Path 2 Quiz 1

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Path 2 Quiz 1
2010-11-10 12:37:18
Life University

Path Lecture
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  1. What is the most important function of the kidneys?
    • Elimination of waste products of metabolism.
    • Regulation of water & salt concentration.
    • Maintaining the acid balance of plasma (normal pH is 7.2-7.4).
    • Hormone secretion: renin, reythropoietin, prostoglandins.
  2. Which hormone is responsible for changing blood pressure?
    • Renin.
    • Erythropoietin: formation of RBC's.
    • Prostoglandins: mediator of inflammation.
  3. Where is the center for erythropoiesis?
    In the kidney.
  4. True or false: capsular pain is referred to the inner thigh.
    • False: referred as back pain.
    • Has many nociceptors.
  5. What are the 2 main functions of the renal cortex?
    • 1. Filtration of blood.
    • 2. Primary urine production.
  6. Which area of the kidney collects urine?
    The pyramids.
  7. Name the 4 major compartments of the kidney:
    • 1. Glomeruli: Immunologically mediate response.
    • 2. Tubules: infection & toxins.
    • 3. Interstitial tissue: infection & toxins.
    • 4. Blood vessels: cardiovascular systems.
  8. True or false: glomerular diseases or immunogically mediated?
  9. Where in the kidney is blood pressure controlled?
    • In the afferent arteriole.
    • Around a complex of Juxtaglomerular cells.
    • Very susceptible to pressure changes.
  10. True or false: with low pressure a high amount of filtration occurs.
    False: low pressure = no filtration.
  11. What are the 3 layers of the Bowman's Capsule from internal to external?
    • 1. Inside layer: endothelial.
    • 2. Basement membrane.
    • 3. Epithelial cells "Podocytes."
  12. Which layer of the Bowman's Capsule has pseudofrenestrations?
    • The endothelial cell layer.
    • Pseudofrenestrations: holes in the ep......
  13. Epithelial cells are also known as?
    • Podocytes (means foot, foot process).
    • 1. Visceral epithelial cells: contains filtration slits, which are located between podocytes.
    • -size of slits play a role in urine filtration... primary urine formation.
    • 2. Parietal epithelial cells.
  14. What is responsible for regulating the filtration process, & is located in between podocytes, @ the bottom of filtration slits?
  15. What is the name of the cell that is located in the space inside the glomerulus, & protects the glomeruluar cell?
    • Mesangial cell.
    • Replication of collagen ground matrix for reparation.
  16. What are the 3 types of Glomerulonephritis?
    • 1. Heymann Glomerulonephritis: autoaggression against the 3rd layer of the glomerular wall, podocytes, & visceral epithelial wall.
    • 2. Anti-GBM: Type II HSR via antibodies.
    • 3. Immune Complex Deposition: Type III HSR in circulation.
  17. Where is the immune complex deposition attracted to in the kidney?
    • The glomerulus.
    • Attaches to the vascular wall, in between epithelial cells & the basement membrane.
  18. What do the antibodies associated with Anti-GBM Glomerulonephritis attack?
    • Production of antibodies against antigenic components of the glomerular basement membrane.
    • Antigen in glomerulus becomes foreign bodies.
    • Attracts neutrophils that cannot engulf.
    • Enzymes are released to digest antibody.
    • Damages basement membrane.
    • = inflammation.
  19. True or false: the glomerular wall is water impermeable.
    • False: the wall is easily permeable to water.
    • Impermeable to protein, albumin, & blood cells.
  20. Name the 6 findings associated with NEPHRITIC Syndrome.
    • 1. Arterial wall damage: becomes impermeable to H2O.
    • 2. Azotemia: accumulation of waste products without signs & symptoms.
    • 3. Hematuria: RBC's in urine.
    • 4. Hypertension: problem due to filtration.
    • 5. Oliguria: little or scanty urine.
    • 6. Uremia: azotemia with clinical signs & symptoms.
  21. Which syndrome is characterized by damage to the arterial wall?
    • Nephritic Syndrome.
    • The wall becomes impermeable to water, & permeable to RBC's.
  22. Nephritic syndrome is associated with the apperance of RBC's in urine, which is also known as what?
    • Hematuria: brownish colored urine due to prescence of RBC's.
    • RBC casts will be present.
  23. True or false: Oliguria is characterized by excessive removal of waste products of metabolism.
    False: Oliguria is characterized by NO removal of waste products of metabolism.
  24. Azotemia is due to the accumulation of waste products of metabolism. How is it diagnosed?
    • Blood tests.
    • Azot = nitrogen.
    • Azotemia: increased blood urea nitrogen (BUN) levels.
    • Results in creatinine in blood.
    • Associated with a reduced GFR.
    • No symptoms = only found with blood tests.
  25. True or false: oliguria is the term used to describe azotemia + clinical signs & symptoms.
    False: uremia is azotemia + clinical signs & symptoms.
  26. Decreased filtration associated with hypertension stimulates the release of which substance?
    • Renin.
    • JG-cells control BP.
    • Causes the release of Ag-II (powerful hypertensive substance).
    • Increases BP.
    • Problem is not in BP, but in filtration.
  27. B-hemolytic strep group A is associated with which form of glomerulonephritis?
    • Acute proliferative glomerulonephritis.
    • "Acute post-streptococcal glomerulonephritis."
    • "Acute post-infectious glomerulonephritis."

    • -Enzymes released by neutrophils = destruction of bacteria & damage to the glomerulus.
    • -Components of nephritic syndrome are visible.
    • -Usually develops in young children, although not severe.
  28. Molecular mimicry is associated with which pathology?
    • Acute proliferative glomerulonephritis.
    • Molecular mimicry: confusion with the attachment of an antibody to different antigens.
    • Glomerulus wall & bacteria have similar structures.
    • May have the same reaction with:
    • -Staph.
    • -Pneumonia.
    • -Measles.
    • -Chicken pox.
    • -Hepatitis.
  29. What is the treatment of choice for post-strep glomerulonephritis?
    • Corticosteroids.
    • Full recovery within 3-4 weeks.
    • Worse in adults.
  30. What is the a/k/a for rapidly progressive glomerulonephritis?
    • Crescenteric glomerulonephritis: rapid & progressive loss of renal function.
    • Death within weeks/months after onset.
    • Due to proliferation of normal parietal epithelial cells in Bowman's Capsule (hyperplasia).
    • Prognosis depends on the number of crescents found in the biopsy.
  31. Crescenteric glomerulonephritis results in the physical compression of which 2 structures?
    • 1. Glomerulus.
    • 2. Arterioles.
    • Leads to loss of arterioles.
    • = dramatic irreversible impairment of function.
  32. Group I Rapidly Progressive Glomerulonephritis (Anti-GBM) is associated with Type II Hypersensitivity Reactions, meaning it is mediated by what?
    • Antibodies.
    • 50% idiopathic.
  33. Anti-GBM is associated with which syndrome?
    • Goodpasture's Syndrome: characterized by autoaggression against antigens of the aveolar basement membrane & glomerular basement membrane.
    • Results in inflammation & blood in sputum (hemoptysis).
    • May result in Cresenteric GMN due to antibodies simultaneously killing the glomerular basement membrane.
  34. How is Good Pasture's Syndrome treated?
    Via plasma pheresis.
  35. Type II Rapidly Progressive Glomerulonephritis (a/k/a Immune Complex Deposition) is associated with Type III Hypersensitivity Reactions, & is mediated by what?
    • Immune complexes.
    • 50-60% idiopathic.
  36. What is the name of a relatively rare disease which targets young women of African descent?
    • Systemic Lupus Erythematosus: development of autoaggresion against components of the cell membrane, especially in the nucleus.
    • Autoimmune disorder.
    • Diagnosis: ANA found in blood.
    • Involves any organ, but prefers skin = Butterfly Rash.
    • -lungs, kidneys, cerebral vessels, joints.
    • High survival rate.
    • Must continue use of corticosteroids.
  37. What are the 3 factors which promote development of SLE?
    • 1. Exposure to UV-radiation.
    • 2. Sulfa salicyclic medications.
    • 3. Vaccinations.
  38. What age group is affected by Henoch-Schonlein Purpura?
    • Young people, mostly boys.
    • Clincal syndromes:
    • 1. Cutaneous Syndrome.
    • 2. Abdominal Syndrome.
    • 3. Articular Syndrome.
    • 4. Rapidly progressive glomerulonephritis = higher mortality rate.
    • -deposition of immune complex IgA.
    • -in mesangium instead of intestinal tract.
  39. What is the a/k/a for rapidly progressive glomerulonephritis?
    • Pauci-immune glomerulonephritis.
    • Does not have a hypersensitivity reaction.
    • Characterized by deposition of anti-neutrophil cytoplasmic antibody.
    • Idiopathic 50%.
  40. What two syndromes are associated with Type III Rapidly Progressive Glomerulonephritis?
    • 1. Wegner's Granulomatosis.
    • 2. Acute necrotizing vasculitis: leads to narrowing of the lumen = ischemia = necrosis.
  41. Polyarteritis Nodosa is also known as Periarteritis Nodosa. Which arteries are affected?
    • Middle & large size arteries.
    • Characterized by vasculitis of the body.
  42. What are the only 2 areas which are not involved with polyarteritis nodosa?
    • 1. Arch of aorta.
    • 2. Vessels of lungs.

    • Results in dramatic narrowing of the lumen = destruction of the kidney.
    • Complication = wet gangrene.
  43. What is the a/k/a for Berger's Disease?
    *Most common glomerular disease in the world.*
    • IgA Neuropathy.
    • Specific, unusual, & hidden.
    • Deposition of IgA complex in the kidney.
    • In meningium: space between bowman's capsule.
    • 1-2 days of respiratory infection, lasting for several days & sudden subsiding.
  44. What kind of infection is associated with Berger's Disease?
    • Urinary tract infection: 30-40%... rarely showing clinical signs & symptoms.
    • #1 cause of gross hematuria = most common cause among all kidney disorders.
    • -Loin pain.
  45. What percentage of urinary tract infections develop into chronic renal failure?
  46. Buerger's Disease: inflammation of vessels that supply nerves with blood.
    "Thromboangitis obliterans"
    • Affects young males.
    • Vasculitis of middle & small size arteries.
    • -Radial & tibial A's.
    • Only disease associated with inflammation of arteries & veins @ the same time.
    • Associated with heavy smoking.
    • HLA antigen found in patient.
  47. What is the major symptom of Buerger's Disease?
    *India, Israel, Japan.
    • Instep claudication: periodic spasm of arteries associated with exertion... starting with Raynaud's Phenomenon: spasm of vessels for distal fingers & toes.
    • Narrowing of the lumen of vessels = decreased blood supply.
    • No problem with sitting or standing... start to walk & legs need more blood = pain in calf.
    • = gangrene of extremities.
    • Treatment = STOP SMOKING!