What conditions can "promote" the formation of Urate stones

-Gout


-hyperuricemia



What conditions can "promote" the formation of Mg-NH3-PO4 (struvite) stones

-Urea splitting bacteria (Proteus)


-Alkaline urine



What conditions can "promote" the formation of Cysteine stones

-cystinuria


-acidic urine (low urine pH)n

Where do Calcium-oxalate stones usually form

at the loop of Henle near the papilla

What are Randall's plaques

subepithelial calcification of the renal papilla

Staghorn calculus are composed of what

Mg-NH3-PO4

What is tubulo-interstitial nephritis

a condition characterized by swelling surrounding the renal tubules with relative sparing of the glomerulus

Name 5 things that can cause tubulo-interstitial nephritis

-infectious pyelonephritis


-toxins


-drugs


-metabolic urates


-myelomas

What is acute infectious pyelonephritis

acute pyelonephritis (aka upper urinary tract infection) is a pus producing infection which results in tubulo-interstitial nephritis


(commonly caused by gram negative bacteria)

Name 5 predisposing factors that increase the risk of acute pyelonephritis

-short urethra in females


-obstruction


-incompetent ureterovesicular valve


-catherization


-instrumentation

True or False: most common mode of infection causing pyelonephritis is via ascending though the bladder into ureter into kidney

TRUE

True or False: 15% of pyelonephritis cases are caused by gram-negative bacteria

FALS. 85% of cases are caused by gram negative bacteria

How does acute pyelonephritis present clinically (name 9 things)

sudden onset


fever


malaise


CVA pain


dysuria (difficult/painful urination)


frequent urination


urgent urination


+ urine culture


WBC casts

True or False: WBC help distinguish infections in the kidney from infections of the bladder

TRUE

How does pyelonephritis present histologically

recall pyelonephritis is as tubulo-interstitial nephritis which is inflammation of the parenchyma....hence we will see neutrophils in the tubules and interstitium (glomeruli are spared)

What is acute tubular necrosis

It is a disease affecting the tubules that can lead to acute renal failure, but can be potential reversible

How does acute tubular necrosis present (name 4 things)

Oliguria (not making urine)


Increased serum creatinine


Fluid retention


Hyperkalemia

Name 2 common things that could lead to acute tubular necrosis and explain why

-ischemia (decreased tubular flow doesn't fulfill tubular nutritional requirement)


-nephrotoxins

Name 4 nephrotoxins that could lead to acute tubular necrosis

antibiotics (aminoglycosides)


heavy metals (lead, mercury)


radiocontrast materials


endogenous agents (myoglobin, Hg)

What is the gross appearance of kidney afflicted by acute tubular necrosis (name 3 things)

Kidneys will be swollen


cortex will be pale


Medulla will be red (due to shunting if blood)

How will acute tubular necrosis appear histologically (name 5 things)

-marked eosinophilia in tubules with loss of nucleus


-tubular edema


-WBC in vasa recta


-sloughing of tubular cells


-protein casts

How does the sloughing of the tubular epithelial cells affect kidney function

sloughing could cause tubular obstruction which would decrease GFR

What is a benign effect of chronic hypertension on the kidney (name a condition) and describe what it is

Nephrosclerosis, hardening of small blood vessels in the kidney commonly associated with hypertension

True or False: In patients with chronic hypertension there is an increased incidence between nephrosclerosis and age

TRUE

True or False: Nephrosclerosis can be bilateral or unilateral

FALSE. it is always bilateral

Nephrosclerosis accounts for what percentage of end-stage renal disease

33.3333333333333%

True or False: Patients with nephrosclerosis will typically present with elevated plasma Cr

TRUE

How will a kidney afflicted by nephrosclerosis appears grossly

granular, nodular surface (Moroccan leather)

Describe the 5/6 renal ablation hyper-filtration injury model

-removal of 1 whole and 2/3rds of 2nd kidney


-marked reduction in number of nephrons


-noted increase RPF and pressure on remaining glomeruli


-mesangial proliferation and sclerosis



The 5/6 renal ablation hyper-filtration injury model is useful for explaining which condition

Nephrosclerosis caused by chronic hypertension

True or False: Small arteriolar lesions are benign

TRUE

Describe what causes small arteriolar lesions

transudation of plasma protein into wall


excessive matrix produced by SM


hyalination and arteriolar sclerosis

True or False: Efferent arterioles are more affect by small arteriolar lesions than afferent arterioles

FALSE. Afferent arterioles are more effected

Name two things that can cause kidney hypertension

-arteriolar lesions


-glomerular obsolescence (loss of proper structure/function)



What can lead to glomerular obsolescence (4 things)

-thickening of capillaries

-collapse of glomerulus


-glomerular scarring


-interstitial inflammation