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Patho > Kidney Exam > Flashcards

Kidney Exam Flashcards

1
Q

Anuria

A

Urine output less than 100 ml/day

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2
Q

Hypotonic fluid

A

Less than 270

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3
Q

Hypertonic fluid

A

Greater than 300

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4
Q

Potter sequence

A

Physical appearance resulting from oligohydramnios-
Beak like nose, small receding chin, low set ears, abnormally bent lower extremities.

Pulmonary hypoplasia- most life threatening component of potter sequence

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5
Q

Bilateral agenesis

A

Most are still born and have potter sequence, often associated with other congenital anomalies

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6
Q

Unilateral agenesis

A

Contra lateral kidney undergoes hypertrophy, may lead to progressive glomerular sclerosis from the overworked kidney

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7
Q

Renal hypoplasia

A

Reduction in renal mass, 6 or fewer renal lobes, no histological malformations

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8
Q

Renal dysplasia

A

Undifferentiated tubular structures surrounded by primitive mesenchyme, cysts often form around abnormal tubules, undifferentiated tubules and ducts lined by cuboidal or columnar epithelium, cartilage

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9
Q

Renal dysplasia clinical signs

A

Palpable flank mass, potter sequence, pulmonary hypoplasia

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10
Q

Autosomal dominant polycystic kidney disease

A

Numerous cysts within the renal parenchyma

  • PKD1 and PKD3 gene mutations, polycystins
  • inflammatory mediators, destruction

Enlarged kidneys bilaterally, contours distorted with numerous cysts, filled with fluid, liver cysts and berry aneurysms

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11
Q

Autosomal recessive polycystic kidney disease

A
  • PKKHD1 mutation, chromosome 6, fibrocystin and polyductin
  • cystic transformation of collecting ducts with smooth outward appearance

Usually die in perinatal period from pulmonary hypoplasia by oligohydramnios and large kidney size, hepatic fibrosis leading to splenomegaly and portal hypertension

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12
Q

Glomerulocystic disease

A

Dilation of bowman’s capsule in many glomeruli, mutation in hepatocyte nuclear factor-1 beta

Small round cysts, dilation of bowman’s capsule

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13
Q

Medullary sponge kidney

A

Multiple small cysts in one or more of the renal papilla a, lined y cuboidal or columnar epithelium and arise from the collecting ducts in the renal papillae, usually bilateral

Usually asymptomatic, 30-60 flank pain, dysuria, hematuria, gravel in urine

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14
Q

Acute kidney injury

A

Sudden decline in GFR over days to weeks, GFR less than 10 ml/min, CR increases by 1-1.5 mg/dL daily

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15
Q

Prerenal acute failure

A

Transient renal hypoperfusion from hypotension, decreased cardiac output, decreased arterial blood volume

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16
Q

Postrenal acute renal failure

A

Obstruction of the urinary tract

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17
Q

Intrinsic acute renal failure

A

Acute glomerulonephritis, acute interstitial nephritis, acute tubular necrosis

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18
Q

Prerenal azotemia

A

Most common cause of acute kidney injury, renal hypoperfusion

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19
Q

Prerenal acute kidney injury

A

BUN:Cr ratio >20:1, increased urea reabsorption

Hyaline casts, >1% sodium excretion, kidney reabsorbs salt and water avidly

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20
Q

Post renal azotemia

A

Least common of acute kidney injury, urinary flow from both or one kidney is obstructed

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21
Q

Post renal AKI

A

Urethral obstruction (anticholinergics), bladder calculator neoplasms, pelvic or retroperitoneal neoplasms, bilateral ureteral obstruction, retroperitoneal fibrosis

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22
Q

Intrinsic renal failure

A

Tubular, glomerular, vascular, interstitial

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23
Q

Oliguria

A

Urine output less than 500 ml/day

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24
Q

Acute tubular necrosis

A

Tubular damage, initiation phase, maintenance phase, recovery phase

85% of intrinsic acute kidney injury

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25
Q

Acute tubular necrosis initiation

A

Ischemia, a continuum of pre renal azotemia

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26
Q

Acute tubular necrosis maintenance

A

Stabilization of GFR at a very low level, usually lasts 1-2 weeks, complications occur

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27
Q

Acute tubular necrosis recover

A

Regeneration of tubular epithelial cells, abnormal diuresis sometimes occurs causing salt and water loss and volume depletion

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28
Q

Acute tubular necrosis labs

A

Hyperkalemia (lysis of muscle cells or impaired excretion)
Hyperphosphatemia (cannot be excreted)
Brown urine
BUN:Cr is

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29
Q

Acute interstitial nephritis

A

Interstitial inflammatory response with edema, cell mediated response, 70% drug hypersensitivity, 15% infection

Drugs: NOT dose dependent

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30
Q

Acute interstitial nephritis findings

A

Fever, rash, arthralgias, serum eosinophilia, WBC CASTS ARE PATHOGNOMONIC, urine eosinophils

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31
Q

Nephritic syndrome

A

Involvement of cell proliferation,

Hematuria, proteinuria, hypertension, reduced GFR
Volume overload, hyperkalemia, metabolic acidosis, edema, congestive heart failure

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32
Q

Decreased C3

A

Alternative pathway activated

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33
Q

Decreased C4

A

Classical pathway activated

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34
Q

Kidney biopsy

A

Glomerular cellularity, thickness of GBM, histopathology, determines presence or absence of crescents

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35
Q

Light microscopy

A

Nature of glomerular disease using stained sections of the kidney biopsy

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36
Q

Immunoflorescence

A

Determines nature of the causative immune process

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37
Q

Electron microscopy

A

Location of election dense immune deposits and degree of injury, integrity and thickness of GBM, forms of podocytes injury

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38
Q

Rapidly progressing glomerulonephritis lab findings

A

> 50% of glomeruli on biopsy will have crescents, trapped immune complexes
Immunofluorescene: IgG, IgA, C3 granular pattern
Electron microscopy deposits in sub epithelium, subendothelial, mesangium

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39
Q

RPGN goodpasture’s syndrome

A

Anti-GBM antibodies, hemoptysis
Immunoflorescence:IgG, C3 linear pattern
Electron microscopy: widening of GBM

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40
Q

RPGN wegener’s granulomatosis, polyarthritis

A

No immunoglobulin or deposits

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41
Q

Post streptococcal glomerulonephritis
Pathology
Signs/symptoms

A

Groups A beta hemolytic streptococci, trapped immune complexes

Edema, oliguric, cola colored uringe, hypertension, ASO levels high, C3 low

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42
Q

PSGN biopsy

A

Microscopy: diffuse proliferation GN
Immunoflorescence:IgG and C3 in granular pattern in mesangium along capillary basement membrane
Electron Microscopy: large, dense sub epithelial deposits or humps

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43
Q

IgA nephropathy

A

Hamturia, URI, GI symptoms, flu0like illness, cola colored urine
Synpharyngitic hematuria- no significant latent period between infection and hematuria (post strep is delayed)
Proteinuria, HTN

44
Q

IgA nephropathy lab

A

IgA deposits in mesangium, proliferation of mesangial cells

45
Q

Henoch-schonlein purpura (anaphylactoid purpura)

A

Leukocytoclasic vasculitis, children and males, palpable purpura, arthralgia, abdominal symptoms, nausea, colic, melena

46
Q

Pauci-immune glomerulonephritis

A

Fever, malaise, weight loss, hematuria, proteinuria, purpura, wegener’s granulomatosis (upper or lower respiratory tract symptoms with nodular lesions that can cavitate and bleed, hemoptysis)

47
Q

Cytoplasmic ANCA

A

Specific for anti-proteinase 3 antibodies

48
Q

Perinuclear ANCA

A

Specific for antimyeloperoxidase antibodies

49
Q

Anti-glomerular basement membrane glomerulonephritis

A

W/ pulmonary hemorrhage= goodpasture’s disease
Mostly male, hemoptysis, dyspnea, respiratory failure, hypertension, edema
Anti GMB antibodie

50
Q

AGBMG biopsy

A

Immunoflorescence: IgG, C3 linear pattern

electron microscopy: widening of GBM

51
Q

Cryoglobulin associated. Glomerulonephritis

A

Cold precipitable immunoglobulins, precipitation of cryoglobulins in glomerular capillaries, usually due to underlying infection

52
Q

Cryoglobulin associated GN S/S

A

Necrotizing skin lesions, arthralgias, fever, hepatosplenomegaly

Complement levels depressed, rheumatoid factor elevated

53
Q

Nephrotic syndrome

A

Leaky basement membrane, heavy proteinuria >3.5 g/24 hours, hypoalbuminemia, edema, hyperlipidemia

Peripheral edema hallmark, dyspnea due to pulmonary edema, pleural effusions, diaphragmatic compromise with ascites

54
Q

Nephrotic syndrome urinalysis

A

Proteinuria, few elements or casts, if hyperlipidemia there will be oval fat bodies and appear like grape like clusters

55
Q

Nephrotic syndrome blood chemistry

A

Decreased albumin and total serum protein less than 6

Hyperlipidemia, decreased oncotic pressure, increased sedimentation rate due to fibrinogen

56
Q

Membranous nephropathy

A

Immune mediated, complexes in sub epithelial portion of capillary walls

Proteinuria, hypoalbuminemia,hyperlipidemia, edema, renal vein thrombosis often, ESRD progression

57
Q

Membranous nephropathy biopsy

A

Light microscopy: capillary thickness increased without inflammatory changes or proliferation, spike and dome pattern
Immunoflorescence: IgG and C3 uniformly along capillary loops
Electron microscopy: discontinuous pattern of dense immune deposits along the sub epithelial surface of basement membrane

58
Q

Focal segmental glomerular sclerosis

A

Most common in adults and African Americans,

Sclerotic lesions on light microscopy, IgM and C3 on immunofluorescence, fusion of epithelial foot processes on EM

59
Q

Minimal change disease

A

Kids under 10, unidentified T cell lymphokine response, nephrotic, podocytes effacement and foot process fusion

60
Q

HIV associated nephropathy light microscopy

A

Collapsing pattern of focal sclerosis, sclerotic segments display collapse of capillaries, swollen podocytes, numerous protein droplets, interstitial fibrosis and infiltration by mononuclear leukocytes

61
Q

HIV associated nephropathy clinical

A

Severe proteinuria, >10 g/day, renal insufficiency, Rogers’s to ESRD in less than one year

62
Q

Diabetic glomerulosclerosis

A

Generalized increase in synthesis of basement membrane material by microvasculature, GBM thickening, expansion of mesangial matrix, nodular sclerotic lesions (kimmelstiel-Wilson nodules)

63
Q

Diabetic glomerulosclerosis biopsy

A

EM: widening of basement membrane lamina dense, increase in mesangial matrix
Immunofluorescence microscopy: linear trapping of IgG, albumin, fibrinogen

64
Q

Amyloidosis amyloid types

A

AA amyloid- serum amyloid A protein, increased during inflammatory process

AL amyloid- lambda or kappa immunoglobulin light chains produced by neoplastic cone of B cells or plasma cells

65
Q

Amyloid

A

Eosinophilic, amorphous material, initially found in mesangium but later extend into capillary walls causing destruction in capillaries, fibrillar deposits in mesangium

66
Q

Amyloidosis clinical features

A

Proteinuria, results in renal failure

67
Q

Alport Syndrome

A

AKA hereditary nephritis, proliferation and sclerosing glomerular disease accompanied by defects of ears or eyes, genetic abnormality of type IV collagen

X linked, autosomal recessive

68
Q

Alport syndrome clinical/biopsy

A

Hematuria, proteinuria, hypertension, ocular and hearing impairment

Matrix expansion, glomerular sclerosis, tubular atrophy, interstitial fibrosis, foam cells, thickened GBM

69
Q

Obstruction of ureteropelvic junction

A

Common form of hydronephrosis, abnormal layering of smooth muscle cells, fibrosis replacing smooth muscle cells at site of UPJ

Abdominal mass, ITU, flank pain, stones, hematuria, sporadic pain

70
Q

Congenital megaureter

A

Ureter is tortuous and lacks peristalsis, stagnation of urine, progressive hydronephrosis that leads to renal failure

71
Q

Tumors of renal pelvis and ureters

A

Transitional cell carcinomas, similar to bladder cancer, hematuria and flank pain

72
Q

Exstrophy of the bladder

A

Absence of anterior bladder wall and part of anterior wall of the abdomen

73
Q

Acute cystitis

A

Most commonly from e. Coli, sometimes enterococcus or staph aureus.

Polyuria, dysuria, lower abdominal or pelvic discomfort

74
Q

Chronic interstitial cystitis

A

Transmural chronic inflammation of the bladder wall, mucosal ulceration (hunger ulcer), mast cells, fibrosis

Frequency, urgency, supra public pain,

75
Q

Acute pyelonephritis

A

Usually ascending from lower urinary tract, usually gram negative (enterococcus and staph aureus)

Irritative voiding symptoms, flank pain, diarrhea, dehydration, tachycardia, CVA tenderness

76
Q

Hypospadias

A

Urethra opens on the underneath side of the penis, incomplete closure of the urethral folds of the urogenital sinus

77
Q

Epispadias

A

Malformation of the urethral groove, urethral canal may create abnormal opening on dorsal surface

78
Q

Phimosis

A

Orifice of prepuce may be too narrow to allow retroaction over the glans penis

79
Q

Paraphimosis

A

Retracted prepuce that is too narrow and may strangulate the glans and impeded the outflow of venous blood

80
Q

Sexually transmitted urethritis

A

Discharge, gonococcal, acute onset, pain or tingling, redness and swelling

81
Q

Nonspecific infectious urethritis

A

Urgency, burning during urination, no discharge

82
Q

Reactive arthritis syndrome

A

Urethritis, conjunctivitis, arthritis of weight bearing joints

HLA B27 hapltotype, inappropriate immune reaction to microbial agent

83
Q

Cancer of urethra

A

Squamous or transitional epithelium, more female

Urethral bleeding and dysuria, spread to adjacent tissues or lymph nodes

84
Q

Hydrocele

A

Collection of serous fluid in scrotal sac between two layers of tunica vaginalis, impedes lmphatic drainage of testicles

Transillumination

85
Q

Hematocele

A

Accumulation of blood between the layers of tunica vaginalis

86
Q

Spermatocele

A

Cystic mass of the epididymis

Benign

87
Q

Varicocele

A

Dilation of testicular veins, appears as nodularity on the lateral side of the scrotum

“Bag of worms”

88
Q

Cryptorchidism

A

Undescended testes, usually requires surgery, unilateral,

Increased incidence of germ cell neoplasia

89
Q

Orchitis

A

Acute or chronic inflammation of the testes, usually secondary to hematogenous spread of pathogen or an immune mediated disease

90
Q

Scrotal inguinal hernia

A

Protrusion of the intestines into the scrotum through the inguinal canal, mass, adhesions may develop, may cause testicular atrophy

91
Q

Scrotal edema

A

Lymph or serous fluid may accumulate in scrotum due to obstruction of lymphatic or venous drainage

92
Q

Cancer of the testes

A

Germ cell origin, malignant, cytogenetic i(p12) marker, chromosome 12

93
Q

Acute epididymitis

A

Infection of epididymis acquired by retrograde spread of organisms down the vas from the urethra or bladder

40 and children, gram negative rods (e. Coli)

94
Q

Acute epididymitis clinical

A

Heaviness and a dull, aching discomfort in the affected hemiscrotum, fever, chills, scrotal swelling, warm, red and elarged scrotal mass, positive prehn’s sign, voiding symptoms, tender prostate

95
Q

Torsion of testes

A

Acute onset of pain and swelling, nausea and vomiting, lack of voiding symptoms, strenuous activity

Lack of cremaster if reflex, entire testis is tender and swollen, high lie

96
Q

Torsion of appendix testis or appendi epididymis

A

Palpating of tender nodule on illumination when skin pulled taut over the superior pole of the testis, blue dot sign, allowed to degenerate

97
Q

Priapism

A

Continuous erection of the penis unrelated to sexual excitation, painful, unknown cause

98
Q

Secondary priapism

A

Caused by pelvic diseases impeding outflow of blood from penis, hematological disorders, brain and spinal cord diseases

99
Q

Peyronie disease

A

Induration of the penis, focal asymmetric fibrosis of the shaft of the penis, penile curvature, may cause pain with erection

100
Q

Cancer of penis

A

Squamous mucosa of the glans and contiguous urethral meatus or the prepuce and the skin covering the shaft of the penis.

Only uncircumcised men, accumulation of keratin debris and inflammatory exudate (smegma)

101
Q

Hermaphroditism

A

Rare, ambiguous genitalia in a person who has both male and female gonads

102
Q

Female pseudohermaphroditism

A

Genetically female, internally genetically female organs, virilization of external genital organs

Often due to 21-hydroxyl are deficiency, overproduction of androgens

103
Q

Male pseudohermaphroditism

A

Genetically male, Cryptorchidism testes, external genital organs appear feminine or ambiguously female

104
Q

Acute prostatis

A

Reflux of infected urine into the prostate, inflammatory infiltrate seen in the prostatic acini and stroma, discomfort on urination, fever chills and perineal pain

105
Q

Chronic bacterial prostatitis

A

Elevation of PSA, bacteria in urine, reflux of the urine, prostatic calculi, infiltrates of lymphocytes and plasma cells and macrophages

106
Q

BPH

A

Enlargement of the gland, obstruction to the flow of urine trough the bladder outlet

107
Q

Adenocarcinoma of the prostate

A

Gleason rating score, bladder outlet obstruction or symptoms of metastatic tumor, DRE with PSA

Patho (5 decks)

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