Renal Flashcards Preview

Internal Medicine > Renal > Flashcards

Flashcards in Renal Deck (43)
Loading flashcards...
1

Four features of nephritic syndrome

1. Microscopic hematuria 2. HTN 3. Edema 4. Proteinuria

2

Four features of nephrotic syndrome

1. Proteinuria (> 3.5 g/24 hr) 2. Hypoalbuminemia 3. Edema 4. Hyperlipidemia **increased risk of infection, hypercoagulability

3

What are three primary glomerular disorders that typically cause nephrotic syndrome?

-Minimal change disease -Focal segmental glomerulosclerosis -Membranous glomerulonephritis (glomerulopathy)

4

What is the most common cause of nephrotic syndrome in adults? Second most common?

FSGS is most common. Membranous glomerulonephritis is 2nd.

5

Minimal change disease features

-Only finding on biopsy is podocyte effacement -Usually in kids and young adults -Treat with steroids (don't need to biopsy) -associated with NHL and Hodgkin's

6

FSGS is more common in what groups?

Black people, Hispanic people

HIV, obesity, heroin use 

7

FSGS often presents with what?

HTN and hematuria in addition to nephrotic syndrome features

8

What are the primary and secondary causes of membranous glomerulopathy?

Primary: idopathic Secondary: Hep B, Hep C, malaria, drugs (e.g. gold), neoplasm (e.g. lung, colon, CLL), autoimmune d/o (e.g. SLE)

9

What are some causes of nephritic syndrome/hematuria?

-IgA nephropathy (Berger's) -Post-strep GN -Goodpasture's (anti-GBM) -Lupus nephritis -ANCA-associated -Membranoproliferative GN

10

What is the deal with IgA nephropathy?

Presents SHORTLY after a URI -most common cause of recurrent hematuria, but renal function is just fine in most patients

11

When does post-strep GN occur?

10-21 days after the strep URI or impetigo C3 will be decreased but C4 normal self limited course

12

Goodpasture's syndrome consists of

Proliferative GN, pulmonary hemorrhage, anti-GBM antibody. Treat with plasmapheresis, immunosuppression *linear deposits

13

What are the ANCA-associated causes of nephritis?

Granulomatosis with polyangiitis, polyarteritis nodosa

14

What are the causes of membranoproliferative GN?

Hep C, also Hep b, syphilis, lupus. Associated with cyroglobulinemia

15

What's the difference between MPGN and membranous GN?

Membranous is usu nephrotic, and deposits are subepithelial. MPGN is usually nephritis and deposits are subendothelial

16

Other important secondary glomerular diseases?

HTN nephropathy Diabetic nephropathy Lupus Sickle cell nephropathy Amlyoidosis HIV nephropathy

17

HIV nephropathy

Proteinuria, edema, hematuria. Tx: prednisone, Ace-I and HAART. Hist resembles collapsing form of FSGS

18

Acute interstiital nephritis features

-recent infection or start of new med -may have fever, rash, eosinophilia, eosinophiluria -AKI

19

Acute vs. chronic interstitial nephritis

Acute: AKI with interstitial lymphs or eosinophils Chronic: indolent course assoc with tulointerstitial fibrosis and atrophy

20

What are the causes of renal papillary necrosis?

1. Analgesic nephropathy [may cause sterile [pyuria]

2. Sickle cell disease

3. UTI or urinary tract obstruction

4. Chronic alcoholism

5. Transplant rejection

21

Renal tubular acidosis (RTA) type 1

Type 1 (distal): cannot excrete H+ in distal tubule so cannot acidify urine --> hypokalemia, metabolic acidosis, renal stones, rickets in children

tx: sodium bicarb, phosphate salts

causes: lithium, amphotericin B, SLE, SCD, hepatitis

22

RTA type 2

Type 2 (proximal): cannot absorb bicarb in proximal tubule --> metabolic acidosis, hypokalemia

tx: Na restriction (increases proximal Na reabsorption and thus bicarb absorption)

causes: myeloma, Fanconi syndrome, amyloid, autoimmune

23

RTA1 and RTA2 both lead to what type of metabolic acidosis

Hypokalemic, hyperchloremic non-anion gap metabolic acidosis

24

RTA type 4

Type 4: Any condition assoc with hypoaldosteronism --> hyperkalemia, hyponatremia. Dec Na absorption + dec K and H excretion in distal tubule. Acidic urine in presence of metabolic acidosis.

 

causes: majority caused by diabetes. also- Addison's, sickle cell

25

ADPKD

Hematuria, HTN, palpable kidneys.

Tx: tx HTN and eventual transplant

Extra-renal manifestations: hepatic cysts (most common), intracranial aneurysm (do not screen), colonic diverticula, abdominal hernia, valvular heart dz 

26

ARPKD

Liver involvement always present and may be the major feature. Pulmonary hypolasia 2/2 enlarged kidneys in utero, can cause Potter syndrome.

27

Hartnup syndrome

AR defect of amino acid transporter --> decreased intestinal and renal reabsorption of amino acids such as tryptophan --> nicotinamide deficiency

28

Fanconi syndrome

Hereditary or acquired proximal tubule dysfunction --> glucosuria, phosphaturia (leads to bone problems), proteinruia, polyuria, hpokalemia, type 2 RTA tx: supplement phos, alkali, salt, K, hydrate

29

Acute tubular necrosis causes

1. Ischemic AKI 2. Nephrotoxic AKI (e.g. abx, toxins, myoglobinuria, NSAIDs)

30

ATN urine microscopy

Muddy brown casts

31

Diabetic nephropathy pathology

GFR elevation --> basement membrane thickening --> mesangial expansion --> glomerulosclerosis. 

 

Nodular glomerulosclerosis of pathognomic but diffuse is more common. Hyalinosis affecting BOTH afferent and efferent arterioles is also pathognomic.

32

Most common type of kidney stone?

Calcium oxalate (envelope shaped)

33

What is the pathophys of membranoproliferative GN type 2?

 

Type 2: dense deposit disease. Due to persistent activation of complement pathway 

 

other types caused by immune complex deposititon 

34

Renal cell carcinoma physical exam

Classic triad (not common): flank pain, hematuria, palpable flank mass

Left-sided varicocele that doesn't drain when recumbent

Paraneoplastic: anemia, thrombocytosis, hypercalcemia, cachexia 

 

Dx: CT scan 

35

What antibiotics are particularly nephrotoxic?

Aminoglycosides (e.g. gentamicin, amikicin, neomycin) 

36

Methanol ingestion causes what symptom?

Blindness

37

Cyanide poisioning

HIGH lactate levels, bitter almond taste

 

Antidote: sodium thiosulfate, hydroxocobalamin

38

What drugs can commonly cause hyperkalemia?

  • Bactrim
  • Heparin
  • NSAIDs
  • Digoxin
  • Acei/arbs
  • Beta blockers
  • Succinylcholine (NM blocker used in intubation) 
  • Cyclosporine 

39

What cause of nephrotic syndrome is most often assoc with renal vein thrombosis?

Membanous nephropathy, most often in association with adenocarcinoma 

40

Waxy or broad casts = ? 

Chronic renal failure 

41

WBC casts = ? 

Interstitial nephritis or pyelonephritis 

42

Fatty casts = ? 

Nephrotic syndrome 

43

Alport's syndrome

Mutation in type IV collagen. Family history. Hematuria, basket weaving on electron microscopy.