First Aid 541 - 545 Renal Flashcards Preview

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Flashcards in First Aid 541 - 545 Renal Deck (37):
1

"lumpy-bumpy" appearance on IF with which renal disease? What causes the lumps and bumps?

Acute poststreptococcal glomerulonephritis -
granular appearance (“lumpy-bumpy”) B due to IgG, IgM, and C3 deposition along GBM and mesangium.

2

What type of HS rxn is Post strep GN?

HS-III

3

What are cresents in rapidly progressive GN made of?

Crescents consist of fibrin and plasma proteins (eg, C3b)
with glomerular parietal cells, monocytes,
macrophages

4

Type of HS and HLA # of Good Pasture?

HS -II, and HLA DR2

5

A vasculitis associated with Rapidly progressing GN?

Granulomatous polyangiitis, Microscopic polyangiitis

6

What does pauci-immune mean?

There is no Ig/C3 deposition involved.

7

Which GN is associated with "wire looping" of capillaries?

Diffuse Proliferative GN

8

Difference in deposition in Diffuse and Post strep GN and IgA nephropathy?

Diffuse has subENDOthelial and sometimes, intramembranous deposition where as Post Strep Gn has subEPIthelial deposits. IgA has mesangial deposits

9

Which GN is assoc with hemoptysis?

Rapidly Progressive - fun fact - most common on exam - Pick this unless proven otherwise

10

Most common cause of death in SLE?

Diffuse Prolif GN

11

IgA nephropathy assoc with what other diseases?

Henoch Schonlein, Celiacs, Dermatitis Herpetiformis

12

GN + deafness (+blindness)?

Alports

13

Difference in IF between the GNs?

Linear - Good Pasture
Granular - PSGN (Diffuse Prolif)
Neg - Wagener's, - PR3 ANCA
Microscopic, MPA ANCA
Churg strauss - eosinophilia, asthma

14

Difference between type I and II Membrano Prolif GN?

Type I - subendothelial immune complex seen on If, "train track" appearence
Type II - intramembranous immune deposition of BM, "dense deposits"

15

MPGN is associated with which infectious disease?

Hep B and C

16

c3 nephritic factor is associated with which Nephritic syndrome?

MPGN, C3 nephritic factor stabilizes C3 convertase --> dec C3 levels

17

Which Nephrotic syndrome assoc with PLA2 - R Ab?

Membranous nephropathy

18

Minimal change disease can be secondary to what disease?

Hodgkin's Lymphoma, due to cytokine mediated damage

19

Which two Nephrotic syndromes assoc with effacement of foot processes? So how do u know which one it is?

Minimal change disease and Focal Segmental
Former = Children; Latter = adults

20

Populations associated with different Nephrotic syndrome?

Focal - African Americans, Hispanics
Membranous - Caucasians

21

Secondary causes of Nephrotic syndrome?
Drugs - 2
Infections - 2
Diseases - 2

Drugs - Penacillamine, NSAIDS, heroin (focal segment)
Infections - Hep B, C, HIV
Diseases - SLE, Solid tumors (colon, lung), Sickle cell

22

Apple green birefrigence under polarized light?

Amyloidosis

23

Most common cause of end stage disease in US?

Diabetic GN

24

Kidney stones assoc with dec/inc PH?

Dec pH - uric acid, cysteine
Inc pH - Struvite, CaPO4

25

Which stones radiolucent/opaque?

Radiol -UC -ent - Uric acid, cysteine
Radioopaque - Ca ones, Struvite

(See the trend??)

26

When does Creatinine rise with hydronephrosis?

If both kidneys affected, or obstruction bilat

27

polygonal clear cells, golden-yellow (poss) - what disease? Why the color?

RCC, yellow color due to inc lipid content (clear if more carbs)

28

Tell me how RCC spreads (v --> blood spread to where?)

Invades renal v --> IVC --> lung, bone

29

RCC assoc with which chromosomal mutation?

VHL on Chr 3

30

Most common presentation of RCC?

As a lung or bone metastasis

31

RCC assoc with which paraneoplastic syndrome?

A heck of a lot - Ectopic EPO, ACTH, PTHrP, renin

32

Are you ready for some Bonus renal qbank q?

Yes, you are!!!

33

8 year old child develops respiratory infection, which resolves without antiobiotics. However, shortly thereafter, child's mother notices his face is swelling. Takes child to Dr after his limbs started swelling and he is also gaining weight. 24hr urine - total protein of 4.2 g. Which of the following is likely elevated in patient's serum?

Albumin
Cholesterol
Antithrombin
Creatinine
Sodium

Cholesterol - Pt has minimal change disease. Often in children follows viral infection or bee sting. Nephrotic syndrome assoc with hyperlipidemia/hypercholesterolemia and is hypercoag state.

34

7 year old presents with nausea, fever, anorexia. He appears ill and has prominent swelling around the eyes. BP elevated, Lab show inc creatinine and BUN. Fresh urine sediment show RBC casts. Most likely outcome?

Complete recovery
Development of Cresenteric GN
Development of Focal and segmental Glomerulosclerosis
Persistent nonprogressive proteinuria
steroid dependency

Choice A is correct. Pt has PSGN. Other tests shown could be inc ASO titers and dec C3, with normal C4 - bacteria activate the alternative, not classical complement pathway. Acute PGSN is benign and self limiting. Major sx resolve in 1-3 mo, and protein/hematuria resolve in 6mo. Complete resolution less likely with inc age.

35

65 yr old African Am male has 3-4 day history of burning sensation upon mictruition and inc urgency. Urinalysis shows white blood cells, LAP, nitrites. CBC - mild anemia. Pt reports that his father and two brothers also have anemia. To treat his UTI while considering his family Hx, which antibiotic is best choice? (Bonus - mech of action of Tx)

Ciprofloxacin
Erythromycin
Nitrofurantoin
Penicillin
TMP-SMX

A is correct. Ciprofloxacin is used to treat UTI and is safe with family Hx of hemoyltic anemia due to G6PD( Is common in both Af Am and Mediterranean populations)

Flouroquionolones (-) DNA replication by blocking topoisomerases

Erythromycin and Penicillin are not recommended choices for UTI, as normally caused by G- bact

Nitrofurantoin and TMP-SMX are oxidants and can trigger a hemolytic attack.

36

Diseases with low c3

SLE, Type II Membranoprolif GN, PSGN

37

CH50 tests for what?

screening test for total complement activity