Kidney Dzs. CA AKI Flashcards
1
Q
Renal calyx
A
renal calyces are chambers of the kidney through which urine passes.
2
Q
Injury to ureter can cause
A
Hydronephrosis
3
Q
Atrophy of renal cortex and medulla
A
Hydronephrosis
4
Q
RCC originates in what part of kidney?
A
PCT
5
Q
RCC cells filled with?
A
Fat-lipids
6
Q
2 RF for RCC
A
- Smoke
2. obesity
7
Q
4 sxs of RCC
A
- Hematuria
- Palpable mass
- Secondary polycythemia
- Flank pain
And fever wt loss in CA
8
Q
How RCC Mets? Moa and to where?
A
Invade renal vein,
Then IVC,
Spread in blood to lung/bone
9
Q
Syndrome assoc with RCC
A
von Hippel-Lindau
10
Q
RCC gene deletion on which chromosome? Mnemonic
A
3
RCC=3 letters
11
Q
RCC paraneoplastic 4 syndromes
A
- Ectopic EPO
- ACTH
- PTHrP
- Renin
12
Q
Benign epithelial cell tumor arising from Collecting Ducts
A
Renal Oncocytoma
13
Q
Renal oncocytoma arises from what part of kidney
A
CD
14
Q
Renal oncocytoma—cells contain a lot of
A
Mitochondria
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
16
Q
Transitional cell carcinoma occurs where?
A
Kidney calyces, pelvis, ureters and bladder
17
Q
Transitional cell carcinoma main symptom
A
Painless hematuria (no casts)
18
Q
Nephrotic syndrome v ca
A
Both hematuria but ca no casts
19
Q
What substances cause transitional cell carcinoma? Mnemonic
A
“Problems in your Pee SAC”
Phenacetin
Smoking
Aniline dye
Cyclophosphamide
Rubber,
Leather,
Textile
20
Q
Name of bladder cancer
A
Squamous cell carcinoma of bladder
21
Q
MOA of squamous cell carcinoma of bladder
A
Irritate bladder—>metaplasia—>dysplasia and squamous cell carcinoma
22
Q
RFs squamous cell carcinoma of bladder 4
A
Schistosoma haematobium infection (Middle East)
Chronic cystitis
Smoking
Chronic stones
23
Q
Painless hematuria means
A
Cancer
Even squamous cell carcinoma of bladder
24
Q
Squamous cell carcinoma of bladder main symptom
A
Painless hematuria
25
Kidney cancers 4 + 2 bladder
1. RCC
2. Renal oncocytoma
3. Nephroblastoma=Wilms tumor
4 transitional cell carcinoma
Bladder
Transitional cell carcinoma—here also
Squamous cell carcinoma of bladder
26
Wilms tumor (nephroblastoma) occurs at what ages
early childhood:ages 2–4
27
Wilms tumor (nephroblastoma)--what's in cells?
embryonic glomerular structures.
28
Wilms tumor (nephroblastoma) 2 sxs.
Presents with
1. large, palpable, unilateral flank mass
2. and/or hematuria.
29
“Loss of function” mutations of TSG WT1 or WT2 on chromosome 11.
Wilms tumor (nephroblastoma)
30
Wilms tumor (nephroblastoma) is a part of what 3 syndromes?
1. WAGR complex
2. Denys-Drash
3. Beckwith-Wiedemann
31
WAGR complex: 4 sxs.
1. Wilms tumor,
2. Aniridia (absence of iris),
3. Genitourinary malformations,
4. mental Retardation/intellectual disability
32
Denys-Drash: 3 sxs.
1. Wilms tumor,
2. early-onset nephrotic syndrome,
3. male pseudohermaphroditism
33
Beckwith-Wiedemann: 3 sxs.
1. Wilms tumor,
2. macroglossia,
3. hemihypertrophy
34
(WT1 deletion) which syndrome?
WAGR complex:
35
(WT1 mutation) which syndrome?
Denys-Drash:
36
(WT2 mutation)
Beckwith-Wiedemann:
37
Urinary incontinence: Outlet incompetence
Stress incontinence
38
Stress incontinence MOA
urethral hypermobility or intrinsic sphincteric deficiency
39
Urinary incontinence: risk with obesity
Stress incontinence
40
Urinary incontinence: vaginal delivery
Stress incontinence
41
Urinary incontinence: prostate surgery.
Stress incontinence
42
Urinary incontinence: Stress incontinence 3 tx.
1. pelvic floor muscle strengthening (Kegel) exercises
2. weight loss,
3. pessaries.
43
Urinary incontinence: Overactive bladder (detrusor instability)
Urgency incontinence
44
Urinary incontinence: Urgency incontinence 3 tx.
1. Kegel exercises,
2. bladder training
(timed voiding, distraction or relaxation techniques),
3. antimuscarinics (eg, oxybutynin).
45
Stress incontinence: 3 RF's
1. obesity,
2. vaginal delivery,
3. prostate surgery
46
pessary 2 uses
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
Mixed incontinence combines which 2 types of incontinence?
Features of both stress and urgency incontinence.
48
detrusor underactivity or outlet obstruction
Overflow incontinence
49
Overflow incontinence 2 tx.
1. catheterization,
| 2. relieve obstruction (eg, α-blockers for BPH).
50
Urinary tract infection (acute bacterial cystitis)--systemic signs present?
Systemic signs (eg, high fever, chills) are usually absent.
51
Urinary tract infection (acute bacterial cystitis) 4 sxs?
1. suprapubic pain,
2. dysuria,
3. urinary frequency,
4. urgency.
52
Urinary tract infection (acute bacterial cystitis) 5 RF's:
1. female gender (short urethra),
2. sexual intercourse (“honeymoon cystitis”),
3. indwelling catheter,
4. diabetes mellitus,
5. impaired bladder emptying.
53
Urinary tract infection (acute bacterial cystitis) 4 bacterial causes
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
Lab findings UA--Urinary tract infection (acute bacterial cystitis)
⊕ leukocyte esterase. ⊕ nitrites (indicate gram ⊝ organisms, especially E coli).
55
Sterile pyuria [=wbc's and leukocyte esterase] and ⊝ urine cultures suggest
```
urethritis
by
Neisseria gonorrhoeae
or
Chlamydia trachomatis
```
56
Sterile pyuria= 2 parts of UA
wbc's and leukocyte esterase
57
-Neutrophils infiltrate renal interstitium
Acute pyelonephritis
58
cortex define
is the outermost (or superficial) layer of an organ
59
Acute pyelonephritis spares what part of kidney
-Affects cortex with relative sparing of glomeruli/vessels.
60
Acute pyelonephritis sxs.
Presents with
1. fevers,
2. flank pain (costovertebral angle tenderness),
3. nausea/vomiting,
4. chills.
61
Acute pyelonephritis sxs. difference from UTI (acute bacterial cystitis)
Systemic signs=N/V, fever, chills in Acute Pyelonephritis, not in UTI
62
UTI other name
acute bacterial cystitis
63
most common cause Acute pyelonephritis
E coli
64
Acute pyelonephritis UA
WBCs in urine +/− WBC casts
65
Acute pyelonephritis--how spread to kidney?
hematogenous spread to kidney
66
parenchyma define
the functional tissue of an organ as distinguished from the connective and supporting tissue.
67
CT of Acute pyelonephritis shows what?
CT would show striated parenchymal enhancement
68
Risk factors of Acute pyelonephritis
include indwelling urinary catheter, urinary tract obstruction, vesicoureteral reflux, diabetes mellitus, pregnancy.
69
Risk factors Acute Pyelo
1. indwelling urinary catheter-same as UTI
2. urinary tract obstruction,
3. vesicoureteral reflux,
4. diabetes mellitus-same as UTI
5. pregnancy.
70
Complications Acute Pyelonephritis
1. chronic pyelonephritis,
2. renal papillary necrosis,
3. perinephric abscess,
4. urosepsis.
71
Tubules can contain eosinophilic casts resembling thyroid tissue C (thyroidization of kidney).
Chronic pyelonephritis
72
With chronic pyelo.-- widespread kidney damage due to:
-granulomatous tissue
containing-->foamy macrophages.
Xanthogranulomatous pyelonephritis
73
Acute generalized cortical infarction of both kidneys
Diffuse cortical necrosis
74
Diffuse cortical necrosis due to what 2 conditions?
1. obstetric catastrophes (abruptio placentae)
| 2. septic shock
75
Renal osteodystrophy moa subperiosteal thinning of bones.
Hypocalcemia, hyperphosphatemia, and failure of vitamin D hydroxylation associated with chronic renal disease
Hyperphosphatemia also independentlyserum Ca2+ by causing tissue calcifications, whereas1,25-(OH)2 D3intestinal Ca2+ absorption. Causes subperiosteal thinning of bones.
76
Renal osteodystrophy effect on pth
Hypocalcemia, hyperphosphatemia, and failure of vitamin D hydroxylation associated with chronic renal disease2° hyperparathyroidism.
77
Prerenal azotemia (ARF) retains
Na+/H2O and BUN
78
Intrinsic renal failure causes: 2 common + 2 UC
1acute tubular necrosis or
2ischemia/toxins;
```
less commonly due to
1 acute glomerulonephritis (eg,
-RPGN,
-hemolytic uremic syndrome) or
2. acute interstitial nephritis
```
79
BUN/creatinine ration in Intrinsic renal failure
< 15:1 BUN reabsorption is impaired
80
BUN/creatinine ratio in pre-renal failure
> 20: 1
81
Postrenal azotemia Develops only with
bilateral obstruction.
82
renal failure define
Inability to make urine and excrete nitrogenous wastes.
83
Consequences of renal failure Mnemonic
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
Uremia—clinical syndrome marked by
| incr. BUN: 6 sxs.
```
Nausea and anorexia
Pericarditis
Asterixis
Encephalopathy
Platelet dysfunction
```
85
Acute interstitial nephritis other name
(tubulointerstitial nephritis)
86
Acute interstitial renal inflammation
Acute interstitial nephritis (tubulointerstitial nephritis)
87
Acute interstitial nephritis (tubulointerstitial nephritis) 5 Drug causes--Mnemonic
```
5 P’s:
Pee (diuretics)
Pain-free (NSAIDs)
Penicillins and cephalosporins Proton pump inhibitors
RifamPin
```
88
Acute interstitial nephritis (tubulointerstitial nephritis) cause
1. drugs that
act as haptens, inducing hypersensitivity
2. Infxn.
3. AI dzs.
89
Pyuria (classically eosinophils) and azotemia
Acute interstitial nephritis (tubulointerstitial nephritis) cause
90
azotemia define
You get it when your kidneys are no longer able to get rid of enough nitrogen waste.
91
Acute interstitial nephritis (tubulointerstitial nephritis) 4 sxs.
1. fever, (in pyelo)
2. rash,
3. hematuria, and (not in pyelo)
4. costovertebral angle tenderness, (also in pyelo)
but can be asymptomatic.
92
costovertebral angle tenderness in which 2 conditions?
Acute interstitial nephritis
| Pyelo
93
Most common cause of acute kidney injury in hospitalized patients.
ATN
94
Key finding: ATN
muddy brown-granular-casts
95
ATN 3 stages:
1. Inciting event
2. Maintenance phase
3. Recovery phase
96
2. Maintenance phase ATN-4 labs
```
(oliguria)
incr.:
1-hyperkalemia,
2-metabolic acidosis,
3-uremia
decr.
4-Na+ (incr. FENa)
```
97
oliguric phase is during which of 3 phases
2. Maintenance phase ATN
98
3. Recovery phase 3 labs
decr. :
1. BUN and
2. serum creatinine fall
3. hypokalemia
99
polyuric during which of 3 ATN phases
3. Recovery phase
100
Acute tubular necrosis due to which 2 types of injury?
1. Ischemic
| 2. Nephrotoxic
101
Nephrotoxic ATN due to which 6 drugs/agents? Mnemonic-for 4 drugs
CARL
1. aminoglycosides,
2. radiocontrast
3. lead,
4. cisplatin)
5. myoglobinuria=crush injury
6. hemoglobinuria
102
Part of kidney susceptible to Ischemic and Nephrotoxic injury?
PCT
103
Sloughing of necrotic renal papillae
Renal papillary necrosis
104
gross hematuria and proteinuria
Renal papillary necrosis
105
gross hematuria and proteinuria in Renal papillary necrosis due to
Sloughing of necrotic renal papillae
106
4 Drugs/Dzs. cause Renal Papillary Necrosis
=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
