Kidney and Bladder, TBP Flashcards
Reason why many kidney disease do not become clinically apparent until majority of the organ is affected
Large physiologic reserve
Reason why many kidney disease do not become clinically apparent until majority of the organ is affected
Large physiologic reserve
Prerenal vs Renal: FENa less than 1%
Prerenal
Prerenal vs Renal: FENa >1%
Renal
Prerenal vs Renal: BUN/Cr ratio >20:1
Prerenal
Prerenal vs Renal: BUN/Cr ratio less than 20:1
Renal
Prerenal vs Renal: Urine sodium
Prerenal
Prerenal vs Renal: Urine sodium >20 mEq/L
Renal
Prerenal vs Renal: Urine osm >500 mOsm/kg
Prerenal
Prerenal vs Renal: Urine osm less than 400 mOsm/kg
Renal
Diagnostic test of choice in post renal azotemia
Ultrasound
Electrolyte disturbances in acute renal failure
1) Hyponatremia
2) Hyperkalemia
3) Hyperphosphatemia
4) Hypocalcemia
Acid-base disorder in acute renal failure
Metabolic acidosis
Oliguria is defined as
Less than 400 mL/day
Very sensitive test for differentiating pre renal from renal cause of ARF
FENa
Chronic renal failure: Electrolyte imbalance
1) Hyperkalemia
2) Hyperphosphatemua
3) Hypocalcemia
Chronic renal failure: Acid-base disorder
Metabolic acidosis
Chronic renal failure: Urine SG
Less than 1.010
Acute renal failure: Urine SG in renal cause
Less than 1.010
Prerenal vs Renal: FENa
Prerenal
Prerenal vs Renal: FENa >1%
Renal
Prerenal vs Renal: BUN/Cr ratio >20:1
Prerenal
Prerenal vs Renal: BUN/Cr ratio
Renal
Prerenal vs Renal: Urine sodium
Prerenal
Prerenal vs Renal: Urine sodium >20 mEq/L
Renal
Prerenal vs Renal: Urine osm >500 mOsm/kg
Prerenal
Prerenal vs Renal: Urine osm
Renal
Diagnostic test of choice in post renal azotemia
Ultrasound
Electrolyte disturbances in acute renal failure
1) Hyponatremia
2) Hyperkalemia
3) Hyperphosphatemia
4) Hypocalcemia
Acid-base disorder in acute renal failure
Metabolic acidosis
Oliguria is defined as
Less than 400 mL urine per day
Very sensitive test for differentiating pre renal from renal cause of ARF
FENa
Chronic renal failure: Electrolyte imbalance
1) Hyperkalemia
2) Hyperphosphatemua
3) Hypocalcemia
Chronic renal failure: Acid-base disorder
Metabolic acidosis
Chronic renal failure: Urine SG
Less than 1.010
Acute renal failure: Urine SG in prerenal cause
> 1.020
Acute renal failure: Urine SG in renal cause
Less than 1.010
Chronic renal failure: Hematologic complications (2)
1) Normocytic normochromic anemia
2) Platelet dysfunction
Chronic renal failure: Skeletal complications (2)
1) Renal osteodystrophy
2) Hyperparathyroidism
Earliest and most sensitive clinical indication of hypovolemia
Oliguria
Stains in LM: Basement membrane and mesangium
PAS
Stains in LM: Fibrosis
Trichrome
Stains in LM: Basement membrane
Silver
Igs used in IF
IgG, IgM, IgA
IF pattern: Reaction of Ab with pathogenic Ab directed against Ag in the GBM
Linear
IF pattern: Reaction of Ab with pathogenic Ag-Ab complexes on GBM
Granular
Allows for detection and determination of location of ICs and evaluation of basement membrane
EM
Origin of MOST glomerular diseases
Immunologic
Mechanism of destruction in IC deposition
Complement activation and chemotaxis via C5a
Type of edema caused by nephrotic syndrome
Generalized (anasarca)
Nephrotic syndrome: Mechanism for hyperlipidemia
Response of liver to loss of albumin by producing more apolipoprotein to compensate for low serum osmotic pressure
Nephrotic syndrome: Key component of the slit diaphragm found between the podocyte foot processes which may help control permeability
Nephrin
Nephrotic syndrome: Risk of thrombosis is secondary to
Urinary loss of antithrombin III, protein C, and protein S
Appearance of lipid droplets under polarised light
Maltese cross
Most common cause of nephrotic syndrome in all populations
Primary
LM: Minimal change disease
Normal
LM: FSGS
Segmental sclerosis of glomeruli
LM: Membranous glomerulopathy
Spike and dome on silver stain
LM: PSGN
Lumpy-bumpy on silver stain
LM: RPGN (all types)
Glomerular crescents
LM: MPGN (all types)
Tram-track appearance on silver stain
IF: MCD
Negative
IF: FSGS
IgM and C3
IF: Membranous GN
IgG, granular
IF: PSGN
IgG, IgM and C3, granular
IF: RPGN I
IgG (anti-GBM) Linear
IF: RPGN II
IgG Granular
IF: RPGN III
Negative
IF: MPGN I
IgG and C3, granular
IF: MPGN II
C3
EM: MCD
Effacement of foot processes
EM: FSGS
No immune complexes
EM: Membranous GN
Subepithelial IC deposits
EM: PSGN
Predominantly subepithelial IC deposits; also subendothelial, intramembranous, and mesangial
EM: RPGN Type I
No IC
EM: RPGN Type II
Subendothelial IC deposits
EM: RPGN Type III
No IC
EM: MPGN Type I
Subendothelial IC
EM: MPGN Type II
Long dense band in lamina densa and sub endothelial region
Nephrotic syndrome: 4 main conditions
1) Minimal change disease
2) Membranous GN
3) FSGS
4) DM nephropathy
MCD: Also known as
Lipoid nephrosis
MCD: Male vs female
Male
MCD: Selective vs nonselective proteinuria
Selective
MCD: Conditions associated (3)
1) Hodgkin’s lymphoma
2) Other lymphomas and leukemias
3) NSAIDs
T/F FSGS is immunologic in origin
F
Mechanism of FSGS
Epithelial injury
FSGS: Type of proteinuria
Nonselective
FSGS: Variant that has worse prognosis and similar to injury seen with HIV infection
Collapsing variant
Significant independent risk factors for the development of FSGS
1) IV heroin
2) HIV
Risk of FSGS in IV heroin users
30x that of the general population