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Pathology 1st aid > Renal Path > Flashcards

Renal Path Flashcards

1
Q

RBC casts seen in

A

Glomerulonephritis
Ischemia
Malignant HTN

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2
Q

WBC casts seen in

A

Tubulointerstitial inflammartion
acute pyelonephritis
Transplant rejection

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3
Q

Fatty Casts seen in

A

Nephrotic Syndromes

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4
Q

Muddy Brown (Granular Casts) seen in

A

Acute tubular necrosis

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5
Q

Waxy casts seen in

A

advanced renal disease

chronic renal failure

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6
Q

Hyaline Casts

A

Non-specific

Can be normal finding

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7
Q

Nephritic Syndromes

A

Acute Postreptococcal GN
Rapidly Progressive GN
Berger’s IgA Glomerulonephropathy
Alport Syndrome

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8
Q

Nephrotic Syndromes

A 
Focal Segmental
Membranous
Minimal ∆
Amyloidosis
Diabetic Glomerulonephropathy
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9
Q

Mixed nephritic/nephrotic

A

Diffuse proliferative GN

Memranoproliferative GN

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10
Q

Nephrotic Characteristics

A 
Massive Proeinuria (> 3.5 g/day)
Hyperlipidemia
Fatty Casts
Edema
Inc. risk of infxn
Hypercoagulable State
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11
Q

Nepthritic Characteristics

A 
Inflammatory Process
Proteinuria (< 3.5 g/day)
Hematuria
RBC Casts
HTN
oliguria
azotemia
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12
Q

Effacement of foot processes
Hyalinosis and segmental sclerosis
HIV
Black pt.

A

Focal Segmental GN

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13
Q

Focal Segmental GN associated with

A

Black/Hispanic

HIV
Heroin
Massive obesity
Interferon Tx
Chronic Kidney disease--agenesis or removal
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14
Q

Nephrotic syndromes with foot process effacement

A

Focal Segmental

Minima ∆

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15
Q

Spike and Dome on EM with subepithelial deposits
Granular IF
Nephrotic Syndrome

A

Membranous Nephropathy

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16
Q

SLE kidney diseases

A

1–Diffuse Proliferative GN (nephritic)

Membranous (nephrotic)

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17
Q

Membranous Nephropathy associated with

A

SLE
Solid Tumors
Rx
Infxn

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18
Q

1 Nephrotic Syndrome in adults

A

Membranous

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19
Q

1 nephrotic syndrome in kids

A

Minimal ∆

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20
Q

Congo Red stain with Apple Green Birefringence

Underlying Chronic Condition

Nephrotic Syndrome

A

Amyloidosis

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21
Q

Amyloidosis associated with

A

Multiple Myeloma (1º)

TB, RA (2º)

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22
Q

Normal glomeruli on LM
EM shows effacement of foot processes
Kid
Nephrotic Syndrome

A

Minimal ∆

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23
Q

minimal ∆ Tx

A

Coritcosteroids

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24
Q

Nephrotic Syndromes associated with HBV/HCV

A

Focal Segmental

Type I Membranoproliferative

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25
``` Subendothelial IC deposition Granular IF Tram Track appearance GBM splitting due to mesangial ingrowth HBV/HCV ```
Type I membranoproliferative
26
INTRAmembranous immune complex deposition Dense deposits C3 nephrotic Factor
Type II membranoproliferative
27
Nonenzymatic glycosylation of GBM Deposition of hyaline in efferent arterioles of kidney Kimmelstiel Wilson lesion
Diabetic GN
28
Kimmelstiel Wilson Lesion
eosinophilic nodular glomerulosclerosis seen in diabetic GN
29
``` Subepithelial Humps seen on EM hypercellular neutorphils with lumpy bumpy appearance Child with recent pharyngitis Granular IF Nephritic Syndrome ```
Acute Poststreptococcal GN
30
Immune complexes deposited in PSGN
IgM IgG C3 Along GBM and Mesangium
31
Nephritic Syndrome Crescent moon shaped lesion on LM and IF deteriorating condition in days to weeks
Rapidly Progressive GN (RPGN)
32
RPGN deposition
Fibrin and plasma proteins Macrophages, parietal cells, monocytes
33
Syndromes that cause RPGN
Goodpasture's (hematuria and hemoptysis) Wegener's (c-ANCA) Microscopic Polyangiitis (p-ANCA)
34
``` Wire looping of capillaries Subendothelial/intramembranous IgG immune complexes C3 deposition Nephritic Factor SLE Granular IF ```
Diffuse Proliferative Can be nephritic and nephrotic concurrently
35
Mesangial Proliferation Mesangial IC deposits IgA deposits in mesangium URI or GI infection
Berger's Disease | IgA nephropathy
36
``` Mutation of Type IV collagen split basement membrane X-linked Hearing deficits Visual disturbances Nephritic syndrome ```
Alport Syndrome
37
Most common Kidney Stone
Calcium Phosphate--high pH ***Oxalate--low pH
38
Tx for Ca stones
Thiazides and citrate
39
Most common presentation of Ca stone pt.
hypercalciuria Normal serum Ca Calcium oxalate stone
40
Causes of Ca stones
Crohn's Vit. C abuse Ethylene Glycol
41
Staghorn stone in adults
Ammonium Mg Phosphate Struvite stones
42
Cause of Struvite stones
Proteus Klebsiealla Staph Urease+ bugs alkalinize the urine
43
Radiolucent Kidney Stone
Uric acid stone visible on CT and US but not Xray
44
Tx Uric Acid Stones
Alkalization of urine
45
Tx Staghorn stones
Surgery | Clear infxn
46
Staghorn stone in children
Cystine Stone | Forms at Low pH
47
Tx cystine stones
Alk. urine
48
Cause of Cystine stones
2º to cystinuria low pH urine
49
Hydronephrosis
Back up of urine into kidney--dilation of renal pelvis and calyces proximal to obstruction vesicoureteral reflux can cause too
50
50-70 year old fat smoker Renal Mass filled with clear cells and lipids/carbohydrates Paraneoplastic Syndrome
Renal cell CA
51
RCC gene association
VHL gene on Chromosome 3 (von Hippel-Lindau) for inherited
52
Paraneoplastic syndromes associated with RCC
EPO ACTH PTHrH
53
RCC Tx
Surgery Resists chemo and radiation
54
Child (2-4) with huge unilateral mass on flank | Hematuria
Wilm's Tumor
55
Wilm's Tumor composed of
Blastema--embryonic glomerular stxrs
56
Gene associated with Wilm's Tumor
WT1 on Chromosome 11
57
WAGR complex
Wilm's Tumor Aniridia Genitourinary Malformations Retardation (motor/mental)
58
Wilm's tumor syndromes
WAGR | Beckwith-Wiedemann Syndrome
59
Most common tumor of lower urinary tract
Urothelial (transitional cell) CA
60
Presentation of Urothelial CA
Painless hematuria | No casts
61
Urothelial CA risk factors
***Smoking*** Phenacetin Aniline Dyes (hair dresser) Cyclophasphamide
62
``` Fever Costovertebral Angle tenderness Cx effected but glomeruli spared N/V White casts in urine ```
Acute Pyelonephritis
63
Cause of chronic pyelonephritis
Recurrent episodes of acute PN Vesicouretal reflux Chronic Obstruction
64
Chronic Pyelonephritis findings of kidney
Coarse, asymmetric corticomedullary scarring Blunted Calyx Eosinophilc Casts in tubules Thyoroidization of kidney
65
``` Acute interstitial renal inflammation Pyuria azotemia Recent Rx started fever, rash, hematuria CVA tenderness ```
Rx Induced Interstitial Nephritis | Tubulointerstitial nephritis
66
Rx Induced Interstitial Nephritis causes
``` Diuretics Penicillin NSAIDS sulfonamides rifampin ```
67
Diffuse Cortical Necrosis
Cortical infaction due to: Vasospasm DIC OB catastrophe Septic Shock
68
Most common cause of intrinsic renal failure
Acute Tubular Necrosis
69
Stages of Acute tubular necrosis
1. Inciting event 2. Maintenance phase--oliguria for 1-3 weeks, hyperkalemia risk 3. Recovery phase--polyuric, BUN/Creatinine fall, hypokalemia risk
70
Causes of Acute Tubular necrosis
renal ischemia crush injury (myoglobinuria) Rx Toxins
71
most common COD in SLE
Diffuse Proliferative GN
72
Gross Hematuria and proteinuria recent infection or immune stim.
Renal Papillary Necrosis
73
Renal Papillary Necrosis associations
DN Acute Pyelonephritis Chronic Phenacetin (acetaminophen is a derivative) Sickle Cell anemia/trait
74
abrupt decline in renal fxn | increased Creatinine and BUN
Acute Renal Failure
75
Urine Osmolality > 500 Urine Na < 20 FeNA < 1% Serum BUN:Cr > 20
Prerenal Azotemia
76
Urine Osmolality 40 FeNA > 2% Serum BUN:Cr < 15
Intrinsic Renal Azotemia
77
Urine Osmolality 40 FeNA > 2% Serum BUN:Cr > 15
Post renal Azotemia
78
Prerenal Azotemia causes
decreased RBF--heart, hemorrhage, etc. Anything before the kidney blood flow
79
Postrenal Azotemia
Urine flow obstruction Stones, BPH, neoplasia, congenital anomalies BILATERAL
80
Intrarenal azotemia mechanism
patchy necrosis --> debris obstructs tubule backflow across necrotic tubule --> dec. GFR Urine has epithelial granular casts
81
Uremia
Increased Nitrogen waste products in blood ``` Nausea/anorexia percarditis Asterixis encephalopathy Plt. Dysfxn ```
82
Renal osteodystrophy
Failure of Vit. D hydroxylation --> decresed Ca abs. in gut Hypo-Ca, Hyper-Pi 2º to hyperparathyroidism Hyper-Pi precipitates Ca and deposits in tissues
83
ADPKD
Presents in young adult Multiple large cysts on both kidneys that destroy parenchyma Flank pain, hematuria, progressive renal failure, urinary infxn, HTN--high renin
84
ARPKD associated with
Hepatic Cysts and fibrosis
85
ADPKD mutation
Autosomal Dominant PKD1 or PKD2
86
ADPKD complicaitons
Berry aneurysm MVP Benign Hepatic Cysts
87
ARPKD Presentation
``` Infant Significant renal failure HTN Portal HTN progressive renal insufficiency Enlarged kidney ```
88
Medullary Cystic Disease
Tubulointerstitial fibrosis and progressive renal insufficienc with inability to concentrate urine Medullay cysts SHRUNKEN kidney Poor prognosis

Pathology 1st aid (11 decks)

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