Renal

Question 1

Goodpasture Synrdome - IF appearance?

Answer 1

Linear

Question 2

Goodpasture Synrdome - Presentation?

Answer 2

Hematuria & Hemoptysis

Question 3

Acute Poststreptococcal Glomerulonephritis - IF appearance?

Answer 3

Granular

Question 4

Diffuse Proliferating Glomerulonephritis - IF appearance?

Answer 4

Granular

Question 5

Characteristics of Nephritic Syndrome?

Answer 5

• Inflammatory process
• Hematuria & RBC casts
• Azotemia, Oliguria, Hypertension
• Proteinuria (<3.5 g/day)

Question 6

Characteristics of Nephrotic Syndrome?

Answer 6

• Massive proteinuria (>3.5 g/day, frothy urine)
• Hyperlipidemia, fatty casts, edema

Ass’d w/ :

• Thromboembolism/hypercoagulable state
• ↑ risk of infection (loss of immunoglobulins)

Question 7

Dx?

• “Spike & Dome” appearance w/ subepithelial deposits on EM
• Diffuse capillary & GBM thickening on LM

Answer 7

Membranous nephropathy

• IF = Granular
• SLE’s nephrotic presentation

Question 8

What is SLE’s nephrotic presentation?

Answer 8

Membranous nephropathy

Question 9

Membranous Nephropathy - IF appearance?

Answer 9

Granular

Question 10

Dx?
LM = Normal glomeruli
EM = Foot process effacement

Answer 10

Minimal change disease
(Nephrotic)

• Selective loss of albumin, not immunoglobulins

Question 11

Most common cause of nephrotic syndrome in adults?

Answer 11

Focal segmental glomerulosclerosis

2nd most common is membranous nephropathy

Question 12

Dx?
LM = segmental sclerosis & hyalinosis
EM = effacement of foot processes

Answer 12

Focal segmental glomerulosclerosis

Nephrotic

Question 13

Dx?

Congo red stain shows apple-green birefringence under polarized light

Answer 13

Amyloidosis
(Nephrotic)

• ass’d w/ chronic conditions
  (e. g. multiple myeloma, TB, RA)

Question 14

Dx?

• Subendothelial IC deposits w/ granular IF
• “Tram track” appearance

Answer 14

Membranoproliferative Glomerulonephritis
(Nephrotic)

• “Tram track” appearance due to GBM splitting caused by mesangial ingrowth

Question 15

Diabetic Glomerulonephropathy can cause non-enzymatic glycosylation of GBM & ______ arterioles.

Answer 15

efferent

Question 16

Dx?

LM = Glomeruli enlarged & hypercellular, neutrophils, "lumpy bumpy" appearance
EM = Subepithelial immune complex humps

Answer 16

Acute Poststreptococcal Glomerulonephritis

Question 17

Dx?

Most frequently seen in children. Presents w/ peripheral & periorbital edema, dark urine, & hypertension. Resolves spontaneously.

Answer 17

Acute Poststreptococcal Glomerulonephritis

“sore throat (1 wk ago), face bloat, piss coke”

Question 18

Acute Poststreptococcal Glomerulonephritis - IF appearance?

Answer 18

Granular

• due to IgG, IgM, & C3 deposition along GBM & mesangium

Question 19

Dx?

LM & IF = Crescent-moon shape

Answer 19

Rapidly progressive glomerulonephritis (RPGN)
(really just a description, not a separate disease)

• Crescents consist of Fibrin & Macrophages
• Potengial outcome of various renal pathologies in adults

Question 20

What is SLE’s nephritic presentation?

Answer 20

Diffuse Proliferative Glomerulonephritis

due to SLE or MPGN

Question 21

Dx?

LM = "wire looping" of capillaries
EM = subendothelial & sometimes intramembranous IgG-based ICs often w/ C3 deposition

Answer 21

Diffuse Proliferative Glomerulonephritis
(Nephritic)

IF = granular

Question 22

What is the most common cause of death in SLE?

Answer 22

Diffuse Proliferative Glomerulonephritis

Question 23

Nephritic syndrome related to Henoch-Schonlein purpura?

Answer 23

Berger’s Disease (IgA Nephropathy)

LM = Mesangial proliferation
EM = Mesangial IC deposits
IF = IgA-based IC deposits in mesangium

Question 24

Dx?

LM = Mesangial proliferation
EM = Mesangial IC deposits
- Often presents/flares w/ a URI or acute gastroenteritis

Answer 24

Berger’s disease (IgA nephropathy)

follows mucosal infection b/c of ↑IgA to fight off infection

Question 25

Dx? - Mutation in type IV collagen → split basement membrane - X-linked

Answer 25

Alport Syndrome - Glomerulonephritis, deafness - Eye problems (less commonly)

Question 26

PTH actions on renal tubules?

Answer 26

Early Proximal Tubule: - Inhibits Na+/phosphate co-transport → phosphate excretion Early Distal Convoluted Tubule: - ↑Ca(2+)/Na+ exchange → Calcium absorption

Question 27

Amiloride - MOA?

Answer 27

Blocks Sodium absorption in Principals cells of Collecting tubules

Question 28

Triamterene - MOA?

Answer 28

Blocks Sodium absorption in Principals cells of Collecting tubules

Question 29

Thiazide Diuretics - MOA?

Answer 29

Block Na/Cl co-transporters in Distal Convoluted Tubule

Question 30

Loop Diuretics - MOA?

Answer 30

Block Na/K/2Cl co-transporters in Thick Ascending Limb (Loop of Henle)

Question 31

Angiotensin II actions on renal tubules?

Answer 31

Stimulates Na/H exchange in Proximal Tubules | → ↑Na+, H2O, HCO3- reabsorption

Question 32

Causes: ↑anion gap metabolic acidosis

Answer 32

Methanol (formic acid), Uremia, Diabetic ketoacidosis, Propylene glycol, Iron tablets, INH, Lactic acidosis, Ethylene glycol (oxalic acid), Salicylates (late) "MUDPIILES"

Question 33

Causes: ↓anion gap metabolic acidosis

Answer 33

Hyperalimentation (↑Cl-), Addison's disease (↓aldosterone), Renal tubular acidosis, Diarrhea, Acetazolamide, Spironolactone, Saline infusion (dilutes bicarbonate) "HARD-ASS"

Question 34

What does the presence of casts indicate?

Answer 34

That hematuria/pyuria is of renal (vs. bladder) origin