Exam 2 Flashcards
(113 cards)
1
Q
What is hematuria?
A
3 RBC seen on >2 occasions
2
Q
Bence Jones proteins?
A
Plasma Cell Myeloma
3
Q
Glomerular protein- albumin?
A
diabetic nephropathy
4
Q
What causes urinary casts?
A
Tamm- Horsfall protein in tubules
5
Q
What cast is seen with concentrated urine, fever, exercise, diuretics?
A
Hyaline casts
6
Q
RBC casts?
A
GN
7
Q
WBC casts?
A
Pyelo, interstitial nephritis
8
Q
Pigemented/muddy brown casts?
A
acute tubular necrosis (ATN)
9
Q
Waxy casts
A
late CKD
10
Q
Granular casts
A
ATN
11
Q
Normal BUN?
A
7-30 mg/dL
12
Q
Normal Creatinine?
A
0.7-1.2 mg/dL
13
Q
Normal BUN/ Creatinine ratio?
A
10:1
14
Q
Abnormal BUN/ Creatinine ratio?
A
20:1
15
Q
What are 6 absolute contraindications for renal biopsy?
A
- Uncorrected bleeding disorder
- Severe uncontrolled HTN
- Renal infection
- Neoplasm
- Hydronephrosis
- Uncooperative pt
16
Q
What are 5 relative contraindications for renal biopsy?
A
- Solitary or ectopic kidney
- Horseshoe
- ESRD
- Congenital anomalies
- PCKD
17
Q
What are 5 relative contraindications for renal biopsy?
A
- Solitary or ectopic kidney
- Horseshoe
- ESRD
- Congenital anomalies
- PCKD
18
Q
What are the 3 criteria for AKI?
A
- Rise in SCr at least > 0.3 over 48hrs OR
- 1.5x baseline within 7dys
- Urine volume < 0.5 ml/kg per 6hrs
19
Q
3 types of AKI?
A
Pre-renal
Intrinsic/Renal
Post-renal
20
Q
Most common AKI form?
A
Pre-renal (hypoperfusion)
21
Q
Criteria used for AKI?
A
RIFLE
22
Q
RIFLE?
A
Risk Injury Failure Loss Endstage
23
Q
What is activated and released during hypotension?
A
SNS and RAAS, Vasopressin/ ADH
24
Q
Once vasopressin and ADH is released what happens?
A
vasocontriction of AFFERENT ARTERIOLE and decrease in urine—- leads to HTN
25
Risk factors for pre-renal AKI?
Advanced age, male, black
26
Pre-renal w/ hypovolemia?
dizziness, thirst, Orthostatic Hypo, poor skin turgor
27
Pre-renal w/ low cardiac output?
Rales, third/ fourth heart sounds, JVD, peripheral edema
28
Pre-renal w/ sepsis?
Fever, elevated WBC, Orthostatic Hypo
29
FEna in prerenal AKI?
<1%
30
Imaging for pre-renal AKI?
Ultrasound
31
Urine osmolality in pre-renal AKI?
>500
32
Txt for Pre-renal AKI?
Txt cause
Txt HTN
Furosemide for overload
Consult nephrology for RRT
33
The least common cause of AKI?
Post-renal
34
Anuria, oliguria, or polyuria?
Post-renal
35
FEna in post-renal AKI?
> 2 or varies
36
Urine Osmolality in post-renal AKI?
<400
37
Urine sediment in Post renal AKI?
normal, RBC, WBC, or cystals
38
Imaging for post-renal AKI?
Ultrasound or CT
39
Txt for post-renal AKI?
Relieve obstruction- bladder cath, stent, surgery
40
85% of all intrinsic/renal AKI?
Acute tubular necrosis (ATN)
41
Caused by renal ischemia or exposure to toxins?
Acute tubular necrosis (ATN)
42
3rd leading cause of new onset AKI in hospitalized patients?
radiographic contrast dye
43
S/S of ATN?
Uremic state
44
Urine sediment for ATN?
Granular, MUDDY BROWN CASTS, epithelial cell casts, free renal tubular epi cells
45
FEna for ATN?
>1% usually >2
46
Txt for ATN?
Treat cause
loop diuretics ONLY for overload
IV thiazide diuretics (chlorothiazide or metolazone)
RRT
47
Prognosis for ATN?
70% ICU, inpatient 20-50%
48
AKA Tubulointerstitial nephritis?
Acute Interstitial nephritis (AIN)
49
What mainly causes Acute Interstitial Nephritis?
Drugs (70%)
50
AIN classic triad?
fever, rash, arthralgia post infection or medication
51
Dx of AIN?
serum eosinophilia (allergic) , eosinophiluria
52
Definitive dx for AIN?
Biopsy
53
Med txt for AIN?
Methylprednisolone 500-1000MG daily for 3 days followed by oral prednisone 2wks
54
If can't tolerate steroids, what can be given?
mycophenolate mofetil
55
Complex relationship between cardiac and renal dysfunction?
cardiorenal syndrome
56
Type 1 Cardiorenal syndrome?
Acute HF results in AKI
57
Type 2 Cardiorenal syndrome?
Chronic cardiac dysfunction causes progressive CKD
58
Type 3 Cardiorenal syndrome?
Abrupt AKI causes actue cardiac dysfunction HF
59
Type 4 Cardiorenal syndrome?
CKD contributes to cardiac dysfunction
60
Type 5 Cardiorenal syndrome?
Heart and kidney dysfunction due to other acute or chronic systemic diseases (sepsis, DM)
61
Txt cardiorenal syndrome?
no medical txt
| treating HF has improved eGFR in Type 1 and 2
62
Rapid loss of renal function in pts w/ cirrhosis and fulminant liver failure?
Hepatorenal
63
Type 1 Hepatorenal syndrome?
rapid decline in renal function
64
Type 2 Hepatorenal syndrome?
unrelenting ascites that does not improve with diuresis
65
Txt Hepatorenal syndrome?
Liver transplant (no renal before liver)
66
Prognosis for Hepatorenal?
risk of death is high
67
Most common Nephrotic syndrome?
Primary
68
Where is minimal change disease seen?
children
69
Where is Focal segmental glomerulosclerosis seen?
adults
70
What s/s is seen in nephrotic syndrome?
severe albuminuria/ proteinuria > 3.5 g/day***
Hypoalbuminemia < 2.5g
Edema (localized or generalized)
Hyperlipemia and Lipiduria
Hypercoagulability (urine loss of antithrombin)
Susceptibility to infections (loss of complement and immunoglobulins)
71
Frothy urine?
nephrotic disease
72
Urine sediment for nephrotic ?
Fatty casts
73
Maltese cross
nephrotic
74
Txt for proteinuria?
ACEI or ARBs (monitor potassium)
75
Txt for edema?
Loop diuretics
76
Most common cause of nephrotic syndrome in children?
MCD
77
Third most common form of primary nephrotic syndrome in adults?
MCD
78
Dx of MCD?
EM shows classical widespread effacement of foot processes of the podocytes
79
Txt for MCD?
Prednisone 60 mg 4-8 wks
80
Txt for relapsed MCD?
chemo meds: cyclophosphamide, tacrolimus, cyclosporine, or rituximab
81
Most common cause of nephrosis in adults?
Focal segmental glomerulosclerosis
82
Occurs in 50% of African Americans and approx 80% of children?
Focal segmental glomerulosclerosis
83
Dx of FSGS?
BIOSPY
84
Txt for FSGS?
Predisone
85
"Spike and dome" pattern
Membranous glomerulonephritis (MGN)
86
Initial presentation of MGN?
DVT or renal vein thrombosis
87
Dx of MGN?
Silver methenamine showing spike
88
Most common cause of ESRD in the US
Diabetic Nephropathy
89
DM type most common in DN?
Type 1
90
DN classic triad?
HTN, heavy proteinuria, and retinopathy
91
obstructs blood flow out of the glomerulus?
efferent arteriole
92
dilates allow blood flow into the glomerulus?
afferent arteriole
93
What is the 1st stage of diabetic nephropathy?
hyperfiltration
94
What does excess matrix form?
Kimmelstiel Wilson nodules- protien balls
95
Protein balls?
DN
96
What secretes more structural matrix?
Mesangial cells
97
Nodular GS (Kimmelstiel Wilson)
DN
98
Txt for DN?
ACEI or ARB
99
Most common form of renal amyloid?
Primary amyloidosis
100
S/S of swelling in the face, ankles, and legs?
RA
101
Dx of choice for RA?
abdominal fat pad
102
LM appears apple green?
RA
103
Lm appears pink
RA
104
what does a congo red stain show?
pink amyloid
105
Txt for RA?
Melphanan w/ high dose dexamethasone
106
Most common cause of asymptomatic hematuria?
Thin basement membrane disease
107
S/S of asymptomatic hematuria incidental finding?
TBMD
108
Txt for TMBD?
Reassurance
109
Triad of Alport syndrome?
GN, ESRD, hearing loss, and eye problems
110
Inherited defect in type IV collagen?
Alport Syndrome
111
What type of genetic disorder is Alport Syndrome?
85% x linked pattern
112
Dx for Alport?
woven basket or basket weave apperance
113
Txt for Alport?
ACEI or ARBS
Hearing aids
Contacts or corneal replacement
