Kidney and Urinary Tract Flashcards Preview

Pathoma > Kidney and Urinary Tract > Flashcards

Flashcards in Kidney and Urinary Tract Deck (267)
1

What vessel does the horseshoe kidney get caught on?

IMA

2

How does the body compensate for unilateral renal agenesis? What does this do in later life?

hypertrophy of existing kidney

increases risk of renal failure

3

What are the two results of bilateral renal agenesis?

oligohydramnios

lung hypoplasia

4

Is PKD inherited or non-inherited?

inherited

5

Does PKD affect the kidneys unilaterally or bilaterally?

bilaterally

6

What is the mode of inheritance for juvenile PKD?

autosomal recessive

7

What are the components of the Potter Sequence?

lung hypoplasia

face deformities

extremity deformities

8

How does juvenile PKD present?

HTN and decreasing renal function

9

What GI tract disease can juvenile PKD present with? What two conditions can this lead to?

congenital hepatic fibrosis

portal HTN and hepatic cysts

10

What are two ways adult PKD often present?

HTN

hematuria

11

What two genes are defective during PKD?

APKD1

APKD2

12

What are three extra-renal presentations of adult PKD?

berry aneurysm

mitral valve prolapse

hepatic cysts

13

What is the mode of inheritance of Medullary Cystic Kidney disease?

autosomal dominant

14

What is the effect on the kidneys during Medullary Cystic Kidney Disease?

shrink

15

What laboratory marker for acute renal failure?

azotemia

BUN and creatinine

16

What gets reabsorbed more during acute renal failure?

BUN

17

What is the minimum ratio of BUN:Creatinine during prerenal azotemia?

at least > 15:1 BUN:creatinine

18

What causes Prerenal Azotemia?

decreased blood flow

19

What causes Postrenal azotemia?

obstruction

20

Does kidney function remain intact during Prerenal Azotemia?

yes

21

Does kidney function remain intact during Postrenal Azotemia?

yes

22

What is the definition of Acute Tubular Necrosis?

injury and necrosis of tubular epithelial cells

23

Why does Acute Tubular Necrosis decrease GFR?

necrotic cells plug tubule

24

What is observed in the urine during acute tubular necrosis? Why?

brown casts

necrotic cells plug tubule and assume shape of nephron

25

What happens to BUN during Acute Tubular Necrosis? Why? What does this do to the ratio?

decreased reabsorption of BUN

dysfunctional tubular epithelial cells

26

What happens to sodium during Acute Tubular Necrosis? What does this do to the FENa?

decreased reabsorption of sodium

FENa = >2%

27

What two portions of the nephron are most severely effected by ischemia?

PCT

MEDULLARY segment of TAL

28

What pathology usually preceedes the ischemia of Acute Tubular Necrosis?

prerenal azotemia

29

What portion of the nephron is most susceptible to toxic agents?

PCT

30

What type of antibiotic most often causes acute tubular necrosis?

aminoglycosides

31

What type of metal most often causes acute tubular necrosis?

lead

32

What type of endogenous toxin most often causes acute tubular necrosis?

myoglobinuria

33

What type of crystal forms in the urine because of ethylene glycol?

oxalate

34

What condition can produce urate that damages the kidney?

tumor lysis syndrome

35

What two methods are employed at the initiation of chemotherapy to prevent Acute Tubular Necrosis?

allopurinol and copious hydration

36

What are the four clinical features of Acute Tubular Necrosis often seen regardless of disease etiology?

oliguria with casts

hyperkalemia

increased BUN/creatinine

acidosis

37

Does Acute Tubular Necrosis cause metabolic acidosis or metabolic alkalosis?

metabolic acidosis

38

Is Acute Tubular Necrosis reversible or irreversible?

reversible

39

What type of reaction is Acute Interstitial Nephritis?

drug induced hypersensitivity

40

What two structures does Acute Interstitial Nephritis involve?

tubules and interstitium

41

What three drugs are known to cause Acute Interstitial Nephritis?

NSAIDs, penicillin and diuretics

42

What are the three presenting symptoms of Acute Interstitial Nephritis?

oliguria

fever

rash

43

What is the timeline for the development of Acute Interstitial Nephritis after insult?

days to weeks

44

What cell type is almost pathogonomic for Acute Inerstitial Nephritis if found in the urine?

Eosinophils

45

What can Acute Interstitial Nephritis progress to?

Renal Papillary Necrosis

46

What are the four causes of Renal Papillary Necrosis?

chronic Analgesic use

Diabetes mellitus

Sickle cell

Severe acute pyelonephritis

47

What is diagnostic criteria for nephrotic syndrome in terms or urine loss?

> 3.5 g/day

48

Why does nephrotic syndrome carry a risk for infection?

hypogammaglobulinemia

49

Why does nephrotic syndrome carry a risk for a hypercoaguable state?

loss of antithrombin III

50

How does the liver react to nephrotic syndrome regarding lipids and cholesterol?

hyperlipidemia

hypercholesterolemia

51

What disease does Minimal Change Disease cause? In what patient group?

nephrotic syndrome

children

52

What disease is Minimal Change Disease associated with? What is the rationale for this?

Hodgkins Lymphoma

cytokines cause effacement of podocytes

53

What happens to the foot processes during minimal change disease?

effacement

54

Why is Minimal Change Disease different than other types of nephrotic syndrome?

MCD only causes loss of albumin

55

Does Minimal Change Disease possess immmunofluoresence? If so, what color?

no

56

How is Minimal Change Disease treated?

steroids

57

What disease is the most common cause of nephrotic syndrome in Hispanics?

FSGS

58

What disease is the most common cause of nephrotic syndrome in African Americans?

FSGS

59

What are the three most common causes of FSGS?

HIV

sickle cell disease

heroin

60

What does the Focal of FSGS mean?

only some glomeruli are affected

61

What does the segmental of FSGS mean?

only certain parts of glomeruli are affected

62

What happens to the foot processes during FSGS?

effacement

63

Does FSGS possess immmunofluoresence? If so, what color?

no

64

What is the difference between FSGS and MCD regarding treatment?

FSGS doesn't respond to steroids

65

What does FSGS progress to?

chronic renal failure

66

What is the most common cause of nephrotic syndrome in Caucasian Adults?

Membranous Nephropathy

67

Regarding Membranous Nephropathy, what is observable upon microscopy?

thickening of glomerular basement membrane

68

Regarding Membranous Nephropathy, what drives the disease process?

immune complex deposition

69

Does Membranous Nephropathy respond to steroids?

no

70

What does Membranous Nephropathy often progress to?

chronic renal disease

71

What specific kidney pathology do HBV and HCV cause?

Membranous nephropathy

72

What specific kidney pathology do solid tumors produce?

membranous nephropathy

73

What specific nephritic syndrome does SLE produce? Nephrotic?

nephritic = DPGN

nephrotic = membranous nephropathy

74

What two drugs are known to cause Membranous Nephropathy?

NSAIDs and penicillamine

75

What process causes Membranoproliferative Glomerulonephritis?

immune complex deposition

76

Is Type I Membranoproliferative Glomerulonephritis subendothelial or intramembranous?

subendothelial

77

What are two strong associations of Type I Membranoproliferative Glomerulonephritis?

HBV and HCV

78

Is Type II Membranoproliferative Glomerulonephritis subendothelial or intramembranous?

intramembranous

79

What is the cause of Type II Membranoproliferative Glomerulonephritis associated with?

C3 convertase

80

What arteriole does DM effect more?

efferent

81

Why does DM cause microalbuminuria?

increased pressure of efferent arteriole pushes protein into urine

82

Diabetes Mellitus leads to sclerosis of what strucutre of the glomerulus? Leading to the formation of what structure?

sclerosis of the Mesangium

Kimmelstiel-Wilson nodules

83

What organ is most commonly effected during Systemic Amyloidosis?

kidney

84

Where does Amyloid deposit in the kidney during Systemic Amyloidosis? Nephritic or nephrotic?

mesangium

nephrotic syndrome

85

What stain is used for Systemic Amyloidosis?

congo red

86

Does Systemic Amyloidosis fluoresce? If so, what color?

apple green

87

What are the two main disease processes of nephritic syndrome?

glomerular inflammation and bleeding

88

How much protein per day is found in the urine during Nephritic Syndrome?

less than 3.5 grams

89

What two symptoms of nephritic syndrome would be evident during a physical?

periorbital edema

HTN

90

What is found in the urine of patients with nephritic syndrome?

RBC casts

91

What deposits in the kidney during Nephritic Syndrome?

immune complex

92

What does immune complex deposition in the kidney attract during Nephritic Syndrome? What cell is activated?

C5a

neutrophils

93

What group of bacteria are known to cause post-streptococcal glomerulonephritis?

Group A β-hemolytic

94

What specific protein of the Group A β-hemolytic strep mediates the damage?

M-protein

95

How long after infection does post-streptococcal glomerulonephritis often present?

2-3 weeks

96

What are four common presenting symptoms for a patient with post-streptococcal glomerulonephritis?

hematuria

oliguria

HTN

periorbital edema

97

What mediates the damage during post-streptococcal glomerulonephritis? Fluoresce?

immune complex deposition

yes

98

What is Rapidly Progressing Glomerulonephritis?

nephritic syndrome that progresses to renal failure in weeks to months

99

In what disease do crescents appear on the glomeruli?

rapidly progressing glomerulonephritis

100

What are the crescents of Rapidly Progressing Glomerulonephritis composed of? Where are these found?

macrophages and fibrin

Bowmans capsule

101

Where is IgA found during Berger disease?

mesangium

102

What type of infection usually preceedes the renal symptoms of Berger Disease?

mucosal

103

Does Berger Disease fluoresce?

yes

104

What type of collagen is defective during Alport Syndrome?

type IV

105

What are the three common presenting symptoms of Alport Syndrome?

hematuria

sensory hearing loss

visual disturbances

106

What is the mode of inheritance for Alport Syndrome?

X-linked

107

What enzyme is present in the urine of a patient with Cystitis?

leukocyte esterase

108

What metabolite is present in the urine of a patient with Cystitis?

nitrites

109

How many bacteria has to be present in to confirm a Dx of cystitis?

greater than 100,000

110

What bacteria is the most common cause of cystitis?

E. coli

111

What bacteria gives urine an alkalinity with a ammonia scent?

Proteus mirabilis

112

Other than E. coli, what bacteria is known to infect young, sexually active women?

S. saprophyticus

113

Other than E.coli/Proteus mirabilis/S. saprophyticus, what other two bacteria is known to cause cystitis?

Klebsiella pneumoniae

Enterococcus faecalis

114

If a sterile cystitis is detected, what two bacteria are the most likely cause? Where does this suggest the infection is located?

Neisseria gonorrhoeae and Chlamydia trachomatis

urethritis

115

What type of cast is preset in the urine with a patient with pyelonephritis?

WBC casts

116

What are the three most common bacterial cause of pyelonephritis?

E. coli

Enterococcus faecalis

Klebsiella

117

What are the two causes of Chronic Pyelonephritis?

vesicoureteral reflux

obstruction

118

What type of scarring does the vesicoureteral reflex lead to?

cortical scarring

119

What disease produces 'Thyroidization' of the kidney?

Chronic Pyelonephritis

120

Why does Chronic Pyelonephritis produce 'Thyroidization' of the kidney?

eosinophilic protein material

121

What heart condition can uremia lead to?

fibrinous pericarditis

122

What part of the coagulation cascade can uremia interfere with?

platelet function

123

Does chronic renal failure result in hyperkalemia or hypokalemia?

hyperkalemia

124

Does Chronic Renal Failure result in metabolic acidosis or alkalosis?

acidosis

125

Does chronic renal failure cause hypocalcemia or hypercalcemia? Why?

hypo

last step of vitamin D synthesis occurs in healthy kidney

126

Which Vitamin D hydroxylation rxn takes place in the kidney?

1-alpha-hydroxylation

127

Other than vitamin D synthesis, why can chronic renal failure produce hypocalcemia?

excessive phosphate can sequester calcium

128

ESRD increases the liklihood of what kidney cancer?

renal cell carcinoma

129

What is the most common benign tumor of the kidney?

Angiomyolipoma

130

What type of growth is an angiomyolipoma?

Hamartoma

131

Presence of what other diseases increases the liklihood of an angiomyolipoma being present?

Tuberous Sclerosis

132

What is the composition of the two most common kidneys stones in adults?

calcium oxalate

calcium phosphate

133

Does Crohns or UC produce kidney stones?

Crohns

134

What is the treatment of a calcium kidney stone?

Hydrochlorothiazide

135

Urease positive organisms produce what type of kidney stone?

Ammonium magnesium phosphate

136

Which two bugs are known to produce Ammonium Magnesium Phosphate stones?

Proteus vulgaris

Klebsiella

137

What is the only type of kidney stone that is radiolucent?

uric acid

138

What type of climates can predispose an individual to developing a uric acid stone?

hot and arid

139

WIll uric acid stone precipitate at a high or low pH?

low

140

What drug is given to alkalize the urine during uric acid nephrolithiasis?

potassium bicarbonate

141

In what age group are cystine kidney stones most often seen?

children

142

What is the most common sign of Renal Cell Carcinoma?

hematuria

143

Renal Cell Carcinoma commonly involves the loss of what tumor suppressor gene?

VHL

144

What chromosome is VHL located on? Arm?

3p

145

Which two cytokines are increased when VHL is mutated?

IGF-1 and HIF

146

What type of protein is VHL?

E3 ubiquitin ligase

147

What three proteins does HIF usually sequester?

VEGF and PDGF and EPO

148

What patient population do sporadic renal cell carcinomas often arise?

older, males

149

What is the major risk factor for the development of sporadic renal cell carcinoma? Where in the kidney?

smoking

upper pole

150

Are sporadic renal cell carcinomas unilateral or bilateral?

bilateral

151

Where in the kidney do renal cell carcinomas often arise?

upper pole

152

Are hereditary RCCs often unilateral or bilateral?

bilateral

153

In what population do hereditary RCCs often arise?

young adults

154

What is the mode of inheritance for VHL Disease?

autosomal dominant

155

What two cancers most commonly arise due to VHL Disease?

hemangioblastoma of cerebellum

renal cell carcinoma

156

What type of spread does renal cell carcinoma prefer?

hematogenous

157

What two locations does renal cell carcinoma prefer to spread via a hematogenous route?

lung and bone

158

What lymph node does RCC like to spread to?

retroperitoneal

159

What type of cell is a Wilms tumor composed of?

blastema

160

What are the two most common presenting symptoms in a Wilms tumor?

hematuria and HTN

161

What is the W of WAGR Syndrome?

Wilms Tumor

162

What is the A of WAGR Syndrome?

Aniridia

163

What is the G of WAGR Syndrome?

genital abnormalities

164

What is the R of WAGR Syndrome?

mental/motor Retardation

165

What gene is often deleted during WAGR Syndrome? What is the specific chromosomal location of this gene?

WT1

11p13

166

What are the three symptoms of Denys-Drash Syndrome?

Wilms tumor

progressive renal failure

male pseudo-hermaphroditism

167

What defective gene is Denys Drash associated with?

WT1

168

What gene is defective in Beckwith-Wiedemann?

WT2

169

What are the symptoms of Beckwith-Wiedemann Syndrome?

wilms tumor

neonatal hypoglycemia

muscular hemihypertrophy

organomegaly

170

What organ is particularly large during Beckwith-Wiedemann Syndrome?

tongue

171

What is the main risk factor for the development of a transitional cell carcinoma?

smoking

172

What type of cancer does naphthylamine cause?

transitional cell carcinoma

173

What type of cancer do azo dyes cause?

transitional cell carcinoma

174

What drug can cause transitional cell carcinoma?

cyclophosphamide

175

What is the most common presentation of a transitonal/urothelial tumor? What are the two types?

painless hematuria

flat and papillary

176

What type of transitional cell epithelium is associated with a p53 mutation?

flat

177

What are the three risk factors for the development of squamous cell carcinoma of the bladder?

chronic cystitis

Schistosoma haemotobia

chronic nephrolithiasis

178

From what structure does adenocarcinoma in the bladder arise? Where in the bladder?

from a urachal remnant

at the dome

179

What invades the parenchyma during Dysplastic Kidney?

cartilage

180

When does dysplatic kidney form?

in utero

181

Where in the kidney are the cysts during Medullary Cystic Kidney Disease located?

medullary collecting ducts

182

What are the main cause of Prerenal Azotemia?

decreased blood flow to kidney

183

What does Acute Tubular Necrosis do to urine osmolality?

> 500 mOsm

184

What type of kidney pathology would be created by radiocontrast dye?

acute tubular necrosis

185

Which nephrotic syndrome is associated with normal glomeruli on H and E stain?

Minimal change disease

186

Why does MCD not fluoresce?

no immune complex deposition

187

What process drives MCD?

cytokine release

188

If MCD doesnt respond to steroids, what disease will it likely progress to?

FSGS

189

What four causes may Membranous Nephropathy be associated with?

HBV/HCV

SLE

solid tumors

190

Does membranous nephropathy fluoresce?

yes

191

What type of immunofluorescence pattern does Membranous Nephropathy possess?

granular

192

Where in the nephron do immune complexes deposit during membranous nephropathy?

sub-epithelial

193

Does Membranoproliferative Glomerulonephritis fluoresce?

yes

194

What cell proliferates during Membranoproliferative Glomerulonephritis? What sort of appearance does this take on?

Mesangial

'tram-track'

195

Which type of Membranoproliferative Glomerulonephritis has more Tram Tracks?

Type I

196

What antibody is present during Type II Membranoproliferative Glomerulonephritis?

C3 Nephritic Factor

197

What is the function of C3 Nephritic Factor?

stabilizes C3 convertase

198

Does Membranoproliferative Glomerulonephritis produce nephritic syndrome, nephrotic syndrome or both?

both

199

What part of the glomerulus undergoes NES first?

vascular basement membrane

200

What type of renal disease is PSGN?

nephritic

201

What is the treatment for PSGN?

supportive

202

How often do children with PSGN progress to chronic renal failure?

1%

203

How often do adults with PSGN progress to chronic renal failure? What is this disease called?

25%

rapidly progressive glomerulonephritis

204

What are the three types of Immunofluorescence in the glomerulus?

Linear

Granular

Negative IF (pauci-immune)

205

What disease is linear glomerular fluorescence indicative of? What specific renal disease?

Goodpasture Syndrome

RPGN

206

What is an auto-antibody formed against during Goodpasture Sydrome?

type four collagen

207

In what two organs does Goodpasture Syndrome manifest itself?

against collagen in kidneys and lungs

208

How would a patient with Goodpastures syndrome present regarding their lungs?

Hemoptysis

209

How would a patient with Goodpastures syndrome present regarding their kidneys?

Hematuria

210

What patient population is clasically effected by Goodpastures Syndrome?

young, adult males

211

What causes granular immunofluorescence?

immune complex deposition

212

What is the most common kidney disease caused by SLE?

diffuse proliferative glomerulonephritis

213

SLE with nephrotic syndrome is due to what disease?

membranous nephropathy

214

What are the two main differences in presentation between Wegeners Granulomatosis and Goodpasture Syndrome?

Wegeners involves nasopharynx

c-ANCA

215

When does IgA Nephropathy most commonly present? How?

childhood

hematuria with casts

216

Would IgA Nephropathy fluoresce?

yes

217

What is the most common mode of inheritance for Alport Syndrome?

X-linked

218

What type of scarring pattern is characteristic of VUR?

scarring at upper and lower poles

219

What shape of caliculi is associated with Proteus or Klebsiella?

staghorn

220

Scarring at the upper and lower pole during Chronic Pyelonephritis is indicative of what disease happening?

vesicouretal reflex

221

What can produce a staghorn caliculi in a child?

cystinuria

222

How are cystine kidney stones treated?

hydration and alkalinization of urine

223

What is often the first metabolite to increase during chronic renal failure?

uremia

224

What specific cells of the kidney produce EPO?

renal peritubular interstitial cells

225

What are our common cytokines does RCC often produce that can cause a paraneoplastic syndrome?

EPO/renin/PTHrP/ACTH

226

A transitional cell carcinoma develops by which two pathways?

flat and papillary

227

Which type of renal cell carcinoma develops as a high grade tumor?

flat

228

Other than a urachal remnant, what are the other two methods by which an adenocarcinoma can develop in the bladder?

cystitis glandularis

bladder exstrophy

229

What is cystitis glandularis?

columnar metaplasia of bladder in response to chronic inflammation

230

What develops during Dysplastic Kidney?

cysts

231

Is dysplastic kidney usually unilateral or bilateral?

unilateral

232

Where in the kidney does PKD produce cysts?

cortex and medulla

233

Does Medullary Cystic Kidney Disease produce an enlarged or shrunken kidney?

shrunken

234

What are the two types of Acute Tubular Necrosis?

ischemic and nephrotoxic

235

What molecule may be present in the cells of the proximal tubule cells during minimal change disease?

lipid

236

Does PSGN fluoresce?

yes

237

Does ESRD produce shrunken or enlarged kidneys?

shrunken

238

What develops in the kidney during dialysis? What does this increase the chance of?

cysts

RCC

239

What type of kidney stone does Crohns often present with? Why?

oxalate

Crohns increases the reabsorption of oxalate crystals

240

According to Sattar, who is most likely to present with a bladder squamous cell carcinoma caused by Schistosoma haemotobium?

Egyptian male

241

What causes the Potter sequence to appear?

oligohydramnios

242

Long-term use of which two drugs can cause Renal Papillary Necrosis?

aspirin and phenacetin

243

What type of kidney disease is Focal Segmental Glomerularsclerosis?

nephrotic

244

What is the appearance of Membranous Nephopathy on EM?

spike and dome

245

Does strep cause a nephritic or nephrotic syndrome?

nephritic

246

What is the age and sex of the classic patient that presents with Goodpasture Syndrome?

young adult males

247

What chromosome is WT1 located on?

11p13

248

Phenacetin is associated with what type of cancer?

transitional cell carcinoma

249

What chromosome is WT2 located?

11p15.5

250

Where in the bladder does cystitis glandularis often arise?

trigone

251

Which three disease would have negative fluorescence yet still cause Rapidly Progressing Glomerulonephritis?

Wegener

Microscopic Polyangiitis

Churg Strauss

252

Is dysplastic kidney inherited or non-inherited?

non-inherited

253

Are there low or high levels of C3 during Type Two MPGN?

low

254

Is nephritic or nephrotic hypercellular?

nephritic

255

Where are the deposits during PSGN?

subepithelial

256

What disease can PSGN progress to in adults?

RPGN

257

What two things happen to the GBM during Alport Disease?

thin and split

258

What cells of the kidney produce Epo?

renal peritubular interstitial cells

259

What three hormones can RCC produce?

Epo

renin

PTHrp

ACTH

260

What is the most common variant of RCC?

clear cell

261

Where chromosome is WT2 located on?

11p15.5

262

Is BUN reabsorbed?

yes

263

Is creatinine reabsorbed?

no

264

If minimal chage disease doesnt respond to steroids, what disease may it progress to?

FSGS

265

How long after mucosal infection does Berger Disease present?

few days

266

What is osteomalacia?

cant mineralize osteoid made by osteoblasts

267

What is the color of RCC on gross appearance?

yellow