An 8-month-old male infant presents with progressive renal and hepatic failure. Despite intensive medical therapy, the infant dies. At the time of autopsy, the external surfaces of his kidneys are found to be smooth, but cut section reveals numerous cysts that are lined up in a row. Which of the following is the mode of inheritance of this renal abnormality? •
A. Autosomal dominant b. Autosomal recessive c. X-linked dominant d. X-linked recessive e. Mitochondrial
An 8-month-old male infant presents with progressive renal and hepatic failure. Despite intensive medical therapy, the infant dies. At the time of autopsy, the external surfaces of his kidneys are found to be smooth, but cut section reveals numerous cysts that are lined up in a row. Which of the following is the mode of inheritance of this renal abnormality? •
A. Autosomal dominant b. Autosomal recessive c. X-linked dominant d. X-linked recessive e. Mitochondrial
An 8-month-old male infant presents with progressive renal and hepatic failure. Despite intensive medical therapy, the infant dies. At the time of autopsy, the external surfaces of his kidneys are found to be smooth, but cut section reveals numerous cysts that are lined up in a row. Which of the following is the mode of inheritance of this renal abnormality? •
A. Autosomal dominant b. Autosomal recessive c. X-linked dominant d. X-linked recessive e. Mitochondrial
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Dilated kidney tubules that do not open into the renal pelvis lead to _______; the condition is congenital. granular contracted kidneys hydronephrosis polycystic kidneys renal calculi
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Healthy nephrons do not filter red blood cells or __________ into the Bowman's capsule. Salts Acids Nutrients protein
The kidneys regulate _______________ balance under the influence of aldosterone and antidiuretic hormone. sugar pH salt and water potassium
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Loss of production of urine is called _________. oliguria anuria polyuria uremia
Which of the following is the most likely cause of the clinical combination of generalized edema, hypoalbuminemia, and hypercholesterolemia in an adult whose urinalysis demonstrated marked proteinuria, with fatty casts and oval fat bodies? •
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a. Nephritic syndrome b. Nephrotic syndrome c. Acute renal failure d. Renal tubular defect e. Urinary tract infection
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Nephrotic syndrome
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Nephritic syndrome •
Edema is due to marked hypoalbuminemia Edema is due to salt & water retension. The main pathogenesis is defective permeability function of glomerular capillaries. The main pathogenesis is obstruction of capillary lumens by prolferating cells.
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Hyaline casts Red blood casts. Fat casts Neutrophil casts Granular casts
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Coagulated protein + degenerated cells Coagulated protein + RBCs. Coagulated protein + Fat globules. Coagulated protein Coagulated protein + neutrophils
Only certain proportion of the glomeruli seen in the biopsy are globally involved .
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Focal global
only a segment of the glomerulus is affected
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All or at least more than 80% of the glomeruli seen in the biopsy are globally affected
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Focal segmental
When all or at least more than 80% of the glomeruli seen in the biopsy is affected with only a segment of the glomerulus is affected
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Only certain proportion of the glomeruli seen in the biopsy is involved and only a segment
of the glomerulus is affected
Diffuse global
Segmental
Diffuse
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Minimal change
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FSGS.
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Membranous nephropathy.
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Mainly in children
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Mainly in adults.
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Any age
Membranoproliferative GN.
Post streptococcal GN. Proliferative GN.
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Minimal change
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Focal segmental glomeruosclerosis. •
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Membanous nephropathy. Membranoproliferative GN.
Crescentic GN.
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Proliferation of parietal epithelial cells Subepithelial deposits. Partial sclerosis of some glomeruli. Hypercellularity with thickened BM.
Fusion of foot processes alone.
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Minimal change.
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Subepithelial deposits.
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FSGS.
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No deposits
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Membranous nephropathy. Segmental deposits.
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Post streptococcal GN.
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MPGN type I.
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MPGN type II. •
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MPGN type III.
Dense intramembranous deposits. Subepithelial humps. Subendothelial deposits & mesangial interposition.
Both subepithelial & Good Pasture’s syndrome subendothelialdeposits. •
Anti GBM disease
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Linear capillary deposits.
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Extensive subendothelial deposits.
A sudden drop in urinary output marks the onset of _______ renal failure.
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chronic diabetic acute lethal
True or False
Which of the following statements are true? - membranous nephropathy may be associated with malignancy - focal segmental glomerulosclerosis never causes renal impairment or renal failure - minimal change nephropathy is usually associated with arthralgia - minimal change nephropathy often responds to steroid treatment
In a patient with the nephrotic syndrome, which of the following are true? •
the patient cannot be pregnant
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hyperlipidemia is a common finding
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the kidney does not secrete enough sodium
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minimal change nephropathy is the commonest cause if the patient is a child membranous nephropathy can be excluded on the basis of a good history
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True or false Acute renal failure usually can be successfully treated. Acute glomerulonephritis is characterized by periods of remission and exacerbation. Kidney stones always produce pain as one of their symptoms. Artificial cleansing of the blood during a period of kidney failure is accomplished by use of dialysis.
Bacteria, viruses, or chemicals can cause inflammation of the urethra (urethritis) in both men and women.
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Many changes are made in the fluid entering Bowman's capsule before it finally becomes urine. Normally, a moderate amount of protein is lost through the kidneys each day. The sudden onset of oliguria or anuria may be a sign of chronic renal failure. Renal failure, whether chronic or acute, may result in the accumulation of nitrogen-containing wastes in the blood.
Match the following words or phrases with the correct definition 1. a clinical syndrome of rapidly progressing renal failure 2. a glomerulonephritis which affects the entire glomerulus 3. a glomerulonephritis affecting some, but not all glomeruli 4. inflammation of blood vessels 5. a glomerulonephritis with abnormal proliferation of cells within the glomerulus
a. focal glomerulonephritis b. global glomerulonephritis c. vasculitis d. proliferative glomerulonephritis e. rapidly progressive glomerulonephritis
In a patient with glomerulonephritis, link the following clinical findings with the correct suggested underlying diagnosis 1. systemic a. severe hemoptysis and high levels of plasma antibodies to vasculitis glomerular basement membrane 2. Goodpasture's b. a recent sore throat, edema, disease haematuria and renal impairment 3. systemic lupus c. a young woman with a facial skin erythematosus rash, arthralgia and antibodies to double stranded DNA 4. post infectious glomerulonephritis d. rapidly progressive renal failure
and high levels of plasma antineutrophil cytoplasmic antibodies (ANCA)
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In suppurative pyelonephritis, blood, albumin, casts, and _________ are found in the urine. sugar pus water acid
Case Studies
Case 1 •
A patient aged 15 years feels tired, and experiences chills and fever. She has lost her appetite, and she notices her ankles are swelling. Her condition does not improve after a few days of rest, so she goes to her doctor. Patient history reveals that she had a very sore throat a few weeks earlier, but she did not seek treatment for it and recovered spontaneously. Other than that, she has been healthy for the past six months. Examination includes a urinalysis, and both blood and casts are present. There is no glycosuria, but there is albuminuria.
Case 1 •
A patient feels tired, and experiences chills and fever. She has lost her appetite.
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she notices her ankles are swelling (mild edema).
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Her condition does not improve after a few days of rest, so she goes to her doctor (persistent edema).
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Patient history reveals that she had a very sore throat a few weeks earlier, but she did not seek treatment for it and recovered spontaneously (sore throat then a latent period).
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Other than that, she has been healthy for the past six months (No past history of illness).
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Examination includes a urinalysis, and both blood and casts are present. There is no glycosuria, but there is albuminuria. (hematuria & blood casts)
Case 1 (continued) •
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What disease does her doctor suspect? What signs support those suspicions? What was the probable cause of the sore throat she had earlier? How does that relate to her present condition? Name the etiology and describe the pathogenesis of her disease. Are there bacteria growing in her kidneys? How is this condition related to immune or incompatible tissue reactions? What is the prognosis?
Case -2•
A 3 years old girl presented with generalised edema shortly after recovery from upper respiratory tract infection. Laboratory studies revealed marked albuminuria, hypoalbuminemia , hypercholesterolemia. Prior similar episode responded to steroid medication. The most likely diagnosis is :
Case -2A 3 years old girl (child) presented with generalised edema shortly after recovery from upper respiratory tract infection. (generalised edema ) Laboratory studies revealed marked albuminuria, hypoalbuminemia , hypercholesterolemia. Prior similar episode (exacerbation & remissions) responded to steroid medication. The most likely diagnosis is : •
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Case -2- (continued) •
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(A) Focal segmental glomerulosclerosis. (B) Membranous glomerulonephritis. (C) Minimal change disease. (D) Post streptococcal GN. (E) Rapidly progressive GN.
Case -3A 35-year-old woman recovering from hepatitis B develops generalised edema, proteinuria, and fat casts in the urine. Which one of the following statements best describes the expected renal changes in this patient? a. Plasma cell interstitial nephritis b. IgG linear fluorescence along the glomerular basement membrane c. Diffuse thickening of the glomerular basement membrane by subepithelial immune deposits d. Nodular hyaline glomerulosclerosis
Case -3•
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A 35-year-old woman recovering from hepatitis B develops generalised edema, proteinuria, and fat casts in the urine. (Nephrotic syndrome)
Case -3- (cont) Which one of the following statements best describes the expected renal changes in this patient? a. Plasma cell interstitial nephritis b. IgG linear fluorescence along the glomerular basement membrane c. Diffuse thickening of the glomerular basement membrane by subepithelial immune deposits d. Nodular hyaline glomerulosclerosis
Case -4A 60 years old man has multiple osteolytic bony lesions in the skull, pelvis & sternum. After 3 months he developed generalised edema. Urine examination revealed proteinuria. Renal biopsy revealed hyaline deposits •
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What is the nature of the bony lesion. What is the nature of the renal lesion. What special stains you should do to confirm your diagnosis.
Case -5A 10 years old boy had an opened infected fracture of his lower 1/3 femur. After one year of persistant infection he developed generalised edema. Urine examination revealed proteinuria. •
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Renal biopsy revealed hyaline deposits. What is the nature of the bony lesion. What is the nature of the renal lesion. What special stains you should do to confirm your diagnosis.
Case – 6Histologic sections of a kidney reveal patchy necrosis of epithelial cells of both the proximal and distal tubules with flattening of the epithelial cells, rupture of the basement membrane (tubulorrhexis), and marked interstitial edema. Acute inflammatory cells are not seen. Which of the following is the most likely diagnosis? •
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a. Acute pyelonephritis b. Acute tubular necrosis c. Chronic glomerulonephritis d. Chronic pyelonephritis e. Diffuse cortical necrosis
Case -7•
A 35-year-old woman presents with the sudden onset of severe, colicky pain on the right side of her abdomen. She does not relate the pain to food, Physical examination finds marked tenderness over the right costovertebral angle, but rebound tenderness is not present. A pelvic examination is unremarkable. Microscopic examination of her urine reveals the presence of numerous red blood cells. The urine is negative for esterase and nitrite, and no bacteria are seen. Urine PH is acidic Which of the following is the most likely cause of her signs and symptoms?
Case -7•
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A 35-year-old woman presents with the sudden onset of severe, colicky pain ( Stone or colitis ) on the right side of her abdomen. (appendix , gall bladder , right renal , right colitis or right ovarian) She does not relate the pain to food ( Not colitis) but rebound tenderness is not present (not appendicitis). A pelvic examination is unremarkable (not ovarian). marked tenderness over the right costovertebral angle (renal ),
Case -7•
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The urine is negative for esterase and nitrite, and no bacteria are seen (not associated with urinary tract infection). Urine PH is acidic ( not due to infection with E-coli) Microscopic examination of her urine reveals the presence of numerous red blood cells (renal stone that causes bleeding Metabolic especiall oxalate stone)
