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Phys/Patho Renal Exam > Schoenwald Renal Part One > Flashcards

Schoenwald Renal Part One Flashcards

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1
Q

This type of kidney disease is characterized by Azotemia (= elevated BUN and Creat +/- anuria)

A

Acute renal failure/AKI (mean the same thing)

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2
Q

Are these causes of prerenal or renal failure?

Hypovolemia, heart failure, sepsis, stenosis, atherosclerosis

A

Prerenal

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3
Q

In prerenal failure, the kidney responds by __________ sodium, water and urea

A

reabsorption

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4
Q

In prerenal failure, the Cr is __________ by the tubules while the BUN is ______ and _______

A

secreted, filtered and absorbed

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5
Q

Are these causes of prerenal or renal failure?

Acute tubular necrosis, glomerular disease and acute interstitial nephritis

A

Renal

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6
Q

What type of renal failure is this?

Obstruction (could be from enlarged prostate, kidney stones, etc)

A

Post-renal failure

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7
Q

Obstruction of the kidneys can cause __________. The _______ is the TOC in evaluation

A

hydronephrosis (when fluid backs up and causes the kidneys to swell

U/S

**Do not want CT w/ contrast because hard on kidneys

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8
Q 
Tell me about the labs in prerenal failure: 
FENa- 
BUN: Cr- 
Urine sodium- 
Urine osmolality- 
Specific gravity-
A 
FENa- <1%
BUN: Cr- >20:1
Urine sodium- <20 
Urine osmolality- >500
Specific gravity- > 1.020
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9
Q 
Tell me about the labs in renal failure: 
FENa- 
BUN: Cr- 
Urine sodium- 
Urine osmolality- 
Specific gravity-
A 
FENa- >1%
BUN: Cr- <20:1
Urine sodium- >20
Urine osmolality- <400
Specific gravity- <1.010
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10
Q

What are three mc causes of chronic renal failure?

A
  1. HTN
  2. DM
  3. Glomerulonephritis
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11
Q

What is the first stage of CRF?

A

Diminished renal reserve- GFR = 50%

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12
Q

What is the second stage of CRF?

A

Renal insufficiency- GFR 20-50% of normal

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13
Q

What are signs of second stage CRF?

A

HTN, anemia, polyuria (decreased concentrating ability)

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14
Q

What is the third stage of CRF?

A

Renal failure- GFR <20% of normal, edema and metabolic acidosis

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15
Q

What is the fourth stage of CRF?

A

End stage renal failure- FGR <5%

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16
Q

What are GI complications of chronic renal failure?

A

N/v and anorexia

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17
Q

What are cardiac complications of chronic renal failure?

A

Pericarditis, CHF, HTN

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18
Q

What type of anemia might a patient with chronic renal failure have?

A

normocytic, normochronic anemia (anemia of chronic disease)

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19
Q

What are hematologic complications of chronic renal failure?

A

normocytic, normochronic anemia (anemia of chronic disease), platelet dysfunction, increased susceptibility to infection

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20
Q

What are CNS complications of chronic renal failure?

A

polyneuropathy and encephalopathy

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21
Q

Segmental and focal glomerular disorders involve a _______ glomerulus whereas global and diffuse glomerular disorders involve ________ glomeruli

A

single, multiple

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22
Q

When a portion of the glomerulus is involved this is called what?

A

segmental

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23
Q

When all of the glomerulus is involved this is called what?

A

global

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24
Q

When some of the glomerulus is involved this is called what?

A

focal

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25
When all or almost all of the glomerulus is involved this is called what?
diffuse
26
There are three ways to evaluate the glomeruli microscopically. What are they?
1. Light Microscopy stains 2. Immunofluorescence (uses IgG, IgM, and IgA) 3. Electron microscopy
27
What three stains are used in the light microscopy stains?
Please Tri Sex - Periodic acid schiff (basement membrane & mesangium) - Trichrome- highlights fibrosis - Silver- highlights the basement membrane
28
What highlights the basement membrane & mesangium?
Periodic acid schiff of light microscopy
29
What highlights fibrosis?
Trichrome of the light microscopy
30
What highlights the basement membrane only?
Silver in light microscopy
31
What two patterns are seen in the immunofluorescence staining?
Linear and granular pattern
32
This is a reaction directed against antigen in glomerular basement membrane (goodpasture syndrome)
Linear pattern of immunofluorescence
33
This is a reaction against antigen/antibody immune complexes in glomerular basement membrane (SLE)
Granular pattern of immunofluorescence
34
Goodpasture syndome is a type of ________ pattern
linear
35
SLE is a _________ pattern
granular
36
This technique to evaluate glomeruli is not clinically used often but shows structure and immune complex deposition
electron microscopy
37
Most glomerular diseases are _________ and activate the ________
immunologic, activate the complement *result of either deposition of immune complexes or result of antibodies directly binding to antigens in the kidney (kind of like garbage smashed together)
38
You will most likely see hypoalbuminemia in nephritic or nephrotic syndrome?
Nephrotic
39
Hypoalbuminemia causes ________(inc/dec) osmotic pressure resulting in _______
decreased, edema
40
Nephrotic can lead to generalized edema called ________
anasarca
41
How does the liver respond to loss of albumin in nephrotic syndrome?
Liver respons to loss of albumin by increasing apolipoprotein (ALP) to compensate for low serum osmostic pressure = hyperlipidemia
42
Loss of albumin in liver in people with nephrotic syndrome ultimately leads to what?
hyperlipidemia
43
What are the four components of nephrotic syndrome?
1. Proteinuria >3.5 2. Hypoalbuminemia 3. Generalized edema 4. Hyperlipidemia
44
These are clinical findings of what disease? | N/V, periorbital edema, frothy urine
nephrotic syndrome *frothy urine because so much protein in urine
45
What will a UA analysis of nephrotic syndrome show?
Waxy casts and oval fat bodies in urine -lipids have maltese cross appearance
46
Waxy casts and oval fat bodies in urine
nephrotic syndrome
47
How do you ultimately dx nephrotic syndrome?
bx of kidneys
48
This disease is the most common cause of nephrotic syndrome in kids ages 2-8 yrs old and 2:1 male to female ratio
Minimal change disease
49
Minimal change disease causes selective _________ and is treated with ________-
proteinuria, steroids
50
Will minimal change disease show abnormalities in the glomeruli? What about immunofluorescence?
no abnormalities in glomeruli or immunofluorescence
51
On light microscopy, proximal convoluted tubule laden with lipid and protein
Minimal change disease
52
This is the second mc cause of nephrotic syndrome in children
Focal segmental glomerulosclerosis
53
This is the mc cause of nephrotic syndrome in adults
Focal segmental glomerulosclerosis
54
Is Focal segmental glomerulosclerosis immunologic in origin? Explain
Not immunologic in origin, however, IgM and C3 are trapped causing injury to epithelial cells
55
What causes a 30x increased risk in Focal segmental glomerulosclerosis compared to the rest of the population?
IV heroin usage
56
What is the outcome for Focal segmental glomerulosclerosis ?
No treatment, leads to chronic glomerulonephritis and end stage renal disease in 10 years
57
What does light microscopy of Focal segmental glomerulosclerosis show?
Segmental sclerosis of a few glomeruli
58
What does immunofluorescence of Focal segmental glomerulosclerosis show?
positive for IgM and c3
59
_______ occurs when the small blood vessels in the kidney (glomeruli), which filter wastes from the blood, become damaged and thickened. As a result, proteins leak from the damaged blood vessels into the urine (proteinuria)
Membranous glomerulonephropathy
60
________ causes nonselective proteinuria
Membranous glomerulonephropathy
61
How many people in Membranous glomerulonephropathy undergo remission, have proteinuria but stable renal fxn, then progress to end stage renal dz in 5-10 years?
1/3 for each category
62
Silver stain of this disease shows thickened basement membrane extending between immune complexes "spike and dome" formation
Membranous glomerulonephropathy
63
immunofluorescence of this disease shows a granular patter, positive for IgG
Membranous glomerulonephropathy
64
Electron microscopy of this disease shows subepithelial immune complexes
Membranous glomerulonephropathy
65
This is the single most common cause of end stage renal disease in the US?
Diabetic nephropathy
66
This disease presents clinically with albuminuria and hypertension
Diabetic nephropathy *albuminuria is a sign of a damaged kidney (shouldn't be peeing out albumin)
67
This test predicts the development of diabetic neuropathy?
microalbumin
68
A common light microscopy finding in this disease is diffuse glomerulosclerosis- thickening of the basement membrane
Dabetic nephropathy
69
This disease is characterized by acute renal failure, hypertension and hematuria
Nephritic syndrome
70
Leakage of protein
nephrotic
71
Leakage of RBCs
nephritic
72
What type of casts are present in nephrotic syndrome?
RBC casts
73
Cola colored or smoky brown urine
nephritic syndrome
74
Proteinuria <3 g/day
nephritic syndrome
75
Difference between glomerulonephropathy and glomerulonephritis?
Glomerulopathy is any disease of these glomeruli. Glomerulonephritis is the result of infection elsewhere in the body, such as strep throat/scarlet fever, upper respiratory infection or tonsillitis.
76
_________ has to do with glomerulonephritis whereas ________ has to do with glomerulonephropathy
nephritic, nephrotic
77
Postinfectious glomerulonephritis mc occurs how many weeks after a group A strep infection?
1-4 weeks
78
Those with Postinfectious glomerulonephritis have an increased or decreased serum complement?
decreased
79
What are two markers of previous strep infection?
ASO and AntiDNAse B
80
Silver stain shows "lumpy bumpy appearance"
Postinfectious glomerulonephritis
81
Microscopy in rapidly progressive glomerulonephritis is characterized by _________ cells in bowman capsule?
crescent cells
82
Goodpasture syndrome is type _____ glomerulonephritis where IgG binds directly to the glomerular basement membrane
Type I
83
Postinfectious glomerulopenritis, IgA nephropathy, SLE, and henoch-Schonlein purpura are type ____ glomerulopnephritis? (immune complex related)
Type II
84
Wegener granulomatosis is type ____ glomerulonephritis with no immune complexes
Type III
85
This is a disease in which is body's antibodies are directed against the glomerular basement membrane and attacks the lungs and kidneys
Goodpasture syndrome
86
Type ___ membranoproliferative glomerulonephritis is associated with Hep B, C and lupus
I
87
Type ___ membranoproliferative glomerulonephritis is associated with hypocomplementemia
II
88
This disease results from long term damage to glomeruli and ultimately sclerosis of glomeruli
chronic glomerulonephritis
89
On gross pathology for this disease, cortex is often pale and swollen due to lipid deposition and interstitial edema
chronic glomerulonephritis

Phys/Patho Renal Exam (4 decks)

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