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Renal-Genitourinary > Exam 1 Review > Flashcards

Exam 1 Review Flashcards

1
Q

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

A

get albumin/creatinine ratio OR protein/creatinine ratio

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2
Q

what are hyaline casts associated with? (4)

A

concentrated urine
fever
exercise
diuretics

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3
Q

what are RBC casts and dysmorphic RBCs associated with?

A

glomerulonephritis (GN)

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4
Q

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

A

pyelonephritis
acute interstitial nephritis (AIN)

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5
Q

what are pigmented/muddy brown casts associated with?

A

acute tubular necrosis (ATN)

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6
Q

what are granular casts associated with?

A

acute tubular necrosis (ATN)

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7
Q

what are broad, waxy casts associated with?

A

chronic kidney disease

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8
Q

what are 6 absolute contraindications to biopsy?

A

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

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9
Q

what are 4 relative contraindications to a biopsy?

A

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

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10
Q

what are the characteristics of nephritic syndrome?

A

“nEPHRIDiC”

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

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11
Q

what are the characteristics of nephrotic syndrome?

A

“nEPHROtiC”

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

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12
Q

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?

A

post-strep glomerulonephritis

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13
Q

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

A

post-strep GN

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14
Q

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?

A

IgA nephropathy (Berger Disease)

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15
Q

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?

A

henoch-schonlein pupura (HSP)

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16
Q

what is the diagnostic for henoch-schonlein purpura?

A

kidney biopsy

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17
Q

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

A

henoch-schonlein purpura

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18
Q

determine classification: minimal mesangial lupus nephritis

Treatment?

A

class 1

ACEI / ARB

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19
Q

determine classification: mesangial proliferative lupus nephritis

Treatment?

A

class 2

ACEI / ARB

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20
Q

determine classification: focal lupus nephritis

Treatment?

A

class 3

corticosteroids + mycophenolate mofetil
OR
cyclophosphamide x 3-6 mo

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21
Q

determine classification: diffuse lupus nephritis

Treatment?

A

class 4

corticosteroids + mycophenolate mofetil
OR
cyclophosphamide x 3-6 mo

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22
Q

determine classification: membranous nephropathy

Treatment?

A

class 5

calcineurin inhibitor

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23
Q

determine classification: advanced sclerosing lupus nephritis

Treatment?

A

class 6

dialysis + transplant

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24
Q

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

A

class 3 and 4

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25
Q

what are 3 supportive therapies for lupus nephritis?

A

ACEI / ARBs
statin
antiplatelet

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26
Q

a biopsy EM has a tram track appearance. Dx?

A

membranoproliferative GN

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27
Q

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

A

C3 glomerulopathy

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28
Q

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?

A

C3 glomerulopathy (type 2)

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29
Q

type 1 membranoproliferative GN whose biopsy shows IgG

A

immune-complex mediated

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30
Q

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?

A

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

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31
Q

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

A

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

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32
Q

supportive treatment for proteinuria?

A

ACEI / ARBs

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33
Q

supportive treatment for hypertension?

A

ACEI / ARB

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34
Q

supportive treatment for edema? (all 3 lines)

A

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

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35
Q

supportive treatment for dyslipidemia? (2)

A

statin
exercise

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36
Q

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

A

warfarin x 3-6 months
lifetime therapy
indefinite therapy

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37
Q

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

what should be avoided?

A

statin / niacin (vit B3)
fibrates

38
Q

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

A

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

39
Q

what is the treatment for secondary focal segmental glomerulosclerosis?

A

treat cause
statin / niacin

40
Q

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

A

membranous nephropathy

41
Q

what is the patho of diabetic nephropathy?

A

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

42
Q

what is the pathognomonic finding in diabetic nephropathy?

A

kimmelstiel-wilson nodules

43
Q

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

A

diabetic nephropathy

44
Q

what is the difference between AL and AA?

A

AL = primary = amyloid light chain IG

AA = secondary = acute phase reactants from chronic inflammatory diseases

45
Q

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

A

renal amyloid

46
Q

what is the treatment for thin basement membrane nephropathy?

A

trial with ACEI to reduce hematuria
reassurance

47
Q

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

A

acute tubular necrosis

48
Q

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

A

acute interstitial nephritis

49
Q

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

A

urine sediment is bland
+/- hematuria

50
Q

treatment for postrenal AKI? (5)

A

relieve obstruction

reduce/stop meds

in + out urinary catheter, meds, surgery (BPH)

remove stones if indicated

+/- refer to nephrology

51
Q

what is the most common manifestation of CKD?

A

hypertension

52
Q

what is the patho of CKD?

A

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

53
Q

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

A

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

54
Q

what are 8 complications associated with CKD?

A

“A Hungry Cat Drinks Often, Meowing Many Days”

Anemia
Hypertension
Cardiovascular disease
Diabetes
Osteodystrophy
Malnutrition
Metabolic acidosis
Dyslipidemia

55
Q

what is the most common complication of CKD?

A

hypertension

56
Q

what type of anemia is common in CKD?

A

normocytic, normochromic (loss of erythropoietin)

57
Q

what is the 2nd cause of death in CKD?

A

infection

58
Q

when should dialysis start?

A

if patient develops AEIOU

59
Q

what does AEIOU mean in terms of beginning dialysis?

A

Acid-base problems
Electrolyte imbalance
Intoxications
Fluid Overload
Uremic problems

60
Q

what are the symptoms of uremia?

A

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

61
Q

what is the #1 complication with dialysis?

A

hypotension

62
Q

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

A

cardiovascular disease

63
Q

what is the most common complication of peritoneal dialysis?

A

peritonitis (staph aureus)

64
Q

what is the most common cause of kidney transplantation?

A

diabetes mellitus

65
Q

what is the treatment of choice for ESKD?

A

transplantation

66
Q

what is the most common kidney fusion anomaly?

A

horseshoe kidney

67
Q

what is the patho of horseshoe kidney?

A

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

68
Q

what does the horseshoe kidney get trapped under?

A

inferior mesenteric artery

69
Q

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

A

16

70
Q

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

A

4

71
Q

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

A

autosomal dominant polycystic kidney disease

72
Q

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

A

autosomal dominant PKD

73
Q

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

A

ACEI / ARBs

74
Q

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

A

hydration

75
Q

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

A

hydration
stone passage/removal

76
Q

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

A

IV ciprofloxacin

77
Q

which chromosome is associated with autosomal recessive polycystic kidney disease?

A

chromosome 6

78
Q

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

A

POTTER

Pulmonary hypoplasia
Oligohydramnios
Twisted skin
Twisted face
Extremity defect
Renal agenesis

79
Q

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

A

autosomal recessive polycystic kidney disease

80
Q

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?

A

medullary cystic kidney disease (sponge)

81
Q

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

A

bilateral renal agenesis

82
Q

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

A

rental artery stenosis

83
Q

what is the gold standard diagnosis for renal artery stenosis?

A

contrast renal angiography

84
Q

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

A

atherosclerosis

85
Q

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

A

fibromuscular dysplasia

86
Q

treatment for acute renal artery stenosis?

A

IV heparin
fibrinolytic

87
Q

treatment for chronic renal artery stenosis?

A

percutaneous transluminal angioplasty +/- stent

88
Q

pathophysiology of renal vein thrombosis?

A

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

89
Q

patho of renal nutcracker syndrome?

A

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

90
Q

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

A

renal nutcracker syndrome

91
Q

study of choice for renal nutcracker syndrome?

A

US

92
Q

treatment for renal nutcracker syndrome? (2)

A

surgery with stent in left renal vein
weight gain

Renal-Genitourinary (7 decks)

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