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Nayla patho > 3- Renal > Flashcards

3- Renal Flashcards

1
Q

What is nephrotic syndrome

A

when systemic diseases (diabetes, SLE, amyloidosis) cause direct injury to BM of glomeruli, making it more permeable so molecules can leak out

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2
Q

In Nephrotic syndrome, what are your abnormal labs

A

Proteinuria (up to 3.5g/day exits plasma into urine)
Hypoalbuminemia (less in blood, more in urine)
Edema (low plasma oncotic pressure and active RAS lets fluid escape into tissues
Hyperlipidemia/Lipiduria (liver makes more lipoproteins)

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3
Q

What is Nephritic syndrome

A

Inflammatory damage to glomerular capillaries, with leukocytes and necrosis of glomeruli (acute post-strep glomerulonephritis) –>chronic renal failure

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4
Q

What are symptoms of Nephritic syndrome

A 
hematuria, proteinuria, RBC casts in urine
low GFR
high BUN/Cr
oliguria
mild edema
HTN
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5
Q

How can you tell the difference between Nephrotic and Nephritic syndrome

A

Renal biopsy! for definitive diagnosis

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6
Q

What is membranous GMN

A

immune mediated thickening f BM due to massive immune complex deposits-
WITHOUT inflammatory cells in glomeruli, or RBC in urine

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7
Q

What is the most common cause of Nephrotic syndrome in adults

A

Membranous glomerulonephritis

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8
Q

What does membranous GMN show on EM

A

Thick BM due to immune deposits (very granular on IF)

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9
Q

How do you treat membranous GMN

A

With progressive renal failure: corticosteroids
Spontaneous remission: 25%
Persistent proteinuria with stable renal function: 50%

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10
Q

What is minimal change disease

A

Nephrotic syndrome with the fusion of podocytes

No glomerular changes OR Ig deposits

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11
Q

What is the MCC of nephritic syndrome in kids

A

Minimal change disease

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12
Q

How do you diagnose Minimal change disease

A

EM to see podocyte fusion

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13
Q

How do you treat Minimal change disease

A

8 weeks corticosteroid therapy (complete remission of proteinuria in most kids and adults)

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14
Q

How do calcium stones present

A

Calcium is hyper excreted leading to abnormal calcium metabolism, hyperparathyroidism, bone disease, etc.

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15
Q

What is a Struvite stone

A

made of magnesium ammonia phosphate as a complication of UTI (Proteus converts urea to ammonia) creating Staghorn calculi

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16
Q

What is a uric acid stone

A

radiolucent stone that occurs along with gout or leukemia (rapid cell turnover d/t cancer tx)

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17
Q

What is a Cysteine stone

A

inborn error of amino acid metabolism

appears with cystinosis

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18
Q

How do you diagnose and treat renal stones

A

Biopsy for definitive Dx

Most are in renal pelvis or bladder and can be voided if small. If larger, surgery or lithotripsy

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19
Q

What are symptoms of all renal stones

A

hematuria and urinary colic (spasmodic pain due to ureter obstruction)

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20
Q

Majority of urinary tract neoplasms are

A

Renal cell carcinoma (adenocarcinoma)

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21
Q

What is RCC associated with

A

Men 55 y/o, cigarette smokers

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22
Q

What do RCC look like on biopsy

A

yellow, boscillated, encapsulated

+/- extending through renal castle into fat, adrenals, or renal vein

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23
Q

What do RCC look like grossly

A

sharply demarcated masses from upper or lower pole of kidney

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24
Q

What are symptoms of RCC

A 
Hematuria
Flank pain
palpable mass
(non-specifically, wt loss, fever, HTN) 
(rarely, polycythemia, hyperalcemia)
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25
What is a transitional cell carcinoma
papillary neoplasm of the renal pelvis that looks like bladder carcinoma Has good prognosis if grade 1/2
26
What are symptoms of transitional cell carcinoma
Hematuria, renal obstruction
27
What is the most common renal tumor in kids and infants
Wilm's tumor, present at birth but doesn't manifest until 2-4 y/o
28
What does Wilm's tumor look like
solitary or multi nodular, palpable abdominal mass | -If malignant, will be composed of blastic or immature cells
29
What is the pathology of Acute post-strep GMN
- Our body has an antibody response to strep antigens (1-2 wks s/p GABHS throat or skin infx) leading to immune complex deposits in BM - In BM, Ig activates complement and inflammatory cells (PMN/monocytes) - Inflam. mediators cause hypercellularity of glomerulus - Leads to nephritic syndrome
30
Who does Acute post-strep GMN affect
Usu. 6-10 y/o but is uncommon in U.S. d/t abx | Most kids recover (1-2% develop rapidly progressive, crescentic GMN)
31
What does acute post-strep GMN look like on IF
Granular deposits (IgG and complement)
32
What is the "classic case" related to acute post-strep GMN
Kid abruptly develops malaise, fever, nausea, oliguria, and hematuria (coca cola) 1-2 weeks after recovering from sore throat -He has RBC casts in urine, proteinuria, periorbital edema, and mild HTN (nephritic syndrome)
33
What is Good Pasteur's
AI disease w/ antibodies that form against body's own BM (collagen type 4)
34
What is the pathophys of Good Pasteur's
- In glomeruli, abs rupture the BM - Macrophages exit and build up in urinary space (form crescents) - Crescents compress capillary loops no there is no blood flow, no GFR, and anuria
35
Do patients usually recover from Good Pasteur's
No, they need dialysis of transplant | unlike Acute post-strep GMN which most kids recover from
36
What is Adult PKD
Autosomal dominant condition in which body forms multiple serous or purulent cysts (larger) that destroy the entire parenchyma, bilaterally -Cysts derived from obstructed tubules d/t atrophic lining in nephron
37
What are early vs late signs of adult PKD
- Early: dull, aching pain in abdomen or back (pressure of expanding cysts) - After rupture, hematuria - Long term, renal failure and HTN
38
What is childhood PKD
Autosomal recessive disorder with enlarged bilateral kidneys that don't function from birth Cysts are in cortex and medulla causing renal failure after birth (smaller but plentiful)
39
What is acute cystitis
When bacteria reach the urinary tract by ascending infection s/p sex, urinary cath, or surgery (usually no obvious cause) W>M
40
What are RF for acute cystitis
``` Pregnancy (estrogen dilates the urethra and uterus) DM Immunosuppression tumors BPH ```
41
What is pyelonephritis
Suppurative infection of kidneys with abscesses that can invade the kidney and fill the renal pelvis Resolves on its own if healthy, but may need abx
42
What do pyelonephritis cysts look like
round, yellow, raised abscesses on the renal surface surrounded by areas of congestion
43
What usually causes pyelonephritis
E. coli (and many gram - rods) | Staph and strep are NOT common
44
What are symptoms of pyelonephritis
sudden onset sharp pain in CVA, chills, fever, malaise
45
What is the most common urinary tract neoplasm
Urinary bladder cancer (2x more common than RCC, but 1/2 the deaths!)
46
What are RF for urinary bladder cancer
Male, 60-80 years old SMOKING (proportionate to # smoked) Industrial carcinogens (Azo dye, rubber, textile chemicals) Schistosome eggs (Egypt)
47
What is urinary bladder cancers
Tumor usually made of transitional cells that can extend into muscle or adjacent pelvic organs
48
What are symptoms of urinary bladder cancer
hematuria, dysuria, lower abdominal pain
49
What is the prognosis of urinary bladder cancer
Excellent if Stage 1 (98%) poor if Grade D (15%) early mets go to pelvis lymph nodes first Treat with surgical resection and chemotherapy
50
What is horseshoe kidney
when the kidney fees at the midline during fetal development. Doesn't cause a problem unless it obstructs renal flow
51
What is the most common renal development disorder
Renal cystic dysplasia
52
What is renal cystic dysplasia
Abnormal differentiation of renal structures during embryonic period Unilateral -Kidneys don't function but NO association with malignancy
53
What does renal cystic dysplasia look like histologically
tube like structures enclosed by mesenchyme foci of cartilage immature glomeruli and tubules
54
What is renal papillary necrosis
complication of papillary necrosis seen in diabetics | -Ischemia and grey-white Necrosis at the tips of renal pyramids
55
What is the #1 complication of renal papillary necrosis
Obstruction from a necrotic pyramid tip breaking off and lodging in ureter
56
What is the hallmark of chronic pyelonephritis
Scarring in the pelvis or calyces causing papillary blunting
57
What does chronic pyelonephritis look like histologically
Dilated glossy tubules that look like thyroid tissue (thyroidization)
58
What is a common cause of acute renal failure
Acute tubular necrosis (s/p MI, cardiac arrest, or hypotensive shock)
59
What is acute tubular necrosis
reduced renal blood flow in cortex and tubules
60
What are Tamm Horsfall proteins
Proteins released by renal tubule cells that lodge in distal tubules and collecting ducts, due to acute tubular necrosis
61
What is Kimmelstiel Wilson disease
Nodular glomerulosclerosis d/t diabetic neuropathy
62
What renal changes occur in diabetics
1. Vascular: thick walls and narrow vessels d/t hyaline in arteriole leading to ischemia and tubular atrophy 2. Interstitial changes: kidneys prone to bacterial infections causing peel. If recurrent, destroys kidneys
63
What is "lumpy bumpy" pattern
acute post-strep GMN and Membranous GMN | -It is due to Immune complexes that give the lumpy bumpy appearance on IF
64
What is "linear" pattern
Good Pasteur's has antibodies, but no immune complexes so it is more linear
65
Where are urinary tract obstructions usually
Below the level of glomeruli
66
What do all urinary tract obstructions usually lead to
ESRD

Nayla patho (9 decks)

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