First Aid 541 - 545 Renal

Question 1

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

Answer 1

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

Question 2

What type of HS rxn is Post strep GN?

Answer 2

HS-III

Question 3

What are cresents in rapidly progressive GN made of?

Answer 3

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

Question 4

Type of HS and HLA # of Good Pasture?

Answer 4

HS -II, and HLA DR2

Question 5

A vasculitis associated with Rapidly progressing GN?

Answer 5

Granulomatous polyangiitis, Microscopic polyangiitis

Question 6

What does pauci-immune mean?

Answer 6

There is no Ig/C3 deposition involved.

Question 7

Which GN is associated with “wire looping” of capillaries?

Answer 7

Diffuse Proliferative GN

Question 8

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

Answer 8

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

Question 9

Which GN is assoc with hemoptysis?

Answer 9

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

Question 10

Most common cause of death in SLE?

Answer 10

Diffuse Prolif GN

Question 11

IgA nephropathy assoc with what other diseases?

Answer 11

Henoch Schonlein, Celiacs, Dermatitis Herpetiformis

Question 12

GN + deafness (+blindness)?

Answer 12

Alports

Question 13

Difference in IF between the GNs?

Answer 13

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

Question 14

Difference between type I and II Membrano Prolif GN?

Answer 14

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

Question 15

MPGN is associated with which infectious disease?

Answer 15

Hep B and C

Question 16

c3 nephritic factor is associated with which Nephritic syndrome?

Answer 16

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

Question 17

Which Nephrotic syndrome assoc with PLA2 - R Ab?

Answer 17

Membranous nephropathy

Question 18

Minimal change disease can be secondary to what disease?

Answer 18

Hodgkin’s Lymphoma, due to cytokine mediated damage

Question 19

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

Answer 19

Minimal change disease and Focal Segmental

Former = Children; Latter = adults

Question 20

Populations associated with different Nephrotic syndrome?

Answer 20

Focal - African Americans, Hispanics

Membranous - Caucasians

Question 21

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

Answer 21

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

Question 22

Apple green birefrigence under polarized light?

Answer 22

Amyloidosis

Question 23

Most common cause of end stage disease in US?

Answer 23

Diabetic GN

Question 24

Kidney stones assoc with dec/inc PH?

Answer 24

Dec pH - uric acid, cysteine

Inc pH - Struvite, CaPO4

Question 25

Which stones radiolucent/opaque?

Answer 25

Radiol -UC -ent - Uric acid, cysteine Radioopaque - Ca ones, Struvite (See the trend??)

Question 26

When does Creatinine rise with hydronephrosis?

Answer 26

If both kidneys affected, or obstruction bilat

Question 27

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

Answer 27

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

Question 28

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

Answer 28

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

Question 29

RCC assoc with which chromosomal mutation?

Answer 29

VHL on Chr 3

Question 30

Most common presentation of RCC?

Answer 30

As a lung or bone metastasis

Question 31

RCC assoc with which paraneoplastic syndrome?

Answer 31

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

Question 32

Are you ready for some Bonus renal qbank q?

Answer 32

Yes, you are!!!

Question 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 ```

Answer 33

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.

Question 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 ```

Answer 34

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.

Question 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 ```

Answer 35

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.

Question 36

Diseases with low c3

Answer 36

SLE, Type II Membranoprolif GN, PSGN

Question 37

CH50 tests for what?

Answer 37

screening test for total complement activity