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22 Pathophysiology of the Urinary System Cheat Sheet by

Chronic kidney disease, diabetic nephropathy, glomerulonephritis, nephrotic syndrome, nephritic syndrome, hypertensive nephropathy

Chronic kidney Disease

Defini­tion:
- Gradual loss of kidney function
- Advanced disease can cause dangerous levels of fluid, electr­olytes & wastes build up in the body
- Also called chronic kidney failure
- Black, Native American & Asian American are more at risk
Risk factor­s/c­auses:
- Diabetes
- Hypert­ension & cardio­vas­cular diseases
- Glomerulonephritis
- Polycystic kidney disease (inherited)
- Smoking & drug abuse
- Obesity
- Age
- Family Hx of kidney disease
Pathop­hys­iology & mechanism: Causes → ↓ number of nephrons → activation of vasoactive mediators, cytokines, RAAS, growth factors → structural & functional changes of surviving nephrons → hyperf­ilt­ration → ↑ intrag­lom­erular capillary pressure → accele­rated sclerosis of remaining nephrons → ↓ number of nephrons
Signs & symptoms:
- Nausea/vomiting
- Loss of appetite
- Freque­nt/­dif­ficulty urinating
- Foamy urine
- Ammoni­a-s­melling breath
- Fatigue & weakness
- Ankle & feet swelling
- Anaemia
- Hypoca­lcaemia (↓ calcium)
- Hyperp­hos­pha­temia (↑ phosphate)
- Metabolic acidosis
- Hyperk­alaemia (↑ potassium)
Treatment: Medication or surgery (kidney transp­lant)

Chronic Kidney Disease

Glomer­ulo­nep­hritis

Defini­tion: Inflam­mation & damage of the tiny filters (glome­ruli) in the kidneys (autoi­mmune origin)
Risk factor­s/c­auses:
- Infections
- Autoimmune
- Vasculitis
- Sclerotic conditions
- Inherited
- Cancers
Signs & symptoms:
- Nausea/vomiting
- Fatigue
- Less urination
- Pink or cola-c­oloured urine
- Foamy urine
- Hypertension
- Oedema (fluid retention)
Compli­cat­ions:
- Accumu­lation of wastes or toxins in the bloodstream
- Poor regulation of essential minerals & nutrients
- Loss of red blood cells
- Loss of blood proteins
Treatment: Therapies for associated kidney failure

Nephritic Syndrome

Defini­tion: Inflam­mation of the glomeruli (glome­rul­one­phr­itis) & renal dysfun­ction
Risk factor­s/c­auses:
- Immuno­logical (IgA nephro­pathy, tend to occur post-infection)
- Within the course of autoimmune disease (Lupus nephritis)
- Kidney disease (causes by many different bacteria, viruses, fungi, parasites, systemic, etc.)
Pathop­hys­iology & mechanism: Deposition of immune complexes (antibody + antigen) or antibodies triggers inflam­mation with leukocyte infilt­ration → injurs cells & degrades the glomerular basement membrane (GBM) → leakage of erythr­ocytes (RBC) + some protei­nuria → S/Sx
Signs & symptoms:
- Blurred vision
- Hypertension
- Oliguria (low urine output)
- Haematuria (blood in urine)
- Proteinuria
- Azotemia (↑levels of nitrog­en-­con­taining substance)
Treatment: Medication & surgery (kidney transp­lant)

Nephritic Syndrome

 

Diabetic Nephro­pathy

Defini­tion: Glomerular loss (glomeruli [filtr­ation] malfun­ction) & secondary disease to diabetes
Risk factor­s/c­auses:
- Hyperg­lyc­aemia (↑ blood sugar)
- Hypertension
- Smoking
- Obesity
- Family Hx of diabetes & kidney disease
- ↑ blood choles­terol
Pathop­hys­iology & mechanism: ↑glucose levels → ↑blood volume, pressure & renal perfusion → damages the blood vessels (form glomeruli) → leaky vessels → extrav­asation of blood proteins (spilt into the capsule)
Signs & symptoms:
- Nausea
- Loss of appetite
- Fatigue/insomnia
- Swollen ankles, feet & hands
- Dry/itchy skin
- Difficulty concen­trating
Treatment: Medication or surgery (kidney transp­lant)

Diabetic Nephro­pathy

Nephrotic Syndrome

Defini­tion: [Sate of kidney failure] Kidney disorder that causes the body to pass too much protein in the urine (heavy protei­nuria 3.0g/24 hours)
Risk factor­s/c­auses:
- Metabolic
- Immunological
- Idiopathic/primary
- Neoplastic
- Medica­tio­n/drug use
- Infection
- Allergic
- Genetic syndromes
Pathop­hys­iology & mechanism: Podocyte injury → podocyte damage, effacement (thinn­ing), & detachment from the basement membrane → proteins leak through the filtration membrane → enter urine → S/Sx
Signs & symptoms:
- Oedema (starts in the face, spreads peripheral)
- Vomiting
- Pale skin/fissures
- Foamy urine (excess protein)
- Fatigue
- Loss of appetite
- Weight gain (fluid retention)
Compli­cat­ions:
- Tachyc­ardia (↑BPM)
- Hyperl­ipi­demia (↑lipid levels)
- Protei­nuria (↑protein in urine)
- Blood clots (blood proteins help prevent them)
Treatment: Medication & surgery (kidney transp­lant)

Nephrotic Syndrome

Hypert­ensive Nephro­pathy

Defini­tion: Progre­ssive kidney damage due to long-term, poorly controlled high blood pressure
Risk factor­s/c­auses: Hypert­ension & lesion = arteriolar nephro­scl­erosis
Pathop­hys­iology & mechanism: Hypert­ension → thickening of Bowman's capsule & nephron capill­aries due to cell prolif­eration (accum­ula­tion) & collagen deposition → ↑glome­rular pressure → ↓renal blood flow → alteration in inflam­matory profile of different cells → ↓perme­ability & filtration → glomerular sclerosis → hypert­ensive nephro­pathy
Signs & symptoms:
- Nausea/vomiting
- Loss of appetite
- Itching
- Confusion
Compli­cations of persistent ↑ BP:
- Brain (strokes, hypert­ensive encephalopathy)
- Blood (↑ sugar levels)
- Eye retina (Hyper­tensive retinopathy)
- Heart (MI, hypert­ensive cardiomyopathy)
- Kidneys (hyper­tensive nephro­pathy)

Hypert­ensive Nephro­pathy

 

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