Exam 3- Chronic Renal Failure- Darrow Flashcards
What is stage 1 kidney disease
give example
inc GFR >90 with kidney damage
DM
what is stage 2 kidney disease
mild dec GFR 60-89
what is stage 3 kidney disease
moderate dec GFR 30-59
what is stage 4 kidney disease
severe dec GFR 15-29
what is the definition of chronic kidney disease
stage 3 for 3 months
70% cases chronic renal disease is caused by what
DM and HTN
what is the second most likely cause chronic renal disease
GN with cystic disease
What conditions can chronic renal disease lead to
HTN, edema , CHF bone disease anemia isothenuria and borad waxy casts acidosis hyperkalemia progressive azotemia paresthesias b/l small kidneys
Why does chronic renal disease caused HTN
because the decreased GFR tells body needs to increase BP and retain more Na and water
how does chronic renal disease lead to bone disease
increased PTH
if GFR is down, increase Na/phosphorus reabsorption, retain phosphorus, so decreased calcium. increased PTH
what are signs of osteodystrophy
proximal muscle weakness and bone pain
What is the role of PTH in tubules
inhibit PO4 reabsorption and increase Ca absorption
How does renal disease affect vit D levels
cant hydroxlyate the 25 vit D kidneys so there is a decreased Vit D production
How does low Vit D affect Ca
low Ca because need activated Vit D to absorb Ca from GI
How does low Ca affect PTH
low Ca causes increase release of PTH
What does PTH do to increase Ca
stimulate osteoblast/clast
how does chronic renal disease cause anemia
kidney is not making erythropoietin anymore
what are broad waxy casts indicative of
chronic renal disease
what is isothenuria
inability to concentrate urine
Why do you get paresthesias with chronic renal disease
toxins against nerves
unknown specificities
why does chronic renal disease lead to b/l small kidneys
scarring and fibrosis
What are nephritic Glomerular diseases
postinfectious GN IgA nephropathy HSP Pauciimmune GN RPGN anti-glomerular BM GN cryoglobulin-associated MPGN hep C infection SLE
post strep GN is depostition of what
IC
subepithelial
dark urine after URI dipstick +protein +blood increased creatinine, normal C' focal mesangioproliferative GN with periorbital edema post likely has what?
synpharyngitic hematuria
IgA nephropathy
Which way does IgA activate C’
properdin alternative pathway
mesangial proliferation is assoc with what nephropathy
IgA
If proteinuria gets worse what could happen
chronic renal disease
what is Bergers disease
only IgA nephropathy
patient with increasing proteinuria with synpharyngitic hematuria what should you Tx him with
ACEI, steroids and maybe even cyclophsphamide because risk for HTN and chronic renal failure
What is Henoch-Scholein purpura
systemic IgA
IgA with glycosylated IgA deposits can be found in what other diseases
hepatic cirrhosis, HIV, GMV, celiac disease
pANCA present, most likely has
microscopic polyangitis
cANCA present, most likely has
granulomatosis
ANCA are assoc with what
type III RPGN
How do you differentiate wegeners and microscopic polyangitis
microscopic polyangitis does not have granulomatous inflammation and does not involve URI
ANCA binds to what proteins
PR3 and MPO
What happens with anti-glomerular BM
antibodies to NC1 of type IV collagen alpha 3 chain
what does goodpastures look like on IF
linear anti-basement deposits
patient getting cold, what are you dealing with
cryoglobulins or cold agglutinins
dec C’, +RF, RBC casts, Hep C +, crescenteric pattern
patient has?
essential mixed cryoglobulinemia
what is essential mixed cryoglobulinemia
Ab against Ab
like IgM against IgG
IgG against IgM
why does patient with essential mixed cryoglobulinemia have arthralgias
the cryoglobulins get stuck in joints
cold agglutinins are indicative of what
hemolytic anemia
What is type I cryoglobulinemia
cancers of blood and immune system
like multiple myeloma, chronic lymphocytic leikemia and Waldenstroms macroglobulinemia
Type II and III cryglobulinemia is associated with what processes
autoimmune diseases like SLE or sjogrens
viruses like Hep C or HIV
female recent URI with gross hematuria, mild proteins HTN, low C' Ig and C3 in mesangium subendothelial tramtracking on EM best Tx option? what is this?
ACEI for chronic glomerulonephritities, because blood pressure is going to go up
MPGN
when do you not give ACEI for chornic renal disease
if creatinine is above 3
what is type I MPGN
IC deposition, subendothelial
low C’
tramtracking
What is type II MPGN
presentation?
Dense deposit disease Ig staining for C3 only ribbon like deposits C'3 levels are low C4 levels normal
type I MPGN can be secondary if caused by what
Hep C, paraproteinemia, or underlying autoimmune disease like lupus
Hep C is assoc with what glomerulopathies
IC mediated MPGN (type I) mixed cryoglobulinemia GN (nephritic) Membranoud nephropathy (nephrotic)
What do you Tx proteinuria with
ACEI and methylprenisolone
when GFR is <70 and prediced ESRD in 5 years what do you prescribe in blacks/hispanics? caucasian?
blacks: mycophenolate mofetil
caucasian: cyclophosphamide
What are the nephrotic glomerular diseases with primary renal disease
minimal change disease
FSGS
membranous glomerulopathy
What mutation is FSGS related to
APOL1 gene
C1q nephropathy
FSGS is seen with what other conditions
VUR
morbid obesity
heroin abuse
HIV
spike and dome pattern of sub epithelial deposits is characteristic of what
membranous nephropathy
membranous nephropathy is associated with what conditions
lymphoma, carcinoma, penicillamine, gold, SLE, MCTD, thyroiditis, hep B and C, endocarditis, syphilis
What are the stages of membranous nephropathy
I- subepithelial DD no projections to BM
II- well defined projections into BM between deposits (spike)
III- deposits surrounded by basement membrane
IV- dense material fades creating holes
V- repair of membrane
What is the Ag in primary membranous nephropathy
PLA2R on podocyte membrane
secondary membranous nephropathy are caused by what
infections Hep B C endocarditis syphilis
autoimmune SLE, thyroiditis
carcinomas and drugs (NSAIDs
Why do people with membranoud nephropathy and proteinuria have clots and thrombosis
leaking out anticoagulants
especially antithrombin III, protein C and S
increased fibrinogen and lipoprotein
the large humps on protein electrophoresis are leaking out or no?
no those are the ones that stay in
What are the nephrotic diseases from systemic disorders
amyloidosis- mesangium
diabetic nephropathy- nodular nephrosclerosis
HIV-assoc- collapsing sclerosis
male with polyuria with oliguria and proteinuria
suprapubic mass
no eos, no crystals, broad waxy casts
most likley has
prostatic obstruction causing tubulointerstitial disease
What are the causes of chronic tubulointerstitial diseases
Prostate obstruction Analgesics (NSAIDs) VU reflux Lead(heavy metals) Gout Myeloma Proud American Veterans Love GM
chronic tubulointerstitial disease is characterized by what
isothenuria with polyuria, moderate proteinuria, very few cells, type I II or IV RTA
broad waxy casts
small kidneys
55 y/o male with back pain and weight loss
takes HCTZ for HTN
Hb elevated with inc sed rate compatible with multiple myeloma(makes protein stick together)
normal anion gap
which type acid base problem?
type II RTA
type IV RTA has what type acid base problem
hyporeninemic, hypoaldosteronsim
high K
type I RTA (distal) has what type acid base problem
urine pH >5.5
Type II RTA has what type acid base problem (proximal)
able to acidify urine once serum HCO3 drops to 15-18
an ABG for advanced renal failure would have what levels that change anion gap acidosis
increased phosphates, sulfates and other organic acids with anion gap acidosis
If have hyperchloremin non gap acidosis what should HCO3 look like
HCO3 should go down the amount Cl goes up because 1:1 exchanger
if it doesn’t match then alkalosis(too much HCO3)
what are the renal diseases of myeloma
myeloma kidney hypercalemia hyperuricemia amyloidosis B cell infiltration hyperviscosity
What is primary defect in type 1 RTA
impaired distal acidification which leads to nephrocalcinosis
What is primary defect in type 2 RTA
reduced proximal HCO3 reabsorption
what is urine pH in type I RTA
greater than 5.3
what are causes of type I RTA
amphoteracin B, Hyperparathyroidism
Sjogrens
what is urine pH in type II RTA
can acidify urine to less than 5.3
What are causes of type II RTA
myeloma proteins, drugs: tenovofir, toluene, acetazolamine, teperimate, zonisamide
What is plasma K like in type II RTA
reduced
What causes type IV RTA
K sparing diuretics, obstruction, interstitial nephritis, HIV, NSAIDs
what is primary defect in type IV RTA
decreased aldosterone secretion or effect
what is the urine pH in type IV RTA
less than 5.3
