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Year2 Renal > Exam 3- Chronic Renal Failure- Darrow > Flashcards

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

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2
Q

what is stage 2 kidney disease

A

mild dec GFR 60-89

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3
Q

what is stage 3 kidney disease

A

moderate dec GFR 30-59

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4
Q

what is stage 4 kidney disease

A

severe dec GFR 15-29

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5
Q

what is the definition of chronic kidney disease

A

stage 3 for 3 months

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6
Q

70% cases chronic renal disease is caused by what

A

DM and HTN

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7
Q

what is the second most likely cause chronic renal disease

A

GN with cystic disease

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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
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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

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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

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11
Q

what are signs of osteodystrophy

A

proximal muscle weakness and bone pain

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12
Q

What is the role of PTH in tubules

A

inhibit PO4 reabsorption and increase Ca absorption

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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

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14
Q

How does low Vit D affect Ca

A

low Ca because need activated Vit D to absorb Ca from GI

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15
Q

How does low Ca affect PTH

A

low Ca causes increase release of PTH

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16
Q

What does PTH do to increase Ca

A

stimulate osteoblast/clast

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17
Q

how does chronic renal disease cause anemia

A

kidney is not making erythropoietin anymore

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18
Q

what are broad waxy casts indicative of

A

chronic renal disease

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19
Q

what is isothenuria

A

inability to concentrate urine

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20
Q

Why do you get paresthesias with chronic renal disease

A

toxins against nerves

unknown specificities

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21
Q

why does chronic renal disease lead to b/l small kidneys

A

scarring and fibrosis

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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
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23
Q

post strep GN is depostition of what

A

IC

subepithelial

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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

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25
Q

Which way does IgA activate C’

A

properdin alternative pathway

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26
Q

mesangial proliferation is assoc with what nephropathy

A

IgA

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27
Q

If proteinuria gets worse what could happen

A

chronic renal disease

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28
Q

what is Bergers disease

A

only IgA nephropathy

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29
Q

patient with increasing proteinuria with synpharyngitic hematuria what should you Tx him with

A

ACEI, steroids and maybe even cyclophsphamide because risk for HTN and chronic renal failure

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30
Q

What is Henoch-Scholein purpura

A

systemic IgA

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31
Q

IgA with glycosylated IgA deposits can be found in what other diseases

A

hepatic cirrhosis, HIV, GMV, celiac disease

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32
Q

pANCA present, most likely has

A

microscopic polyangitis

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33
Q

cANCA present, most likely has

A

granulomatosis

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34
Q

ANCA are assoc with what

A

type III RPGN

35
Q

How do you differentiate wegeners and microscopic polyangitis

A

microscopic polyangitis does not have granulomatous inflammation and does not involve URI

36
Q

ANCA binds to what proteins

A

PR3 and MPO

37
Q

What happens with anti-glomerular BM

A

antibodies to NC1 of type IV collagen alpha 3 chain

38
Q

what does goodpastures look like on IF

A

linear anti-basement deposits

39
Q

patient getting cold, what are you dealing with

A

cryoglobulins or cold agglutinins

40
Q

dec C’, +RF, RBC casts, Hep C +, crescenteric pattern

patient has?

A

essential mixed cryoglobulinemia

41
Q

what is essential mixed cryoglobulinemia

A

Ab against Ab
like IgM against IgG
IgG against IgM

42
Q

why does patient with essential mixed cryoglobulinemia have arthralgias

A

the cryoglobulins get stuck in joints

43
Q

cold agglutinins are indicative of what

A

hemolytic anemia

44
Q

What is type I cryoglobulinemia

A

cancers of blood and immune system

like multiple myeloma, chronic lymphocytic leikemia and Waldenstroms macroglobulinemia

45
Q

Type II and III cryglobulinemia is associated with what processes

A

autoimmune diseases like SLE or sjogrens

viruses like Hep C or HIV

46
Q 
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?
A

ACEI for chronic glomerulonephritities, because blood pressure is going to go up
MPGN

47
Q

when do you not give ACEI for chornic renal disease

A

if creatinine is above 3

48
Q

what is type I MPGN

A

IC deposition, subendothelial
low C’
tramtracking

49
Q

What is type II MPGN

presentation?

A 
Dense deposit disease
Ig staining for C3 only
ribbon like deposits
C'3 levels are low
C4 levels normal
50
Q

type I MPGN can be secondary if caused by what

A

Hep C, paraproteinemia, or underlying autoimmune disease like lupus

51
Q

Hep C is assoc with what glomerulopathies

A 
IC mediated MPGN (type I)
mixed cryoglobulinemia GN (nephritic)
Membranoud nephropathy (nephrotic)
52
Q

What do you Tx proteinuria with

A

ACEI and methylprenisolone

53
Q

when GFR is <70 and prediced ESRD in 5 years what do you prescribe in blacks/hispanics? caucasian?

A

blacks: mycophenolate mofetil
caucasian: cyclophosphamide

54
Q

What are the nephrotic glomerular diseases with primary renal disease

A

minimal change disease
FSGS
membranous glomerulopathy

55
Q

What mutation is FSGS related to

A

APOL1 gene

C1q nephropathy

56
Q

FSGS is seen with what other conditions

A

VUR
morbid obesity
heroin abuse
HIV

57
Q

spike and dome pattern of sub epithelial deposits is characteristic of what

A

membranous nephropathy

58
Q

membranous nephropathy is associated with what conditions

A

lymphoma, carcinoma, penicillamine, gold, SLE, MCTD, thyroiditis, hep B and C, endocarditis, syphilis

59
Q

What are the stages of membranous nephropathy

A

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
Q

What is the Ag in primary membranous nephropathy

A

PLA2R on podocyte membrane

61
Q

secondary membranous nephropathy are caused by what

A

infections Hep B C endocarditis syphilis
autoimmune SLE, thyroiditis
carcinomas and drugs (NSAIDs

62
Q

Why do people with membranoud nephropathy and proteinuria have clots and thrombosis

A

leaking out anticoagulants
especially antithrombin III, protein C and S
increased fibrinogen and lipoprotein

63
Q

the large humps on protein electrophoresis are leaking out or no?

A

no those are the ones that stay in

64
Q

What are the nephrotic diseases from systemic disorders

A

amyloidosis- mesangium
diabetic nephropathy- nodular nephrosclerosis
HIV-assoc- collapsing sclerosis

65
Q

male with polyuria with oliguria and proteinuria
suprapubic mass
no eos, no crystals, broad waxy casts
most likley has

A

prostatic obstruction causing tubulointerstitial disease

66
Q

What are the causes of chronic tubulointerstitial diseases

A 
Prostate obstruction
Analgesics (NSAIDs)
VU reflux
Lead(heavy metals)
Gout
Myeloma
Proud American Veterans Love GM
67
Q

chronic tubulointerstitial disease is characterized by what

A

isothenuria with polyuria, moderate proteinuria, very few cells, type I II or IV RTA
broad waxy casts
small kidneys

68
Q

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?

A

type II RTA

69
Q

type IV RTA has what type acid base problem

A

hyporeninemic, hypoaldosteronsim

high K

70
Q

type I RTA (distal) has what type acid base problem

A

urine pH >5.5

71
Q

Type II RTA has what type acid base problem (proximal)

A

able to acidify urine once serum HCO3 drops to 15-18

72
Q

an ABG for advanced renal failure would have what levels that change anion gap acidosis

A

increased phosphates, sulfates and other organic acids with anion gap acidosis

73
Q

If have hyperchloremin non gap acidosis what should HCO3 look like

A

HCO3 should go down the amount Cl goes up because 1:1 exchanger
if it doesn’t match then alkalosis(too much HCO3)

74
Q

what are the renal diseases of myeloma

A 
myeloma kidney
hypercalemia
hyperuricemia
amyloidosis
B cell infiltration
hyperviscosity
75
Q

What is primary defect in type 1 RTA

A

impaired distal acidification which leads to nephrocalcinosis

76
Q

What is primary defect in type 2 RTA

A

reduced proximal HCO3 reabsorption

77
Q

what is urine pH in type I RTA

A

greater than 5.3

78
Q

what are causes of type I RTA

A

amphoteracin B, Hyperparathyroidism

Sjogrens

79
Q

what is urine pH in type II RTA

A

can acidify urine to less than 5.3

80
Q

What are causes of type II RTA

A

myeloma proteins, drugs: tenovofir, toluene, acetazolamine, teperimate, zonisamide

81
Q

What is plasma K like in type II RTA

A

reduced

82
Q

What causes type IV RTA

A

K sparing diuretics, obstruction, interstitial nephritis, HIV, NSAIDs

83
Q

what is primary defect in type IV RTA

A

decreased aldosterone secretion or effect

84
Q

what is the urine pH in type IV RTA

A

less than 5.3

Year2 Renal (20 decks)

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