Quiz #4 Highlights Flashcards
(227 cards)
1
Q
Nephrotic Syndrome proteinuria levels?
A
> 3.0 and >300mg/mmol
2
Q
The most common form of primary GN in the world?
A
IgA GN (Berger’s disease)
3
Q
Most common symptom of Berger’s disease?
A
episodic gross hematuria
4
Q
Describe the urine seen in Berger’s disease?
A
pink, cola, or tea
5
Q
What is seen on biopsy for Berger’s disease?
A
IgA in mesangium
6
Q
Glomerular crescent formation
A
RPGN
7
Q
Most common vasculitis in children?
A
Henoch- Schonlein Purpura (HSP)
8
Q
Occurs 1-2 days after a cold, sore throat, or URI?
A
acute IgA GN
9
Q
Classic triad for Henoch Schonlein?
A
Palpable purpura
Arthralgia
Abdominal pain
10
Q
Most common cause of nephritic disease in children 5-15y/o?
A
Poststreptococcal GN
11
Q
Develops 1-3 wks after Group A beta-hemolytic strep throat or impetigo?
A
Poststreptococcal GN
12
Q
Describe urine in Poststreptococcal GN?
A
cola-colored, brown, smoky or frank blood
13
Q
Subepithelial deposits or “humps”
A
PSGN
14
Q
“Starry sky” or granular appearance on the GBM and mesangium
A
PSGN
15
Q
What is NOT used for txt in PSGN?
A
Corticosteriods!
16
Q
Whom is lupus most common in?
A
AA and female child bearing age
17
Q
How many classifications of Lupus Nephritis?
A
Class 1-6
18
Q
Most common and most severe class of LN?
A
Class IV (4)
19
Q
LN class that has thrombotic events?
A
Class V: Membranous GN with nephropathy
20
Q
Butterfly or malar facial rash
A
LN
21
Q
What is the most common type of MPGN?
A
Type 1
22
Q
“Tram track” appearance on LM?
A
MPGN Type 1
23
Q
Partial lipodystrophy?
A
MPGN Type II
24
Q
NO tram tracks?
A
MPGN Type II
25
"Ribbon like" - "dense deposit disease"
MPGN Type II
26
Most common cause of Cryoglobulin- GN?
Hepatitis C
27
What is Meltzer's triad?
Purpura
Arthralgia
Weakness
28
Where is Meltzer's triad seen?
Cryoglobulin- GN
29
Comes out in cold weather "cold sensitive"
Cryoglobulin -GN
30
What is the most common presentation of HCV?
Cryoglobulinemia (30%)
31
What 3 dx are HCV seen in ?
Membranoproliferative GN Type I
Cryoglobulinemia
Membranous nephropathy
32
Type I RRGN?
Goodpasture's Syndrome
33
Type III RRGN?
ANCA
34
What makes up ANCA?
cANCA (ctyoplasmic)
| pANCA (perinuclear)
35
What makes up cANCA?
GPA
36
What makes up pANCA?
MPA
| EGPA (Chrug-Strauss syndrome)
37
Hallmark of Goodpasture's?
Anti-GBM antibodies
38
Linear deposition of IgG and C3 along the GBM
Goodpasture's
39
Rapid renal loss and pulmonary hemorrhage?
Goodpasture's
40
Classic triad of GPA?
URT
LRT
Renal
41
Classic triad of EGPA?
Asthma
Peripheral blood eosinophilia
Vasculitis
42
Gold standard for dx EGPA?
lung biopsy
43
What is txt of EGPA based on?
"five-factors score"
44
How many months for chronic kidney disease?
> 3mos
45
What is the #1 cause of CKD?
Diabetic nephropathy
46
What is the gold standard for CKD staging?
24-hour urine (to measure albuminuria)
47
What is the more practical way to stage CKD?
Albumin to Creatinine Ratio (ACR)
48
Alot of people are in what stage of CKD?
3A
49
What is classic finding on imaging for CKD?
bilateral or single SMALL kidney
50
What is a HIGH risk of CKD?
Cardiovascular risk
51
What is the most common complication of CKD?
HTN
52
What bone disorder is seen CKD?
Osteomalacia
53
What is the most common bone lesion seen in CKD?
Osteitis fibrosa cystica
54
How does anemia look in CKD?
Normocytic, normochromic anemia
55
AEIOU used for?
Dialysis
56
What does AEIOU stand for?
```
Acid base problems
E- electrolyte
I- intoxication
O- overload of fluids
U-remic s/s
```
57
Most common complication of peritoneal dialysis?
Peritonitis
58
Most common infectious pathogen of hemodialysis?
Staphylococcus
59
#1 complication of hemodialysis?
Hypotension
60
Txt of choice for ESRD?
Renal transplant
61
What is the most common cause of kidney transplantation (25%)
DM
62
Bence Jones protein?
Myoglobin
63
Myglobinuria
Rhabdo
64
RBC casts?
GN
65
WBC casts?
interstitial nephritis
66
Pigmented/muddy brown casts
acute tubular necrosis (ATN)
67
Absolute contraindications in renal biopsy?
```
Uncorrected bleeding disorder
Severe uncontrolled HTN
Renal infection
Neoplasm
Hydronephrosis
Uncooperative pt
```
68
Relative c/I to renal biopsy?
```
Solitary or ectopic kidney
Horseshoe
ESRD
Congenital anomalies
PCKD
Kidney transplant
```
69
The most common AKI?
pre-renal (80%)
70
The least common AKI?
post-renal (15%)
71
What is RIFLE used for?
AKI
72
RIFLE?
```
Risk
Injury
Failure
Loss
End stage
```
73
Most common renal/intrinsic AKI?
acute tubular necrosis (ATN)
74
3RD leading cause on new onset AKI in hospitalized patients?
Radiographic contrast dye
75
Classic Traid for AIN?
Fever, rash, arthralgia post infection or medication
76
Serum eosinophilia and eosinophiluria?
AIN
77
Txt for AIN?
Methylprednisolone 500-1000mg for 3 days
78
Heart and kidney dysfunction due to other acute or chronic disease?
Type 5 Cardiorenal Syndrome
79
Acute HF results in AKI?
Type 1
80
Most common type of nephrotic syndrome?
Primary
81
Severe albuminuria/ proteinuria?
> 3.5 g/day
82
frothy urine?
nephrotic
83
Maltese cross
Nephrotic (lipiduria)
84
Fatty cast?
Nephrotic
85
Proteinuria txt?
ACEI or ARBs (monitor K+)
86
Edema txt?
Loop diuretics
| Thiazide
87
Most common cause of nephrotic syndrome in children?
Minimal change disease (MCD)
88
Third most common form of primary nephrotic syndrome in adults?
MCD
89
What is seen on biopsy for MCD?
widespread effacement of foot processes of the podocytes
90
Txt for MCD?
Prednisone
91
Most common cause of nephrosis in adults?
Focal segmental glomerulosclerosis
92
"Spike and dome" pattern?
Membranous glomerulonephritis (MGN)
93
DVT or renal vein thrombosis initial presentation?
MGN
94
Classic triad for Diabetic Nephropathy?
HTN, heavy proteinuria, and retinopathy
95
Most common type of DN?
Type 1 DM
96
What is the 1st stage of diabetic nephropathy?
hyperfiltration
97
Nodular GS (Kimmelstiel Wilson)
DN
98
Most common renal amyloid?
primary amyloidosis
99
Swelling in the face, ankles, and legs?
Renal amyloid (RA)
100
Dx for RA?
Abdominal fat pad biopsy
101
Apple green under LM?
RA
102
Congo red stain appears pink?
RA
103
Most common cause of asymptomatic hematuria?
Thin basement membrane disease (TBMD)
104
Txt for TBMD?
Reassurance
105
Classic triad for Alport?
GN, ESRD, hearing loss, and eye problems
106
Alport is what type of genetic problem?
X- linked (85%)
107
Inherited defect in type IV collagen?
Alport Syndrome
108
Dx of Alport?
woven basket or basket weave appearance
109
woven basket or basket weave appearance
Alport Syndrome
110
Most common ECF buffer?
carbonic acid (H2CO3)
111
Most common ICF buffer?
Sodium carbonate (Na2CO) and proteins (albumin)
112
Main independent urinary buffer?
Main independent urinary buffer?
113
Anion gap and winter's formula?
metabolic acidosis
114
Formula for winter's formula?
pc02= (1.5 x HCO3-) + 8 +/-2
115
Hyperkalemia, COPD, drugs?
Respiratory acidosis
116
Stimulate ventilation?
Doxapram HCL
117
Anxiety, hyperventilation?
Respiratory alkalosis
118
Hyperkalemia, Kussmal respirations (DKA)
metabolic acidosis
119
Normal gap with INCREASE in chloride and DECREASE in bicarb?
Hyperchloremic metabolic acidosis
120
pulling water into the bv
oncotic pressure
121
Keeping fluid from leaving bv
hydrostatic pressure
122
Most common hyponatremia?
hypotonic (90%)
123
Most common electrolyte abnormality in hospitalized pts?
hyponatremia
124
Txt for Respiratory Acidosis?
Doxapram HCL
125
Txt for Respiratory Alkalosis?
Txt cause, relax, rebreathe
126
Txt for Metabolic Acidosis <7.1?
IV bicarb
| txt hyperkalemia
127
Txt for DKA in metabolic acidosis?
fluids, insulin, bicarb
128
Txt for ASA overdose?
bicarb
129
Txt for alcoholic metabolic acidosis?
thiamine w/ glucose
130
Txt for methanol metabolic acidosis?
Fomepizole w/wo dialysis
131
Txt for RTA metabolic acidosis?
large amounts of alkali replacement w/ salts
132
Txt for Hyperaldosteronism?
Fludrocortisone
133
Txt for chloride metabolic alkalosis?
chloride and volume replacement
134
Txt for non-chloride metabolic alkalosis?
Spironolactone or ACEI
135
Dehydration txt?
prevention
| PO fluid replacement w/ pure water
136
Severe dehydration txt?
IV hydration w/ crystalloids
| Monitor I + Os
137
Causes for dehydration?
```
Infants and elderly- thirst and access
Hemorrhage
Inadequate fluid replacement
Hot + Humid + High attitudes
Endurance activities
Chronic illness: Cardio, Renal, Hyperaldosteronism
```
138
Txt for Hypovolemia?
Oxygen 1st
IVF- crystalloids, colloids, blood
Surgery
139
Txt for hypervolemia?
Txt cause
Diuretics
Oral/ sodium restriction
140
Txt for Hypokalemia?
Oral potassium replacement
| IV K+
141
Txt for Hyperkalemia?
Stop exogenous K+
Patiromer- FDA approved
Sodium polystyrene
142
Txt for emergent Hyperkalemia (>6.5)?
insulin/glucose, bicarb, beta agonist
IV calcium stablize membrane
Hemodialysis
143
Peaked T waves
Hyperkalemia
144
Prominent U waves, Broadened T waves?
Hypokalemia
145
Black licorice- glycyrrhizinc acid
metabolic alkalosis
146
Lower number of nephrons, small kidneys without scarring on nuclear scan?
Simple renal hypoplasia
147
No ureter development, with recurrent UTIs and impaired renal dysfunction?
Renal dysplasia
148
Txt for bilateral severe renal dysplasia?
Family counseling
149
Most common and severe form of non-heritable renal cystic disease?
Multicystic Dysplastic Kidney (MCDK)
150
A non-functioning dysplastic kidney with no renal tissue present?
Multicystic Dysplastic
151
US- shows multiple cysts on the periphery kidney
Dx for MCDK
152
Most common HEREDITARY disease in the US?
Polycystic Kidney Disease (PCKD)
153
What usually develops later in the 4th and 5th decade of life in PCKD?
ESRD
154
Most common form of PKD?
Autosomal Dominant PKD (adult onset)
155
Most common complication in females with PKD?
Liver cysts
156
Classic symptoms seen with PCKD?
Abdominal, flank, or back pain, hematuria and HTN
157
What is seen in the history of a PCKD pt?
Fhx of renal tract problems
158
Dx for PCKD for confirmation?
US
159
Dx for PCKD support?
CT scan
160
How early is ARPKD detectable?
24 weeks
161
Large "bright" cystic kidneys and hepatic cysts?
Autosomal Recessive PCKD
162
What is Potter Syndrome?
pulmonary hypoplasia, flattened face, widely separated eyes, epicanthal folds, low-set ears, club foot
163
Potter Syndrome
ARPKD
164
Txt for ARPKD?
Supportive team therapy
165
Renal agenesis txt?
counseling parents
166
Rare, BUT most common genetic cause of childhood kidney failure?
Nephronophthisis
167
Polyuria, Polydipsia, and salt wasting, HTN before 20y/o?
NPH
168
"Swiss cheese appearance"
Medullary Syndrome (Cacci Ricci Disease)
169
Fluid filled cysts form in the tubules?
Medullary sponge
170
"Paintbrush- like appearance"
Medullary Sponge
171
Most common congenital anomaly of the urinary tract
Duplication of ureters
172
Most common renal fusion anomaly?
Horseshoe kidney
173
Where is the horseshoe kidney connected?
isthmus
174
What stops the horseshoe kidney?
inferior mesenteric artery
175
When is horseshoe kidney found?
on autopsy
176
2nd most common fusion anomaly?
crossed fused renal ectopia
177
Txt of crossed fused renal ectopia?
pyeloplasty
178
Txt for fetal hydronephrosis?
resolves own its on
179
Prune belly syndrome?
hydronephrosis
180
What is prune belly syndrome?
abdominal muscles, enlargement of the ureters and bladder, bilateral UDT and VUR
181
Most common cause of hydronephrosis in adults?
BPH or stones
182
Imaging for hydronephrosis?
US
183
Txt for acute hydronephrosis?
percutaneous nephrostomy tube
184
Txt for chronic hydronephrosis?
ureteric stent or pyeloplasty
185
Txt for lower obstruction in hydronephrosis?
urinary or suprapubic catheter
186
Most common causes of secondary hypertension?
Renal artery stenosis
| Renal vein thrombosis
187
What is a treatable cause of secondary HTN?
Renovascular disease
188
90% of renal artery stenosis?
atherosclerosis plaque formation
189
Who is at risk of RAS?
```
ELDERLY
OBESE
>60
MALE
Elevated lipids
```
190
Triple effect?
Juxtaglomerurlar cells
Macula densa cells
Renin
191
Gold standard for dx RAS?
Renal angiography
192
"Strings of pearls"
Fibromuscular dysplasia
193
What medication should be AVOIDED in RAS txt?
ACEI
194
Txt for RAS?
angioplasty w/wo stent
195
MOST COMMON cause of Renal vein thrombosis?
Nephrotic syndrome (membranous nephropathy)
196
Vircho's Triad?
Endothelial damage
Low blood flow (dehydration/shock)
Increase coagulability of blood
197
Vircho's Triad seen in?
Renal vein thrombosis (RVT)
198
Nephrotic pt has a PE?
RVT
199
Imaging of choice for RVT?
CT angiography
200
What is compressed in Nutcracker syndrome?
superior mesenteric artery
201
Txt for Nutcracker syndrome
weight gain (fat pad)
202
Most common type of kidney cancer?
Renal cell carcinoma
203
Where is RCC mostly found?
PCT
204
9TH MOST common cancer in US?
Renal cell carcinoma
205
Increased risk and decrease risk for RCC?
Smoking- significant risk
| Alcohol- protective effect
206
Most common RCC type?
Clear cell
207
Classic triad of RCC?
Flank pain, hematuria, abdominal mass
208
Stauffer syndrome?
liver disease in the absence of mets
209
What is renal hemartomas?
a bruise to the kidney (most common)
210
What is angiomyolipoma?
blood vessels, muscle tissue, fatty tissue
211
What is checked prior to treatment of RCC?
TSH
212
What can be tested for in RCC?
Alkaline phosphatase
213
Dx for RCC?
Renal US
214
What detects nodal and organ mets in RCC?
MRI and CT
215
WHAT SHOULD NEVER BE DONE IN RCC?
renal biopsy
216
Treatment of choice for RCC?
Partial or radical nephrectomy
217
When is a radical nephrectomy performed?
>7cm or partial is not feasible
218
When is partial nephrectomy performed?
single kidney, bilateral RCC, cancer in a kidney, significant renal disease
219
If a partial or radical nephrectomy can't be performed what txt is used?
cryotherapy or radio-frequency ablation
220
Targets vascular?
Suniti(nib), Pazopanib, Cabozantinib (tyrosine inhibitors)
221
Targets the cancer?
Temsiroli(mus) and everolimus (mTOR rapamycin inhibitors)
222
Most common renal tumor in children?
Wilms tumor
223
Second commn anomaly?
Hemihypertrophy
224
WAGR?
Wilm tumor
Aniridia (no iris)
G-GU abnormalities
R- intellectual disability
225
Painless, palpable abdominal mass found incidentally
Wilms tumor
226
Dx for Wilm's tumor?
Abdominal US
227
What does Wilms tumor usually progress to by age 50y?
a 2nd malignant neoplasm (chest)
