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**Old DOOS > Kidney 3 > Flashcards

Kidney 3 Flashcards

1
Q

what is the semi-quantitative number for a trace dipstick protein

A

<30 mg/dL

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2
Q

A 2+ dipstick protein indicates what range of protein in the urine?

A

100>300 mg/dL

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3
Q

how many dL in a L?

A

10

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4
Q

what are the three types of proteinuria?

A

prerenal/overflow
glomerular
tubular

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5
Q

what is prerenal/overflow proteinuria?

A

globulins

light chains

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6
Q

what is glomerular protein that leads to proteinuria?

A

albumin

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7
Q

what can cause functional proteinuria?

A

fever
exercise
CHF stress

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8
Q

what is orthostatic proteinuria?

A

t occur when laying down

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9
Q

what are the three types of glomerular proteinuira?

A

functional
orthostatic
fixed/persistent (most concerning)

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10
Q

what causes tubular proteinuira?

A

microglobulins

albumin

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11
Q

what is the nephrotic range of proteinuria?

A

> 3.5 gm/day

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12
Q

with nephritic syndrome how will the urine sediment look?

A

active or angry

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13
Q

what will urine sediment look like w/ nephrotic syndrome?

A

bland or busy

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14
Q

is nephritis syndrome usually acute or chronic

A

acute

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15
Q

symptoms of nephrotic syndrome

A 
proteinuria >3.5 gms
hypoalbuminemia
edema
hyperlipidemia
hyperlipiduria
urine usually bland
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16
Q

what is seen with nephritis syndrome

A

proteinuria usually <3.5
hematuria- casts, dysmorphic rbcs
altered renal function (increased SrCr, decreased crCl)
HTN often severe

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17
Q

how much albumin can you make in one day?

A

12-15 grams

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18
Q

causes of a bland urine

A

minimal change dz
membranous glomerulonephropathy
focal segmental glomerulosclerosis

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19
Q

causes of a secondary bland urine

A

diabetic neuropathy

amyloidosis

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20
Q

primary cause of an angry urine

A

membranoproliferative glomerulonephritis

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21
Q

what can cause acute post infectious GN?

A

sub bacterial endocarditis
shunt nephritis
abscess

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22
Q

what types of nephritis syndromes will present w/ low complement levels?

A

Acute post infectious GN
membranoprolifeartive GN
SLE
lcryoglobulinemia

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23
Q

nephritis syndrome w/ normal complement levels can be caused by what?

A 
IgA nephropathy
idiopathic RPGN
AG basement membrane
PAN (polyarteritis nodosa) 
wegener's 
HSP
Goodpasture's
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24
Q

what does a proliferative glomerulus dz involve?

A

> 3/lobule, increase in number of cells

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25
Q

what goes wrong in minimal change nephrotic syndrome

A

integrity of endothelial compromised

the podocytes are efaced

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26
Q

what goes wrong w/ the glomerulus in SLE

A

large subendothelial deposits are on top of the basement membrane
efaced podocytes
smaller deposits in subepithelial

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27
Q

what happens in post strep GN?

A

large subepithelial humps (antigen-antibody complexes)

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28
Q

what happens with membranous GN?

A

smaller depositions in the subepithelial humps

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29
Q

what are the three categories of renal biopsies?

A 
light microscopy (LM)
immunofluoresence (IF)
electron microscopy (EM)
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30
Q

what will complement level be in minimal change dz?

A

normal

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31
Q

what is a hallmark of minimal change dz on EM?

A

foot process effacement

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32
Q

what causes MCD?

A

largely idiopathic

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33
Q

will minimal change dz respond to steroids?

A

yes, but if it doesn’t more likely to progress to renal failure

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34
Q

what are some associated w/ minimal change dz?

A 
NSAIDs
atopic allergic states
hodgkins dz
T-cell leukemias 
(these would make it more a secondary MCD)
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35
Q

what causes 85% of nephrotic syndrome in shildren and 20% of nephrotic syndrome in adults?

A

minimal change dz

36
Q

are there any abnormalities on light microscopy w/ MCD?

A

no

37
Q

what can’t see you on light microscopy?

A

foot process effacement

38
Q

what is the most common primary glomerular disorder leading to ESRD and accounts for about 50% of ESRD from glomerular dz.

A

Focal and Segmental Glomerulosclerosis (FSGS)

39
Q

are complement levels abnormal w/ FSGS?

A

no, complement levels are normal

40
Q

what conditions are associated w/ FSGS

A

ADIS

heroin users

41
Q

what symptoms are common at presentation for FSGS?

A

HTN
azotemia
hematuria

42
Q

what peaks in the 4th and 5th decades, has normal complements and poor tx options. Often present w/ hematuria w/out casts

A

membranous nephropmathy (MN)

43
Q

what is azotemia

A

elevated BUN

44
Q

what is the rule of 1/3s with membranous nephropathy?

A

1/3 w/ spontaneous remissions
1/3 w/ persistent proteinuria but stable function
1/3 progress to ESRD within 10 years

45
Q

what is frequently associated w/ Hep C, has low complement, commonly progressive.

A

Membranoproliferative glomerulonephritis (MPGN)

46
Q

what makes the prognosis of MPGN worse?

A

early age on onset
cresentic changes
persistent NS
decreased GFR

47
Q

Worldwide the most common primary glomerular disease. accounts for 40-50% of asymptomatic hematuria and associated w/ viral illness. normal complement levels

A

IgA neprhopathy mesangioproliferative GN (IgAN)

48
Q

tx for IgA nephropathy mesangioproliferative GN

A

tx associated HTN (ARB, ACEI)

49
Q

variation of IgA nephropathy, present like a GI virus

A

Honch-Schonlein purpua

50
Q

worse prognosis for IgAN with what other factors?

A

NR proteinuria Uprot -HTN

-High grade biopsy changes -Age

51
Q

what is the Leading cause of ESRD in US ~40%

A

diabetic nephropathy (DN)

52
Q

what cancers can cause 2ndary glomerular dz?

A

lyphoma
myeloma
adenoCA

53
Q

what connective tissue disorders can cause 2ndary glomerular dz?

A

SLE
RA
sjogrens
ACL syndrome

54
Q

what needs to be controlled in diabetics to prevent nephropathy

A

BP control
weight control
reduction of proteinuria

55
Q

what is the most common cause of post-infectious glomerulonephritis?

A

Group A beta hemolytic strep

56
Q

do you treat PIGN associated w/ GAS?

A

no, self-limited

57
Q

what will complement levels be like with PIGN?

A

low

58
Q

who will have persistent GN from PIGN?

A

those w/ chronic infections

59
Q

for a skin cause of PIGN what lab do you need?

A

anti-DNAase strep test

60
Q

what will most patients with PIGN present with?

A 
hematuria
proteinuria
rbc casts
ARF
HTN
61
Q

are complement levels high or low with lupus nephritis

A

low

62
Q

with lupus nephritis what will there be deposits of?

A

IgA
IgG
IgM
subendothelial deposits associated w/ poor tx outcomes

63
Q

more common in males and hearing loss is seen in 50%, will have hematuria w/ variable proteinuria

A

alport syndrome

thin basement membrane diseaes

64
Q

is there a specific treatment w/ alport syndrome?

A

no

65
Q

is thin basement membrane disease usually progressive?

A

no

66
Q

is pregnancy discouraged in basement membrane disease?

A

no, but in lots of other renal conditions

67
Q

what does rapidly progressive glomerulonephritis mean?

A

creatinine is going up on a daily basis

68
Q

what are ANCA associated rapidly progressive glomerulonephritis?

A

Wegner’s granulomatosis
Microscopic polyarteritis nodosa (PAN)
Idiopathic cresentic glomerulonephritis

69
Q

what are anti-GBM mediated conditions that can cause RPGN?

A

Goodpasture’s syndrome

Idiopathic anti-GBM disease

70
Q

rapid renal failure + upper resipratory syndromes

A

wegner’s granulmatosis

71
Q

ANCA positive that may have a respiratory component

A

Microscopic polyarteritis nodosa (PAN)

72
Q

what are immune-complex mediated conditions that can lead to RPGN?

A

Lupus nephritis
Infection associated
Cryoglobulinemia
Henoch-Schonlein purpura

73
Q

associated w/ a dramatic respiratory componenet, but has anti-GBN antibody

A

goodpasture’s syndrome

74
Q

protein deposition dz, associated w/ hep c when showing RPGN

A

Cryoglobulinemia

75
Q

present w/ a vasculitis and RPGN

A

henoch-schonlein purpua

76
Q

what does the C-ANCA correspond to?

A

Wegner’s

77
Q

what does the p-ANCA correspond to?

A

polyangitis

78
Q

what are the four types of kidney disorders

A

simple cyst (aging)
ADPKD
ACKD (acquired)
MSK

79
Q

CKD commonly found in aging people. Will have a normal kidney size and no stones.

A

simple cyst

80
Q

CKD associated w/ hematuria, pain, UTI is larger than normal and stones are common

A

ADPKD

81
Q

CKD associated w/ people on dialysis. Hematuria is common, will ahve a small kidney, stones aren’t common

A

ACKD

82
Q

CKD that is common and associated with UTIs. stones are common

A

medullary (MSK)

83
Q

what are 3 main causes of acute interstitial nephritis

A

diuretics (most common)
abx
NSAIDs

84
Q

features of acute interstitial nephritis

A 
Fever                        
Skin rash
Arthralgias
Peripheral eosinophilia
Eosinophiliuria
Sterile pyuria (leukocyte cast)
Hematuria/proteinuria (<1 gm/day)
Hyperkalemia 
 RTA
85
Q

what is seen in fanconi’s syndrome

A

Uglucose, Uaa, Uposphate, RTA.

86
Q

what will chronic tubulointerstitial disease look like on urinalysis?

A

sterile pyruia
proteinuria (<1gm/day)
low specific gravity

**Old DOOS (11 decks)

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