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62 Cards in this Set
- Front
- Back
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What is a cyst |
a fluid filled sac |
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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 |
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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 |
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-Autosomal dominant poly-cystic kidney disease is most common among... |
adults |
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Autosomal recessive polycystic kidney disease is most common among... |
children |
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How is renal cystic dysplasia characterized pathologically |
-immature tubules and (immature) glomerulus -surrounding mesenchyme with smooth muscle and cartilage |
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True or False: Renal cystic dysplasia is a developmental disorder caused by abnormal metanephric differentiation |
TRUE.
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How and When does renal cystic dysplasia present |
Presents as birth as a flank mass simulating a tumor |
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How do you treat unilateral renal cystic dysplasia |
unilateral cases are treated by nephrectomy |
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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 |
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True or False: Simple renal cysts are common amongst older patients |
TRUE. 50% of people over the age of 50 have simple renal cysts |
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True or False: Simple renal cysts are only malignant if they are greater than 2 cm |
FALSE. almost all simple renal cysts are benign |
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Do simple renal cysts affect renal function |
NO |
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Name three possible causes of urinary obstruction |
neoplastic obstruction congenital obstruction (ex. urethral atresia) calculi-obstruction |
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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 |
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What is hydroureter |
-dilation of the ureter caused by obstruction distal to the ureter |
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What do you see histologically with hydronephrosis |
the back-up of urine causes dilation of Boweman's space and dilated renal tubules |
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True or False: Unilateral renal obstructions always produces pain |
FALSE. Unilateral (and sometimes bilateral) obstructions may be silent |
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Name 3 things that can happen as a result of long term (late) hydronephrosis |
-tubular atrophy due to dilation -glomerular collapse -interstitial fibrosis |
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Urinary calculi are most common in which demographics |
younger males |
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Are urinary calculi commonly bilateral or unilateral |
unilateral (80% of cases) |
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What are stones in the kidney called (the formal medical term) |
nephrolithiasis |
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How do urinary calculi present clinically (name 3 features) |
-severe perceived abdominal pain -hematuria -symptoms related to obstruction |
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How do you diagnose and treat urinary calculi |
diagnose using imaging treat with lithotripsy (ultrasound crushing) |
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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 |
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Name four urinary stone compositions and relative prevalence |
Calcium-oxalate stones (75%) Urate stones (10%) Magnesium-NH3-PO4 (struvite stones) (15%) Cystine (1%) |
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What conditions can "promote" the formation of Calcium stones |
-hypercalcemia -hypercalcuria (w/o hypercalcemia) -hyperoxaluria |
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What conditions can "promote" the formation of Urate stones |
-Gout -hyperuricemia |
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What conditions can "promote" the formation of Mg-NH3-PO4 (struvite) stones |
-Urea splitting bacteria (Proteus) -Alkaline urine |
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What conditions can "promote" the formation of Cysteine stones |
-cystinuria -acidic urine (low urine pH)n |
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Where do Calcium-oxalate stones usually form |
at the loop of Henle near the papilla |
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What are Randall's plaques |
subepithelial calcification of the renal papilla |
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Staghorn calculus are composed of what |
Mg-NH3-PO4 |
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What is tubulo-interstitial nephritis |
a condition characterized by swelling surrounding the renal tubules with relative sparing of the glomerulus |
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Name 5 things that can cause tubulo-interstitial nephritis |
-infectious pyelonephritis -toxins -drugs -metabolic urates -myelomas |
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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) |
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Name 5 predisposing factors that increase the risk of acute pyelonephritis |
-short urethra in females -obstruction -incompetent ureterovesicular valve -catherization -instrumentation |
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True or False: most common mode of infection causing pyelonephritis is via ascending though the bladder into ureter into kidney |
TRUE |
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True or False: 15% of pyelonephritis cases are caused by gram-negative bacteria |
FALS. 85% of cases are caused by gram negative bacteria |
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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 |
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True or False: WBC help distinguish infections in the kidney from infections of the bladder |
TRUE |
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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) |
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What is acute tubular necrosis |
It is a disease affecting the tubules that can lead to acute renal failure, but can be potential reversible |
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How does acute tubular necrosis present (name 4 things) |
Oliguria (not making urine) Increased serum creatinine Fluid retention Hyperkalemia |
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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 |
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Name 4 nephrotoxins that could lead to acute tubular necrosis |
antibiotics (aminoglycosides) heavy metals (lead, mercury) radiocontrast materials endogenous agents (myoglobin, Hg) |
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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) |
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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 |
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How does the sloughing of the tubular epithelial cells affect kidney function |
sloughing could cause tubular obstruction which would decrease GFR |
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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 |
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True or False: In patients with chronic hypertension there is an increased incidence between nephrosclerosis and age |
TRUE |
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True or False: Nephrosclerosis can be bilateral or unilateral |
FALSE. it is always bilateral |
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Nephrosclerosis accounts for what percentage of end-stage renal disease |
33.3333333333333% |
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True or False: Patients with nephrosclerosis will typically present with elevated plasma Cr |
TRUE |
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How will a kidney afflicted by nephrosclerosis appears grossly |
granular, nodular surface (Moroccan leather) |
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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 |
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The 5/6 renal ablation hyper-filtration injury model is useful for explaining which condition |
Nephrosclerosis caused by chronic hypertension |
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True or False: Small arteriolar lesions are benign |
TRUE |
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Describe what causes small arteriolar lesions |
transudation of plasma protein into wall excessive matrix produced by SM hyalination and arteriolar sclerosis |
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True or False: Efferent arterioles are more affect by small arteriolar lesions than afferent arterioles |
FALSE. Afferent arterioles are more effected |
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Name two things that can cause kidney hypertension |
-arteriolar lesions -glomerular obsolescence (loss of proper structure/function) |
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What can lead to glomerular obsolescence (4 things) |
-thickening of capillaries
-collapse of glomerulus -glomerular scarring -interstitial inflammation |
