Subject: PATHOPHYSIOLOGY
Place: Department of General and Experimental Pathology, room 371
Division: FACULTY OF MEDICINE
YEAR: 3
CLASS no: 9
Pathophysiology of the kidney
Goal: to explain etiology, pathogenesis, manifestations and consequences of selected
kidney diseases
Time: 4 hours
Didactic tools: multimedia presentation
Before pathophysiology classes students should revise anatomy, histology and physiology of kidney,
as well as tests of renal function.
Problems:
CONGENITAL AND INHERITED DISORDERS OF THE KIDNEYS
Inherited Cystic Kidney Diseases
Polycystic Kidney Disease
Simple and Acquired Renal Cysts
OBSTRUCTIVE DISORDERS
Mechanisms of Renal Damage
Hydronephrosis
Renal Calculi
Etiology and Pathogenesis
Types of Stones
DISORDERS OF GLOMERULAR FUNCTION
Etiology and Pathogenesis of Glomerular Injury
Types of Glomerular Disease
Acute Nephritic Syndrome
Rapidly Progressive Glomerulonephritis
Nephrotic Syndrome
Asymptomatic Hematuria or Proteinuria
Alport Syndrome
Chronic Glomerulonephritis
Glomerular Lesions Associated with Systemic Disease
Systemic Lupus Erythematosus Glomerulonephritis
Diabetic Glomerulosclerosis
Hypertensive Glomerular Disease
TUBULOINTERSTITIAL DISORDERS
Renal Tubular Acidosis: Proximal and Distal Renal Tubular Acidosis
Pyelonephritis: Acute and Chronic Pyelonephritis
Drug-Related Nephropathies
ACUTE KIDNEY INJURY
Pathogenesis of AKI
Types of AKI: Prerenal, Intrarenal, Postrenal AKI
CHRONIC KIDNEY DISEASE
Definition and Classification
Assessment of Glomerular Filtration Rate and Other Indicators of Renal Function
Clinical Manifestations
Accumulation of Nitrogenous Wastes
Fluid, Electrolyte, and Acid–Base Disorders
Disorders of Calcium and Phosphorus Metabolism and Bone Disease
Hematologic Disorders
Cardiovascular Disorders
Gastrointestinal Disorders
Neuromuscular Disorders
Altered Immune Function
Disorders of Skin Integrity
Sexual Dysfunction
Elimination of Drugs
Measures to Slow Progression of the Disorder
Dialysis and Transplantation
Dietary Management
ALTERATIONS IN BLADDER FUNCTION
Lower Urinary Tract Obstruction and Stasis
Neurogenic Bladder Disorders
Urinary Incontinence
References:
Porth's Pathophysiology: Concepts of Altered Health States - Tommie L Norris; Wolters Kluwer;
10thEdition, International, (November 3, 2018), chapters 32-35.
Color Atlas of Pathophysiology - Stefan Silbernagl, Florian Lang, Thieme; 3rd Edition, 2016.
Diseases
Acute Kidney Injury
Chronic Kidney Disease
Polycystic Kidney Disease
Neprolithiasis
Nephrotic Syndrome
Acute Postinfectious Glomeruloneprtitis
Rapidly Progressive Glomerulonephritis
Alport Syndrome
Chronic Glomerulonephritis
Systemic Lupus Erythematosus Glomerulonephritis
Diabetic Glomerulosclerosis
Hypertensive Glomerular Disease
Renal Tubular Acidosis
Acute and Chronic Pyelonephritis
Drug-Related Nephropathies
Fanconi syndrome
Questions
1. What is the renal threshold and how it differs from tubular transport maximum?
2. How the tubulo-glomerular feedback works?
3. How glucose induces glomerular hyperfiltration?
4. What are the mechanisms of reduced glomerular filtration?
5. What is pyelonephritis and what portion of the nephron is mostly affected?
6. What conditions predispose to nephrolithiasis?
7. What material are renal stones made of most commonly?
8. What are struvite stones?
9. What are the renal consequences of prolonged urinary tract obstruction?
10. What is the pathogenesis of primary glomerulonephritis?
11. What are the mechanisms of decreased GFR in the course of primary glomerulonephritis?
12. How reduced GFR affects renal angiotensin II production?
13. What is the pathogenesis of diabetic glomerulonephritis?
14. What are the manifestations glomerulonephritis?
15. What types of proteinuria there are?
16. Which defect leads to selective proteinuria?
17. What is nephrotic syndrome?
18. What is the pathogenesis of hyperlipidemia in nephrotic syndrome?
19. What is the pathogenesis of edema in nephrotic syndrome?
20. Why edema in nephrotic syndrome is seen on the face/eyelids?
21. What is the pathogenesis of hypercoagulability in nephrotic syndrome?
22. What are the mechanisms of overhydration in nephrotic syndrome?
23. What are the mechanisms of acute kidney injury (AKI)?
24. What is the mechanism of reduced GFR in prerenal/renal/postrenal AKI?
25. How tubular transport is affected in each prerenal, renal and postrenal AKI?
26. What are the consequences of tubular dysfunction on the urine’s biochemical parameters?
27. What is the etiology of acute tubular necrosis?
28. What is the relation between GFR and urine output in different types of acute renal failure?
29. What is the pathophysiology of oliguric and postoliguric phase of acute kidney injury?
30. What are the most common etiologies of chronic kidney disease?
31. Why chronic kidney disease is irreversible?
32. What promotes progression of chronic kidney disease?
33. What causes hypocalcemia in chronic kidney disease?
34. What causes secondary hyperparathyroidism in chronic kidney disease?
35. What is the pathogenesis of anemia in chronic kidney disease?
36. List electrolyte disbalances in chronic kidney disease. What kidney defect causes them?
37. How acid-base balanced is disturbed in chronic kidney disease and what are its mechanisms?
38. What are uremic toxins?
39. What are the mechanisms of arterial hypertension in chronic kidney disease?
40. What mechanisms promote development of atherosclerosis in the course of chronic kidney disease?