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Flashcards - Renal

1
Q

fetal hydronephrosis

A

failure to canalize uteropelvic junction

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2
Q

fetal renal embryology

A

pronephros (week 4) –> mesonephros (1st trimester) –> metanephros (5th week on)

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3
Q

mulitcystic dysplastic kidney

A

defect when ureteric bud (caudal) meets with metanephric mesenchyme to induce differentiation, usually unilateral cystic kidney

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4
Q

Fanconi syndrome

A

PCT defect - loss of AA, glu, HCO3, PO4 = metabolic acidosis

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5
Q

Bartter syndrome

A

thick ascending loop defect - Na/K/2Cl (lasix)

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6
Q

Gitelman syndrome

A

DCT - NaCl reabsorption defect (thiazide)

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7
Q

Liddle syndrome

A

collecting tubule - increased epithelial Na channel activity (increased Na absorption)

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8
Q

Genetic causes of Horseshoe kidney

A

Edwards, Down, Patau, Turner

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9
Q

Hartnup disease

A

AR - neutral AA transporter defect (tryptophan –> decreased niacin, pellagra)

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10
Q

RTA Type I

A

DCT - inability to excrete H+ - urine pH >5.5 - hypokalemia

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11
Q

RTA Type II

A

PCT - unable to reabsorb HCO3 - urine pH <5.5 - hypokalemia

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12
Q

RTA Type IV

A

no aldosterone - adrenal/collecting tubule - hyperK –> decreased NH4 excretion - urine pH

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13
Q

heparan sulfate

A

provides negative charge barrier in basement membrane - lost in nephrotic syndrome

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14
Q

Loop diuretic

A

TALH - blocks Na/K/2Cl ATPase - can cause hypokalemia, gout, ototoxocity

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15
Q

Thiazide

A

DCT - blocks Na/Cl co transporter - can cause hyperGLUC, hypoK

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16
Q

Angiotensin II - tubule effect

A

PCT - stimulates Na+/H+ exchanger (increased Na+ absorption)

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17
Q

ANP/BNP

A

relaxes smooth muscle via cGMP –> increased GFR, decreased renin

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18
Q

Macula densa

A

senses decreased NaCl delivery to DCT –> adenosine release –> vasocontriction

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19
Q

Digitalis

A

blocks Na+/K+ - hyperkalemia

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20
Q

RBC casts

A

Glomerulonephritis, malignant hypertension.

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21
Q

WBC casts

A

Tubulointerstitial inflammation, acute pyelonephritis, transplant rejection. Nephrotic syndrome.

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22
Q

Fatty casts (“oval fat bodies”)

A

Acute tubular necrosis.

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23
Q

Granular (“muddy brown”) casts

A

End-stage renal disease/chronic renal failure and ATN

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24
Q

Waxy casts Hyaline casts

A

Nonspecific, can be a normal finding, often seen in concentrated urine samples.

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25
Q

IF: starry-sky, lumpy bumpy (IgM, IgG, C3 deposition in GBM and mesangium) EM: subepithelial immune complex humps

A

acute post-strep glumerulonephritis - group A b-hemolytic strep (pyo) - decreased complement levels, type III hypersensitivity

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26
Q

LM and IF—crescent moon shape of fibrin and plasma proteins

A

Rapidly progressive (crescentic) glomerulonephritis (RPGN) –>
Goodpasture syndrome - Anti-GBM (type II hypersensitivity), linear IF;
GPA - negative IF;
MPA - negative IF
Diffuse proliferative - SLE - granular IF

27
Q

LM - “wire looping” of capillaries. EM—subendothelial and sometimes intramembranous IgG-based ICs often with C3 deposition, IF—granular

A

Diffuse proliferative glomerulonephritis (DPGN)

28
Q

LM—mesangial proliferation, EM—mesangial IC deposits, IF—IgA-based IC deposits in mesangium –> HSP

A

IgA nephropathy (Berger disease)

29
Q

Alport syndrome

A

XL - Mutation in type IV collagen - hematuria, hearing loss, ocular disturbances

30
Q

Membrano­ proliferative glomerulonephritis (MPGN)

A

Type I - HBV, HCV (tram-tracks); Type II - C3 nephritic factor deposits (autoantibody stabilizes C3 convertase, increased complement activation)

31
Q

LM: thick glomerular basement membrane, EM: “spike and dome” sub epithelial deposits

A

membranous nephropathy - HCV, HBV, SLE

32
Q

Bence Jones proteins

A

light chains from MM - nephrotoxic

33
Q

Tamm Horsfall protein

A

eosinophilic casts from light chains - MM

34
Q

acute interstitial nephritis

A

drug induced (NSAIDs, PCN, diuretics) - eosinophils in tubules and interstitium

35
Q

renal papillary necrosis

A

analgesic abuse (phenacetin, aspirin), DM, sickle cell, pyelo

36
Q

acute tubular necrosis

A

reversible, may require dialysis –> tubule cells can regenerate from stable state (2-3 weeks)

37
Q

ovoid hyaline masses in the glomerular mesangium

A

Kimmelstiel-Wilson lesions - eosinophilic and PAS+ - diabetic nepropathy

38
Q

Amphotericin B renal side effects

A

tubular necrosis - hypoK and hypoMg

39
Q

renal cell carcinoma

A

epithelial malignancy of PCT tubules - “clear cell” of carbs/lipids - paraneoplastic (EPO, renin, PTHrP, ACTH) - loss of VHL on Ch3 = increased IGF1

40
Q

angiomyolipma

A

hamartoma associated with tuberous sclerosis

41
Q

calcium phosphate/oxalate

A

envelope/dumbbell shaped - treat w/ Ca-sparing HCTZ

42
Q

ammonium magnesium phosphate

A

coffin lid shaped - staghorn calculi (infection w/ urease+ bacteria)

43
Q

uric acid

A

rhomboid - only radiolucent stone - alkalinalize urine

44
Q

cysteine

A

hexogonal - staghorn calculi - sodium nitroprusside + - alkanalize urine

45
Q

calcineurin

A

dephosphorylates NFAT –> NFAT enters nucleus –> binds to IL-2 receptor –> growth/differentiation of T cell

46
Q

HUS

A

shiga-toxin - microangiopathic hemolytic anemia - acute kidney injury

47
Q

urothelial (transitional) carcinoma risks

A

cigarette smoke (polycystic hydrocarbons), nathylamine, azo dyes, cyclophosphamide, phenacetin - early p53 mutation = flat, high grade

48
Q

wilms tumor genetic association

A

associated with turner syndrome,

49
Q

WAGR syndrome

A

WT1 deletion - Wilms, anidria, genital abnormalities, mental/motor retardation

50
Q

Denys-Drash syndrome

A

WT1 mutation - Wilms, progressive glomeruli disease, male pseudohermaphroditism

51
Q

Beckwith-Wiedemann

A

WT2 mutation - Wilm’s, hypoglycemia, acromegaly (glossitis)

52
Q

eosinophlic cells with abundant mitochondria without perinuclear clearing

A

benign - Renal oncocytoma - usually resected

53
Q

K+ sparing diuretics

A

amiloride, triamterene, spironolactone

54
Q

Normal filtration fraction

A

20% (GFR/RPF)

55
Q

principal cell

A

NA+/K+ ATPase (K into lumen, Na out into blood) and aquaporins (ADH on V2 receptor)

56
Q

alpha intercalated

A

H+/K+ ATPase and H+ pump (H+ out into lumen)

57
Q

juxtaglomerular cells

A

modified smooth muscle in afferent arterial

58
Q

Vitamin D 25OH to 1,25-OH2 conversion location

59
Q

drugs causing HyperK

A

digitalis, beta-blockers

60
Q

LM—segmental sclerosis and hyalinosis A.
IF—nonspecific for focal deposits of IgM, C3, C1.
EM—effacement of foot process similar to minimal change disease.

A

Focal segmental glomerulosclerosis - idiopathic, or HIV, sickle cell, heroin, obesity, IFN

61
Q

squamous cell carcinoma of bladder

A

chronic irritation - schistosoma haematobium infection (middle east)

62
Q

prerenal azotemia

A

BUN:Cr >15 - decreased blood flow, tubules intact FeNa <1%

63
Q

postrenal azotemia

A

late BUN:Cr 2% - outflow obstruction, tubular damage

64
Q

EPO production location

A

peritubular interstitial cells

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