anmol kant singh

Ma2002o
Topic of the lesson: PATHOPHISIOLOGY OF KIDNEYS.

Aim: To study contemporary definitions of disturbances of renal processes and functions. To study common mechanisms of renal
function disturbances and general links of pathogenesis of pathologic processes in kidneys.
Main questions over the topic of the lesson:
1. Structure, blood supplying and functions of kidneys.
2. Morpho-functional state of renal processes: filtration, reabsorbing, excretion.
3. Disturbance of renal processes, classification.
4. Etiology, pathogenesis of renal syndromes.
5. Urinal syndrome. Characteristic.
Literature:
1. General and clinical pathophysiology / Gozhenko A.I. etal. – Odessa National Medical University.– 2002. – P. 185-194
2. Pathophysiology / Gozhenko A.I., Gurkalova I.P. – Odessa National Medical University.– 2005. – P. 260-271

CONTROL QUESTIONS
№№ Instructions to the execution of the task Answers of the students with complements at the lessons
1 Disturbance of homeostatic renal functions a. Reduced glomerular filtration rate (GFR)
includes…a, b
b. Electrolyte imbalances

2 Disorders of excretory function of kidneys may a. Filtration:

be caused by disturbances of such renal b. Reabsorption
processes… - a, b, c c. Secretion

3 Disorders of incretory renal functions may be a. Hormone secretion

b. Acid-base balanceType your text
evident by disturbances of: a, b, c c. Blood pressure regulation

renal insufficiency, is a medical condition in which the kidneys are unable to function
4 Renal failure (insufficiency) – is… properly and filter waste products from the blood. It is a serious condition that can
lead to a buildup of toxins and waste products in the body, electrolyte imbalances,
and fluid overload.
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5 Classification of renal insufficiency… - a, b, c, d a. Acute renal failure (ARF)
b. Chronic kidney disease (CKD)
c. End-stage renal disease (ESRD)
d. Acute-on-chronic renal failure

6 Etiology of ARF is connected with action of a. Decreased blood flow to the kidneys
b. Direct damage to the kidneys
factors… - a, b c. Urinary tract obstruction
d. Glomerulonephritis

7 There are such stages in clinical course of a. Onset or initiation phase

b. Oliguric or anuric phase
ARF… - a, b, c, d c. Diuretic phase
d. Recovery phase

8 Etiology of CRF is connected with chronicle a. Diabetes

b. High blood pressureType your text
progressive diseases of kidneys, and actually… - c. Glomerulonephritis
a, b, c

9 There are such stages in clinical course of a. Stage 1

b. Stage 2
CRF… - a, b, c, d c. Stage 3
d. Stage 4

10 What is the essence of prerenal function a. HypovolemiaType your text

disturbances of kidneys… - a, b, c, d b. Decreased cardiac outputType your text
c. Vasodilation
d. Renal artery stenosis

11 What is the essence of postrenal function a. Urinary tract obstructionType your text
disturbances of kidneys… - a, b b. Bladder outlet obstruction

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TASK 1. To analyze, interpret and fill in the schematic structure:

Changes in urea at injury of kidneys

Quantitive Qualitive
This can lead to an increase in the amount of urea in the blood, This can lead to the formation of abnormal forms of urea

TASK 2. Fill in the table by quantitive and qualitive changes in urea at injury of kidneys, mark (+) what is right.

Data Oligouria Anuria Polyuria Nycturia Hyposthenuria Isosthenuria Cylindruria

Changes in urea at
injury of tubules
epithelium.
Daily diuresis is less
than 700 ml.
Daily diuresis is more
than 1,8 l.
Full absence of
diuresis.
Overreaching of night
diuresis over day one.
Density of urea is
1010.
Density of urea is to
1012-1006.
+ + +
+ +
+
+
+ +Type your text + + + + +
+ + + +
+
+ + +
+
+ + +
+ +
+
+ +
+ +Type your text +
+

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TASK 3. Fill in the table by pathogenic mechanisms of edemas at pathology of kidneys, mark (+)what is right.

Hydrostatic Oncotic Osmotic Membranogenous Lymphogenous

Mechanism of + +
+ + +
nephrotic edemas
Mechanism of
+ +
edemas at ARF and + + +
CRF
Mechanis of + + + +
nephritic edemas +

TASK 4. Describe data, which is in the task, by medical terms. On a base of analysis form conclusion about renal pathology.
Diuresis 420 ml daily
Density of urea 1,011
Protein 2 g/l
Glucose No
Ketone bodies No
Alkaline erythrocytes One
Cylinders hyaline, waxy, granular One
AP 180/100
Residual Nitrogen of blood 190 mg %

1. _________________
decreased urine output or oliguria.
2. _________________
density of 1.011 is within the normal range.
3. _________________
protein level of 2 g/l is higher than normal, indicating proteinuria.
absence of glucose in urine
4. _________________
5. _________________
Hyaline, waxy, and granular casts are often seen in patients with kidney disease.
6. _________________
alkaline erythrocyte :It may indicate kidney or urinary tract infection
7. _________________
absence of ketone bodies in urine
CONCLUSION:
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TASK 5. Patient K. has spread edemas. Their decreasing is noticed, especially on low limbs.
In urea:
Daily diuresis 700 ml
Density of urea 1,040
Protein 5,3%
Cylinders hyaline, waxy, granular Many
AP 120/70
In blood:
Residual Nitrogen 40 mg%
Common protein 4,8 g%
Albumins 1,5g%(normal is 4 g%)
Globulins 2 g%(normal is 3 g%)
Cholesterol 800 mg%(normal is 200mg%)

Questions:
1. About development of which syndrome may say detected changes?
________________________________________________________________________________________________________
the development of nephrotic syndrome.
2. Which is the mechanism of development of edemas at the patient?
________________________________________________________________________________________________________
due to increased capillary permeability caused by the nephrotic syndrome, which leads to leakage of fluid and protein from the blood vessels into the
surrounding tissues, resulting in edema.

TASK 6. Patient K., 48 years old, during 5 years is sick chronicle diffuse glomerulonephritis. Have appeared heartbeat, evident
edemas, especially on lower limbs.
In urea:
Daily diuresis 800 ml
Density of urea 1,042
Protein 3,8%
Cylinders hyaline, waxy, granular Many
AP 130/80
In blood:
Residual Nitrogen 30 mg%
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Questions:
1. Which deviations are detected at the patient? _________________________________________________________________
he patient has evident edemas, abnormal protein levels in urea, and presence of cylinders
_________________________________________________________________
(hyaline, waxy, granular) in urea. Blood pressure is also elevated.
_________________________________________________________________
_________________________________________________________________

2. About development of which syndrome may say __________________________________________________________

The abnormal protein levels and presence of cylinders suggest damage to the glomeruli.
The elevated blood pressure may also contribute to the development of renal insufficiency.
detected at the patient deviations? Are there any __________________________________________________________
Uremia may develop in the patient if the renal insufficiency progresses to the point where
basements on development of uremia at the patient? _________________________________________________________
waste products build up in the blood due to inadequate excretion by the kidneys.

TASK 7. At the patient in 1 week after tonsillitis began appear edemas under eyes, especially after sleep.
In urea:
Daily diuresis 750 ml
Density of urea 1,028
Protein 0,1%
Glucose, acetone No
Alkaline erythrocytes 10-26 in a field of vision
Cylinders hyaline, waxy, granular Not many
AP 190/110
In blood:
Residual Nitrogen 60 mg%(normal is 20-40 mg%)
Common protein 7,3 g%
Clearance of endogenous creatinin 50 ml/min(normal is 100-110)

Questions:
1. For which form of pathology are disease signs _____________________________________________________________
The disease signs detected at the patient are consistent with nephritis or glomerulonephritis.
detected at the patient evident? _____________________________________________________________
_____________________________________________________________

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 2. What is the main link in pathogenesis of this form of pathology? _______________________________________________
The main link in the pathogenesis of nephritis or glomerulonephritis
is inflammation and damage to the glomeruli, which are responsible
_______________________________________________
for filtering waste and excess fluids from the blood.
1. What are the mechanisms of development of azotemia ______________________________________________________
The elevated levels of residual nitrogen in the blood indicate reduced kidney
function, which leads to the accumulation of waste products in the bloodstream.
and hypertension in this case? _______________________________________________________
The high blood pressure is a result of the kidneys' reduced ability to regulate fluid
_______________________________________________________
balance in the body, leading to excess fluid retention and edema.

TASK 8. Describe data, which is in the task, by medical terms. On a base of analysis form conclusion about renal pathology.
Diuresis 4,8 l daily
Density of urea 1,013
Protein 13 g/l
Glucose No
Ketone bodies No
Alkaline erythrocytes One
Cylinders hyaline, waxy, granular One
AP 220/100
Residual Nitrogen of blood 130 mg %

1. The
_________________
patient has a high diuresis of 4.8 liters per day.
2. The
_________________
density of urea is slightly elevated at 1.013.
The patient has a high protein level in the urine at 13 g/l.
3. The
_________________
patient has no glucose or ketone bodies in their urine.
4. There
_________________
is the presence of one alkaline erythrocyte in the urine.
The presence of one hyaline, waxy, granular cylinder in the urine.
5. The
_________________
patient has high blood pressure at 220/100 mmHg and elevated residual nitrogen levels in the blood at 130 mg%.Type your text
6. _________________
7. _________________
CONCLUSION:

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TASK 8. To solve tests for selfcontrol
1.What of the following take the major
place in pathogenesis of renal
edemata:
A. increasing of oncotic blood
pressure.
B. decreasing of oncotic blood
pressure. answer
C. hold-up of sodium in the organism.
D. venous standstill.
E. increasing of pressure in venous
department of capillary.
2. A man had an increasing of
glomerular filtration speed on 20%
because of prolonged starvation.What
is the reason of renal filtration change
in such conditions?
A. increasing of system arterial
pressure. answer
B. increasing of renal plasma flow.
C increasing of filtration coefficient.
D. increasing of permeability of renal
filter.
E. decreasing of oncotic pressure in
blood plasma.
3. A man with renal disease has AP
170\140 mm. Concentration of what
bioactive substance is probably
increased in blood of patient?
A. adrenalin
B. vasopressin
C. noradrenaline
D. catecholamines
E. renin answer
4. At the examination of patient’s
blood the permanent nitrogen amount
48 mmol/l, urea – 15.3 mmol/l.A
disease of what organ can cause such
results?
A. liver
B. intestines
C. gaster answer
D. kidneys
E. spleen
5. M-30-years-old. Complains about
weakness, headache and waist pain.10
days ago he had quinsy. There are
edemata on the face. Pulse 84
beat/min, pressure 175/100 mm. In the
urine: erythrocytes 100-120 in the
field of vision, leucocytess 1-2 in the
field of vision, proteins 8 g/l.
Diagnosis: acute diffusive
glomerulonephritis. What is the
mechanism of renal function disorder?
A. disturbances of urodinamics
B. immunal injury of tubules
C. injury of tubules
D. disturbances of hemodinamics in
kidneys answer
E. straight injury of tubules
6. M-32-years-old, for 4 years has
chronical glomerulonephritis with
nephrotic syndrome. What of the
following is characteristic for edema
formation?
A. increasing of hydrostatic blood
pressure in capillaries.
B. decreasing of oncotic blood
pressure answer
C. increasing of oncotic pressure of
interstitial tissues.
D. increasing of permeability of
capillaries.
E. impediment of lymph flow.
7. At the examination of the patient it
was fixed, that clearence of
endogenous kreatinine amount 50
mmol/min(normal is 110-150
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mmol/min).Lowering of what function
is the reason of such signs?
A. incretory function
B. tubular reabsorption
C. glomerular filtration answer
D. ions going out from organism
E. uric acid going out from organism
8. M-25-years-old called a doctor and
complained about face edema, waist
pain, nausea.From anamnesis:18 days
ago he had quinsy.The diagnosis is
diffusive glomerulonephritis.The
mechanism of glomerules injury:
A. nephrotoxic
B. ischemic
C. thrombotic answer
D. immune complex
E. medicamentic
9. M-50-years-old, for 17 years has
chronic glomerulonephritis. Pulse 82
beat/min, pressure 190/120 mm. The
main reason of increasing of arterial
pressure is:
A. activation of renin-angiotensin-
aldosterone system
B. increasing of the circulatory blood
volume
C. increasing of percussive blood
volume
D. increasing of minute blood volume
E. increasing of general peripheral answer
resistance
10. A 24-years-ld patient in 2 weeks
after severe streptococcic quinsy had
face edemata, AP increased.Hematuria
and proteinuria 1,2 g/l. There are
antistreptococcic antibodies and
decreasing of complement components
in blood.In microvessels of what
structures of kidneys is probably
localizied gathering of immune
complexes, that caused nephropathy?
A. Henle’s loop
B. proximal department of tubules
C. pyramides answer
D. glomerules
E. descending department of tubules
11. A patient after severe injury had
shock, there appeared signs of acute
renal insufficiency(ARI). What is the
major mechanism of ARI development
is this case?
A. decreasing of arterial pressure
B. increasing of pressure in renal
arteries
C. increasing of pressure in glomerular
capsule
D. decreasing of oncotic blood
pressure
E. disorder of urine flow answer
12. A patient with glomerulonephritis
has: anasarca, AP 185/125 mm,
anemia, hyperazotemia, leucocytosis,
hypoproteinemia. What sign is
evidence of complication of
glomerulonephritis by nephrotic
syndrome:
A. leucocytosis
B. arterial hypertension
C. anemia
D. hypoproteinemia
E. hyperazotemia answer
13. W-40-years-old, 4 months ago
appeared a headache, breathlessness at
walking, disorders of
appetite,weakness.Diagnosis:
glomerulonephritis, complicated by
chronic renal insufficiency. The
definition of what laboratory index is
the most informative in this case?
A. potassium of blood
B. urea of blood answer
C. sodium of blood
D. kreatinine of blood
E. nitrogen of urea of blood
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14.W-40-years old complains about
ache in the right lumbar region,
permanent subfibrilar temperature for
6 month.In anamnesis:chronical
tonsilitis.Evenly:pressure 160/110
mm, pulse 80 beat/min, syndrome of
Pasternatskiy is positive in the right.In
blood:Hb 130 g/l,er. – 3,9 T/l, leuc.-
10,4 G/l, ESR 20 mm/hour.In urine:
density 1.010, proteins 0,033 g/l,
leuc.- 18-20, er.- 1-4 in field of vision,
oxalates – no.What disease does the
patient have?
A. acute glomerulonephritis
B. chronic glomerulonephritis
C. chronic pyelonephritis answer
D. chronic cystitis
E. urolithiasis
15. M-38-years-old complains about
weakness, nocturia. Pulse 68 beat/min,
pressure 135/75 mm. Urine:proteins
0,19 g/l, glucose 0,6 g/l, leuc.- 5-7, er.-
0-1 in field of vision, density of urine
1,006-1012. Daily diuresis 1200 ml,
nightly – 1100 ml. Blood: Hb 135 g/l,
er. 3,8 T/l, sugar 5,4 mmol/l,
kreatinine 0,15 mmol/l, PNa+ - 135
mmol/l, pH of blood = 7,38.What of
the renal functions is mostly
disturbed?
A. homeostatic
B. filtrative
C. concentrative answer
D. erythropoetic
E. nitroexcretory
16. A 18-years-old patient at
laboratory examination had glucose in
urine at it’s normal concentration in
blood.The most likely reason of it is
disturbance of:
A. tubular secretion
B. insulin secretion
C. glomerular filtration answer
D. glucocorticoids secretion
E. tubular reabsorption
17. A 24-years-old patient in a week
after streptococcic quinsy appeared
face edemata, AP increased.
Hematuria and proteinuria.In blood:
there are antistreptococcic antibodies
and decreasing of complement
components. In microvessels of what
structures of kidneys is probably
localizied gathering of immune
complexes, that caused nephropathy?
A. pyramides
B. glomerules answer
C. proximal department of tubules
D. Henle’s loop
E. descending department of tubules
18. A 55-years-old patient has acute
glomerulonephritis.What is the main
mechanism of anemia development at
renal diseases:
A. leucocyturia answer
B. decreasing of glomerular filtration
C. decreasing of synthesis of renal
prostoglandines
D. renal azotemia
E. decreasing of erythropoetine
production answer
19. A patient 55-years-old has
chronical glomerulonephritis. What is
the main pathogenetic mechanism:
A. renal glomerules basal membrane
injury by antibodies and immune
complexes
B. toxic
C. degenerate cell injury
D. hypoxic cell injury
E. inflammatory tubular injury answer
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For notes
________________________________________________________________________________________________________
________________________________________________________________________________________________________
_____________________________________________________

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