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Questions and Answers
Which of the following diseases can lead to disorders of renal function as secondary conditions?
Which of the following diseases can lead to disorders of renal function as secondary conditions?
What characterizes nephrotic syndrome?
What characterizes nephrotic syndrome?
Which of the following complications may arise from progressive renal diseases?
Which of the following complications may arise from progressive renal diseases?
What is a common cause of nephrotic syndrome?
What is a common cause of nephrotic syndrome?
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Which of these conditions is least likely to cause primary renal disorders?
Which of these conditions is least likely to cause primary renal disorders?
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Disorders of renal function can develop secondary to diseases such as systemic lupus ______ and diabetes mellitus.
Disorders of renal function can develop secondary to diseases such as systemic lupus ______ and diabetes mellitus.
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Massive ______ (≥3.5 g/day in adults) is a characteristic of nephrotic syndrome.
Massive ______ (≥3.5 g/day in adults) is a characteristic of nephrotic syndrome.
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Chronic kidney disease may eventually lead to the need for ______ or transplantation.
Chronic kidney disease may eventually lead to the need for ______ or transplantation.
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Nephrotic syndrome is also characterized by ______ (e.g., free fat, oval bodies, fatty casts).
Nephrotic syndrome is also characterized by ______ (e.g., free fat, oval bodies, fatty casts).
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The kidneys are subject to many ______ processes that affect other organs.
The kidneys are subject to many ______ processes that affect other organs.
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Study Notes
Disorders of the Renal System
- Kidneys experience similar disease processes as other organs, including genetic defects, infections, immune disorders, and neoplasms.
- Many kidney disorders are secondary to systemic diseases like lupus erythematosus and diabetes mellitus.
- Some diseases progressively lead to chronic kidney disease, requiring dialysis or transplantation.
Kidney Anatomy
- Shows diagram of kidney with labels for renal cortex, renal medulla, renal papilla, renal pyramids, renal pelvis, ureter, major calyx, minor calyx, renal columns, and fibrous capsule.
Nephrotic Syndrome
- Characteristics: massive proteinuria (3.5g/day or more in adults) , lipiduria (free fat, oval bodies, fatty casts), hypoalbuminemia (<3g/dL), generalized edema, and hyperlipidemia.
- Age and Cause: In children under 15, usually idiopathic glomerular disease; in adults, often secondary to systemic diseases.
- Secondary Causes (Table 2): Infections (Hepatitis B/C, HIV, Malaria), Drugs (gold, NSAIDs, interferon), Malignancies (lymphoma, leukemia), Systemic lupus erythematosus, Mesangioproliferative glomerulonephritis, Immunoglobulin A nephropathy, and Diabetes mellitus.
- Hyperlipidemia: Characterized by elevated triglycerides and low-density lipoproteins (LDLs); those with nephrosis are at a higher risk for atherosclerosis.
- Protein Loss: Albumin is the major protein lost in the urine, but globulins are also lost. This makes those with nephrosis vulnerable to infections, especially staphylococci and pneumococci.
- Thrombosis: Persons with nephrotic syndrome are at risk for thrombotic complications due to a loss of coagulation and anticoagulation factors in the urine. This leads to risks of renal vein thrombosis, deep vein thrombosis, and pulmonary emboli.
Pyelonephritis
- Definition: A renal disease affecting the tubules, interstitium, and pelvis of the kidney.
- Acute Pyelonephritis: Caused by bacterial infection. Escherichia coli is the most common cause (80%). Other less common causes include Enterobacteriaceae, Pseudomonas species, group B Streptococcus, Staphylococcus, and enterococci.
- Acute Pyelonephritis Progression: Typically develops from a lower urinary tract infection.
- Acute Pyelonephritis Symptoms: Fever, flank pain, and systemic symptoms.
- Treatment: Antibiotics
- Acute Pyelonephritis Types: Uncomplicated (healthy young women without urinary tract obstructions) and Complicated (children or adults with structural or functional urinary tract abnormalities or predispositions).
- Complicated Pyelonephritis Factors: Outflow obstruction, catheterization and urinary instrumentation, vesicoureteral reflux, pregnancy, and neurogenic bladder.
- Chronic Pyelonephritis: Characterized by a progressive process of scarring and deformation of the renal calyces and pelvis, along with atrophy and thinning of the overlying renal tissue. It involves recurrent or persistent bacterial infection superimposed on urinary tract obstructions, urine reflux, or both.
Drug-Related Nephropathies
- Drug-related nephropathies: functional or structural changes in the kidneys after exposure to a drug.
- Kidney vulnerability to drug toxicity factors: large blood flow, metabolism of drugs, and concentrating urine.
- Mechanisms of drug-related renal toxicity: decrease in renal blood flow (NSAIDs and Furosemide), Direct damage to tubulointerstitial structures (NSAIDs), Hypersensitivity reactions (sulfonamides), and Obstruction of urine flow (sulfonamides and vitamin C by forming stones in the tubules).
Chinese Herbal Drugs
- Chinese herbal drugs associated with kidney damage, particularly ephedra in weight loss programs.
- Growing evidence of damage linked to aristolochic acid in these slimming herb preparations.
Obstructive Disorders
- Urinary obstruction can involve any level of the urinary tract from the urethra to the renal pelvis, and can be sudden or insidious, partial or complete, and unilateral or bilateral.
- Causes of Urinary Obstruction: Congenital anomalies, urinary calculi (stones), pregnancy, benign prostatic hyperplasia, Scar tissue from infection and inflammation, Tumors, Neurologic disorders like spinal cord injury.
- Consequences of Urinary Obstruction: Urine stasis (increased risk of infection and stone formation), Progressive dilation of renal collecting ducts which leads to renal tubule destruction and atrophy of renal tissue.
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Description
This quiz covers the disorders of the renal system, including nephrotic syndrome and its characteristics. It also explores kidney anatomy, detailing various structures and their functions. Test your knowledge on how systemic diseases can affect kidney health and the impact of genetic factors.
