EXAM 3: Urinary System (Ch. 13)

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Describe horseshoe kidney -problems?-no symptoms -kidneys remain as one functional unit. Still function properly and each have a ureter. -people don't usually realize they have it until they have a CT scan -only problem would be: if something injured their kidney.... they only have one -or kidney disease >>rapid declineDescribe renal agenesis-agenesis= lack of formation -unilateral agenesis is usually asymptomatic. Same sort of problems as horseshoe kidney, though -bilateral agenesis: fatalAutosomal Dominant Polycystic Kidney Disease -mutation in WHAT gene? -are both kidneys affected?-ADPKD or PKD -mutation in polycystin 1 gene -both kidneys affectedAutosomal Dominant Polycystic Kidney Disease -describe pathology-enlarged (20x), numerous cysts -cysts impair renal function -renal failure 40-50 yearstreatment for PKD:kidney removalOverview of major kidney disease categories (5)-immunologic disorders >> glomerulonephritis -metabolic disorders >> diabetic nephropathy -circulatory disturbances >> prerenal renal failure -bacterial infections >> pyelonephritis -tumors3 categories of glomerular diseases: (those which target the glomeruli and affect the nephron loop as well)1. immune-mediated 2. metabolic 3. circulatoryImmune-mediated glomerular diseases can be WHAT type of hypersensitivity rxns?Type II (cytotoxic) hypersensitivity orrrr Type III (immune complex) hypersensitivityWhat are the 4 potential syndromes associated with immune-mediated glomerulonephropathies?1. acute renal failure 2. Nephritic Syndrome 3. Nephrotic Syndrome 4. Isolated hematuriabe able to distinguish the 4 types of immune-mediated glomerulonephropathies by their presenting symptoms1. Acute Renal Failure -symptoms -how is urine affected-rapidly progressing glomerulonephritis (RPGN) -loss of excretory function over several weeks -hematuria>> oliguria>> anuria blood in the urine. becomes scanty. then no urine whatsoever.What is an example of a disease that leads to acute renal failure?Crescentic glomerulonehpritis -can be caused by Goodpasture's syndrome or Wegener's disease1. Acute Renal Failure: Cresentic GN -describe -how would it be treated?-inflammatory cells surround glomerular capillaries forming a crescent moon shape in between Bowman's Capsule and the glomerulus -leads to fibrous scar tissue formation -continual dialysis or transplantBe able to compare/contrast Nephritic and Nephrotic Syndromes -what are the key distinguishers?-things in the urine can distinguish them2. Nephr*i*tic Syndrome -Distinguishing symptoms (3)1. Hematuria 2. Oliguria 3. Hypertension2. Nephr*i*tic Syndrome -usually due to....usually due to: 1. postinfectious glomerulonephritis 2. SLE (lupus)3. Nephr*o*tic Syndrome -distinguishing symptoms: (2)1. hyperlipidemia 2. lipiduria3. Nephr*o*tic Syndrome -usually caused by: (3)-focal glomerulosclerosis -membranous nephropathy -diabetesWhat are some shared symptoms between Nephritic and Nephrotic Syndromes?-proteinuria, hypoalbuminemia, and generalized edema2 causes of nephritis syndrome:-Acute Glomerulonephritis -SLENephritis Syndrome: Acute glomerulonephritis -common cause:-usually 1-2 weeks after strep throat -usually affects childrenAcute glomerulonephritis -what portion of the glomerulus is targeted by complement in this disorder?-antigen-Ab complexes trapped in glomerular BM>> complementwhat changes are seen in the glomerulus?-there are an increased number of mesangial cells that end up inside the capillary region -leukocytes are atracted to the inside of capillaries >> thickening of capillaries >> narrowed capillary lumenAcute glomerulonephritis -How is it treated & will the kidney likely recover?-sometimes will put them on a temporary dialysis while they treat them for the infections >> give the kidneys a break to let them heal -usually full recovery -1-2% may lead to acute renal failure3. Nephrotic Syndrome -3 common causes:-Membranous nephropathy -Lipoid nephrosis -Focal segmental glomerulosclerosisUnderstand both lipoid nephrosis and focal segmental glomerulosclerosis. How are these similar & how are they different?Nephrotic Syndrome: Lipoid Nephrosis -cause? -most common in what population? -associated with... -gold standard of identifying:-*Nil* disease aka no known cause -common cause of nephrotic syndrome in *children* -associated with hyperlipidemia & lipiduria -EM shows fusion of glomeruli foot processes!Nephrotic Syndrome: Focal Segmental Glomerulosclerosis -most common in what population? -associated with...-most common cause of nephrotic syndrome in *adults* -associated with obesity, HIV, sickle cell anemia, and other diseases in adults >> *secondary* FSG -unknown cause in children >> primary FSG -"focal"= not all glomeruli are scarred -"segmental"= not all of the capillary loops in a single glomerulus are affectedHow could you distinguish between Lipoid Nephrosis & FSG medically without an electron microscope?-Lipoid nephrosis CAN be treated with corticosteroids -FSG is RESISTANT to corticosteroidsIn end-stage kidney disease, what has happened grossly and microscopically to the kidneys? -size -surface-Grossly shrunken kidneys >> symmetrical -Surface is granular due to fibrosis. Lumpy. -histologically, the glomeruli have undergone hyalinization and are solid, globular structures. Thick capillaries.2 causes of Metabolic Glomerular diseases:1. Diabetes 2. AmyloidosisAny diabetic related kidney issue is called...Diabetic nephropathyHow does uncontrolled diabetes affect different parts of the kidney? -glomeruli -arterioles-can affect all parts of the kidney! -glomeruli have thick BM and increased matrix >>increased permeability -proteinuria develops >> nephrotic syndrome -arterioles have thick walls, narrow lumen >> ischemia & tubular (PCT, DCT) atrophy -Necrosis and tissue damage occurs where urine is supposed to be coming out (damaged tubes)>> susceptible to bacterial infections >>damage moves down>> *papillary necrosis*What is the most common type of urinary stone?Calcium stones: calcium phosphate or calcium oxalate >> too much calcium absorbed from intestinesurinary stones are most commonly found where?usually in renal pelvis or urinary bladderHow does the formation/location of urinary stones differ in younger versus older patients?20-30 yrs old: >> *upper UT*, remains inside kidney >> hematuria >> spasms of obstructed ureter (uriary colics) >> pain older patients: >> lower UT= *bladder* >> associated with chronic infection >> typically less painExplain ascending vs. descending route of infection in the urinary system.ascending: most common. Bacteria travel up and get to kidney descending: begins in kidney and goes down.hematogenous infection?secondary infection due to hematogenous infectionPyelonephritis: -often caused by..Bacterial infection of the kidney. >> inflammation -E.coli, Klebsiella, and Pseudomonas aeroginosaCystitis: -caused by....infection of the bladder -caused by same pathogens as pyelonephritisWhat are the gross effects of chronic pyelonephritis on the kidney?at first: -scarred, but normal size later stages: -shrunken. scar tissue leads to loss of mass of kidneyHow do acute and chronic cystitis differ?Acute cystitis= -affect on mucosa? -may have...-grossly visible congestion -mucosal hemorrhages -may have pus, ulceration -visualized by cystoscopy in pic, notice the grossly visible congestion= all the redchronic cystitis= -affect on mucosa? -may contain... -associated with...-thickened mucosa with ulceration and sites of hemorrhage -may contain stones -may be associated with diabetes, urinary stones, and prostatic hyperplasiahow does chronic cystitis respond to antibiotics?typically resistant >> recurrent infectionswhat can lead to acute tubular necrosis? (3)-MI, cardiac arrest, or hypotensive shock >> sudden hypoperfusion of kidneyacute tubular necrosis -what portion of the kidney is most affected? -especially..-cortex affected most -especially proximal convoluted tubules >> PCT necrosis, severe entire cortex diesHow is acute tubular necrosis treated?-if only tubules affected, they may regenerate with dialysis support for 1-2 weeksFrom what tissue layer do most tumors of the urinary tract develop?-90% are from transitional cells (pelvis, ureter, urinary bladder, posterior urethra) -some may be squamous or adenocarcinomasWhat is the most common type of cancer found in the kidney?Renal cell carcinomaRenal cell carcinoma -loss of WHAT gene is associated with this disease?-almost all RCC's show loss of VHL tumor suppressor geneMost common symptom of renal cell carcinoma:-hematuriaurinary bladder tumors can be ___ or ___flat, mucosal thickenings OR papillary protrusions >> both can be invasiveBe able to describe the invasive stages of bladder cancer. (What layers of the bladder are invaded as the tumor progresses?)1. carcinoma in situ 2. papillary tumor in urothelium 3. papillary tumor invading lamina propria 4. papillary tumor invading muscle *detrusor* 5. papillary tumor invading surrounding fat >>> tends to stay localized to bladder, though.