1. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 25 Disorders of Renal Function

2. Copyright © 2015 Wolters Kluwer All Rights Reserved Disorders of Kidney Development Renal agenesis Renal hypoplasia Renal dysplasia

3. Copyright © 2015 Wolters Kluwer All Rights Reserved 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. Copyright © 2015 Wolters Kluwer All Rights Reserved 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. Glomerulus

5. Copyright © 2015 Wolters Kluwer All Rights Reserved Immune Mechanisms: Glomerular Disease

6. Copyright © 2015 Wolters Kluwer All Rights Reserved 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. Copyright © 2015 Wolters Kluwer All Rights Reserved Question True or false? Nephritic syndromes are characterized by blood in the urine.

8. Copyright © 2015 Wolters Kluwer All Rights Reserved Answer True Rationale: Nephritic syndromes decrease the permeability of the glomerular capillary membrane, which results in hematuria, HTN, oliguria, and ↓ GFR.

9. Copyright © 2015 Wolters Kluwer All Rights Reserved Disorders of Glomerular Function Acute nephritic syndromes Rapidly progressive glomerulonephritis Nephrotic syndrome IgA nephropathy Hereditary nephritis Chronic glomerulonephritis

10. Copyright © 2015 Wolters Kluwer All Rights Reserved 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. Copyright © 2015 Wolters Kluwer All Rights Reserved Nephrotic Syndrome

12. Copyright © 2015 Wolters Kluwer All Rights Reserved 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. Copyright © 2015 Wolters Kluwer All Rights Reserved 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. Copyright © 2015 Wolters Kluwer All Rights Reserved 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. Copyright © 2015 Wolters Kluwer All Rights Reserved 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. Copyright © 2015 Wolters Kluwer All Rights Reserved Tubular and Interstitial Disorders Acute tubular necrosis Tubulointerstitial nephritis Pyelonephritis –Acute pyelonephritis –Chronic pyelonephritis Drug-related nephropathies

17. Copyright © 2015 Wolters Kluwer All Rights Reserved Chronic Pyelonephritis

18. Copyright © 2015 Wolters Kluwer All Rights Reserved Obstructive Disorders Hydronephrosis Renal calculi

19. Copyright © 2015 Wolters Kluwer All Rights Reserved 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. Copyright © 2015 Wolters Kluwer All Rights Reserved Question True or false? Hydronephrosis is categorized as a disorder of glomerular function.

21. Copyright © 2015 Wolters Kluwer All Rights Reserved Answer False Rationale: Hydronephritis is caused by a urinary obstruction, so it is considered an obstructive disorder. The glomerulus is not involved.

22. Copyright © 2015 Wolters Kluwer All Rights Reserved 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. Copyright © 2015 Wolters Kluwer All Rights Reserved Four Types of Renal Calculi Calcium stones (i.e., oxalate or phosphate) Magnesium ammonium phosphate stones Uric acid stones Cystine stones

24. Copyright © 2015 Wolters Kluwer All Rights Reserved Renal Calculi (cont.)

25. Copyright © 2015 Wolters Kluwer All Rights Reserved Malignant Kidney Tumors Embryonic kidney tumors –That is, Wilms tumor, nephroblastoma –Childhood Renal cell carcinoma –Adulthood

26. Copyright © 2015 Wolters Kluwer All Rights Reserved Wilms Tumor of the Kidney

27. Copyright © 2015 Wolters Kluwer All Rights Reserved Renal Cell Carcinoma of the Kidney