Lecture 5 - Renal and Metabolic Disease

a group of kidney diseases that damage the glomeruli, the kidney's filtering units

Acute/chronic glomerular nephritis;

kidney conditions that have an identifiable underlying cause, such as an infection or systemic disease

Toxic or infectious substances

Result from toxic or infectious substances

Caused by a reduction in renal perfusion that induces morphologic and functional changes in kidney.

immunologic, metabolic, and hereditary

Immune mediated

Increased numbers of endothelial and other cells in glomerular tuft

drawn by a local chemotactic response

includes any process that results in enlargement of basement membrane (immune complexes and diabetes)

GFR

Oliguria - more water in the blood and hypertension: can't filter the blood well

WBC, albumin, RBCs

blood in urine

condition in which you have too much nitrogen, creatinine and other waste products in your blood.

loss of protein (albumin) in blood vessel
water comes out of the capillary tubes and goes TO the tissue and causes inflammation and hypertension (oncotic pressure).

Heavy proteinuria (≥3 g/day)

a kidney disease that causes the kidneys to leak too much protein into the urine

Hypoalbuminemia - loss of albumin

LIPIDS: hyperlipidemia/ lipiduria (oval fat bodies)

when the filtering units of the kidney are damaged

diseases that affect tubules and interstitium.

a clinical syndrome that presents as
1.Hematuria2.Oliguria3.Azotemia4.Hypertension

decreased glomerular filtration rate, manifested clinically as oliguria and azotemia

result of fluid retention and increased renin released from ischemic kidneys.

inflammation of the tiny filters in the kidneys (glomeruli).

Outlook: Acute nephritic syndrome.
Pathogenesis: Antibody mediated.

Cellular proliferation (diffuse), leukocytic infiltration, interstitial swelling.

Outlook: Acute nephritic syndrome.
Pathogenesis: Antibody mediated; often anti-GBM.

Cellular proliferation to form characteristic "crescents"; leukocytic infiltration, fibrin deposition, GBM disruptions.

Outlook: Nephrotic syndrome.
Pathogenesis: Antibody mediated.

Basement membrane thickening due to immunoglobulin (Ig) and complement (C) deposits, loss of foot processes (diffuse).

Outlook: Nephrotic syndrome.
Pathogenesis: T-cell immunity dysfunction, loss of glomerular polyanions.

Loss of foot processes.

Outlook: Proteinuria variable; subnephrotic to nephrotic.
Pathogenesis: Unknown; possibly a circulating systemic factor; can reoccur after kidney transplant.

Sclerotic glomeruli with hyaline and lipid deposits (focal and segmental); diffuse loss of foot processes; focal IgM and C3 deposits.

Outlook: Depends on type, either nephrotic syndrome or hematuria/proteinuria. Pathogenesis: Immune complex or complement activation.

Cellular proliferation (mesangium); leukocytic infiltration; IgG and complement deposits.

Outlook: Recurrent hematuria and proteinuria.
Pathogenesis: IgA mediated; complement activation.

Deposition of IgA in mesangium; variable cellular proliferation.

Outlook: Chronic renal failure.
Pathogenesis: Variable.

Hyalinized glomeruli.

Autoimmune disorder with immune complex deposits

Carbohydrate metabolism disorder due to lack of insulin or cellular resistance to insulin

Group of systemic diseases involving many organs; characterized by deposits of amyloid, a pathologic protein substance.

a type of acute kidney injury (AKI) that occurs when the kidneys are damaged due to a lack of blood flow and oxygen
Seen in sepsis, shock, trauma

occurs when the tubular cells are exposed to a toxic substance
From exogenous or endogenous nephrotoxins

dysfunction in proximal tubules; aminoacids excreted in urine due to exposure to lead or hereditary disease

a rare condition in which too much of the simple sugar glucose is removed through the urine.

when the kidneys do not remove acids from the blood into the urine as they should.
renal tubules become acidic because of the impaired ability to exchange sodium and potassium.

upper and lower

E. coli

Women > Men

Bacterial kidney infection

infection caused by Backflow of urine from bladder to kidney

is characterized by the presence of inflammatory infiltrates and edema within the interstitium

a fungal infection caused by an overgrowth of the yeast Candida

Sudden decrease in glomerular filtration rate (GFR), azotemia, and oliguria.

Progressive loss of renal function

Functional abnormality; but no cellular changes

hypertrophy of remaining healthy nephrons, not clinically recognizable until 80% to 85% function lost

obstruction of urethra

decrease blood flow to kidney

damage to epithelial cells

End-stage renal disease

also known as kidney stones, are solid masses of minerals and salts that form in the kidneys
Aggregates of mineral salts in a matrix of proteins and lipids

>75%

calcium

A person that lives a sedentary life has an increased concentration of urine; therefore, calcium/salts form crystals or stones.

having the same or constant pH, or the same concentration of hydrogen ions

Cystine stones

UTI

Cystinosis. forms crystals first and then stones

body can’t break down certain amino acids for whatever reason

): inherited and where there is not enough BCKAD enzyme to break down isoleucine and leucine and valine; Amino acids accumulate in brain (children’s brain is damaged). Babies develop sleepiness or irritability. Screened at the newborn stage.

rare inherited disorder that causes an amino acid called phenylalanine to build up in the body.

black urine disease, is a very rare inherited disorder that prevents the body fully breaking down two protein building blocks: tyrosine and phenylalanine

a condition where there is an abnormally high level of tyrosine in the urine

a medical condition that refers to the presence of dark-colored urine due to an increased amount of melanin or its precursors in the urine.

Phenylalanine can't convert to tyrosine which causes pigmentation in eyes, skin

PKU
Albinism
Creatinism
Tyrosinosis
Alkaptonuria

Alkaptonuria

mutation of certain gene that affects melanin production.

urine becomes oxidized in the air

a condition of abnormal mental and physical development resulting from a deficiency of thyroid hormone in fetal or early life

Pancrease can't produce insulin. genetics; low production of the insulin by the pancrease, glucose stays in the blood

90% (no receptors on cells) occurs mostly after age 30; obesity; solute diuresis; solute in urine; has glucose and salt.

Liver disorder; increase porphryins; skin is photosensitive; color of urine is purple.