renal casts + stones + cysts + tumors + failure

Question 1

cylindrical structure that forms in distal convoluted tubule + collecting duct

Answer 1

renal cast (cellular + acellular casts)

Question 2

RBC casts

Answer 2

glomerular damage: glomerulonephritis
ischemia/infarction of kidney
malignant HTN: end-organ kidney damage

Question 3

WBC casts

Answer 3

acute pyelonephritis

Question 4

bacterial casts

Answer 4

pyelonephritis

Question 5

epithelial cell casts

Answer 5

acute tubular necrosis

toxic ingestion: mercury, DEG, salicylates

Question 6

waxy casts

Answer 6

chronic renal failure

low urine flow

Question 7

hyaline casts

Answer 7

most common type
substance secreted from tubular epithelial cells
concentrated urine (dehydrated person)

Question 8

fatty casts “oval fat bodies”

Answer 8

nephrotic syndrome

Question 9

granular casts “muddy brown”

Answer 9

chronic renal disease

Question 10

yellow, brown in color

cylindrical

Answer 10

RBC cast = pathology in kidney (vs RBCs = pathology anywhere in urinary tract)

Question 11

pyuria

no casts

Answer 11

acute cystitis

Question 12

hematuria

no casts

Answer 12

bladder cancer

kidney stones

Question 13

complications of obstruction of stone in ureter/ureterovesicular junction → black flow of urine into glomerulus

Answer 13

hydronephrosis: expansion of pelvis of kidney
pyelonephritis
chronic renal failure, if untreated

Question 14

most common type of renal stone

Answer 14

calcium stone

Question 15

radiopaque (see on xray)
calcium oxalate +/- calcium phosphate
associated with hypercalciuria

Answer 15

calcium stone

Question 16

causes of hypercalciuria

Answer 16

hypercalcemia: cancer, ↑ PTH

Question 17

causes of calcium oxolate stones

Answer 17

ethylene glycol (antifreenze) ingestion
vitamin C abuse (>2000 mg/day for long period)

Question 18

prevent calcium stones

Answer 18

hydrochlorothiazide: decreases Ca in urine (loops loose, thiazides retain Ca)

Question 19

urease + bugs (proteus mirabilis, staph, klebsiella, pseudomonas): urea →ammonia + H20
ammonia → ammonium binds to Mg, phosphate →”staghorn calculi”

Answer 19

ammonium magnesium phosphate stones (struvite stones)

Question 20

staghorn calculi: outlines renal pelvis

Answer 20

ammonium magnesium phosphate stones (struvite stones) or

cystine stones

Question 21

treatment of ammonium magnesium phosphate stones (struvite stones)

Answer 21

surgical removal of stone

Question 22

only stone that is radiolUcent (use US or CT)

associated with hyperuricemia and gout

Answer 22

Uric acid stones

Question 23

children with cystinuria

“staghorn calculi”

Answer 23

cystine stones

Question 24

treatment of cystine stones

Answer 24

alkalinize urine

Question 25

multiple BILATERAL cysts of ENLARGED kidneys | associated with LIVER cysts

Answer 25

ADPKD

Question 26

``` flank pain hematuria urinary infections HTN progressive renal failure ```

Answer 26

ADPKD

Question 27

``` in utero/infants fetal US: BILATERAL ENLARGED, echogenic kidneys absent or small bladder oligohydramnios → potter sequence ```

Answer 27

ARPKD

Question 28

inherited SMALL shrunken kidneys fibrosis + progressive renal insufficiency

Answer 28

medullary cystic disease

Question 29

common | usually outer cortex: inconsequential

Answer 29

simple cysts

Question 30

multiple or thick/septated walls follow or remove due to ↑ risk renal cell carcinoma associated with dialysis

Answer 30

complex cyst

Question 31

most common primary renal malignancy

Answer 31

renal cell carcinoma

Question 32

cancer originates in renal tubular cells | polyglonal clear cells full of lipids + carbs

Answer 32

renal cell carcinoma

Question 33

men 50-70 yo hematuria palpable flank mass associated with paraneoplastic syndromes: ectopic EPO → polycythemia ectopic ACTH → cushing syndrome ectopic PTHrP → hypercalcemia ↑ prolactin → hypogonadism, ↓ libido, galactorrhea if invades IVC → spread in blood → mets to lung + bone risk factor: smoking, obesity

Answer 33

renal cell carcinoma

Question 34

associated with von Hippel Lindau syndrome

Answer 34

wilms tumor

Question 35

most common renal malignancy of childhood (2-4 yo) | contain embryological glomerular structures

Answer 35

wilms tumor

Question 36

child: 2-4 yo huge palpable flank mass hematuria

Answer 36

wilms tumor

Question 37

associated with deletion of tumor suppressor gene WT1 on chrom 11 WAGR complex associated with gene mutation: Wilms tumor Aniridia (lack of iris) GU malformations Retardation (mental/motor)

Answer 37

wilms tumor

Question 38

most common tumor of urinary system: renal calcyes, renal pelvis, ureters, bladder (transitional cells here)

Answer 38

transitional cell carcinoma

Question 39

PAINLESS hematuria risk factors: smoking (biggest), cyclophosphamide (can cause hemorrhagic cystitis and also induce TCC), aniline dye exposure

Answer 39

transitional cell carcinoma

Question 40

``` WBC or WBC casts in urine fever nausea painful urination CVA AMS: elderly tx: empiric abx ```

Answer 40

acute pyelonephritis

Question 41

eosinophilc casts → dilate tubules (thyroidization of kidneys)

Answer 41

chronic pyelonephritis

Question 42

``` causes acute renal failure presentation: fever, rash, eosinophilia, azotemia common causes: *NSAIDs* penicillin cephalosporin, sulfonamides (TMP-SMX, furosemide) ciprofloxacin cimetidine allopurinol proton-pump inhibitors indinavir mesalamine ```

Answer 42

drug-induced interstitial nephritis (acute interstitial nephritis)

Question 43

treatment of acute interstitial nephritis (drug-induced)

Answer 43

2 wks of CS | stop offending drug

Question 44

common cause of acute renal failure in hospitals cause: muscle breakdown from seizures, crush injuries, cocaine use or statin drug use → rhabdomyolysis, myoglobinuria (myoglobin into kidney) ischemia radiocontrast dye (prevent with fluids + naHCO3) nephrotoxic drugs: aminoglycosides cephalosporins polymyxins

Answer 44

acute tubular necrosis

Question 45

``` sloughing of papillae gross hematuria flank pain proteinuria ischemic causes: sickle cell disease analgesia use: acetaminophen, nsaids diabetes pyelonephritis ```

Answer 45

renal papillary necrosis

Question 46

types of acute renal failure

Answer 46

prerenal intrsinisc postrenal

Question 47

``` insufficient blood flow to kidneys: hypovolemia hypotension shock renal vasoconstriction via NSAIDs kidneys try to compensate for low blood flow: BUN/Cr ratio >20 ```

Answer 47

prerenal acute renal failure

Question 48

``` intrinsic renal diseases that can lead to: acute interstitial nephritis acute pyelonephritis glomerulonephritis acute tubular necrosis DIC ```

Answer 48

intrinsic acute renal failure

Question 49

``` obstruction of urine: stones BPH- blocks urethra neoplasia congenital anomalies ```

Answer 49

postrenal acute renal failure

Question 50

BUN/Cr ratio >20

Answer 50

prerenal azotemia: prerenal acute renal failure

Question 51

complications of renal failure

Answer 51

``` fluid retention (can't produce urine): peripheral edema, HTN, heart failure, pulmonary edema hyperkalemia (retain K+) metabolic acidosis (high H+) anemia (low epo) low Ca uremia:high BUN, Cr ```

Question 52

symptoms of uremia

Answer 52

``` manifestations of severe azotemia: ↑BUN/Cr nausea anorexia pericarditis asterixis encephalopathy platelet dysfunction ```

Question 53

acute generalized cortical infarction of both kidneys due to vasospasm + DIC associated with multi-organ failure, ARDS, DIC (all can be caused by septic shock)

Answer 53

diffuse cortical necrosis

Question 54

no vitamin D activation → less Ca reabsorption in gut → 2° hyperparathyroidism → degrade bones to ↑ Ca tx: vitamin D + Ca in renal failure patients

Answer 54

renal osteodystrophy

Question 55

differential diagnosis for blood/red urine

Answer 55

rifampin excessive ingestion of beets UTI, kidney stones, bladder cancer