F 6/2 Flashcards
Where do horseshoe kidneys get “caught?”
On IMA
How does AR PCKD present?
Infants w worsening RF and HTN
Newborns may present w Potter sequence
Assoc w cong hep fibrosis (leads to portal HTN) and hepatic cysts
How does AD PCKD present?
Young adults w HTN (inc renin), hematuria and worsening RF
What is the gene in AD PCKD?
APKD1, APKD2
What are non-renal associations w AD PCKD?
Berry aneurysm (COD), hepatic cysts, MV prolapse
What is medullary cystic kidney disease and how is it inherited?
Cysts in medullary CD
Parenchymal fibrosis - shrunken kidneys, RF
AD
How is azotemia defined?
Inc BUN, Inc Cr
What causes prerenal azotemia
Dec BF to kidneys
Dec GFR, azotemia, oliguria
What is the BUN:Cr in pre-renal azotemia?
> 15
Reabs of fluid and BUN - tubular function intact
What causes postrenal azotemia?
Downstream obstruction of UT
Dec GFR, azotemia, oliguria
What is the BUN:Cr in longstanding postrenal azotemia?
<15
Tubular damage
What is the most common cause of acture renal failure?
ATN
Which areas of the nephron are particularly susceptible to ischemia?
PT
Medullary segment of TAL
What area of the nephron is particularly susceptible to toxins?
PT
What are the lab findings in ATN?
Oliguria w brown granular casts
Inc BUN, Inc Cr
HK (dec renal exc)
Met acidosis (inc anion gap)
What is acute interstitial nephritis?
Drug-induced hypersensitivity involving interstitiom and tubules?
What are causes of AIN?
NSAIDs, penicillin, diuretics
How does AIN present?
Oliguria, fever, rash - days to wks after starting drug
Eosinophils in urine
What is renal papillary necrosis and how does it present?
Necrosis of renal papillae
Gross hematuria, flank pain
What are some causes of RPN?
Chronic analgesic use (phenacetin, aspiriin)
DM
SCT or SCD
severe acute pyelonephritis
What are the features of nephrotic syndrome?
Proteinuria > 3.5 g/d hypoalbuminemia - pitting edema hypogammaglobulinemia - risk inf hypercoaguable state - loss of AT III HL, Hchol - fatty casts in urine
What is the most common cause of nephrotic syndrome in children? What is its cause?
MCD
Usually idiopathic
may be associated w HL
How does MCD appear on HE, EM, IF?
HE - N
EM - effacement of foot processes
IF - N
How does MCD respond to steroids?
well
damage is mediated by cytokines from T cells
Is there inc risk of inf in MCD?
No - selective proteinuria
loss of albumin but not Ig
What is the most common cause of nephrotic syndrome in Hispanics and AAs?
FSGS
What causes FSGS?
Usually idiopathic
may be assoc w HIV, heroin use, SCD
What are the findings in FSGS on HE, EM, IF?
HE - focal and segmental sclerosis
EM - effacement of foot processes
IF - N
How does FSGS respond to steroids?
Not well; progresses to CRF
What is the most common cause of nephrotic syndrome in caucasian adults?
Membranous nephropathy
What causes MN?
Usually idiopathic
assoc w HBV, HCV, solid tumors, SLE, drugs (NSAID, penicillamine)
MN - HE, IF, EM
HE - thick GBM
IF - granular (IC depo)
EM - subepithelial deposits w spike and dome appearance
How does MPGN look on HE and IF?
HE - Thick GBM w tram-track appearance
IF - granular (IC depo)
Where are the IC deposits located in Type I and II MPGN?
Type I - subendothelial
Assoc w HBV, HCV
Type II = dense deposit disease - intramembranous
assoc w C3 nephritic factor
What is C3 nephritic factor?
AutoAb that stabilizes C3 convertase, leading to overactivation of complement, inflammation, and low levels of circulation C3
What happens to the kidney in DM?
NEG of vasc BM leads to hyaline arteriolosclerosis
What is more affects in DM - aff or eff arteriole?
Efferent
Leads to high GFP
Hyperfiltration injury leads to microalbuminuria
What is the first indication of kidney damage in DM?
Albuminuria
What are Kimmelstiel-Wilson nodules?
Sclerosis of the mesangium in diabetic nephropathy
What is the most commonly involved organ in systemic amyloidosis?
Kidney
Where does amyloid deposit in the kidney?
Mesangium
What are the features of nephritic syndrome?
proteinuria < 3.5 g/d Oliguria, azotemia salt retention - periorbital edema, HTN RBC casts/dysmorphic RBCs in urine Hypercellular, inflamed glomeruli
What is the inciting event for PSGN?
GAS skin inf or pharyngitis
What are the histological findings of PSGN?
IC depo - granular IF
subepitheial humps - EM
What is the IF patterin in Goodpasture?
Linear (anti-BM Ab)
What causes Goodpasture?
Ab against collagen in glomerular and alveolar BM
How does Goodpasture present?
Hematuria
Hemoptysis young adult males
What is the most common type of renal disease in SLE?
Diffuse proliferative GN
How does Wegener present on IF, what is it associated w?
Negative (pauci-immune)
c-ANCA
How do Churg-Strauss and microscopic polyangiitis present on IF, what is it associated w?
Negative IF (pauci-immune) p-ANCA
What distinguishes Churg-Strauss from microscopic polyangiitis?
Granulomatous inflammation, eosinophilia, arthma
What is RPGN?
Nephritic syndrome that progresses to RF in w to m
What is found in Bowman space in RPGN? What are they composed of?
Crescents
Fibrin and macrophages
What is the most common nephropathy worldwide?
Iga ( Berger)
How does IgA nephropathy present?
During childhood as episodic gross or microscopic hematuria w RBC casts
Usually following mucosal infection
Where does IgA deposit in IgA nephropathy?
Mesangium
What is Alport syndrome?
Inherited defect in type IV collagen Most commonly X-linked Thinning, splitting GBM Isolated hematuria sensory hearing loss ocular disturbances
What causes “thyroidization” of the kidney?
Chronic pyelonephritis
Scarring at what location is characteristic of VER?
Upper and lower poles
What is the most common type of nephrolithiasis?
Calcium oxalate/phosphate
What are causes of Ca stones?
Idiopathic hypercalciuria
HyperCa
Crohn disease
What is tx for Ca stones?
HCT
What is the most common cause of Ammonium Mg PO4 stones?
Inf w urease pos organisms (Proteus, Klebsiella)
alkaline urine leads to formation of stone
What type of stone is radiolucent?
Uric acid
What are risk factors for uric acid stones?
hot arid climates low urine vol acidic pH gout hyperuricemia (leukemia, MPD)
What is the tx for uric acid stones?
Hydration
alkalinization of urine (K bicarb)
What type of nephrolithiasis is mostly seen in children?
Cystine
What is the result of loss of VHL tumor suppressor gene
Increased IGF-1
Inc HIF TF
Increased VEGF, PDGF
What is Wilms tumor?
Malignant kidney tumor
comprised of blastema (immature kidney mesenchyme)
primitive glomeruli and tubules
stromal cells
Most common malignant renal tumor in children
avg age = 3y
How does Wilms tumor present?
Lg, unilateral flank mass w hematuria and HTN
What is WAGR syndrome?
Wilms tumor Aniridia Genital abN Mental and motor retardation del of WT1 tumor suppressor gene
What is Denys-Drash syndrome?
Wilms tumor
Prog glomerular disease
male pseudohermaphroditism
assoc w muts of WT1
What is Beckwith-Wiedemann syndrome?
Wilms tumor neonatal hypoglycemia muscular hemihypertrophy organomegaly assoc w muts in WT2 gene cluster, particularly IGF1
What are the 2 types of urothelial carcinomas and their progression?
Flat - high grade, invades, early p53 muts
Papillary - low grade, prog to high grade then invades
What is nimodipine and what is used for following subarachnoid hemorrhage?
CCB
Prevent cerebral vascular spasm
What is the most common primary cerebral neoplasm in adults?
Glioblastoma
What does cleft 1 become?
External auditory meatus
What CNs are associate with arch 1?
V2, V3
What CNs are associated with arch 2?
VII
What CNs are associated w arch 3?
IX - stylopharyngeus
What CNs are associated w arch 4 (and 6)
X
What does pouch 3 become
Thymus and inferior PTs
What does pouch 4 become?
Super PT
What does pouch 5 become/
C cells of thyroid
What are the clefts derived from?
Ectoderm
What are the arches derived from?
Mesoderm and neural crests
What are the pouches derived from?
Endoderm
What is a branchial cleft cyst?
Cleft 2, lateral neck
Can have pharyngeal fistula
What pharyngeal arches are disrupted in MEN 2A?
PT - 3rd, 4th
Parafollicular cells of thyroid - 4th, 5th
What is aberrand in Digeorge?
Aberrant 3rd and 4th pouch deveopment
T cell deficiency (athymic)
hCa (aPT)
What pharyngeal arch is associated with the carotid arteries?
3
What pharyngeal arch is associated with the aortic arch?
4
What is a cleft lip?
Failure of the fusion of the maxillary and medial nasal processes to fuse
What is cleft palate?
Failrue of fusion of lateral palatine process, nasal septum, and/or median palatine process
What is Treacher-Collins syndrome?
Failure of the 1st arch to migrate
Mandibular hypoplasia, facial abN
What is the msot common congenital malformation of the head and neck?
Unilateral cleft
What is the most common arterial malformation in infants?
PDA