Kidney Diseases Quiz

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Questions and Answers

Which condition is characterized by abnormal ureteric bud-mesenchyme interaction and often diagnosed in utero?

Autosomal Dominant Polycystic Kidney Disease

Medullary Cystic Kidney Disease

Autosomal Recessive Polycystic Kidney Disease

Multicystic Dysplastic Kidney (correct)

What is a common consequence of bilateral Multicystic Dysplastic Kidney?

Berry aneurysm development

Chronic renal failure in young adults

High blood pressure due to RAAS activation

Oligohydramnios leading to Potter’s syndrome (correct)

Which type of Polycystic Kidney Disease is associated with liver disease and can occur with Potter’s syndrome?

Autosomal Dominant Polycystic Kidney Disease

Multicystic Dysplastic Kidney

Autosomal Recessive Polycystic Kidney Disease (correct)

Medullary Cystic Kidney Disease

In Autosomal Dominant Polycystic Kidney Disease, which of the following symptoms commonly presents in young adults?

High blood pressure and hematuria Signup and view all the answers

Which statement correctly describes Medullary Cystic Kidney Disease?

It primarily affects the collecting ducts of the medulla. Signup and view all the answers

What primary characteristic distinguishes nephrotic syndrome from nephritic syndrome?

Massive proteinuria exceeding 3.5g/day Signup and view all the answers

In which scenario would hematuria likely be considered a common cause?

Urinary tract infections (UTIs) Signup and view all the answers

Which of the following molecules can pass through the glomerular filtration barrier?

Glucose Signup and view all the answers

What is the significance of the podocytes in the glomerular filtration barrier?

They provide a size-selective barrier with their foot processes. Signup and view all the answers

What urinary finding is typically observed in pre-renal failure?

Concentrated urine with high osmolality Signup and view all the answers

Which test is considered the gold standard for evaluating proteinuria?

24-hour urine collection Signup and view all the answers

What finding would suggest a diagnosis of nephritic syndrome?

Presence of dysmorphic red blood cells in urine Signup and view all the answers

In glomerular disease, which parameter would be expected to be elevated?

BUN Signup and view all the answers

Which of the following is a potential consequence of nephrotic syndrome?

Edema due to retained sodium and water Signup and view all the answers

What is the typical urinary dipstick result for someone with nephrotic syndrome?

4+ protein indicating massive proteinuria Signup and view all the answers

Which is NOT a common risk factor for urinary tract infections (UTIs)?

Consuming a high protein diet Signup and view all the answers

What characterizes sterile pyuria observed in certain infections?

Presence of white blood cells without bacterial growth Signup and view all the answers

How would chronic pyelonephritis typically manifest in a patient's kidneys?

Corticomedullary scarring and thyroidization of the kidney Signup and view all the answers

What is a typical consequence of unilateral Multicystic Dysplastic Kidney?

Hypertrophy of the remaining kidney Signup and view all the answers

Which condition is characterized by microscopic cysts present at birth that develop over many years?

Autosomal Dominant Polycystic Kidney Disease Signup and view all the answers

What is a common association found in Autosomal Recessive Polycystic Kidney Disease?

Renal failure Signup and view all the answers

What is unique about the kidney appearance in Medullary Cystic Kidney Disease compared to Autosomal Dominant Polycystic Kidney Disease?

Kidneys are small and shrunken with fibrosis Signup and view all the answers

Which of the following is not typically a feature of Autosomal Dominant Polycystic Kidney Disease?

Presenting symptoms in infants Signup and view all the answers

What primarily causes red blood cells to be repelled from the capillary endothelium in the glomerulus?

Negatively charged molecules in the basement membrane Signup and view all the answers

In nephrotic syndrome, what is typically the primary urinary finding?

Massive proteinuria Signup and view all the answers

What effect does damage to the podocytes in the glomerulus have?

Loss of the protein barrier allowing albumin in urine Signup and view all the answers

What is a classic presentation of nephrotic syndrome?

Frothy urine and periorbital swelling Signup and view all the answers

Which type of proteinuria test provides the most accurate assessment of protein levels in the urine?

24-hour urine collection Signup and view all the answers

What percentage of people with urinary tract infections are women, due to anatomical factors?

10 times more likely Signup and view all the answers

In nephritic syndrome, which laboratory finding would be expected?

RBC casts in urine Signup and view all the answers

Which of the following findings in urine suggests glomerular bleeding?

Red cell casts and dysmorphic red blood cells Signup and view all the answers

What is the typical urine protein-to-creatinine ratio for a normal individual?

Less than 0.2 mg/mg Signup and view all the answers

What alteration in plasma protein levels is associated with nephrotic syndrome?

Decreased immunoglobulins Signup and view all the answers

Which of the following can lead to hematuria, although it is a rare cause?

Severe glomerular disease Signup and view all the answers

Which of the following statements about the filtration barrier in the glomerulus is FALSE?

Capillaries allow the passage of all molecules. Signup and view all the answers

What is the most common cause of hematuria after exercise?

Glomerular dysfunction Signup and view all the answers

Which type of casts are typically found in nephrotic syndrome?

Fatty casts Signup and view all the answers

Study Notes

Glomerular Disease Principles

Glomerular disease involves the breakdown of filtration barrier components.
Key components in glomerular filtration that should not be filtered are red blood cells and protein, especially albumin.
Proteinuria and hematuria are common indicators of glomerular pathology.

Glomerulus Functions

The glomerulus allows an "ultrafiltrate" into Bowman's space, including water, electrolytes, glucose, and amino acids.
It prevents the filtration of most proteins and red blood cells.
Proteinuria and hematuria can result from glomerular pathology.

Glomerular Filtration Barrier

The glomerular filtration barrier consists of capillary endothelium, basement membrane, and podocytes (epithelium).
The capillary endothelium is fenestrated (with openings) and repels red blood cells, white blood cells and platelets.
It's the first barrier to filtration.
Damage to the capillary endothelium can result in red blood cells appearing in the urine (hematuria), and inflammation (nephritis).

Capillary Endothelium

The capillary endothelium has openings (~40nm) that only allow small molecules to pass through.
Red blood cells, white blood cells, and platelets are typically repelled.
Damage leads to red blood cells in the urine (hematuria).
Damage can also lead to inflammation and nephritis.

Basement Membrane

The basement membrane contains negatively charged molecules (like heparan sulfate) that repel negatively charged molecules (like albumin).
It acts as a size barrier, only small molecules (~4nm) can pass through.
Type IV collagen is a component of the basement membrane.

Podocytes

Podocytes are epithelial cells with "foot processes" that wrap around capillaries.
Slits between the foot processes filter the blood.
These slits act as a size barrier.
Damage to podocytes results in protein loss.

Albumin

Albumin is small (~3.6nm), able to pass through all size barriers, and negatively charged.
It is repelled by the glomerular basement membrane's negative charge.
Podocyte/GBM disease may cause albumin to be present in urine.

Glomerular Diseases

Glomerular diseases occur due to a breakdown in the glomerular filtration barrier.
Substances not normally present in urine, such as red blood cells and proteins (especially albumin), may be found.

Hematuria

Urinalysis, using dipsticks, can detect heme (hemoglobin or myoglobin) in urine.
Microscopy can confirm the presence of red blood cells.
Hematuria has many causes, including kidney stones, bladder cancer, urinary tract infections (UTIs), and glomerular disease, with glomerular disease being a less common cause.

Glomerular Bleeding

Red cell casts, dysmorphic red blood cells, and acanthocytes can all indicate glomerular bleeding.
Proteinuria is also frequently seen.
The urine may have a red, smoky brown or coca-cola appearance.
Blood clots are generally not present.

Proteinuria

Urine dipsticks measure protein, primarily albumin, in the urine.
The color change indicates the amount of protein.
A spot urine test, using a protein/creatinine ratio, is also beneficial for identifying proteinuria.
Proteinuria is associated with the loss of the protein barrier, especially albumin.
A 24-hour urine collection is a standard for assessing the amount of protein excreted in urine.

Nephritic Syndrome

Filtration barrier loss to red blood cells (RBCs) and proteins are characteristic in this syndrome.
Massive proteinuria, with a 4+ reading on dipsticks (greater than 3.5g/day), and/or inflammation are frequent indicators.
The presence of RBC casts is observed in the urine, demonstrating various degrees of renal dysfunction, ranging from mild proteinuria to renal failure.

Nephrotic Syndrome

In this syndrome, the glomerular filtration barrier is damaged, leading to significant protein loss (massive proteinuria), while the barrier to red blood cells remains intact.
Proteinuria typically exceeds 3.5 g per day.
A 4+ reading on routine dipsticks, and an abnormal degree of lipid in the urine (e.g., fatty casts, oval fat bodies) are indicative of nephritic syndrome.
Signs and symptoms can include frothy urine, swelling in ankles and around the eyes, elevated serum cholesterol levels, and often a mistaken observation of an allergic reaction (due to swelling).

Microscopy

These are essential tools for the diagnosis of renal diseases.
Light microscopy examines kidney tissue at low magnification (up to ~2000x).
Immunofluorescence microscopy analyzes the distribution of immune complexes (IgG, IgM, C3, C1q) within the kidney.
Electron microscopy provides a detailed view of the glomerular structures at high magnification (up to ~10,000,000x).

Post-Streptococcal Glomerulonephritis

Follows a group A beta-hemolytic streptococcal infection.
Nephritogenic strains of bacteria carry specific M proteins associated with this disorder.
Immune complexes deposit in the kidney, often following an infection.
This causes inflammation, hypercellularity in the glomeruli, and subepithelial humps, as seen using electron microscopy.
This disorder is generally less severe in children, and has a favorable prognosis, while adults tend to have worse outcomes.

IgA Nephropathy (Berger's Disease)

This is the most common form of glomerulonephritis worldwide.
Repeated episodes of hematuria (often seen in children) are a key characteristic.
Immunologic factors (overactive immune system, IgA immune complexes) drive the development of this type of nephritis.
Many patients eventually develop ESRD and HD.

Henoch-Schönlein Purpura

This is a type of IgA nephropathy affecting extrarenal tissues.
Palpable purpura commonly occurs on the buttocks and legs.
Abdominal pain and melena (black, tarry stools) are common gastrointestinal manifestations.
Inflammatory joint pain is another frequently observed presentation.
IgA deposition in kidney tissues is a diagnostic indicator.

Diffuse Proliferative Glomerulonephritis (DPGN)

Systemic Lupus Erythematosus (SLE) often causes this type of glomerulonephritis.
Immune complexes deposit within the glomeruli, triggering a significant immune response.
Thickening of capillary loops ("wire looping") is a classic finding, visible using electron microscopy.
Granular IF, demonstrating an accumulation of immune complexes (IgG, IgA, IgM, C3, C1q), is confirmed using immunofluorescence analysis.
Often characterized as a mixed clinical presentation, which includes proteinuria (sometimes nephrotic) and hematuria.
Significant reduction in GFR, and can lead to end-stage renal disease (ESRD) and hemodialysis (HD), often causing patients to become critically ill.

Rapidly Progressive Glomerulonephritis (RPGN)

Also called "crescentic" glomerulonephritis, frequently caused by a number of disorders. The different types are distinguished by immunofluorescence microscopy results.
Inflammation, involving cells like monocytes/macrophages and fibrin, forms crescents in glomeruli.
Symptoms (fatigue and anorexia) and signs (acute renal failure; nephritic urine) commonly appear abruptly, which is an important indicator.
The pathogenesis of RPGN is diagnosed and differentiated based on immunofluorescence microscopy results showing positive or negative findings (e.g., type I - linear IF; type II - granular IF; type III - negative IF.

Goodpasture's Syndrome

This is a type of RPGN. It is characterized by antibodies against the alpha-3 chain of type IV collagen within the glomerular basement membrane (GBM) and alveoli.
Hemoptysis and evidence of nephritic syndrome are diagnostic indicators.
The typical patient is a young adult male who experiences hemoptysis and hematuria.

Membranoproliferative Glomerulonephritis (MPGN)

MPGN constitutes rare glomerular diseases.
Significant basement membrane thickening and proliferation of mesangial cells frequently results in proteinuria and/or hematuria, and varying degrees of renal dysfunction.
MPGN has two main types: type I, far more prevalent than type II (a.k.a "dense deposit disease".) Type II is mediated by complement activation and C3 deposits are frequently observed but IgG is usually absent

Tubulointerstitial Disorders

Acute Tubular Necrosis (ATN) is caused by sudden damage to tubular epithelial cells.
Ischemia (lack of blood flow) and toxins/drugs can be causative factors.
Urine obstructed by sloughed cells and casts results in an increasing rise in BUN and Cr (blood urea nitrogen and creatinine).
ATN commonly results in "muddy brown" urine and patchy necrosis of nephrons.
Progression typically leads to kidney recovery.
Acute Interstitial Nephritis (AIN) involves inflammation of the renal tubules and interstitium (the spaces between tubules).
Hypersensitivity (allergic) reaction to certain drugs or infections are frequently the cause (but not exclusively.)
This type of nephritis typically resolves by stopping the offending agent and resolves when the causal drug/infection is eliminated.
Chronic Interstitial Nephritis (CIN) results from long-term exposure, most often to Nonsteroidal Anti-inflammatory Drugs (NSAIDs), and results in fibrosis and atrophy of tubules.

Papillary Necrosis

Coagulative necrosis of the renal papillae (small structures at the end of the kidneys' collecting ducts) with sloughing of tissue, often causes painlessness and gross hematuria.
Often caused by longstanding use/infection/congenital disorders, such as chronic use of phenacetin, diabetes, acute pyelonephritis, and sickle cell anemia.

Cortical Necrosis

Due to ischemia of the renal cortex, this type of necrosis results in abrupt, severe renal failure, frequently seen in critically ill patients (septic shock; obstetric catastrophes.)
It commonly develops abruptly and can progress to anuria due to lack of proper kidney filtration.

Renal Failure

Decrease in glomerular filtration rate (GFR) over days/years can be either acute or chronic.
Acute renal failure develops quickly and is often reversible (caused by poor perfusion), while chronic renal failure is slow and progressive, and leads to dialysis, and, eventually, end-stage renal disease (ESRD).
Azotemia (abnormally high BUN and Cr in blood) and uremia (azotaemia + symptoms like: nausea, vomiting, pericarditis, asterixis, and encephalopathy) are observed in severe cases.

Cystic Kidney Disease

Renal cysts are an abnormal accumulation of fluid-filled sacs within the kidney.
Key types include multicystic dysplastic kidney diseases (MDK); autosomal recessive polycystic kidney disease (ARPKD); autosomal dominant polycystic kidney disease (ADPKD) and medullary cystic kidney disease (MCKD)

Other Relevant Information

There are particular types and characteristics of glomerulonephritis, and each has different indicators and treatments.
Determining which specific disease is occurring is essential for appropriate medical management.
Determining the cause of renal failure often requires multiple tests and a thorough medical history.

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Description

Test your knowledge on various kidney diseases, including Multicystic Dysplastic Kidney and Polycystic Kidney Disease. This quiz covers abnormalities, symptoms, and consequences associated with these conditions. Gauge your understanding of these medical phenomena and their implications.