1. Kidneys and Urinary Tract
Premed 2
Pathophysiology

2. The kidneys are paired organs, which have the production of urine as their primary function.They are an essential part of the urinary system, but have several secondary functions concerned with homeostatic functions. These include the regulation of electrolytes, acid-base balance, and blood pressure.

3. In producing urine, the kidneys excrete wastes such as urea and ammonium; the kidneys also are responsible for the reabsorption of glucose and amino acids. Finally, the kidneys are important in the production of hormones including calcitriol, renin and erythropoietin.

4. Located behind the abdominal cavity in the retroperitoneum, the kidneys receive blood from the paired renal arteries, and drain into the paired renal veins. Each kidney excretes urine into a ureter, itself a paired structure that empties into the urinary bladder.

8. Endocrine Function
The kidneys secrete the following hormones to initiate processes that occur in other parts of the body: 
1. Erythropoietin
2. The active form of Vitamin D, 1,25-dihydroxyvitamin D3,
3. Renin

9. Urinary tract Infection
More common in women, pregnancy
Most common organism: Escherichia coli
Predisposing factors:
obstruction
surgery
catheters
gyne abnormalities
Urinary frequency
Dysuria, pyuria, hematuria, bacteriuria

10. UTI Acute cystitis pyuria hematuria no white cell casts
Acute pyelonephritis
fever, flank pains
white cell casts

11. Urolithiasis Calculi or stones in the urinary tract; men
Most common type:
calcium stones
calcium oxalate, calcium phosphate
radiopaque
Hypercalcemia, hypercalciuria
Causes: hyperparathyroidism
malignancy
vitamin D intoxication

12. Urolithiasis MAP stones: magnesium ammonium phosphate
Second most common type
Radioluscent
Staghorn (struvite) calculi
Infections with Proteus and Staphylococcus

14. Urolithiasis Uric acid stones hyperuricemia gout leukemia
myeloproliferative diseases
Cystine stones
cystinuria

18. Adult polycystic disease
Most common inherited disease of the kidney
Shows clinically at 15 to 30 years old
Large kidneys, bilateral
Numerous cysts in the parenchyma
Associated with berry aneurysms in the circle of willis

20. Renal Failure May be acute or chronic Always presents with azotemia
Late stages: uremia
Others: acidosis
hyperkalemia
abnormal fluid control
hypocalcemia
anemia
hypertension

21. Glomerulus

22. Glomerular diseases Nephrotic syndrome Proteinuria Hypoalbuminemia
Edema
Hyperlipidemia, hypercholesterolemia
Nephritic syndrome
Oliguria
Azotemia
Hematuria
Hypertension

23. Glomerular diseases Minimal change disease
Focal segmental glomerulosclerosis
Membranous glomerulonephritis
Lupus nephropathy
Poststreptococcal glomerulonephritis
Rapidly progressive glomerulonephritis
Goodpasture syndrome
Alport syndrome

24. Minimal change disease(lipoid nephrosis)
common in young children
fused or absent epithelial foot processes

25. Membranous glomerulonephritis
primary cause of nephrotic syndrome
teens, young adults
Diffuse thickening of the glomerular capillary wall
immune complexes deposits
“spike and dome” appearance

26. Nephrotic syndrome
Lupus nephropathy
immune complexes :
“ wire loops”

27. Nephritic syndrome: Post-streptococcal glomerulonephritis
-immune complex deposits : “lumpy-bumpy”
-follows/accompanies infection: group A beta-hemolytic streptococci
-increased ASO titers

28. ALPORT SYNDROME Is hereditary nephritis. abnormal collagen (type IV)
deafness,various eye disorders, lens dislocation, cataracts, corneal dystrophy.

29. Rapidly progressive glomerulonepritis
Renal failure in weeks
Fibrin deposits in the Bowmans spacecrescents
Caused by: poststreptococcal – 50%

30. Goodpasture syndrome antibodies against the glomerular membrane
Linear pattern
hemoptysis