Kidney Exam Flashcards
(107 cards)
1
Q
Anuria
A
Urine output less than 100 ml/day
2
Q
Hypotonic fluid
A
Less than 270
3
Q
Hypertonic fluid
A
Greater than 300
4
Q
Potter sequence
A
Physical appearance resulting from oligohydramnios-
Beak like nose, small receding chin, low set ears, abnormally bent lower extremities.
Pulmonary hypoplasia- most life threatening component of potter sequence
5
Q
Bilateral agenesis
A
Most are still born and have potter sequence, often associated with other congenital anomalies
6
Q
Unilateral agenesis
A
Contra lateral kidney undergoes hypertrophy, may lead to progressive glomerular sclerosis from the overworked kidney
7
Q
Renal hypoplasia
A
Reduction in renal mass, 6 or fewer renal lobes, no histological malformations
8
Q
Renal dysplasia
A
Undifferentiated tubular structures surrounded by primitive mesenchyme, cysts often form around abnormal tubules, undifferentiated tubules and ducts lined by cuboidal or columnar epithelium, cartilage
9
Q
Renal dysplasia clinical signs
A
Palpable flank mass, potter sequence, pulmonary hypoplasia
10
Q
Autosomal dominant polycystic kidney disease
A
Numerous cysts within the renal parenchyma
- PKD1 and PKD3 gene mutations, polycystins
- inflammatory mediators, destruction
Enlarged kidneys bilaterally, contours distorted with numerous cysts, filled with fluid, liver cysts and berry aneurysms
11
Q
Autosomal recessive polycystic kidney disease
A
- PKKHD1 mutation, chromosome 6, fibrocystin and polyductin
- cystic transformation of collecting ducts with smooth outward appearance
Usually die in perinatal period from pulmonary hypoplasia by oligohydramnios and large kidney size, hepatic fibrosis leading to splenomegaly and portal hypertension
12
Q
Glomerulocystic disease
A
Dilation of bowman’s capsule in many glomeruli, mutation in hepatocyte nuclear factor-1 beta
Small round cysts, dilation of bowman’s capsule
13
Q
Medullary sponge kidney
A
Multiple small cysts in one or more of the renal papilla a, lined y cuboidal or columnar epithelium and arise from the collecting ducts in the renal papillae, usually bilateral
Usually asymptomatic, 30-60 flank pain, dysuria, hematuria, gravel in urine
14
Q
Acute kidney injury
A
Sudden decline in GFR over days to weeks, GFR less than 10 ml/min, CR increases by 1-1.5 mg/dL daily
15
Q
Prerenal acute failure
A
Transient renal hypoperfusion from hypotension, decreased cardiac output, decreased arterial blood volume
16
Q
Postrenal acute renal failure
A
Obstruction of the urinary tract
17
Q
Intrinsic acute renal failure
A
Acute glomerulonephritis, acute interstitial nephritis, acute tubular necrosis
18
Q
Prerenal azotemia
A
Most common cause of acute kidney injury, renal hypoperfusion
19
Q
Prerenal acute kidney injury
A
BUN:Cr ratio >20:1, increased urea reabsorption
Hyaline casts, >1% sodium excretion, kidney reabsorbs salt and water avidly
20
Q
Post renal azotemia
A
Least common of acute kidney injury, urinary flow from both or one kidney is obstructed
21
Q
Post renal AKI
A
Urethral obstruction (anticholinergics), bladder calculator neoplasms, pelvic or retroperitoneal neoplasms, bilateral ureteral obstruction, retroperitoneal fibrosis
22
Q
Intrinsic renal failure
A
Tubular, glomerular, vascular, interstitial
23
Q
Oliguria
A
Urine output less than 500 ml/day
24
Q
Acute tubular necrosis
A
Tubular damage, initiation phase, maintenance phase, recovery phase
85% of intrinsic acute kidney injury
25
Acute tubular necrosis initiation
Ischemia, a continuum of pre renal azotemia
26
Acute tubular necrosis maintenance
Stabilization of GFR at a very low level, usually lasts 1-2 weeks, complications occur
27
Acute tubular necrosis recover
Regeneration of tubular epithelial cells, abnormal diuresis sometimes occurs causing salt and water loss and volume depletion
28
Acute tubular necrosis labs
Hyperkalemia (lysis of muscle cells or impaired excretion)
Hyperphosphatemia (cannot be excreted)
Brown urine
BUN:Cr is
29
Acute interstitial nephritis
Interstitial inflammatory response with edema, cell mediated response, 70% drug hypersensitivity, 15% infection
Drugs: NOT dose dependent
30
Acute interstitial nephritis findings
Fever, rash, arthralgias, serum eosinophilia, WBC CASTS ARE PATHOGNOMONIC, urine eosinophils
31
Nephritic syndrome
Involvement of cell proliferation,
Hematuria, proteinuria, hypertension, reduced GFR
Volume overload, hyperkalemia, metabolic acidosis, edema, congestive heart failure
32
Decreased C3
Alternative pathway activated
33
Decreased C4
Classical pathway activated
34
Kidney biopsy
Glomerular cellularity, thickness of GBM, histopathology, determines presence or absence of crescents
35
Light microscopy
Nature of glomerular disease using stained sections of the kidney biopsy
36
Immunoflorescence
Determines nature of the causative immune process
37
Electron microscopy
Location of election dense immune deposits and degree of injury, integrity and thickness of GBM, forms of podocytes injury
38
Rapidly progressing glomerulonephritis lab findings
>50% of glomeruli on biopsy will have crescents, trapped immune complexes
Immunofluorescene: IgG, IgA, C3 granular pattern
Electron microscopy deposits in sub epithelium, subendothelial, mesangium
39
RPGN goodpasture's syndrome
Anti-GBM antibodies, hemoptysis
Immunoflorescence:IgG, C3 linear pattern
Electron microscopy: widening of GBM
40
RPGN wegener's granulomatosis, polyarthritis
No immunoglobulin or deposits
41
Post streptococcal glomerulonephritis
Pathology
Signs/symptoms
Groups A beta hemolytic streptococci, trapped immune complexes
Edema, oliguric, cola colored uringe, hypertension, ASO levels high, C3 low
42
PSGN biopsy
Microscopy: diffuse proliferation GN
Immunoflorescence:IgG and C3 in granular pattern in mesangium along capillary basement membrane
Electron Microscopy: large, dense sub epithelial deposits or humps
43
IgA nephropathy
Hamturia, URI, GI symptoms, flu0like illness, cola colored urine
Synpharyngitic hematuria- no significant latent period between infection and hematuria (post strep is delayed)
Proteinuria, HTN
44
IgA nephropathy lab
IgA deposits in mesangium, proliferation of mesangial cells
45
Henoch-schonlein purpura (anaphylactoid purpura)
Leukocytoclasic vasculitis, children and males, palpable purpura, arthralgia, abdominal symptoms, nausea, colic, melena
46
Pauci-immune glomerulonephritis
Fever, malaise, weight loss, hematuria, proteinuria, purpura, wegener's granulomatosis (upper or lower respiratory tract symptoms with nodular lesions that can cavitate and bleed, hemoptysis)
47
Cytoplasmic ANCA
Specific for anti-proteinase 3 antibodies
48
Perinuclear ANCA
Specific for antimyeloperoxidase antibodies
49
Anti-glomerular basement membrane glomerulonephritis
W/ pulmonary hemorrhage= goodpasture's disease
Mostly male, hemoptysis, dyspnea, respiratory failure, hypertension, edema
Anti GMB antibodie
50
AGBMG biopsy
Immunoflorescence: IgG, C3 linear pattern
| electron microscopy: widening of GBM
51
Cryoglobulin associated. Glomerulonephritis
Cold precipitable immunoglobulins, precipitation of cryoglobulins in glomerular capillaries, usually due to underlying infection
52
Cryoglobulin associated GN S/S
Necrotizing skin lesions, arthralgias, fever, hepatosplenomegaly
Complement levels depressed, rheumatoid factor elevated
53
Nephrotic syndrome
Leaky basement membrane, heavy proteinuria >3.5 g/24 hours, hypoalbuminemia, edema, hyperlipidemia
Peripheral edema hallmark, dyspnea due to pulmonary edema, pleural effusions, diaphragmatic compromise with ascites
54
Nephrotic syndrome urinalysis
Proteinuria, few elements or casts, if hyperlipidemia there will be oval fat bodies and appear like grape like clusters
55
Nephrotic syndrome blood chemistry
Decreased albumin and total serum protein less than 6
| Hyperlipidemia, decreased oncotic pressure, increased sedimentation rate due to fibrinogen
56
Membranous nephropathy
Immune mediated, complexes in sub epithelial portion of capillary walls
Proteinuria, hypoalbuminemia,hyperlipidemia, edema, renal vein thrombosis often, ESRD progression
57
Membranous nephropathy biopsy
Light microscopy: capillary thickness increased without inflammatory changes or proliferation, spike and dome pattern
Immunoflorescence: IgG and C3 uniformly along capillary loops
Electron microscopy: discontinuous pattern of dense immune deposits along the sub epithelial surface of basement membrane
58
Focal segmental glomerular sclerosis
Most common in adults and African Americans,
| Sclerotic lesions on light microscopy, IgM and C3 on immunofluorescence, fusion of epithelial foot processes on EM
59
Minimal change disease
Kids under 10, unidentified T cell lymphokine response, nephrotic, podocytes effacement and foot process fusion
60
HIV associated nephropathy light microscopy
Collapsing pattern of focal sclerosis, sclerotic segments display collapse of capillaries, swollen podocytes, numerous protein droplets, interstitial fibrosis and infiltration by mononuclear leukocytes
61
HIV associated nephropathy clinical
Severe proteinuria, >10 g/day, renal insufficiency, Rogers's to ESRD in less than one year
62
Diabetic glomerulosclerosis
Generalized increase in synthesis of basement membrane material by microvasculature, GBM thickening, expansion of mesangial matrix, nodular sclerotic lesions (kimmelstiel-Wilson nodules)
63
Diabetic glomerulosclerosis biopsy
EM: widening of basement membrane lamina dense, increase in mesangial matrix
Immunofluorescence microscopy: linear trapping of IgG, albumin, fibrinogen
64
Amyloidosis amyloid types
AA amyloid- serum amyloid A protein, increased during inflammatory process
AL amyloid- lambda or kappa immunoglobulin light chains produced by neoplastic cone of B cells or plasma cells
65
Amyloid
Eosinophilic, amorphous material, initially found in mesangium but later extend into capillary walls causing destruction in capillaries, fibrillar deposits in mesangium
66
Amyloidosis clinical features
Proteinuria, results in renal failure
67
Alport Syndrome
AKA hereditary nephritis, proliferation and sclerosing glomerular disease accompanied by defects of ears or eyes, genetic abnormality of type IV collagen
X linked, autosomal recessive
68
Alport syndrome clinical/biopsy
Hematuria, proteinuria, hypertension, ocular and hearing impairment
Matrix expansion, glomerular sclerosis, tubular atrophy, interstitial fibrosis, foam cells, thickened GBM
69
Obstruction of ureteropelvic junction
Common form of hydronephrosis, abnormal layering of smooth muscle cells, fibrosis replacing smooth muscle cells at site of UPJ
Abdominal mass, ITU, flank pain, stones, hematuria, sporadic pain
70
Congenital megaureter
Ureter is tortuous and lacks peristalsis, stagnation of urine, progressive hydronephrosis that leads to renal failure
71
Tumors of renal pelvis and ureters
Transitional cell carcinomas, similar to bladder cancer, hematuria and flank pain
72
Exstrophy of the bladder
Absence of anterior bladder wall and part of anterior wall of the abdomen
73
Acute cystitis
Most commonly from e. Coli, sometimes enterococcus or staph aureus.
Polyuria, dysuria, lower abdominal or pelvic discomfort
74
Chronic interstitial cystitis
Transmural chronic inflammation of the bladder wall, mucosal ulceration (hunger ulcer), mast cells, fibrosis
Frequency, urgency, supra public pain,
75
Acute pyelonephritis
Usually ascending from lower urinary tract, usually gram negative (enterococcus and staph aureus)
Irritative voiding symptoms, flank pain, diarrhea, dehydration, tachycardia, CVA tenderness
76
Hypospadias
Urethra opens on the underneath side of the penis, incomplete closure of the urethral folds of the urogenital sinus
77
Epispadias
Malformation of the urethral groove, urethral canal may create abnormal opening on dorsal surface
78
Phimosis
Orifice of prepuce may be too narrow to allow retroaction over the glans penis
79
Paraphimosis
Retracted prepuce that is too narrow and may strangulate the glans and impeded the outflow of venous blood
80
Sexually transmitted urethritis
Discharge, gonococcal, acute onset, pain or tingling, redness and swelling
81
Nonspecific infectious urethritis
Urgency, burning during urination, no discharge
82
Reactive arthritis syndrome
Urethritis, conjunctivitis, arthritis of weight bearing joints
HLA B27 hapltotype, inappropriate immune reaction to microbial agent
83
Cancer of urethra
Squamous or transitional epithelium, more female
Urethral bleeding and dysuria, spread to adjacent tissues or lymph nodes
84
Hydrocele
Collection of serous fluid in scrotal sac between two layers of tunica vaginalis, impedes lmphatic drainage of testicles
Transillumination
85
Hematocele
Accumulation of blood between the layers of tunica vaginalis
86
Spermatocele
Cystic mass of the epididymis
Benign
87
Varicocele
Dilation of testicular veins, appears as nodularity on the lateral side of the scrotum
"Bag of worms"
88
Cryptorchidism
Undescended testes, usually requires surgery, unilateral,
Increased incidence of germ cell neoplasia
89
Orchitis
Acute or chronic inflammation of the testes, usually secondary to hematogenous spread of pathogen or an immune mediated disease
90
Scrotal inguinal hernia
Protrusion of the intestines into the scrotum through the inguinal canal, mass, adhesions may develop, may cause testicular atrophy
91
Scrotal edema
Lymph or serous fluid may accumulate in scrotum due to obstruction of lymphatic or venous drainage
92
Cancer of the testes
Germ cell origin, malignant, cytogenetic i(p12) marker, chromosome 12
93
Acute epididymitis
Infection of epididymis acquired by retrograde spread of organisms down the vas from the urethra or bladder
40 and children, gram negative rods (e. Coli)
94
Acute epididymitis clinical
Heaviness and a dull, aching discomfort in the affected hemiscrotum, fever, chills, scrotal swelling, warm, red and elarged scrotal mass, positive prehn's sign, voiding symptoms, tender prostate
95
Torsion of testes
Acute onset of pain and swelling, nausea and vomiting, lack of voiding symptoms, strenuous activity
Lack of cremaster if reflex, entire testis is tender and swollen, high lie
96
Torsion of appendix testis or appendi epididymis
Palpating of tender nodule on illumination when skin pulled taut over the superior pole of the testis, blue dot sign, allowed to degenerate
97
Priapism
Continuous erection of the penis unrelated to sexual excitation, painful, unknown cause
98
Secondary priapism
Caused by pelvic diseases impeding outflow of blood from penis, hematological disorders, brain and spinal cord diseases
99
Peyronie disease
Induration of the penis, focal asymmetric fibrosis of the shaft of the penis, penile curvature, may cause pain with erection
100
Cancer of penis
Squamous mucosa of the glans and contiguous urethral meatus or the prepuce and the skin covering the shaft of the penis.
Only uncircumcised men, accumulation of keratin debris and inflammatory exudate (smegma)
101
Hermaphroditism
Rare, ambiguous genitalia in a person who has both male and female gonads
102
Female pseudohermaphroditism
Genetically female, internally genetically female organs, virilization of external genital organs
Often due to 21-hydroxyl are deficiency, overproduction of androgens
103
Male pseudohermaphroditism
Genetically male, Cryptorchidism testes, external genital organs appear feminine or ambiguously female
104
Acute prostatis
Reflux of infected urine into the prostate, inflammatory infiltrate seen in the prostatic acini and stroma, discomfort on urination, fever chills and perineal pain
105
Chronic bacterial prostatitis
Elevation of PSA, bacteria in urine, reflux of the urine, prostatic calculi, infiltrates of lymphocytes and plasma cells and macrophages
106
BPH
Enlargement of the gland, obstruction to the flow of urine trough the bladder outlet
107
Adenocarcinoma of the prostate
Gleason rating score, bladder outlet obstruction or symptoms of metastatic tumor, DRE with PSA
