Transcript Renal Calculi - Wolters Kluwer Health

Chapter 25
Disorders of Renal Function
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Disorders of Kidney Development
• Renal agenesis
• Renal hypoplasia
• Renal dysplasia
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Cystic Disorders
• Genetic
– Autosomal dominant polycystic kidney disease
– Autosomal recessive polycystic kidney disease
– Nephronophthisis
– Medullary cystic kidney disease
• Acquired
– Simple cysts
– Acquired form of renal cystic disease
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Glomerulus
• Glomerular capillaries and the Bowman capsule
are both made of epithelial cells sitting on a basement
membrane.
• They are so tightly attached to each other that they
share one basement membrane.
• The epithelial cells of the Bowman capsule stand
up from the basement membrane on foot processes,
leaving pores between the feet for filtration.
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Immune Mechanisms: Glomerular Disease
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Glomerular Damage
• Proliferative: number of cells increase.
• Membranous: glomerular basement membrane
thickens.
• Sclerotic: amount of extracellular matrix increases.
• All can decrease the efficiency of filtration.
• Allow blood cells, lipids, or proteins to pass into the
urine.
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Question
• True or false?
• Nephritic syndromes are characterized by blood in the
urine.
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Answer
• True
• Rationale: Nephritic syndromes decrease the
permeability of the glomerular capillary membrane,
which results in hematuria, HTN, oliguria, and ↓ GFR.
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Disorders of Glomerular Function
• Acute nephritic syndromes
• Rapidly progressive glomerulonephritis
• Nephrotic syndrome
• IgA nephropathy
• Hereditary nephritis
• Chronic glomerulonephritis
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Nephritic Syndromes
• Inflammatory process damages the capillary wall.
– Hematuria with red cell casts, decreased GFR
• Acute postinfectious glomerulonephritis.
– Proliferative inflammatory response
– Azotemia (presence of nitrogenous wastes in the
blood), oliguria, cola-colored urine
• Rapidly progressive glomerulonephritis.
• Goodpasture syndrome.
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Nephrotic Syndrome
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Nephrotic Syndrome: Proteins in Urine
• Albumin  edema and increased free drug
• Immunoglobulins and complement  immune
suppression
• Binding proteins  low ions and hormones
• Clotting and anticlotting factors  thrombosis
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Scenario
A woman with diabetes mellitus:
• Has severe edema and frothy, cola-colored urine
• Has difficulty breathing, with crackles in both lungs
• Just finished a course of antibiotics for strep throat
• Is taking corticosteroids for lupus-related arthritis
Question:
• What are three reasons for her renal problems?
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Scenario (cont.)
A woman:
• Has diabetes mellitus and lupus
• Recently had strep throat
• Has severe edema and frothy, cola-colored urine
Question:
• The doctor says the only way to determine what has
caused her glomerular disease is a renal biopsy.
Why?
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Scenario (cont.)
• Urinalysis show that she is producing urine
– With 500 mg protein/day
– Containing blood and RBC casts
– With high level of K+
• Blood tests show
– Hypoalbuminemia and slightly decreased K+
• She has borderline hypertension
Question:
• Does she have nephritic syndrome or nephrotic
syndrome?
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Tubular and Interstitial Disorders
• Acute tubular necrosis
• Tubulointerstitial nephritis
• Pyelonephritis
– Acute pyelonephritis
– Chronic pyelonephritis
• Drug-related nephropathies
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Chronic Pyelonephritis
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Obstructive Disorders
• Hydronephrosis
• Renal calculi
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Consequences of Dilation of the Renal
Tubules or Tract
• Expansion of the kidney with urine (hydronephrosis)
– Increased pressure inside the renal capsule
– Compartment syndrome compresses blood vessels
inside kidney
– Renal ischemia
• Stasis of urine
– Risk of infection
– Stones
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Question
• True or false?
• Hydronephrosis is categorized as a disorder of glomerular
function.
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Answer
• False
• Rationale: Hydronephritis is caused by a urinary
obstruction, so it is considered an obstructive disorder.
The glomerulus is not involved.
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Renal Calculi
• Saturation theory: Urine is supersaturated with
stone components.
• Matrix theory: Organic materials act as a nidus for
stone formation.
• Inhibitor theory: A deficiency of substances that
inhibit stone formation.
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Four Types of Renal Calculi
• Calcium stones (i.e., oxalate or phosphate)
• Magnesium ammonium phosphate stones
• Uric acid stones
• Cystine stones
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Renal Calculi (cont.)
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Malignant Kidney Tumors
• Embryonic kidney tumors
– That is, Wilms tumor, nephroblastoma
– Childhood
• Renal cell carcinoma
– Adulthood
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Wilms Tumor of the Kidney
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Renal Cell Carcinoma of the Kidney
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