Term
| Signs that Kidneys are not working Properly |
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Definition
1.Urine Test-may show blood (hematuria) or protein (proteinuria) that should not normally be there.
2.Blood pressure may be high. Most people with high blood pressure do not have serious kidney disease, but high blood pressure can be a sign of kidney disease. It is more likely to be connected to kidney disease in people who are young, or have severe high blood pressure.
3.Trouble passing urine is rarely caused by kidney trouble - unless the kidneys are very severely damaged. It is more commonly caused by problems in the bladder, or in the nerves supplying the bladder, or by infection in the urine.
4.Pain around the kidneys is an uncommon symptom in kidney disease except with kidney stones, and usually has alternative explanations. It is very common with kidney stones, and sometimes occurs with urine infections. Patients with large cysts in the kidney may get pain from them. Sometimes blockage of the artery to the kidney causes pain.
5.Other symptoms come from loss of kidney function. In the early stages of many kidney diseases, there are no symptoms at all. Kidney function needs to be quite badly damaged before any symptoms become noticeable |
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Term
Diagnostics- IVP or IVU aka
Intravenous Urography |
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Definition
In this test an injection of a substance that is eliminated through the kidneys is given. This shows up on X-rays, and it can be followed traveling from the kidney, down the ureters into the bladder.
It is useful for showing the ureters and for suspected kidney stones. |
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Term
| Arteriography (angiography) |
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Definition
| This is a way of showing the blood supply to the kidneys. It usually requires injection of contrast material into the artery that you are trying to see. |
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Term
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Definition
| is widely used to show organs and structures. |
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Term
| MRI - Magnetic resonance imaging |
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Definition
| is another type of cross-sectional imaging like CT. It is sometimes useful for showing particular regions well, and it can sometimes be used to show blood vessels as an alternative to arteriography. |
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Term
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Definition
| is the most commonly used technique. It uses sound waves, not X-rays, and seems to be completely safe, even in pregnancy. The pictures look better during the examination than when 'stills' are shown. |
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Term
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Definition
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Term
| More accurate tests to show GFR |
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Definition
| GFR means glomerular filtration rate, the most useful measure of kidney function. As the normal value is about 100, it gives an approximate 'score out of 100' for kidney function. However your normal GFR depends on your size and age. |
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Term
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Definition
| requires collection of all urine over 24h, with a blood test. |
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Term
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Definition
| involve injecting a small amount of a substance and seeing how fast the kidneys remove it. This is usually more accurate than creatinine clearance. |
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Term
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Definition
| The Cockroft-Gault and MDRD equations use blood tests, age, and weight to work out approximately what the creatinine clearance or GFR are. They are not as good as measuring GFR directly, but they are very useful. Calculate yours (from the Renal Association website). Remember that this is not as accurate as measuring GFR, and in some people eGFR may be quite far from the real GFR. Explain reduced GFR. |
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Term
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Definition
Production of Cr depends only on muscle mass, rarely fluctuates
Entirely excreted by kidney
ONLY renal disorders will affect CR levels |
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Term
| If BUN & CR are both ↑ (Ratio ↓) |
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Definition
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Term
BUN:Cr ratio ~20:1 (normal)
If BUN >>Cr (Ratio ↑) |
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Definition
| PRE-RENAL: dehydration, malnutrition, CHF, hepatic failure |
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Term
1.Nonoliguric acute renal failure
2.Oliguria:
3.Anuria: |
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Definition
1.urine output> 400cc/24 hr
2.urine output 100- 400cc/24 hr.
3.Urine output< 100cc/24hr. |
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Term
1.Urinary tract obstruction
2.Severity based on: |
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Definition
is an interference with the flow of urine at any site along the urinary tract
2.Location
Completeness
Involvement of one or both upper urinary tracts
Duration
Cause
3.Compensatory hypertrophy |
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Term
Urinary Tract Obstruction:
Hydroureter |
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Definition
| A long-standing obstruction (probably congenital) at the ureteral orifice through which the metal probe passes led to the marked hydroureter and hydronephrosis seen here. |
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Term
Urinary Tract Obstruction:
Hydronephrosis |
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Definition
| Hydronephrosis is an abnormal collection of urine within the renal pelvis. It usually indicates some obstruction to urine drainage. Since urine is a uniform liquid it generates no echoes on ultrasound. That is why it appears as a black (anechoic) area on the ultrasound image. |
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Term
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Definition
| A simple method for identifying glomerular bleeding |
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Term
1.Uric acid stones
2.Calcium stones
3.Cystine stones
4.Struvite stones |
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Definition
1.These stones are formed of uric acid, a byproduct of protein metabolism. Chemotherapy patients and those on high protein diets are more susceptible.
2.Roughly four out of five kidney stones are calcium stones. These stones are usually a combination of calcium and oxalate.
3.These stones represent only a small percentage of kidney stones. Form in patients with cystinuria.
4.Found more often in women than in men, struvite stones are almost always the result of chronic urinary tract infections caused by bacteria that produce specific enzymes. These enzymes increase the amount of ammonia in the urine, which is incorporated in the crystals of struvite stones. These stones are often large, may have a characteristic stag's-horn shape and can seriously damage your kidneys. |
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Term
| Common Causes of Abnormal Urine Coloration |
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Definition
Color Pathologic causes
Cloudy Phosphaturia, pyuria, chyluria, lipiduria, hyperoxaluria
Brown Bile pigments, myoglobin
Brownish-black Bile pigments, melanin, methemoglobin
Green or blue Pseudomonal UTI, biliverdin
Orange Bile pigments
Red Hematuria, hemoglobinuria, myoglobinuria, porphyria
Yellow Concentrated urine |
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Term
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Definition
1.patient's hydration status.
reflects the concentrating ability of the kidneys.
Normal USG can range from 1.003 to 1.030
a value of less than 1.010 indicates relative hydration
decreased USG is associated with diuretic use, diabetes insipidus, adrenal insufficiency, aldosteronism, and impaired renal
greater than 1.020 indicates relative dehydration
Increased USG is associated with glycosuria and the syndrome of inappropriate antidiuretic hormone |
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Term
| Urine pH-Renal Tubular Acidosis |
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Definition
can range from 4.5 to 8 but normally is slightly acidic (i.e., 5.5 to 6.5) because of metabolic activity.
Ingestion of proteins and acidic fruits (e.g., cranberries) can cause acidic urine
diets high in citrate can cause alkaline urine.
Urinary pH generally reflects the serum pH, except in patients with renal tubular acidosis (RTA).
The inability to acidify urine to a pH of less than 5.5 despite an overnight fast and administration of an acid load is the hallmark of RTA. |
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Term
Type I (distal) RTA
Type II (proximal) RTA |
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Definition
the serum is acidic but the urine is alkaline, secondary to an inability to secrete protons into the urine.
2.is characterized by an inability to reabsorb bicarbonate. This situation initially results in alkaline urine, but as the filtered load of bicarbonate decreases, the urine becomes more acidic. |
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Term
1.Renal tumors
2.Bladder tumors |
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Definition
Renal adenomas
Renal cell carcinoma (RCC)
2.Transitional cell carcinoma
Gross, painless hematuria
Most common in males older than 60 years |
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Term
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Definition
Urothelial carcinoma can arise anywhere in the urothelium lining the urinary tract from the urethra to the calyces, but is most common in bladder. Urothelial carcinoma is often multifocal and has a tendency to recur.
Hematuria is a frequent presenting symptom. |
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Term
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Definition
Renal cell carcinomas have a tendency to invade into the renal vein, as shown here at the white arrow in a resected kidney surrounded by adipose tissue. They may even crawl up the vena cava and into the heart, but even these can be removed!
Renal cell carcinomas may invade through the renal capsule.
Renal cell carcinomas may metastasize to odd locations, and about a fourth of them first present as metastatic lesions. |
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Term
| Urinary Tract Infection (UTI) |
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Definition
UTI is inflammation of the urinary epithelium caused by bacteria
Acute cystitis
Painful bladder syndrome/interstitial cystitis
Interstitial cystitis
Acute and chronic pyelonephritis
Most common pathogens
Escherichia coli
Virulence of uropathogens
Host defense mechanisms |
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Term
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Definition
Cystitis is an inflammation of the bladder
Manifestations
Frequency, dysuria, urgency, and lower abdominal and/or suprapubic pain
This bladder at autopsy has been opened to reveal areas of hyperemia of the mucosa. This is acute cystitis. |
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Term
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Definition
Acute pyelonephritis
Acute infection of the renal pelvis interstitium
Vesicoureteral reflux,
E. coli, Proteus, Pseudomonas
Chronic pyelonephritis
Persistent or recurring episodes of acute pyelonephritis that leads to scarring
Risk of chronic pyelonephritis increases in individuals with renal infections and some type of obstructive pathologic condition |
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Term
| Acute pyelonephritis continued... |
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Definition
Infection of the upper urinary tract
Renal parenchyma and renal pelvis
Most common pathogen is E. coli
Most infections occur due to migration of pathogen from the urethra, into the bladder, and then through the ureters to the kidneys; but infection can occur through the blood.
Predisposing factors include: kidney stones, vesicoureteral reflux, pregnancy, neurogenic bladder, instrumentation, female sexual trauma
Symptoms
Cystitis
dysuria, frequency, urgency, gross hematuria, suprapubic pain
Upper urinary tract infection
fever, chills, flank pain, nausea, vomiting, costovertebral angle tenderness
Pyuria
Potentially life and/or organ threatening
damage to the kidney, kidney failure, abscess formation, sepsis, or sepsis shock/multiorgan system failure
Potential complications
Abscess formation
Acute renal failure
Chronic renal damage
Sepsis syndromes
Renal papillary necrosis
Xanthogranulomatous pyelonephritis |
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Term
| Intratubular aggregations of polymorphonuclear neutrophils (PMNs). |
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Definition
2 step pathogenesis
Pathogen attaches to epithelium
and causes inflammatory response
2. Result of inflammatory response
- chemokines released and attach to neutrophil-activating chemokine receptor 1.
- PMNs are able to cross over epithelial wall into urine
Causes urinary tract infection symptoms |
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Term
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Definition
The glomerulopathies are disorders that directly affect the glomerulus
Urinary sediment changes
sudden or insidious onset of hypertension, edema, and an elevated blood urea nitrogen (BUN)
Decreased glomerular filtration rate
Elevated plasma creatinine, urea, and reduced creatinine clearance
Glomerular damage causes a decreased glomerular membrane surface area, glomerular capillary blood flow, and blood hydrostatic pressure
Increased glomerular capillary permeability and loss of negative ionic charge barrier result in passage of plasma proteins into the urine
Resulting hypoalbuminemia encourages plasma fluid to move into the interstitial spaces
Edema |
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Term
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Definition
Inflammation of the glomerulus
Immunologic abnormalities (most common)
Drugs or toxins
Vascular disorders
Systemic diseases
Viral causes
Most common cause of end-stage renal failure
Mechanisms of injury
Deposition of circulating soluble antigen-antibody complexes, often with complement fragments
Formation of antibodies against the glomerular basement membrane
Streptococcal release of neuramidase |
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Term
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Definition
Acute poststreptococcal glomerulonephritis
Rapidly progressing glomerulonephritis
Antiglomerular basement membrane disease (Goodpasture syndrome)
Chronic glomerulonephritis |
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Term
| Crescentic glomerulonephritis |
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Definition
| is known as rapidly progressive glomerulonephritis (RPGN) because this disease is very progressive. |
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Term
| membranoproliferative glomerulonephritis (MPGN |
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Definition
| Those cases that are idiopathic are divided into types I and II by pathologic findings. As seen here, the glomerulus has increased overall cellularity, mainly increased mesangial cellularity. |
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Term
| Chronic glomerulonephritis |
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Definition
| And finally, if all else fails, call it "chronic glomerulonephritis". Seen here are atrophic kidneys with a thin cortex from a patient at autopsy with chronic renal failure (CRF). About a third to half of patients with CRF slowly reach end stage without significant signs or symptoms along the way, and at the end stage renal disease (ESRD) there are no diagnostic features and, therefore, no point in performing a renal biopsy. A steadily rising serum creatinine and urea nitrogen are clues. Most patients will also be hypertensive. (Some simple cysts are also seen here.) |
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Term
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Definition
Excretion of 3.5 g or more of protein in the urine per day
The protein excretion is caused by glomerular injury
Findings
Hypoalbuminemia, edema, hyperlipidemia, and lipiduria, and vitamin D deficiency
Membranous glomerulonephritis
Focal glomerulosclerosis
Minimal change disease (lipoid nephrosis) |
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Term
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Definition
| Proposed interactions between the glomerular basement membrane, glomerular endothelial cells, podocytes and slit diaphragm (based on a concept proposed by Kalluri20), showing signaling pathways via which endothelin-1 might contribute to glomerular injury |
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Term
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Definition
This is minimal change disease (MCD) which is characterized by effacement of the epithelial cell (podocyte) foot processes and loss of the normal charge barrier such that albumin selectively leaks out and proteinuria ensues.
By light microscopy, the glomerulus is normal with MCD
However, overlying epithelial cell foot processes are effaced (giving the appearance of fusion) and run together. |
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Term
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Definition
| This is focal segmental glomerulosclerosis (FSGS). An area of collagenous sclerosis runs across the middle of this glomerulus. In contrast to minimal change disease, patients with FSGS are more likely to have non-selective proteinuria, hematuria, progression to chronic renal failure, and poor response to corticosteroid therapy. |
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Term
| Acute Renal Failure (ARF) |
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Definition
| is a rapid loss of renal function due to damage to the kidneys, resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste products that are normally excreted by the kidney. |
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Term
Three catgories:
Pre-renal |
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Definition
Caused by impaired renal blood flow
GFR declines because of the decrease in filtration pressure
hypovolemia (decreased blood volume), usually from shock or dehydration and fluid loss or excessive diuretics use.
hepatorenal syndrome in which renal perfusion is compromised in liver failure
vascular problems, such as atheroembolic disease and renal vein thrombosis (which can occur as a complication of the nephrotic syndrome |
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Term
ARF
Intra Renal (damage to the kidney itself): |
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Definition
infection usually sepsis (systemic inflammation due to infection),rarely of the kidney itself, termed pyelonephritis
toxins or medication (e.g. some NSAIDs, aminoglycoside antibiotics, iodinated contrast, lithium)
rhabdomyolysis (breakdown of muscle tissue) - the resultant release of myoglobin in the blood affects the kidney; it can be caused by injury (especially crush injury and extensive blunt trauma), statins, stimulants and some other drugs
hemolysis (breakdown of red blood cells) - the hemoglobin damages the tubules; it may be caused by various conditions such as sickle-cell disease, and lupus erythematosus
multiple myeloma, either due to hypercalcemia or "cast nephropathy" (multiple myeloma can also cause chronic renal failure by a different mechanism)
acute glomerulonephritis which may be due to a variety of causes, such as anti glomerular basement membrane disease/Goodpasture's syndrome, Wegener's granulomatosis or acute lupus nephritis with systemic lupus erythematosus |
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Term
| Post-renal (obstructive causes in the urinary tract) due to: |
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Definition
medication interfering with normal bladder emptying.
benign prostatic hypertrophy or prostate cancer.
kidney stones.
due to abdominal malignancy (e.g. ovarian cancer, colorectal cancer).
obstructed urinary catheter. |
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Term
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Definition
Chronic renal failure is the irreversible loss of renal function that affects nearly all organ systems
Stages
Chronic renal insufficiency
Chronic renal failure
End-stage renal failure |
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Term
| Pathophysiology of Chronic Renal Failure |
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Definition
Disturbances of fluid balance- polyuria and compensatory polydipsia
Loss of urine concentrating ability- due to tubular damage
Gastrointestinal signs- oral and gastrointestinal ulceration & vomiting Causative factors-↑ [urea] in saliva, Hypergastrinaemia
↓ production of erythropoietin
Suppression of bone marrow occurs b/c of accumulated uremic toxins
Metabolic acidosis- arises from ↓ excretion of H+, b/c ↓ renal mass
Hyperphosphatemia-
glomerular filtration rate drops ˂ 20% b/c development of renal secondary hyperparathyroidism
soft tissue calcification
↑ [PTH] present before hyperphosphataemia is marked
PTH ↑ soft tissue mineralization & dyslipoproteinaemias renal osteodystrophy & neurotoxicity
Hypertension |
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Term
| Alterations of Renal and Urinary Tract Function in Children |
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Definition
| Alterations of Renal and Urinary Tract Function in Children |
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Term
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Definition
Horseshoe kidney
Hypospadias
Epispadias
Exstrophy |
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Term
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Definition
| Chordee-the phallus is incompletely separated from the perineum or is still tethered downwards by connective tissue, or with undescended testes |
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Term
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Definition
| Epispadias-a failure of midline penile fusion much earlier in embryogenesis. |
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Term
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Definition
| the malformation of the bladder and urethra, in which the bladder is turned "inside out". The bladder does not form into its normal round shape but instead is flattened and exposed outside the body |
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Term
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Definition
is a birth defect of the urethra in the male that involves an abnormally placed urinary meatus (opening). Instead of opening at the tip of the glans of the penis, a hypospadic urethra opens anywhere along a line (the urethral groove) running from the tip along the underside (ventral aspect) of the shaft to the junction of the penis and scrotum or perineum.
The more severe degrees are more likely to be associated with chordee, in which the phallus is incompletely separated from the perineum or is still tethered downwards by connective tissue, or with undescended testes (cryptorchidism). |
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Term
| Variations of hypospadias from mild to severe |
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Definition
| (A) Glanular (meatus is on the dorsal surface of the glans penis). (B) Coronal (meatus is at or just below the coronal margin). (C) Distal (meatus is on the distal third of the penile shaft). (D) Penoscrotal (meatus is at the base of the shaft, in front of the scrotum). (E) Scrotal (meatus is on the scrotum or between the genital swellings). (F) Perineal (meatus is below the scrotum or genital swellings). Note that the more severe forms are associated with penile curvature. Photographs courtesy of Laurence Baskin, MD. |
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Term
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Definition
Prenatal testosterone, converted in the genital skin to dihydrotestosterone, causes migration of skin fibroblasts to fully enclose the urethral groove in fetal males, normally resulting in an enclosed penile urethra by the second trimester of pregnancy.
Failure of adequate prenatal androgen effect is therefore thought to be involved in many cases, making hypospadias a very mild form of intersex (under virilization of a genetic male).
Since postnatal androgen deficiency can only be demonstrated in a minority of cases, it has been proposed that transient deficiency of testosterone can occur during critical periods of fetal genital development, due to elevation of anti-müllerian hormone or more subtle degrees of pituitary-gonadal dysfunction. More recently, abnormalities of transcription factors have been proposed. |
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Term
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Definition
| Bladder exstrophy is a defect of the caudal fold of the anterior abdominal wall; a small defect may cause epispadias alone, whilst a large defect leads to exposure of the posterior bladder wall. In cloacal exstrophy, both the urinary and gastrointestinal tracts are involved |
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Term
| Cloacal exstrophy (also referred to as OEIS |
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Definition
| is the association of an omphalocele, exstrophy of the bladder, imperforated anus, and spinal defects such as meningomyelocele. The hemibladders are on either side of the intestines. |
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Term
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Definition
should be suspected when, in the presence of normal amniotic fluid, the fetal bladder is not visualized (the filling cycle of the bladder is normally in the range of 15 min); an echogenic mass is seen protruding from the lower abdominal wall, in close association with the umbilical arteries.
With aggresive reconstructive bladder, bowel and genital surgery, survival is more than 80%. Although it has been suggested that gender re-assignment to females should occur, psychological follow-ups of such patients suggest that both male and females with this condition are capable of a normal lifestyle, although some form of urinary tract diversion is required for all. Furthermore, both sexes have been reported to be fertile after surgery. |
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Term
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Definition
Bladder outlet obstruction
Ureteropelvic junction obstruction (UPJ)
Hypoplastic or dysplastic kidneys
Renal aplasia or dysplasia
Polycystic kidney disease
Renal agenesis
Unilateral or bilateral (Potter syndrome) |
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Term
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Definition
| It is a relatively rare (1/1000 births) congenital defect that when unilateral, may remain asymptomatic for many years or even the patient’s entire life. Bilateral renal aplasia is invariably fatal because amniotic fluid is largely derived from fetal urine. Unilateral renal aplasia is often discovered by accident during CT scans, sonography, or bone scans. However, unilateral renal aplasia often results in enlargement of the single kidney and sometimes abnormalities there. |
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Term
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Definition
is a gram negative bacteria that causes dysuria which is painful urination and an infection of the urinary tract (UTI).
This bacteria also tends to affect people with underlying diseases that go untreated such as in this case. The patient had a UTI that went untreated even though she was given antibiotics that did not clear up the UTI and caused the bilateral cysts on the kidney. Since the patient was already predisposed to this genetic disorder because of the defective gene the bacteria that was present brought about the proper diagnosis along with testing of family in the first degree. |
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Term
| Vesicoureteral Reflux (VUR) |
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Definition
Retrograde flow of urine from the bladder into the ureters
Reflux encourages infected urine from the bladder to be swept up into the kidneys
Leads to frequent pyelonephritis
Caused by a congenital abnormality or ectopic insertion of the ureter into the bladder
Diagnosed by a voiding cystourethrogram (VCUG) and an intravenous pyelogram (IVP) |
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Term
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Definition
Wilms tumor is an embryonal tumor of the kidney
Wilms tumor arises from the proliferation of abnormal renal stem cells
Inherited and sporadic forms
Usually found by parent due to abdominal swelling
WT1, the first Wilms tumor suppressor gene at chromosomal band 11p13, was identified as a direct result of the study of children with Wilms tumor who also had aniridia, genitourinary anomalies, and mental retardation (WAGR syndrome). Karyotypic analysis revealed constitutional deletions within the short arm of 1 copy of chromosome 11. |
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Term
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Definition
Involuntary passage of urine by a child who is beyond the age (4 to 5 years old) when voluntary bladder control should have been acquired
Primary enuresis
The child has never been continent
Secondary enuresis
Diurnal, nocturnal, or both Theories
Organic causes (diabetes)
Maturational lag
Genetic factors
Sleep patterns
Psychosocial theories
Since urinary continence is reached earlier in girls than in boys, NE is 2-3 times more frequent in boys.
Interestingly, family studies show a strong genetic predisposition for enuresis. More recently studies suggest a genetic linkage of primary nocturnal enuresis to the short arm of chromosome 13.
Some children with severe constipation may compress the bladder and present with bed-wetting. |
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