Kidney Path Flashcards

Question

``` Acute Proliferative (Poststreptococcal) Glomerulonephritis (PGN) path ```

Answer 1

``` Immune complex formation, but unclear if complexes are simply trapped as they pass through the glomerulus, or if C3 is deposited on GBM before IgG subepithelial humps ```

Answer 2

Abrupt onset, with malaise, slight fever, nausea, and nephritic syndrome Hematuria: urine appears smoky brown Hypocomplementemia; elevated serum antistreptolysin O titers in poststreptococcal cases Children: complete recovery in most (95%) Adults: complete recovery (60%); many develop RPGN or chronic GN

Answer 3

Clinical syndrome (not a specific etiologic form of GN) Characterized by rapid and progressive loss of renal function associated with severe oliguria and (if untreated) death from renal failure in weeks to months All types demonstrate crescents (proliferation of parietal cells/migration of monocytes into Bowman's space)

Answer 4

anti-GBM disease Type IV collagen is target Linear deposits of IgG (sometimes C3 also) on GBM In some patients, anti-GBM antibodies also bind to pulmonary alveolar capillary basement membranes = GOODPASTURE SYNDROME -Goodpasture antigen is noncollagenous component of Type IV collagen -Males > females; peak age is 20-40 y.o. -Pulmonary involvement precedes renal disease *Pulmonary hemorrhage and recurrent hemoptysis -Plasmapheresis is beneficial (removes pathogenic antibodies) Least common of all CrGN types

Answer 5

Complication of any immune complex nephritides (PGN, SLE, IgA nephropathy) Granular IF pattern

Answer 6

Component of a systemic vasculitis, like microscopic polyangiitis or Wegener granulomatosis, or idiopathic Most have serum ANCAs No anti-GBM antibodies or immune complexes

Answer 7

Crescents obliterate the Bowman's space | and compress the glomeruli

Answer 8

Typical nephritic syndrome, but oliguria and azotemia more pronounced Rapid progression to severe renal failure; longterm dialysis or transplantation required Prognosis roughly related to crescent number (<80% crescents means better prognosis) and type

Answer 9

Most common glomerular disease, and one of most common causes of recurrent hematuria Usually affects children and young adults (mostly males) Typical presentation = gross hematuria that occurs 1-2 days after a nonspecific respiratory tract infection; disappears, but recurs every few months

Answer 10

Genetic or acquired abnormality of IgA production and clearance -IgA synthesis is increased in response to respiratory or GI exposure to antigen *IgA nephropathy occurs with increased frequency in patients with celiac sprue and liver disease -IgA and IgA complexes are entrapped in the mesangium, where they activate the alternative complement pathway and cause glomerular injury Proposed to be a variant of Henoch-Schönlein purpura

Answer 11

``` Typically presents with loin pain, gross hematuria; usually after respiratory, gastrointestinal, or urinary infection Some develop slow progression to chronic renal failure in 20 years ```

Answer 12

Group of hereditary familial renal diseases Best studied is Alport syndrome -GBM defect due to mutation in type IV collagen components -Nephritis accompanied by nerve deafness and eye disorders, including lens dislocation, posterior cataracts, and corneal dystrophy -Males affected more frequently, more severely Patients present at age 5-20 y.o., and develop renal failure by 20-50 yoa Heterogenous inheritance (X-linked, autosomal recessive, or autosomal dominant)

Answer 13

``` The final stage of many forms of glomerular disease; characterized by progressive renal failure, uremia, and untimely death Usually from rapidly progressive GN, focal glomeulosclerosis, membranoproliferative GN ```

Answer 14

``` decreased renal acuity cramps restless leg sleep disturbances bone disease itching anemia ```

Answer 15

Kidneys small with | granular surface

Answer 16

``` Usually undiscovered until late in its course, when symptoms of renal insufficiency develop (proteinuria, hypertension, azotemia, anasarca, anemia, anorexia) Urinalysis: broad waxy casts Dialysis and renal transplantation required ```

Answer 17

Poor glycemic control hypertension diabetic retinopathy (high correlation)

Answer 18

``` Nonenzymatic glycosylation (NEG) -glomerular and tubular BMs -arterioles (efferent 1st) osmotic damage to glomerular capillary endothelial cells - glucose → osmotically active sorbitol hyperfiltration damage to mesangium diabetic microangiopathy ```

Answer 19

Microalbuminuria -first lab manifestation (usually after ~10 y of poor glycemic control) -microalbuminuria dipsticks detect albumin levels 1.5-8 mg/dL increased susceptibility to acute and chronic pyelonephritis infarction of renal papillae = papillary necrosis most common cause of chronic renal failure in U.S.

Answer 20

B-2 microglobulin

Answer 21

``` if obstruction prevents draining, the renal pelvis, calyces, and ureter may fill with exudate = pyonephrosis -pus under pressure may develop ischemic and suppurative necrosis of the renal pyramid tips = papillary necrosis -more common in diabetics papillary necrosis ```

Answer 22

Fever, chills, malaise Dysuria, frequency, and urgency Costovertebral angle (CVA) tenderness Urinalysis shows WBC casts and pyuria

Answer 23

``` Due to recurrent infections promoted by chronic obstruction or reflux -Chronic Obstructive Pyelonephritis -Chronic Reflux-Associated Pyelonephritis Important cause of chronic renal failure ```

Answer 24

``` Uneven scarring of the pelvis and/or calyces -Leads to blunted calyces ```

Answer 25

Unnoticed until renal insufficiency begins; may cause hypertension n Some develop FSGS

Answer 26

Adverse reaction to drugs that begins ~15 days (range, 2-40 days) after exposure -Synthetic antibiotics, especially penicillins -Diuretics (thiazides) -Nonsteroidal anti-inflammatory agents (phenylbutazone)

Answer 27

Drugs acts as haptens that covalently bind to cytoplasmic or extracellular component of tubular cells and become immunogenic eosinophils in the urine help support the diagnosis

Answer 28

Fever Eosinophilia (may be transient) Rash (only ~25% of patients) Renal abnormalities: hematuria, minimal or no proteinuria, leukocytouria A rising serum creatinine level or acute renal failure with oliguria develops in about 50% of cases (esp. elderly) Withdrawal of offending drug results in recovery (may take months)

Answer 29

``` Seen in patients consuming large quantities of analgesics -Most consume mixtures containing some combination of phenacetin, aspirin, acetaminophen, caffeine, and codeine for long periods papillary necrosis ```

Answer 30

``` Chronic renal failure (more common in those with preexisting renal disease), hypertension, anemia Increased incidence of transitional cell carcinoma ```

Answer 31

The most common cause of acute renal failure Characterized by destruction of tubular epithelial cells Generally a reversible lesion that arises in a variety of clinical settings: Ischemic Type = due to decreased blood flow (e.g., severe hemorrhage, shock, dehydration) Nephrotoxic Type = death of tubular cells due to poisons, drugs

Answer 32

Aminoglycosides (#1 cause) and other drugs IV radiographic contrast agents (#2 cause) Heavy metals (e.g., mercury, gold, lead) Organic solvents (e.g., carbon tetrachloride) Ethylene glycol Mushroom poisoning Pesticides Myoglobin (from crushing injuries)

Answer 33

Oliguria and elevation of blood urea nitrogen and creatinine Metabolic acidosis and hyperkalemia Urinalysis: dirty brown granular casts and epithelial casts Prognosis is excellent in nephrotoxic ATN if patient survives the disease responsible

Answer 34

BUN: 7-18 mg/dL creatinine = 0.6-1.2 mg/dL Ratio should be ~15:1

Answer 35

caused by a decrease in cardiac output to kidneys (e.g., blood loss, CHF) that ↓GFR BUN:Cr > 15

Answer 36

caused by damage to the kidneys (e.g., ATN, chronic renal failure) BUN:Cr ≤ 15

Answer 37

↓GFR due to obstruction and increased tubular pressure causes backdiffusion of urea into blood BUN:Cr > 15 **persistent obstruction will lead to renal azotemia

Answer 38

``` term for the renal changes observed in benign hypertension -always associated with hyaline arteriolosclerosis * homogeneous, pink hyaline thickening of the vessel lumen ```

Answer 39

``` kidneys atrophy --> grain leather appearance does not cause severe damage to kidneys -↓ GFR -loss of concentrating ability ```

Answer 40

associated with malignant hypertension -always associated with hyperplastic arteriolosclerosis

Answer 41

small, pinpoint petechial hemorrhages cover the kidney surface -“flea-bitten kidney"

Answer 42

Diastolic pressure >120 mm Hg, papilledema, encephalopathy, cardiovascular abnormalities, renal failure At onset, there is marked proteinuria and hematuria, but no significant alteration in renal function -quickly progresses to renal failure, so treat as medical emergency ~50% survive 5 years; 90% of deaths caused by uremia

Answer 43

``` occur as multiple or single cystic spaces in renal cortex -~1-5 cm in diameter; filled with clear fluid no clinical significance; common postmortem finding main importance is differentiation from tumors (usually simply via ultrasound) ```

Answer 44

occur in patients with end-stage renal disease that have undergone prolonged dialysis present in both cortex and medulla, and may bleed, causing hematuria increase risk for adenomas and adenocarcinomas

Answer 45

``` multiple expanding cysts of both kidneys that destroy underlying parenchyma important cause of chronic renal failure (~10% of cases) ```

Answer 46

caused by inheritance of an autosomal dominant polycystin (PKD) gene, either PKD1 (90% of families) or PKD2 -both genes encode proteins of unknown function, but have homology to those involved in cell-cell or cellmatrix adhesion pressure of expanding cysts leads to ischemic atrophy of renal parenchyma

Answer 47

``` usually does not produce symptoms until the 4th decade -flank pain; "heavy, dragging sensation" -intermittent gross hematuria -superimposed hypertension and urinary infection are most important complications Berry aneurysms of the circle of Willis present in 10-30% of patients - high incidence of subarachnoid hemorrhage Asymptomatic liver cysts in 1/3rd of patients ```

Answer 48

``` better than other most chronic renal diseases -slow progression; renal failure occurs, on average, at 50 yoa, but variable - treat with renal transplantation ```

Answer 49

rare polycystic kidney disease with perinatal, neonatal, infantile, and juvenile categories caused by inheritance of two mutated copies of the fibrocystin gene (PKHD1) - unknown function, but may be a receptor with role in collecting-duct and biliary differentiation

Answer 50

numerous small cysts in the cortex and medulla; give kidney sponge-like appearance - all cysts derive from collecting tubules

Answer 51

``` perinatal and neonatal forms are most common - cysts present at birth - may die quickly from pulmonary or renal failure - patients surviving infancy develop liver cirrhosis ```

Answer 52

stones may arise at any level in the urinary tract, but the kidney is the most common site affect 5-10% of Americans in their lifetime - men > women; peak age: 20-30s -most commonly contain calcium oxalate (70%), followed by magnesium ammonium phosphate (struvite), uric acid, and cystine

Answer 53

increased urine concentration of the stone's constituents so that it exceeds their solubility in urine (supersaturation) e.g., hypercalciuria associated with calcium oxalate stones

Answer 54

``` associated with UTIs caused by urea-splitting bacteria (e.g., Proteus sp.) bacteria also serve as nidus for stone formation ```

Answer 55

predisposition with gout, diseases involving rapid cell turnover (leukemias), and low urine pH (<5.5)

Answer 56

genetic defect in renal transport of amino acids

Answer 57

``` renal or ureteral colic - flank pain radiating toward the groin gross hematuria predispose to bacterial infection; large stone may cause hydronephrosis ```

Answer 58

dilation of the renal pelvis and calyces, with atrophy of the parenchyma, caused by obstruction to urine outflow

Answer 59

kidney may be massively enlarged renal parenchyma is compressed and atrophied; papillae are obliterated and pyramids are flattened

Answer 60

``` complete bilateral obstruction (below ureters) causes anuridia, but partial bilateral obstruction causes polyuria (due to defects in tubular concentrating mechanism) unilateral obstruction often remains silent for long period reversible if obstruction is removed within a few weeks ```

Kidney Path Flashcards

(84 cards)