10 RENAL Disorder.pptx

University of Tabuk Faculty of Applied Medical Sciences Department of Nursing Pathophysiology (PATN 201) Level 4, 2nd Academic Year Disorders of Renal Function  imp Abnormal findings  Azotemia:  BUN, creatinine  Uremia...

University of Tabuk Faculty of Applied Medical Sciences Department of Nursing Pathophysiology (PATN 201) Level 4, 2nd Academic Year Disorders of Renal Function  imp Abnormal findings  Azotemia:  BUN, creatinine  Uremia: azotemia + more problems  Acute renal failure: oliguria  Chronic renal failure: prolonged uremia The Kidney Disorder  Major Topics for Kidney Disorder I. Glomerular diseases II. Tubular Diseases III. Congenital anomalies IV. Vascular diseases V. Kidney stones VI. Neoplasia I. Glomerular diseases Nephrotic syndrome 1. Minimal change disease 2. Focal segmental glomerulosclerosis 3. Membranous nephropathy Nephritic syndrome 1. Post-infectious GN 2. IgA (immune) nephropathy  imp Nephrotic syndrome Nephritic syndrome  Massive proteinuria  Hematuria  Hypoalbuminemia  Oliguria  Edema  Azotemia  Hyperlipidemia/-uria  Hypertension Nephrotic Syndrome  Massive proteinuria  Hypoalbuminemia  Edema  Hyperlipidemia Causes  Adults: systemic disease (diabetes)  Children: minimal change disease  Characterized by loss of foot processes  Good prognosis Nephritic Syndrome  Hematuria  Oliguria, azotemia  Hypertension Causes  Post-infectious GN, IgA nephropathy  Immunologically-mediated  Characterized by proliferative changes and inflammation  Post-Infectious Glomerulonephritis  Child after streptococcal throat infection  Immune complexes  Hypercellular glomeruli  Subepithelial humps Minimal change disease  Classification and external resources The three hallmarks of Minimal Change Disease: diffuse loss of podocyte foot processes, vacuolation, and the appearance of microvilli Minimal change disease Normal glumerular structure Minimal change disease Normal glomerulus Focal Segmental Glomerulosclerosis  Primary or secondary  Some (focal) glomeruli show partial (segmental) hyalinization  Unknown pathogenesis  Poor prognosis  Membranous Glomerulonephritis  Autoimmune reaction against unknown renal antigen  Immune complexes  Thickened GBM  Subepithelial deposits Membranous glomerulonephritis  IgA Nephropathy Common! Child with hematuria after (URI) Upper Respiratory Infection IgA in mesangium Variable prognosis Drug-Induced Interstitial Nephritis  Antibiotics, NSAIDS  IgE and T-cell-mediated immune reaction  Fever, eosinophilia, hematuria  Patient usually recovers  Analgesic nephritis is different (bad) II. Tubular and interstitial diseases Inflammatory lesions pyelonephritis Pyelonephritis Invasive kidney infection Usually ascends from UTI Fever, flank pain Organisms: E. coli, Proteus Urinary Tract Infection  Women, elderly  Patients with catheters or mal-formations  Dysuria, frequency  Organisms: E. coli, Proteus Acute pyelonephritis with abscesses Chronic pyelonephritis is an ascending urinary tract infection that has reached the pyelum or pelvis of the kidney.:  Acute Tubular Necrosis  The most common cause of ARF! Acute kidney injury (AKI), previously called acute renal failure (ARF), is a rapid loss of kidney function. Its causes are numerous and include low blood volume from any cause, exposure to substances harmful to the kidney , and obstruction of the urinary tract.  Reversible tubular injury  Many causes: ischemic (shock), toxic (drugs)  Most patients recover  III.Congenital anomalies  Adult Polycystic Kidney Disease  Autosomal dominant  Huge kidneys full of cysts  Usually no symptoms until 30 years  Associated with brain aneurysms. Childhood Polycystic Kidney Disease  Autosomal recessive  Numerous small cortical cysts  Associated with liver cysts  Patients often die in infancy  Medullary Cystic Kidney Disease  Chronic renal failure in children  Complex inheritance  Kidneys contracted, with many cysts  Progresses to end-stage renal disease IV. Vascular diseases Benign Nephrosclerosis  Found in patients with benign hypertension  Hyaline thickening of arterial walls  Leads to mild functional impairment  Rarely fatal Malignant nephrosclerosis Arises in malignant hypertension Hyperplastic vessels Ischemia of kidney Medical emergency  Malignant Hypertension  5% of cases of hypertension  Super-high blood pressure, encephalopathy, heart abnormalities  First sign often headache, scotomas  Decreased blood flow to kidney leads to increased renin, which leads to increased BP!  5y survival: 50% V. Tumors Renal cell carcinoma Bladder carcinoma  Renal Cell Carcinoma  Derived from tubular epithelium  Smoking, hypertension, cadmium exposure  Hematuria, abdominal mass, flank pain  If metastatic, 5y survival = 5%  Bladder Carcinoma  Derived from transitional epithelium  Present with painless hematuria  Prognosis depends on grade and depth of invasion  Overall 5y survival = 50%