19 diseases of the kidney
TRANSCRIPT
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Diseases of the Kidney
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Major Determinants of Disease
• Disease of one renal structure usually affects others• The urinary tract is especially susceptible to bacterial
infection• Most primary glomerular disease is caused by
autoimmune reactions• High blood pressure is a common cause of kidney
disease• The kidney collects, concentrates, & excretes toxins,
some of which may cause neoplasms or damage to the kidney or urinary tract
• Renal tubules are metabolically very active & therefore especially susceptible to oxygen deprivation or toxic damage
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• renal failure– loss of ability of kidneys to excrete, concentrate
• aminoaciduria• anuria
– little or no urine output• bacteruria• diuresis
– increased urine output• dysuria
– painful urination• glycosuria• hematuria
– RBCs in urine• hemoglobinuria• lipiduria• nocturia• oliguria
– less than normal urine output• polyuria
– more than normal urine output• proteinuria• pyuria
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Syndromes• Acute nephritic syndrome
– autoimmune glomerular disease with HTN & hematuria• Acute renal failure• Azotemia
– renal failure detectable only with lab tests• Chronic renal failure• Nephrolithiasis• Nephrotic syndrome
– renal fialure with marked proteinuria & edema• Occult hematuria• Occult proteinuria• Uremia
– renal failure with clinical signs & symptoms• UTI• Urinary tract obstruction
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Azotemia
• No clinical signs
• Caused by almost any type of underlying renal disease
• Discovered incidentally
• Increased BUN & creatinine
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Uremia
• Clinical signs & symptoms
• Accumulation of waste products in blood
• Caused by almost any type of underlying renal disease
• HTN, anemia, edema, oliguria
• Pericarditis, gastroenteritis, bleeding, neuropathies
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Acute Nephritic Syndrome
• Caused by acute glomerulonephritis– autoimmune
• Hematuria, HTN, azotemia, oliguria, edema
• Acute glomerular inflammation & reactive hyperplasia of glomerular cells
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Nephrotic Syndrome
• Caused by various glomerular diseases
• Marked proteinuria, hypoalbuminemia, generalized edema, hyperlipidemia
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Acute Renal Failure
• Acute oliguria or anuria associated with azotemia
• Most common cause is acute tubular necrosis from shock
• Also due to– damage from drugs or toxins– severe hemolysis– muscle necrosis– acute glomerular diseases or vascular diseases
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Chronic Renal Failure
• Low urine output & prolonged uremia
• End result of all serious chronic renal disease
• Causes– diabetes– chronic glomerulonephritis– HTN– unknown
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Simple Cyst
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Polycystic Disease
• Genetic• Fairly common • Usually not
symptomatic until after 30
• Hematuria, chronic UTI, HTN
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Glomerular Disease
• Named according to– etiology– microscopic findings– clinical syndrome
• Most common clinical presentations– acute nephritic syndrome– nephrotic syndrome
• Most common cause is autoimmune
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Autoimmune Reactions
Some progress as either focal segmental glomerulosclerosis ortubulointerstitial nephritis
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Poststreptococcal Glomerulonephritis
• Autoimmune injury initiated by beta-hemolytic streptococcus
• aka acute proliferative glomerulonephritis• Presents as acute nephritic syndrome
– hematuria– HTN– increased BUN & creatinine– low urine output– edema
• Antibodies produced by strep throat deposit in glomerulus
• Most fully recover but about 10% evolve into rapidly progressive glomerulonephritis
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Rapidly Progressive Glomerulonephritis
• Unknown causes or secondary to poststreptococcal glomerulonephritis
• Autoimmune• aka crescentric
glomerulonephritis• Some present as acute
nephritic syndrome & others as renal failure
• Caused by deposition of An-Ab complexes
• All but a few progress to renal failure
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Membranous Glomerulonephritis
• Autoimmune• Most common cause
of nephrotic syndrome in adults
• About 10% proceed to renal failure within 10 yrs, 25% recover completely, most progress slowly with proteinuria, HTN, loss of renal function
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• Minimal Change Glomerulonephritis– very subtle changes– presents as nephrotic
syndrome– unknown etiology– relatively benign– sudden appearance of
proteinuria & edema
• IgA Glomerulonephritis– Autoimmune– Most common
worldwide– aka Berger disease– Usually presents as
hematuria– About ½ of adults
develop chronic renal failure
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Chronic Glomerulonephritis
• Incidental discovery of occult proteinuria or HTN
• Usually presents as chronic renal failure or occult proteinuria
• Glomerulus has scar tissue
• Dialysis & transplant
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Secondary Glomerulonephritis
• Diabetes most common cause – most common cause of renal failure– glycoproteins deposit in basement membrane
• Vascular disease– atherosclerosis– HTN– vascultitis
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Benign Nephrosclerosis
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Malignant Nephrosclerosis
• In patients with malignant HTN
• Vicious cycle of renin release
• Renal failure, vascular stress, increased intracranial pressure
• Medical emergency• About 25% die within 5
yrs
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Acute Tubular Necrosis
• Most common cause of acute renal failure• Consequence of shock or chemicals
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Tubulointerstitial Nephritis
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Hydronephrosis
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Urinary Tract Infection
• Common & tend to recur
• Women > men
• Acquired during– sexual intercourse– catheterization
• Pyelonephritis– bacterial infection of kidney– Gram neg fecal bacteria
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Acute Pyelonephritis
• Secondary to lower UTI• Acute neutrophilic
inflammatory exudates• Small abcesses• Presents as
– flank pain– fever– high WBC– pyuria
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Chronic Pyelonephritis
• Chronic urinary reflux or obstruction
• Scars & shrinks kidney
• About 10% of patients on dialysis
• Most not diagnosed until late in the disease
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Tubulointerstitial Nephritis
• Drugs– antibiotics – NSAIDs– diuretics
• Can be caused by– protein deposits– uric acid crystal deposits– renal calcium deposits
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Renal Stones
• Calcium• Infection• Uric acid• Symptoms
– hematuria– renal colic
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Staghorn Calculus
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Renal Cell Carcinoma
• About 90% of renal malignancies
• 2X risk in smokers• Usually presents as
hematuria• Metastasizes to lung &
bone• 5 yr survival
– 75% without metastasis– 50% with metastasis– 15% with renal vein
invasion