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Renal > Day 7 5/20/15 > Flashcards

Day 7 5/20/15 Flashcards

1
Q

BUN Creatinine Ratio

A

The ratio of serum BUN to creatinine is usually between 10:1 and 20:1. An increased ratio may be due to a condition that causes a decrease in the flow of blood to the kidneys, such as congestive heart failure, early stage post-renal failure or dehydration.

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2
Q

Crockoft Gault Equation for Creatinine Clearance (GFR)

A 
Creatinine Clearance (or GFR) = [(140-age) x weight kg] / [serum creatinine x 72] x0.85 for females
-slightly overestimates GFR because creatinine is moderately secreted by renal tubules
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3
Q

Fractional Excretion of Na (FeNa) Equation

A

FeNa = 100 [(Na urinary x Cr plasma) / (Na plasma x Cr urinary)]

1% = damage to kidney itself

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4
Q

nocturia

A

-need to urinate waking one from sleep

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5
Q

Urinary loss of albumin results in:

A
  • dec. oncotic pressure leading to edema

- hallmark of nephrotic syndrome

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6
Q

Nephrotic Syndrome

  • blood albumin leve
  • blood gammaglobulin level
  • blood coagulation state
  • blood lipid and cholesterol level
A
  • hypoalbuminemia- edema
  • hypogammaglobulinemia
  • hypercoagulable state- loss of antithrombin III
  • hyperlipidemia
  • hyperchoesterolemia
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7
Q

Nephrotic Syndromes

A
  • minimal change disease
  • focal segmental glomerulosclerosis (FSGS)
  • membranous nephropathy
  • membranoproliferative glomerulonephritis (MPGN)
  • diabetes mellitus
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8
Q

Minimal Change Disease Causes

A
  • nephrotic
  • common in children
  • idiopathic or Hodgkin lymphoma related
  • loss of foot processes due to cytokines
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9
Q

Minimal Change Disease Lab Findings

A
  • normal glomeruli on H&E stain
  • effacement of foot processes on EM
  • negative IF, no immune complexes
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10
Q

Minimal Change Disease Protein Loss

A
  • selective proteinuria
  • loss of albumin
  • normal immunoglobluin
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11
Q

Minimal Change Disease Treatment

A

Excellent Response to Steroids

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12
Q

FSGS Causes

A
  • nephrotic
  • usually idiopathic
  • HIV
  • heroin use
  • sickle cell disease
  • most common nephrotic syndrome in hispanics and african americans
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13
Q

FSGS Labs

A
  • segmental sclerosis on H&E
  • effacement of foot processes on EM
  • negative IF; no immune complexes
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14
Q

FSGS Treatment

A
  • minimal response to steroids; progresses to chronic renal failure
  • usually doesn’t respond to treatment
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15
Q

Membranous Nephropathy Causes

A
  • nephrotic
  • most common cause of nephropathy in caucasians
  • usually idiopathic
  • HEP B/C
  • solid tumors
  • SLE
  • drugs (NSAIDS, penicillamine)
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16
Q

Membranous Nephropathy Labs

A
  • H&E: thick glomerular basement membrane
  • granular IF: due to immune complex deposition
  • EM: subepithelial (level of podocyte) deposits with spike and dome appearance
17
Q

Two Types of MPGN & Causes

A
  • nephrotic
  • type 1: subendothelial, associated with HBV and HCV, more often associated with formation of tram-tracks
  • type 2: intramembranous, associated with C3 nephritic factor autoantibody
18
Q

MPGN Labs

A
  • H&E: thick capillary membranes, often tram-track appearance in type 1 most commonly
  • IF: granular due to immune complex deposition
  • can also sometimes be nephritic
19
Q

DM Nephrotic Syndrome Causes

A
  • high serum glucose causes basement membrane to become leaky and causes hyaline arteriolosclerosis (thickening of blood vessel wall)
  • efferent arteriole is most affected, leading to high glomerular filtration pressure
  • hyperfiltration injury results in microalbuminuria and progresses to nephrotic syndrome
20
Q

DM Treatment for Kidney

A

-ACE inhibitors prevent additional contraction of efferent arterioles in kidney, preventing further injury

21
Q

Nephritic Syndrome Hallmarks

A

-limited proteinuria (

22
Q

Nephritic Syndromes

A
  • post strep glomerulonephritis (PSGN)
  • rapidly progressive glomerulonephritis
  • IgA nephropathy
  • alport syndrome
  • benign familial hematuria (thin basement membrane disease)
  • focal/necrotizing/crescentic GN
  • lupus GN
23
Q

Post Strep Glomerulonephritis (PSGN) Causes

A
  • nephritic
  • arises after group A beta hemolytic strep infection of skin (impetigo) or pharynx
  • occurs with nephritogenic strains that carry M protein virulence factor
24
Q

Post Strep Glomerulonephritis (PSGN) Presentation

A
  • hematuria (cola colored urine)
  • oliguria
  • hypertension
  • periorbital edema
  • usually seen in children but can occur in adults
25
Q

Post Strep Glomerulonephritis (PSGN) Labs

A
  • H&E: hypercellular, inflamed glomeruli
  • IF: granular, mediated by immune complex deposition
  • EM: subepithelial humps
26
Q

Post Strep Glomerulonephritis (PSGN) Treatment

A
  • supportive
  • children rarely progress to renal failure
  • some adults develop rapidly progressive glomerulonephritis (RPGN)
27
Q

Rapidly Progressive Glomerulonephritis (RPGN) Lab Differentiation

A
  • H&E: crescents in bowmans space, comprised of fibrin and macrophages
  • IF:
    • linear: goodpastures
    • granular: post strep glomerular nephritis (PSGN), or diffuse proliferative GN
    • negative IF: pausi-immune: cANCA means wegners granulomatosis, pANCA means microscopic polyangiitis or churg straus
28
Q

IgA Nephropathy Causes

A
  • nephritic
  • IgA immune complex deposition in mesangium of glomeruli
  • most common nephropathy worldwide
29
Q

Alport Syndrome Causes

A
  • nephritic
  • inherited defect in type 4 collagen
  • most commonly X linked
  • results in thinning and splitting of glomerular basement membrane
30
Q

Alport Syndrome Presentation

A
  • isolated hematuria
  • sensory hearing loss
  • ocular disturbances
31
Q

Renal Clearance Equation

A

C = (U x V) / P

C- clearance of X (mL/min)
U- urine concentration of X (mg/mL)
P- plasma concentration of X (mg/mL)
V- urine flow rate (mL/min) (1440 min per day)

32
Q

Glomerular Filtration Rate Equation

A

-inulin clearance can be used to calculate GFR because it is freely filtered and not reabsorbed or secreted

GFR= Kf [(Pgc - Pbs) - (pgc - pbs)]

  • gc- glomerular capillary
  • bs- bowman space
  • pbs normal equals 0
  • normal GFR = 100 mL/min

Renal (14 decks)

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