Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

P&T Block 5 Renal > L52 > Flashcards

L52 Flashcards

1
Q

Define acute kidney injury

A

Rapid ↓fxn

↑Cr + BUN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 3 categories of damage that can cause AKI?

A

Pre-renal
Intrinsic kidney injury
Post-renal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe why the ↓RBF cause pre-renal failure? Explain the change to BUN, Cr?

A

↓GFR
Kidney is being under profused:
1. Retain Na (H2O) = ↓FE Na
2. Reabsorb BUN, Cr is not: ↑ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What disease is the mot common cause of intrinsic kidney injury that leads to AKI? Name the 2 possible causes.

A

Acute tubular necrosis -> AKI

Due to ischemia or toxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ischemic cause of acute tubular necrosis:

  • Biopsy?
  • Reversible or not?
A

HYPOPROFUSION
No biopsy - very typical presentation (small/no urine)
Reversible if you remove the block in time
Results in death of tubular cells that may slough into tubular lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the changes to the kidney grossly with ischemic ATN?

A

Large, pale kidneys

  • Cortex BVs constricted b/c ↓RBF
  • Medulla becomes congested with blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the microscopic histo changes with ischemic ATN? Explain prox vs distal tubule changes.

A

Ischemic -> reversible cell damage
Cells SWELL, interstitial edema
No inflammatory cells
Some cell death, scattered (not regular like toxic cause ATN)
1. Prox tubules lose specification from swelling, “distalization”
2. Distal tubules + hyaline casts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Does urine sediment change in ischemic ATN?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does the urine profile change through the initial, maintenance, and recovery phases of ischemic ATN?

A

Initiating: ↑Uosm, very [ ] urine indicates injury, basically excreting what gets filtered to it
Recovery: ↓Uosm as urine becomes dilute again, ↓BUN/Cr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What histo changes indicate you’re recovering from ATN?

A

Mitosis

Nuclear enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the BUN:Cr ratio for intrinsic renal failure AKI?

A

↓BUN/Cr

BUN reabsorption is impaired b/c kidney damaged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is diffuse cortical necrosis?

A

Widespread cortical infarct of BOTH kidneys
Likely due to combo do vasospasm + DIC
Think septic shock, big surg (GYN), hemorrhage: ↓renal profusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are exogenous toxins that can cause toxic ATN?

A 
IV contrast scans
Aminoglycosides
MTX
Heavy metals
Cyclosporin/tacrolimus (transplant)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are endogenous toxins that can cause toxic ATN?

A

Hgb (hemolytic anemia)
Myoglobin (rhabdo) - crush injury
Uric acid
HyperCa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Main differences in damage between ischemic v toxic ATN

A

Ischemic - patchy throughout the nephron w/ skip areas

Toxic: damage to all prox tubules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Key finding in urine for ATN

A

Muddy brown, granular casts

17
Q

What is acute drug induced interstitial nephritis?

A

Pt has allergic rxn to a normal drug at kidney (vs drugs that would damage any kidney at high doses via toxic ATN)
Latent period 1-2 wks after you take drug
May be months after if took NSAIDs
Fever, rash, hematuria, CVA tenderness

18
Q

What are the histo findings that indicated drug induced interstitial nephritis?

A

Eosinophils in the urine + ↑IgE serum
Inflam cells (nephritis)
Maybe granulomas
↑BUN (azotemia)

19
Q

How does acute cell mediated allograft rejection look different on histo than drug-induced interstitial nephritis?

A

Allograft rejection - immune cells vs tubules

Nephritis - inflam cells in interstitium

20
Q

What is acute pyelonephritis? Gross vs histo appearance

A

Acute infection of cortex
Gross - abscesses
PMNs in the tubules and interstitium
- WBCs in urine +/- WBC casts

21
Q

2 causes pyelonephritis?

A 
Ascending UTI (rose from bladder), GNs:
- E. Coli
- Proteus
- Kleb & Enterobacter (urine bag on pts bed)
Blood infection spread to kidneys
22
Q

Clinical presentation acute pyelo

A

CVA tenderness

Fever

23
Q

Clinical risk factors for acute pyelo

A 
Indwelling catheter (nosocomial)
Urinary tract obstruction
Vesicourteteral reflex
Diabetes
Preggo
24
Q

2 major complications of acute pyelo

A

Papilary necrosis - more likely if diabetic or cause was obstruction (gray/white tips of renal pyramids)
Perinephritic abscess b/c pus went through renal capsule

25
Q

If a pt has vasculitis, how would it present in the kidney?

A

Vasculitis = fibrinoid necrosis = necrotic damage to BV wall
Proteins leak into the BV wall and stain bright pink

26
Q

Do you need to get a biopsy to dx vascular processes in the kidneys for large, medium, or micro vasculature?

A

Microvasculature

27
Q

Give examples of diseases that would cause thrombotic microangiopathy in the kidney

A 
Vasc damage -> thrombosis -> vasc obstruction -> distal ischemia
2ary renal failure
TTP (ADAM TS 13 def - can't cleave VWF)
HUS (EColi O157H7)
Drugs
AI: SLE
28
Q

What are the 2 types of glomerulonephritis that microvascular pathology can cause (via glomerular injury)

A

Necrotizing

Cresentic (RPGN) - see crescents of damaged Bowman’s

P&T Block 5 Renal (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions