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Flashcards in cram.pathoma Deck (71)
1

Dx
Bilateral cysts in the kidney, but NOT inherited

Dysplastic kidneys

2

Dx
Potter sequence, HTN, renal failure in child

Autosomal Recessive Polycystic Kidney Disease

3

Associated with renal cysts

Hepatic cysts
Both ADPKD and ARPKD

4

Dx
HTN, hematuria, renal failure in young adult, berry aneurysm, hepatic cysts, mitral valve prolapse

Autosomal Dominant Polycystic Kidney Disease

Cysts in Kidney, Liver, and Brain

5

Renal cysts: Medullary Cystic Kidney Disease vs Polycystic Kidney Disease
1) Kidney size
2) Location of cysts

MDCK = Small, Cysts in Medulla

PKD = Large, Cysts in Cortex and Medulla

6

Why does BUN/Cr increase in Prerenal azotemia?

BUN is resorbed in tubule. Cr is not. Nl BYN:Cr is 15:1. Prerenal will cause increased Aldosterone --> Inc Na resorption --> Inc water resorption --> Inc BUN resorption.

7

Signs of Tubular damage
(5)

1) BUN:Cr 2%
3) Urine Osm <500
4) Hyperkalemia
5) Metabolic Acidosis

8

Why does ATN cause azotemia/renal failure?

Dead tubule cells slough off and block filtrate causing backpressure that prevents Filtering --> Renail failure/azotemia

9

Dx
Brown granular cast

ATN

10

Dx
Eosinophils in urine

Drug induced ATN

11

Characteristics of Nephrotic Sx
(4)

1) Hypoalbuminemia
2) Hypogammaglobulinemia
3) Hypercoagulable (ATIII decreased)
4) Hyperlipidemia

12

Kidney disease in Hodgkin's Lymphoma

Minimal Change Disease (bc of cytokines!)

13

Dx
Nl glomeruli, effacement on EM, negative IF

Minimal Change Disease

14

Tx
Minimal Change Disease

Steroids
(only Nephrotic sx with excellent response to steroids)

15

Dx
HIV pt develops Nephrotic sx
(or heroin, or sickle cell, basically someone from The Wire)

Focal Segmental Glomerular Sclerosis

16

Dx
Lupus pt gets Nephrotic Sx

Membranous Nephropathy

17

Dx
Thick basement membrane, Granular on IF, Spike and dome on EM

Membranous Nephropathy

(spikes/domes from immune deposits)

18

Dx
Thick capillary membrane in Glomerulus, Tram Track appearance, IF deposits

Membranoproliferative Glomerulonephritis

19

Which Nephrotic sx is called -nephritis

Membranoproliferative Glomerulonephrtitis
Can cause Nephritic or Nephrotic or Both

20

Types of Membranoproliferative Glumerulonephritis
C3 Nephritic Factor, Intramembranous

HBV/HCV, Subdendothelial

1) Type I

2) Type II

(Membranous deposits are above BM)

21

Mech Nephrotic sx in Diabetes

High Sugar glycosylates vascular membrane --> Hyaline arteriosclerosis of Efferent > Afferent --> High filtration --> Microalbuminuria

22

Tx
Nephrotic sx due to Diabetes

ACE-Is

23

Dx
Nephrotic sx, apple-green birefrigence

Systemic Amyloidosis

24

Characteristics of Glomerulonephritis
(4)

Glomerular Inflmmation with
1) Oliguria
2) Salt retention and edema
3) RBC casts
4) Limited proteinuria

25

What carries Nephritic potential on Strep bugs

M Factor

26

What is Crescent in RPGN?

Fibrin and Macrophages

27

Dx
Linear immunoflouorescence pattern

Goodpasture's

28

Dx: Pauci-Immune IF
cANCA:

pANCA:

cANCA: Wegener's Granulomatosis

pANCA: Churg-Strauss and Microscopic Polyangiitis

Churg-Strauss has Eos and Asthma

29

Dx
Isolated hematuria, sensory hearing loss, ocular disturbances

Alport Sx

(Type IV collagen defect)

30

What do urine nitrItes show?

That bacteria turned NitrAtes into NitrItes

31

Dx
Pyruria with negative urine cx

Urethritis (Gonorrhea or Chlamydia)

32

Tx
Calcium oxalate/phosphate

HCTZ

33

Dx
Staghorn caliculus
(2)

Proteus or Klebsiella

34

Tx
Uric acid stone

Hydration and alkalinization of urine

35

Which cells make EPO

Renal Peritubular Interstitial cells

36

Renal risk for Dialysis
(2)

1) Cysts
2) Renal Cell Carcinoma

37

Dx
Hematuria, palpable mass, flank pain

Renal Cell Carcinoma

38

Paraneoplasms of Renal Cell Carcinoma
(4)

1) EPO - PV
2) Renin - HTN
3) PTHrP - Osteomalcia
4) ACTH - Cushings

39

Mech Renal Cell Carcinoma

Loss of VHL tumor supressor gene, Inc IGF-1, Inc HIF and VEGF

40

Dx
Blastema (i.e. small dark blue cells in kidney mass)

Wilms Tumor

41

Wilms tumor associations
(2)

1) Beckwith-Wiedemann Sx
2) WAGR syndrome

42

Dx
Middle eastern male with urogenital cancer

Squamous Cell Carcinoma

43

Where do Adenocarcinoma of Bladder originate from
(3)

1) Urachal remnant (dome of bladder)
2) Bladder extrophy
3) Cysitis Glandularis

44

How to predict what Healthy Kidneys will do if extra-renal perturbation?

-ADH and Water Retention/Excretion will always respond to NATREMIA

-Na Retention/Excretion will always respond to VOLEMIA

*Exception: In Hypovolemic Hyponatremia the low volume trumps the hyponatremia causing Water Retention not loss

45

Which Renal diseases are both Nephritic and Nephrotic?
(2)

Diffuse Proliferative Glomerulonephritis

Membranoproliferative Glomerulonephritis

46

Type of Hypersensitivity reaction in Post Strep GN?

Type III (Immune complex mediated)

47

Dx
Increased thickness of glomerular basement membrane, granular deposits on IF, spike and dome deposits

Membranous Nephropathy

48

Dx
Palpable abdominal mass with pain to groin after cervical cancer

Hydonephrosis due to ureteral damage during hysterectomy

49

Where doe ADH act SPECIFICALLY?

MEDULLARY portion of Collecting Duct

50

Potassium reabsorption and regulation along Nephron
-Proximal Tubule =
-Loop of Henle =
-Collecting Duct =

-Proximal Tubule = 70% Does not regulate K
-Loop of Henle = 20% Does not regulate K
-Collecting Duct = Where K is regulated

51

Things that increase K secretion at Collecting Duct
(4)

1) Hyperkalemia
2) Aldosterone
3) Alkalosis
4) Thiazide Diurecics

52

Diuretics that
-Waste Ca
-Retain Ca

-Waste Ca = Loop Diuretics
-Retain Ca = Thiazides

53

Which part of Nephron is Impermeable to water?

Thick Ascending Limb of LoH

54

What is interesting about Minimal Change disease's protein loss?

It is Selective and thus loses much albumin but little Ig for example

55

Dx
Microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure

Henoch-Schonlein Purpura

56

Causes of HUS

Shigella
or
E Coli O157

57

What constitutes deposits in Post Strep GN?
(3)

IgG
IgM
C3

58

Tx
To prevent recurrent Ca stones

Thiazide diuretics

59

Renal S/e
Amphotericin B
(2)

Hypokalemia
and
Hypomagenesemia

60

Where is urine the most dilute in Nephron?

Distal tubule

61

Dx
Bilateral Renal Angiomyolipoma

Tuberous sclerosis

62

Dx
Anti alpha3-chain of collagen Type IV Abs

Goodpature's

63

Dx
Nodular glomerulosclerosis (Kimmelstiel-Wilson disease)

Diabetic Nephropathy

64

Tx
Diabetic nephropathy
(2)

ACE-I or
ARB

65

Dx
IgG4 Abs to Phospholipase A2 receptor

Membranous nephropathy

66

Which polymerase incorporates Uracil into DNA in prokaryotes?

Primase

67

Where does AngII cause vasoconstriction in kidney?

1) EFFERENT arteriole

68

Which parts of nephron are most susceptible to ischemia?

Proximal Tubule
then Thick Ascending Limb of LoH

69

S/e
Antidiuretic causes Ototoxicity

Furosemide

70

What is gene on C'some 3 causing Renal Cell Carcinoma

von Hippel Lindau

71

What happens to Phos in urine during Acidosis?

Acidosis = Titratable acids (H2PO4- and NH4+ are excreted)