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Block 9 Week 5 > Fung > renal path II > Flashcards

Fung > renal path II Flashcards

1
Q

what 7 things can a urine dipstick tell you?

A
  1. pH
  2. specific gravity
  3. protein
  4. glucose
  5. ketones
  6. nitrite
  7. leukocyte esterase
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2
Q

what are the 3 ways you can examine urine?

A

macroscopic
microscopic
chemical

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3
Q

what 2 things can you see macroscopically in urinalysis?

A

color & turbidity

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4
Q

what can you see microscopically in urinalysis?

A 
casts
RBCs
WBCs
epithelial cells
organisms
crystals
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5
Q

what can you tell about urine on chemical examination of urinalysis?

A 
specific gravity
protein
glucose
ketones
hemoglobin
bile
urobilinogen
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6
Q

what are the shapes of oxalate, triphosphate, & cystine crystals?

A

oxalate > square (studs)
triphos > rectangle
cystine > hexagon

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7
Q

what characterizes acute kidney injury?

A
  1. acutely diminished renal fxn

2. morphologic evidence of tubular injury

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8
Q

what is the most common cause of acute renal failure?

A

acute kidney injury

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9
Q

T/F: acute kidney injury is reversible

A

TRUE

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10
Q

what are the 4 main causes of acute kidney injury?

A
  1. ischemia
  2. direct toxic injury
  3. acute tubulointerstitial nephritis
  4. obstruction
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11
Q

what is the difference in the damage pattern btwn ischemic & toxic acute kidney injuries?

A

ischemic is just pieces of both the PCT & loop

toxic is the whole PCT & pieces of the loop

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12
Q

what are the tubulointerstitial nephritides?

A

group of renal diseases characterized by histo & fxnal alterations in tubules & interstitium

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13
Q

T/F: you can have acute or chronic tubulointerstitial nephritis

A

TRUE

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14
Q

what does acute tubulointerstitial nephritis look like on histo?

A

edema
acute inflammatory infiltrate
focal tubular necrosis

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15
Q

what does chronic tubulointerstitial nephritis look like on histo?

A

mononuclear infiltrate
interstitial fibrosis
widespread tubular atrophy

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16
Q

what can cause tubulointerstitial nephritis?

A 
infection
toxins
metabolic dz
obstruction
neoplasm
vascular
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17
Q

how do tubulointerstitial nephritides evolve?

A

early phase: easy to distinguish from glomerular dz

late phase: hard to tell

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18
Q

how is tubulointerstitial nephritis different from glomerular dz?

A

inability to concentrate urine
metabolic acidosis
defects in tubular secretion/absorption
(EARLY phase > easy to distinguish)

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19
Q

what areas does pyelonephritis affect?

A

tubules
interstitium
renal pelvis

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20
Q

what is pyelonephritis a complication of?

A

cystitis

acute or chronic complication

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21
Q

where do the organisms that cause pyelonephritis usu come from?

A

pt’s fecal flora

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22
Q

what are the most common pathogens assoc w/ pyelonephritis?

A

E coli (90%)
Proteus
Klebsiella
Enterococcus faecalis

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23
Q

T/F: pyelonephritis is usu d/t descending infection

A

FALSE

ascending!

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24
Q

what is ACUTE pyelonephritis?

A

acute suppurative inflammation d/t microbial infection

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25
Q

what can predispose a pt to acute pyelonephritis?

A 
obstruction
instrumentation (??)
vesicoureteral reflux
female
diabetes
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26
Q

what are the sx of acute pyelonephritis?

A
  1. fever
  2. flank pain or pain at costovertebral angle
  3. WBC casts
  4. malaise
  5. dysuria
  6. frequency & urgency
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27
Q

what is CHRONIC pyelonephritis?

A

chronic tubulointerstitial inflammation & renal scarring w/ calyx involvement

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28
Q

what are the 2 types of chronic pyelonephritis?

A
  1. reflux nephropathy

2. chronic obstructive pyelonephritis

29
Q

what does chronic pyelonephritis look like on H&E?

A

atrophic tubules w/ eosinophilic proteinaceous material that looks like thyroid > “thyroidization”

30
Q

what 3 ways can drugs & toxins produce renal injury?

A
  1. acute hypersensitivity nephritis
  2. direct
  3. chronic injury & chronic renal insuff
31
Q

what 2 types of drugs can cause nephropathy?

A

analgesics & NSAIDs

32
Q

T/F: multiple myeloma can affect the kidney

A

TRUE

33
Q

what are the effects of multiple myeloma w/ kidney involvement?

A
  1. Bence Jones proteinuria
  2. amyloidosis
  3. light chain deposition
34
Q

how can HTN manifest in the kidney?

A

benign or malignant nephrosclerosis

35
Q

besides nephrosclerosis, how can HTN affect the kidney (not IN it)?

A

renal artery stenosis

36
Q

what does a HTN kidney look like grossly?

A

bumpy

37
Q

what do tubules look like in HTN pts?

A

thickened d/t sclerosis

38
Q

what are 3 characteristics of the thrombotic microangiopathies?

A
  1. microangiopathic hemolytic anemia
  2. thrombocytopenia
  3. renal failure
39
Q

what are the 2 forms of thrombotic microangiopathies?

A

hemolytic uremic syndrome
AND
thrombotic thrombocytopenic purpura

40
Q

how can you get a renal cyst?

A

hereditary
developmental
or
acquired

41
Q

how do you acquire a renal cyst?

A

dialysysysysysys

42
Q

what are the 2 ways to inherit renal cysts?

A

PKD

medullary cystic kidney disease

43
Q

how is PKD inherited?

A

autosomal dominant

44
Q

what genes are involved in ADULT PKD?

A

PKD1 & PKD2

45
Q

what are the 3 extrarenal anomalies assoc w/ adult PKD?

A
  1. polycystic liver disease
  2. intracranial berry aneurysm
  3. mitral valve prolapse
46
Q

what are the 4 forms of CHILDHOOD PKD?

A

perinatal
neonatal
infantile
juvenile

47
Q

what gene is involved in CHILDHOOD PKD?

A

PKHD1

48
Q

what is childhood PKD assoc w/?

A

hepatic fibrosis

49
Q

what do medullary cysts look like?

A

lots of tiny cysts in the medulla/pyramids

50
Q

what are the 3 forms of medullary cysts?

A
  1. medullary sponge kidney
  2. nephronophthisis
  3. adult-onset medullary cystic disease
51
Q

T/F: nephrolithiasis occurs only sporadically

A

FALSE

they can, but you can also have a genetic predisposition

52
Q

what are the 4 types of kidney stones?

A

calcium oxalate
struvite (MAP)
uric acid
cystine

53
Q

what is the most common type of kidney stone?

A

calcium oxalate

54
Q

what must there be in order for a calculi to form?

A

supersaturation

55
Q

how do calcium oxalate stones form?

A

hypercalciuria

56
Q

how do struvite/MAP stones form?

A

post-UTI d/t proteus

57
Q

how do uric acid stones form?

A

idopathic
gout
leukemia

58
Q

how do cystine stones form?

A

genetic defects in the renal absorption of amino acids

59
Q

T/F: kidneys only get malignant neoplasms

A

FALSE

benign & malignant neoplasms occur in the kidney

60
Q

what types of malignant neoplasms can you get in the kidney (3)?

A
  1. renal cell carcinoma
  2. urothelial carcinoma
  3. Wilms tumor
61
Q

what types of benign neoplasms can you get in the kidney (3)?

A
  1. papillary adenoma
  2. angiomyolipoma
  3. oncytoma
62
Q

what is an angiomyolipoma composed of?

A 
BVs (angio)
smooth muscle (myo)
mature adipose (lipo)
63
Q

what is angiomyolipoma assoc w/?

A

tuberous sclerosis

that’s high yield

64
Q

what does angiomyolipoma look like grossly?

A

yellow

65
Q

what does angiomyolipoma look like on histo?

A

clear cytoplasm

66
Q

are renal cell carcinomas sporadic or hereditary?

A

MOST are sporadic but some are hereditary

67
Q

what are the 3 types of renal cell carcinoma?

A
  1. von hippel-lindau
  2. hereditary clear cell carcinoma
  3. hereditary papillary carcinoma
68
Q

what does urothelial carcinoma look like on histo?

A

can be flat or papillary

69
Q

what does Wilms tumor look like on histo?

A

BLASTEMA (immature kidney mesenchyme) > primitive glomeruli, tubules, stromal cells

Block 9 Week 5 (3 decks)

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