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Acute RF + nephrotic syndrome Flashcards

1
Q

Increased BUN and creatinine

A

azotemia

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2
Q

Acute severe decrease in renal function (w/i days) marked by azotemia and oliguria (low production of urine)

A

Acute renal failure

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3
Q

ARF due to decreased blood flow to kidneys (e.g. cardiac failure)

A

Prerenal azotemia

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4
Q

ARF due to obstruction of urinary tract downstream from the kidney

A

Postrenal azotemia

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5
Q

serum BUN:CR>15;
FENa < 1%
urine osm > 500

A

Prerenal azotemia

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6
Q

Normal BUN:Cr

A

15

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7
Q

Serum BUN:CR< 15
FENa > 2%
urine osm < 500

A

postrenal azotemia (long-standing) or intrarenal (ATN)

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8
Q

Injury and necrosis of tubular epithelial cells –> necrotic cells plug tubules –> obstruction decreases GFR –> brown granular casts in urine

A

acute tubular necrosis

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9
Q

Causes of intrarenal azotemia

A

acute tubular necrosis
acute interstitial nephritis
renal papillary necrosis

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10
Q

Etiology of acute tubular necrosis (ATN)

A

ischemic or nephrotoxic

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11
Q

Decreased blood supply results in necrosis of tubules (often preceded by prerenal azotemia)

A

Ischemia ATN

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12
Q

Parts of the kidney that are most susceptible to ischemic ATN

A

proximal tubule and medullary segment of thick ascending limb

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13
Q

part of the kidney that is most susceptible to nephrotoxic ATN

A

proximal tubule

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14
Q
  1. Aminoglycosides
  2. Heavy metals (lead)
  3. Myoglobinuria (crush injury)
  4. Ethylene glycol (antifreeze –> oxylate crystals)
  5. radiocontrast dye
  6. urate (tumor lysis syndrome, prevent with allopurinol and hydration)
A

Causes of nephrotoxic ATN

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15
Q

Oliguria with brown granular cases,
elevated BUN and creatinine,
hyperkalemia w/ metabolic acidosis (inc anion gap),

A

clinical features of ATN

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16
Q

Treatment of ATN

A

supportive dialysis bc electrolyte imbalances can be fatal (NB: ATN is reversible)

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17
Q

Why does oliguria persist for 2-3 weeks after ATN?

A

Tubular cells (stable cells) take time to reenter the cell cycle and regenerate

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18
Q

Drug-induced HSR of interstitium and tubules –> intrarenal ARF

A

acute interstitial nephritis

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19
Q

eos in the urine

A

acute interstitial nephritis

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20
Q

3 causes of acute interstitial nephritis

A

NSAIDs, PCN, diuretics

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21
Q

oliguria + fever + rash + eos in urine days to weeks after starting a drug

A

acute interstitial nephritis

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22
Q

Treatment of acute interstitial nephritis

A

stop the drug!

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23
Q

possible complication of acute interstitial nephritis

A

renal papillary necrosis

24
Q

Gross hematuria + flank pain

A

renal papillary necrosis

25
1. chronic analgesic abuse (e.g long-term phenacetin or aspirin use) 2. diabetes mellitus 3. sickle cell trait or disease 4 severe acute pyelonephritis
renal papillary necrosis
26
glomerular disorders characterized by proteinuria > 3.5 g/day
nephrotic sydnrome
27
Nephrotic syndrome --> hypoalbuminemia presents as:
pitting edema
28
nephrotic syndrome --> hypogammaglobulinema presents as:
increased risk of infection
29
why does nephrotic syndrome --> hypercoagulable state?
loss of antithrombin III
30
nephrotic syndrome --> hyperlipidemia + hypercholesterolemia (liver trying to beef up urine)--> ?
fatty cases in urine
31
5 Hs of nephrotic syndrome
hypoalbuminemia hypogammaglobunemia hypercoagulable state hyperlipidemia & hypercholesterolemia
32
nephrotic syndromes
``` Minimal change disease (MCD) focal segmental glomerulosclerosis membranous nephropathy membranoproliferative GN diabetes mellitus systemic amyloidosis ```
33
most common cause of nephrotic syndrome in children; usually idiopathic; may be associated w/ Hodgkin lymphoma
Minimal change disease
34
normal glomeruli on H&E; lipid may be seen in proximal tubule cells effacement of foot processes (podocytes) on EM No immune complex deposits (negative IF) selective proteinuria (loss of albumin, not immunoglobulin)
MCD
35
Treatment of MCD
steroids! (excellent response bc damage is mediated by cytokines from T cells)
36
most common cause of nephrotic syndrome in Hispanics & African Americans; usually idiopathic but may be associated with HIV, heroin use, or sickle cell anemia
FSGS
37
focal and segmental sclerosis on H&E Effacement of foot processes on EM no immune complex deposits; negative IF
FSGS
38
Most common cause of nephrotic syndrome in Caucasian adults; usually idiopathic but may be associated with hepatitis B or C, solid tumors, SLE, or drugs (NSAIDs or penicillamine)
Membranous nephropathy
39
Thick glomerular basement membrane on H&E; | Due to immune complex deposition (granular IF); subepithelial deposits with "spike and dome" appearance on EM
membranous nephropathy
40
thick capillary membranes ("tram-track" appearance) on H&E; due to immune complex deposition (granular IF)
membranoproliferative glomerulonephritis
41
Type I membranoproliferative glomerulonephritis
subendothelial; associated with HBV & HCV; most associated with tram tracks
42
Type II membranoproliferative glomerulonephritis
dense deposit disease - intramembranous; associated with C3 nephritic factor
43
autoantibody that stabilizes C3 convertase, leading to overactivation of complement, inflammation, and low levels of circulating C3
C3 nephritic factor (type II glomerulonephritis)
44
two systemic diseases that can cause nephrotic syndrome
diabetes mellitus & systemic amyloidosis
45
NEG
nonenzymatic glycosylation (DM)
46
high blood sugar --> NEG of vascular membrane --> hyaline arteriolosclerosis of efferent > afferent arteriole --> high GFR --> hyperfiltration injury --> microalbuminuria --> nephrotic syndrome
how DM --> nephrotic syndrome
47
What slows progression of hyperfiltration-induced damage (--> nephrotic syndrome) in DM?
ACE inhibitors
48
Characterized by sclerosis of the mesangium with formation of Kimmelstiel-Wilson nodules
DM --> nephrotic syndrome
49
most commonly involved organ in systemic amyloidosis
kdney
50
amyloid deposits in mesangium -->
nephrotic syndrome
51
apple-green birefringence under polarized light
systemic amyloidosis
52
BUN:Cr < 15 FENa > 2% urine osm < 500
postrenal or intrarenal (ATN)
53
What does FENa represent?
tubular function (fractional excretion of sodium, lower is better)
54
What does urine osmolality represent?
ability to concentrate urine (low is bad)
55
what nephrotic syndrome is associated with lupus?
membranous nephropathy! (but they more often get diffuse proliferative glomerulonephritis - a nephritic syndrome)

Renal (22 decks)

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