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Flashcards in RSL - Renal Deck (61):
1

Extracellular compartments:

70kg

  • 60% water (42L)
    • 1/3 extracellular fluid (14L)
      • 75% interstitial fluid (10.5L)
      • 25% plasma (3.5L)
    • 2/3 intracellular fluid (28L)
      • 10% RBC volume (2.8L)
  • 40% non-water mass (28kg)

2

Fanconi Syndrome

(and causes)

Causes: PCT

  • Hereditary defects:
    • Wilson's disease,
    • tyrosinemia,
    • glycogen storage disease, 
  • Ischemia
  • Multiple myeloma
  • Nephrotoxins: Expired tetracyclines, tenofovir,
  • Lead poisoning

3

Bartter 

Thick ascending loop of henle: Na/K/2Cl

  • Hypokalemia
  • metabolic acidosis
  • Hypercalciuria

4

Gitelman syndrome

DCT

  • Hypokalemia
  • Hypomagnesemia
  • Metabolic alkalosis
  • Hypocalciuria

5

Liddle syndrome

Collecting duct: gain of function (ENaC)

  • Hypokalemia
  • metabolic alkalosis
  • decreased aldosterone

Treat: amiloride

6

Syndrome of apparent mineralocorticoid excess

Collecting duct: (11 B-hydroxysteroid dehydrogenase)

  • Hypokalemia,
  • hypertension
  • metabolic alkalosis

Can be acquired from glycyrrhetic acid

7

Na+ Low/High serum conc.

Low:Nausea, malaise, stupor, coma, seizures

High: Irritability, stupor, coma

8

K+ low/high [ ]

9

[Ca++] low/high

Low Ca++: tetany, seizures, GT prolongation

High Ca++: Kidney stones, Bone pain, diahrea, increased urinary freq, psychiatric changes

10

[Mg++] low/high

Low: Tetany, torsades de pointes, hypokalemia

High: Decreased DTRs, Lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia

11

[PO4---]

Low: Bone loss, osteomalacia, rickets

High: Renal stones, metastatic calcifications, hypocalcemia

12

Distal (type 1), urine pH >5.5

Defect in alpha intercalated cells

  • --> no H+ secretion
    • --> no HCO3- regeneration --> Acidosis
      • --> Kidney stones
    • --> no H+/K+ exchange --> hyperkalemia

Causes:

  • Amphotericin B, analgesic nephropathy, congenital anomalies of urinary tract

13

Proximal (type 2), Urine pH <5.5

PCT HCO3- reabsorption:

  • increased HCO3- excretion --> metabolic acidosis
  • Na+ not reabsorbed --> increased Acid/K+ loss
    • Hypokalemia, low pH

Causes: fanconi syndrome, CA inhibitors

14

Hyperkalemic (type 4), urine pH <5.5

Hypoaldosteronism

  • hyperkalemia --> decreased NH3 synthesis in PCT --> decreased NH4+ excretion

Causes:

  • Low aldosterone (diabetic hyporeninism, ACE inhibitors, ARBs, NSAIDS, heparin, cyclosporine, adrenal insufficiency
  • Aldosterone resistance (K+ sparing diuretics, nephropathy due to obstruction, TMP/SMX)

15

Post streptococcal Glomerulonephritis

(LM/IF/EM)

LM: Hypercellular glomeruli that is enlarged

IF: Starry sky granular appearance. Lumpy bumpy due to IgG, IgM, C3  deposition in GBM and mesangium

EM: Subepithelial imunne complex humps

16

Rapidly progressive Glomerulonephritis

(LM/IF)

LM/IF: Crescent moon shape consisting of fibrina and plasma proteins with glomerular parietal cells, monocytes, macrophages

17

Good pasture syndrome

Type II hypersensitivity --> ab to GBM and Alveolar basement membrane --> hematuria/hemoptysis

18

Granulomatosis with polyangitis (wegener)

PR3-ANCA / c-ANCA

(sinusitis; not seen in good pastures)

19

Microscopic polyangitis

MPO-ANCA / p-ANCA

20

Diffuse proliferative glomerulonephritis

(LM/IF/EM)

(DT/)

LM: wire looping of capillaries

IF: granular

EM: subendothelial and sumetimes intramembranous IgG based IC often with C3 deposition

Often nephrotic / nephritic concurrently

Dt/ SLE or membranoproliferative glomerulonephritis

21

IgA nephropathy (Berger disease)

(LM/IF/EM)

(disease)

LM: Mesangial proliferation

IF: IgA based IC deposits in mesangium

EM: mesangial IC deposits

DT/ Henoch-Schönlein purpura

22

Alport syndrome

(mutation)

(symptoms)

(EM)

Type IV collagen mutation --> thinning and splitting of GBM

Symp: Eyes, glomerulonephritis, sensorineural deafness

EM: Basket weave appearance

23

Membranoproliferative glomerulonephritis

Type 1: (EM/IF/PAS)(association)

Type 2: (EM)

1: hep B / C

  • EM: Subendothelial immune complex deposits
  • IF: granular
  • PAS (LM): tram track appearance

2:  C3 nephritic factor (stabolizes C3 convertase)

  • EM: intramembranous IC deposits; dense deposits

24

Focal segmental glomerulosclerosis

(LM/IF/EM)

(Associations)

Treat:

LM: Segmental sclerosis and hyalinosis

IF: Non-specific deposits of IgM, C3, C1

EM: Effacement of foot processes similar to minimal change disease

Associations: African american, Hispanic, HIV, Sickle cell, Obesity, Heroin use, IFN treatment, 

Treat: inconsistent response to steroids

25

Minimal change disease

(LM/IF/EM)

LM: normal

IF: negative

EM: podocyte effacement

Secondary to: immunization, recent infection

Treat: responds well to steroids

26

Membranous nephropathy

(LM/IF/EM)

(associations)

LM: diffuse capillary and GBM thickening

IF: Granular

EM: Spike and dome appearance with subepithelial deposits

Association:

  • ab to PLA2R,
  • ab to drugs (NSAIDS, penicillin),
  • infections (HBV,HCV),
  • SLE,
  • solid tumors

27

Amyloidosis:

(Deposits?)

Subepi, subendo, GBM, Mesangium

28

Diabetic glomerulonephropathy

(LM)

LM: mesangial expansion, GBM thickening, eosinophilic nodular glomerulosclerosis (kimmelstiel-wilson nodules)

29

Renal Cell carcinoma (histology)

PCT --> Polygonal Clear cells filled with lipid and carbohydrates

30

Renal Oncytoma

(origin, histology)

Epithelial cells --> Collecting duct

Large eosinophillic cells abundant with mitochondria and no perinuclear clearing

31

Wilms tumor (nephroblastoma)

(ages, presentation, genes)

2-4, unilateral flank mass + HTN (DT/renin secretion, WT1/WT2 on ch 11

32

Beckwith-Wiedman syndrome

  • Wilms tumor
  • Macroglossia
  • organomegally
  • Neonatal decreased glucose
  • Muscular hemihypertrophy

33

WAGR syndrome

  • Wilm's tumor
  • Aniridia
  • Genitourinary malformation
  • Mental retardation

34

Transition cell carcinoma risk factors

(urothelial CA)

Phenacetin

Smoking (napthylamine)

Analine dyes (azo dyes)

Cyclophosphamide

35

Chronic pyelonephritis: histology

36

Acute pyelonephritis: Imaging

CT

37

Drug induced interstitial nephritis 

(Tubulointerstitial nephritis)

38

Acute interstitial nephritis Drugs

39

Acute tubular necrosis: Stage 1

Oliguria; decreased GFR

  • High: BUN, creatinine, Kalemia, acid, urea

 

40

Acute Tubular necrosis: Stage 3

Recovery: polyuric

  • Low BUN, Creatinine, k+, Mg++, Ca++, PO4--, Na+

41

ATN: nephrotoxins

aminoglycosides, radiocontrast agents, lead, cisplatin

Crush injury (myoglobinuria)

Hemoglobinuria

42

Calcium stones (precipitation, X-Ray, Appearance, cause, treat)

Precipitation:

  • CaPO4: high pH
  • CaOxalate: low pH

X-Ray: Radiopaque

Appearance: Envelope (octahedron; square with X in middle)

Cause: hypercalciuria

Treat: Hydration, Thiazides, Citrate

43

Ammonium magnesium phosphate

(precipitaiton, X-Ray, Appearance, cause, treatment)

high pH

Radiopaque

Coffin lid

*AKA struvite; caused by urease positive bugs (Urea --> ammonia)

- often causes staghorn

Treat: infection, surgical removal of stone

44

Uric acid

(precipitaiton, X-Ray, Appearance, cause, treatment)

low pH

radiolucent

Rhomboid or rosettes

low urine volue, arid climates, hyperuricemia, increased cell turnover

Treat: alkalinization of urine, allopurinol

45

Cysteine

(precipitaiton, X-Ray, Appearance, cause, Test, treatment)

low pH

radiopaque

Hexagonal

Hereditary PCT transporter loss

(can form staghorn calliculi)

Sodium cyanide nitroprusside test

Treat: alkalinization of urine

46

Calcium stones (precipitation, X-Ray, Appearance, cause, treat)

Precipitation:

  • CaPO4: high pH
  • CaOxalate: low pH

X-Ray: Radiopaque

Appearance: Envelope (octahedron; square with X in middle)

Cause: hypercalciuria

Treat: Hydration, Thiazides, Citrate

47

Ammonium magnesium phosphate

(precipitaiton, X-Ray, Appearance, cause, treatment)

high pH

Radiopaque

Coffin lid

*AKA struvite; caused by urease positive bugs (Urea --> ammonia)

- often causes staghorn

Treat: infection, surgical removal of stone

48

Uric acid

(precipitaiton, X-Ray, Appearance, cause, treatment)

low pH

radiolucent

Rhomboid or rosettes

low urine volue, arid climates, hyperuricemia, increased cell turnover

Treat: alkalinization of urine, allopurinol

49

Cysteine

(precipitaiton, X-Ray, Appearance, cause, Test, treatment)

low pH

radiopaque

Hexagonal

Hereditary PCT transporter loss

(can form staghorn calliculi)

Sodium cyanide nitroprusside test

Treat: alkalinization of urine

50

Calcium stones (precipitation, X-Ray, Appearance, cause, treat)

Precipitation:

  • CaPO4: high pH
  • CaOxalate: low pH

X-Ray: Radiopaque

Appearance: Envelope (octahedron; square with X in middle)

Cause: hypercalciuria

Treat: Hydration, Thiazides, Citrate

51

Ammonium magnesium phosphate

(precipitaiton, X-Ray, Appearance, cause, treatment)

high pH

Radiopaque

Coffin lid

*AKA struvite; caused by urease positive bugs (Urea --> ammonia)

- often causes staghorn

Treat: infection, surgical removal of stone

52

Uric acid

(precipitaiton, X-Ray, Appearance, cause, treatment)

low pH

radiolucent

Rhomboid or rosettes

low urine volue, arid climates, hyperuricemia, increased cell turnover

Treat: alkalinization of urine, allopurinol

53

Cysteine

(precipitaiton, X-Ray, Appearance, cause, Test, treatment)

low pH

radiopaque

Hexagonal

Hereditary PCT transporter loss

(can form staghorn calliculi)

Sodium cyanide nitroprusside test

Treat: alkalinization of urine

54

Calcium stones (precipitation, X-Ray, Appearance, cause, treat)

Precipitation:

  • CaPO4: high pH
  • CaOxalate: low pH

X-Ray: Radiopaque

Appearance: Envelope (octahedron; square with X in middle)

Cause: hypercalciuria

Treat: Hydration, Thiazides, Citrate

55

Ammonium magnesium phosphate

(precipitaiton, X-Ray, Appearance, cause, treatment)

high pH

Radiopaque

Coffin lid

*AKA struvite; caused by urease positive bugs (Urea --> ammonia)

- often causes staghorn

Treat: infection, surgical removal of stone

56

Uric acid

(precipitaiton, X-Ray, Appearance, cause, treatment)

low pH

radiolucent

Rhomboid or rosettes

low urine volue, arid climates, hyperuricemia, increased cell turnover

Treat: alkalinization of urine, allopurinol

57

Cysteine

(precipitaiton, X-Ray, Appearance, cause, Test, treatment)

low pH

radiopaque

Hexagonal

Hereditary PCT transporter loss

(can form staghorn calliculi)

Sodium cyanide nitroprusside test

Treat: alkalinization of urine

58

Calcium stones (precipitation, X-Ray, Appearance, cause, treat)

Precipitation:

  • CaPO4: high pH
  • CaOxalate: low pH

X-Ray: Radiopaque

Appearance: Envelope (octahedron; square with X in middle)

Cause: hypercalciuria

Treat: Hydration, Thiazides, Citrate

59

Ammonium magnesium phosphate

(precipitaiton, X-Ray, Appearance, cause, treatment)

high pH

Radiopaque

Coffin lid

*AKA struvite; caused by urease positive bugs (Urea --> ammonia)

- often causes staghorn

Treat: infection, surgical removal of stone

60

Uric acid

(precipitaiton, X-Ray, Appearance, cause, treatment)

low pH

radiolucent

Rhomboid or rosettes

low urine volue, arid climates, hyperuricemia, increased cell turnover

Treat: alkalinization of urine, allopurinol

61

Cysteine

(precipitaiton, X-Ray, Appearance, cause, Test, treatment)

low pH

radiopaque

Hexagonal

Hereditary PCT transporter loss

(can form staghorn calliculi)

Sodium cyanide nitroprusside test

Treat: alkalinization of urine