Exam 1 Review Flashcards by Sarah Sanchez

what should we do during renal assessment if a spot/random urine is abnormal?

get albumin/creatinine ratio OR protein/creatinine ratio

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what are hyaline casts associated with? (4)

concentrated urine
fever
exercise
diuretics

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what are RBC casts and dysmorphic RBCs associated with?

glomerulonephritis (GN)

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what are WBC and WBC casts associated with? (2)

pyelonephritis
acute interstitial nephritis (AIN)

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what are pigmented/muddy brown casts associated with?

acute tubular necrosis (ATN)

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what are granular casts associated with?

acute tubular necrosis (ATN)

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what are broad, waxy casts associated with?

chronic kidney disease

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what are 6 absolute contraindications to biopsy?

uncorrected bleeding disorder
severe uncontrolled HTN
renal infection
neoplasm
hydronephrosis
uncooperative patient

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what are 4 relative contraindications to a biopsy?

solitary/ectopic kidney
horseshoe kidney
end-stage kidney disease
polycystic kidney disease

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what are the characteristics of nephritic syndrome?

“nEPHRIDiC”

Edema
Proteinuria <3.5 g/day
HTN
Reduced GFR
Increased BUN/SCr
Decreased urine output (oliguria)
Cola-colored urine

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what are the characteristics of nephrotic syndrome?

“nEPHROtiC”

Edema
Proteinuria >3.5 g/day
Hyperlipidemia
Reduced albuminemia
Osteomalacia
ti
Clots (hypercoagulation)

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a patient presents with a history of an infection 2 weeks ago. they have edema, syn-pharyngitic hematuria, and hypertension. On physical exam, there is oligura w/ smoky, dark urine. Dx?

post-strep glomerulonephritis

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EM shows large, dense subepithelial deposits or “humps” and IF shows deposits of IgG or C3 “starry appearance”. Dx?

post-strep GN

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a patient presents with a history of bouts of hematuruia 1-3 days after URI/cold/sore throat, with HTN, edema to hands and feet, flank pain, fever and malaise. Dx?

IgA nephropathy (Berger Disease)

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a patient presents with a history of URI or drug exposure 3 days ago. They have palpable purpura rash to LE and buttocks, abdominal pain, and arthalgia. Dx?

henoch-schonlein pupura (HSP)

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what is the diagnostic for henoch-schonlein purpura?

kidney biopsy

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kidney biopsy shows mesangial proliferation like IgAGN and skin biopsy shows leukocytoclastic vasculitis. Dx?

henoch-schonlein purpura

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determine classification: minimal mesangial lupus nephritis

Treatment?

class 1

ACEI / ARB

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determine classification: mesangial proliferative lupus nephritis

Treatment?

class 2

ACEI / ARB

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determine classification: focal lupus nephritis

Treatment?

class 3

corticosteroids + mycophenolate mofetil
OR
cyclophosphamide x 3-6 mo

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determine classification: diffuse lupus nephritis

Treatment?

class 4

corticosteroids + mycophenolate mofetil
OR
cyclophosphamide x 3-6 mo

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determine classification: membranous nephropathy

Treatment?

class 5

calcineurin inhibitor

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determine classification: advanced sclerosing lupus nephritis

Treatment?

class 6

dialysis + transplant

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which 2 lupus nephritis classes are the most active and require treatment?

class 3 and 4

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what are 3 supportive therapies for lupus nephritis?

ACEI / ARBs statin antiplatelet

a biopsy EM has a tram track appearance. Dx?

membranoproliferative GN

characterized by dysregulation of the alternative complement pathway, resulting in C3 deposition within the glomeruli and classified by EM biopsy

C3 glomerulopathy

a patient presents with renal failure post-infection, has drusen/macular degeneration, and acquired partial lipodystrophy. If shows C3 deposits and EM reveals tram tracks. Dx?

C3 glomerulopathy (type 2)

type 1 membranoproliferative GN whose biopsy shows IgG

immune-complex mediated

a patient presents with rapid decline in renal function w/wo pulmonary hemorrhage, cough, SOB, DOE, and hemoptysis. labs show elevated anti-GBM antibodies. Dx?

anti-glomerular basement membrane GN (Goodpasture's Disease)

biopsy shows crescent formation on LM and IF shows linear deposition of IgG along the basement membrane. Dx?

anti-glomerular basement membrane GN (Goodpasture's Disease)

supportive treatment for proteinuria?

ACEI / ARBs

supportive treatment for hypertension?

ACEI / ARB

supportive treatment for edema? (all 3 lines)

1: loop diuretics / lasix 2: thiazide 3: IV albumin

supportive treatment for dyslipidemia? (2)

statin exercise

supportive treatment for hypercoagulability? if recurrent? if PE or renal vein thrombosis?

warfarin x 3-6 months lifetime therapy indefinite therapy

what is the supportive therapy for focal segmental glomerulosclerosis that causes HTN, proteinuria, edema, or for HDL? what should be avoided?

statin / niacin (vit B3) fibrates

what are the 1st and 2nd line treatments for primary focal segmental glomerulosclerosis?

1: prednisone x 4-16 weeks 2: cyclosporine / tacrolimus

what is the treatment for secondary focal segmental glomerulosclerosis?

treat cause statin / niacin

biopsy LM shows GBM wall thickness and silver stain shows "spike and dome" pattern. Dx?

membranous nephropathy

what is the patho of diabetic nephropathy?

efferent arterioles become sclerotic = obstructs blood flow = increases glomerular pressure = afferent arteriole dilates = more blood into glomerulus = increased blood flow = increased GFR = increased kidney size = excretion of more matrix = glomerulosclerosis

what is the pathognomonic finding in diabetic nephropathy?

kimmelstiel-wilson nodules

a patient presents with HTN, heavy proteinuria, and retinopathy. Dx?

diabetic nephropathy

what is the difference between AL and AA?

AL = primary = amyloid light chain IG AA = secondary = acute phase reactants from chronic inflammatory diseases

a patient presents with nephrosis with significant proteinuria. LM appears pink under normal light and shows apple-green birefringence under polarized light. Dx?

renal amyloid

what is the treatment for thin basement membrane nephropathy?

trial with ACEI to reduce hematuria reassurance

a patient presents with uremia, decreased urine output, edema, hyper/hypotension. UA shows brown, muddy casts. Dx?

acute tubular necrosis

a patient presents with fever, rash, arthralgia, hematuria, proteinuria, and oliguria with eosinophilia. UA shows WBCs and WBC casts. Dx?

acute interstitial nephritis

what should we expect to see in labs in postrenal AKI?

urine sediment is bland +/- hematuria

treatment for postrenal AKI? (5)

relieve obstruction reduce/stop meds in + out urinary catheter, meds, surgery (BPH) remove stones if indicated +/- refer to nephrology

what is the most common manifestation of CKD?

hypertension

what is the patho of CKD?

nephron loss = hyperfiltration = fibrosis/sclerosis = loss of function

what criteria must be met to diagnose CKD? (2)

abnormal kidney function > 3mo OR abnormal structure > 3mo +/- abnormal renal function

what are 8 complications associated with CKD?

**"A Hungry Cat Drinks Often, Meowing Many Days"** **A**nemia **H**ypertension **C**ardiovascular disease **D**iabetes **O**steodystrophy **M**alnutrition **M**etabolic acidosis **D**yslipidemia

what is the most common complication of CKD?

hypertension

what type of anemia is common in CKD?

normocytic, normochromic (loss of erythropoietin)

what is the 2nd cause of death in CKD?

infection

when should dialysis start?

if patient develops AEIOU

what does AEIOU mean in terms of beginning dialysis?

Acid-base problems Electrolyte imbalance Intoxications Fluid Overload Uremic problems

what are the symptoms of uremia?

Fatigue Anemia Taste (metallic taste) Itchy Gastrointestinal (N/V) Uremic frost (tremors, AMS) Edema Dyspnea (shallow breaths)

what is the #1 complication with dialysis?

hypotension

what is the most common cause of death for hemodialysis and peritoneal dialysis?

cardiovascular disease

what is the most common complication of peritoneal dialysis?

peritonitis (staph aureus)

what is the most common cause of kidney transplantation?

diabetes mellitus

what is the treatment of choice for ESKD?

transplantation

what is the most common kidney fusion anomaly?

horseshoe kidney

what is the patho of horseshoe kidney?

kidneys move caudally in 5th-9th gestational weeks = trapped in lower abdomen

what does the horseshoe kidney get trapped under?

inferior mesenteric artery

autosomal dominant polycystic kidney disease-1 has a defect on chromosome ___

autosomal dominant polycystic kidney disease-2 has a defect on chromosome ___

patient presents with bilateral flank/back pain, hypertension, recurring hematuria, recurrent infections, and renal stones. Dx?

autosomal dominant polycystic kidney disease

labs show polycythemia vera, elevated phosphorus, elevated uric acid, and decreased vitamin D. what dx could this be?

autosomal dominant PKD

what is the treatment for HTN caused by autosomal dominant polycystic kidney disease?

ACEI / ARBs

what is the treatment for hematuria caused by autosomal dominant polycystic kidney disease?

hydration

what is the treatment for nephrolithiasis caused by autosomal dominant polycystic kidney disease? (2)

hydration stone passage/removal

what is the treatment for infected cyst/ pyelonephritis caused by autosomal dominant polycystic kidney disease?

IV ciprofloxacin

which chromosome is associated with autosomal recessive polycystic kidney disease?

chromosome 6

what are the signs and symptoms of autosomal recessive polycystic kidney disease?

**POTTER** Pulmonary hypoplasia Oligohydramnios Twisted skin Twisted face Extremity defect Renal agenesis

prenatal and postnatal US shows a "bright" cyst on enlarged kidneys/liver. Dx?

autosomal recessive polycystic kidney disease

a patient presents with recurrent stones, hematuria, UTIs, and decreased ability to concentrate urine. US shows paintbrush appearance and CT shows swiss cheese appearance. Dx?

medullary cystic kidney disease (sponge)

occurs more often in males, is incompatible with life d/t inability to make amniotic fluid, and we must counsel parents.

bilateral renal agenesis

a patient presents with papilledema of the eyes, abdominal bruits, and rales/edema heard in the lungs. Dx?

rental artery stenosis

what is the gold standard diagnosis for renal artery stenosis?

contrast renal angiography

what type of renal artery stenosis forms at the beginning of the renal artery where it branches off the aorta?

atherosclerosis

what type of renal artery stenosis shows a "string of beads/pearls" on contrast renal angiography?

fibromuscular dysplasia

treatment for acute renal artery stenosis?

IV heparin fibrinolytic

treatment for chronic renal artery stenosis?

percutaneous transluminal angioplasty +/- stent

pathophysiology of renal vein thrombosis?

endothelial damage = low blood flow = increased coag of blood (Vircho's triad)

patho of renal nutcracker syndrome?

left renal vein losses fat pad = compression of left renal vein by superior mesenteric artery

patient presents with left flank pain, hematuria, left varicocele (male), engorged left labia (females). Dx?

renal nutcracker syndrome

study of choice for renal nutcracker syndrome?

treatment for renal nutcracker syndrome? (2)

surgery with stent in left renal vein weight gain