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Renal Exam III > Lange Renal Reading > Flashcards

Lange Renal Reading Flashcards

1
Q

Hyaline casts

A 
Concentrated urine, febrile disease, after strenuous exercise, in the course of
diuretic therapy (not indicative of renal disease)
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2
Q

Red cell casts

A

Glomerulonephritis

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3
Q

White cell

casts

A

Pyelonephritis, interstitial nephritis (indicative of infection or inflammation)

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4
Q

Coarse,

granular casts

A

Nonspecific; can represent acute tubular necrosis

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5
Q

Conditions elevating creatinine

A

Ketoacidosis, cephalothin, cefoxitin, flucytosine - Noncreatinine chromogen

Other drugs: aspirin, cimetidine, probenecid,
trimethoprim - Inhibition of tubular creatinine secretion

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6
Q

Conditions decreasing creatinine

A

Advanced age - Physiologic decrease in muscle mass
Cachexia - Pathologic decrease in muscle mass
Liver disease - Decreased hepatic creatine synthesis and
cachexia

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7
Q

Conditions affecting BUN independently of GFR.

Increased BUN

A

Reduced effective circulating blood volume (prerenal azotemia)
Catabolic states (gastrointestinal bleeding, corticosteroid use)
Highprotein
diets
Tetracycline

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8
Q

Conditions affecting BUN independently of GFR.

decreased BUN

A

Liver disease
Malnutrition
Sickle cell anemia
SIADH

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9
Q

Etiology

Prerenal Azotemia -

Postrenal Azotemia -

Intrinsic Renal Disease
Acute Tubular Necrosis Oliguric or Polyuric) -

Acute Glomerulonephritis -

Acute Interstitial Nephritis -

A

Prerenal Azotemia - Poor renal perfusion

Postrenal Azotemia - Obstruction of the urinary tract

Intrinsic Renal Disease
Acute Tubular Necrosis Oliguric or Polyuric) - Ischemia,
nephrotoxins

Acute Glomerulonephritis - Immune complexmediated, pauciimmune, antiGBM
related

Acute Interstitial Nephritis - Allergic reaction; drug reaction; infection,
collagen vascular disease

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10
Q

Serum
BUN:Cr
ratio

Prerenal Azotemia -

Postrenal Azotemia -

Intrinsic Renal Disease
Acute Tubular Necrosis Oliguric or Polyuric) -

Acute Glomerulonephritis -

Acute Interstitial Nephritis -

A

Prerenal Azotemia - > 20:1

Postrenal Azotemia - > 20:1

Intrinsic Renal Disease
Acute Tubular Necrosis Oliguric or Polyuric) - 20:1

Acute Interstitial Nephritis -

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11
Q

UNa (meq/L)

Prerenal Azotemia -

Postrenal Azotemia -

Intrinsic Renal Disease
Acute Tubular Necrosis Oliguric or Polyuric) -

Acute Glomerulonephritis -

Acute Interstitial Nephritis -

A

Prerenal Azotemia - > 20:1

Postrenal Azotemia - variable

Intrinsic Renal Disease
Acute Tubular Necrosis Oliguric or Polyuric) - > 20:1

Acute Glomerulonephritis -

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12
Q

FE (%)

Prerenal Azotemia -

Postrenal Azotemia -

Intrinsic Renal Disease
Acute Tubular Necrosis Oliguric or Polyuric) -

Acute Glomerulonephritis -

Acute Interstitial Nephritis -

A

Prerenal Azotemia -

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13
Q

Urine
osmolality
(mosm/kg)

Prerenal Azotemia -

Postrenal Azotemia -

Intrinsic Renal Disease
Acute Tubular Necrosis Oliguric or Polyuric) -

Acute Glomerulonephritis -

Acute Interstitial Nephritis -

A

Prerenal Azotemia - >500

Postrenal Azotemia -

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14
Q

Urinary
sediment

Prerenal Azotemia -

Postrenal Azotemia -

Intrinsic Renal Disease
Acute Tubular Necrosis Oliguric or Polyuric) -

Acute Glomerulonephritis -

Acute Interstitial Nephritis -

A

Prerenal Azotemia - Benign or hyaline casts

Postrenal Azotemia - Normal or red cells, white cells, or crystals

Intrinsic Renal Disease
Acute Tubular Necrosis Oliguric or Polyuric) - Granular muddy brown) casts, renal tubular casts

Acute Glomerulonephritis - Red cells, dysmorphic red cells and red cell casts

Acute Interstitial Nephritis - White cells, white cell casts, with or without eosinophils

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15
Q

Stages of chronic kidney disease 1

A

Kidney damage with normal or ↑↑ GFR
≥ 90
Diagnosis and treatment. Treatment of comorbid conditions. Slowing of progression. Cardiovascular disease risk reduction.

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16
Q

Stages of chronic kidney disease 2

A

Kidney damagewith mildly ↓ GFR
60–89
Estimating progression.

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17
Q

Stages of chronic kidney disease 3

A

Moderately ↓GFR
30–59
Evaluating and treating complications.

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18
Q

Stages of chronic kidney disease 4

A

Severely ↓ GFR
15–29
Preparation for kidney replacement therapy.

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19
Q

Stages of chronic kidney disease 5

A

Endstage-renal disease (ESRD)

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20
Q

Primary glomerular diseases

A 
Focal and segmental glomerulosclerosis
Membranoproliferative glomerulonephritis
IgA nephropathy
Membranous nephropathy
Alport syndrome (hereditary nephritis)
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21
Q

Secondary glomerular diseases

A 
Diabetic nephropathy
Amyloidosis
Postinfectious glomerulonephritis
HIVassociated
nephropathy
Collagenvascular
diseases (eg, SLE)
HCVassociated
membranoproliferative glomerulonephritis
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22
Q

Tubulointerstitial nephritis causes

A 
Drug hypersensitivity
Heavy metals
Analgesic nephropathy
Reflux/chronic pyelonephritis
Sickle cell nephropathy
Idiopathic
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23
Q

Cystic diseases

A

Polycystic kidney disease

Medullary cystic disease

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24
Q

Obstructive nephropathies

A

Prostatic disease
Nephrolithiasis
Retroperitoneal fibrosis/tumor
Congenital

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25
Q

Vascular diseases

A

Hypertensive nephrosclerosis

Renal artery stenosis

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26
Q

Symptoms and signs of uremia. General

A

Symptoms -Fatigue, weakness

Signs - Sallowappearing,
chronically ill

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27
Q

Symptoms and signs of uremia.

skin

A

Symptoms -Pruritus, easy bruisability

Signs - Pallor, ecchymoses,
excoriations, edema, xerosis

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28
Q

Symptoms and signs of uremia. ent

A

Symptoms -Metallic taste in mouth, epistaxis

Signs - Urinous breath

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29
Q

Symptoms and signs of uremia. eye

A

Symptoms -

Signs - Pale conjunctiva

30
Q

Symptoms and signs of uremia. pulmonary

A

Symptoms -Shortness of breath

Signs - Rales, pleural effusion

31
Q

Symptoms and signs of uremia. cardiovascular

A

Symptoms - Dyspnea on exertion, retrosternal pain on
inspiration (pericarditis)

Signs - Hypertension, cardiomegaly,
friction rub

32
Q

Symptoms and signs of uremia. gastrointestinal

A

Symptoms - Anorexia, nausea, vomiting, hiccups

Signs -

33
Q

Symptoms and signs of uremia. gentiourinary

A

Symptoms - Nocturia, erectile dysfunction

Signs - Isosthenuria

34
Q

Symptoms and signs of uremia. neuromuscular

A

Symptoms - Restless legs, numbness and cramps in
legs

Signs -

35
Q

Symptoms and signs of uremia. neurologic

A

Symptoms - Generalized irritability and inability to
concentrate, decreased libido

Signs - Stupor, asterixis, myoclonus,
peripheral neuropathy

36
Q

Reversible causes of kidney injury. infection

A

Urine culture and sensitivity tests

37
Q

Reversible causes of kidney injury. obstruction

A

Bladder catheterization, then renal

ultrasound

38
Q

Reversible causes of kidney injury. Extracellular fluid volume depletion or significant
hypotension relative to baseline

A

Blood pressure and pulse, including

orthostatic pulse

39
Q

Reversible causes of kidney injury. Hypokalemia, hypercalcemia, and hyperuricemia (usually
> 15 mg/dL)

A

Serum electrolytes, calcium,

phosphate, uric acid

40
Q

Reversible causes of kidney injury.nephrotoxic agents

A

Drug history

41
Q

Reversible causes of kidney injury. severe/urgent hypertension

A

Blood pressure, chest radiograph

42
Q

Reversible causes of kidney injury. heart failure

A

Physical examination, chest

radiograph

43
Q

Postinfectious glomerulonephritis

A

Children: abrupt onset of
nephritic syndrome and acute
kidney injury but can present
anywhere in nephritic spectrum

Streptococci, other
bacterial infections (eg, staphylococci, endocarditis, shunt infections)

Rising ASO titers, low complement levels

44
Q 
IgA nephropathy (Berger disease) and HenochSchönlein
purpura, systemic IgA vasculitis
A

Classically: gross hematuria with per respiratory tract
infection; can present anywhere in nephritic spectrum; HenochSchönlein purpura with vasculitic rash and gastrointestinal hemorrhage

Abnormal IgA glycosylation in both primary (familial predisposition) and secondary disease (associated with cirrhosis, HIV, celiac disease)
HenochSchönlein
purpura in children after
an inciting infection

No serologic
tests helpful;
complement
levels are

45
Q 
Pauciimmune
(granulomatosis
with polyangiitis,
ChurgStrauss,
polyarteritis,
idiopathic
crescentic
glomerulonephritis)
A 
Classically as crescentic or
RPGN, but can present
anywhere in nephritic spectrum;
may have respiratory tract/sinus
symptoms in granulomatosis
with polyangiitis

See Figure 22–5

ANCAs: MPO
or PR3 titers
high;
complement
levels normal
46
Q 
Antiglomerular
basement
membrane
glomerulonephritis;
Goodpasture
syndrome
A 
Classically as crescentic or
RPGN, but can present
anywhere in nephritic spectrum;
with pulmonary hemorrhage in
Goodpasture syndrome

May develop as a result
of respiratory irritant
exposure (chemicals or
tobacco use)

AntiGBM
antibody titers
high;
complement
levels normal
47
Q

Cryoglobulinassociated

glomerulonephritis

A

Often acute nephritic syndrome;
often with systemic vasculitis
including rash and arthritis

Most commonly
associated with chronic
hepatitis C; may occur
with other chronic
infections or some
connective tissue
diseases
Cryoglobulins
positive;
rheumatoid
factor may be
elevated;
complement
levels low
48
Q

Idiopathic MPGN

A

Classically presents with acute
nephritic syndrome, but can see
nephrotic syndrome features in
addition

Most patients are

49
Q

Hepatitis C

infection

A

Anywhere in nephritic spectrum

Can cause MPGN
pattern of injury or
cryoglobulinemic
glomerulonephritis;
membranous
nephropathy pattern of
injury uncommon
Low
complement
levels;
positive
hepatitis C
serology;
rheumatoid
factor may be
elevated
50
Q

Systemic lupus

erythematosus

A

Anywhere in nephritic spectrum,
depending on pattern/severity
of injury

Treatment depends on
clinical course andInternational Society of
Nephrology and Renal
Pathology Society
(ISN/RPS) classification
on biopsy
High ANA
and antidoublestranded
DNA titers;
low
complement
levels
51
Q

Minimal change
disease (nil disease;
lipoid nephrosis)

A

Child with sudden onset of
full nephrotic syndrome

Children: associated with allergy or viral
infection

Adults: associated with Hodgkin disease,
NSAIDs

52
Q

Membranous

nephropathy

A 
Anywhere in nephrotic
spectrum, but nephrotic
syndrome not uncommon;
particular predisposition to
hypercoagulable state

Primary (idiopathic) may be associated

with antibodies to PLA R
Associated with nonHodgkin
lymphoma,
carcinoma (gastrointestinal, renal,
bronchogenic, thyroid), gold therapy,
penicillamine, SLE, chronic hepatitis B or
C infection
53
Q

Focal and segmental

glomerulosclerosis

A

Anywhere in nephrotic
spectrum; children with
congenital disease have
nephrotic syndrome

Children: congenital disease with
podocyte gene mutation, or in spectrum
of disease with minimal change disease

Adults: Associated with heroin abuse,
HIV infection, reflux nephropathy,
obesity, pamidronate, podocyte protein
mutations, APOL1 mutations in blacks

54
Q

Amyloidosis

A

Anywhere in nephrotic
spectrum

AL: plasma cell dyscrasia with Ig light
chain overproduction
and deposition;
check SPEP and UPEP

AA: serum amyloid protein A overproduction
and deposition in response to
chronic inflammatory disease
(rheumatoid arthritis, inflammatory bowel
disease, chronic infection)

55
Q

Diabetic nephropathy

A

High GFR (hyperfiltration) →
microalbuminuria → frank
proteinuria → decline in
GFR

Diabetes diagnosis precedes diagnosis
of nephropathy by years

56
Q

HIVassociated

nephropathy

A

Heavy proteinuria, often
nephrotic syndrome,
progresses to ESRD
relatively quickly

Usually seen in antiviral treatmentnaïve
patients (rare in HAART era),
predilection for those of African descent
(APOL1 mutations)

57
Q

Membranoproliferative

glomerulonephropathy

A 
Can present with nephrotic
syndrome, but usually with
nephritic features as well
(glomerular hematuria)
See Table 22–8
58
Q

Causes of acute tubulointerstitial nephritis
Drug reactions
Antibiotics

A 
Betalactam
antibiotics: methicillin, penicillin, ampicillin, cephalosporins
Ciprofloxacin
Erythromycin
Sulfonamides
Tetracycline
Vancomycin
Trimethoprimsulfamethoxazole
Ethambutol
Rifampin
59
Q

Causes of acute tubulointerstitial nephritis
Drug reactions
NSAIDS

60
Q

Causes of acute tubulointerstitial nephritis
Drug reactions
Diuretics

A

Thiazides

Furosemide

61
Q

Causes of acute tubulointerstitial nephritis
Drug reactions
Misc

A

Allopurinol
Cimetidine
Phenytoin

62
Q

Causes of acute tubulointerstitial nephritis
Systemic infections
bacteria

A

Streptococcus
Corynebacterium diphtheriae
Legionella

63
Q

Causes of acute tubulointerstitial nephritis
Systemic infections
Viruses

A

Epstein barr

64
Q

Causes of acute tubulointerstitial nephritis
Systemic infections
Others

A

Mycoplasma
Rickettsia rickettsii
Leptospira icterohaemorrhagiae
Toxoplasma

65
Q

Causes of acute tubulointerstitial nephritis

idiopathic

A

idiopathic

66
Q 
Causes of acute tubulointerstitial nephritis
Tubulointerstitial nephritisuveitis
(TIN–U)
A 
Tubulointerstitial nephritisuveitis
(TIN–U)
67
Q

Simple renal cysts

A 
Prevalence - common
inheritance- none
age at onset- ...
kidney size - normal
cyst location -  cortex and medulla
hematuria - occasional 
hypertension - none
associated complication - none
kidney failure - never
68
Q

acquired renal cysts

A 
Prevalence - dialysis pts
inheritance-none
age at onset-...
kidney size - small
cyst location - cortex and medulla
hematuria - occasional 
hypertension - variable
associated complication - adenocarcinoma in cysts 
kidney failure - always
69
Q

autosomal dominant polycystic kidney disease

A 
Prevalence - 1:1000
inheritance- autosomal dominant
age at onset- 20-40
kidney size - large
cyst location - cortex and medulla
hematuria - common 
hypertension - common
associated complication - urinary tract infections, renal calculi, cerebral aneurysms 10-10%, hepatic cysts 40-60% 
kidney failure - frequently
70
Q

medullary sponge kidney

A 
Prevalence - 1:5000
inheritance-none
age at onset-40-60
kidney size - normal
cyst location - collecting ducts
hematuria - rare
hypertension - none
associated complication - renal calculi, uti
kidney failure - never
71
Q

medullary cystic kidney

A 
Prevalence - rare
inheritance-autosomal dominant
age at onset- adulthood
kidney size - small
cyst location - corticomedullary junction
hematuria - rare
hypertension - none
associated complication - polyuria, salt wasting
kidney failure - always

Renal Exam III (17 decks)

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