Flashcards in Renal - Grab Bag Deck (47)
Granulomatosis with polyangiits treatment
Cyclophosphamide and prednisone
What is the difference between Type 1 and Type 2 MPGN on EM?
Type 1 - Subendothelial ICs with granular IF
Type II - diffuse intramembranous deposits (dense deposit disease); EM shows tram tracks.
Nephritic vs nephrotic syndrome definition by cause
Nephritic - glomerular injury is primarily due to neutrophils
Nephrotic - glomerular injury is due to cytokines, not neutrophils and the negative charge on the GBM is lost
Most common subtype of glomerular disease in SLE?
Which disease is Hodgkin's associated with?
Minimal change disease
Which disease is associated with HIV?
Which kidney diseases are HBV and HCV associated with?
Type I MPGN; membranous nephropathy
Which disease is associated with sickle cell anemia?
Which disease is the most common cause of primary nephrotic syndrome in caucasian adults?
What is the most common cause of nephrotic syndrome in African Americans and Hispanics?
What is the most common primary renal malignancy?
Renal cell carcinoma
Most common tumor of the urinary tract system?
Transitional cell carcinoma
Most common renal malignancy of early childhood (age 2-4)?
Wilms tumor (nephroblastoma)
Huge palpable flank mass and/or hematuria in a 2-4 year old?
Congenital abdominal wall defects, large tongue, large body/long limbs (macrosomia), midline abdnominal wall defect (omphalocele/exomphalos), ear crease, ear it, neonatal hypoglycemia, Wilms tumor
What is the WAGR complex?
Wilms tumor, Aniridia, Genitourinary abnormalities, Retardation
Usually due to a mutation on tumor suppressor gene WT1 or WT2 on chromosome 11.
What are risk factors for transitional cell carcinoma?
Phenacetin, Smoking, Aniline dyes, Cyclophosphamide
What are risk factors for squamous cell carcinoma of the bladder?
Chronic irritation of the urinary bladder
Drugs that induce TIN versus drugs that cause ATN?
TIN - Diuretics, Penicillins, Sulfonamides, Rifampin, NSAIDs
ATN - Sisters Lead a Mean Radio - Cisplatin, Lead, Aminoglycosides, Radiocontrast agents (proximal tubule is esp susceptible)
Type 1 RTA
Defect in alpha-intercalated cells to secrete H+ results in no new bicarb generation
Increase urine pH --> increase risk for Ca phosphate stones
Type 2 RTA
Defect in proximal tube HCO3- reabsorption results in increased excretion of bicarb
Urine pH is normal
Causes of Type 1 RTA?
Amphoteracin B toxicity, Analgesic nephropathy, Multiple myeloma, congenital obstruction of the urinary tract
Causes of Type 2 RTA?
Fanconi syndrome (Wilson's??), chemical toxins to proximal tubule (lead, aminoglycoside), carbonic anhydrase inhibitors
Type 4 RTA
Hypoaldosteronism, aldosterone resistance, or K+ sparing diuretics - resulting hyperkalemia impairs ammoniagenesis in the proximal tubule and decreases buffering capacity and H+ excretion into urine.
Glomerulonephritis, ischemia, or malignant hypertension
TIN, Acute pyelo, transplant rejection
Fatty casts / oval fat bodies / maltese cross
Granular (muddy brown) casts
Acute tubular nephrosis
Advanced renal disease / chronic renal failure
Nonspecific, normal finding, often seen in concentrated urine samples
Increased Na reabsorption in the distal and collecting tubules - increased activity of epithelial sodium channel.
Results in hypertension, hypokalemia, metabolic alkalosis, decreased aldosterone.
Treat with amiloride.
Microscopy for IgA nephropathy
LM - mesangial proliferation
EM - mesangial IC deposits
IF - IgA based IC deposits in mesangium
Microscopy for DPGN
LM - wire looping of capillaries
IF - granular
EM - subendothelial and sometimes intramembranous IgG ICs with C3
Microscopy for RPGN
LM and IF - crescent moon shape (fibrin and plasma proteins, C3B with glomerular parieal cells, monocytes, macrophages)
Microscopy for Acute poststrep
LM - glomeruli enlarged and hypercellular
IF - starry sky granular appearance (lumpy bumpy) due to IgG, IgM, and C3 deposition along GBM
EM - subepithelial immune complex bumps
Microscopy for FSGS
LM - segmental sclerosis and hyalinosis
IF - negative
EM - foot process effacement
Microscopy for Membranous
LM - diffuse capillary and GBM thickening
IF - granular due to immune complex deposition
EM - spike and dome appearance with subepithelial deposits
Minimal change microscopy
LM - normal
IF - negative
EM - foot process effacement
LM - congo red stain shows apple green birefringence under polarized light
Membranoproliferative type I microscopy
subendothelial immune complex deposits with granular IF
Tram track appearance due to GBM splitting
Type II membranoproliferative
Intramembranous IC deposits - dense deposits
Which kidney diseases are associated with lupus?
Mesangial expansion, GBM thickening, eosinophilic nodular glomerulosclerosis with Kimmelsteil wilson lesions
Hypokalemia leads to
U-waves on ECG, flattened T waves, arrhythmias, muscle weakness