GU Flashcards
Spike and dome basement membrane thickening?
membranous glomerulonephritis
uncommon cause of chronic nephritis that occurs primarily in children and young adults
- tram track appearance (double glomerular basement membrane)
- may be idiopathic, result from antibodies against complement components, or be secondary to chronic infections, especially hepatitis B or C
membranoproliferative glomerulonephritis
hematuria and increasing azotemia (increased BUN and creatinine)
- crescentic glomerulonephritis and a linear pattern along the glomerular basement membrane
rapidly progressive glomerulonephritis
Antibodies directed against the glomerular basement membrane typically cause rapidly progressive glomerulonephritis with hematuria and increasing azotemia (increased BUN and creatinine)
- antibodies also attack the pulmonary basement membranes, causing hemoptysis
Goodpasture’s syndrome
MCC nephrotic syndrome in children
- absence of glomerular foot processes on podocytes
- light microscopy of the glomeruli is normal
minimal change dz
- effectively treated w/ steriods!
what do ACE-I’s and ARB’s prevent?
progression of kidney disease
- best tx for proteinuria* (have antiproeinuric effects)
mesangial matrix becomes more abundant and forms masses of pink-staining, hyaline material among the capillary loops
Kimmelstiel-Wilson nodules
flank pain, hematuria, hypertension, and progressive renal failure in their 30s
- Renal cysts located in cortex and medulla
- 50% of pts require dialysis by age 60
- cardiac problems MCCOD
- berry aneurysms/SAH are serious complication
ADPKD
- Gene mutations in PKD inhibit production of polycystin 1 and 2
self-limited epidermal infection caused by a Poxviridae virus
- flesh-colored, dome-shaped papules that are firm and umbilicated
- transmitted by skin to skin contact
molloscum contagiosum
- widespread infection indicates immunocomp (HIV/aids)
flat, cauliflower-shaped, filiform, and verrucous warts
- can be white, erythematous, violaceous, brown, hyperpigmented, and even skin-colored
HPV
what transplant drug creates a complex with intracellular immunophilins (FKBP) and binds to mTOR inhibiting T-cell proliferation in response to IL-2
sirolimus
urinalysis positive for blood with no red blood cells seen on microscopy?
- can occur with trauma, severe dehydration, seizures, or confinement in a fixed position for a prolonged period of time
rhabdomyolysis (muscle breakdown)
abrupt decline in renal function, manifested by an increase in plasma BUN and serum creatinine, occurring hours to days after injury
- BUN:Cr< 15
- hyperkalemia
- muddy brown casts in the urine
acute tubular necrosis
MC kidney stone?
calcium oxalate
what causes hematuria?
When the glomerulus is damaged, red blood cells can squeeze their way through the glomerulus and enter the urine
a healthy patient receiving antibiotics for a joint infection, who suddenly has an increased creatinine level 2 days after starting antibiotics should be worked up for what?
acute tubular necrosis
what is 2nd MCC of UTI in young females?
staph saprophiticus
what does finasteride inhibit?
5a-reductase (decreasing conversion of T -> DHT)
NOTE: finasteride is a teratogen and should not be handled by pregnant women
tamsulosin, terazosin, or prazosin can alleviate the symptoms of BPH by inhibiting smooth muscle contraction on the prostate via what receptor?
alpha-1-antagonism
- can also be used for women w/ overflow incontinence (relaxes the bladder neck)
hematuria, proteinuria, hypertension, or evidence of renal impairment
- CT scan showing bilaterally enlarged kidneys with multiple cystic lesions as well as several small hepatic cysts
ADPKD
what are the tx options for mercury poisoning?
dimercaprol, penicillamine, unithiol, or succimer
what drug class is a common cause of acute tubular necrosis and acute renal failure due to the buildup of myoglobin in the kidneys?
statins
- affect ATP production by impairing the electron transport chain of mitochondria
what is the gold standard of measurement of GFR?
inulin
- more accurate than creatinine, although measuring creatinine is much easier (don’t need to inject tracer dye)
what vessel causes horseshoe kidney?
IMA
- A horseshoe kidney occurs due to fusion of the inferior poles of the kidneys during fetal development
- As the kidneys ascend from the pelvis, the horseshoe kidney becomes entrapped under the inferior mesenteric artery (IMA)
what type of stone?
- high urine pH (8+)
- recent URI w/urease producing organism (Proteus, Klebsiella)
Magnesium ammonium phosphate stones
- aka struvite stones
ratio of glomerular filtration rate (GFR) to renal plasma flow (RPF)
Filtration Fraction: FF = GFR/RPF
- proportion of the fluid reaching the kidneys
what preferentially constricts the EFFERENT arteriole?
Ang II
- stimulates aldosterone secretion by the adrenal cortex
efferent arteriole constriction will lead to an increase or decrease in GFR?
increase
NOTE: ANG II -> efferent constriction will decrease RPF (less blood flow), but increases GFR -> leading to an overall increase in FF
afferent arteriole constriction will lead to an increase or decrease in GFR?
decrease
- NSAIDs inhibit prostaglandins -> thus decreasing GFR
what dilates the afferent arteriole?
prostaglandins
- causes increase in FF and GFR
BPH, or constriction of the ureter will have what change on FF, GFR, RPF?
decreases GFR -> decreases FF
- no change in RPF (no change in blood reaching glomerulus)
what is the imaging study of choice for nephrolithiasis?
CT
- US will not pick up small stones
what should a psoas sign make you think of? (lower back pain radiating to groin)?
nephrolitiasis
- as the ureter passes just over the psoas muscle
why is PCR or ELISA typically used to confirm the diagnosis of C. trachomatis?
chlamydia is difficult to culture (gram-indeterminate)
what is the form of Chlamydia trachomatis that infects cells?
elementary body
- inclusion bodies replicate once inside cells
genetic disorder with renal, auditory, and ocular manifestations due to type 4 collagen defects
Alport syndrome (x-linked)
- hemturia
- sensorineural hearing loss
- anterior lenticonus (conical protrusion d/t lens thinning)
- other type 4 collagen defects (splitting of GBM)
children, 2 weeks after pharyngitis or skin infection
- Dark urine (tea/cola-colored)
- HTN
- periorbital edema
- ↑ anti-DNase B/ASO titers
- ↓ C3 complement
- subepithelial humps (lumpy bumpy!)
PSGN
subepithelial humps = irregular, finely granular pattern with small deposits on the GBM overlying the mesangium
IgA deposits lodge in the mesangium of the renal corpuscle
- occurs concurrently with an upper respiratory or gastrointestinal infection, with normal compliment levels (unlike PSGN)
Bergers disease (IgA nephropathy)
MCC of nephrotic syndrome in AA’s
- in children, it is most often idiopathic
- in adults, heroin use and HIV infection are common associations
Focal segmental glomerulosclerosis (FSGS)
- segmental areas of mesangial collapse with sclerosis in some glomeruli
rapid loss of renal function over days to weeks
- bx shows glomerular “crescent” formation
- if left untreated, progresses into acute renal failure and death within months
RPGN
- significant proteinuria (> 3.5 g/day)
- edema
- hypoalbuminemia
- hyperlipidemia
nephrOtic
- hematuria with dysmorphic red blood cells and red blood cell casts
- edema (due to salt retention)
- proteinuria (< 3.5 g/day)
- HTN
nephritic
where does aldosterone exert its effects?
distal tubules and collecting ducts
what effect does ANP have on the kidneys?
tells the renal tubule to decrease sodium absorption
- triggered in response to high Na (HTN)
what effect do kidney stones have on GFR?
decreases GFR
- fluid buildup increases the hydrostatic pressure within the kidney tubules and Bowman’s space
- an increase in the hydrostatic pressure of Bowman’s space leads to a decrease in net ultrafiltration pressure -> decreasing GFR
what is the most common renal malignancy in children?
Wilms tumor (nephroblastoma) - epithelial, blastemal, and stromal cells = mesoderm (NOT neural crest)
Wilms tumor in association with:
- organomegaly
- macroglossia (large tongue)
- neonatal hypoglycemia (d/t excess insulin production)
Beckwith-Wiedemann syndrome
lack of ADH?
can’t concentrate urine (stays dilute)
what is the drug of choice for a UTI during pregnancy?
macrolides: amoxicillin, erythromycin, azithromycin
what is the anterior Chapman point for the prostate?
POSTERIOR edge of the proximal IT band near the TFL muscle
bladder contractions are weak or nonexistent, causing incomplete voiding, urinary retention, and over-distension of the bladder
overflow incontinence
- bladder fullness, incomplete voiding
typically caused by surgical procedures that result in urethral stenosis or obstruction, or excessive urethral scarring either from surgeries or recurrent UTIs
outflow obstruction
increase in the intra-abdominal pressure, either from laughing, sneezing, or exercise
stress incontinence
what med counteracts acetylcholine, acting on the bladder and making the wall muscles contract?
oxybutinin
hyperactive detrusor muscle that causes incontinence regardless of bladder urine volume
urge incontinence
autoimmune vasculitis with:
- recurrent oral aphthous ulcers
- genital ulcers
- uveitis
- panniculitis/erythema nodosum (skin infection)
Behçet syndrome
crescents of fibrin and plasma proteins on LM?
rapidly progressive (crescentic) glomerulonephritis
Diffuse capillaries and GBM thickening on LM?
- present with edema, nonspecific complaints of anorexia, malaise, and fatigue
- strong granular capillary wall staining for IgG, complement component 3, and kappa and lambda light chains
membranous glomerulonephritis
- enlarged hypercellular glomeruli
- starry sky appearance
- subepithelial immune complex “humps”
PSGN
metronidazole causes disulfram rxn
:)
chronic renal disease leads to a decrease in what?
- ultimately leading to hypocalcemia
1,25-dihydroxy vitamin D
edema, hyperkalemia, metabolic acidosis, hyperphosphatemia, hypocalcemia, renal osteodystrophy, hypertension, pruritis
chronic renal failure
- due to decrease in GFR
chronic renal failure results in alkalosis or acidosis?
high anion gap metabolic ACIDOSIS
- due to loss of renal mass, which decreases NH4+ excretion, and the kidney’s inability to excrete H+
palpable purpura on the buttocks and lower extremities of a young child
- subcutaneous non-pitting edema
- IgA immune complexes on small vessel walls (type 3 HSRxn)
Henoch-Schonlein Purpura (small vessel dz)
elderly (50+) w/fever, fatigue, temporal headache, and high erythrocyte sedimentation rate
- granulomas and giant cells will be seen within the large vessel walls
giant cell arteritis (large vessel dz)
immune destruction of medium-sized blood vessels
- vasculitis generally occurs secondary to either hepatitis B, hepatitis C, or hairy cell leukemia
- The tetrad for diagnosis is fever, hypertension, abdominal pain with melena, and renal disease
polyarteritis nodosa (PAN) - Kussmaul disease
positive p-ANCA?
- hypersensitivity arteritis
- microscopic polyarteritis
- Churg-Strauss
- ENT complaints (sinusitis, rhinitis, otitis media, rhinorrhea, oral and nasal ulcers, hearing loss)
- pulmonary complaints (wheeze/cough/hemoptysis)
- renal involvement (glomerulonephritis; crescents of fibrin, epithelial cells, and white blood cells in the glomeruli)
- positive c-ANCA
- segmental crescentic necrotizing glomerulonephritis with little or no immunoglobulin or complement deposition (pauci-immune)
GPA (WeCeners)
- need immunosuppressive tx
what is ketorolac?
NSAID that inhibits prostaglandin synthesis
- will cause a decrease in RPF and a subsequent decrease in GFR
what xsome deletion for Wilms tumor?
deletion of the WT1 gene on chromosome 11
papular eruptions that appear pearly, filiform, fungating, cauliflower, or plaquelike
- can be quite smooth, verrucous, or lobulated
condyloma acuminata
- HPV 6, 11
Coffin lid shaped stones; seen in the setting of infection with a urease-producing bacteria
struvite stones
Hexagonal shaped stones; found in acidic urine
cysteine stones “six”-teine
Rhomboid shaped stones; seen in the setting of hyperuricemia
- precipitate out in acidic urine (pH < 5.5)
uric acid stones
Envelope/dumbbell shaped stones
- seen in hypercalciuria
calcium oxalate
wedge shaped
- seen in hypercalciuria
calcium phosphate
what type of HsRxn is PSGN?
type 3
- high concentrations of M protein (targeting s. pyogenes) and antibody form immune complexes that affect the kidney
cholinergic agonist that can increase detrusor muscle tone
- used to treat overflow incontinence of neurogenic cause (diabetic neuropathy)
Bethanechol
when do you see kimmelstiel-wilson lesions?
glomerular sclerosis seen in membranous nephropathy secondary to diabetes mellitus
what causes edema in nephrotic syndrome?
Decreased plasma proteins leads to decreased oncotic pressure
- less force for pulling fluids back into the capillaries
what is the MOA of thiazide diuretics?
they inhibit NaCl cotransporters in the distal convoluted tubule
- prevent hypercalciuria by decreasing calcium excretion
- good for people with recurrent calcium kidney stones! (less calcium in urine)
what is the MOA of spironolactone?
inhibits aldosterone in the collecting duct
- leads to hyponatremia and hyperkalemia (K-sparing)
- good for pts with heart failure or ascites
what is the MOA of furosemide?
blocks the Na-K-2Cl transporter in the descending loop of henle
- increased sodium, calcium, and magnesium excretion (bad for calcium stones)
- can lead to hyponatremia, hypocalcemia, and hypomagnesemia
what are carbonic anhydrase inhibitors used for?
altitude sickness, glaucoma, and idiopathic intracranial hypertension
- decreases formation of bicarbonate -> metabolic acidosis
what causes mesangial expansion, glomerular basement membrane thickening, podocyte injury, and ultimately, glomerulosclerosis?
diabetic nephropathy
what tests for high urine cysteine levels
cyanide nitroprusside test
- cystinuria causes hexagonal urine crystals
where does ADH work?
collecting tubule
- binds V2 receptors on the principal cells in the distal convoluted tubule and collecting duct
what stimulates 1-alpha-hydroxylase in the kidneys to increase 1,25 (OH)2 vitamin D production?
PTH
what stimulates adenylate cyclase to increase cAMP in the renal tubules?
PTH
- increases calcium reabsorption in the distal tubule
- decreases phosphate reabsorption in the proximal tubule
what is the tx for nocturnal enuresis?
desmopressin (ADH)
- to increase urine osmolarity
what is the virulence factor for Gram-negative rod sepsis?
lipid A portion of LPS
what is the virulence factor of cholera?
cAMP inducing exotoxin -> influx of Ca
what type of RTA causes a defect in the proximal tubule resulting in impaired bicarbonate reabsorption?
type 2
what type of RTA is caused by a defect in the distal tubule resulting in acidosis, generally hypercalciuria, autoimmune diseases in adults, or hereditary defects in children?
type 1
what type of RTA is caused by an aldosterone problem which can be due to either decreased aldosterone secretion or aldosterone resistance
- pts generally have a minor metabolic acidosis in the setting of hyperkalemia
type 4
how do you calculate renal clearance?
Renal Clearance = (Urine concentration of substance) X (Urine formation rate) / (Plasma concentration of substance)
chronic schistosomiasis can lead to what type of cancer?
- painless gross hematuria with vague lower abdominal/suprapubic pain
- eosinophilia
squamous cell carcinoma
look out for travel to the Middle East and East Africa, especially with agricultural and/or fresh water interaction, smoking, aniline dyes, and petroleum byproducts
what is DES exposure in utero linked to?
clear cell carcinoma of the vagina
Urinalysis revealing epithelial cells and granular casts is pathognomonic for what?
acute tubular necrosis
what do white blood cell casts suggest?
pyelonephritis
- white = neutrophils (infection)
- casts = formed in renal tubules (infection in kidney)
ANP and BNP cause what?
an increase in glomerular filtration rate and an increase in sodium filtration/excretion
- released in response to stretch -> goal is to lower BP
what are the water permeable sections of the nephron?
- proximal convoluted tubule
- thin descending limb of the loop of Henle
- collecting duct
radiolucent stone, rhomboid shaped?
uric acid
radiopaque stones, envelope shaped?
calcium oxalate
why are patients with diabetes, especially those with DKA, at a greatly increased risk for mucormycosis infection?
those organisms have an enzyme, ketone reductase, which favors their growth in the high glucose, acidic environment created in the DKA state
tamsulosin?
alpha-1 antagonist that will inhibit smooth muscle contraction of the prostatic urethra
oxybutinin?
antispasmodic, antimuscarinic medication that affects smooth muscle
- increases bladder capacity, decreases uninhibited contractions, and delays the desire to void
hemangioblastomas of the central nervous system and the retina, usually presenting in early adults
- hematuria, visual deficits or visceral symptoms
- bilateral renal cell carcinoma in 50% of patients
- can also have tumors in pancreas and adrenals
von Hippel-Lindau (AD)
H: hemangioblastoma
I: increased risk of renal cell cancer
P: pheochromocytoma
P: pancreatic lesions (cyst, cystadenoma, cystadenocarcinoma)
E: eye dysfunction (retinal hemangioblastoma), endolymphatic sac tumors
L: liver, renal and pancreatic cysts
- cutaneous lesions (“cafe-au-lait” spots, inguinal/axillary freckles)
- benign and malignant CNS neoplasms (neurofibromas and gliomas)
- eye lesions (iris hamartomas)
neurofibromatosis
where is the macula densa located?
in the early distal convoluted tubule
- macula densa is part of the JG aparatus
- where renin is released
- is where ARBs (-sartans) and ACEI’s (-prils) exert effects
hypercalcemia from metastatic cancer, what should you give to manage fluid levels? (other than biphosphonates and calcitonin)
loop diuretics (loops loose calcium)
- cause an increase in Ca and Mg excretion
- adverse effects: ototoxicity (vertigo, nausea, and hearing loss), hypokalemia, photosensitivity, hypersensitivity
what diuretic re-acidifies the blood and alkalinizes the urine?
carbonic anhydrase inhibitors (acetazolamide)
what would paCO2 be of someone hyperventilating?
less than 40
- breathing harder = more CO2 expelled = less in blood
what does an aspirin overdose cause?
metabolic acidosis via uncoupling of the electron transport chain and converting to anaerobic metabolism
rhabdomyolysis would cause what type of acid/base disturbance?
metabolic acidosis
- toxic myoglobin breakdown products injure the kidneys
- kidneys would not be able to produce or retain adequate stores of bicarbonate to offset the accumulation of anaerobic metabolism byproducts, leading to an acidotic state
angiomylipomas, renal cysts
- seizures, intellectual disability
- subependymal astrocytoma
- ash leaf spots (hypopigmented macules)
- ungual fibromas
tuberous sclerosis (AD) - CNS most commonly affected, then kidneys and skin
hydronephrosis on fetal US?
posterior urethral valves
what does Wilms tumor WAGR stand for?
- Wilms tumor
- Aniridia
- GU abnormalities
- mental Retardation
what effect do burns have on plasma proteins?
proteins leaks into the tissue, decreasing the oncotic pressure within the glomerular capillaries resulting in an increase in glomerular filtration rate
what organism causes punctate hemorrhages of the cervix and vagina?
trichonomas (strawberry cervix!)
nephrotic syndrome and anti–double-stranded DNA
- biopsy demonstrating diffuse capillary thickening and mesangial hypercellularity
diffuse proliferative glomerulonephritis
Anechoic renal parenchymal lesions?
cysts!
- a stone would be distinctly seen as a hyperechogenic foci with posterior shadowing
T. vaginalis only exists in what form?
trophozoite! no cyst form exists
A high sodium diet predisposes to what type of stone?
calcium oxalate stones
- causes increased urinary excretion of calcium.
NOTE: decreased sodium intake DECRE`ASES stone formation
what blood gas levels are expected n chronic kidney disease?
anion gap metabolic acidosis w/ respiratory compensation
phospholipase A2 receptor antibodies are high specific for what nephrotic syndrome?
membranous nephropathy
