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Renal Flashcards

1
Q

Potter sequence

A
  1. Lung hypoplasia –> death
  2. Flat face
  3. Low set ears
  4. Defects in extremities - club feet

Assoc w/ Oligohydramnios
- B/L adrenal aplasia

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2
Q

BL kidneys cysts containing cartilage and other abnormal tissue

A

Dysplastic kidney

NON-inherited (vs. PKD)

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3
Q

Hispanics & Blacks with Proteinuria >10g, lipiduria, edema
HIV, heroin, sickle cell
Effacement of foot processes
NO response to steroids

A

FSGS

  • Collapsing w/ HIV
  • can be a progression of minimal change
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4
Q

Caucasian adult male with hematuria, proteinuria mild HTN
HBV, HCV, Tumors (lung & colon), SLE, drugs, DM
Thick BM, Sub-EPIthelial deposits - SPIKE & DOME
Granular IC deposition of IgG4 to PLA2R

A

Membranous

  • SLE usually nephritic
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5
Q

Pt w/ HCV, cryoglobulinemia or IVDU with palpable purpura, weakness, arthralgia, red and fatty casts

A

MPGN
TRAM-TRACK

I - sub-ENDOthelial - HBV, HCV, early complement
II - intramembranous - C3 nephritic factor
- low serum complement

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6
Q

Non-enzymatic glycosylation –> hyaline arteriosclerosis of EFFERENT –> hyperfiltration –> microalbuminuria

A

Diabetic nephropathy

Sclerosis of mesanigum = Kimmelsteil-wlison nodules
ACE-I slow progression

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7
Q 
Light chain casts
Kidney = most common
Large amorphous nodular mesangium
Apple-green birefringence
Congo red
A

Amyloidosis

Primary = AL light chains, multiple myeloma
Secondary = AA
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8
Q

Massive proteinura, no HTN, no hematuria in Kids or adults w/ NSAID abuse

Normal glomeruli
Foot process effacement - t-cell cytokines
RESPONDS to steroids (vs. FSGS)

A

Minimal change

Assoc Hodgkin lymphoma*

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9
Q

Muddy/Brown, granular casts, oliguria, elevated BUN, Cr, hyperK w/ acidosis

A

Acute Tubular Necrosis = PROXIMAL TUBULE

Dec GFR

  • BUN:Cr 2%
  • Urine Osm <500

Ischemic - MI
Nephrotoxic - aminoglycosides, lead, ethylene glycol, contrast

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10
Q

Pre/Post-Renal azotemia

A

Pre - Dec RNF
Post - Obstruction downstream

BUN:Cr >15
Osm 500
Fractional Na excrestion (FENa) 2%

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11
Q

AD - PKD

A

AD
HTN - inc renin
hematuria

BERRY ANEURYSM, hepatic cysts, MVP

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12
Q

AR - PKD

A

AR mutation on PKHD1
SMOOTH, sponge-like kidneys (vs. AD)
Infants w/ HTN
Hepatic fibrosis & cysts

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13
Q

SLE w/ nephrotic

A

Membranous

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14
Q

SLE w/ nephritic

A

Diffuse proliferative

Sub-endothelial, granular deposits

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15
Q

Nephritic syndrome

A

Proteinuria neutrophil damage***

RBC CASTS
HYPERCELLULAR

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16
Q

Kid w/ hx of skin infection 2 wks ago has hematuria, oliguria, HTN, periorbital edema.

A

Post-Strep GN
Nephritic
M-protein
Hypercellular - neutrophils & MO

Histology shows sub-EPIthelial HUMPS and low serum C3.

Granular “starry sky” !gG & C3 deposits

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17
Q

Nephritic syndrome w/ CRESCENTS w/ FIBRIN + MO. Collaped glomerular tufts, severe oliguria

A

Rapidly progressing GN

Goodpasture
Diffuse proliferative
Wegeners
Microscopic polyangiitis
Churg-Strauss
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18
Q

Young male presents with hematuria and hemoptysis. Anti-GBM Abs, proteinuria

A

Goodpasture

  • LINEAR
  • Kidney + lung hemorrhage
  • Crescent formation (RPGN)
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19
Q

Diffuse proliferative

A

Nephritic
GRANULAR
Sub-ENDOthelial
MOST COMMON SLE renal disease

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20
Q

Persistent sinusitis does not resolve w/ antibiotics. Hematuria, hemoptysis, HTN, high Cr, Abs against neutrophils and monocytes. Non-caseating granuloma and focal cresentric or RPGN

A

Wegener’s

  • c-ANCA (cytoplasmic antineutrophil cytoplasmic antibody)
  • SINUSITIS, No asthma or eosinophils

Polyangitis is similar but w/o granuloma

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21
Q

Polyangiitis vs. Churg Strauss

A 
Nephritic
NO IF (pauci-immune)

Churg

  • ASTHMA
  • Granulomatous
  • eosinophilia
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22
Q

NO FEVER
Frequency, urgency, suprapubic pain

> 10WBC
+ Leukocyte esterase
+ Nitrates
+ culture >100,000

A

1 = E. coli

Cystitis

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23
Q

> 10WBC
+ Leukocyte esterase
- culture ***

A

Sterile pyuria

chlamydia or gonorrhoeae

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24
Q 
FEVER
Flank pain
WBC casts*
Neutrophils
Pyuria*
A

1 = E. coli

Acute Pyelonephritis

—> Pre-mature labor

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25
Q

WBC casts

A

Pyelonephritis, transplant rejection

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26
Q

Waxy casts

A

Chronic pyelonephritis, CRF

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27
Q

Thyroidization of the kidney

A

Chronic pyelonephritis

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28
Q

Chronic pyelonephritis

A

Fibrosis + atrophy from recurrent pyelonephritis –> scarring, blunted calyces

Kids - VUR
Adults - obstruction

Thyroidization (eosinophilic protein)
Waxy casts

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29
Q

Calcium stones

A

Idiopathic hypercalciuria - normal serum Ca
Anything that inc serum Ca - PTH, cancer
CD

Tx = HTCZ = reabs Ca so its not in urine

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30
Q

Mg stones

A

Urease + bacteria
- PV
- Kleb
Alkaline urine

STAGHORN calculi in ADULTS (vs. cysteine)

Tx = Acidify urine or surgical removal

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31
Q

Uric acid stones

A

RADIOLUCENT

GOUT, Leukemia

Tx = alkalinize urine w/ potassium bicarb
allopurinol
Acetazolamide

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32
Q

Cysteine stones

A

Staghorn calculi in KIDS

Defect in cysteine reabs - cysteinuria

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33
Q

Chronic RF

A 
DM
HTN
Glomerular disease
Dec EPO --> anemia
Dec Vit D & PO4- --> hypoCa
Renal osteodystrophy - 2 HPTH, osteomalacia, osteoporosis

Dialysis –> cysts, SHRUNKEN, RENAL CELL CARCINOMA

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34
Q

Renal mass composed of fat, smooth muscle and blood vessels (Angiomyolipoma) is assoc w/?

A

Tuberous sclerosis

  • 80-90% w/ B/L
  • cortical tubers & subependymal hamartomas
  • seizures, MR, rhabdomyomas, facial angiofibromas
  • “ash-leaf” patches of hypopigmentation
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35
Q

60 y/o male smoker w/ painless hematuria, flank pain and palpable mass in RUQ, weight loss

A

Renal Cell Carcinoma

PARANEOPLASTIC - EPO, PTHrP, ACTH
Left renal vein block –> left varicocele

Hereditary = von Hippel-Lindau
Loss of VHL 3p

Sporadic

  • single
  • upper pole
  • smoking***

Clear-cell = lipid & glycogen accumulation

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36
Q

Most common malignant renal tumor in kids

A

Wilms Tumor

  • Blastema
  • WT1 mutation on chr 11p
  • WAGR syndrome
  • Beckwith-Wiedemann syndrome
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37
Q

WAGR syndrome

A

Wilms tumor
Aniridia
Genital abnormalities
Motor/mental retardation

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38
Q

Beckwith-Wiedemann syndrome

A

Wilms tumor
Neonatal hypoglycemia
Muscular hemihypertrophy
Organomegaly (tongue)

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39
Q

Urothelial/transition cell carcinoma

A

“P-SAC”

  • Phenacetin
  • SMOKERS
  • AZO dyes
  • Cyclophosphamide

Flat - high grade - early p53 mutation
Papillary - low grade –> high, no p53 mutation

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40
Q

Squamous cell carcinoma

A

Squamous cell metaplasia

  1. Chronic cystitis (old woman)
  2. S. haematobium (Egyptian male)
  3. Nephrolithiasis
41
Q

Adenocarcinoma

A
  1. URACHAL REMNANT - DOME of bladder
  2. Cystitis glandularis
  3. Exstrophy
42
Q

Asian or Hispanic w/ cough, pulmonary infiltrates, runny nose about 2 wks prior, presents w/ intermittent hematuria, proteinuria

A 
IgA nephropathy (Berger Disease)
Mesangial IgA deposits, widening but NOT hypercellular

Flares w/ URI or gastroenteritis

If it’s in kids w/ palpable purpura = Henoch-Scholein

43
Q

Teenage male presents w/ red casts proteinuria, difficulty hearing, and seeing

A

Alport syndrome

X-linked, nerve deafness + lens dislocation/cataracts

44
Q

Basket-weave GBM

A

Alport syndrome

45
Q

How does urine pH affect solute reabsorption?

A

pH opposite the substance ionizes it –> can’t be reabs = EXCRETED

46
Q

60-40-20 rule

A

60 = TBW - D2O, pyrene
40 = ICF - (TBW - ECF)
20 = ECF - Inulin
“TIE”

47
Q

Plasma volume % of TBW

A

1/4 of ECF = 1/12 TBW

- measured w/ Evan’s blue, radiolabeled albumin

48
Q

Interstitial % of TBW

A

3/4 of ECF = 1/4 TBW

49
Q

Nephrotic syndrome

A

Charge barrie is lost (heparan GBM) –> albuminuria, edema, hyperlipidemia

50
Q

Renal Clearance

A

C = [urine] x urine flow rate / [plasma]

C > GFR = secretion

51
Q

GFR

A

Inulin

GFR = [urine inulin] x urine flow rate / [plasma inulin]

52
Q

ERPF

A

PAH is both filtered and secreted

ERPF = [urine PAH] x urine flow rate / [plasma PAH]

53
Q

RBF

A

RPF / (1 - Hct)

{[urine PAH] x urine flow rate / [plasma PAH]} / (1 - Hct)

54
Q

Filtration fraction

A

GFR / RPF

Normal = 20%

55
Q

NSAID / afferent arteriole constriction on FF

A

NO CHANGE d/t dec in GFR

Can –> acute renal failure

56
Q

ACE-I / efferent arteriole dilation on FF

A

Dec FF –> dec hyperfiltration in diabetics to dec nephropathy

AGII constricts to preserve RBF/GFR/renal fxn and inc FF

57
Q

Inc plasma protein or constriction of ureter on FF

A

Dec FF

58
Q

Hartnup disease

A

Deficiency of NEUTRAL A/A transporter (tryptophan) –> pellagra

59
Q

PCT

A

Na/Glucose
Na/Phos - inhibited by PTH
Na/H - Inc by ATII
CA - inhibited by acetazolamide

60
Q

Concentrating segment

A

Thin descending loop

Highest [urine] = CD

61
Q

Thick ascending

A

NKCC - inhibited by loops

Indirect Mg, Ca reabs

62
Q

Diluting segment

A

DCT

63
Q

DCT

A

NaCl reabs

  • inhibited by thiazides
  • Inc by ATII

Ca/Na exchange - inc by PTH
Diluting segment

64
Q

CD

A

Na exchange w/ K (Principal cells)

  • inc by aldosterone
  • inhibited by K+ sparing

ADH - V2 receptors to inc AQ channels in medullary CD (Principal cell)

  • reabs H2O and urea
  • V1 –> vasoconstriction & inc PG
65
Q

Isoosmotic expansion/contraction

A

NaCl

Diarrhea

66
Q

Hyperosmotic volume contraction

A

Sweating, fever, DI

67
Q

Hypoosmotic volume expansion/contraction

A

SIADH

Adrenal Insufficiency

68
Q

ANP

A

Na & volume loss - PCT

69
Q

PTH

A

Dec phos - PCT

Inc Ca - Thick ascending

70
Q

Aldosterone

A

Inc Na reabs - CD

Inc K, H+ loss - CD

71
Q

Causes hypoK

A

Shifts INTO cell

  • Insulin
  • B-agonist
  • Alkalosis
  • Hypo-osmolarity
72
Q

Resp Acidosis/Alkalosis

A

pH & PCO2 = OPPOSITE

Acidosis - high PCO2, HCO3
Alkalosis - Low PCO2, HCO3

73
Q

Metabolic Acidosis/Alkalosis

A

Acidosis = all down
- hyperventilation

Alkalosis = all up
- hypoventilation

74
Q

Anion gap metabolic acidosis

A 
MUDPILES
M - methanol (formic acid)
U - Uremia
D - DKA
P - Paraldehyde, phenformin
I - Iron or INH
L - Lactic acidosis
E - Ethylene glycol (oxalic acid)
S - Salicylates
75
Q

Metabolic alkalosis

A

Diuretics
Vomiting
Antacid
Hyperaldosteronism

76
Q

Pt had infection treated with antibiotics and NSAIDs and now presents with fever, arthralgias and a rash that comes and goes

A

Acute Interstitial nephritis

- eosinophils in urine

77
Q

Shrunken kidney with parenchymal fibrosis, localized to the medullary collecting ducts

A

Medullary cystic kidney disease

- Marfans, Ehlers-Danlos, Caroli’s

78
Q

Eosinophils in urine

A

Acute interstitial nephritis

- NSAIDs, beta-lactams, diuretics, anti-convulsants

79
Q

Nephrotic Syndrome

A

Proteinuria >3.5
Pitting edema
Hypogammaglobulinemia - Infections
Hypercoagulable - loss of AT-III

  • Lipiduria - Fatty casts*
  • hyperlipid/cholesterolemia
80
Q

Minimal change assoc w/?

A

Hogdkin lymphoma

81
Q

GN assoc w/ sickle cell and HIV

A

FSGS

82
Q

Sub-epithelial spike & dome

A

Membranous

83
Q

Track-Track

A

Membranoproliferative

84
Q

Sub-endothelial

A

MPGN - I = HBV, HCV (more tram tracks)

85
Q

Intramembranous deposits

A

MPGN - II = C3 nephritic factor, low C3

86
Q

Sclerosis of mesanigum = Kimmelsteil-wlison nodules

A

Diabetic

87
Q

What slows the progression of diabetic nephropathy?

A

ACE-I = dilates efferent

88
Q

Sub-epithelial humps & low serum C3

A

Post-strep

89
Q

Causes of renal papillary necrosis

A

Chronic analgesic use
DM
Sickle cell
Severe acute pyeonephritis

90
Q

Loop diuretics

A

Furosemide
Inhibits NKCC in TAL
Stimulate PG release –> inc RBF, GFR

SE = “OH DANG”
- oto, hypoK, dehydration, allergy, nephritis, gout

91
Q

(+) Hale’s colloidal iron stain

A

Chromophobe RCC

92
Q

Acetazolamide

A

CA inhibitor in PCT
Use = glaucoma, mountain sickness
SE = acidosis, sulfa, stones

93
Q

Thiazides

A

Inhibits NaCl in DCT
Use = HTN, NDI
SE = HyperGLUC
Sulfa

94
Q

K-sparing diuretics

A

Spironolactone = blocks aldosterone receptor in CD
Triamterene, Amiloride = block Na in CD

Use = CHF, hyperaldosterone, low K

95
Q

ACE-I

A

Use = HTN, CHF, DM - prevents heart remodeling by aldosterone

SE = dec GFR, FF

96
Q

Type I RTA

A

Can’t secrete H+ in CD –> Ca stones

Hyperchloremic, non-anion gap acidosis

97
Q

Type II RTA

A

Cant reabsorb HCO3- in PCT

  • multiple myeloma,amyloidosis
  • Hyperchloremic, non-anion gap acidosis
98
Q

Type IV RTA

A

Most common

Aldosterone deficiency

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