Page 1 of 33
PATHO EXAM 4 STUDY GUIDE REVIEW
RENAL SYSTEM
Acute unilateral renal obstruction and
hypertension.
• The reduced perfusion of the affected kidney activates the (RAAS),
which causes constriction of peripheral arterioles.
• Kidneys require at least 20-25% cardiac output – MAP
• Most common type of renal stone: Calcium oxalate.
• Passage of kidney stones can be extremely painful and may
produce “referred pain” to umbilicus area – this is d/t sensory
innervation of the upper part of the ureter arising from the 10th
thoracic nerve roots.
Urinary tract infections:
• Clinical manifestations in an older adult
o Confusion
o Poorly localized abdominal discomfort
o Can be very difficult to diagnose due to vague symptoms.
Pyelonephritis
o Infection of one or both upper urinary tracts (ureter, renal pelvis,
and kidney interstitium).
o Most common underlying risk factors: Urinary obstruction and reflux of
urine from the bladder (vesicoureteral reflux)
o Microorganisms usually associated with acute pyelonephritis include
E. coli, Proteus, or Pseudomonas. These microorganisms also split
urea into ammonia, making alkaline urine that increases the r/o
stone formation.
Painful bladder syndrome/interstitial cystitis
(PBS/IC)
o Nonbacterial infectious cystitis (viral, mycobacterial, chlamydial, fungal)
o Noninfectious cystitis (radiation, chemical, autoimmune,
hypersensitivity).
o Cause is unknown, autoimmune reaction may be responsible for the
inflammatory response, which includes mast cell activation, altered
epithelial permeability, neuroinflammation, and increased sensory
, Page 2 of 33
nerve sensitivity.
Differentiating symptoms of cystitis from those of
pyelonephritis by clinical assessment alone is difficult. The
specific diagnosis is established by urine culture, urinalysis,
and clinical signs and symptoms. White blood cell casts
indicate pyelonephritis, but they are not always present in the
urine.
, Page 3 of 33
Glomerular disorders.
Reduced GFR during glomerular disease is evidenced by elevated
plasma urea, creatinine concentration, or reduced renal
creatinine clearance.
Acute glomerulonephritis
o Renal diseases in which glomerular inflammation is caused by
immune mechanisms that damage the glomerular capillary
filtration membrane including the endothelium, basement
membrane, and epithelium (podocytes).
o Symptoms
o Sudden onset of hematuria including red blood cell
casts and proteinuria (milder than nephrotic
syndrome)
o In more severe cases, these symptoms are also
accompanied by edema, hypertension, and impaired
renal function.
Nephrotic syndrome
o Symptoms
o Excretion of 3.0 g or more of protein (massive proteinuria) in
the urine per day
o Hypoalbuminemia (less than 3.0 g/dl)
o Peripheral edema.
o Nephrotic syndrome is characteristic of glomerular injury.
o Primary causes
o Minimal change disease (lipoid nephrosis)
o Membranous glomerulonephritis
o Focal segmental glomerulosclerosis
o Secondary forms of nephrotic syndrome occur in systemic
diseases including DM, amyloidosis, and SLE
o Nephrotic syndrome also is seen with certain drugs,
infections, malignancies, and vascular disorders.
Acute Kidney injury
o Acute and rapidly progressive (within hours), and the process may be
reversible.
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o Can be chronic, progressing to end-stage kidney failure over a period
of months or years.
o Renal insufficiency refers to a decline in renal function to about 25% of
normal or a GFR of 25 to 30 ml/minute.
o Levels of serum Cr and urea are mildly elevated; changes in serum Cr
level occur only if more than 50% of GFR is lost and are often delayed
by more than 24 hours.
o Such diagnostic delays make the implementation of early therapy
very difficult, contributing to disease progression and mortality.
o Prone to hyperkalemia and metabolic acidosis.
o Renal phosphate excretion is decreased, causing hyperphosphatemia.
o Fluid retention may cause edema.
o Symptoms of CHF develop in persons with cardiac disease.
o N/V, and fatigue accompany uremia and electrolyte imbalances.
o Wound healing is delayed, and the risk of infection, particularly
pneumonia, is greater.
Gastrointestinal System
Obesity
• BMI > 30 kg/m2
• Develops when caloric intake > caloric expenditure in genetically
susceptible individuals
• Major risk factor for morbidity, death, and high healthcare cost in the
United States
and worldwide.
• Three leading causes of death in the United States are associated with
obesity
o Cardiovascular disease
o Type 2 DM
o Cancer.
Visceral obesity
• AKA intra-abdominal, central, or masculine obesity
• Distribution of body fat is localized around the abdomen and upper
PATHO EXAM 4 STUDY GUIDE REVIEW
RENAL SYSTEM
Acute unilateral renal obstruction and
hypertension.
• The reduced perfusion of the affected kidney activates the (RAAS),
which causes constriction of peripheral arterioles.
• Kidneys require at least 20-25% cardiac output – MAP
• Most common type of renal stone: Calcium oxalate.
• Passage of kidney stones can be extremely painful and may
produce “referred pain” to umbilicus area – this is d/t sensory
innervation of the upper part of the ureter arising from the 10th
thoracic nerve roots.
Urinary tract infections:
• Clinical manifestations in an older adult
o Confusion
o Poorly localized abdominal discomfort
o Can be very difficult to diagnose due to vague symptoms.
Pyelonephritis
o Infection of one or both upper urinary tracts (ureter, renal pelvis,
and kidney interstitium).
o Most common underlying risk factors: Urinary obstruction and reflux of
urine from the bladder (vesicoureteral reflux)
o Microorganisms usually associated with acute pyelonephritis include
E. coli, Proteus, or Pseudomonas. These microorganisms also split
urea into ammonia, making alkaline urine that increases the r/o
stone formation.
Painful bladder syndrome/interstitial cystitis
(PBS/IC)
o Nonbacterial infectious cystitis (viral, mycobacterial, chlamydial, fungal)
o Noninfectious cystitis (radiation, chemical, autoimmune,
hypersensitivity).
o Cause is unknown, autoimmune reaction may be responsible for the
inflammatory response, which includes mast cell activation, altered
epithelial permeability, neuroinflammation, and increased sensory
, Page 2 of 33
nerve sensitivity.
Differentiating symptoms of cystitis from those of
pyelonephritis by clinical assessment alone is difficult. The
specific diagnosis is established by urine culture, urinalysis,
and clinical signs and symptoms. White blood cell casts
indicate pyelonephritis, but they are not always present in the
urine.
, Page 3 of 33
Glomerular disorders.
Reduced GFR during glomerular disease is evidenced by elevated
plasma urea, creatinine concentration, or reduced renal
creatinine clearance.
Acute glomerulonephritis
o Renal diseases in which glomerular inflammation is caused by
immune mechanisms that damage the glomerular capillary
filtration membrane including the endothelium, basement
membrane, and epithelium (podocytes).
o Symptoms
o Sudden onset of hematuria including red blood cell
casts and proteinuria (milder than nephrotic
syndrome)
o In more severe cases, these symptoms are also
accompanied by edema, hypertension, and impaired
renal function.
Nephrotic syndrome
o Symptoms
o Excretion of 3.0 g or more of protein (massive proteinuria) in
the urine per day
o Hypoalbuminemia (less than 3.0 g/dl)
o Peripheral edema.
o Nephrotic syndrome is characteristic of glomerular injury.
o Primary causes
o Minimal change disease (lipoid nephrosis)
o Membranous glomerulonephritis
o Focal segmental glomerulosclerosis
o Secondary forms of nephrotic syndrome occur in systemic
diseases including DM, amyloidosis, and SLE
o Nephrotic syndrome also is seen with certain drugs,
infections, malignancies, and vascular disorders.
Acute Kidney injury
o Acute and rapidly progressive (within hours), and the process may be
reversible.
, Page 4 of 33
o Can be chronic, progressing to end-stage kidney failure over a period
of months or years.
o Renal insufficiency refers to a decline in renal function to about 25% of
normal or a GFR of 25 to 30 ml/minute.
o Levels of serum Cr and urea are mildly elevated; changes in serum Cr
level occur only if more than 50% of GFR is lost and are often delayed
by more than 24 hours.
o Such diagnostic delays make the implementation of early therapy
very difficult, contributing to disease progression and mortality.
o Prone to hyperkalemia and metabolic acidosis.
o Renal phosphate excretion is decreased, causing hyperphosphatemia.
o Fluid retention may cause edema.
o Symptoms of CHF develop in persons with cardiac disease.
o N/V, and fatigue accompany uremia and electrolyte imbalances.
o Wound healing is delayed, and the risk of infection, particularly
pneumonia, is greater.
Gastrointestinal System
Obesity
• BMI > 30 kg/m2
• Develops when caloric intake > caloric expenditure in genetically
susceptible individuals
• Major risk factor for morbidity, death, and high healthcare cost in the
United States
and worldwide.
• Three leading causes of death in the United States are associated with
obesity
o Cardiovascular disease
o Type 2 DM
o Cancer.
Visceral obesity
• AKA intra-abdominal, central, or masculine obesity
• Distribution of body fat is localized around the abdomen and upper
