Exam 3- Chronic Renal Failure- Darrow Flashcards
1
Q
What is stage 1 kidney disease
give example
A
inc GFR >90 with kidney damage
DM
2
Q
what is stage 2 kidney disease
A
mild dec GFR 60-89
3
Q
what is stage 3 kidney disease
A
moderate dec GFR 30-59
4
Q
what is stage 4 kidney disease
A
severe dec GFR 15-29
5
Q
what is the definition of chronic kidney disease
A
stage 3 for 3 months
6
Q
70% cases chronic renal disease is caused by what
A
DM and HTN
7
Q
what is the second most likely cause chronic renal disease
A
GN with cystic disease
8
Q
What conditions can chronic renal disease lead to
A
HTN, edema , CHF bone disease anemia isothenuria and borad waxy casts acidosis hyperkalemia progressive azotemia paresthesias b/l small kidneys
9
Q
Why does chronic renal disease caused HTN
A
because the decreased GFR tells body needs to increase BP and retain more Na and water
10
Q
how does chronic renal disease lead to bone disease
A
increased PTH
if GFR is down, increase Na/phosphorus reabsorption, retain phosphorus, so decreased calcium. increased PTH
11
Q
what are signs of osteodystrophy
A
proximal muscle weakness and bone pain
12
Q
What is the role of PTH in tubules
A
inhibit PO4 reabsorption and increase Ca absorption
13
Q
How does renal disease affect vit D levels
A
cant hydroxlyate the 25 vit D kidneys so there is a decreased Vit D production
14
Q
How does low Vit D affect Ca
A
low Ca because need activated Vit D to absorb Ca from GI
15
Q
How does low Ca affect PTH
A
low Ca causes increase release of PTH
16
Q
What does PTH do to increase Ca
A
stimulate osteoblast/clast
17
Q
how does chronic renal disease cause anemia
A
kidney is not making erythropoietin anymore
18
Q
what are broad waxy casts indicative of
A
chronic renal disease
19
Q
what is isothenuria
A
inability to concentrate urine
20
Q
Why do you get paresthesias with chronic renal disease
A
toxins against nerves
unknown specificities
21
Q
why does chronic renal disease lead to b/l small kidneys
A
scarring and fibrosis
22
Q
What are nephritic Glomerular diseases
A
postinfectious GN IgA nephropathy HSP Pauciimmune GN RPGN anti-glomerular BM GN cryoglobulin-associated MPGN hep C infection SLE
23
Q
post strep GN is depostition of what
A
IC
subepithelial
24
Q
dark urine after URI dipstick +protein +blood increased creatinine, normal C' focal mesangioproliferative GN with periorbital edema post likely has what?
A
synpharyngitic hematuria
IgA nephropathy
25
Which way does IgA activate C'
properdin alternative pathway
26
mesangial proliferation is assoc with what nephropathy
IgA
27
If proteinuria gets worse what could happen
chronic renal disease
28
what is Bergers disease
only IgA nephropathy
29
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
30
What is Henoch-Scholein purpura
systemic IgA
31
IgA with glycosylated IgA deposits can be found in what other diseases
hepatic cirrhosis, HIV, GMV, celiac disease
32
pANCA present, most likely has
microscopic polyangitis
33
cANCA present, most likely has
granulomatosis
34
ANCA are assoc with what
type III RPGN
35
How do you differentiate wegeners and microscopic polyangitis
microscopic polyangitis does not have granulomatous inflammation and does not involve URI
36
ANCA binds to what proteins
PR3 and MPO
37
What happens with anti-glomerular BM
antibodies to NC1 of type IV collagen alpha 3 chain
38
what does goodpastures look like on IF
linear anti-basement deposits
39
patient getting cold, what are you dealing with
cryoglobulins or cold agglutinins
40
dec C', +RF, RBC casts, Hep C +, crescenteric pattern
| patient has?
essential mixed cryoglobulinemia
41
what is essential mixed cryoglobulinemia
Ab against Ab
like IgM against IgG
IgG against IgM
42
why does patient with essential mixed cryoglobulinemia have arthralgias
the cryoglobulins get stuck in joints
43
cold agglutinins are indicative of what
hemolytic anemia
44
What is type I cryoglobulinemia
cancers of blood and immune system
| like multiple myeloma, chronic lymphocytic leikemia and Waldenstroms macroglobulinemia
45
Type II and III cryglobulinemia is associated with what processes
autoimmune diseases like SLE or sjogrens
| viruses like Hep C or HIV
46
```
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
47
when do you not give ACEI for chornic renal disease
if creatinine is above 3
48
what is type I MPGN
IC deposition, subendothelial
low C'
tramtracking
49
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
```
50
type I MPGN can be secondary if caused by what
Hep C, paraproteinemia, or underlying autoimmune disease like lupus
51
Hep C is assoc with what glomerulopathies
```
IC mediated MPGN (type I)
mixed cryoglobulinemia GN (nephritic)
Membranoud nephropathy (nephrotic)
```
52
What do you Tx proteinuria with
ACEI and methylprenisolone
53
when GFR is <70 and prediced ESRD in 5 years what do you prescribe in blacks/hispanics? caucasian?
blacks: mycophenolate mofetil
caucasian: cyclophosphamide
54
What are the nephrotic glomerular diseases with primary renal disease
minimal change disease
FSGS
membranous glomerulopathy
55
What mutation is FSGS related to
APOL1 gene
| C1q nephropathy
56
FSGS is seen with what other conditions
VUR
morbid obesity
heroin abuse
HIV
57
spike and dome pattern of sub epithelial deposits is characteristic of what
membranous nephropathy
58
membranous nephropathy is associated with what conditions
lymphoma, carcinoma, penicillamine, gold, SLE, MCTD, thyroiditis, hep B and C, endocarditis, syphilis
59
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
60
What is the Ag in primary membranous nephropathy
PLA2R on podocyte membrane
61
secondary membranous nephropathy are caused by what
infections Hep B C endocarditis syphilis
autoimmune SLE, thyroiditis
carcinomas and drugs (NSAIDs
62
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
63
the large humps on protein electrophoresis are leaking out or no?
no those are the ones that stay in
64
What are the nephrotic diseases from systemic disorders
amyloidosis- mesangium
diabetic nephropathy- nodular nephrosclerosis
HIV-assoc- collapsing sclerosis
65
male with polyuria with oliguria and proteinuria
suprapubic mass
no eos, no crystals, broad waxy casts
most likley has
prostatic obstruction causing tubulointerstitial disease
66
What are the causes of chronic tubulointerstitial diseases
```
Prostate obstruction
Analgesics (NSAIDs)
VU reflux
Lead(heavy metals)
Gout
Myeloma
Proud American Veterans Love GM
```
67
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
68
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
69
type IV RTA has what type acid base problem
hyporeninemic, hypoaldosteronsim
| high K
70
type I RTA (distal) has what type acid base problem
urine pH >5.5
71
Type II RTA has what type acid base problem (proximal)
able to acidify urine once serum HCO3 drops to 15-18
72
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
73
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)
74
what are the renal diseases of myeloma
```
myeloma kidney
hypercalemia
hyperuricemia
amyloidosis
B cell infiltration
hyperviscosity
```
75
What is primary defect in type 1 RTA
impaired distal acidification which leads to nephrocalcinosis
76
What is primary defect in type 2 RTA
reduced proximal HCO3 reabsorption
77
what is urine pH in type I RTA
greater than 5.3
78
what are causes of type I RTA
amphoteracin B, Hyperparathyroidism
| Sjogrens
79
what is urine pH in type II RTA
can acidify urine to less than 5.3
80
What are causes of type II RTA
myeloma proteins, drugs: tenovofir, toluene, acetazolamine, teperimate, zonisamide
81
What is plasma K like in type II RTA
reduced
82
What causes type IV RTA
K sparing diuretics, obstruction, interstitial nephritis, HIV, NSAIDs
83
what is primary defect in type IV RTA
decreased aldosterone secretion or effect
84
what is the urine pH in type IV RTA
less than 5.3
