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Nephrology > Kidney Disorders > Flashcards

Kidney Disorders Flashcards

1
Q

Infectious inflammatory disease of the renal parenchyma and pelvis
that usually ascends from the lower urinary tract

Complication of lower UTI – can ascend and affect one or both
kidneys

A

Pyelonephritis

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2
Q

What are the most common organisms that cause Pyelonephritis?

A

gram negative organisms:
E. coli
Proteus
Klebsiella
Enterobacter
Pseudomonas

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3
Q

What is a complication of pyelonephritis in diabetics that you should be aware of?

A

Emphysematous pyelonephritis

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4
Q

What type of organisms cause emphysematous pyelonephritis?

A

gas producing organisms

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5
Q

Why is emphysematous pyelonephritis so concerning?

A

Nephrotic, gangrenous

May be lift threatening

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6
Q

What condition presents as the following:

Dysuria
Fever
tachycardia
Shaking chills/rigors
Flank pain
NVD
Costovertebral tenderness
Back pain
Sepsis with shock

A

Pyelonephritis

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7
Q

List some complications of pyelonephritis

A

Sepsis with shock
Emphysematous pyelonephritis in diabetics
Scarring or chronic pyelonephritis
Abscess formation

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8
Q

Glomerular inflammation and damage resulting in microscopic or gross hematuria

5% of intrinsic renal failure

Usually children

A

Glomerulonephritis

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9
Q

What condition presents as the following:

Gross hematuria with or without systemic symptoms (tea colored urine)

Asymptomatic hematuria

Periorbital and scrotal edema

HTN

RBC casts and positive ASO titer

A

Glomerulonephritis

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10
Q

What is a common predisposing factor of glomerulonephritis, especially in children?

A

s/p Group A strep infection within 1-3 weeks

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11
Q

If a child had appropriate strep infection treatment, does that mean you can rule out glomerulonephritis?

A

No - glomerulonephritis can still happen even if the strep infection was treated appropriately

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12
Q

What type of glomerulonephritis is associated with extensive
glomerular crescent formation?

A

Rapidly-Progressive Glomerulonephritis

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13
Q

In rapidly-progressive glomerulonephritis, what indicates a poor prognosis?

A

Associated with extensive glomerular crescent formation

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14
Q

What are some causes of rapidly-progressive glomerulonephritis?

A

Infectious
Anti-GBM disease
Idiopathic (common)

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15
Q

What type of glomerulonephritis presents as the following:

Patients with idiopathic type note a preceding viral-like illness

Nephrotic or non-nephrotic proteinuria

Active urinary sediment with hematuria and RBC casts, leukocytes

Oliguria may be present

A

rapidly-progressive glomerulonephritis

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16
Q

In rapidly-progressive glomerulonephritis, what on urinalysis warrant
rapid diagnosis and treatment?

A

RBC casts

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17
Q

Prognosis in poor in rapidly-progressive glomerulonephritis when treatment is begun with a creatinine greater than what or when what is present?

A

6mg/dL or when oliguria is present

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18
Q

What type of glomerulonephritis presents as the following:

Proteinuria

Glomerular hematuria - Usually asymptomatic except for hematuria

Usually follows a group A beta-hemolytic strep infection by
1-3 weeks

Usually self-limiting (95%) and resolves spontaneously

No therapy required unless febrile

A

Post-Infectious Glomerulonephritis

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19
Q

What is the most common prior infection to post-infectious glomerulonephritis?

A

Post streptococcal is the most common

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20
Q

What age range is the greatest incidence to see post-infectious glomerulonephritis?

A

ages 2-5

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21
Q

What time frame post infection is it most likely to see post-infectious glomerulonephritis?

A

10-14 days post infection

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22
Q

What testing is used to diagnosis Post-Infectious Glomerulonephritis?

A

Confirm with ASO titer

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23
Q

What is the most common chronic nephritis in children?

A

IgA Nephropathy

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24
Q

What condition presents as the following:

Cause unknown

Present with asymptomatic gross hematuria

Initial onset usually 1-2 days after febrile URI

A

IgA Nephropathy

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25
Q

How is IgA nephropathy diagnosed?

A

Made by biopsy showing IgA deposits in glomeruli

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26
Q

What percentage of IgA nephropathy patients progress to hypertension and renal failure?

A

10%

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27
Q

What are the two classifications for glomular disease?

A

Nephritic and Nephrotic Syndromes

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28
Q

Which syndrome of glomular disease is described below?

Think acute glomerulonephritis

Inflammatory process causing renal dysfunction over days to weeks

May or may not resolve

Can cause permanent damage to nephrons, glomeruli, progresses to ESRD

Classified by edema, HTN, hematuria

Possible RBC casts and dysmorphic RBCs

“urinating blood”

A

Nephritis syndrome

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29
Q

Which syndrome of glomular disease is described below?

Think chronic system disease with glomerular involvement

33% have DM, amyloidosis, SLE, 66% idiopathic

Classified by proteinuria, hypoalbuminemia, peripheral edema

Hypercoagulability

Oval fat bodies in urine

“urinating protein”

A

Nephrotic syndrome

30
Q

Nephritis syndrome is classified by what?

A

hematuria

31
Q

Nephrotic syndrome is classified by what?

A

proteinuria

32
Q

What is the most common cause of nephrotic syndrome?

A

idiopathic

33
Q

What is the hallmark sign for nephrotic syndrome?

A

> 3.5 gram/day proteinuria

34
Q

Seeing lipid bodies showing a “maltese cross” appearance in polarized light are called what? And what disorder should you consider?

A

Oval fat bodies

nephrotic syndrome

35
Q

The majority of kidney stones are comprised of what?

A

calcium

36
Q

What are reasons to admit a patient with nephrolithiasis?

A

Presence of a fever

Intractable nausea, vomiting, or pain

37
Q

What are the five major types of urinary stones?

A

Calcium oxalate
Calcium phosphate
Struvite (magnesium ammonium phosphate)
Uric acid
Cystine

38
Q

What high intake of these two items may be important factors in the
development of urinary stones?

A

High protein
high salt

39
Q

What are the risk factors for developing a kidney stone?

A

Male gender
Dietary
Genetic

40
Q

What type of stone is most commonly seen in women?

A

Struvite

41
Q

Sudden onset of severe pain originating in the flank and radiating inferiorly and anteriorly (classic presentation)

Renal or ureteral colic – intermittent, can’t sit still

At least 50% of patients will have nausea
and vomiting

May present with gross hematuria

Back pain, Abdominal pain, Flank pain radiating to groin

A

Nephrolithiasis

42
Q

What is the test of choice for suspected nephrolithiasis?

A

CT scan without contrast

43
Q

What size of kidney stone is unlikely to pass spontaneously and
require some type of surgical procedure?

A

7mm or larger stone

44
Q

When to refer in cases of nephrolithiasis?

A

Evidence of urinary obstruction

Anatomic abnormalities or solitary kidney

Concomitant pyelonephritis

45
Q

Swelling of one or both kidneys

Occurs when a blockage somewhere in the urinary tract causes a
backup into the kidneys

A

Hydronephrosis

46
Q

One of the most common fetal problems seen during a prenatal
ultrasound

A

Hydronephrosis

47
Q

What are the causes of fetal hydronephrosis?

A

Posterior urethral valves
Vesicourethral reflux
Pelvic junction obstruction

48
Q

Severe cases of fetal hydronephrosis require what intervention?

A

a shunt to be placed in the bladder to relieve pressure

49
Q

Corrective surgery recommended in fetal hydronephrosis cases
if it doesn’t resolve within what time frame?

A

the first two years of life

50
Q

Born without one or both kidneys

A

Renal Agenesis

51
Q

Multiple cysts found on the kidney

Autosomal dominant or recessive

50% of patients will have ESRD by age 60

A

Polycystic Kidney Disease

52
Q

What ultrasound finding is seen in polycystic kidney disease?

A

“honeycomb” appearance

53
Q

What is the imaging of choice in polycystic kidney disease?

A

Ultrasound of kidneys

54
Q

What are some associated findings in patients with polycystic kidney disease?

A

hepatic, splenic, pancreatic cysts
Mitral valve prolapse – 25%
Aneurysm in Circle of Willis – 10%
Renal calculi – 20%

55
Q

Condition where protein accumulates in various organs

Amyloid deposits in the kidney

Pathology - Glomeruli filled with amorphous deposits that stain with Congo red (Bence-Jones proteins) showing green bifringence

A

Amyloidosis

56
Q

In patients with amyloidois with kidney involvement, how long until they typically progress to ESRD?

A

in 2-3 years

57
Q

Glomeruli filled with amorphous deposits that stain with Congo red
(Bence-Jones proteins) showing green bifringence should alert you to what disorder?

A

Amyloidosis

58
Q

One of the most common solid tumors in children

A

Wilm’s Tumor

59
Q

Most common abdominal neoplasm in children

A

Wilm’s Tumor

60
Q

nephroblastoma

Usually occurs before age 4

Mixed tumor of embryonic and mesenchymal tissues

Can occur in any part of the kidney

Usually is sharply demarcated with variable encapsulation

A

Wilm’s Tumor

61
Q

Wilm’s Tumor is also associated with what other findings?

A

Sporadic aniridia
Hemihypertrophy
GU malformations

62
Q

What condition presents with the following clinical presentation?

Large abdominal mass

Hypertension

Abdominal pain

+/- vomiting

A

Wilm’s Tumor

63
Q

What imaging is used to confirm the diagnosis of Wilm’s Tumor?

A

CT scan to confirm

64
Q

Originates in the proximal tubule cells

Not common: 2-3% of all adult cancers

M>F = 2:1

Biggest risk factor is smoking

A

Renal Cell Carcinoma

65
Q

What is the biggest risk factor for renal cell carcinoma?

A

smoking

66
Q

What is the most common presentation in renal cell carcinoma?

A

Gross or microscopic hematuria – 60%

67
Q

On a kidney ultrasound, if a complex cyst is identified, what must be ruled out?

A

renal cell carcinoma

68
Q

What is the imaging of choice for renal cell carcinoma?

A

CT abdomen/pelvis (best)

69
Q

What condition presents with the following clinical presentation?

Gross or microscopic hematuria – 60%

Flank pain/abdominal mass – 30%

Cough and bone pain in 20-30% of patients at presentation

A

renal cell carcinoma

70
Q

What is the gold standard treatment for renal cell carcinoma?

A

Radical nephrectomy

71
Q

Why is a radical nephrectomy the gold standard treatment for renal cell carcinoma?

A

No effective chemo regimen!

Nephrology (4 decks)

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