Fung > renal path II Flashcards by Colt Williams

what 7 things can a urine dipstick tell you?

pH
specific gravity
protein
glucose
ketones
nitrite
leukocyte esterase

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what are the 3 ways you can examine urine?

macroscopic
microscopic
chemical

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what 2 things can you see macroscopically in urinalysis?

color & turbidity

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what can you see microscopically in urinalysis?

casts
RBCs
WBCs
epithelial cells
organisms
crystals

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what can you tell about urine on chemical examination of urinalysis?

specific gravity
protein
glucose
ketones
hemoglobin
bile
urobilinogen

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what are the shapes of oxalate, triphosphate, & cystine crystals?

oxalate > square (studs)
triphos > rectangle
cystine > hexagon

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what characterizes acute kidney injury?

acutely diminished renal fxn

2. morphologic evidence of tubular injury

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what is the most common cause of acute renal failure?

acute kidney injury

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T/F: acute kidney injury is reversible

TRUE

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what are the 4 main causes of acute kidney injury?

ischemia
direct toxic injury
acute tubulointerstitial nephritis
obstruction

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what is the difference in the damage pattern btwn ischemic & toxic acute kidney injuries?

ischemic is just pieces of both the PCT & loop

toxic is the whole PCT & pieces of the loop

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what are the tubulointerstitial nephritides?

group of renal diseases characterized by histo & fxnal alterations in tubules & interstitium

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T/F: you can have acute or chronic tubulointerstitial nephritis

TRUE

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what does acute tubulointerstitial nephritis look like on histo?

edema
acute inflammatory infiltrate
focal tubular necrosis

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what does chronic tubulointerstitial nephritis look like on histo?

mononuclear infiltrate
interstitial fibrosis
widespread tubular atrophy

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what can cause tubulointerstitial nephritis?

infection
toxins
metabolic dz
obstruction
neoplasm
vascular

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how do tubulointerstitial nephritides evolve?

early phase: easy to distinguish from glomerular dz

late phase: hard to tell

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how is tubulointerstitial nephritis different from glomerular dz?

inability to concentrate urine
metabolic acidosis
defects in tubular secretion/absorption
(EARLY phase > easy to distinguish)

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what areas does pyelonephritis affect?

tubules
interstitium
renal pelvis

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what is pyelonephritis a complication of?

cystitis

acute or chronic complication

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where do the organisms that cause pyelonephritis usu come from?

pt’s fecal flora

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what are the most common pathogens assoc w/ pyelonephritis?

E coli (90%)
Proteus
Klebsiella
Enterococcus faecalis

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T/F: pyelonephritis is usu d/t descending infection

FALSE

ascending!

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what is ACUTE pyelonephritis?

acute suppurative inflammation d/t microbial infection

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what can predispose a pt to acute pyelonephritis?

``` obstruction instrumentation (??) vesicoureteral reflux female diabetes ```

what are the sx of acute pyelonephritis?

1. fever 2. flank pain or pain at costovertebral angle 3. WBC casts 4. malaise 5. dysuria 6. frequency & urgency

what is CHRONIC pyelonephritis?

chronic tubulointerstitial inflammation & renal scarring w/ calyx involvement

what are the 2 types of chronic pyelonephritis?

1. reflux nephropathy | 2. chronic obstructive pyelonephritis

what does chronic pyelonephritis look like on H&E?

atrophic tubules w/ eosinophilic proteinaceous material that looks like thyroid > "thyroidization"

what 3 ways can drugs & toxins produce renal injury?

1. acute hypersensitivity nephritis 2. direct 3. chronic injury & chronic renal insuff

what 2 types of drugs can cause nephropathy?

analgesics & NSAIDs

T/F: multiple myeloma can affect the kidney

TRUE

what are the effects of multiple myeloma w/ kidney involvement?

1. Bence Jones proteinuria 2. amyloidosis 3. light chain deposition

how can HTN manifest in the kidney?

benign or malignant nephrosclerosis

besides nephrosclerosis, how can HTN affect the kidney (not IN it)?

renal artery stenosis

what does a HTN kidney look like grossly?

bumpy

what do tubules look like in HTN pts?

thickened d/t sclerosis

what are 3 characteristics of the thrombotic microangiopathies?

1. microangiopathic hemolytic anemia 2. thrombocytopenia 3. renal failure

what are the 2 forms of thrombotic microangiopathies?

hemolytic uremic syndrome AND thrombotic thrombocytopenic purpura

how can you get a renal cyst?

hereditary developmental or acquired

how do you acquire a renal cyst?

dialysysysysysys

what are the 2 ways to inherit renal cysts?

PKD | medullary cystic kidney disease

how is PKD inherited?

autosomal dominant

what genes are involved in ADULT PKD?

PKD1 & PKD2

what are the 3 extrarenal anomalies assoc w/ adult PKD?

1. polycystic liver disease 2. intracranial berry aneurysm 3. mitral valve prolapse

what are the 4 forms of CHILDHOOD PKD?

perinatal neonatal infantile juvenile

what gene is involved in CHILDHOOD PKD?

PKHD1

what is childhood PKD assoc w/?

hepatic fibrosis

what do medullary cysts look like?

lots of tiny cysts in the medulla/pyramids

what are the 3 forms of medullary cysts?

1. medullary sponge kidney 2. nephronophthisis 3. adult-onset medullary cystic disease

T/F: nephrolithiasis occurs only sporadically

FALSE | they can, but you can also have a genetic predisposition

what are the 4 types of kidney stones?

calcium oxalate struvite (MAP) uric acid cystine

what is the most common type of kidney stone?

calcium oxalate

what must there be in order for a calculi to form?

supersaturation

how do calcium oxalate stones form?

hypercalciuria

how do struvite/MAP stones form?

post-UTI d/t proteus

how do uric acid stones form?

idopathic gout leukemia

how do cystine stones form?

genetic defects in the renal absorption of amino acids

T/F: kidneys only get malignant neoplasms

FALSE | benign & malignant neoplasms occur in the kidney

what types of malignant neoplasms can you get in the kidney (3)?

1. renal cell carcinoma 2. urothelial carcinoma 3. Wilms tumor

what types of benign neoplasms can you get in the kidney (3)?

1. papillary adenoma 2. angiomyolipoma 3. oncytoma

what is an angiomyolipoma composed of?

``` BVs (angio) smooth muscle (myo) mature adipose (lipo) ```

what is angiomyolipoma assoc w/?

tuberous sclerosis | that's high yield

what does angiomyolipoma look like grossly?

yellow

what does angiomyolipoma look like on histo?

clear cytoplasm

are renal cell carcinomas sporadic or hereditary?

MOST are sporadic but some are hereditary

what are the 3 types of renal cell carcinoma?

1. von hippel-lindau 2. hereditary clear cell carcinoma 3. hereditary papillary carcinoma

what does urothelial carcinoma look like on histo?

can be flat or papillary

what does Wilms tumor look like on histo?

BLASTEMA (immature kidney mesenchyme) > primitive glomeruli, tubules, stromal cells

Fung > renal path II Flashcards

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