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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  b. Injury from Ab reacting with in-situ glomerular antigens. Fig. 14-3-B. Clinical Manifestations of Glomerular Diseases  ( Fig. 14-1 ) Nephrotic syndrome: heavy proteinuria, hypoalbuminemia, severe edema, hyperlipidemia, lipiduria 2 Examples— 1. Lipoid Nephrosis: 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. 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. U p to age 40, more common in females . Ascending vs . hematogenous infections. ( Fig. 14-14)   Chronic pyelonephritis & Reflux Nephropathy    Obstruction and chronic reflux . One or both kidneys  may be involved. Deep scars . First sign frequently hypertension (benign nephrosclerosis). 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)  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--  8 0% 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. 3 rd  most common organ cancer in children .
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