Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Internal Medicine - Nephro and gastro > DDX Kidney lecture > Flashcards

DDX Kidney lecture Flashcards

1
Q

Pain - LITRAAA

A

localization, intensity, type, radiation, aggravating – alleviating factors, accompanying signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pain - Sudden onset, cramping

A

Obstruction of the urinary tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pain - Blunt, unilateral

A

renal cyst infection/bleeding,
tumor,
renal infarct,
renal vein thrombosis,

with fever and UTI:
pyelonephritis,
abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pain - Blunt, bilateral

A

interstitial nephritis,
renal edema,
glomerular diseases are usually not painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pain - Dysuria, pollakisuria

A

Lower UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hematuria - Macroscopic

A

suggest urological origin (but may be seen in IgA nephropathy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hematuria - Microscopic

A

may be either urological or nephrological in origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hematuria - Urology causes

A 
Renal/uroepithelial tumor, 
stone, 
UTI (eg. cystitis), 
renal cyst rupture, 
papillary necrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hematuria - Nephrological causes

A

Glomerulonephritis,
Alport-syndrome,
thin basement membrane disease,
acute interstitial nephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hematuria - Healthy person

A

Dipstick negative, sediment < 3-4 RBC/high power field

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Hematuria - isomorphic RBCs

A

Urolological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hematuria - dysmorphic RBCs

A

Nephrological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Proteinuria and albuminuria - „clinically significant” proteinuria:

A

> 500mg/day (>50mg/mmol creatinine)

Dipstick usually positive for proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Proteinuria and albuminuria - microalbuminuria

A

> 30mg/day (30 mg/mmol)

May suggest early diabetic nephropathy

Is associated with cardiovascular events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Proteinuria - „nephrotic” proteinuria

A

> 3-3.5g/day (0.3-0.35 g/mmol) that is accompanied with the nephrotic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Proteinuria - Spurious proteinuria (non renal)

A

inaccurate sampling,
blood in the urine,
colpitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Proteinuria - Functional

A

temporary:
fever,
intense physical exercise,
venous congestion

Orthostatic proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Proteinuria - Glomerular: glomerulonephritis, glomerulopathy

A

Damaged glomerular tuft spills albumin and variable amount of globulins in the primary filtrate

(more severe damage more globulin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Proteinuria - Tubular proteinuria

A

Damage to the proximal tubule leads to failure to reabsorb small molecular weight proteins

(eg. Fanconi syndrome, interstitial nephritis)

20
Q

Proteinuria - „overflow” proteinuria

A

High amount of small molecular weight protein in the serum is being filtered and overflows reabsorption

(kappa/lambda light chains a.k.a. Bence-Jones proteinuria)

21
Q

Urinary electrophoresis - Albumin spike

A

AL amyloidosis

22
Q

Urinary electrophoresis - Gamma spike

A

Multiple myeloma (often w/ albumin spike)

23
Q

Urinary electrophoresis - General increase

A

Nephrotic syndrome

24
Q

Immunological tests - ANA (anti-nuclear antibody)

A

SLE, other systemic autoimmune disease

25
Q

Immunological tests - ANCA (anti-neutrophil cytoplasmic antibody)

A

Small vessel vasculitis (pauci-immune crescentic GN)

26
Q

Immunological tests - Anti-dsDNS antibody

A

SLE

27
Q

Immunological tests - SS-A, SS-B antibody

A

Sjögrens’ syndrome, SLE

28
Q

Immunological tests - Anti-GBM antibody

A

Goodpasture syndrome

29
Q

Immunological tests - Anti-streptolysin antibody

A

Poststreptococcal glomerulonephritis

30
Q

„Major” nephrology syndromes

A
  • Nephritis
  • Rapidly progressive glomerulonephritis (RPGN)
  • Nephrosis
  • Acute kidney injury
  • Asymptomatic proteinuria and/or haematuria
  • Chronic kidney disease
31
Q

Nephritic syndrome hallmarks

A
  • Hematuria
  • Proteinuria
  • Urinary casts (RBC)
  • Hypertension
  • Edema
  • Oliguria
  • Decreased GFR
32
Q

Differential diagnosis hallmarks: Postinfectiosus glomerulonephritis

A

subacute endocarditis, abscess

33
Q

Differential diagnosis hallmarks: Membranoproliferative glomerulonephritis

A

Lupus nephritis,
cryoglobulinemia,
monoclonal immunoglobulin deposition

„dens-deposit” disease,
C3 glomerulonephritis

34
Q

Rapidly progressive glomerulonephritis syndrome (RPGN) - general overview

A

Rapid worsening of kidney function (weeks/months)

Nephritic urinary findings
• Glomerular hematuria, variable proteinuria
• Cellular (RBC) casts

Frequent systemic symptoms
• vasculitis
• Pulmonary (bleeding)
• upper airway infection (usually occurs DURING an ongoing mucosal infection)
• Arthritis
• Fever
• Neuropathy
35
Q

RPGN Light microscope

A

Crescents with parietal cell proliferation

Glomerular necrosis

36
Q

Differentiation of crescent glomerulonephritis with RPGN: 1. Linear immunglobulin deposition

A
  • Anti-GBM antibodies
  • Renal +/- pulmonary symptoms
  • Goodpasture disease
37
Q

Differentiation of crescent glomerulonephritis with RPGN: 2. Granular immunglobulin deposition

A
  • These are immuncomplexes

* eg. lupus nephritis, IgA nephropathy

38
Q

Differentiation of crescent glomerulonephritis with RPGN: 3. No immunglogulin deposition

A 
„pauci-immune” = „hardly any”
• These are ANCA vasculitides
• Granulomatosis with polyangitis
• Microscopic polyangitis
• Eosinophil granulomatosis with polyangitis
39
Q

Nephrotic syndrome overview

A
  • Proteinuria (usually >3 g/day)
  • Hypolbuminemia
  • Edema
  • Hyperlipoproteinemia
  • Thromboembolic events
  • GFR may be normal
40
Q

Differential diagnosis of the nephrotic syndrome: Primary renal disease (no other organ involvement)

A

– Primary membranous glomerulopathy (usually anti-PLA2 receptor antibody positive)
– Minimal change nephropathy
– Primary focal segmental glomerulosclerosis

41
Q

Differential diagnosis of the nephrotic syndrome: Renal manifestation of a systemic disease

A

– Diabetic nephropathy
– Amyloidosis
– Secondary FSGS (congenital podocytopathy, HIV, extreme obesity, glomerular loss for an unrelated reason)

– Secondary membranous glomerulopathy (lupus nephritis, malignancy, drugs, hepatitis B/C, syphilis, NSAIDs, TNF- inhibitors)

42
Q

Indications for renal biopsy

A
  • Nephrotic syndrome
  • Nephritic syndrome
  • RPGN
  • Asymptomatic proteinuria in the 1-3g/day range (particulary if GFR declines or proteinuria increases)
  • Acute kidney injury (intrinsic)
  • If there is a suspicion that it is not caused by acute tubular necrosis
  • Chronic kidney disease of unknown origin
  • But not if on US small scarred kidneys
  • Dysfunction of transplanted kidney
43
Q

Contraindications to renal biopsy

A
  • Uncooperative patient
  • Single kidney
  • Multiple renal cysts
  • Renal neoplasm
  • Acute pyelonephritis
  • Uncontrolled bleeding diathesis
  • Uncontrolled blood pressure (BP > 160/95 mmHg)
44
Q

Asymptomatic urinary abnormality - Asymptomatic proteinuria (usually 0,5-2g/day)

A

Glomerular diseases eg.

  • Early diabetic nephropathy
  • secondary FSGS
  • Hypertensive nephropathy
45
Q

Asymptomatic urinary abnormality - Asymptomatic microhaematuria

A

Glomerular diseases eg.

  • IgA nephropathy
  • Alport syndrome
  • Thin basement membrane abnormality

Internal Medicine - Nephro and gastro (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions