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 Chapter 25 Disorders of Renal Function

 Chapter 25 Disorders of Renal Function. Disorders of Kidney Development. Renal agenesis Renal hypoplasia Renal dysplasia. Cystic Disorders. Genetic Autosomal dominant polycystic kidney disease Autosomal recessive polycystic kidney disease Nephronophthisis Medullary cystic kidney disease

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 Chapter 25 Disorders of Renal Function

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  1.  Chapter 25Disorders of Renal Function

  2. Disorders of Kidney Development • Renal agenesis • Renal hypoplasia • Renal dysplasia

  3. Cystic Disorders • Genetic • Autosomal dominant polycystic kidney disease • Autosomal recessive polycystic kidney disease • Nephronophthisis • Medullary cystic kidney disease • Acquired • Simple cysts • Acquired form of renal cystic disease

  4. Glomerulus • Glomerular capillaries and the Bowman capsule are both made of epithelial cells sitting on a basement membrane. • They are so tightly attached to each other that they share one basement membrane. • The epithelial cells of the Bowman capsule stand up from the basement membrane on foot processes, leaving pores between the feet for filtration.

  5. Immune Mechanisms: Glomerular Disease

  6. Glomerular Damage • Proliferative: number of cells increase. • Membranous: glomerular basement membrane thickens. • Sclerotic: amount of extracellular matrix increases. • All can decrease the efficiency of filtration. • Allow blood cells, lipids, or proteins to pass into the urine.

  7. Question • True or false? • Nephritic syndromes are characterized by blood in the urine.

  8. Answer • True • Rationale: Nephritic syndromes decrease the permeability of the glomerular capillary membrane, which results in hematuria, HTN, oliguria, and ↓GFR.

  9. Disorders of Glomerular Function • Acute nephritic syndromes • Rapidly progressive glomerulonephritis • Nephrotic syndrome • IgA nephropathy • Hereditary nephritis • Chronic glomerulonephritis

  10. Nephritic Syndromes • Inflammatory process damages the capillary wall. • Hematuria with red cell casts, decreased GFR • Acute postinfectious glomerulonephritis. • Proliferative inflammatory response • Azotemia (presence of nitrogenous wastes in the blood), oliguria, cola-colored urine • Rapidly progressive glomerulonephritis. • Goodpasture syndrome.

  11. Nephrotic Syndrome

  12. Nephrotic Syndrome: Proteins in Urine • Albumin  edema and increased free drug • Immunoglobulins and complement  immune suppression • Binding proteins  low ions and hormones • Clotting and anticlotting factors  thrombosis

  13. Scenario A woman with diabetes mellitus: • Has severe edema and frothy, cola-colored urine • Has difficulty breathing, with crackles in both lungs • Just finished a course of antibiotics for strep throat • Is taking corticosteroids for lupus-related arthritis Question: • What are three reasons for her renal problems?

  14. Scenario (cont.) A woman: • Has diabetes mellitus and lupus • Recently had strep throat • Has severe edema and frothy, cola-colored urine Question: • The doctor says the only way to determine what has caused her glomerular disease is a renal biopsy. Why?

  15. Scenario (cont.) • Urinalysis show that she is producing urine • With 500 mg protein/day • Containing blood and RBC casts • With high level of K+ • Blood tests show • Hypoalbuminemia and slightly decreased K+ • She has borderline hypertension Question: • Does she have nephritic syndrome or nephrotic syndrome?

  16. Tubular and Interstitial Disorders • Acute tubular necrosis • Tubulointerstitial nephritis • Pyelonephritis • Acute pyelonephritis • Chronic pyelonephritis • Drug-related nephropathies

  17. Chronic Pyelonephritis

  18. Obstructive Disorders • Hydronephrosis • Renal calculi

  19. Consequences of Dilation of the Renal Tubules or Tract • Expansion of the kidney with urine (hydronephrosis) • Increased pressure inside the renal capsule • Compartment syndrome compresses blood vessels inside kidney • Renal ischemia • Stasis of urine • Risk of infection • Stones

  20. Question • True or false? • Hydronephrosis is categorized as a disorder of glomerular function.

  21. Answer • False • Rationale: Hydronephritis is caused by a urinary obstruction, so it is considered an obstructive disorder. The glomerulus is not involved.

  22. Renal Calculi • Saturation theory: Urine is supersaturated with stone components. • Matrix theory: Organic materials act as a nidus for stone formation. • Inhibitor theory: A deficiency of substances that inhibit stone formation.

  23. Four Types of Renal Calculi • Calcium stones (i.e., oxalate or phosphate) • Magnesium ammonium phosphate stones • Uric acid stones • Cystine stones

  24. Renal Calculi (cont.)

  25. Malignant Kidney Tumors • Embryonic kidney tumors • That is, Wilms tumor, nephroblastoma • Childhood • Renal cell carcinoma • Adulthood

  26. Wilms Tumor of the Kidney

  27. Renal Cell Carcinoma of the Kidney

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