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Path 4 > Renal: other > Flashcards

Renal: other Flashcards

1
Q

acute tubular necrosis causes

A

ischemia: polyarteritis, HUS, HTN, shock
direct toxic injury: drugs, dyes, myoglobin (rhabdomyolysis)
tubulointerstitial nephritis: hypersensitivity to drugs
DIC
urinary obstruction

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2
Q

necrosis in tubules in ischemic vs nephrotoxic injury

A

ischemia: patchy necrosis, sloughing of endothelial cells obstruct lumen in DCTs
nephrotoxic: continuous necrosis in PCT mostly

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3
Q

nephrotoxic substances

A

heavy metals like mercury, ethylene glycol, organophosphates, drugs, contrast dye (CT scan)

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4
Q

cause of tubulointerstitial nephritis

A

infections: pyelonephritis
toxins: drugs (thiazides inc uric acid), analgesics, metals, lead
metabolic dz: urate, nephrocalcinosis
physical factors: chronic obstruction
neoplasms: myeloma (light chains)
immune: transplant, sarcoidosis
vascular

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5
Q

2 mechanisms of renal infections

A

1 - ascending infection of G- rods –> bladder, reflux of urine into kidneys –> kidney infection
2 - G+ organism hematogenous spread, in valvular heart dz or bacterial endocarditis

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6
Q

acute pyelonephritis causes, epi

A

usually ascending infection but may be hematogenous
m/c: E. coli
in diabetics, people with recurrent bladder or prostate infections
more common w: stones, indwelling catheters, neurogenic bladder

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7
Q

acute pyelonephritis: gross and histo

A

gross: yellow pustules on kidney surface
histo: acute inflammation in tubules and interstitium -> WBC casts

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8
Q

acute pyelonephritis clinical

A

fever, chills, CVA pain
elevated white count
WBCs and WBC casts in urine
elevated CRP

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9
Q

alkaline pH of urine cause

A

suggests infection with urea-splitting organism like Proteus

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10
Q

papillary necrosis - what is it, where is it, who is it

A

necrosis of distal 2/3 renal pyramids, unilateral or bilateral
seen in diabetics, analgesic abuse, sickle cell, urinary tract obstruction

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11
Q

chronic pyelonephritis causes

A

2’ to obstruction or vesicoureteral reflux

*recurrent infections may contribute to parenchymal damage

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12
Q

chronic pyelonephritis gross features

A

interstitial inflammation and uneven scarring
broad scars, blunted calyces
usually small kidney with irregular surface
deformed pelvis and calyces and reduced parenchyma
hydronephrosis possible with some causes

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13
Q

chronic pyelonephritis histo

A

atrophic renal parenchyma compressed by dilated pelvis, blurred cortical-medulla distinction; fibrosis and glomerulosclerosis
chronic inflammatory infiltrate; thickened vessels
“thyroidization” of tubules possible
hyaline arteriolosclerosis

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14
Q

nephrosclerosis

A

2’ to HTN, shrunken kidneys with irregular granular surface

may -> ESRD (less than 5% GFR)

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15
Q

chronic renal failure definition and causes

A

GFR

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16
Q

renal insufficiency

A

GFR 20-50% normal, azotemia, HTN, anemia

? polyuria and nocturia d/t decreased ability to concentrate urine

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17
Q

renal failure

A

GFR

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18
Q

ESRD GFR

A
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19
Q

common causes of drug-induced nephritis

A

NSAIDs, diuretics, Abx (synthetic penicillins, cephalosporins)
*reverse with discontinuation of drug

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20
Q

drug-induced IN pathogenesis

A

drug = hapten –> type 1 and 4 HS rxns
2 weeks post-drug ingestion -> fever, eosinophilia, rash (25%), hematuria, ARF (50%)
WBC and eos in urine
LM: interstitial edema, mononuclear cells and eos

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21
Q

arteriolar nephrosclerosis: 2 forms

A

“flea-bitten” kidney d/t diastolic BP elevation
small atrophic kidneys with fine granular surface = benign
hemorrhage in malignant form

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22
Q

benign arteriolosclerosis cause and pathogenesis

A

systolic BP >140
2nd m/c cause ESRD (1 is DM)
atherosclerosis and intimal hyperplasia of endothelium
concentric hyaline thickening of arterioles
renal vascular and glomerular sclerosis with mild-mod HTN

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23
Q

malignant arteriolosclerosis

A

diastolic BP >130
CNS, retinal, cardiac changes
fibrinoid necrosis small arterioles and SM proliferation -> “onion skin”
*high mortality rate

24
Q

pathogenesis of undefined etiology vasculitis

A

immune complex deposition
attack on vessel wall by circulating Abs
cell-mediated immunity

25
Q

causes of vasculitis

A 
undefined etiology
polyarteritis nodosa
Wegener granulomatosis
Churg-Strauss
Giant cell, Takayasu arteritis
26
Q

renal artery stenosis

A

usually d/t atherosclerosis, dec blood flow leads to increased renin secretion

27
Q

fibromusclar dysplasia

A

rare; women in reproductive years -> renal artery stenosis –> HTN
thickening of media and proliferation of mm

28
Q

thrombotic microangiopathy pathogenesis

A

systemic process d/t endothelial injury and activation of coagulation cascade -> thrombosis
endotoxin, immune complexes, TNF; inc endothelin, dec NO -> vasoconstriction

29
Q

thrombotic microangiopathy clinical

A

fever, hemolytic anemia, RF after GI or flu-like illness –> dec haptoglobin and schistocytes
greater severity of arteriole involvement = worse prognosis

30
Q

Potter’s sequence

A

oligohydramnios

clubbed feet, pulmonary hypoplasia, cranial anomalies

31
Q

ectopic kidney

A

usually pelvic

kinking of ureter –> obstruction and infection

32
Q

horseshoe kidney

A

a/w trisomy 18 (Edward)

kidneys fused at lower pole and held in pelvis by IMA

33
Q

ADPKD: cause and sx

A

genotype: PKD1 (85%) codes for polycystin 1 (cell-cell and cell-matrix intxns)
bilateral, asymptomatic until adulthood
sx: renal failure, HTN -> LVH, hemorrhage into cyst and hematuria

34
Q

ADPKD complications

A

berry aneurysm in COW (5-15% pts)
hepatic cysts (40-60% pts)
cardiac dz d/t HTN and LVH

35
Q

ADPKD histo

A

functional nephrons between cysts filled w serous or proteinaceous fluid
cysts have variable lining epithelium d/t arising from tubules throughout nephron

36
Q

ARPKD: gross appearance and complications

A

gross: massive kidneys in newborn, cyst formation in ducts (“sunburst”) vs haphazard (ADPKD)
comp: resp distress (no room)

37
Q

ARPKD: cause, histo, and types

A

cause: PKHD1 mutation -> fibrocystin (cell surface R)
histo: cysts lined by cuboidal epithelium
infantile: oligohydramnios
juvenile: congenital hepatic fibrosis

38
Q

cystic renal dysplasia

A

sporadic, uni- or bilateral

grossly-large cysts with abnormal lobular architecture

39
Q

urolithiasis: causes

A

m/c Ca++ stones, may be a/w systemic dz or idiopathic (50% pts normocalcemic w hypercalciuria)
uric acid - gout, chemotherapy
Mg ammonium phosphate - “infection” stone -> stag-horn calculi

40
Q

benign renal tumors

A

adenoma
angiomyolipoma (tuberous sclerosis)
oncocytoma

41
Q

renal cell carcinoma: pts, risk factors

A

60-70s, M>F
a/w smoking, cadmium exposure
seen in VHL syndrome (bilateral) and dialysis kidney

42
Q

renal cell carcinoma symptoms

A

hematuria, flank pain, palpable abdominal mass (10% pts)
weight loss, cachexia, fever, anemia (50%), polycythemia (5%)
renal vein invasion common -> presenting sx

43
Q

paraneoplastic syndromes of renal cell carcinoma

A

polycythemia d/t EPO secretion
Cushing’s syndrome d/t ACTH secretion
HTN d/t renin
hypercalcemia d/t PTHrP

44
Q

renal cell carcinoma histo and tx

A

clear cell pattern most frequent (80-85%; VHL gene)
papillary (10-15%; MET gene), chromophobe (5%)
tx: resection including solitary metastasis

45
Q

hereditary renal cancers and mutations

A

sporadic papillary: trisomy 7, 16, 17, loss of Y; active MET
hereditary papillary: trisomy 7, active MET
sporadic and hereditary clear cell: translocations 3:6, 3:8, 3:11 or chr 3 deletions; loss or inactive VHL

46
Q

Wilm’s tumor

A

childhood tumor d/t deletion tumor suppressor on 11p (WT gene)

47
Q

Wilm’s tumor gross and histo

A

gross: large tan mass w hemorrhage and necrosis (90%)
histo: triphasic: metanephric blastema, immature stroma, and immature tubular elements

48
Q

WAGR syndrome

A

Wilms tumor, aniridia, genital abnormalities, mental retardation
d/t deletion of WT1

49
Q

Denys-Drash syndrome

A

gonadal dysgenesis, renal abnormalities
a/w Wilms tumor
d/t inactive WT1

50
Q

Beckwith-Wiedemann syndrome

A

enlarged body organs or body segments, enlarged adrenocortical cells, and neonatal hypoglycemia
a/w Wilms tumor
d/t imprinting error, WT2

51
Q

Wilm’s tumor prognosis and tx

A

poor prognosis if anaplasia present

good prognosis if

52
Q

urothelial neoplasm risk factors and population

A

exposure to aniline dyes, smoking, analgesic abuse, chronic cystitis, schistosomiasis
50-70, M>F

53
Q

urothelial neoplasm sx

A

painless hematuria, dysuria, hydronephrosis

54
Q

urothelial neoplasm types

A

transitional cell carcinoma, squamous cell carcinoma, adenocarcinoma
also TCC of renal pelvis (*smoking)

55
Q

gross appearance of TCC vs RCC

A

TCC: tends to be in pelvis, 10% renal tumors
RCC: large mass in cortex, 90% renal tumors

Path 4 (8 decks)

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