finding in renal biopsy in MPGN
dense deposit in glomerular basement membrane
quid of dense deposit
C3
Physiopatho in MPGN
persistent activation of alternative pathway of complement
quid of nephritic factor
IGG against c3 convertase
clue for MPGN
Hematuria and SN
action of cyclosporin
inhibits interleukin 2 transcription
what s the most common side effect of cyclo
nephrotoxicity
how nephrotoxicity induced by cyclo manifest
hyperkalimia
Hus sometimes
side effect of cyclo to remember(5)
nephrototoxycity tremor hta gum hypertrophy hyperkaliemia
Mycophenolate side effect
marrow suppression
azathioprine side effect(3)
diarhee
leukopenia
hepatotoxicity
patient with autosomal dominant polykystic renal disease with intracerebral hemorrrage,why
rupture of berry aneurism
most common extra renal manif of ADPKD
Hepatic cyst
other extra renal manif of ADPKD(3)
Mitral valve prolapse/aortic regurgitation
colonic diverticula
abdominal wall hernia or inguinal hernia
urinalysis sign of nephritis
WBC cast
patient on cephalexin develops dark urine
drug induced intersticial nephritis
hallmark of drugs induced intersticial nephritis(2)
eosiniphiluria
hypereosniphilie
treatment of drug induced intersticial nephritis
stop the offending agent
the first phenomenon occuring in diabetic
glomerular hyperfiltration
why GFR increases in diabetics patient
because of glomerular hypertrophy
perio to have high GFR in diabetic patient
0-5 ans
laps of time to have microalbuminuria
5-10 years
why you will have microalbuminuria
mesangial expansion
quid of arterial hyalinosis
thickening of the basement membrane=mesangial expansion
what will happen after ten years in diabetics patient(2)
mesangial nodule
(kimmelstiel nodules disease)
tubulointersticial fibrosis
nephrotic syndrome avec low GFR
what can you have during mesangial expansion
HTA
quid of glomerulosclerosis
tubulointersticial fibrosis
hallmark of renal problem in diabetics patient
microangiopathy
risks factor for diabetics nephropathy
bad glycemia control HTA smoking age ethnicity
what nationality is a risk fector for diabetic nephropathy
mexican
african american
first cause of renal failure in north america
diabetes
management of uncomplicated pyelonephritis
blood culture
followed by empiric antibiotics
indication of MRI or US in pyelonephritis(2)
persistent fever
rulet out abcess or obstruction
persistent fever in pyelonephritis(2)
abcess
obstruction
indication of iv pyelogram in pyelonephritis
chronic pyelonephritis
complication of acute pyelonephritis(3)
abcess
papillary necrosis
emphysematous pyelonephritis
cause of bleeding in renal failure
platelet dysfunction
rx of bleeeding in renal failure
desmopressin(DDAVP)
what cause platelet dysfunction in renal failure
accumulation of guanidino succinic acid
red urine in patient taking anti tb
drug reaction(rifampicin)
clue for renal cell carcinoma(2)
blood in urine
left sided varicoceles
work up of renal cell carcinoma
abdominal CT
clue for varicocele
they fail to empty due to obstruction of gonadal vein by the the tumor when it entries in renal vein when the patient is in recumbent position
why erythrocytosis in renal cell carcinoma
high production of erythropoietine by the tumor
paraneoplastic syndrome in RCC(5)
anemia or erythrocytosis hypercalcemia thrombocytosis cachexia fever
patient whith tonic clonic seizure develops renal failure and high K+ why
rhabdomyolysis
why renal failure in rhabdomyolysis
tubular injury by myoglobin
cause of high K+
rein prroblem medication Metaboloic acidosis hyperglycemia tissue or cell destruction pseudo hyperkaliemia
medication induced high K+(7)
amyloride ACE inhibitor ARBS NSAIDS K+sparing diuretics non selectived B blocker digoxin
secret to hyperkaliemie
all the time you block the SRAA —>high K+
quid of pseudo hyperkaliemia
hemolysed blood sample
why hyperglycemia causes high K+
K+ Movement out of the cells
why ACE inhibitor and ARB’s causes high K+
block SRAA axis
why k+ sparing diuretics causes high K+
block receptor aldosterone
why NSAIDS causes high K+
because prostanglandin plays a key role in the activation of SRAA axis
why digoxin causes high K+
by blocking K+NA+ ATPASE PUMP
why B Blocker causes high K+
block uptake of K+ by cells
EKG finding of hyperkaliemia
peaked T waves
Patient with disk herniation develops retention of urine
2 possibilities
-severe pain plus HBP
cauda equina syndrome
Patient with disk herniation develops retention of urine sever pain and HBP
because of HBP valsalva maneuver will be perfrom strongly by the patient and more pain wil be produced if disk herniation because of high intra abdominal peressure
so retention can occur
clue of cauda equina syndrome
anal sphincter tone will decrease because of nerve root injury
cause of neurologic deficit in herniated disk
spinal nerve inpingement
why elderly is prone to dehydration(3)
decrease thirst response to dehydration
impaired renal Na+ conservation
impaired renal ability concentration
rx of dehydration
crystalloid
why you should rehydrate elderly with caution
because sodium loading can unmask subclinical heart failure in elderly
4 types of renal stones(4)
calcium oxalate/phosphate
acid uric
struvite or triple phosphate
cysteine
most common type of stone
calcium stone
most common cause of calcium stones(7)
idiopathic hypercalciuria hyperuricosuria hyperoxaluria decrease urinary citrate renal tubular acidosis chronic decrease of urine output hypercalciuria secondary to systemic disorder
quid idiopathic hypercalciuria(2)
hypercalciuria
normal calcemia
whaT’s the most common cause of hypercalciuria
idiopathic hypercalciuria
systemic disorder causing hypercalciuria(2)
primary hyperparathyroidism
sarcoidosis
causes of hyperoxaluria(4)
high vit C intake
high green leafy vegetables intake
IBD
short bowel syndrome
finding in renal tubular acidosis
nephrocalcinosis
hypercalciuria in Men
> 300 mg /24 H
hypercalciuria in women
> 250 mg/24 h
rx of stones induced by idiopathic hypercalciuria(3)
fluid intake
dietary Na+ restriction
thiazide or amiloride
action of thiazide(2)
decrease urinary calcium excretion
precent precipitation of calcium in urine
rx of stones induced by hyperuricosuria(2)
purine restricted diet
allopurinol
recommandation for rx of calcium stone what to restrict
Na+
oxalate
proteins
restriction of na+ in calcium stones
source of oxalate (3)
dark roughage
chocolate
vit C
protein source to avoid in calcium stone(4)
beef
poultry
eggs
fish
what to increase in rx of calcium stone
fluid
normal or high calcium intake
fluid to take during rx of calcium stone
> 3 l day
intake of calcium in rx of calcium stone
1000 mg daily
why furosemide is contraindicated in calcium stone
it increase excretion of calcium
first thing in acute non complicated calcium stone(3)
fluid
observation
analgesique
nephrotic syndrome tetrad
proteinuria > 3-3.5 g par 24 h
hypoalbuminemia
edema
hyperlipidemia and lipiduria
the most common manif of SN
proteinuria
basic pathology of SN
altered permeability of basement glomerular membrane
disease causing SN(5)
Minimal change
Membranous glomerulopathy
mesangial proliferative glomerulonephritis
membranous proliferative glomerulonephritis
glomerulosclerose focale et segmentaire
cause of hypercoagulability in SN(5)
Loss of antithrombine 3 altered level of protein C et S increased platelet aggregation hyperfibrinogenemia impaired fibrinolysis
why hyperfibrinogenemie
because of increase hepatic synthesis of fibrinogene
the most common manif of hypercoagulability in SN
renal vein thrombosis
why microcytic anemia in SN
because of loss of transferrin
complication of SN(5)
microcytic anemia VIT D deficiency low thyroxin level infection malnutrition
why low vit D in SN
because of increase excretion of cholecalciferol binding protein
why low thyroxin level in SN
loss of thyroxin binding protein
protein transporter of fer
transferrin
protein transporter of T3 T4
thyroxin binding globulin
protein tranporter of vit D
cholecalciferol binding protein
why acute renal failure in cocaine abuse
rhabdomyolisis
rhabdomyolisis in acute renal failure
myoglobin causes acute tubular necrosis
red flag for acute tubular necrosis in cocaine abuse
CPK >20000
differentiate drugs induced renal failure and drugs induced intersticial nephritis(2)
no wbc in the urinary sediment in drug u=induced renal failure
as the opposite of intersticial nephritis induced by drug
drugs causing renal failure
aminoglycoside
what to do during administration of aminoglycoside(2)
monitor renal fonction
monitor drug level
patient with CRAB cause of that(2)
paraproteinemia=
Bencejones
other name of Multiple myeloma
kahler disease
why renal inssuficiency in MM
obstruction of distal and collectig tubules by bence jones protein
simple renal cyst on ct (4)
black mass with no multilocular
no septae intra the mass
on thickened wall
ono enhancement on CT
management of simple renal cyst(2)
observation
reassurance
most common cause of SN in hogkin lymphoma
minimal change disease
the best way to remove K+ in the body in case of Hyperkaliemia(3)
kayexalate
dyalisis
diuretics
what’s kayexalate(2)
cation exchange resin
Na+ entre K + sort
why amitryptiline can cause urinary retention(4)
anticholinergic effect
block detrusor contraction
prevent sphincter relaxation
no relaxation
why foley catheterization is important in urinary retention(2)
to provide symptomatic relief
to document retention
quid of priapism
painful and persistent erection
Med causing priapism(2)
trazodone
prazocin
disease causing priapism(2)
sickle cell disease
leukemia
quid of trazodone
it’s a anti depressant
diabetic patient with proteinuria possibilities(2)
infection
glomerular basement changes
the 2 presentations of diabetic nephropathy
nodular glomerulosclerosis
diffuse glomerulosclerosis
most common cause of nephropathy in diabetic
diffuse glomerulosclerosis
clue for UTI in urinalysis(2)
leucocyte esterase positive
nitrites
quid of nitrites
presence of enterobacteriacea
quid of leucocyte esterase
pyuria
clue for chronic prostatitis(3)
voiding symptom
why in SN you have accelarated atherosclerosis(3)
hyperlipidemia
High LDL
Low HDL
risk in aptient with SN
MI
Stroke
prevention rx of hyperlipidemia in SN
statin
patient with HBP develops high creatine next step
abdominal US
what to do ig in HBP US shows hydronephrosis
foley is mandatory
how acyxclovir causes renal failure
renal tubular obstruction by crystalization of the drug in urine
what the main risk factor for acyclovir causing renal failure
inadequate hydration
specificity in urinalysis in colic nephretic(3)
wbc
rbc
no cast
indication of EPO(2)
anemia in renal failure
less than 10 g HB
side effect of EPO(4)
worsening HTA
headaches
flulike syndrome
red cell aplasia
how to prevent HTA worsening in EPO administration
slow raising of HMt with a goal of 30-35%
urinary retention with anticholinergic(4)
diphendramine
doxepin
hydroxyzine
chlorpheniramine
the earliest abnormality seen in diabetics
glomerular hyperfiltration rate
the earliest abnormality that can be quantified in diabetics
thickening of the basement membrane
role of ACE inhibitor in the prevention of nephropathy in diabetics
decrease intra glomerular HTA
prevention of acyclovir induced nephropathy
agressive hydration
after coronary stenting patient develops blue toe and high creat cause?
cholesterol emboli by disruption of plaques
clue cholesterol emboli inducing renal circulation problem and pedal circulation
elevated eosinophiles
low C3
patient taking NSAIDS develops high creat
analgesic nephropathy
physiopatho of analgesic nephropathy
papillary necrosis
chronic tubulointersticial nephritis
danger of analgesic(3)
premature aging
UT cancer
atherosclerotic vascular disease
HTA puls right sided renal bruit
stenose de l’artere renale
rx of stenose of renal artery
percutaneous angioplasty with placement
first cause of renal artery stenosis
fibro muscular disease
HIV black with SN cause of that
focal segmental glomerulosclerosis
2 causes of glomerular hematuria(2)
IGA nephropathy
GNA
clue for IGA nephropathy(3)
upper respiratory infection
later hematuria
complement is normal
painless hematuria in black
sickle cell trait
cause of hematuria in sickle cell disease
papillary necrosis
patient with HBP, gross and micro hematuria in smoker, next step
cystoscopy
why you should ask for cystoscopy even if you suspect HBP
any hematuria and risk factor of bladder cancer,cystoscopy is mandatory
what’s the most important risk factor for bladder cancer
smoking
renal cause of hematuria(3)
CA
IGA nephropathy
GNA
ureteral cause of hematuria(2)
stones
stricture
bladder cause of hematuria(2)
ca
cystitis
prostate and uretral cause of hematuria(2)
ca prostate
uretritis
rsk factors for bladder cancer(6)
cigarette cyclosporine painter chronic cystitis metal worker pelvic radiation
the most common cause of death in patient on dyalisis
cardiovascular
most common cause of death in renal transplant
cardiovascular
patient with SN develops acute flanck pain in the right DX
renal vein thrombosis
what the most comon disease causing SN
membranous glomerulonephritis
most common cause of painless hematuria in adults
bladder cancer
SRAA axis in hypovolemia(3)
angiotensine constrict efferent arterioles
prostaglandin dolate afferent arteriole
but if hypovolemia worsens this mechanism will fail and you will have damage in kidney
why elderly in nursing room can easily develops prerenal azatemia(3)
because they are taking
Aspirin
Ace inhibitor
diuretics
cause of epididymitis in elderly
E coli
cause of epididymitis in sexually active individual(2)
chlamydia
gonorrhea
symptom of epididimytis(2)
scrotal pain
irradiation in flank
name two improtant caus of pulmonary renal syndrome(2)
wegener
good pasture
rx in Wegener(2)
cycolphosphamide
steroids
rx in goodpasture (2)
plasmapheresis
why plasmapheresis in goodpasture
because of the presence of anti membrane basal antibody
rx of uncomplicated cystitis(4)
nitrofurantoin
TMS
phosphomycin
fluoquinolones
duration of rx of uncomplicated cystitis using TMS
3 jours
indication ofquinolones in uncomplicated cystitis
if you cannot use the 3 first drug listed above
meaning of complicated cystitis(3)
diabetes
immunosuppression
kidney disease
RX of complicated cystitis
fluoquinolones
indication of urine culture in uncomplicated cystitis
if rx fails
patient renal failure taking metformin risk
lactic acidosis
risk for metformin to induce lactic acidosis(3)
renal fialure
hepatic failure
sepsis
clue for chlamydial uretritis(3)
mucopurulent discharge
no bacteria
sexual active individual
clue for gonococcal uretritis
purulent discharge
tetrad of amyloidosis(4)
hepatomegaly
renal problem
heart problem S4
maladie inflammatoire sous jascente
finding in renal biopsy in amyloidosis ordinary microscopy
apple green birefringence under polarised light
stain coloration for amyloidosis
congo red stain
finding in renal biopsy in amyloidosis electronical microscopy
extra cellular or amyloid fibrils
most common type of renal stones
oxalate calcium 75/90%
cause of fat malabsortion
surgical ileal resection
chronic diarrhea
small bowel disease
condition predisposing for renal calcium stones
fat malsorption
why fat malabsortion causes renal oxalate calcium stones
because in fat mlabsorption, fat chelates calcium making oxalate free to be absorb
stone in parathyroidism
calcium stone
stone in chemo
acid uric stone
cause of cysteine stone
inborn error of metabolism in children
cause of struvite stone
proteus infection
quid of hepato renal syndrome
renal failure in patient with cirrhosis
rx of hepato renal syndrome
liver transplant
cause of death in hepato renal syndrome(2)
hemmorrahe
infection
most common cause of death in patient with hepatic failure
renal problem
patient with long term renal failure best long term measure in management
tranplantation renal from living related donor
what are the 2 options for end stage renal disease(2)
dyalisis
renal transplantation
advantage of transplantation over dyalisis(4)
good quality of living and survival
anemia bone disease and HTA are well controlled
autonomic neuropathy is improved
better survival rate
is dyalisis improves autonomic neuropathy in diabetics
no
clue for alport syndrome(3)
high creat
deafness
hematuria
biopsy finding in alport
foam cells
electron microscopy in alport
alternating areas of thinned and tickened capillary loopswith splitting GBM
cause of infertility in athlete
steroid abuse
why steroid abuse causes of infertility in athlete(2)
blockage of GNRH release
no LH and FSH
after renal transplantation patient develops oliguria
high BUN/CREAT DX(5)
acute rejection ureteral obstruction cyclosporine toxicity ATN vascular obstruction
after renal transplantation patient develops oliguria
high BUN/CREAT ,work up?(3)
US
biopsy
cyclosporine level
rx of acute rejection
steroids IV
biopsy in acute rejection
heavy lymphocyte infiltration and vascular involvementwith swelling of the intima
test to do after renalm transplantation(4)
radfio isotope scanning
MRI
US
Biopsie renale
prevention of contrast nephropathy(2)
hydration
or
acetylcysteine
action of aqcetyl cysteine in caseof contrast nephropathy rx
vasodilation
antioxydant
cause of painless hematuria(3)
analgesic
SCD
CA
[hysiopatho of analgesic induced nephropathy
papillary necrosis
caused by vasoconstriction of medullary blood vessel
(vasa recta)
most specific test to DX renal carcinoma
ct of abdomen
work up for patient with HBP symptomatic first step(2)
creat
urinalysis
work up for patient with HBP symptomatic creat and urinalysis anormal next step(2)
U/S
or
abdomen CT
clue to differentiate prostatis from cystitis(2)
systemic symptom
boggy and tender prostate
after urinalysis what’s the next step for prostatitis
midstream urine sample culture
clue to differentiate acute from chronic prostatis
no systemic sympton in chronic prostatitis
rx of acute prostatitis
TMS
rx of chronic prostatitis
fluoquinolones
rx of acute pericarditis in qacute renal failure
hemodyalisis
clasic EKG findings in acute pericarditis(2)
ST and PR elevation in AVR
PR segment depression in other leads
the best test to DX renal calculi
ct of abdomen
xray of calcium stone
radioopaque
xray of acid uric stone
radioluscent
most beneficial next step in aptient with acid uric stone(2)
citrate de K+ to alkalinisation of the urine
or
bicarb K+
people at risk for acid uric stone
low pH urine
cause of low PH urine(2)
renal ammonia secretion deficit
hyperuricosuria
patient with classic renal colic and negative xray
acid uric stone
calcium stone 1-3 mm
non stone cause
nonstone cause of renal colic(2)
caillot
tumor
what’s the target when alkalinisation of the urine
PH>6,5
terminal hematuria(2)
bladder disease
prostate disease
initial hematuria
uretritis
total hematuria(2)
renal disease
ureter
clue for renal hematuria
no clots
best test for bladder cancer
cystoscopy
clue for mixed essential cryoglobulinemia(3)
hematuria
proteinuria
palpable purpura
what infectious test should be done if you suspect cryoglonulinemia
HCV serology
why HCV serology in cryoglobulinemia
majority of patient have HCV infection
complement in cryo
low
most common cause of painlesss hematuria
bladder cancer
BPH treatment(3)
doxazocin or
tamsulosin Alpha 1 blockers plus
finasteride
quid of finasteride
5 alpha reductase inhibitor
zone of prostate touched by BPH
transitionnal zone
ALP in ca prostate
high
rapid rx in hyperkalemia even if renal failure
gluconate de calcium
next step after gluconate de calcium in hyperkalemia rx
remove calcium in the body
EKG in hyperkaliemia(4)
peaked T waves
wide RQS complex
bradycrdia
no P waves
cause of C3 levels(4)
immune complex reaction
GNA
cryoglobulinemia
membranous glomerulonephritis
Clue for GNA(3)
hta
skin infection
low c3
management of urolithiasis(3)
CT abdomen
analgesics
fluid > 2 l/jour
when to refer urolithiasis in urologic physician(3)
anuria
sepsis
acute ranl failure
grasseur of stone to be passed with hydration
less than 5 mm
clue for ATN(3)
BUN/CREAT2
urine osmolarity 300-350(never
what can cause ATN
prolonged hypotension
hallmark of ATN
muddy brown cast
quid of brown cast
renal tubular epithelial cells
mechanism of cystitis
ascending infection
role of sexual intercourse in cystitis(3)
massage uretral during sexual intercourse
entry of germs dans la vessie
honeymoon cystitis
RBC cast
GNA
WBC cast(2)
intersticial nephritis
pyelonephritis
fatty cast
SN
broad and waxy cast
chronic renal failure
patient at risk for contrast nephropathy(2)
diabetics
Creat> 1,5
what should be done to prevent contrast nephropathy(4)
nonionic contrast agent
acetylcysteine
good hydration
SN with focal glomerulosclerosis(4)
african american
HIV
heroin use
obesity
SN in hogkin(2)
minimal change
or
focal glomerulosclerosis
pyelonephritis unresponsive to rx after 48 h
ask for CT or US
why imagery in pyelonephritis unresponsive to rx after 48 h
rule out obstruction
or
abcess
vascular changes in HTA(2)
atherosclerotic changes of afferent and efferent artery renal arterioles and glomerular capillar tufs
narrowing of renal arterioles with sclerosisand intimal tickening
vascular changes in diabetics(4)
increased extra cellular matrix
basement membrane tickening
mesangial expansion
fibrosis
clue for drugs induced intersticial nephritis(4)
eosiniphilia
hematuria
sterile pyuria
eosinophiluria
in renal failure with platelet dysfunction ,bilan de coagulation
Pt,PTT normal
BT prolonged
action of desmopressin in renal failure with platelet dysfunction(2)
release of factor 8
and v willebrand
why platelet transfusion is not good in renal failure with platelet dysfunction
because transfused platelet will be inactivated
important clue for renal carcinoma
unilateral varicocele that fails to empty when the patient is in recumbent position
in rhabdomyolysis clue for myoglobinuria
large amount of blood in urinalysis with relative absence of RBC in microscopy(0-1 rbc)
differentiate myoglubunuria from Hemoglobinuria
large amount of blood in urinalysis with relative absence of RBC in microscopy(0-1 rbc)=myoglobin
rx of renla stone with hypercalciuria(3)
high fluid intake
sodium restriction
thiazide diuretic
indication of amikacin in pyelonephritis
multi drug resistant pyelonephritis
kahler disease(2)
plasma cells myeloma
Myelomatosis
clue for malignant cystic mass(2)
thick and irregular wall
multiple septae
presence of contrast enhancement
physical exam of urinary retention
tenderness and fulllness on palpation along the midline below the umbilicus
why patient with SN is at risk for MI and stroke(2)
hypercoagulable state
accelerated etherosclerosis
hallmark of diabetic nephropathy
nodular glomerulosclerosis
diabetes with proteiunuria and UTI you treat the UTI proteinuria still persist
glomerular basement membrane damage
drugs causing crystal induced nephropathy(5)
acyclovir sulfonamides methotrexate ethyleneglycol protease inhibitor
anemia in renal insufficiency(2)
normochromic
normocytic
cause of hematuria in AF
papillary necrosis
any hematuria with no glomerular involvement plus risk factor of bladdder cancer
cystoscopy
when to avoid nitrofurantoin in the rx of uncomplicated cystitis
clearance creat
contraindication of metformin(2)
sepsis
renal failure
hepatic failure
clue for chlamydial uretritis(3)
Multiple sexual partners
absent bacteriuria
mucopurulent discharge
finding in amyloidosis
renal amyloid deposit showing apple green birefringence under polarised light after congo red stain ing
clue for hepatorenal syndrome(2)
high creat in patient with cirrhosis
no improvement of creat value after fluid resuscitation
indication of hemodyalisis(7)
refractory hyperkaliemia volume overload or pulmonary edema unresponsive to diuretics refractory metabolic acidosis uremic pericarditis uremic encephalopathy or neuropathy caogulopathy due to renal failure
first in hyoerkaliemia(2)
gluconate de calcium
later use insulin and/orsodium polystyrene sulfonate
first episode of renal stone management
hydration
no further metabolic work up is required
mady having sex for the first time ,days later develops urinary symptom
honeymoon cystitis
cause of honey moon cystitis
sexual intercourse introduces bugs directly in bladder
size of kidney in HTA
small size
