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patho 3
Renal Corpuscle
Characteristics
Arterioles
Glomerulus
Capillaries
Fenestrations
Plasma Solutes and Other Small Molecules Become Ultrafiltrate
Bowman's Capsule Encapsulates Glomerulus
2 mins
Proximal Tubule
Characteristics
Na+ Reabsorbed Via Active Transport
Water Follows Na+
Most Of Glucose Reabsorbed
Most Of Amino Acids Reabsorbed
Bicarbonate Exchanged For H+
Drugs and Toxins Excreted
Filtrate Osmolarity Same As Plasma
Leads To Loop Of Henle
2 mins
Loop of Henle
Characteristics
Descending Limb
Water Follows Na+
Medullary Hypertonicity
Increased Water Reabsorption
Vasa Recta
Na+ Reabsorbed Via Active Transport
Ascending Limb
Reabsorbs Na+, K+, Cl-
Decreased Concentration of Filtrate
Impermeable to Water
Distal Tubule
2 mins
Distal Tubule
Characteristics
Hormonally Regulated
Aldosterone Causes Na+ Reabsorption
Na+ Reabsorbed Via Active Transport
Water follows Na+
Parathyroid Hormone Causes Ca2+ Reabsorption
Leads to Collecting Duct
1 min
Collecting Duct
Characteristics
Na+ Reabsorption
Vasopressin Causes Water reabsorption
Concentrates Filtrate
2 mins
Nephritic Syndrome
Inflammatory
Hematuria
RBC casts
Increased Nitrogen in blood
Oliguria
Hypertension
Proteinuria < 3.5 grams per day
2 mins
Nephrotic Syndrome
Signs and Symptoms
Massive Proteinuria > 3.5g per Day
Edema
Increased risk of infection
Thromboembolism
Hyperlipidemia
Fatty casts
1 min
Post Streptococcal Glomerulonephritis
Pathophysiology
Nephritic
Children
Signs and Symptoms
Edema
Cola Colored Urine
Follows Group A Streptococcal pharyngitis or Skin Infection
Diagnosis
Neutrophils
Immunofluorescence (IF) Granular
Lumpy Bumpy Appearance on Immunofluorescence (IF)
Subepithelial Immune Complex Humps
2 mins
Membranous Glomerulonephritis
Characteristics
Nephrotic
Diagnosis
LM Thickening of Capillary and Glomerular Basement Membrane (GBM)
EM Spike and Dome Appearance with Subepithelial Deposits
IF Granular
Primary
Phospholipase A2 Receptor Autoantibodies
Secondary
NSAIDS
Gold
Solid Tumors
Hepatitis B Virus (HBV)
Lupus
3 mins
Membranoproliferative Glomerulonephritis
Nephritic-Nephrotic Syndrome
Type I
Subendothelial Immune Complexes
Hepatitis C Virus
Granular IF
Tram Tracks Caused by Splitting of the GBM
Ingrowth of Mesangium
Type II
Dense Deposit Disease
C3 Nephritic Factor
2 mins
Rapidly Progressive Glomerulonephritis
Pathogenesis
Nephritic Syndrome
Crescent Shape
Crescents Consist of Fibrin and C3b
With Parietal Cells, Monocytes, and Macrophages
IMMUNOFLUORESCENCE
Linear Immunofluorescence
Negative Immunofluorescence
Granular Immunofluorescence
Etiology
Goodpasture Syndrome
Granulomatosis with Polyangiitis (Formerly Wegener's)
Microscopic Polyangiitis
Prognosis
Poor Prognosis
3 mins
Focal Segmental Glomerulosclerosis
Most Common Cause of Nephrotic Syndrome in Hispanic People and African Americans
Associated with Sickle Cell Disease and HIV
Associated Interferon Therapy and Heroin Abuse
Histopathology
LM Segmental Sclerosis and Hyalinosis
EM Focal Damage of Visceral Epithelial Cells
IF Negative
Signs & Symptoms
Microscopic Hematuria
Nonselective Proteinuria
Considerations
Poor Prognosis
2 mins
Pyelonephritis Assessment
Cause/Mechanism
Ascending Urethral Bacteria
Assessment
Dysuria
Fever
Fatigue
Flank Pain
Costovertebral Tenderness
Nausea and Vomiting
1 min
Pyelonephritis Interventions
Urinalysis
NSAIDs
Antibiotics
Increase Fluid Intake
Avoid Catheterization
Consideration
Urosepsis
1 min
Kidney Transplant
Indications
End Stage Renal Disease (ESRD)
Considerations
Selective Candidacy
Close Compatibility
Immunosuppressants
Monitor for Rejection
Monitor for Infection
Monitor Urine Output
2 mins
Wilms' Tumor (Nephroblastoma)
Cause
Malignant Renal Tumor
Assessment
Abdominal Mass
Hematuria
Fever
Hypertension
Interventions
Nephrectomy
Chemotherapy
Radiation
Considerations
Do Not Palpate Abdomen
Children Under 5 Years Old
2 mins
Indications for Urgent Dialysis (AEIOU)
Signs and Symptoms
AEIOU Mnemonic
Acidosis
pH < 7.1
Electrolyte Imbalances
Symptomatic Hyperkalemia
> 6.5 mEq/L
Ingestion
Overload (Volume)
Uremia
Encephalitis
Pericarditis
2 mins
Casts in Urine (Differential Diagnosis)
Characteristics
RBC Casts
Glomerular Disease
WBC Casts
Acute Interstitial Nephritis
Acute Pyelonephritis
Fatty Casts
Maltese Cross Sign
Nephrotic Syndrome
Granular Muddy Brown Casts
Acute Tubular Necrosis (ATN)
Waxy Casts
End Stage Renal Disease (ESRD) (Chronic Renal Failure)
Hyaline Casts
Non-Specific
2 mins
Fanconi Syndrome Characteristics
Pathophysiology
Resorption Defect in Proximal Tubule
Signs and Symptoms
Hypophosphatemia
Rickets
Osteomalacia
Hypokalemia
Metabolic Acidosis
Type 2 Renal Tubular Acidosis
Treatment
Treat Underlying Disorder
Bicarbonate
1 min
Fanconi Syndrome Causes
Hereditary Causes
Cystinosis
Dent's Disease
Wilson's Disease
Oculocerebrorenal (Lowe) Syndrome
Galactosemia
Hereditary Fructose Intolerance
Glycogen Storage Diseases
Tyrosinemia
Acquired and Medication Causes
Tenofovir
Heavy Metals
Expired Tetracyclines
Cisplatin
Gentamycin (Aminoglycosides)
Valproate Sodium
Multiple Myeloma
2 mins
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