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Flashcards in Renal - Grab Bag Deck (47)
1

Granulomatosis with polyangiits treatment

Cyclophosphamide and prednisone

2

Goodpasture's treatment

Immediate plasmapheresis

3

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.

4

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

5

Most common subtype of glomerular disease in SLE?

DPGN

6

Which disease is Hodgkin's associated with?

Minimal change disease

7

Which disease is associated with HIV?

FSGS

8

Which kidney diseases are HBV and HCV associated with?

Type I MPGN; membranous nephropathy

9

Which disease is associated with sickle cell anemia?

FSGS

10

Which disease is the most common cause of primary nephrotic syndrome in caucasian adults?

Membranous nephropathy

11

What is the most common cause of nephrotic syndrome in African Americans and Hispanics?

FSGS

12

What is the most common primary renal malignancy?

Renal cell carcinoma

13

Most common tumor of the urinary tract system?

Transitional cell carcinoma

14

Most common renal malignancy of early childhood (age 2-4)?

Wilms tumor (nephroblastoma)

15

Huge palpable flank mass and/or hematuria in a 2-4 year old?

Wilms tumor

16

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

Beckwith-Wiedemann syndrome

17

Wilms tumor
Aniridia
Genitourinary abnormalities
Retardation

WAGR complex

18

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.

19

What are risk factors for transitional cell carcinoma?

Phenacetin, Smoking, Aniline dyes, Cyclophosphamide

20

What are risk factors for squamous cell carcinoma of the bladder?

Chronic irritation of the urinary bladder
Schistosoma
Chronic cystitis
Smoking
Chronic nephrolithiasis

21

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)

22

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

23

Type 2 RTA

Defect in proximal tube HCO3- reabsorption results in increased excretion of bicarb

Urine pH is normal

24

Causes of Type 1 RTA?

Amphoteracin B toxicity, Analgesic nephropathy, Multiple myeloma, congenital obstruction of the urinary tract

25

Causes of Type 2 RTA?

Fanconi syndrome (Wilson's??), chemical toxins to proximal tubule (lead, aminoglycoside), carbonic anhydrase inhibitors

26

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.

27

RBC casts

Glomerulonephritis, ischemia, or malignant hypertension

28

WBC casts

TIN, Acute pyelo, transplant rejection

29

Fatty casts / oval fat bodies / maltese cross

Nephrotic syndrome

30

Granular (muddy brown) casts

Acute tubular nephrosis

31

Waxy casts

Advanced renal disease / chronic renal failure

32

Hyaline casts

Nonspecific, normal finding, often seen in concentrated urine samples

33

Liddle syndrome

Increased Na reabsorption in the distal and collecting tubules - increased activity of epithelial sodium channel.
Autosomal dominant.
Results in hypertension, hypokalemia, metabolic alkalosis, decreased aldosterone.
Treat with amiloride.

34

Microscopy for IgA nephropathy

LM - mesangial proliferation
EM - mesangial IC deposits
IF - IgA based IC deposits in mesangium

35

Microscopy for DPGN

LM - wire looping of capillaries
IF - granular
EM - subendothelial and sometimes intramembranous IgG ICs with C3

36

Microscopy for RPGN

LM and IF - crescent moon shape (fibrin and plasma proteins, C3B with glomerular parieal cells, monocytes, macrophages)

37

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

38

Microscopy for FSGS

LM - segmental sclerosis and hyalinosis
IF - negative
EM - foot process effacement

39

Microscopy for Membranous

LM - diffuse capillary and GBM thickening
IF - granular due to immune complex deposition
EM - spike and dome appearance with subepithelial deposits

40

Minimal change microscopy

LM - normal
IF - negative
EM - foot process effacement

41

Amyloidosis microscopy

LM - congo red stain shows apple green birefringence under polarized light

42

Membranoproliferative type I microscopy

subendothelial immune complex deposits with granular IF
Tram track appearance due to GBM splitting

43

Type II membranoproliferative

Intramembranous IC deposits - dense deposits

44

Which kidney diseases are associated with lupus?

DPGN
Membranous glomerulonephritis

45

Diabetes microscopy

Mesangial expansion, GBM thickening, eosinophilic nodular glomerulosclerosis with Kimmelsteil wilson lesions

46

Hypokalemia leads to

U-waves on ECG, flattened T waves, arrhythmias, muscle weakness

47

Hypocalcemia

Tetany, seizure, QT prolongation