Renal Pathology[1]

7/31/2019 Renal Pathology[1]

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Altered Renal Function


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Clinical features

1-Loin pain

2-Renal ureteric pain

3-Dysurea, oliguria, polyuria,anuria,Nocturia,Frequency,Urinary incontinence

4-Dribbing of urine

5-Hematuria

6-Retension of urine

7-Fever and rigor


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Investigations

1-Urine analysis

2-Ultrasound 3-IVP

4-Renal arteriograph

5-MRI 6-Renal biopsy


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Overview of Kidney Diseases

Classified by site or cause of disease Organization by site:

Prerenal

Intrarenal (Renal)

Postrenal


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Prerenal disease Results from inadequate blood flow to the

kidney Decreased intravascular volume

Lesions in the renal arteries

Hypotension Systemic disorders that decrease urine output

Creatinine clearance? Plasma creatine?

BUN?


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Renal diseases

Result from direct damage to nephron

Glomerular disorders

Tubulointerstitial disorders disorders ofthe medullary tubules and interstitial cells


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Postrenal diseases

Commonly due to urinary tract obstruction

Kidney stones

Tumors of bladder, ureters or prostate gland


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Obstructive Disorders

Interference with urine flow at any point

Anatomic or functional

Impedes flow proximal to blockage

Dilates urinary system

Increases risk for infection

Compromises renal function

Anatomic changes are called obstructiveuropathy


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Causes of obstruction

Congenital malformations

Stones

Abdominal tumor

Tumor of urinary system or prostate

Severe pelvic organ prolapse in women


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Urinary Tract infections

Bacteria most common cause

Can also be due to viruses, fungi or

parasites

Classified by location in system or by

complicating factors


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Cystitis inflammation of the bladder

Urinary frequency Dysuria painful or difficult urination

Urgency

Lower abdominal, lower back or suprapubic

pain


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Incidence Young adult women 0.2/month

Lifetime risk in women 50%

Young adult men prevalence < 1%

High risk groups:

Premature infants

Sexually active women

Women using a diaphragm or spermicide

Diabetics

HIV or immunosuppressive disorders

Obstruction of lower urinary tract


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Treatment

Antibiotics

Drink normal amounts of water, but avoid

bladder irritants, such as caffeine


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Acute pyelonephritis

Inflammation is usually focal, affecting

pelvis, calyces, and medulla but glomerulinot usually involved.

Kidney is infiltrated with wbcs pyuria

Healing involves scarring and atrophy ofaffected tubules


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Acute pyelonephritis Clinical manifestations:

Acute onset Fever or chills

Flank or groin pain

Frequency and dysuria May be difficult to distinguish from cystitis

look for white cell casts

Treatment: Microorganism specific antibiotics


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Chronic Pyelonephritis Manifestations are often minimal-

Hypertension Frequency and Dysuria

Flank pain

Diagnosis Urine analysis

Intravenous pyelography, ultrasound

Treatment Relieve obstruction

antibiotics


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Glomerulonephritis

Caused by a number of factors, mostcommonly abnormal immune response

Infection

Toxins

Vascular diseases

Systemic diseases (diabetes mellitus)


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Acute Glomerulonephritis

Symptoms occur 10-21 days after infection

Hematuria Proteinuria

Decreased GFR, oliguria

Hypertension Edema around eyes, feet and ankles

Ascites or pleural effusion


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Nephrotic Syndrome

Defined as excretion of 3.5 or more grams

of protein / day

Also see hypoalbuminemia, edema,

hyperlipidemia

Decrease in vitamin D


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Nephrotic Syndrome

Treatment:

Diet normal protein, low-fat, salt restricted

Diuretics

Protein supplements


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Renal Failure Acute renal failure abrupt decrease in renal

function Increase in BUN and creatinine

Usually oliguria (output < 30 ml/hour or 400ml/day)

Most cases are reversible if diagnosed and treatedearly

Prerenal most common cause failure to

restore blood volume or pressure and oxygencan lead to acute tubular necrosis or acutecortical necrosis


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Acute Renal Failure

Intrarenal acute renal failure

Usually due to acute tubular necrosis

Usually caused by ischemia most often

after surgery (40 -50 %)

Also sepsis, burns, obstetricalcomplications, antibiotics, radiocontrast

media, other toxic substances

Whatever the cause, get decreased

GFR and oliguria


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Acute Renal Failure

Postrenal acute renal failure

Usually due to urinary tract obstruction that

affects both kidneys

Characterized by several hours of anuria

with flank pain, followed by polyuria

A t R l F il


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Acute Renal Failure Clinical symptoms of ARF are divided into three

stages:Stage1 Oliguria:

urine vol.about 25 % of normal to anuria

can last 1-3 weeksBUN, plasma creatinine

K+ (hyperkalemia) and electrolyte imbalance

fluid retention and edema

congestive heart failure


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Stage 2 Diuresis:

3-4 L/day of urine

Stage 3 Recovery

May take 3-12 months for plasma

creatinine to return to normal

About 30 % never regain normal kidney

function.


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Acute Renal Failure Treatment

Prevention if possible Maintain individuals life until renal function is

recovered

Correct fluid and electrolyte imbalances Treat infections

Maintain nutrition and cardiac function

Remember drugs and/or medications are

not excreted!


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Chronic Renal Failure Progressive and irreversible loss of

nephrons Slow development (years)

Alterations in salt and water balance not

apparent until renal function is less than25% of normal.

Common causes:

Chronic glomerulonephritis

Chronic pyelonephritis


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Chronic Renal Failure Clinical manifestations are often described using the

term uremia

symptoms due to accumulation oftoxins in plasma.

hypertension

Anorexia

Nausea

Vomiting

Diarrhea

Weight loss

Pruritis (itching)

Edema

Anemia

Neurologic changes


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Chronic Renal Failure Diagnosis is by increased BUN and serum

creatinine; imaging will show smallkidneys, and can be confirmed by biopsy

Management includes:

Diet control restrict proteins, potassium Evaluate fluid and sodium levels

Treat with erythropoietin as needed.

Renal Pathology[1]

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