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Kidney Dzs. CA AKI Flashcards

1
Q

Renal calyx

A

renal calyces are chambers of the kidney through which urine passes.

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2
Q

Injury to ureter can cause

A

Hydronephrosis

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3
Q

Atrophy of renal cortex and medulla

A

Hydronephrosis

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4
Q

RCC originates in what part of kidney?

A

PCT

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5
Q

RCC cells filled with?

A

Fat-lipids

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6
Q

2 RF for RCC

A
  1. Smoke

2. obesity

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7
Q

4 sxs of RCC

A
  1. Hematuria
  2. Palpable mass
  3. Secondary polycythemia
  4. Flank pain

And fever wt loss in CA

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8
Q

How RCC Mets? Moa and to where?

A

Invade renal vein,
Then IVC,
Spread in blood to lung/bone

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9
Q

Syndrome assoc with RCC

A

von Hippel-Lindau

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10
Q

RCC gene deletion on which chromosome? Mnemonic

A

3

RCC=3 letters

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11
Q

RCC paraneoplastic 4 syndromes

A
  1. Ectopic EPO
  2. ACTH
  3. PTHrP
  4. Renin
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12
Q

Benign epithelial cell tumor arising from Collecting Ducts

A

Renal Oncocytoma

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13
Q

Renal oncocytoma arises from what part of kidney

A

CD

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14
Q

Renal oncocytoma—cells contain a lot of

A

Mitochondria

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15
Q

Renal oncocytoma like RCC has abdominal mass, hematuria and flank pain but not what?

A

No secondary polycythemia or paraneoplastic like RCC

Is benign but is resected to r/o malignant rcc

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16
Q

Transitional cell carcinoma occurs where?

A

Kidney calyces, pelvis, ureters and bladder

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17
Q

Transitional cell carcinoma main symptom

A

Painless hematuria (no casts)

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18
Q

Nephrotic syndrome v ca

A

Both hematuria but ca no casts

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19
Q

What substances cause transitional cell carcinoma? Mnemonic

A

“Problems in your Pee SAC”

Phenacetin

Smoking
Aniline dye
Cyclophosphamide

Rubber,
Leather,
Textile

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20
Q

Name of bladder cancer

A

Squamous cell carcinoma of bladder

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21
Q

MOA of squamous cell carcinoma of bladder

A

Irritate bladder—>metaplasia—>dysplasia and squamous cell carcinoma

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22
Q

RFs squamous cell carcinoma of bladder 4

A

Schistosoma haematobium infection (Middle East)
Chronic cystitis
Smoking
Chronic stones

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23
Q

Painless hematuria means

A

Cancer

Even squamous cell carcinoma of bladder

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24
Q

Squamous cell carcinoma of bladder main symptom

A

Painless hematuria

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25
Q

Kidney cancers 4 + 2 bladder

A
  1. RCC
  2. Renal oncocytoma
  3. Nephroblastoma=Wilms tumor
    4 transitional cell carcinoma

Bladder
Transitional cell carcinoma—here also
Squamous cell carcinoma of bladder

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26
Q

Wilms tumor (nephroblastoma) occurs at what ages

A

early childhood:ages 2–4

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27
Q

Wilms tumor (nephroblastoma)–what’s in cells?

A

embryonic glomerular structures.

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28
Q

Wilms tumor (nephroblastoma) 2 sxs.

A

Presents with

  1. large, palpable, unilateral flank mass
  2. and/or hematuria.
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29
Q

“Loss of function” mutations of TSG WT1 or WT2 on chromosome 11.

A

Wilms tumor (nephroblastoma)

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30
Q

Wilms tumor (nephroblastoma) is a part of what 3 syndromes?

A
  1. WAGR complex
  2. Denys-Drash
  3. Beckwith-Wiedemann
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31
Q

WAGR complex: 4 sxs.

A
  1. Wilms tumor,
  2. Aniridia (absence of iris),
  3. Genitourinary malformations,
  4. mental Retardation/intellectual disability
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32
Q

Denys-Drash: 3 sxs.

A
  1. Wilms tumor,
  2. early-onset nephrotic syndrome,
  3. male pseudohermaphroditism
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33
Q

Beckwith-Wiedemann: 3 sxs.

A
  1. Wilms tumor,
  2. macroglossia,
  3. hemihypertrophy
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34
Q

(WT1 deletion) which syndrome?

A

WAGR complex:

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35
Q

(WT1 mutation) which syndrome?

A

Denys-Drash:

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36
Q

(WT2 mutation)

A

Beckwith-Wiedemann:

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37
Q

Urinary incontinence: Outlet incompetence

A

Stress incontinence

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38
Q

Stress incontinence MOA

A

urethral hypermobility or intrinsic sphincteric deficiency

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39
Q

Urinary incontinence: 􏰃risk with obesity

A

Stress incontinence

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40
Q

Urinary incontinence: vaginal delivery

A

Stress incontinence

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41
Q

Urinary incontinence: prostate surgery.

A

Stress incontinence

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42
Q

Urinary incontinence: Stress incontinence 3 tx.

A
  1. pelvic floor muscle strengthening (Kegel) exercises
  2. weight loss,
  3. pessaries.
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43
Q

Urinary incontinence: Overactive bladder (detrusor instability)

A

Urgency incontinence

44
Q

Urinary incontinence: Urgency incontinence 3 tx.

A
  1. Kegel exercises,
  2. bladder training
    (timed voiding, distraction or relaxation techniques),
  3. antimuscarinics (eg, oxybutynin).
45
Q

Stress incontinence: 3 RF’s

A
  1. obesity,
  2. vaginal delivery,
  3. prostate surgery
46
Q

pessary 2 uses

A

A pessary is a prosthetic device that can be inserted into the vagina to support its internal structure.

It’s often used in the case of urinary incontinence

and a

vaginal or pelvic organ prolapse.

47
Q

Mixed incontinence combines which 2 types of incontinence?

A

Features of both stress and urgency incontinence.

48
Q

detrusor underactivity or outlet obstruction

A

Overflow incontinence

49
Q

Overflow incontinence 2 tx.

A
  1. catheterization,

2. relieve obstruction (eg, α-blockers for BPH).

50
Q

Urinary tract infection (acute bacterial cystitis)–systemic signs present?

A

Systemic signs (eg, high fever, chills) are usually absent.

51
Q

Urinary tract infection (acute bacterial cystitis) 4 sxs?

A
  1. suprapubic pain,
  2. dysuria,
  3. urinary frequency,
  4. urgency.
52
Q

Urinary tract infection (acute bacterial cystitis) 5 RF’s:

A
  1. female gender (short urethra),
  2. sexual intercourse (“honeymoon cystitis”),
  3. indwelling catheter,
  4. diabetes mellitus,
  5. impaired bladder emptying.
53
Q

Urinary tract infection (acute bacterial cystitis) 4 bacterial causes

A

􏰅 E coli (most common).
􏰅 Staphylococcus saprophyticus—seen in sexually active young women (E coli is still more
common in this group).
􏰅 Klebsiella.
􏰅 Proteus mirabilis—urine has ammonia scent.

54
Q

Lab findings UA–Urinary tract infection (acute bacterial cystitis)

A

⊕ leukocyte esterase. ⊕ nitrites (indicate gram ⊝ organisms, especially E coli).

55
Q

Sterile pyuria [=wbc’s and leukocyte esterase] and ⊝ urine cultures suggest

A 
urethritis 
by 
Neisseria gonorrhoeae 
or 
Chlamydia trachomatis
56
Q

Sterile pyuria= 2 parts of UA

A

wbc’s and leukocyte esterase

57
Q

-Neutrophils infiltrate renal interstitium

A

Acute pyelonephritis

58
Q

cortex define

A

is the outermost (or superficial) layer of an organ

59
Q

Acute pyelonephritis spares what part of kidney

A

-Affects cortex with relative sparing of glomeruli/vessels.

60
Q

Acute pyelonephritis sxs.

A

Presents with

  1. fevers,
  2. flank pain (costovertebral angle tenderness),
  3. nausea/vomiting,
  4. chills.
61
Q

Acute pyelonephritis sxs. difference from UTI (acute bacterial cystitis)

A

Systemic signs=N/V, fever, chills in Acute Pyelonephritis, not in UTI

62
Q

UTI other name

A

acute bacterial cystitis

63
Q

most common cause Acute pyelonephritis

64
Q

Acute pyelonephritis UA

A

WBCs in urine +/− WBC casts

65
Q

Acute pyelonephritis–how spread to kidney?

A

hematogenous spread to kidney

66
Q

parenchyma define

A

the functional tissue of an organ as distinguished from the connective and supporting tissue.

67
Q

CT of Acute pyelonephritis shows what?

A

CT would show striated parenchymal enhancement

68
Q

Risk factors of Acute pyelonephritis

A

include indwelling urinary catheter, urinary tract obstruction, vesicoureteral reflux, diabetes mellitus, pregnancy.

69
Q

Risk factors Acute Pyelo

A
  1. indwelling urinary catheter-same as UTI
  2. urinary tract obstruction,
  3. vesicoureteral reflux,
  4. diabetes mellitus-same as UTI
  5. pregnancy.
70
Q

Complications Acute Pyelonephritis

A
  1. chronic pyelonephritis,
  2. renal papillary necrosis,
  3. perinephric abscess,
  4. urosepsis.
71
Q

Tubules can contain eosinophilic casts resembling thyroid tissue C (thyroidization of kidney).

A

Chronic pyelonephritis

72
Q

With chronic pyelo.– widespread kidney damage due to:
-granulomatous tissue
containing–>foamy macrophages.

A

Xanthogranulomatous pyelonephritis

73
Q

Acute generalized cortical infarction of both kidneys

A

Diffuse cortical necrosis

74
Q

Diffuse cortical necrosis due to what 2 conditions?

A
  1. obstetric catastrophes (abruptio placentae)

2. septic shock

75
Q

Renal osteodystrophy moa subperiosteal thinning of bones.

A

Hypocalcemia, hyperphosphatemia, and failure of vitamin D hydroxylation associated with chronic renal disease

Hyperphosphatemia also independently􏰄serum Ca2+ by causing tissue calcifications, whereas􏰄1,25-(OH)2 D3􏰂􏰄intestinal Ca2+ absorption. Causes subperiosteal thinning of bones.

76
Q

Renal osteodystrophy effect on pth

A

Hypocalcemia, hyperphosphatemia, and failure of vitamin D hydroxylation associated with chronic renal disease􏰂2° hyperparathyroidism.

77
Q

Prerenal azotemia (ARF) retains

A

Na+/H2O and BUN

78
Q

Intrinsic renal failure causes: 2 common + 2 UC

A

1acute tubular necrosis or
2ischemia/toxins;

less commonly due to 
1 acute glomerulonephritis (eg, 
-RPGN, 
-hemolytic uremic syndrome) or 
2. acute interstitial nephritis
79
Q

BUN/creatinine ration in Intrinsic renal failure

A

< 15:1 BUN reabsorption is impaired

80
Q

BUN/creatinine ratio in pre-renal failure

81
Q

Postrenal azotemia Develops only with

A

bilateral obstruction.

82
Q

renal failure define

A

Inability to make urine and excrete nitrogenous wastes.

83
Q

Consequences of renal failure Mnemonic

A

Consequences (MAD HUNGER):

􏰅 Metabolic
Acidosis
􏰅 Dyslipidemia (especially 􏰃 triglycerides)

􏰅 Hyperkalemia
􏰅 Uremia—clinical syndrome marked by
    incr. BUN:
      Nausea and anorexia  
      Pericarditis
      Asterixis
      Encephalopathy
     Platelet dysfunction
􏰅 Na+/H2O retention (HF, pulmonary edema, hypertension)
􏰅 Growth retardation and developmental delay
􏰅 Erythropoietin failure (anemia)
􏰅 Renal osteodystrophy
84
Q

Uremia—clinical syndrome marked by

incr. BUN: 6 sxs.

A 
Nausea and anorexia  
      Pericarditis
      Asterixis
      Encephalopathy
     Platelet dysfunction
85
Q

Acute interstitial nephritis other name

A

(tubulointerstitial nephritis)

86
Q

Acute interstitial renal inflammation

A

Acute interstitial nephritis (tubulointerstitial nephritis)

87
Q

Acute interstitial nephritis (tubulointerstitial nephritis) 5 Drug causes–Mnemonic

A 
5 P’s:
􏰅 Pee (diuretics)
􏰅 Pain-free (NSAIDs)
􏰅 Penicillins and cephalosporins 􏰅 Proton pump inhibitors
􏰅 RifamPin
88
Q

Acute interstitial nephritis (tubulointerstitial nephritis) cause

A
  1. drugs that
    act as haptens, inducing hypersensitivity
  2. Infxn.
  3. AI dzs.
89
Q

Pyuria (classically eosinophils) and azotemia

A

Acute interstitial nephritis (tubulointerstitial nephritis) cause

90
Q

azotemia define

A

You get it when your kidneys are no longer able to get rid of enough nitrogen waste.

91
Q

Acute interstitial nephritis (tubulointerstitial nephritis) 4 sxs.

A
  1. fever, (in pyelo)
  2. rash,
  3. hematuria, and (not in pyelo)
  4. costovertebral angle tenderness, (also in pyelo)

but can be asymptomatic.

92
Q

costovertebral angle tenderness in which 2 conditions?

A

Acute interstitial nephritis

Pyelo

93
Q

Most common cause of acute kidney injury in hospitalized patients.

94
Q

Key finding: ATN

A

muddy brown-granular-casts

95
Q

ATN 3 stages:

A
  1. Inciting event
  2. Maintenance phase
  3. Recovery phase
96
Q
  1. Maintenance phase ATN-4 labs
A 
(oliguria)
incr.: 
1-hyperkalemia, 
2-metabolic acidosis,
3-uremia
decr.
4-Na+ (incr. FENa)
97
Q

oliguric phase is during which of 3 phases

A
  1. Maintenance phase ATN
98
Q
  1. Recovery phase 3 labs
A

decr. :
1. BUN and
2. serum creatinine fall
3. hypokalemia

99
Q

polyuric during which of 3 ATN phases

A
  1. Recovery phase
100
Q

Acute tubular necrosis due to which 2 types of injury?

A
  1. Ischemic

2. Nephrotoxic

101
Q

Nephrotoxic ATN due to which 6 drugs/agents? Mnemonic-for 4 drugs

A

CARL

  1. aminoglycosides,
  2. radiocontrast
  3. lead,
  4. cisplatin)
  5. myoglobinuria=crush injury
  6. hemoglobinuria
102
Q

Part of kidney susceptible to Ischemic and Nephrotoxic injury?

103
Q

Sloughing of necrotic renal papillae

A

Renal papillary necrosis

104
Q

gross hematuria and proteinuria

A

Renal papillary necrosis

105
Q

gross hematuria and proteinuria in Renal papillary necrosis due to

A

Sloughing of necrotic renal papillae

106
Q

4 Drugs/Dzs. cause Renal Papillary Necrosis

A

=recent infection or immune stimulus.

SAAD papa with papillary necrosis:

  1. Sickle cell disease or trait
  2. Acute pyelonephritis
  3. Analgesics (NSAIDs)
  4. Diabetes mellitus

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