Exam 2 Flashcards
What is hematuria?
3 RBC seen on >2 occasions
Bence Jones proteins?
Plasma Cell Myeloma
Glomerular protein- albumin?
diabetic nephropathy
What causes urinary casts?
Tamm- Horsfall protein in tubules
What cast is seen with concentrated urine, fever, exercise, diuretics?
Hyaline casts
RBC casts?
GN
WBC casts?
Pyelo, interstitial nephritis
Pigemented/muddy brown casts?
acute tubular necrosis (ATN)
Waxy casts
late CKD
Granular casts
ATN
Normal BUN?
7-30 mg/dL
Normal Creatinine?
0.7-1.2 mg/dL
Normal BUN/ Creatinine ratio?
10:1
Abnormal BUN/ Creatinine ratio?
20:1
What are 6 absolute contraindications for renal biopsy?
- Uncorrected bleeding disorder
- Severe uncontrolled HTN
- Renal infection
- Neoplasm
- Hydronephrosis
- Uncooperative pt
What are 5 relative contraindications for renal biopsy?
- Solitary or ectopic kidney
- Horseshoe
- ESRD
- Congenital anomalies
- PCKD
What are 5 relative contraindications for renal biopsy?
- Solitary or ectopic kidney
- Horseshoe
- ESRD
- Congenital anomalies
- PCKD
What are the 3 criteria for AKI?
- Rise in SCr at least > 0.3 over 48hrs OR
- 1.5x baseline within 7dys
- Urine volume < 0.5 ml/kg per 6hrs
3 types of AKI?
Pre-renal
Intrinsic/Renal
Post-renal
Most common AKI form?
Pre-renal (hypoperfusion)
Criteria used for AKI?
RIFLE
RIFLE?
Risk Injury Failure Loss Endstage
What is activated and released during hypotension?
SNS and RAAS, Vasopressin/ ADH
Once vasopressin and ADH is released what happens?
vasocontriction of AFFERENT ARTERIOLE and decrease in urine—- leads to HTN
Risk factors for pre-renal AKI?
Advanced age, male, black
Pre-renal w/ hypovolemia?
dizziness, thirst, Orthostatic Hypo, poor skin turgor
Pre-renal w/ low cardiac output?
Rales, third/ fourth heart sounds, JVD, peripheral edema
Pre-renal w/ sepsis?
Fever, elevated WBC, Orthostatic Hypo
FEna in prerenal AKI?
<1%
Imaging for pre-renal AKI?
Ultrasound
Urine osmolality in pre-renal AKI?
> 500
Txt for Pre-renal AKI?
Txt cause
Txt HTN
Furosemide for overload
Consult nephrology for RRT
The least common cause of AKI?
Post-renal
Anuria, oliguria, or polyuria?
Post-renal
FEna in post-renal AKI?
> 2 or varies
Urine Osmolality in post-renal AKI?
<400
Urine sediment in Post renal AKI?
normal, RBC, WBC, or cystals
Imaging for post-renal AKI?
Ultrasound or CT
Txt for post-renal AKI?
Relieve obstruction- bladder cath, stent, surgery
85% of all intrinsic/renal AKI?
Acute tubular necrosis (ATN)
Caused by renal ischemia or exposure to toxins?
Acute tubular necrosis (ATN)
3rd leading cause of new onset AKI in hospitalized patients?
radiographic contrast dye
S/S of ATN?
Uremic state
Urine sediment for ATN?
Granular, MUDDY BROWN CASTS, epithelial cell casts, free renal tubular epi cells
FEna for ATN?
> 1% usually >2
Txt for ATN?
Treat cause
loop diuretics ONLY for overload
IV thiazide diuretics (chlorothiazide or metolazone)
RRT
Prognosis for ATN?
70% ICU, inpatient 20-50%
AKA Tubulointerstitial nephritis?
Acute Interstitial nephritis (AIN)
What mainly causes Acute Interstitial Nephritis?
Drugs (70%)
AIN classic triad?
fever, rash, arthralgia post infection or medication
Dx of AIN?
serum eosinophilia (allergic) , eosinophiluria
Definitive dx for AIN?
Biopsy
Med txt for AIN?
Methylprednisolone 500-1000MG daily for 3 days followed by oral prednisone 2wks
If can’t tolerate steroids, what can be given?
mycophenolate mofetil
Complex relationship between cardiac and renal dysfunction?
cardiorenal syndrome
Type 1 Cardiorenal syndrome?
Acute HF results in AKI
Type 2 Cardiorenal syndrome?
Chronic cardiac dysfunction causes progressive CKD
Type 3 Cardiorenal syndrome?
Abrupt AKI causes actue cardiac dysfunction HF
Type 4 Cardiorenal syndrome?
CKD contributes to cardiac dysfunction
Type 5 Cardiorenal syndrome?
Heart and kidney dysfunction due to other acute or chronic systemic diseases (sepsis, DM)
Txt cardiorenal syndrome?
no medical txt
treating HF has improved eGFR in Type 1 and 2
Rapid loss of renal function in pts w/ cirrhosis and fulminant liver failure?
Hepatorenal
Type 1 Hepatorenal syndrome?
rapid decline in renal function
Type 2 Hepatorenal syndrome?
unrelenting ascites that does not improve with diuresis
Txt Hepatorenal syndrome?
Liver transplant (no renal before liver)
Prognosis for Hepatorenal?
risk of death is high
Most common Nephrotic syndrome?
Primary
Where is minimal change disease seen?
children
Where is Focal segmental glomerulosclerosis seen?
adults
What s/s is seen in nephrotic syndrome?
severe albuminuria/ proteinuria > 3.5 g/day***
Hypoalbuminemia < 2.5g
Edema (localized or generalized)
Hyperlipemia and Lipiduria
Hypercoagulability (urine loss of antithrombin)
Susceptibility to infections (loss of complement and immunoglobulins)
Frothy urine?
nephrotic disease
Urine sediment for nephrotic ?
Fatty casts
Maltese cross
nephrotic
Txt for proteinuria?
ACEI or ARBs (monitor potassium)
Txt for edema?
Loop diuretics
Most common cause of nephrotic syndrome in children?
MCD
Third most common form of primary nephrotic syndrome in adults?
MCD
Dx of MCD?
EM shows classical widespread effacement of foot processes of the podocytes
Txt for MCD?
Prednisone 60 mg 4-8 wks
Txt for relapsed MCD?
chemo meds: cyclophosphamide, tacrolimus, cyclosporine, or rituximab
Most common cause of nephrosis in adults?
Focal segmental glomerulosclerosis
Occurs in 50% of African Americans and approx 80% of children?
Focal segmental glomerulosclerosis
Dx of FSGS?
BIOSPY
Txt for FSGS?
Predisone
“Spike and dome” pattern
Membranous glomerulonephritis (MGN)
Initial presentation of MGN?
DVT or renal vein thrombosis
Dx of MGN?
Silver methenamine showing spike
Most common cause of ESRD in the US
Diabetic Nephropathy
DM type most common in DN?
Type 1
DN classic triad?
HTN, heavy proteinuria, and retinopathy
obstructs blood flow out of the glomerulus?
efferent arteriole
dilates allow blood flow into the glomerulus?
afferent arteriole
What is the 1st stage of diabetic nephropathy?
hyperfiltration
What does excess matrix form?
Kimmelstiel Wilson nodules- protien balls
Protein balls?
DN
What secretes more structural matrix?
Mesangial cells
Nodular GS (Kimmelstiel Wilson)
DN
Txt for DN?
ACEI or ARB
Most common form of renal amyloid?
Primary amyloidosis
S/S of swelling in the face, ankles, and legs?
RA
Dx of choice for RA?
abdominal fat pad
LM appears apple green?
RA
Lm appears pink
RA
what does a congo red stain show?
pink amyloid
Txt for RA?
Melphanan w/ high dose dexamethasone
Most common cause of asymptomatic hematuria?
Thin basement membrane disease
S/S of asymptomatic hematuria incidental finding?
TBMD
Txt for TMBD?
Reassurance
Triad of Alport syndrome?
GN, ESRD, hearing loss, and eye problems
Inherited defect in type IV collagen?
Alport Syndrome
What type of genetic disorder is Alport Syndrome?
85% x linked pattern
Dx for Alport?
woven basket or basket weave apperance
Txt for Alport?
ACEI or ARBS
Hearing aids
Contacts or corneal replacement