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P&T Block 5 Renal > L53 > Flashcards

Flashcards in L53 Deck (29)
1

Creatinine is a metabolic product from (what) and (what)? Why do you care?

From arginine & creatine
Formed at constant rate
Plasma Cr used to monitor GFR (P Cr = 1/GFR)
- Everything that is filtered gets excreted in urine
Formation = filtration = elimination rate

2

Describe the 4 stages of change to Cr in the unsteady state of AKI

P Cr does NOT reflect GFR
1. Generation = excretion (can't see damage effects yet)
2. G > E
3. G = E as damage plateaus
4. G

3

What is the cause of AKI if there are WBC casts + eosinophils in the urine?

Acute intersitital nephritis

4

What is the cause of AKI if there is protein, RBC casts and WBCs in the urine?

Acute glomerulonephritis

5

What is the cause of AKI if there are granular casts in the urine?

Acute tubular necrosis

6

Causes of pre-renalAKI

Volume loss: hemm, diarrhea/vomiting, diuretics
Look intravasc depleted:
- CHF
- Nephrotic syndrome
- Cirrhosis

7

Describe changes with pre-renal cause of AKI
- GFR
- BUN/Cr
- FE Na

↓RBF -> ↓GFR -> ↑Cr
↑BUN + ↓FE Na as trying to ↑ECF

8

4 big causes of intra-renal AKI

ATN
Acute interstitial nephritis
Acute glomerulonephritis
TTP, HUS

9

Give some examples of things that would cause ischemia leading to ATN

Hypotension
Cardiac bypass
Aortic crossclamp during aneurysm repair

10

Histo for ATN

Flattened epithelia
Debris in tubular lumen
+/- mitotic figures (if recovering)

11

Treat ATN

Supportive

12

Most common drugs that cause acute interstitial nephritis

Antibiotics
NSAIDs

13

What is the classic triad of acute interstitial nephritis (that may not be seen together)

**Fever + CVA tenderness
Rash
Eosinophilia

14

Urinalysis of acute interstitial nephritis

WBCs +/- casts
Eosinophils

15

Treat acute interstitial nephritis

Supportive
Remove the insult (but might not need to do this since presentation is delayed, drug may have already stopped)

16

5 big causes of rapidly progressive glomerulonephritis

1. Goodpastures
2. Granulomatous polyangitis
3. Mircoscopic polyarteritis
4. SLE
5. Post-infectious (strep)

17

What is rapidly progressive GN?

Renal fxn deteriorates fast (days/wks), poor prognosis
Nephritic syndrome = inflam process = glomerular basement membrane disrupted
- ↑BUN
- HTN
- ↓Urine output

18

Urinalysis for RPGN

RBC casts indicates effects glomerulus

19

What is granulmoatosis polyangitis? What is the key histo finding

= Wegner's syndrome
AI inflam of BVs
**+ c ANCA**
Symptoms:
- Nephritis
- Pulm infiltrates // hemoptysis

20

What is ANCA?

Anti-neutrophil cytoplasmic Abs
c = cytoplasmic
p = perinuclear

21

Treat Wegner's

Steroids
Cyclophosphamide - immune suppression, cross links DNA

22

What do you see on renal biopsy for Wegner's

Crescents
Segmental necrotizing lesions
Pauci-immune

23

What is Goodpasture's disease?

Abs vs glomerular & alveolar basement membrane (T2 HST)
Pulm hemm + RPGN

24

Renal biopsy of Goodpasture's

Crescent
LINEAR IgG deposits

25

Treat Goodpasture's

Plasma exchange
Steroids (methylpredniolone)
Cyclophosphomide

26

What is the immuno-fluorescence + electron microscopy for RPGN after strep?

Lumpy bumpy on IF
Subepithelial humps on EM (immune deposits)

27

Treat TTP/HUS as cause of RPGN

Plasma exchange ASAP

28

What are causes of post-renal AKI

BLOCKAGE
@ ureter
@ bladder outlet obstruction

29

Dx post-renal cause of AKI

Palpable bladder
Large prostate
Hydronephrosis on imaging (enlarged renal pelvis)