10.24 Flashcards by Joseph Marvin

What type of collagen forms the backbone of the GBM?

Type IV collagen (COL4A1-COL4A6)

How well did you know this?

Not at all

Perfectly

What is azotemia?

High in nitrogen byproducts–BUN and creatinine

How well did you know this?

Not at all

Perfectly

What is uremia?

Azotemia + clinical symptoms (gastroenteritis, anemia, periph. neuropathy, pruritis, pericarditis, etc)

How well did you know this?

Not at all

Perfectly

What is the presentation of nephritic syndromes?

Hematuria
Mild/moderate proteinuria
HTN

How well did you know this?

Not at all

Perfectly

What is the presentation of nephrotic syndromes?

>3.5g/day proteinuria
Hypoalbuminemia
Edema
Hyperlipidemia
Lipiduria

How well did you know this?

Not at all

Perfectly

What are signs of Acute Renal Failure (ARF)?

Recent onset azotemia (increases in BUN/Cr)

Oliguria or anuria

How well did you know this?

Not at all

Perfectly

What causes ARF?

Glomerular, tubulointerstitial, or vascular disease

How well did you know this?

Not at all

Perfectly

What are signs of Chronic Renal Failure (CRF)?

Prolonged symptoms of uremia

How well did you know this?

Not at all

Perfectly

What are the symptoms of renal tubular defects?

Polyuria
Nocturia
Electrolyte imbalances (metabolic acidosis)

How well did you know this?

Not at all

Perfectly

What causes renal tubular defects?

Inherited (RTA, cystinuria)

Acquired (lead)

How well did you know this?

Not at all

Perfectly

When do renal tumors typically present?

Late…not good

How well did you know this?

Not at all

Perfectly

What are the 4 stages of Chronic Renal Failure?

Diminished renal reserve
Renal Insufficiency (CRI)
Renal Failure (CRF)
End-Stage Renal Disease (ESRD)

How well did you know this?

Not at all

Perfectly

What are the symptoms of Diminished renal reserve?

GFR of 50% normal
Normal range BUN/Cr
Asymptomatic

How well did you know this?

Not at all

Perfectly

What are the symptoms of CRI?

GFR is 20-50% normal
Azotemia
Anemia
HTN

How well did you know this?

Not at all

Perfectly

What are the symptoms of CRF?

GFR <20-25% normal
Edema
Metabolic acidosis
Uremia

How well did you know this?

Not at all

Perfectly

What are the symptoms of ESRD?

GFR <5% normal

Terminal stage of uremia

How well did you know this?

Not at all

Perfectly

What causes pre-renal increases in BUN?

Increased synthesis of urea: 
Catabolism--burns, fever, stress
High protein diet
GI bleed
Hemolyis
Malignancy

How well did you know this?

Not at all

Perfectly

What causes renal increases in BUN?

Glomerular disease
ATN (Acute Tubular Necrosis)
Interstitial disease

How well did you know this?

Not at all

Perfectly

What causes post-renal increases in BUN?

Urinary tract obstruction

How well did you know this?

Not at all

Perfectly

What causes pre-renal increases in serum creatinine?

Increased synthesis (muscle hypertrophy/necrosis [and similar], high meat diet)
Decreased renal perfusion (CHF, hypotension/shock, etc)

How well did you know this?

Not at all

Perfectly

What causes post-renal increases in serum creatinine?

Urinary tract obstruction

How well did you know this?

Not at all

Perfectly

Is creatinine a good indicator of GFR?

Yes…but exceeds actual by 10-40%–creatinine is secreted in the tubules

How well did you know this?

Not at all

Perfectly

What causes a high BUN:Cr ratio?

Pre-renal conditions–increased proximal urea reabsorption (accompanies the reabsorption of water)

How well did you know this?

Not at all

Perfectly

What would a FeNa of <1.0% indicate?

Pre-renal condition

How well did you know this?

Not at all

Perfectly

What would a FeNa of >2.0% indicate?

ATN

What protein does a urine dipstick measure?

Albumin

What causes false positives for protein in a urine dipstick test?

Alkaline urine Gross hematuria Dilute urine

What does an acid precipitation detect?

Albumin | Globulins--light chains

What causes false positives in an acid precipitation test?

Hematuria | Some meds

What conditions can cause proteinuria other than renal disease?

CHF Massive obesity Constrictive pericarditis Renal vein thrombosis

What would the proteinuria pattern of a glomerular condition look like?

Albumin Small globulins--usually reabsorbed with normal tubular function (protein level may be in nephrotic range)

What would the proteinuria pattern of a tubular condition look like?

Beta-2-microglobulin (1-2gms/24hrs)

What percentage of people are born with urinary tract malformations?

10%

What percentage of CRF in kids is caused by dysplasia and hypoplasia?

20%

Are horseshoe kidneys usually fused at the upper or lower poles?

Lower poles (9:1)

How common are horseshoe kidneys?

0.2-0.1%

What are the gross characteristics of cystic renal dysplasia?

Enlarged Multi-cystic Irregular

What are the micro characteristics of cystic renal dysplasia

Undifferentiated mesenchyme Cartilage Immature collecting ductules Variably sized cysts lined by flattened epithelium

What genes are possibly affected in Autosomal Dominant Polycystic Kidney Disease (PCKD)?

PKD1 (on 16p13.3)...80-85% of cases | PKD2 (on 4q21)...10-15% of cases

What does PKD1 encode for?

Polycystin 1...cell/cell or cell/matrix interactions On cilia of tubular cells

What does PKD2 encode for?

Polycystin 2...acts as a nonspecific calcium-permeable channel On cilia of tubular cells

When is the onset of Autosomal Dominant PCKD?

Usually between 40 and 75 Renal failure in <75% by age 75

What is destroyed due to multiple expanding cysts?

Renal parenchyma

What are the gross characteristics of AD PCKD?

Bilaterally enlarged kidneys | Look like bags of cysts

What are the micro characteristics of AD PCKD?

Cysts with variable lining Arise from tubules throughout the nephron Normal parenchyma presents between cysts

What is the clinical presentation of AD PCKD?

Asymptomatic/pain/hematuria

What are some extra-renal anomalies associated with AD PCKD?

Liver cysts (40%) Intracranial berry aneurysms--causes deaths in 4-10% of PCKD patients Mitral valve prolapse in 20-25%

What are the categories of AR PCKD?

Perinatal Neonatal Infantile Juvenile

Patients in which categories survive infancy?

Infantile (die before adolescents) | Juvenile (die shortly after adolescents)

What are the gross features of AR PCKD?

Enlarged Smooth externally Sections show many small cysts in cortex and medulla

What are the micr features of AR PCKD?

Dilation of all collecting tubules...uniform cuboidal lining of cysts

What other anomalies are associated with AR PCKD?

Liver cysts Bile duct proliferations Congenital hepatic fibrosis--in infantile and juvenile

Who gets Medullary Sponge Kidney?

Adults

What happens with Medullary Sponge Kidney?

Multiple cystic dilatations of collecting ducts in the medulla form

What causes Medullary Sponge Kidney?

Can be incidental | Or associated with hematuria, infection, or stones

How does the kidney function with Medullar Sponge Kidney?

Normally

What are the gross features of Medullary Sponge Kidney?

Dilated papillary ducts in the medulla

What are the micro features of Medullary Sponge Kidney?

Cysts lined by cuboidal or transitional epithelium

What is Nephronophthisis-Uremic Medullary Cystic Disease Complex?

A progressive disorder with onset in childhood

What are the features of Nephronophthisis-Uremic Medullary Cystic Disease Complex?

Cysts in the medulla associated with cortical tubular atrophy and interstitial fibrosis

How do children present with Nephronophthisis-Uremic Medullary Cystic Disease Complex?

Polyuria and polydipsia--because of tubular defect

What is the concern with Acquired (dialysis-associated) Cystic Disease?

Development of renal cell carcinoma within the cysts (7% of dialysis patients w/in 10 years)

What is a simple cyst?

1-5cm Filled with clear fluid Single layer of cuboidal or flattened epithelium line the cysts

What is the important thing about simple cysts?

Making sure they aren't tumors

10.24 Flashcards

(64 cards)