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Visceral pain from the kidney is referred to...
the flank
Uretic referred pain is felt...
intensely from the flank to external genitalia down anterior thigh
Cystic Kidney Diseases (2)
PKD, simple renal cysts
Congenital or acquired disorders of kidney leading to cyst formation that causes parenchymal distortion and dysfunction
Polycystic Kidney Disease (PKD)
____% of all end stage kidney disease is attributed to PKD
10
50% of pts with PKD have end stage dz by age _____.
60
Genes associated with PKD
APKD 1 and 2
BILATERAL inc. in kidney size; cysts filled with ultrafiltrate; inc. cyst size cause inc. pressure and loss of renal parenchyma
Adult PKD
Associated with hepatic cysts and cerebral aneurysms
Adult PKD
Common Acquired lesions of the kidney
Simple Renal Cysts
70% of all renal masses are these
Simple Renal Cysts
Simple renal cysts are present in ____% of patients > ____ yo
50, 50
Rarely produce sxs; solitary or multiple; USUALLY FOUND ON CORTEX
Simple Renal Cysts
Simple Renal Cysta must be differentiated from...
Malignancy, abscess, PKD
Renal Failure (2)
Acute, Chronic
Rapid Dec. in GFR, increase in [BUN] and [Creatinine]
Acute Renal Failure (ARF)
End stage Renal Dz characterized by uremia d.t. chronic state of severe inc. in [BUN]
Chronic Renal Failure
T/F In Acute Renal Failure, the problem lies AT the kidney.
False. d.t. Pre-Renal Etiology
MCC of ARF (prerenal)
dec renal blood flow d.t. HYPOTN
Other Causes: structural lesions in renal artery, drug effects
ARF (Pre Renal Azotemia)\\\\
Normal [BUN] and [Creatinine]
8-20 (24); 0.5-1.1 (1.2)
BUN: Creatinine >20:1
ARF (Pre Renal Azotemia)
3 Classes of Renal Failure
Pre Renal, Intra Renal, Post Renal
In PreRenal Azotemia, why would you expect a low renal excretion of sodium? (FEna <1%)
Problem not at kidney.. still functioning working to filter sodium out of urine
Direct damage to Glomerulus and/or tubules due to inflammatory dzs or Acute Tubular Necrosis
ARF (intrarenal)
Severe tubular dysfunction secondary to ischemia or direct toxic injury
ARF (intrarenal)
Most common cause of intrinsic renal failure
Tubular Injury
UA: Granular casts, tubular epithelial cells and epithelial casts
ARF (intrarenal)
BUN:Cr <20:1 FEna >1%
ARF (intrarenal)
LCC/type of ARF
Post Renal
Caused by urinary tract obstructions such as kidney stones and structural lesions
ARF (Post Renal)
Structural lesions that can cause post-renal ARF
Tumor, prostatic hyperplasis, strictures
BUN: CR >20:1; FEna variable
ARF (post renal)
Inflammatory Dzs that can cause Intrarenal ARF
Vasculitis or GN
Intrarenal ARF due to Acute Tubular Necrosis secondary to these conditions
Rhabdomyolysis or Drugs
MCC of chronic renal failure
DM
Overtime, chronic renal failure can lead to....
glomerulus sclerosis
Fibrosis and scarring of the glomerulus
glomerulus sclerosis
dec. GFR leading to inc. PO4 -2 retention
Osteodystrophy
In osteodystrophy, inc. in PO4-2 binds ______, causing a _____ in serum [___]
Ca+2, dec. Ca+2
Dec. in serum ionized [Ca+2] can lead to ________________ as seen in _____________________.
hyperparathyroidism, Osteodystrophy
Hyperparathyroidism (dt osteodystrophy) can lead to inc. bone ________ and _________, and can also _____ vit. D
resorption, osteomalacia, dec.
In osteodystrophy, dec in _______ can lead to anemia of chronic dz.
Erythropoietin
Glomerular Syndromes (2)
Non Inflammatory (nephrotic syndrome); Inflammatory (Nephritic Syndrome)
Nephrotic syndrome proteinuria must be > ________
3.5g/24hrs
Nephrotic syndromes usually caused by
Noninflammatory glomerulopathies
In unilateral leg edema suspect..
DVT or outflow obstruction
Major causes of Nephrotic Syndrome in adults...(3)
Membranous glomerulopathy, Glomerulopathy from systemic dz, Focal glomerulosclerosis
Glomerulopathy from systemic dz (2)\\\\
DM, amyloidosis
Major causes of Nephrotic syndrome in kids...(4)
Minimal change dz, focal segmental glomerulosclerosis, membranous glomerulopathy, glomerulopathy from systemic dz
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