Renal and Urinary Flashcards
(140 cards)
1
Q
Laboratory Findings of [Post Strep GN] / [Post infectious GN] (4)
A
- INC ASO (Anti-Streptolysin)
- INC [Anti-DNase B]
- [DEC C3 and total compliment]
- Cryoglobulins
2
Q
Name the greatest risk factor for [Catheter Associated UTI]
A
REMOVE CATHETER AS SOON AS IT IS NOT INDICATED ANYMORE
(DURATION IS THE GREATEST RISK)
3
Q
Most common cause of nephrOtic syndrome in Children and its Tx
A
A: Minimal Change Dz
B: REVERSIBLE with Corticosteroids
4
Q
What is almost always associated with Acute Pyelonephritis? (2)
A
[VUR -Vesicoureteral Reflux] (Anatomical vs. Functional) and [WBC Cast]
5
Q
Diabetic Autonomic Neuropathy
A: Clinical Presentation (2)
B: Dx method
C: What’s the earliest sign/detection method for Diabetic Nephropathy
D: Diabetic Nephropathy is the leading cause of _____
A
A: [Overflow incontinence 2° to inability to sense full bladder] and [incomplete emptying when voiding]
B: [PVR-PostVoid Residual] testing with US vs. Catheter to confirm [incomplete emptying when voiding]
C: [INC Albuminuria ( urine will be)]
D: [ESRD Chronic Kidney Dz]
6
Q
How does Multiple Sclerosis affect the Bladder?
A
[Loss of CNS inhibition on [Bladder Detrusor Contraction] allows bladder to always stay contracted –> Urge Incontinence–>eventually progresses [Bladder Atony and Dilation] –> Overflow Incontinence
7
Q
A: Most common cause of [Nephrolithiasis/Kidney Stones]
B: Most common Risk Factor
C: Other Risk Factors (3)
A
A: Idiopathic Hypercalciuria = [Normocalcemia + Hypercalcuria]
B: Hypercalcuria
C:
- [Crohn Dz / Fat Malabsorption / Spinach]–> HyperOxaluria
- [Distal RTA Type 1] –> hypOcitraturia
- Gout –> Hyperuricosuria
* Pts are Normocalcemic due to intact serum regulations by Vitamin D and PTH*
8
Q
Benign Prostatic Hyperplasia
Clinical Manifestation (3)
A
- [Intermittent Bladder Outlet Obstruction]–>Urinary Retention –> Reflux Nephropathy
- Overflow Incontinence
- Later: Hydronephrosis–>[Renal Interstitial atrophy] –> Chronic Renal Failure
9
Q
A: How do you Calculate Anion Gap
B: What is the normal Anion Gap
C: Name the Etiologies for [INC Anion Gap Acidosis] (9)
A
A: Never Carry Hotsauce: [Na+ - (Cl + HCO3)]
B: [10 - 12]
C: “The MUDPILES INC our Gap”
Methanol
Uremia
DKA (Tx= IV normal saline + Insulin)
Paraldehyde
[Isonizid vs. Iron]
Lactic Acid
Ethylene Glycol
Salicylates
10
Q
DKA- Diabetic KetoAcidosis
A: Tx (3)
C: What type of Anion Gap Acidosis does this cause
D: Why is the pH of the Urine acidic during DKA
A
A: [IV Normal Saline + Insulin + K+]
C: [INC Anion Gap Acidosis] (MUDPILES)
D: INC production of NH4 & H2PO4
11
Q
A: Which Renal Structure is subject to Injury from Pelvic Surgery and why?
B: Clinical manifestation (3)
A
A: Ureters can become unintentially ligated during [Pelvic surgery] –> Obstruction–> [Hydronephrosis w/Flank pain]
B:
- [Flank pain radiating to groin (from ureter and renal pelvis distension]
- [Flank Mass developing within weeks of pelvic surgery]
- [Normal Urine output & Serum creatinine (contralateral kidney compensates)]
12
Q
[Post Strep Glomerulonephritis / Post infectious GN]
A: Clinical Presentation (5)
B: Which Kidney is most affectred from PSGN
A
A: [Older Child/Young Adult] with [Edema / Hematuria (Cola Colored Urine) / ProteinUria] few weeks after [Impetigo vs. pharyngeal infection]
B: Affects BOTH Kidneys (enlarged and swollen)
13
Q
[Pauci Immune ANCA-associated RPGN]
Histology (3)
A
Is a type 2 Hypersensitivity
1) Absence of Ig and C3 deposit
2) Crescent formation
3) Focal Necrosis
14
Q
Acute Tubular Necrosis
A: Clinical Course (3 Phases)
B: Outcomes (2)
A
A:
- Initiation phase =36 hour period = slight DEC in urine output from ischemic/toxic injury
- Maintenance Phase= 1-2 week period= Tubular damage is established –> [Oliguria/Fluid overload/Electrolyte abnormalitities]
- Recovery Phase= [Tubular Re-epithelization] which clears cast –> Transient polyuria and [loss of electrolytes from still impaired tube reabsorption]
B: ([[Renal Function imprvmnt]) vs. [Foci of interstitial scaring –> permanent renal impairment (rare)]
15
Q
NephrOtic Syndrome
A: Classic Presentation (5)
B: COMMON Renal Complication from this. What are the sx (3)
A
A: CLag + [Proteinuria > 3.5 gm/day–>FOamy Urine] =
[INC Coagulability from loss of AT3]
[INC Lipidemia]
[DEC alubuminemia] –> Edema
[DEC gammaglobinemia]
B: Renal Vein Thrombosis –>
- Acute Flank Pain
- Hematuria
- [LEFT Varicocele]
16
Q
A: Describe Histology for Hyaline Arteriolosclerosis
B: Causes (2)
A
A: [Homogenous deposition of eosinophilic hyaline in intima and media of small vessels]
B:
1) Benign HTN
2) [Diabetic Autonomic NephrOpathy:–> will also have [Kimmelsteil Wilson Nodules from Mesangial Sclerosis]
17
Q
Where in the Renal Tubule is PAH secreted into?
A
PCT (but also some PAH is freely filtered by Glomerulus)
so PAH concentration is lowest in Bowman’s Capsule
18
Q
Describe Tubular Solute Concentrations for Creatinine along the renal tubule (PCT –> Loop–>DCT –> CD)
A
Basically the same path as [Inulin & Mannitol]
19
Q
Describe Tubular Solute Concentrations for [Innulin & Mannitol] along the renal tubule (PCT –> Loop–>DCT –> CD)
A
Basically the same path as Creatinine
20
Q
FORMULA for:
A: RPF: Renal plasma Flow
B: RBF: Renal Blood Flow. - Also Define RBF
C: Filtration Fraction
A
A: rpf = PAH Clearance =UV / P
B: RBloodF = [rpf ÷ (1 - Hct)] = volume of blood flowing thorugh kidneys per unit time
C: [Filtration Fraction] = [GFR ÷ rpf]
21
Q
A: Demographic for Renal Artery Stenosis (2)
B: Manifestations (3)
A
A:
- Elderly
- [Pregnant Women 2º to fibromuscular Dysplasia]
B:
- Unilateral Kidney Atrophy
- HTN
- Abd Bruit
- R Kidney Atrophy from RAS in image*
22
Q
Promoters of Nephrolithiasis (8)
A
IM COUGHS
- Injury
- [Mg+ –> Struvite Stones]
- Calcinuria**
- Oxalate INC**
- [Uric Acid INC in urine (Tumor lysis syndrome vs. Gout)
- Gravity
- Hydrogen ions
- Sodium
23
Q
A: INHIBITORS of Nephrolithiasis (2)
B: Once a pt develops Nephrolithiasis, what are the tx (4)
A
- CITRATE (found in Fruits & Veggies) + Hydration
- INC Urine Flow
B:
- Tamsulosin
- NSAIDs
- [INC Fluid Intake to 2-3 L/day]
- Proximal Ureter location –> Surgery
24
Q
A: Describe Histology for [Multiple Myeloma Nephropathy]
B: Demographic
C: Other common sx with this presentation (3)
A
A: [Large Eosinophilic light chain cast] made of [Bence Jones proteins] in tubular lumen –> [1º DTiN-DrugTubularInterstitialNephritis]
B: Elderly
25
A: Classic Presentation Triad for [**_Drug Induced_ -DTiN**]
B: What Drugs mostly cause this (3)
C: What *Wt Loss* Drug can cause this?
**ERF** me some **DAN** drugs !
A: [**E**dema & **E**osinophilia], **R**ash, **F**ever
B: **D**iuretics / **A**bx (PCN) / **N**SAIDs
C: [Chinese Herb AristoLochic Acid]
DTiN = Drug Tubular Interstitial nephritis
26
A: *Describe Histology*
B: Dz
A: image
B: [**ATN** - **A**cute **T**ubular **N**ecrosis]
"ERF me some DAN drugs"
27
A: How does [**Bladder** **Urothelial Transitional Carcinoma**] clinically present
B: Risk Factors (5)
C: Describe Histology (2)
A: Gross Hematuria in an elderly Man
B: "aww, :-( your [**P**oor **P**ee **SAC**]"
**P**henacetin/**P**lastics/**S**moking/**A**niline dyes/**C**yclophosphamide]
C: Malignant Epithelial Cells =
\*Papillary structures
\*Nuclear atypica/pleomorphism
28
A: Most common causes of **Acute Tubular Necrosis** (7)
B:Which stage would these things lead to
1. Ischemia (**Sepsis** = MOST COMMON/Hemorrhage/Surgery)
2. Toxic (Aminoglycosides/Lead/Crush injury/Ethylene glycol antifreeze)
B: Initiation Stage (*1st stage*)
29
Describe the _Maintenance Stage_ of [Acute Tubular Necrosis] (3)
* [Oliguria --\> Volume Overload] from tubules not allowing any fluids through
* INC BUN/Creatinine ratio
* **Hyper**kalemia
30
Describe the _Recovery Stage_ of [Acute Tubular Necrosis] (3)
* Polyuria --\> Dilute Urine and [DEC Electrolyte]
* Na+ is spared and actually --\> Hypernatremia
* **hypO**kalemia (too much K+ is kicked out)
31
Clinical Presentation of **Renal** **Papillary Necrosis** (2)
1. Gross Hematuria (passage of small blood clots)
2. Acute Flank pain
32
Classic Presentation for [**R**enal **C**ell **C**arcinoma] (4)
RCC looks like **HAWF**!
[**H**ematuria PAINLESS (most common)] / [**A**bd Yellow Mass] / [**W**t loss] / [**F**lank Pain]
*L RCC in image*
33
A: What conditions can [Untreated Hydronephrosis] lead to (3)
B: Common cause
C: Clinical Presentation (3)
A: HTN, [DEC Renal Function] & Sepsis!
B: Lower Urinary Tract Obstruction
C: **Palpable Kidneys** + LE Edema + Pain
34
A: [Tumor Lysis Syndrome] MOD
B: What parts of the Nephron is involved (2)
C: Tx for [**Uric Acid** Nephrolithiasis] in general (4)
A: High cell turnover from tumors --\> INC [K+ / Phosphorous / Uric Acid] in serum. [Uric Acid] **precipitates** in Kidneys 2° to [_Acidity_ within normal urine]
B: DCT and CD (are where Uric Acid crystallizes)
C:
- Urine Alkalinization (use NaHCO3 vs. [K+ citrate])
- Hydration
- Allopurinol (if gout)
- [low purine diet (EtOH vs. seafood)]
35
A: c-ANCA Hypersensitivity targets what antigen
B: Dz
C: What type of Hypersensitivitiy is this
D: Clinical Presentation (3)
A: [Positive **c-ANCA** in **vasculature**] = Ab against [Lysosomal PR3 of neutrophil/monocytes]
B: [Wegener's Granulomatosis + Polyangiitis] (*Type 3 _Crescenteric_ RPGN*)
C: Type 2
D: [**ELK** = **E**NT (Destructive Sinusitis & Hemoptysis) / **L**iver / **K**idney(*Type 3 _Crescenteric_ RPGN*)]
36
Clinical Presentation of [**BrIAN**-**B**e**r**ger's **I**g**A** **N**ephropathy] (4)
## Footnote
[**H**enoch **S**choenlein **P**urpura]
**H**inge problems = Joint Arthritis
**S**tomach problems = NV + bloody diarrhea
**P**alpable Purpura (Butt, Legs, Feet) + [**P**ee with blood]
*Mesangial IgA-C3 immune complex deposition*
37
How can **Infective Endocarditis** affect Kidneys
[**Immune Complex deposition**] in kidneys --\> Glomerulonephritis]
## Footnote
*Think [SubEpithelial humps from IC deposition in PSGN]*
38
A: What *Kidney Stone* is in image?
B: What urine pH does it precipitate in?
C: Causes (4)
A: [Calcium Oxalate / Phosphate]
B: [Oxalate \< 7] but [Phosphate \>7]
C: [Ethylene Glycol (Antifreeze)] / Excess VitC / Crohn Disease / poor hydration
39
A: What *Kidney Stone* is in image?
B: What urine pH does it precipitate in?
C: Causes
A: [**MAPS- M**g+ **A**mmonium **P**hosphate ***S**truvite*]
B: **MORE THAN** 7 pH
C: Urease + Organisms
40
A: What *Kidney Stone* is in image?
B: What urine pH does it precipitate in?
C: Causes
A: [**U**ric Acid] is RadioL**U**cent
B: [**less than** 7 pH] *"Uric Acid likes Acid"*
C: High Cell turnover (Leukemia)
41
A: What *Kidney Stone* is in image?
B: What urine pH does it precipitate in?
C:Cause
A: Cystine
B: **less than** 7 pH
C: auto recessive [Cysteine ReAbsorb transporter defect] in PCT--\>Staghorn Calculi
42
A: Dz in image
B: Composition (3)
A: **Clear Cell Carcinoma** (*type of RCC*)
B: [**Clear Cytoplasm**] / Large cells that are [Round vs. Polygonal cells]
43
A: What parts of the nephron are most affected by [**ATN**-***A**cute **T**ubular **N**ecrosis*] (2)
B: Lab finding for **ATN**??
A:PCT & [**thick aLOH**]
B: Muddy Brown Cast!
44
A: What is Conn's Syndrome
B: Tx
A: [Primary **Hyper**aldosteronism] 2° to Adenoma
B: Aldosterone Blockers (Spironolactone / Eplerenone)
45
Which **BP medication** is used in pts with [Diabetic Nephropathy]? (2)
[ACEK2 inhibitors] vs. ARBS
46
A: In pts with **Renal Artery Stenosis**, what renal factor do they become *Dependent* on for appropriate GFR
B: What drugs are Contraindicated in these pts (2)
A: [Angiotensin 2 _efferent_ vasoconstriction]
B: [ACEk2 inhibitors] vs. ARBS
*Same rule applies for CHF vs. hypOvolemic vs. [Chronic Renal Dz] pts*
47
Which **Anti-Virals** cause [crystalline neprhopathy] if adequate hydration is not given? (3)
"**F**end **V**iruses with **A**gua"
1. **F**amciclovir
2. **V**alocyclovir
3. **A**cyclovir
48
A: What 3 things does **ADH** do? What receptors are used for this?
B: How does this affect medullary osmotic gradient??
USES [Distal Collecting Duct **V2 Receptor**] to..
1. INC Water Reabsorption
2. INC Urea Reabsorption --\> **INC [medullary osmotic gradient] --\> production of maximally concentrated urine!**
3. Use **V1 Receptors** to Vasoconstrict
49
Excretion Rate formula
UV (Urine concentration x Urine flow)
50
A: Symptoms of DKA (3)
B: What type of metabolic acidosis would this cause
"Too Many **FUDGE** bars --\> DKA!"
## Footnote
1. Poly**U**ria --\>POTENTIAL WT LOSS from urinating out water weight
2. Poly**D**ipsia
3. [**F**ruity odor in breath vs. urine from acetone]
4. **G**lasses foggy (Intermittent blurry vision)
5. **E**ats a lot (polyphagia)
B: Anion Gap metabolic Acidosis
51
List the *Main* Reabsorption rates for ions in the:
**Early PCT** (6)
- **MOST OF WATER REABSORPTION** (done passively with solute ReAbsorption)
- 98% of **Glucose** ReAbsorption
- 85% of **HCO3** ReAbsorption
- 70% of **Phosphate** ReAbsorption
- 67% of **Na+** ReAbsorption
- 67% of **K+** ReAbsorption
52
List the *Main* Reabsorption rates for ions in the:
**Late PCT**
- 60% of **Ca+** ReAbsorption (mostly by PTH)
53
List the *Main* Reabsorption rates for ions in the:
**thin descending LOH**
- 15% of **WATER** ReAbsorption
54
List the *Main* Reabsorption rates for ions in the:
**THICK aLOH** (4)
- 25% of **Na+** ReAbsorption
- 20% of **K+** ReAbsorption
- Trace **Mg+** (driven by positive lumen potential)
- Trace **Ca+** (driven by positive lumen potential AND PTH)
55
List the *Main* Reabsorption rates for ions in the:
**Early **_D_**CT**
- 5% of **Na+** ReAbsorption
56
List the *Main* Reabsorption rates for ions in the:
**[Late **_D_**CT** & **Cortical CD****]**
- 3% of **Na+** ReAbsorption
57
List the *Main* Reabsorption rates for ions in the:
**Distal (Medullary) CD** (3)
- 17% of **WATER** ReAbsorption
- 3% of **Na+** ReAbsorption
- 110% of **K+** SECRETION
58
Describe the relationship between **GFR** and **Serum Creatinine**
Every time GFR halves...[Serum Creatinine] doubles
59
Common Bacteria that cause **Cystitis** (6)
- *E.Coli* (MOST COMMON!!!)
- *Klebsiella*
- Enterobacter
- Staph
- Saprophyticus (Young Women)
- Proteus Mirabilis (Alkaline urine + Ammonia scent)
60
Common Bacteria that cause **Pyelonephritis** (4)
- *E.Coli* (MOST COMMON!!!)
- *Klebsiella*
- Enterococcus Faecalis
- Pseudomonas Aeruginosa (indwelling bladder catheters)
61
Which Bacteria causes **Pyelonephritis** in pts with [Indwelling Bladder Catheters]?
Pseudomonas
62
A: SE of **Amphotericin B** (2)
B: Mechanism of SE
A:
- hypOkalemia --\> weakness and arrhythmias (T wave flattening)
- hypOmagnesemia
B: INC DCT permeability (from damage) allows K+ and Mg+ to escape into urine
63
Describe Histology for [**P**ost **S**trep **GN**] / [**P**ost **i**nfectious **G****N**] (3)
1. Hypercellular Inflammed Glomerulus w/RBC Cast
2. [**Lumpy Bumpy** IgG and C3 granular deposits on IF]
3. [Subepithelial **HUMPS** on EM]
64
**Renal Clearcell Carcinoma** MOD (3)
RCC (3 letters) =
1. [Chromo 3 VHL hypermethylation]--\>[INC IGF1 & HIF tx factor] --\> [INC VEGF & PDGF]
* VHL = Tumor Suppressor Gene*
2. Sporadic = upper pole = smokers
3. Hereditary = Bilateral = AUTO DOM
65
A: Clinical Manifestation of this [Renal Clearcell Carcinoma] (4)
B: Where does RCC **spread to**? (3)
C: Where did this Dz **originate from**?
**Clear Cell Carcinoma** (*type of RCC*)
## Footnote
A: RCC was **HAWF**! = [**H**ematuria / **A**bd Yellow Mass / **W**t loss / **F**lank pain]
B: Lung, Bone, [Retroperitoneal lymph nodes]
C: PCT of Kidney
66
A: Most common cause of [Unilateral Fetal Hydronephrosis]
B: What typically causes *NON-Obstructive* Fetal Hydronephrosis
A: Inadequate canalization of **Ureteropelvic Junction**
B: Vesicoureteral Reflux (incomplete closure of vesicoureteral junction during detrusor contraction)
67
Is the Bladder *Extra*Peritoneal or *Intra*Peritoneal?
Bladder is ***Extra***Peritoneal (outside of the Peritoneum)
68
A: What perfuses [**Proximal** Ureter]
B: What perfuses [**Distal** Ureter]
A: Renal A.
B: [SUP Vesical A.]
*Middle Ureter is perfused variably*
69
From a Posterior view: where is the:
A: Kidney
B: Spleen
C: Liver
D: Pancreas
A: Deep to 12th rib
B: [L abd cavity - in front of (L 9th - 11th ribs)]
C: [RUQ - in front of (R 8th-11th) ribs]
D: Mostly retroperitoneal: Overlies 2nd lumbar Vertebra
70
Crushing Abd trauma is most likely to injur which organ?
Pancreas
71
Transplant Rejection: **Hyperacute**
A: Onset Time
B: Etiology
A: Minutes - Hours
B: **Preformed** Ab attack graft
72
Transplant Rejection: **Acute**
A: Onset Time
B: Etiology
A: Days
B: Exposure to Donor Antigens --\> **Naive** Recepient Humoral & Cell-mediated attack
73
Transplant Rejection: **Chronic**
A: Onset Time
B: Etiology
A: Months - Years
B: continued low-grade immune response, **refractory to immunosuppressants :-(**
74
Transplant Rejection: **Hyperacute**
Histology (3)
1. Gross mottling
2. Cyanosis
3. [Arterial Fibrinoid Necrosis + Capillary occlusion]
75
Transplant Rejection: **Acute**
*Humoral* Histology (3)
* C4d deposition
* **Neutrophilic** infiltrate
* Necrotizing Vasculitis
76
Transplant Rejection: **Acute**
*Cellular* Histology (2)
* **Lymphocytic** interstitial infiltrate
* Endotheliits
77
Transplant Rejection: **Chronic**
Histology (4)
1. Vascular Wall thickening
2. Luminal narrowing
3. Obliterative Intersitital Fibrosis
4. Parenchyma Atrophy
78
Lithium SE (4)
L**MNOP**
## Footnote
Lithium SE:
**M**ovement / Tremor
**N**ephrogenic Diabetes Insipidus (blocks ADH)
hyp**O**thyroidism
[**P**regnancy teratogenic - Epstein anomaly]
79
[Sirolimus Rapamycin] MOA
[**Si**rolimus **R**apamycin]
Forms complex with [FK506 Binding Protein] --\> inhibits mTO**R** --\> **BLOCKS [IL2 signal]** --\> Prevents lymphocyte growth/proliferation
80
[Sirolimus Rapamycin] Indication (2)
[**Si**rolimus **R**apamycin]
## Footnote
1. **S**irvival of Kidney when [nephrotoxic cyclospoRine] is given
2. **R**enal transplant px
81
Mycophenolate MOA
[Reversibly inhibits nucleotide synthesis], required for lymphocyte proliferation --\> [promotes T-cell apoptosis]
82
Leflunomide MOA
[Reversibly inhibits nucleotide synthesis], required for lymphocyte proliferation --\> [promotes T-cell apoptosis]
83
A: CyclospoRine MOA
B: Which organ is harmful to?
**Cyclo**spoRine
A: Forms complex with **Cyclo**philin --\> inhibits Calcineurin --\> [**inhibits IL2 transcription**]
B: Renal toxic (give with [Sirolimus Rapamycin] to lessen nephrotoxicity)
84
CyclospoRine Indications (3)
**P**revents **T**ransplant **R**ejection
1. **P**soriasis
2. **T**ransplant Px
3. **R**heumatoid Arthritis
85
A: What 2 things are pts with [**Antiphospholipid Ab Syndrome**] at risk for
B: This syndrome is mostly associated with \_\_\_\_\_
A: Antiphospholipid Abs --\>
1. [Thromboembolism]
2. [Unexplained AND Recurrent Miscarriages] (placental insufficiency vs. preeclampsia)
B: some **SLE** pts have [Antiphospholipid Ab Syndrome]
86
A: **Fabry Disease** MOD
B: Mode of Inheritance
A: [**lysosomal** (**a-galactosidase A) deficiency**] --\> [sphingolipid accumulation]
B: X-linked Recessive
87
**Fabry Disease** Clinical manifestations (7) - also list onset time
"Fabry is [**N**ever **T**oo **BRASH**]"
1. **S**weating DEC (hypOhidrosis) - early on
2. **N**europathy - early on
3. **A**ngiokeratomas - late adolescence
4. **T**elangiectasias - late adolescence
5. **B**rain (TIA vs. stroke) - mid adult
6. **H**ypertrophied LV - mid adult
7. [**R**enal Failure 2° to Glomerular & DCT accumulation]
88
**Acute Hemolytic Transfusion** MOD
[**Preformed** Anti-ABO IgM] bind to donor RBC --\> [Anaphylatoxin C3a and C5a activation] + [C5b-C9 membrane attack complex] --\> Cy-2-toxicity
## Footnote
*Type 2 Hypersensitivity*
89
**Acute Hemolytic Transfusion**
A: Manifestations (6)
B: What type of Hypersensitivity is this
A: **T**ransfusions **L**eft **H**arry & **B**erry **C**old & **F**uckd!
**T**achycardia
**L**umbar Pain
**H**emoglobinuria (Red/Brown urine)
**B**leeding w/hypOtension
**C**hest Constriction
**F**lu-like Sx
B: Type 2 Hypersensitivity
90
Describe the Composition of Crest in [Cresenteric RPGN] (3)
**FIBRIN** / [Glomerular Parietal Cells] / [Macrophages] -- all in Bowman's Space
## Footnote
*Macrophages pass through gaps into Bowman's Space--\> Macrophages secrete factors that INC fibrin deposition and fibrin deposition--\>[Glomerular Parietal cell proliferation]*
91
[Crescenteric RPGN] MOD for Crest formation
Macrophages pass through **gaps**(from destruction) into Bowman's Space--\> Macrophages secrete factors that INC fibrin deposition and fibrin deposition--\>[Glomerular Parietal cell proliferation]
92
A: Which 2 CA can **IL2** treat?
B: What's the Mechanism (2)
A: [Renal Clearcell Carcinoma] & [Metastatic Melanoma]
B: Activation of [**NK cells**] and [**T-cell Growth**]
93
A: **Potters Sequence** etx
B: Clinical Presentation - 6
A: [Fetal **R**enal Agenesis / Dysfunction] --\> Oligohydraminos (No Amniotic Fluid)
B: **POTTER**
**P**ulm hypOplasia
**O**ligohydraminos
**T**wisted Face
**T**wisted Limbs
[**E**ars set low & **E**xtremities shortened]
**R**enal agenesis = cause
94
**ArPKD** - [**A**utosomal **r**ecessive **P**olycystic **K**idney **D**z] MOD
[Chromo 6 PKD1 gene mutation] --\> Defective Fibrocystin (present in kidney & liver)
95
**ArPKD** - [**A**utosomal **r**ecessive **P**olycystic **K**idney **D**z]
Manifestations (4)
- Bilaterally Enlarged Kidneys with Reniform shape
- [Sponge-like Cross Section]
- Liver Fibrosis
- Saccular Dilitation of CD
96
**ADPKD** - [**A**utosomal **D**ominant **P**olycystic **K**idney **D**z]
Describe the Dz (8)
**ADPKD**
## Footnote
**A**neurysm (Berry) and [**A**dults affected]
**D**oomed [HTN and MVP]
[**P**rOteinuria AND Hematuria]
**K**idney Failure (Early vs. Late onset)
**D**ifferentation problem = etiology
97
Histology for nephrOtic syndrome (2)
[Diffuse [Epithelial Podocyte foot process] effacement **ONLY SEEN ON ELECTRON MICROSCOPY**] *All other imaging is normal!*
98
**nephrOtic** syndrome MOD
Cytokine Hyperproduction **Directly damages** [Epithelial Podocyte foot processes] --\> [Effacement and Fusion]
99
Describe Histology for **Acute** Pyelonephritis (3)
## Footnote
1) Tubular Lumen neutrophils
2) Interstitial neutrophils
3) Microabscesses
100
Clinical Presentation for **Acute** Pyelonephritis (8)
[**DUCS FFLW**]
[*Cysitits Sx:* **D**ysuria + (**U**rinary sx) + (**C**ulture\>100K colonies/Pyruia/+LE&Nitrites) + (**S**uprapubic pain)]
AND
[*Pyelonephritis Sx*: (**F**ever & Malaise) + (**F**lank pain) + **L**eukocytosis + **WBC CAST**]
[Pyruia- x\>10 WBC on hpf in urine} & [Positive Leukocyte Esterase & Nitrites] are seen in BOTH
101
Where does the **majority** of water ReAbsorption occur in the nephron?
PCT!
## Footnote
*occurs passively with ReAbsorption of Solutes*
102
Which artery perfuses Proximal ureter
Renal A.
103
Which artery perfuses Distal ureter
SUP Vesical A.
104
What is the Urachus and how is it related to Dz
Remnant of Allantois that connects bladder with yolk sac during fetal development
Failure of **U**rachus to obliterate --\> **U**rine discharge from the **U**mbilicus
*Normally: Allantois --\> Urachus --\> MediaN umbilical ligament*
105
Which main vessels lie in front and behind the Ureter within the pelvic inlet
In Front of Ureter = *Water Under Bridge* = Uterine a. vs. Vas Deferens
Behind Ureter (in the pelvis) = Internal iliac A.
106
In addition to Water permeability, what other substance does ADH INC permeability to and what part of the nephron?
Urea
_Medullary_ **DCPC**(**D**istal **C**D **P**rincipal **C**ell)
*Aquaporin channels = Cortical Collecting Duct*
107
In Metabolic acidosis, Urine pH DEC because of INC excretion of what 3 compounds?
1. H+
2. NH4+
3. H2PO4
108
[Stress Incontinence] MOD (2)
Loss of pelvic floor support & incompetence of urethral sphincter; Exacerbated w/coughing
109
Name 2 inhibitors of [**Nephrolithiasis**] (2)
Citrate vs. INC Water intake
## Footnote
*Pts are Normocalcemic due to intact serum regulations by Vitamin D and PTH*
110
What 2 chromosomes are associated with ADPKD
* [PKD1 Chromo 16 mutation = most common]
* [PKD1 Chromo 4 mutation]
111
A: Causes of **Renal** **Papillary Necrosis** (9)
B: Out of these, which is the MOST COMMON CAUSE
**POST C**_A_**RDS** for the *Pap*py!
[**P**yelonephritis/**O**bstruction/**S**ickle Cell/**T**B / **C**irrhosis/ [**_A_**nalgesics vs. **A**lcohol] / [**R**enal Vein Thrombosis] / **D**M / **S**ystemic Vasculitis
: **_A_**nalgesics most common!
112
Tx for this Kidney Stone (3)
[Calcium Oxalate / Phosphate]
Citrate vs. Thiazides vs. Hydrate
113
Tx for this Kidney stone (2)
[**U**ric Acid] is RadioL**U**cent
Alkalinize urine vs. Allopurinol
114
Tx for this Kidney Stone (2)
[**MAPS- M**g+ **A**mmonium **P**hosphate ***S**truvite*]
Treat infection AND Surgical removal
115
Tx for this Kidney Stone
Cystine
Alkalinize Urine
116
Classic Presentation for Nephritic Syndrome (3)
1. [Hematuriiia w/some proteinuria]
2. [Periorbital Edema & HTN from Na+ retention]
3. RBC Cast
## Footnote
Caused by Hypercellular finlammed Glomeruli
117
Nephritic Syndrome MOD
**Immune complex deposition** activates C5a --\> recruits neutrophils--\> Hypercellular inflammed Glomeruli
118
Immunofluorescence pattern for [GoodPasture Type 1 Crescenteric RPGN] (2)
and clinical presentation (2)
Linear (anti-Basement membrane Ab) + Sieve effect;
**G**ood**P**asture
**G**lomerulus damage--\>Hematuria
**P**ulmonary damage--\> Hemoptysis
119
Immunofluorescence pattern for [**PSGN**-**PiG**] and [Diffuse Proliferative GN]
## Footnote
*[Type 2 Crescenteric RPGN]*
Granular (Immune complex deposition)
120
What's the most common renal dz in SLE
[Diffuse Proliferative GN] - Type 2 Crescenteric RPGN
## Footnote
*SLE pts may also have membranous nephropathy*
121
Which type of [Crescenteric RPGN] has NO immunofluorescence pattern?
Pauci-immune (microscopic polyangiitis vs. Wegener vs. ChurgStrauss)
122
A: Clinical Presentation for [Microscopic Polyangiitis Type 3 Crescenteric RPGN] (2)
B: MOD
A: Hemoptysis + [Vasculitis with **NO** granulomas or asthma]
B: **p**-ANCA attacks [Neutrophil MPO]
123
A: Clinical Presentation for [Churg Strauss Type 3 Crescenteric RPGN] (3)
B: MOD
"**PAGE** Churg Strauss! "
A: **p**-ANCA / **A**sthma / **G**ranulomas / **E**osinophilia
B: **p**-ANCA attacks [Neutrophil MPO]
124
Tx for [Type 3 Crescenteric RPGN] (2)
Cyclophosphamide vs. Steroids
125
What's the most common nephropathy worldwide?
[**B**r**IAN** - **B**erger **I**g**A** **N**ephropathy]
126
A: Clinical Presentation for [**AXS- A**lport **X**-linked **S**yndrome] (3)
B: MOD
A:
1. Hearing Loss
2. Hazy view (ocular disturbances)
3. Hematuria
B: [Type 4 Collagen thinning & splitting of Basement membrane]
127
How can you differentiate Cystitis vs. Urethritis
Urethritis does NOT have [Culture \>100K] = Sterile Pyuria
128
Which Kidney cells produce EPO
[Peritubular interstitial cells]
129
Why are ESRD pts closely monitored during Dialysis
Cyst develop within **shrunken** ESRD Kidneys during dialysis --\> [Renal Cell Carcinoma]!
130
Scarring of the kidney upper and lower poles usually describes \_\_\_\_\_
VUR - Vesicoureteral Reflux
131
Histology for Chronic Pyelonephritis (3)
1. Atrophic tubules containing eosinophilic proteinaceous thyroidization (*shown in image*)
2. Waxy Cast
3. Cortical scarring with blunted calyces (if at upper and lower poles only = VUR etiology)
132
What type of Paraneoplastic characteristics does [Renal Clearcell carcinoma] have? (2)
can secrete PTHrP or ACTH!
133
Clinical Presentation of a Malignant kidney tumor made of Blastema. What's the cause
Wilms Tumor = **WAGR**
**W**ilms tumor (unilateral flank mass w/hematuria & HTN from renin)
**A**niridia
**G**enital abnormalities
**R**etardation
Caused by [Chromo 11 WT1 tumor suppressor gene deletion]
134
Describe [Denys Drash Syndrome] (3)
Wilms tumor + [progressive glomerular dz] + [male pseudohermaphroditism]
135
What are the 2 pathways for [**BUTC** - Bladder Urothelial Transitional Carcinoma] and which is associated with early p53 mutation
1. **Flat** = early p53 mutation --\> Immediately High grade
2. **Papillary**= starts as low grade --\>progresses to High grade
136
Which Bladder CA arises from Urachal remnant and develops at the ___ of the bladder?
[Bladder **ADC**] arises from Urachal remnant --\> develops at **DOME** of bladder
## Footnote
*Also can come from exstrophy*
137
Which Bladder CA is associated with Middle Eastern man, Schistosoma Haemotobium and Chronic Cysitis?
Bladder **SQC**
Urothelial cells undergo metaplasia --\> Squamous due to Chronic cystitis--\>dysplasia --\> SQC
138
Common characteristics for Nephriiitic Syndrome (4)
**HARP**
[**H**ypercellular inflammed Glomeruli w/Hematuria]
**A**zotemia COB
**R**BC Cast
[**P**eriorbital Edema + HTN]
139
Classic signs of Uremia-4
* Pericardial Rub
* Lethargy
* Pruritus
* Nausea
140
What is normal Creatinine Clearance for Men vs Women
Men = 97-137
Women = 88-128
