Nephro Flashcards
Red cell casts
Glomerulonephritis
White cell casts
Pyelonephritis
Eosinophil casts
Acute/allergic interstitial nephritis
Hyaline casts
Dehydration concentrates the urine and normal Tamm-Horsfall proteins precipitate into casts
Broad, waxy casts
Chronic renal disease
Granular muddy-brown casts
ATN-collection of dead tubular cells
Most common meds causing ATN
Contrast agents Aminoglycosides Cisplatin Amphotericin Cyclosporine NSAIDs
Most common meds causing AIN/drug rash/SJS/hemolysis?
Penicillin Cephalosporin Sulfa drugs Phenytoin Rifampin Quinolones Allopurinol PPI
Most accurate test for AIN
Hansel or Wright stain
Possible kidney damage from NSAIDs
ATN from direct tubule toxicity AIN Membranous glomerulonephritis Vascular insufficiency from vasoconstriction of afferent arteriole Papillary necrosis
Goodpasture Syndrome
Glomerulonephritis
Lung involvement- hemoptysis
NO OTHER SIGNS!
Best initial test: antiglomerular basement membrane Ab
Most accurate test: kidney biopsy showing linear immunoflouresence
Tx: plasmapheresis and steroids
IgA nephropathy (Berger’s disease)
Glomerulonephritis
Asian population
Gross hematuria 1-2 days after a URI
IgA level only increased 50% of the time
Kidney biopsy: mesengial deposits and C3 seen on EM
Tx: None
Post-infectous GN
1-3 weeks following throat or skin infection with group A beta-hemolytic strep
Sx: Dark urine Periorbital edema HTN Oliguria
Dx: Low complement
ASO and anti-DNAse Ab
Biopsy rarely done
Tx: self limited, use supportive measures such as antibiotics and diuretics to control fluid overload
Alport Syndrome
Congenital defect of IV collagen
glomerulonephritis plus:
High frequency hearing loss
Visual disturbances- loss of collagen that holds lens of eye together
No treatment
Polyarteritis Nodosa
Systemic vasculitis of small and medium vessels- SPARES THE LUNGS
Glomerulonephritis Fever, weight loss, myalgias/arthralgias GI symptoms and pain worse with eating Peripheral mononeuropathies Stroke Purpura, petichiae Cardiac disease
Dx:
Anemia, leukocytosis
Elevated ESR and CRP
p-ANCA (not usually)
Angiography showing aneurysmal dilatation of renal, mesenteric, or hepatic artery
Most accurate test: biopsy
Treat: prednisone and cyclophosphamide, Check HBV
GN associated with lupus
Membranous glomerulonephritis
Amyloidosis
Abnormal protein produced in: Multiple Myeloma Chronic inflammatory diseases RA IBD Chronic infections
Bx: green birefringence with Congo red staining with polarizing light
Treatment: mephalan and prednisone
Nephrotic syndrome associated with solid organ cancer
Membranous
Nephrotic syndrome associated with children
Minimal change
Nephrotic syndrome associated with drug use and AIDS
FSGS
Nephrotic syndrome associated with NSAID use
Minimal change or membranous
Nephrotic syndrome definition
Hyperproteinuria >3.5g in 24 hours
Hypoproteinemia- decreased immunity, increased clotting
Hyperlipidemia
Edema
Distal RTA (Type I)
Amphotericin or autoimmune damage to distal tubule preventing it from making new bicarb and prohibiting H+ to be secreted from tubule. Hypokalemic acidosis
Increased formation of kidney stones
Dx:
Best initial test: UA with pH > 5.5 Most accurate test: infuse acid into blood with ammonium chloride- pH in urine remains basic = positive test
Tx: Replace bicarb
Proximal RTA (Type II)
Amyloidosis, myeloma, Fanconi, acetazolamide, or heavy metals decrease the ability of kidney to reabsorb bicarb.
Hypokalemic metabolic acidosis
Acidosis steals calcium from bones- osteomalacia
Dx:
Urine pH is variable: basic until most bicarb lost from body then acidic (bc distal tubule doing the work)
Accurate test: Give bicarb and measure urine pH- urine pH will rise
Tx: difficult to treat
Give bicarb and thiazie (volume depletion helps bicarb reabsorption).
Hyporeninemia, hypoadosteronism (Type IV RTA)
Occurs in diabetes
Decreased amount or effect of aldosterone- loss of Na, retention of K and H
Dx: persistently high urine Na, despite sodium restricted diet
Hyperkalemia
Hypotension/hypoperfusion
Anion gap metabolic acidosis
Acid: lactate
Test: blood lactate level
Treatment: correct hypoperfusion
DKA/Starvatoin
Anion gap metabolic acidosis
Acid: Ketoacid
Test: Acetone level
Treatment: Insulin and fluid
Ethylene glycol overdose
Anion gap metabolic acidosis
Acid: Oxalic acid
Test: Crystals on UA
Treatment: Fomepizole or dialysis
Methanol overdose
Anion gap metabolic acidosis
Acid: Formic acid
Test: Inflamed retina (going blind from moonshine)
Treatment: Fomepizole or dialysis
Renal failure
Anion gap metabolic acidosis
Acid: Uremia
Test: BUN/Cr
Treatment: Dialysis
Aspirin overdose
Anion gap metabolic acidosis
Acid: Salicylates
Tests: Aspirin level
Treatment: Alkanize urine
