Lecture on Renal Pathology and Related Conditions

Key Renal Pathologies

• White Blood Cell Casts in Urine

  • Indicative of:
    • Acute Interstitial Nephritis (AIN)
    • Pyelonephritis

• Uremia

  • Resulting from kidney disease, elevated urea levels
  • Manifestations leading to dialysis:
    • Hemolytic Uremic Syndrome (HUS)
      • Microangiopathic hemolytic anemia
      • Platelet clumping, RBC shearing
      • Can be precipitated by E. coli O157:H7 from undercooked burgers
    • Uremic Pericarditis
    • Platelet Dysfunction
    • Confusion (Uremia)

Chronic Kidney Disease (CKD)

• Top Causes

  • Hypertension
  • Diabetes Mellitus

• Dialysis Indications (AEIOU mnemonic)

  • Acidosis (refractory)
  • Electrolytes (hyperkalemia, refractory)
  • Intoxications (e.g., methanol, aspirin, lithium, ethylene glycol)
  • Overload (fluid overload from CKD)
  • Uremia symptoms

Acute Renal Conditions

• Acute Interstitial Nephritis (AIN)

  • Causes: NSAIDs, diuretics, antibiotics
  • Symptoms: FEAR mnemonic
    • Fever
    • Eosinophilia
    • Azotemia
    • Rash
  • Associated with medication use

• Acute Tubular Necrosis (ATN)

  • Causes: Hypoxia, toxins
  • Symptoms: Muddy brown casts in urine
  • Treatment: IV fluids

Renal Tubular Acidosis (RTA)

• Types of RTA
  • Type 1 (Distal)
    • Underexcretion of hydrogen
    • Associated with kidney stones
  • Type 2 (Proximal)
    • Unable to reabsorb bicarbonate
  • Type 4
    • Hypoaldosteronism
    • Hyperkalemia

Metabolic Conditions

• Anion Gap Metabolic Acidosis (MUDPILES mnemonic)

  • Methanol, Uremia, DKA, etc.

• Non-Anion Gap Metabolic Acidosis

  • Common causes: Diarrhea, RTA

• Metabolic Alkalosis

  • Check urine chloride to differentiate causes

Kidney Stones

• Calcium Oxalate Stones
  • High fat diet binds calcium, increases oxalate reabsorption
  • Diet recommendations: low salt, low fat, high calcium, lots of water

Urological Conditions

• Renal Cell Carcinoma vs. Bladder Cancer

  • Renal cell carcinoma: Hematuria, flank pain, abdominal mass
  • Bladder cancer: Painless hematuria, especially in smokers

• Testicular Conditions

  • Testicular Torsion

    • Symptoms: Acute pain, absent cremasteric reflex
    • Treatment: Bilateral orchidopexy if confirmed

  • Epididymitis

    • Symptoms: Fever, tender cord, pain relieved upon elevation

• Prostatitis and Related Infections

  • Young men: Treat for gonorrhea, chlamydia
  • Older men: Treat for E. coli with fluoroquinolones

These notes provide a comprehensive overview of renal pathologies, diagnostic processes, and treatments as discussed in the lecture. Focus on understanding the conditions, their causes, symptoms, and recommended management strategies.