Renal 3

Question 1

3 causes/triggers of dz for disorders of glomerular function

Answer 1

immunologic, nonimmunologic, or hereditary

Question 2

3 names for glomerular diseases

Answer 2

proliferative, membranous, or sclerotic

Question 3

what is the third leading cause of end stage kidney failure worldwide?

Answer 3

glomerulonephritis

Question 4

what is glomerulonephritis?

Answer 4

inflammatory process involving the glomerular structures

Question 5

two types of conditions OF glomerulonephritis

Answer 5

primary- glomerular abnormality is the only disease present

secondary- glomerular abnormality results from another dz (such as DM or SLE)

Question 6

what type of syndrome is diffuse proliferative glomerulonephritis?

Answer 6

nephrITIC; mesangial/endothelial cell proliferation and large, irregularly spaced sub-epithelial deposits (“lumpy bumpy”)

Question 7

what type of syndrome is membranous glomerulopathy? what is seen on microscopy?

Answer 7

nephrOTIC; thickening of GBM and small, evenly spaced sub epithelial deposits (“fine granularity”)

Question 8

five glomerular syndromes

Answer 8

1) . acute nephritic syndrome
2) . rapidly progressive glomerulonephritis
3) . nephrotic syndrome
4) . asymptomatic disorders of urinary sediment (hematuria, proteinuria)
5) . chronic glomerulonephritis

Question 9

what is acute nephritic syndrome?

Answer 9

acute proliferative inflammation that occludes the glomerular capillary lumen and damages capillary wall

Question 10

what does acute nephritic syndrome present as? (4)

Answer 10

sudden onset hematuria, positive for RBC casts or dysmorphic RBCs, tea colored urine, salt and water retention causing edema or HTN

Question 11

what disease is most common after group A beta hemolytic strep infection?

Answer 11

post infectious glomerulonephritis

Question 12

interventions to prevent or slow progression of CKD (3)

Answer 12

1) . target BP less than 140/90 (130/90 if DM or proteinuria)
2) . A1C target of 7% with T2DM
3) . CKD stage 4 & 5: reduced protein intake might reduce risk of death

Question 13

tx of CKD comorbidities (2- anemia and CVD)

Answer 13

1) . consider ESA to tx anemia with target Hb levels > 12

2) . prevent/tx CVD with statin and asp therapy

Question 14

which two drugs should you reduce dose by 50% when GFR < 30 in CKD?

Answer 14

fluoroquilolones and trimethoprim

Question 15

ACE/ARB for CKD: start at lower dose with GFR < ____, and assess _____ and _____ 1 week after starting

Answer 15

45; GFR and K+

Question 16

NSAIDS for CKD: avoid GFR < _____ and avoid prolonged therapy when GFR < ______

Answer 16

30; 60

Question 17

metformin for CKD: review use when GFR is less than ____ and avoid when GFR is less than ____

Answer 17

45; 30

Question 18

med adjustments for CKD: may dec insulin when GFR < _____; adjust gabapentin when GFR < ____

Answer 18

30; 60

Question 19

when using warfarin in a CKD pt, there is an increased risk of what when GFR < 30?

Answer 19

bleeding

Question 20

post infectious glomerulonephritis: most common in ___________, characterized by _____ infection; tx with _____ to help infection; excellent ______ and ______ causes KD; kids resolve within ___-____ weeks, adults take a bit _____

Answer 20

children; strep; ABX; prognosis rarely; 6-8 weeks; longer

Question 21

rapidly progressive glomerulonephritis: presents with progression of _____ _____ over ____ to _____, in most cases in the context of _______ ___________

Answer 21

renal failure; days to weeks; NEPHRITIC PRESENTATION

Question 22

rapidly progressive glomerulonephritis is also called: _____________ _____________. why?

Answer 22

crescentic glomerulonephritis, bc pathologic findings of glomerular crescent formation

Question 23

rapidly progressive glomerulonephritis does not have a _______. if left _____, it rapidly progresses to ______ ______ ______ and ____ within a few months

Answer 23

cause; untreated; acute renal failure; death

Question 24

Good pasture syndrome is associated with what disease? what is GPS?

Answer 24

rapidly progressive glomerulonephritis; its when antibodies attack the glomeruli basement membranes

Question 25

GPS's staining hallmark is what? what might these pts present with?

Answer 25

diffuse (smooth) linear staining of glomerular BM's for IgG; present with coughing up blood

Question 26

characteristics of nephrotic syndrome (4)

Answer 26

1) . nephrotic range proteinuria: >3.5g/day in adults 2) . hypoalbuminemia (<3) 3) . hyperlipidemia 4) . lipiduria: free fat, urine foam, fatty casts, oval bodies

Question 27

Nephrotic syndrome is NOT a specific ______________ disease, but a constellation of clinical findings that results from what two things?

Answer 27

glomerular; loss of plasma proteins and inc in glomerular permeability

Question 28

pts with nephrotic syndrome are at an increased risk of what? it develops as a ______ or ________ disorder

Answer 28

thrombotic complications; primary or secondary

Question 29

nephrITIC: 5 things nephrotic: 3 things

Answer 29

ITIC: inflammatory, hematuria, edema, HTN, lower degree of proteinuria (<3.5g in 24 hrs) OTIC: noninflammatory, protein >3.5g, increased lipids in blood and urine

Question 30

two asymptomatic disorders of urinary sediment

Answer 30

Alport syndrome and IgA nephropathy

Question 31

pts with asymptomatic disorders of urinary sediment present with what two asymptomatic things?

Answer 31

hematuria and/or proteinuria

Question 32

what is IgA nephropathy? what does this lead to? what syndrome is it a form of?

Answer 32

presence of glomerular IgA immune complex deposits in mesangial cells of glomerulus; leads to damage in the basement membrane, which allows blood and proteins to pass through; form of nephritic syndrome

Question 33

tx for IgA nephropathy

Answer 33

no great tx's

Question 34

what is Alport syndrome?

Answer 34

hereditary defect of GBM which results in hematuria and might progress to chronic renal failure

Question 35

Alport syndrome: _____ are more commonly affected and typically progress to _______ ________ as adults

Answer 35

men; renal failure

Question 36

how to dx Alport syndrome

Answer 36

made by UA of a child who comes from a family of Alport syndrome (maybe microscopic hematuria/proteinuria)

Question 37

most Alport syndrome pts have _________ _______ and _____ diseases

Answer 37

sensorineural deafness and eye dz

Question 38

tx for Alport syndrome

Answer 38

ACEI for pts with proteinuria. maybe ARB and statin | those with CRF, transplant

Question 39

chronic glomerulonephritis is characterized by ______ kidneys with __________ glomeruli. develops _________ and has _______ __________; slowly progresses to ________ _________

Answer 39

small; sclerosed; insidiously; PERSISTENT PROTEINURIA; kidney disease

Question 40

what are three types of glomerular lesions associated with systemic dz?

Answer 40

systemic lupus erythematous glomerulonephritis, diabetic glomerulosclerosis, and hypertensive glomerular dz

Question 41

systemic lupus erythematous glomerulonephritis is ____________ ______________; _______ disease is the most common complication. these pts will need _____ ______ and routine UAs if anything is abnormal. Tx is _____ and _____

Answer 41

tubulointerstitial inflammation; renal disease; RENAL BIOPSIES; steroids and ACEIs

Question 42

diabetic glomerulosclerosis: look for ______________. tx: control ________, start _____ and ______

Answer 42

MICROALBUMINURIA (30-300 mg in 24 hrs); glucose, ACEI and ARBs

Question 43

Hypertensive Glomerular Dz: mild to moderate HTN causes ______ changes in renal arterioles and small arteries....this leads to what? tx are what meds?

Answer 43

sclerotic; leads to poor perfusion of kidneys' lower BP, ACEI/ARBs

Question 44

IgA Nephropathy is what type of syndrome?

Answer 44

nephritic

Question 45

acute tubular necrosis: death of _______ _________ cells in the renal tubules. presents with ______ ________ ______ and is one of the most common causes of ________ AKI (85%)

Answer 45

tubular epithelial; acute renal failure; intrinsic

Question 46

two common causes of ATN

Answer 46

hypotension with ischemia and use of nephrotoxic drugs

Question 47

ATN: presence of "________ _______ _______". BUN/Cr will be less than ____ and urine Na will be less than _____

Answer 47

MUDDY BROWN CASTS; 20, 40

Question 48

management of ATN relies on aggressive tx of factors that ___________ ATN; overall prognosis is ______ if the cause is corrected. recovery within ___-____ days

Answer 48

precipitated; good; 7-21 days

Question 49

acute pyelonephritis (APN): _______ infection of the ______ urinary tract. most common by ______, ____, _________ and __________

Answer 49

bacterial; upper; causes by E coli, Klebsiella, Enterobacter, pseudomonas

Question 50

APN: kidneys can become infected via what two ways?

Answer 50

ascending infection from lower urinary tract or through blood stream

Question 51

APN: _____ onset of infection with _____, _____, constant ache in the ______, _____ pain, positive _____ tenderness

Answer 51

acute; chills, fever, flank; abdominal; CVA

Question 52

diagnosis of APN: positive ____, ____ elevated, CT indicates what

Answer 52

pos UA, WBC elevated, pyelo +/- abscess

Question 53

what two pt populations ALWAYS get admitted for APN?

Answer 53

pregnant women and kids

Question 54

chronic pyelonephritis: scarring and deformation of renal ______ and _______, along with ____ of the overlying cortex

Answer 54

calyces and pelvis; atrophy

Question 55

chronic pyelonephritis involves a ______ or ________ bacterial infection superimposed on _____, ___ _____, or both

Answer 55

recurrent or persistent; UTI, urine reflex

Question 56

chronic pyelonephritis: involves one or both sides? what is tx?

Answer 56

can be bilateral; tx: determine the source and tx, ABX

Question 57

what four drugs can cause ACUTE PRERENAL FAILURE?

Answer 57

1) . diuretics 2) . IV dye 3) . immunosuppressive drugs (tacro/cyclosporine) 4) . NSAIDS

Question 58

acute drug-related hypersensitivity reactions produce _________ ________. associated with what drugs? (4) ____% of the time, pt has a rash

Answer 58

tubulointerstitial nephritis; sulfa, methicillin, beta lactams. Lasix/thiazides; 25%

Question 59

chronic analgesia nephritis is associated with _____ ____

Answer 59

analgesic abuse (pain killers)

Question 60

ARF is caused by _______ _____ use, especially _______ or _____

Answer 60

illicit drug use; cocaine or NSAIDs

Question 61

what are the three cystic diseases of the kidney?

Answer 61

1) . polycystic kidney dz (ADPKD or ARPKD) 2) . nephronophthisis- Medullary cystic disease complex 3) . simple and acquired renal cysts

Question 62

PKD is an ________ disorder with many cyst sacs or segments in the _______ structures of the kidney

Answer 62

inherited; tubular

Question 63

ADPKD: _____ common, appears when pt is an _____, ___-___% of pts have an associated aneurysm; ____ is preferred method for diagnosis

Answer 63

most; adult; 10-30%; US

Question 64

tx for ADPKD

Answer 64

supportive: control HTN and UTI prevention, pain control (dialysis/transplant for those to progress to renal failure)

Question 65

ARPKD: cystic _____ of the ______ and _________ collecting tubules. this disease is ____

Answer 65

dilation; cortical and medullary; rare

Question 66

ARPKD: infant presents with bilateral ______ _____, severe _____ failure, ______ fibrosis, impaired _____ development. ____ ______ may be present

Answer 66

flank masses; renal; liver; lung; potter facies

Question 67

ARPKD: ___% of infants die during the perinatal period

Answer 67

75%

Question 68

tx of ARPKD

Answer 68

supportive, aggressive ventilator support, renal transplant

Question 69

nephronophthisis- Medullary cystic disease complex: group of ________ ______ and ________ disorders with _______ onset

Answer 69

autosomal dominant and recessive; childhood

Question 70

what happens to the kidneys in nephronophthisis- Medullary cystic disease complex? what is present on the kidneys?

Answer 70

small and shrunken, presence of numerous cysts at corticomedullary junction

Question 71

progression of dz in what happens to the kidneys in nephronophthisis

Answer 71

progress to azotemia (high levels of nitrogen compounds in the blood) and renal failure within 5-10 yrs

Question 72

simple cysts: single or _______, unilateral or ______, confined to the _____. if symptomatic, they can cause _____ pain, hematuria, infection. common in people

Answer 72

multiple, bilateral; cortex; flank; 50 yrs

Question 73

acquired cysts: forms in people with ____ who have undergone prolonged _____ tx

Answer 73

CKD; dialysis

Question 74

acquired cysts are typically _____, but may have cysts that ______, causing ____. what might develop in the walls of the cysts?

Answer 74

asymptomatic; bleed, causing hematuria; tumors might develop in the walls

Question 75

what type of syndrome is FSGS? _____ urine due to ____ levels of protein; ____ and chronic _____ impairment

Answer 75

nephrOTIC; foamy; high; HTN and chronic renal impairment

Question 76

microscopy for FSGS shows what?

Answer 76

focal and segmental glomerular sclerosis