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Flashcards in Renal Deck (115)
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Differentiate cyst location in dysplastic kidney dz, PKD, Medullary cystic kidney dz

dysplastic => renal parenchyma & abnormal tissue

PKD=> bilateral enlarged kidneys w/ cysts in cortex & medulla

medullary => medullary collecting ducts w/ parenchymal fibrosis leading to shrunken kidneys


How does the ARPKD present?

baby w/ portal HTN due to congenital hepatic fibrosis


How does ADPKD present?

young adult w/ HTN, hematuria, progressive renal failure w/ FHx of death due to berry aneurysm rupture or chronic renal failure


What is the timeline & hallmark of acute renal failure?

azotemia (high BUN & Cr) w/in days often w/ oliguria


What is the cause of pre renal ARF? what are the assoc labs?

decreased Q to kidneys so decreased GFR;
BUN:Cr > 15
tubular fxn intact so FENa < 1% & urine osm > 500 mOsm/kg


What is cause of post renal azotemia?

obstruction of urinary tract downstream decreasing GFR (backup), azotemia & oliguria


Differentiate the timeline of early & long-standing post renal obstruction

early increase in pressure leads to BUN:Cr > 15
FENa < 1% & urine osm > 500mOsm

long term causes tubular damage causing BUN:Cr < 15
FENa > 2% & urine osm < 500mOsm


what is the MCC of acute renal failure?

intrarenal azotemia => injury & necrosis of tubular epithelial cells


What will be seen on urinalysis during ATN?

brown, granular casts in urine
serum BUN:Cr < 15
FENa > 2%
urine osm < 500 mOsm


What are the clinical features of ATN?

oliguria w/ brown granular casts
BUN:Cr < 15
Hyperkalemia (decresed renal fxn) w/ metabolic acidosis


Describe ATN if ischemia is the cause. What is the most susceptible part of kidney?

decreased Q so often preceded by pre renal azotemia =>
proximal tubule & medullary segment of thick ascending limb are most susceptible


What are nephrotoxic agents to the kidney that may lead to ATN?

MC is aminoglycosides;
heavy metals (lead);
myoglobinuria (crush injury to muscle);
ethylene glycol;
radiocontrast dye (CT scan);
urate (tumor lysis syndrome or high gout)


How will you know if someone ingested ethylene glycol?

oxalate crystals in urine


What are ways to avoid tumor lysis syndrome causing ATN?

hydration & allopurinol prior to CTX


If ATN occurs, how is it treated and can the pt recover? what is the timeframe?

Reversible => supportive dialysis due to severe electrolyte imbalances

oliguria can present for 2-3wks before recovery due to tubular cells regenerating


Why does it take 2-3wks for oliguria to remit?

tubular cells are stable cells so takes time to re-enter the cell cycle & regenerate


What causes acute interstitial nephritis? How is it treated? What happens if it is not?

Drug induced HSR causing infrarenal azotemia typically from NSAIDs, penicillin & diuretics
Resolves w/ drug stoppage;
if Rx is not pulled then renal papillary necrosis may occur


How does acute interstitial nephritis present?

oliguria, fever & rash varying from days to weeks (any time) after using a Rx => eosinophils MAY be in urine


How does renal papillary necrosis present? What are the common causes?

gross hematuria w/ flank pain
Chronic analgesic pain (phenacetin or aspirin use);
Sickle cell disease OR trait;
Severe acute pyelonephritis


Define nephrotic syndrome & the 4 possible results

proteinuria > 3.5g/day

hypoalbuminemia - pitting edema;
hypogammaglobulinemia - increased infection risk;
hyper coagulable state - due to loss of AT-3;
hyperlipidemia & hypercholesterolemia - fatty casts in urine


How does the MCC of nephrotic syndrome in children present on H&E? EM? IF? urinalysis?

H&E: normal glomeruli;
EM: effacement of foot processes
IF: no IC deposits so negative IF

Urinalysis has selective proteinuria w/ loss of albumin but not Ig loss


What cancer is minimal change disease associated with? why?

Hodgkin lymphoma due to massive increase of cytokines from RS cells


What is the response to treatment of minimal change disease?

excellent response to steroids due to damage caused by cytokines from T cells


What is the MCC of nephrotic syndrome in Hispanics & AA?

Focal segmental glomerulosclerosis (FSGS)


What is FSGS associated with?

HIV; heroin use; sickle cell disease


How does FSGS appear on H&E? EM? IF?

HE: focal & segmental pink sclerosis
EM: effacement of foot processes
IF: no IC deposits = neg IF


What is the response to Tx in FSGS?

poor response to steroids leading to chronic renal failure


What is the MCC of nephrotic syndrome in caucasian adults?

membranous nephropathy


What is membranous nephropathy assoc w/?

solid tumors;
SLE (usually diffuse proliferative GN);
Rx (NSAIDs & penicillamine)


How does membranous nephropathy appear on H&E? EM? IF?

HE: thick glomerular BM
EM: subepithelial deposits w/ 'Spike & dome" appearance
IF: IC deposits so granular IF