Renal Pathology Flashcards Preview

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Flashcards in Renal Pathology Deck (161):
1

Angiotensin II

Vasoconstricts peirpheral resistance arterioles and efferent arterioles, stimulates synthesis and release of aldosterone

2

Renal derived PGE2

Vasodilates the afferent arterioles

3

1-alpha-hydroxylase is synthesized in where of kidney? What does it do?

1. Proximal renal tubule cells
2. converts 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol

4

Two functions of vitamin D

1. increase GI absorption of calcium and phosphate
2. promotes bone mineralization (release of alkaline phosphatase from osteoblasts)

5

Hematuria: upper urinary tract

1. renal stone
2. GN
3. Renal cell carcinoma

6

Hematuria: lower urinary tract

1. infection
2. transitional cell carcinoma (in absence of infection)
3. benign prostatic hyperplasia (microscopic hematuria in males)

7

Drugs associated with hematuria

1. anticoagulants
2. cyclophosphamide: hemorrhagic cystitis

15

Dipstick detects what?

albumin

16

SSA detects what?

albumin and globulins

17

Normal serum BUN level

7-18mg/dL

18

Where is BUN absorbed? What does it depend on?

Proximal tubule, flow dependent.

19

Decreased GFR = more or less BUN absorbed

More

20

Increased GFR = more or less BUN absorbed

Less

21

Most common cause of increased serum BUN level?

CHF

22

Normal serum creatinine level

0.6 to 1.2 mg/dL

23

Non-selective proteinuria with loss of albumin and globulin

post-streptococcal glomerulonephritis

24

Loss of negative charge on GBM, selective proteinuria with loss of only albumin

minimal change disease

25

Nephritic or nephrotic: <3.5g/24 hours of protein loss

Nephritic

26

Inability to reabsorb glucose, amino acids, uric acid, phosphate, and bicarbonate - leading to proteinuria

Fanconi syndrome

27

Defect in reabsorption of neutral AA (tryptophan) in GI and kidney - leading to proteinuria

Hartnup disease

28

Decreased cardiac output: increase or decrease BUN

Increase. low CO=low GFR=more absorption in proximal

29

Third degree burns: increase or decrease serum BUN

increase. increased aa degradation.

30

Causes of pre-renal Azotemia: Serum BUN:Cr >15

1. decrease in CO
2. hypoperfusion and decrease in GFR
3. blood loss, CHF

31

Acute GN (poststreptococcal GN): increase or decrease serum BUN

increase

32

Urinary tract obstruction: increase or decrease BUN

increase.

33

Increase plasma volume (pregnancy): increase or decrease BUN

decrease, increase plasma volume, increases GFR, decreases serum BUN

34

Kwashiorkor: BUN level increase or decrease

decrease serum BUN

35

Azotemia

increase in serum BUN and creatinine

36

Normal serum BUN:creatinine ratio

15

37

Why use creatinine for renal clearance testing?

it is filtered, not reabsorbed or secreted

40

Causes of Renal Azotemia: Ratio <15

parenchymal damage, ATN, chronic renal failure

41

Postrenal Azotemia: ration>15 initially, <15 if obstruction persists

obstruction below the kidneys

42

Ccr equation

Ccr=Ucr x V/Pcr

43

Smoky-colored urine

nephritic type of GN

44

Black urine after exposure to light

alkaptonuria, increase in homogentisic acid in the urine

45

Vegan urine pH

alkaline,

46

Meat eater urine pH

acidic

47

Absent urine UBG, increase urine bilirubin

obstructive jaundice

48

Increase urine UBG, absent urine bilirubin

extravascular hemolytic anemia

49

increase urine UBG, increase urine bilirubin

hepatitis

50

4 types of kidney stones

1. calcium oxalate
2. uric acid
3. triple phosphate
4. cystine

51

Oval fat bodies

nephrotic syndrome

52

Hyaline cast without proteinuria

no significance

53

RBC Cast

nephritic type of GN (poststreptococcal GN)

54

WBC Cast

acute pyelonephritis, acute tubulointerstitial nephritis

55

Renal tubular cell cast

acute tubular necrosis

56

Fatty cast

nephrotic cast

57

Waxy cast

sign of chronic renal failure

58

Calcium oxalate

renal stone, ethylene glycol poisoning

59

Cystine hexagonal crystal

cystinuria

63

Vasoconstrictor of efferent arterioles

ATII

64

What produces negative charges of GBM?

Heparin sulfate

65

fusion of podocytes

nephrotic syndrome

66

Proliferation of parietal epithelial cells

Crescents

67

Horseshoe Kidney

Congenital disorder: fused at lower lobe. kidney trapped behind inferior mesenteric artery.

68

Increased incidence with Turner's syndrome

Horseshoe kidney

69

Most common cystic disease in children. abnormal development of one or both kidneys

renal dysplasia

70

AR inheritance, cysts bilaterally cortex and medulla, hepatic fibrosis, maternal oligohydramnios

juvenile polycystic kidney disease

71

AD inheritance, chromosome 16, bilateral cystic disease by 20-25 years, cysts in liver, pancreas, and spleen, intracranial berry aneurysms, intracerebral hemorrhage, CRF by 40-60

adult polycystic kidney disease

72

Swiss-cheese appearance, multiple cysts of collecting ducts in medulla

medullary sponge kidney

73

Most common cause is renal dialysis

acquired polycystic kidney disease

74

Linear IF

anti-GBM, goodpasture syndrome

75

Only a few glomeruli ar abnormal

Focal GN

76

All glomeruli are abnormal

Diffuse glomerulonephritis

77

4 types of nephritic glomerular disease

1. IgA glomerulopathy (Bergers disease)
2. Acute proliferative GN/post-streptococcal GN
3. DIffuse proliferative GN (SLE)
4. Rapidly progressive crescentic GN

78

>100 nuclei in affected glomeruli

Proliferative GN

79

Thick GBM, no proliferative change

membranous glomerulopathy

80

Thick GBM, hypercellular glomeruli

membranoproliferative GN

81

Fibrosis involving only a segment of the involved glomerulus

focal segmental glomerulosclerosis

82

Proliferation of parietal epithelial cells around glomerulus

crescentic GN

83

Inovlves only glomeruli and no other target organs (MCD)

primary glomerular disease

84

involves glomeruli and other target organs

secondary glomerular disease

85

Granular irregular deposits in the capillaries

poststreptococcal GN

86

Fusion of podocytes

All nephrotic disease (like MCD)

87

Subendothelial immunocomplex deposits

proliferative GN due to SLE

88

Subepitheial immunocomplex deposits, hypercellular

posttreptococcal GN

89

5 Types of Nephrotic Glomerular Disease

1. MCD
2. Focal segmental glomerulosclerosis
3. diffuse membranous gloemropathy
4.Type I MPGN
5. Type II MPGN

90

Nephritic Syndrome

Neutrophil-related injury to glomeruli, hypertension (salt retention), oliguria, hematuria (dysmorphic RBCs), RBC casts, proteinuria 15

94

Overlapping features with Henoch-Schonlein purpura

IgA glomerulopathy

95

Episodic bouts of hematuria following an upper respiratory infection

IgA glomerulopathy

96

Increaed anti-DNase B titers, ASO not increased

Acute proliferative GN/post-streptococcal GN

97

Wire looping, serum ANA test positive with anti-dsDNA antibodies,

DIffuse proliferative GN (SLE)

98

ARF over days, Goodpastures syndrome, Wegener's granulomatosis (c-ANA), hemoptysis and ends with renal failure

Rapidly progressive crescentic GN

99

Cytokine injury to podocytes, loss of negative charge on GBM, proteinuria >3.5, fatty casts

nephrotic syndrome

100

Pitting edema due to hypoalbuminemia

Nephrotic syndrome

101

Pitting edema due to salt rentention

Nephritic syndrome

102

Hypercholesterolemia, hypogammaglobulinemia

nephrotic syndrome

103

Kimmelstiel-Wilson disease

Diabetic glomerulopathy

104

Diabetic glomerulopathy is type of systemic disease in nephrotic or nephritic syndrome?

Nephrotic syndrome

105

Two types of ATN

1. ischemic
2. nephrotoxic

109

Most common nephrotic syndrome in children, selective proteinuria, Hodgkin's lymphoma as secondary cause, negative IF, fusion of podocytes,

MCD

110

What is the treatment for MCD?

Steroid therpy

111

Negative IF, HIV secondary cause, nonselective proteinuria, hypertension early, poor prognosis

Focal Segmental Glomerulosclerosis

112

Most common nephrotic syndrome in adults, diffuse thickening of membranes (spikes and domes) beneath subepithelial deposits, subepithelial with granular ICs,

diffuse membranous gloemropathy

113

Common causes of oliguria

1. prerenal azotemia
2. acute GN
3. ATN
4. postrenal azotemia

114

Most common type of MPGN, HBV, HCV, subendothelial ICs with granular IF, tram tracks splitting of GBM, hypertension, hematuria

Type I MPGN

115

C3 nephritic factor, dense deposit disease, tram tracks, hypertension, hematuria

Type II MPGN

116

Nonenzymatic glycosylation of GBM

Diabetic glomerulopathy

117

Osmotic damage in diabetic glomerulopathy is due to?

sorbitol

118

Afferent/efferent hyaline arteriolosclerosis, nodular masses in mesangial matrix

Diabetic glomerulopathy

119

microalbuminuria as initial laboratory finding, what med should be prescribed in the begining?

Diabetic glomerulopathy

121

How is Alport inherited

X-linked, or autosomal dominant

122

autoantibodies to IV collagen in GBM, lipid accumulation in VECs-foam cells, sensorineural hearing loss and ocular abnormalities

Alport Syndrome

123

Persistent microscopic hematuria

Thin basement membrane disease (benign familial hematuria)

124

Most common cause of chronic glomerulonephritis

RPGN (rapidly progressive glomerulonephritis)

125

Most common cause of ARF

acute tubular necrosis (ATN)

128

Preprenal azotemia due to hypovolemia

Ischemic ATN

129

Ischemic ATN on endothelial cells

Net effect is vasoconstriction of afferent arterioles, which decreases GFR

130

Pigmented renal tubular cell casts

Ischemic ATN (in both types of ATN)

131

Aminoglycosides, heavy metals, damages in proximal tubule cells, tubular BM intact, hyperkalemia, increased BUN/creatinine

Nephrotoxic type of ATN

132

Acute pyelonephritis mos common cause

Tubulointerstitial nephritis (TIN)

133

What bacteria is most common cause of APN?

E. Coli

134

Vesicoureteral reflex (VUR)

Urine reflex into ureters during micturition

138

FENa equation

FENa=[(UNaxPcr)/(PnaxUcr)]x100

139

FENa < 1%

indicates good tubular function

140

FENa>2%

tubular dysfunction, highly predictive of ATN as cause of oliguria

141

Findings in APN and not lower UTIs

fever, flank pain, WBC casts in urine,

142

Treatment for APN

CIprofloxacin

143

Causes of chronic pyelonephritis (CPN)

VUR in young girls, lower urinary tract obstruction

144

U-shaped cortical scars overlying a blunt calyx, chronic inflammation, scarring, tubular atrophy, thyroidization

CPN

145

Acute drug-induced TIN

penicillin, methicillin, rifampin, sulfonamides, NSAIDs, diuretics

146

Reflux nehropathy causes what in children?

hypertension

147

abrupt onset fever, oliguria, rash, BUN:Cr ratio <15, eosinophilia

Acute drug-induced TIN

148

Chronic use of acetaminophen and aspirin for 3 or more years, renal papillary necrosis (medulla problem)

Analgesic nephropathy

149

Ring defect on IVP

Renal papillary necrosis of Analgesic nephropathy

150

Treatment for calcium stone, uric acid stone, struvite stone

1. HCTZ, cellulose phosphate (binds calcium in intestine)
2.allopurinol
3. surgery and antibiotics

151

How to prevent urate nephropathy?

Allopuriol before aggressive cancer therapy

152

Nuclear acid-fast inclusions in PCT

Chronic lead poisoning

153

Bence Jones Proteinuria produced tubular casts

Multiple Myeloma

154

What reaction dues BJ proteinuria produce?

casts with foreign body giant cell reaction

155

Nephrocalcinosis

multiple myeloma

156

Normocytic anemia; qualitative platelet defect: prolonged bleeding time

Chronic Renal Failure

157

Secondary hyperparathyroidism (HPTH)

Chronic Renal Failure

158

Hypertension, pericarditis, CHF, atherosclerosis

Chronic Renal Failure

159

Uremic frost (urea crystals deposit in skin)

Chronic Renal Failure

160

Hyperkalemia and metabolic acidosis, hypocalcemia, hyperphosphatemia

Chronic Renal Failure

161

Biomarker of kidney function

cystatin C

162

Free water clearance is zero (lack concentration and dilution), waxy/broad casts

Chronic Renal Failure

163

Most common renal disease in essential hypertension, hyaline arteriolosclerosis of arterioles in renal cortex, finely granular cortical surface due to atrophy of tubules, glomerular sclerosis

Benign Nephrosclerosis (BNS)

164

Most common cause of malignant hypertension

Pre-existing BNS

165

Onion skin appearance

Malignant hypertension

166

Initial treatment for malignant hypertension

IV nitroprusside

167

Most common cause of Renal infarction

emoblization from thrombi in left side of the heart

168

Hematuria, loss concentration, renal papillary necrosis, APN

sickle cell nephropathy

169

Anuria followed by ARF in pregnant women

Diffuse cortical necrosis

170

Dilated ureter and renal pelvis, with thinning of overlying cortex and medulla due to compression atrophy

Hydronephrosis

171

Most common metabolic abnormality causing calcium stones

hypercalciuria

172

Most common renal stone in adult

calcium oxalate

173

Most common renal stone in kids

calcium phosphate

174

Staghorn calculus, urease producers, urine is alkaline and smells like ammonia

magnesium ammonium phosphate (MAP)

177

Hamartoma associated with tuberous sclerosis

Angiomyolipoma

178

Von Hippel-Lindau disease (VHL), asbestos exposure,smoking, yellow tumor with renal vein invasion, PCT cells, poor prognosis, hemorragic

Renal cell carcinoma

179

Ectopic secretion EPO and PTH-related peptide

Renal cell carcinoma

180

Transitional cell carcinoma most common cause

smoking, phenacetin abuse, aniline dyes, cyclophosphamide

181

Squamous cell carcinoma

Renal pelvic cancer

182

Most common primary renal tumor in children

Wilm's tumor

183

Child with unilateral flank mass and hypertension

Wilm's Tumor

184

Genetic type associated with WIlm's Tumor

AD, chromosome 11,

185

WAGR w/ Wilm's tumor

Wilm's tumor, aniridia (absent iris), genital abnormalities, retardataion

186

Beckwith-Wiedemann Syndrome of Wilms Tumor

Wilm's tumor, enlarged body organs, hemihypertrophy of extremities

187

Wilm's tumor derived from

mesonephric mesoderm