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Chapter 14 Renal Diseases Glomerular Disease: -- Glomerulonephritis (GN) is one of the most common reasons for renal failure.

--GN is caused by a variety of primary and secondary glomerular diseases. We are concerned with the primary diseases. See Table 14-1. -- Immune rxns underlie most causes of primary GN. 2 forms Ab mediated injury established: a. Type III HS, immune complex disease from circulating immune cmplxs, Fig.14-3-A, and

TUBULAR DISEASES & INTERSTITIAL DISEASES

Acute pyelonephritis Most retrograde gram (-) organisms i.e. E. coli. May occur from catheters. Vesicoureteral reflux in children. Causes: obstruction, instrumentation, reflux, pregnancy. Up to age 40, more common in females. Ascending vs. hematogenous infections. (Fig. 14-14)

b. Injury from Ab reacting with in-situ glomerular antigens. Fig. 14-3-B.

Chronic pyelonephritis & Reflux Nephropathy Obstruction and chronic reflux. One or both kidneys may be involved. Deep scars. First sign frequently hypertension (benign nephrosclerosis).

Clinical Manifestations of Glomerular Diseases (Fig. 14-1) Nephrotic syndrome: heavy proteinuria, hypoalbuminemia, severe edema, hyperlipidemia, lipiduria 2 Examples 1. Lipoid Nephrosis:

Drug-Induced Interstitial Nephritis (Acute) oliguria or a rise in serum creatinine levels common signs. Associated with synthetic antibiotics, NSAIDs. May be both a type I (IgE) and a type IV response

Analgesic nephropathy (Chronic) papillary necrosis. NSAIDs (asp, phenacetin, acetaminophen, caffeine combos) 2. Membranous glomerulonephritis: Nephritic syndrome: hematuria, oliguria, mild proteinuria, azotemia, edema, hypertension Example acute post-Streptococcal GN: Chronic GN: This is the end result of several glomerular diseases. A non-specific end point. Results in ... 30-50% of dialysis or transplantation. 20-25% occur w/o previous history of renal disease.

Acute Tubular Necrosis A lot of causes - Mostly REVERSIBLE. MC cause of acute renal failure.

BLOOD VESSEL DISEASES: Talking about 2 renal blood vessel diseases associated with systemic hypertension. 1. Benign Nephrosclerosis (hyaline arteriolosclerosis)-Common over age 60. The term refers to renal vascular disease seen in benign (common) hypertension. Vascular lesions are called hyaline arteriosclerosis.

2. Malignant Nephrosclerosis-A severe form of nephrosclerosis seen in malignant hypertension. The vessels of the kidneys show fibrinoid necrosis and hyperplastic arteriosclerosis.

CYSTIC DISEASES: Common renal lesions that may lead to renal failure. 1. Simple Cysts-Most asymptomatic. Dialysis may cause them, too.

2. (Adult) Polycystic Disease-- Asymptomatic until over 40. Causes 10% of renal failure cases.

URINARY OBSTRUCTIONS: Renal Stones (Urolithiasis) 75% calcium oxalate or calcium oxalate mixtures. Causes are from supersaturation of the stones constituents in the urine. In 10% of cases, hypercalcemia, from whatever the cause, results in hyper calciurea.

TUMORS: Renal Cell Carcinoma-80% of all kidney cancers. Hematuria common presenting sign (~50%) Clear Cell - most common type --- 70-80% of renal cell carcinomas. Wilms Tumor Some genetic infl. but most are sporadic. 3rd most common organ cancer in children.

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