kidney Flashcards
common clinical findings of somebody who has nephrotic syndrome
proteinuria hypoalbuminemia edema hyperlipidemia lipiduria
what is the most common cause of nephrotic syndrome in children?
min. change syndrome
what are some microscopic changes that can be found in min. change syndrome
loss of foot processes
smeared look over GBM
how would you treat a child that you suspect might have min. change disease?
corticosteroids
if child presence to clinic with proteinuria hypoalbuminemia edema hyperlipidemia lipiduria
what will you treat them with?
what do you suspect that they have?
min. change disease
treat with corticosteroids
membranous GN special lab findings?
spike like projections
sub-epithelial immune deposits
no cellular proliferations
thickening of GBM
which nephrotic syndromes have spike like projections?
MGN
what are some secondary causes of MGN?
Hep. B syphilis malaria malignant carcinoma of the lung SLE Drugs NSAIDS
what is most common primary cause of MGN?
idiopathic
pt. comes in with nephrotic symptoms, you run a lab and find thickening of the GBM, sub-epithelial spikes, has no cellular proliferation…
what will be on the top of your differential dx.?
membranous GN
what are some special findings linked too FSGS?
sclerosis of focal spots of glomeruli involved and
segmental capillary tufts
what are some primary causes of FSGS?
nephrotic syndrome
what are some secondary causes of FSGS?
HIV
heroin
pt. has a history of heroin usage and nephrotic syndrome disorder, you do a lab test and find sclerosis of only some glomeruli and some capillary tufts what should be the top of you differential dx.?
FSGS
microscopically what are some findings of FSGS?
loss of foot processes
Cell detachment
Cytokines
blue collagen
which of the nephrotic syndromes can be caused by cytokines?
FSGS
which of the nephrotic syndromes uses trichome stain?
FSGS
which of the nephrotic syndromes can be seen as a final stage of pyelonephritis?
FSGS
which of the nephrotic syndromes has epithelial detachment?
FSGS
membranoproliferative GN (MPGN) involves which cells of the kidney?
mesangial cells
MPGN:
the proliferation of the mesangial cells split the GBM which leaves it looking like what microscopically?
tramtrack
what may be found microscopically in a pt. who has MPGN?
double contour of subendothelial IgG and C3 --> immune complexes infiltrating leukocytes lobular pattern splitting of GBM
can children get MPGN?
yes
what are some secondary causes of MPGN?
Hep c and b
SLE
what do MPGN and MGN have in common?
they both have immune complexes
which autoimmune disease has MPGN, increase of WBC’s in mesangium, IgA deposits and edema within the capillary lumen?
henoch schonlein purpura (HSP)
what are some findings of alport nephritis?
unexplained hematuria Hx. of nephritis B/L sensorineural hearing loss ocular lesions alterations of GBM familial ESR
what are the symptoms of pre eclampsia?
HEP =>
hypertension
edema
proteinuria
Eclampsia symptoms
HEP + coma, convulsions –> death
pregnant lady come to clinic with history of hypertension, you notice edema and proteinuria what should be on the top of your Dx.?
pre-eclampsia
pt. comes into the clinic with unexplained hematuria, B/L sensorineural hearing loss and ocular lesions what is on the top of your Dx.?
alport neohritis
you use a jones silver stain and notice IgA deposits, capillary lumina edema and increase of WBC’s along with the pt. having nephrotic findings.. what should be on the top of Dx.?
henoch schontein purpura (HSP) MPGN
what are common clinical findings of acute proliferative GN?
azotemia hematuria oliguria hypertension some proteinuria and edema
what is an example of an endogenous cause of acute proliferative GN>
SLE
what is an example of an exogenous cause of acute proliferative GN?
streptococcus HEP b mumps measels checkenpox
what are some pathological findings of acute proliferative GN?
increase of glomerular tufts
proliferation of mesangial and endothial cells
neutrophilic and monocytic infiltration
in acute proliferation GN where are the immune complex deposits located?
subendothelial and intramembranous
what special appearance does acute proliferative GN appear like under microscope?
‘lumpy bumpy’
what kind of immune complexes can you find in the capillary loops?
IgG
clinical:
an infant comes into the clinic and the mother says they got over ‘strep’ about 4 weeks ago and now she notices the child is barely peeing, he is lethargic and notices the pee is brown
what should you suspect as a Dx.?
acute proliferative GN (post streptococcus)
what are some findings of somebody that has rapidly progressive glomerulonephritis?
- severe oliguria
*crescence of glomeruli (ruptured GBM)
presence of monocytes and macrophages
fibrin
if a person has good pastures disease what kind of nephritic syndrome can you assume they are presenting with if have the common symtoms?
rapidly progressive glomerulonephritis
what type of HSR is goodpasture syndrome?
type 2
what might be a 2ry cause of rapidly progressive GN?
SLE
you run a lab on somebody who is presenting with azotemia
hematuria
oliguria
hypertension and you find macrophages and focal spots of ruptured GBM and crescence parietal cells what would be on the top of differential Dx.?
rapidly progressive GN
what is the leading cause of acute pyleonephritis?
ecoli
what are the two routes somebody can get pyelonephritis?
blood stream or ascending infection
what are some other organisms that cause acute pyelonephritis?
strep, staph, pseudomonas, klebsiella
what are some predisposing factors of acute pyelonephritis?
cytoscopy catheterization female outflow obstruction incompetent vesicoureteral orifice diabetic
what are the pathological findings of a kidney that has acute pyelonephritis
enlarged
yellow abcesses
deeply congested between abcesses
you are dissecting a kidney are realize suppurative inflammation of renal pelvis and interstitium and yellow abscesses.. what did the person suffer from?
acute pylonephritis
what are the two causes of chronic pyelonephritis?
chronic obstructive pyelonephritis
chronic reflux associated with pylenophritis
what is the most common form of chronic pyelonephritis?
chronic reflux associated with pyelonephritis
what are some pathological findings of chronic pyelonephritis?
1.diffuse patches of fibrin and scarring of pelvis and calyces 2.papillary blunting 3.interstitial fibrosis 4. contraction and dilation of tubules 5. arteriosclerosis
you do a dissection of kidney and your lab findings include:
glossy pink colloid appearance
contraction and dilation of tubules (cast filled)
scarring of pelvis and calyces &
arteriosclerosis
what is at the top of your Dx.?
chronic pyelonephritis
pt. presents to clinic with nocturia, polyuria and hypertension what should suspect?
especially if they have history of infection
chronic pyelonephritis
