AUBF (finals)

DIABETIC NEPHROPATHY
 also known as “Kimmelstiel-Wilson disease”
 Most common cause of end-stage renal disease.
 Continual damage to the glomerular membrane due
URINARY TRACT DISEASES (RENAL DISEASES) to thickening and increased cellular proliferation and
an accumulation of solid substances around the
vascular tufts. This causes Vascular Sclerosis.
GLOMERULONEPHRITIS
 A sterile, inflammatory process that affects the
ANATOMICAL VARIATION AFFECTING THE
glomerulus and is associated with the finding of
Blood, Protein (CHON), and Casts in the urine. URINARY TRACT
 May also lead to Nephrotic Syndrome  Congenital Problems
➔when the person has scarlet fever  Accidents
 Injuries
➔GLOMERULI-filters plasma; main part of urinary system
➔ It can damage the kidneys or urinary tract leaving them
which is affected by the disease
vulnerable to infections and diseases
A. Acute Poststreptococcal Glomerulonephritis
➔(common) MALES aged 40s-60s, marami sakanila
(AGN)
nagkaakroon ng diperensya sa PROSTATE GLAND, which
 Deposition of immune complexes formed in can affect UT function.
conjunction with group A streptococcus infection, on
➔ PROSTATE is located just below the bladder and in front of
the glomerular membrane.
the rectum.
 These may include fever; edema, most noticeably
around the eyes; fatigue; hypertension; oliguria; and
hematuria. CONDITIONS RELATED TO ANATOMIC CHANGES IN
THE URINARY TRACT
B. Rapidly Progressive (Crescentic) Benign prostatic hyperplasia
Glomerulonephritis  Associated with urinary discomfort and frequency.
 Deposition of immune complexes from systemic
immune disorders on the glomerular membrane. INFECTIONS OF THE LOWER URINARY TRACT
 More serious form URINARY TRACT INFECTION (UTI)
 Most common renal disease
C. Goodpasture Syndrome  Women are more prone than males due to short
 An autoimmune disorder with cytotoxic auto- urethra.
antibodies to collagen that are called Antiglomerular  Factors that can increase the risk of acquiring UTI:
Basement Membrane Antibody and with  Obstruction
subsequent complement activation producing  Foreign Bodies
glomerular capillary destruction.  Presence of Catheters
 Affect both KIDNEY & LUNGS
 Symptoms: PYELONEPHRITIS
 Hemoptysis  Infection of the upper urinary tract
 Hypertension
 Dyspnea
 Hematuria MICROSCOPICAL EXAMINATION
 Proteinuria NEUTROPHILS
 RBC casts.  increased levels is evidence of UTI

MEMBRANOUS GLOMERULONEPHRITIS WBC CASTS

 Is a pronounced thickening of the glomerular  indicates kidney infection rather than a bladder
basement membrane resulting from the deposition of infection because casts are formed in the nephrons
immunoglobulin G (IgG) immune complexes.
 One of the most common causes of “Nephrotic UROLITHIASIS
syndrome”  a kidney stones, most common urinary tract
 Symptoms: microscopic hematuria, elevated CHON, obstruction.
foamy urine, and tendency toward thrombosis.  Men are more commonly affected than women.
 Basic type of stones:
CHRONIC GLOMERULONEPHRITIS 1) calcium oxalate (CaC2O4)
 Advanced stage of several kidney disorders resulting  very common, usually causing
in inflammation and slowly worsening destruction of hematuria (there is blood in your urine)
glomeruli with progressive loss of kidney function.  producing a kind of calculi or stone
having a hard and rough surface
A. Immunogloblin A (IgA) Nephropathy 2) calcium phosphate (CaPO4)
 Also known as “Berger Disease” 3) Magnesium ammonium phosphate
 most common cause of Chronic Glomerulonephritis (MgNH4PO4)
 Patients have increased (↑) serum levels of IgA, 4) uric acid
which may be a result of a mucosal infection  Moderately hard
 IgA are deposited on the glomerular membrane  They have a smooth surface
 Associated with high intake of salty foods
NEPHROTIC SYNDROME 5) cystine
 Marked by massive proteinuria (greater than 3.5 g/d),  manifestation: Pain and Hematuria
low blood protein levels, high cholesterol levels,
edema, and urine (may contain: fat globules, oval fat →Calculi- describe as sand, gravel, and stone.
bodies or fatty casts) - If it is small, when the person urinates, it comes out,
but when it gets big, it will block it.
 Alternative name: NEPHROSIS (site of primary
injury : tubules and designated as tubular nephritis
COMMON DISEASES OF THE KIDNEY
 Common cause: MEMBRANOUS
GLOMERULONEPHRITIS  High Blood Pressure causes the heart to work harder
 Symptoms: and damages the overworked blood vessels
 Edema with weight gain throughout the body.
 swollen abdomen  If kidneys’ blood vessels are damaged, removal of
 Poor appetite nitrogenous wastes and excess fluids stop. This
 Hypertension. raises blood pressure more.
 Low blood protein levels →CHON in urine measurement can also help assess
 Proteinuria more than 3.5 g/day hypertension.
 High cholesterol levels
 Urine- may contain fat globules, oval fat →HYPERTENSION (high blood pressure)
bodies or fatty casts  mga taong merong ito, sila rin yung nagkakaroron ng
sakit sa ut, ending damage sa kidney.
 Remedy: hemodialysis
  Present time: using dip strips (determine chemical
→PROTEIN content of urine sample)
 Not to be observed in urine; this indicates something
is wrong in the kidney.
 Associated with hypertension.
 Also called proteinuria or albuminuria

SERUM CREATININE EXAM

 can determine the severity of kidney damage.
 used to estimate GFR (Glomerular Filtration Rate).
 Increased creatinine is a sign of kidney damage.

CREATININE
 a nitrogenous waste product from metabolism
 normally excreted by the nephrons
 It rises as GFR falls (↓ GFR → ↑ Creatinine)

DIABETES
 small blood vessels are injured.
 When kidney blood vessels are injured, the kidneys
cannot cleanse the blood properly.
 The body retains H2O and salts which can result in
weight gain and ankle swelling (edema).
 Finding CHON in urine is one of the key findings of
kidney diseases.
 May cause nerve damage causing difficulty in
emptying the bladder.
 Pressure from the overfull bladder leads to urine
backup and injures the kidneys.

MICROALBUMIN EXAM
 help detect diabetic kidney damage.

MICROALBUMINURIA
 may be corrected with creatinine levels to assess
significance and also associated with heart disease

SCREENING TESTS FOR KIDNEY DISEASES

AMONG DIABETIC AND HYPERTENSIVE PATIENTS
1.GFR or estimated GFR (eGFR)
 Kidney disease is present when the eGFR is less than
60 ml/min

2. Urine Microalbumin
 Urine microalbumin in patients with diabetes type 2
and those with diabetes type 1 (for more than 5 years)
are recommended to have an annual assessment.
 Kidney disease is present if urine contains more than
30 mg of albumin/gm of creatinine with or without a
decreased eGFR

➔NEPHROSIS
 site of primary injury: tubules
 designated as tubular nephritis
 related to the toxic effects of mercury. We need to
choose a fish to eat, especially big fish (yellow-fin
fish). It has been discovered that the majority of them
contain mercuric, which is one of the causes of
mercury poisoning
 other toxic agents: mercury chloride, arsenic,
barbiturates (drugs)

➔NEPHROSCLEROSIS
 primary site of involvement is the vascular system of
the kidney
 termed formerly chronic interstitial nephritis
 (common) hypertension

➔ PYELONEPHRITIS
 There is inflammation of the kidney

➔ MICROORGANISMS
 has also involvement in infections in the kidneys and
other parts of urinary tract, especially the E.coli, which
is very common in causing UTI.
 Escherichia coli (E.coli) nangangaling sa intestine
which is normally seen in the stool and affecting the
urethra (ex: babies, gumagamit ng diaper,
nagkakaroon ng UTI dahil ‘di napapalitan ang diaper)
 Staphylococcus- another organism common causing
inflammation, pelvis of kidney (pyelitis & cystitis)

➔CHEMICAL EXAMINATION
 Conventional method- which is done by mixing the
chemical agents, and it has procedures (warm or heat
the mixture before observation of the results)