Nephrology Clues with Additions Flashcards
Define renal insufficiency generally
What is renal dysfunction in men defined as
Creatinine > 2 mg/dl
Men: creatinine = or > 1.5 mg/dl
Women: creatinine = or > 1.4 mg/dl
What is Goldblatt’s Kidney?
Flea-bitten kidney (ruptured capillaries from high blood pressure)
What is Azotemia?
high levels of BUN and/or creatinine (because they indicate high levels of nitrogen
Increased BUN/Creatinine ratio
renal failure
What is uremia?
Azotemia= “high level of nitrogen” (urea, creatinine)
(renal failure) with symptoms
What is Nephritic Kidney Disease?
Inflammation with protein loss <3.5 in urine
Increased size of Fenestrations, RBC casts, HTN
What is Nephrotic Kidney Disease?
Lost basement membrane charge
Proteinuria >3.5
hypercoagulable
lipiduria
What is seen in Rapidly Progressive Glomerulonephritis (RPGN)?
Crescents
Nephritis syndrome
rapidly deteriorating renal function (days to weeks)
Crescents are fibrin and plasma protein– C3b, with glomerular parietal cells, monocytes, and macrophages
Goodpasture syndrome
Wegener (Granulomatosis with polyangiitis)
Microscopic Polyangiitis
-angiitis: (inflammation of blood vessels)
What is Drug Induced Hypersensitivity?
Eosinophils in the urine
What is Poststreptococcal glomerulonephritis (PSGN)?
Most common in kids, lumpy bumpy, granular
Subepithelial humps (IgG/C3/C4 deposition) ASO antibodies (deposition on glomerulus basement membrane and mesangium)
Nephritis syndrome
What is Membranous glomerulonephritis (Membranous Nephropathy)?
Nephrotic syndrome
- EM: “spike and dome” appearance, granular/linear supepithelial spikes and closes
- glomerular basement membrane (GBM) thickening with little or no cellular proliferation or infiltration
- 20 to 30 percent of cases of nephrotic syndrome in White adults
- one of the most common causes of nephrotic syndrome in non-diabetic adults
FA580
Primary:
- humoral autoimmune response to a normal podocyte antigens in the absence of secondary features or etiologies of disease.
- antibodies to phospholipase A2 receptor
Secondary: drugs (NSAIDS, penicillamine, gold)
infections (HBV, HCV, syphilis),
SLE, or solid tumors.
**Poor response to steroids
What is Membrano-proliferative glomerulonephritis (MPGN)?
Tram tracks seen (Type II has low C3) on LM
Most common in Adults
Nephritic-> Nephrotic
FA581
Nephritis syndrome often copresents with nephrotic syndrome
Type 1: secondary to….
- hepatitis B/C infection (subendothelial IC deposition with granular IF)
- cryoglobulinemia
- subacute bacterial endocarditis
- LUPUS (creates a low complement state)
Type 2: associated with…..
-C3 nephritic factor: increased C3 levels (also called “dense deposit disease”)
-
“tram track appearance” on H&E and PAS stains.
What is Minimal Change Disease (MCD)?
Most common nephrotic in kids, fused foot processes, no renal failure, loss of charge barrier
**excellent response to corticosteroids
What is Focal Segmental glomerulosclerosis (FSGS)?
Nephrotic Syndrome
MC nephrotic disease in adults
Effacement of foot processes similar to minimal change disease)
Most common in IVDA(IV drug abusers), African American, Hispanics and HIV patients
What are the Vasculitis associated with LOW C3? (6 total)
"PMS in Salt Lake City" 1. Post-Strep GN 2 Membranoproliferative Glomerulonephritis Type II 3 Sub Bacterial endocarditis 4 Serum Sickness 5 Lupus 6 Cryoglobulinemia
What is the Most Common Cause of Kidney Stones?
Dehydration
What is the Most common type of Kidney Stone?
How common?
What is the most common cause of these?
How do they appear on x ray and CT?
Calcium Oxalate/calcium phosphate = 83% of stones
MCC: idiopathic, followed by primary hyperparathyroidism
radio-opaque on both
What type of Kidney Stones have Coffin-Lid Crystals?
How common
Triple Phosphate (Struvite) (Ammonium Magnesium Phosphate) = 9% of stones
MCC: urease + organisms, increase pH
FA582
Urease + bugs (proteus mirabilis, staphylococcus saprophyticus, klebsiella)
*Can form Staghorn calculi
Increased pH
What type of kidney stones have Rosette Crystals?
How common?
Most common causes
Appearance on imaging
Uric acid = 7% of stones
Associated with Gout, leukemia/chemo
low pH conditions of urine facilitate
Radiolucent on xray; low visibility on CT
What type of kidney stones have hexagonal crystals?
Cysteine
Cystine-reabsorbing PCT transporter loses function (cystinuria) and poor reabsorption of Ornithine, Lysine, Arginine (COLA)
*can form Staghorn calculi
“sixtine” stones have SIX sides
What type of kidney stones have envelope or dumbbell-shaped crystals?
Calcium oxalate
Correlated with ethylene glycol (antifreeze) ingestion, vitamin C abuse, hypocitraturia, and malabsorption (Crohns disease)
What disease has Aniridia?
Aniridia means “absense of an Iris (pupil)
Wilms Tumor
(Most common renal malignancy of early childhood (ages 2–4). Contains embryonic glomerular structures.
Presents with large, palpable, unilateral flank mass)
What disease has Iridocyclitis?
Inflammation of Iris
Juvenile rheumatoid Arthritis
What is Phimosis?
Foreskin scarred at penis head
What is Paraphimosis?
Foreskin scarred at base of the corona,
foreskin cant retract and will strangulate the glands penis
What is Urge incontinence?
Urgency leads to complete voiding detrusor spasticity leads to small bladder volume
What is Stress Incontinence?
Weak pelvic floor muscles, urinating when coughing, laughing, etc. Estrogen effect
What is Overflow Incontinence?
Cannot completely empty bladder
What structures have one-way valves?
Urethra and ejaculatory duct
What structures have Fake sphincters?
Ureters, LES, Ileocecal valve
What has WBC Casts?
Nephritis
What has WBC Casts ONLY?
Pyelonephritis
What has WBC casts and eosinophils?
Interstitial Nephritis (Allergies)
What has WBC Casts and RBC Casts?
Glomerulonephritis
What has Fat Casts?
Nephrotic Syndrome
What has Waxy Casts?
Chronic Renal Failure
What has Tubular Casts?
Acute Tubular Necrosis (ATN)
What has Muddy Brown Casts?
Acute Tubular Necrosis (ATN)
What has Hyaline Casts?
Normal sloughing
What has Epithelial Casts?
Normal sloughing
What has Crescents?
RPGN
How do you measure afferent renal function?
Creatinine or Inulin
How do you measure efferent renal function?
BUN or PAH (para-aminohippurate= renal plasma flow)
What is the afferent arteriole’s job?
Monitor pressure (JG cells-Renin release)
What is the efferent arteriole’s job?
To secrete
What can you measure to test afferent arteriole’s function?
Glomerular filtration rate (GFR) or Inulin
What can you measure to test afferent arteriole’s function?
Glomerular filtration rate (GFR) or Inulin
How do you test efferent arteriole function?
Renal plasma flow (RPF) or PAH
What is Pre-Renal Failure?
Low flow to kidney; BUN; Creatinine ratio >20/1 in the serum
What is intra-Renal Failure?
Damaged Glomerulus or tubules; BUN: Creatinine Ratio <20/1
What is Post-Renal Failure?
Obstruction (hydronephrosis)
What is the job of the Proximal Convoluted Tubule?
Reabsorb Glucose, Amino Acids, Salt, Bicarb. >60-80% Reabsorption occurs here
What is the job of the Thin Descending Loop of Henle?
Reabsorbs Water
What is the job of the TAL of Henle?
Makes the concentration gradient by reabsorbing Na, K, Cl, Mg, and Ca without water. (Impermeable to H2O)
What is the job of the early distal tubule?
Concentrate urine by reabsorbing NaCl
What is the job of the late Distal Tubule and Collecting Duct?
Final concentration of urine by reabsorbing water and excretion of acid
What does the Macula Densa do?
Measures osmolality (osmoles of solute-kg)
What does the JGA do?
Measures volume, secretes renin (low volume state)
What is Fanconi Syndrome?
damage to proximal tubules!!!!!!!
can present like Renal Acidosis type II
compromises reabsorption phosphates, bicarb, glucose, and Amino Acids
causes: wilsons, tyrosinemia, cystinosis, glycogen storage dzs, expired tetracycline, ifosfamide, tonofovir, lead poisoning, multiple myloma
What is Bartter’s Syndrome?
JG cell hyperplasia with renin excess, no increase in blood pressure, defect in kidney’s ability to reabsorb potassium
FA570
Thick ascending loop of Henle (affects Na/K2Cl- cotransporter)
Metabolic alkalosis, hypokalemia, hypercalciuria
(similar to chronic loop diuretic use)
What is Psychogenic Polydipsia?
Drinking a lot of water, diluting Na in blood
What is Hepatorenal Syndrome?
High urea from the Liver leads to: increased Glutaminase, Ammonia, GABA- Kidney shuts down
HRS is characterized by rapid-onset kidney injury without evidence of renal ischemia or other renal insult. (normal US and UA lab).
Shunting blood away from the kidneys induces a cycle of progressive renal vascular vasoconstricion and acute kidney injury, so any other medical condition that shifts volume away from kidneys will induce it.
What is Type I RTA (Renal Tubular Acidosis)?
Distal RTA: H/K in collecting duct is broken, high urine pH
What is Type 2 RTA (Renal Tubular Acidosis)?
Proximal RTA: bad Carbonic Anhydrase, lost all HCO3-
What is Central Pontine Myelinolysis?
“Locked-in Syndrome”
This happens when you correct serum sodium faster than 0.5 mEq/hr. (infarct the PONS- patient can only blink)
What disease states have increased Anion Gap?
"MUDPILES" Methanol Uremia DKA Paraldehyde/Phenoformin INH/ Iron tablets Lactic Acidosis Ethylene Glycol Salicylates
What are the IgA Nephropathies?
HSP
Berger’s
Alport Syndrome
What is the most common Nephrotic disease in diabetics?
Nodular Sclerosis
What is the most common Nephrotic disease complication with cancer?
Amyloidosis
What are the nephritic syndromes?
Post strep GN, Goodpastures, RPGN, IgA Nephropathies, Membranoproliferative GN
What disease correspond to IF patterns
a) granular (non-linear)
b) smooth (linear)
c) crescent
d) mesangial
a) post strep
b) goodpastures
c) RPGN
d) IgA nephropathies
What produces supepithelial bumps and which produce subendothelial bumps?
supEPithelial = post strep, subENDo = membranoproliferative GN
What are the LM results for each nephritic syndrome?
post strep = hypercellular PMNs
goodpasture = hypercellular crescents
IgA nephropathy = hypercellular mesangial prolif
membranoprolif GN = hypercellular TRAM TACK BM splitting (silver stain)
What are the nephrotic syndromes?
membranous GN, minimal change, focal seg, amyloidosis, nodular glomular sclerosis
“basket weave”
alports, type IV collagen defect x linked dominant condition thinning and spllitting of glom basement mem cant see. cant pee. cant hear a bee. reto
“wire looping” of capillaries
diffuse prolf. glomerulonephritis
SLE associated, nephritic and nephrotic concurrently, subENDOthelial and intramembranous Ig-G-ICs with C3 deposition
Granular IF
PSGN or DPGN
Starry Sky IF
PSGN, and gramular
RPGN:
linear IF due to….
negative IF due to…
Granular IF due to…
linear—goodpastures, type II hypersen.,
nothing if….no Ig/C3 dep–> (MPO, PR3 ANCAs)
granular if….PSGN, DPGN related
Metabolic alkalosis
hypokalemia,
hypercalciuria
presents similar to a loop diuretic
failure to thrive
autosomal recessive
triangular facies
Bartter syndrome
resorptive defect in thick ascending loop of Henle
affects Na/K/2Cl- cotransporter
presents in children from mother’s who had polyhydramnios and repeated bouts of dehydration
metabolic alkalosis
hypokalemia
hypocalciuria
hypo-magnesemia
cramping/spasms
failure to thrive
autosomal recessive
Gitelman syndrome
reabsroption defect in NaCl in CT
presents similar to lifelong thiazide diuretic use
less severe than Bartter syndrome
metabolic acidosis (potentially) weak bones hypophosphatemia osteopenia failure to thrive
Fanconi syndrome
generalized defect in PCT
decreased reabsorption of glucose, amino acids, ions
Metabolic alkalosis hypokalemia hypertension decreased aldosterone autosomal dominant
Symptoms are of hypertension, fluid retention, and metabolic alkalosis.
Liddle syndrome
presents similarly to hyperaldosteronism
Liddle syndrome is a rare hereditary disorder involving increased activity of the epithelial sodium channel (ENaC), which causes the kidneys to excrete potassium but retain too much sodium and water, leading to hypertension.
Symptoms are of hypertension, fluid retention, and metabolic alkalosis.
Metabolic alkalosis hypokalemia hypertension decreased serum aldosterone increased cortisol autosomal recessive presents similarly to licorice because of glycyrrhetinic acid, which blocks 11 beta-oh-steroid dehrogenase
SAME
syndrome of apparent mineralcorticoid excess
one of the most common causes of nephrotic syndrome in adults and its etiologies
focal segmental glomerulosclerosis (FSGS): can be secondary to heroin and IV drug abuse.
Other causes of secondary FSGS include
lithium
malignancy (particularly lymphoma)
HIV infection
obesity
most common cause of glomerulonephritis worldwide.
IgA nephropathy: Complement levels are low, and about 50% of patients have elevated serum IgA levels.
It often presents in adults with asymptomatic microscopic hematuria, sometimes with elevated serum IgA. Proteinuria predicts progression to ESRD
Diagnosis of IgA nephropathy can only be made with certainty through a renal biopsy, which typically will show mesangial IgA deposits on immunofluorescence.
nephritic glomerular diseases: positive anti glomerular basement membrane antibodies
Goodpasture syndrome
hemoptysis and nephritic glomerulonepthritis (hematuria, renal failure)
nephritic glomerular diseases:
increased blood eosinophils
eosinophilic granulomatosis with polyangiitis (previously Churg Strauss)
small vessel vasculitis that typically presents with hematuria and purpura in the setting of chronic allergies or asthma.
nephritic glomerular diseases: positive c-ANCA
granulomatosis with polyangiitis
small vessel vasculitis that causes upper respiratory (sinus) and lung inflammation, plus glomerulonephritis
nephritic glomerular diseases: positive ASO or anti hyaluronidase A titers
post streptococcal GN
