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Renal Flashcards

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1
Q

Potter sequence

A
  1. Lung hypoplasia –> death
  2. Flat face
  3. Low set ears
  4. Defects in extremities - club feet

Assoc w/ Oligohydramnios
- B/L adrenal aplasia

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2
Q

BL kidneys cysts containing cartilage and other abnormal tissue

A

Dysplastic kidney

NON-inherited (vs. PKD)

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3
Q

Hispanics & Blacks with Proteinuria >10g, lipiduria, edema
HIV, heroin, sickle cell
Effacement of foot processes
NO response to steroids

A

FSGS

  • Collapsing w/ HIV
  • can be a progression of minimal change
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4
Q

Caucasian adult male with hematuria, proteinuria mild HTN
HBV, HCV, Tumors (lung & colon), SLE, drugs, DM
Thick BM, Sub-EPIthelial deposits - SPIKE & DOME
Granular IC deposition of IgG4 to PLA2R

A

Membranous

  • SLE usually nephritic
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5
Q

Pt w/ HCV, cryoglobulinemia or IVDU with palpable purpura, weakness, arthralgia, red and fatty casts

A

MPGN
TRAM-TRACK

I - sub-ENDOthelial - HBV, HCV, early complement
II - intramembranous - C3 nephritic factor
- low serum complement

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6
Q

Non-enzymatic glycosylation –> hyaline arteriosclerosis of EFFERENT –> hyperfiltration –> microalbuminuria

A

Diabetic nephropathy

Sclerosis of mesanigum = Kimmelsteil-wlison nodules
ACE-I slow progression

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7
Q 
Light chain casts
Kidney = most common
Large amorphous nodular mesangium
Apple-green birefringence
Congo red
A

Amyloidosis

Primary = AL light chains, multiple myeloma
Secondary = AA
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8
Q

Massive proteinura, no HTN, no hematuria in Kids or adults w/ NSAID abuse

Normal glomeruli
Foot process effacement - t-cell cytokines
RESPONDS to steroids (vs. FSGS)

A

Minimal change

Assoc Hodgkin lymphoma*

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9
Q

Muddy/Brown, granular casts, oliguria, elevated BUN, Cr, hyperK w/ acidosis

A

Acute Tubular Necrosis = PROXIMAL TUBULE

Dec GFR

  • BUN:Cr 2%
  • Urine Osm <500

Ischemic - MI
Nephrotoxic - aminoglycosides, lead, ethylene glycol, contrast

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10
Q

Pre/Post-Renal azotemia

A

Pre - Dec RNF
Post - Obstruction downstream

BUN:Cr >15
Osm 500
Fractional Na excrestion (FENa) 2%

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11
Q

AD - PKD

A

AD
HTN - inc renin
hematuria

BERRY ANEURYSM, hepatic cysts, MVP

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12
Q

AR - PKD

A

AR mutation on PKHD1
SMOOTH, sponge-like kidneys (vs. AD)
Infants w/ HTN
Hepatic fibrosis & cysts

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13
Q

SLE w/ nephrotic

A

Membranous

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14
Q

SLE w/ nephritic

A

Diffuse proliferative

Sub-endothelial, granular deposits

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15
Q

Nephritic syndrome

A

Proteinuria neutrophil damage***

RBC CASTS
HYPERCELLULAR

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16
Q

Kid w/ hx of skin infection 2 wks ago has hematuria, oliguria, HTN, periorbital edema.

A

Post-Strep GN
Nephritic
M-protein
Hypercellular - neutrophils & MO

Histology shows sub-EPIthelial HUMPS and low serum C3.

Granular “starry sky” !gG & C3 deposits

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17
Q

Nephritic syndrome w/ CRESCENTS w/ FIBRIN + MO. Collaped glomerular tufts, severe oliguria

A

Rapidly progressing GN

Goodpasture
Diffuse proliferative
Wegeners
Microscopic polyangiitis
Churg-Strauss
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18
Q

Young male presents with hematuria and hemoptysis. Anti-GBM Abs, proteinuria

A

Goodpasture

  • LINEAR
  • Kidney + lung hemorrhage
  • Crescent formation (RPGN)
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19
Q

Diffuse proliferative

A

Nephritic
GRANULAR
Sub-ENDOthelial
MOST COMMON SLE renal disease

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20
Q

Persistent sinusitis does not resolve w/ antibiotics. Hematuria, hemoptysis, HTN, high Cr, Abs against neutrophils and monocytes. Non-caseating granuloma and focal cresentric or RPGN

A

Wegener’s

  • c-ANCA (cytoplasmic antineutrophil cytoplasmic antibody)
  • SINUSITIS, No asthma or eosinophils

Polyangitis is similar but w/o granuloma

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21
Q

Polyangiitis vs. Churg Strauss

A 
Nephritic
NO IF (pauci-immune)

Churg

  • ASTHMA
  • Granulomatous
  • eosinophilia
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22
Q

NO FEVER
Frequency, urgency, suprapubic pain

> 10WBC
+ Leukocyte esterase
+ Nitrates
+ culture >100,000

A

1 = E. coli

Cystitis

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23
Q

> 10WBC
+ Leukocyte esterase
- culture ***

A

Sterile pyuria

chlamydia or gonorrhoeae

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24
Q 
FEVER
Flank pain
WBC casts*
Neutrophils
Pyuria*
A

1 = E. coli

Acute Pyelonephritis

—> Pre-mature labor

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25
WBC casts
Pyelonephritis, transplant rejection
26
Waxy casts
Chronic pyelonephritis, CRF
27
Thyroidization of the kidney
Chronic pyelonephritis
28
Chronic pyelonephritis
Fibrosis + atrophy from recurrent pyelonephritis --> scarring, blunted calyces Kids - VUR Adults - obstruction Thyroidization (eosinophilic protein) Waxy casts
29
Calcium stones
Idiopathic hypercalciuria - normal serum Ca Anything that inc serum Ca - PTH, cancer CD Tx = HTCZ = reabs Ca so its not in urine
30
Mg stones
Urease + bacteria - PV - Kleb Alkaline urine STAGHORN calculi in ADULTS (vs. cysteine) Tx = Acidify urine or surgical removal
31
Uric acid stones
RADIOLUCENT GOUT, Leukemia Tx = alkalinize urine w/ potassium bicarb allopurinol Acetazolamide
32
Cysteine stones
Staghorn calculi in KIDS | Defect in cysteine reabs - cysteinuria
33
Chronic RF
``` DM HTN Glomerular disease Dec EPO --> anemia Dec Vit D & PO4- --> hypoCa Renal osteodystrophy - 2 HPTH, osteomalacia, osteoporosis ``` Dialysis --> cysts, SHRUNKEN, RENAL CELL CARCINOMA
34
Renal mass composed of fat, smooth muscle and blood vessels (Angiomyolipoma) is assoc w/?
Tuberous sclerosis - 80-90% w/ B/L - cortical tubers & subependymal hamartomas - seizures, MR, rhabdomyomas, facial angiofibromas - "ash-leaf" patches of hypopigmentation
35
60 y/o male smoker w/ painless hematuria, flank pain and palpable mass in RUQ, weight loss
Renal Cell Carcinoma PARANEOPLASTIC - EPO, PTHrP, ACTH Left renal vein block --> left varicocele Hereditary = von Hippel-Lindau *Loss of VHL 3p* Sporadic - single - upper pole - smoking*** Clear-cell = lipid & glycogen accumulation
36
Most common malignant renal tumor in kids
Wilms Tumor - Blastema - WT1 mutation on chr 11p - WAGR syndrome - Beckwith-Wiedemann syndrome
37
WAGR syndrome
Wilms tumor Aniridia Genital abnormalities Motor/mental retardation
38
Beckwith-Wiedemann syndrome
Wilms tumor Neonatal hypoglycemia Muscular hemihypertrophy Organomegaly (tongue)
39
Urothelial/transition cell carcinoma
"P-SAC" - Phenacetin - SMOKERS - AZO dyes - Cyclophosphamide Flat - high grade - early p53 mutation Papillary - low grade --> high, no p53 mutation
40
Squamous cell carcinoma
Squamous cell metaplasia 1. Chronic cystitis (old woman) 2. S. haematobium (Egyptian male) 3. Nephrolithiasis
41
Adenocarcinoma
1. URACHAL REMNANT - DOME of bladder 2. Cystitis glandularis 3. Exstrophy
42
Asian or Hispanic w/ cough, pulmonary infiltrates, runny nose about 2 wks prior, presents w/ intermittent hematuria, proteinuria
``` IgA nephropathy (Berger Disease) Mesangial IgA deposits, widening but NOT hypercellular ``` Flares w/ URI or gastroenteritis If it's in kids w/ palpable purpura = Henoch-Scholein
43
Teenage male presents w/ red casts proteinuria, difficulty hearing, and seeing
Alport syndrome X-linked, nerve deafness + lens dislocation/cataracts
44
Basket-weave GBM
Alport syndrome
45
How does urine pH affect solute reabsorption?
pH opposite the substance ionizes it --> can't be reabs = EXCRETED
46
60-40-20 rule
60 = TBW - D2O, pyrene 40 = ICF - (TBW - ECF) 20 = ECF - Inulin "TIE"
47
Plasma volume % of TBW
1/4 of ECF = 1/12 TBW | - measured w/ Evan's blue, radiolabeled albumin
48
Interstitial % of TBW
3/4 of ECF = 1/4 TBW
49
Nephrotic syndrome
Charge barrie is lost (heparan GBM) --> albuminuria, edema, hyperlipidemia
50
Renal Clearance
C = [urine] x urine flow rate / [plasma] C > GFR = secretion
51
GFR
Inulin GFR = [urine inulin] x urine flow rate / [plasma inulin]
52
ERPF
PAH is both filtered and secreted ERPF = [urine PAH] x urine flow rate / [plasma PAH]
53
RBF
RPF / (1 - Hct) {[urine PAH] x urine flow rate / [plasma PAH]} / (1 - Hct)
54
Filtration fraction
GFR / RPF Normal = 20%
55
NSAID / afferent arteriole constriction on FF
NO CHANGE d/t dec in GFR | Can --> acute renal failure
56
ACE-I / efferent arteriole dilation on FF
Dec FF --> dec hyperfiltration in diabetics to dec nephropathy AGII constricts to preserve RBF/GFR/renal fxn and inc FF
57
Inc plasma protein or constriction of ureter on FF
Dec FF
58
Hartnup disease
Deficiency of NEUTRAL A/A transporter (tryptophan) --> pellagra
59
PCT
Na/Glucose Na/Phos - inhibited by PTH Na/H - Inc by ATII CA - inhibited by acetazolamide
60
Concentrating segment
Thin descending loop Highest [urine] = CD
61
Thick ascending
NKCC - inhibited by loops | Indirect Mg, Ca reabs
62
Diluting segment
DCT
63
DCT
NaCl reabs - inhibited by thiazides - Inc by ATII Ca/Na exchange - inc by PTH Diluting segment
64
CD
Na exchange w/ K (Principal cells) - inc by aldosterone - inhibited by K+ sparing ADH - V2 receptors to inc AQ channels in medullary CD (Principal cell) - reabs H2O and urea - V1 --> vasoconstriction & inc PG
65
Isoosmotic expansion/contraction
NaCl | Diarrhea
66
Hyperosmotic volume contraction
Sweating, fever, DI
67
Hypoosmotic volume expansion/contraction
SIADH | Adrenal Insufficiency
68
ANP
Na & volume loss - PCT
69
PTH
Dec phos - PCT | Inc Ca - Thick ascending
70
Aldosterone
Inc Na reabs - CD | Inc K, H+ loss - CD
71
Causes hypoK
Shifts INTO cell - Insulin - B-agonist - Alkalosis - Hypo-osmolarity
72
Resp Acidosis/Alkalosis
pH & PCO2 = OPPOSITE Acidosis - high PCO2, HCO3 Alkalosis - Low PCO2, HCO3
73
Metabolic Acidosis/Alkalosis
Acidosis = all down - hyperventilation Alkalosis = all up - hypoventilation
74
Anion gap metabolic acidosis
``` MUDPILES M - methanol (formic acid) U - Uremia D - DKA P - Paraldehyde, phenformin I - Iron or INH L - Lactic acidosis E - Ethylene glycol (oxalic acid) S - Salicylates ```
75
Metabolic alkalosis
Diuretics Vomiting Antacid Hyperaldosteronism
76
Pt had infection treated with antibiotics and NSAIDs and now presents with fever, arthralgias and a rash that comes and goes
Acute Interstitial nephritis | - eosinophils in urine
77
Shrunken kidney with parenchymal fibrosis, localized to the medullary collecting ducts
Medullary cystic kidney disease | - Marfans, Ehlers-Danlos, Caroli's
78
Eosinophils in urine
Acute interstitial nephritis | - NSAIDs, beta-lactams, diuretics, anti-convulsants
79
Nephrotic Syndrome
Proteinuria >3.5 Pitting edema Hypogammaglobulinemia - Infections Hypercoagulable - loss of AT-III * **Lipiduria - Fatty casts*** - hyperlipid/cholesterolemia
80
Minimal change assoc w/?
Hogdkin lymphoma
81
GN assoc w/ sickle cell and HIV
FSGS
82
Sub-epithelial spike & dome
Membranous
83
Track-Track
Membranoproliferative
84
Sub-endothelial
MPGN - I = HBV, HCV (more tram tracks)
85
Intramembranous deposits
MPGN - II = C3 nephritic factor, low C3
86
Sclerosis of mesanigum = Kimmelsteil-wlison nodules
Diabetic
87
What slows the progression of diabetic nephropathy?
ACE-I = dilates efferent
88
Sub-epithelial humps & low serum C3
Post-strep
89
Causes of renal papillary necrosis
Chronic analgesic use DM Sickle cell Severe acute pyeonephritis
90
Loop diuretics
Furosemide Inhibits NKCC in TAL Stimulate PG release --> inc RBF, GFR SE = "OH DANG" - oto, hypoK, dehydration, allergy, nephritis, gout
91
(+) Hale's colloidal iron stain
Chromophobe RCC
92
Acetazolamide
CA inhibitor in PCT Use = glaucoma, mountain sickness SE = acidosis, sulfa, stones
93
Thiazides
Inhibits NaCl in DCT Use = HTN, NDI SE = HyperGLUC Sulfa
94
K-sparing diuretics
Spironolactone = blocks aldosterone receptor in CD Triamterene, Amiloride = block Na in CD Use = CHF, hyperaldosterone, low K
95
ACE-I
Use = HTN, CHF, DM - prevents heart remodeling by aldosterone SE = dec GFR, FF
96
Type I RTA
Can't secrete H+ in CD --> Ca stones | Hyperchloremic, non-anion gap acidosis
97
Type II RTA
Cant reabsorb HCO3- in PCT - multiple myeloma,amyloidosis - Hyperchloremic, non-anion gap acidosis
98
Type IV RTA
Most common | Aldosterone deficiency

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