Acquired Kidney Pathologies

Acquired Kidney Pathologies

Disease / Description
Renal osteodystrophy / Hypocalcemia, hyperphosphatemia, dec. functional Vitamin D
2O parathyroidism leads to subperiosteal bone thinning
Diffuse cortical necrosis / Cortical infarction, both kidneys (spares medullas)
Due to vasospasm, DIC (obstetric issues, septic shock)
Renal papillary necrosis / Sloughing of necrotic papilla
Gross hematuria/proteinuria
Sickle cell disease, urinary obstruction, acute pyelo., analgesics, diabetes
Acute Kidney Injury
Acute renal function decline
Inc. creatinine and BUN / Type / Mechanism / Causes / Consequences:
(AKI or CKD)
Prerenal / Dec. RBF -> dec. GFR
Inc. BUN/creatinine ratio
Dec. FENa / Hypotension / Metabolic acidosis
(Unable to excrete acid)
Dyslipidemia
Hyperkalemia
(Unable to excrete K+)
Uremia (Inc. BUN)
(Pericarditis, asterixis, nausea,
encephalopathy, platelet dysfxn)
Na/H2O retention
(Unable to excrete)
Growth retardation
(Loss of needed metabolites)
EPO failure (anemia)
Renal osteodystrophy
(Dec. Vitamin D production)
Intrinsic
ATN, acute glomerulonephritis, acute interstitial nephritis
Tubule obstruction, fluid backflow, dec. GFR, dec. BUN/creatinine ratio
Granular (muddy brown) casts (sloughed tubule cells), inc. FENa
Acute
Tubular
Necrosis
(ATN)
1.inciting
2.Maintenance
3. Recovery / Ischemic / Dec. renal blood flow
Tubular ischemia
PCT, TAL susceptible / Hypotension
Shock/sepsis
Hemorrhage
Toxic / Toxic necrosis
PCT susceptible / Myoglobinuria
Radiocontrast agent
Lead
Cisplatin
Aminoglycosides
Acute
Interstitial
Nephritis
(AIN) / Interstitial inflammation
Eosinophil pyuria
Azotemia
Drugs are haptens
2O to infection/autoimmune / Penicillins
Diuretics
PPIs
Sulfonamides
Rifampin
NSAIDs
Postrenal / Outflow tract obstruction
Must be bilateral
BUN/creatitine varies
Inc. FENa / BPH
Stones
Neoplasia

Renal cancers

Cancer / Presentation / Morphology/Causes
Renal cell
(PCT cells) / Hematuria
Palpable mass
Flank pain / Polygonal clear cells
(lipids, carbs)
Golden yellow
Oncocytoma
(collecting duct) / Hematuria
Abdominal mass
Flank pain / Well circumscribed mass
Central scar
Eosinophilic cells
No perinuclear clearing
WIlms
(WAGR complex)
(Denys-Drash)
(Beckwith-Wiedemann) / Palpable flank mass
Hematuria / Embryonic glomerular structures
Transitional cell
(renal pelvis to bladder) / Hematuria / Phenacetin
Smoking
Aniline dyes
Cyclophosphamide
Squamous cell
(bladder) / Hematuria / Schistosoma haematobium
Chronic cystitis
Smoking
Nephrolithiasis

Incontinence types

Type / Notes / Treatment
Overflow / Incomplete emptying
Leak w/ overfilling
Urinary retention / Catheterization
Relieve obstruction
(a-blockers)
Urge / Overactive bladder
Leak w/ urge to void immediately / Kegel
Bladder training
Antimuscarinics
Stress / Outlet incompetence
Leak w/ inc. abdominal pressure
Bladder stress test + / Kegel
Weight loss
AUS implantation