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tsomkapQ > Nephrology Clues with Additions > Flashcards

Nephrology Clues with Additions Flashcards

1
Q

Define renal insufficiency generally

What is renal dysfunction in men defined as

A

Creatinine > 2 mg/dl

Men: creatinine = or > 1.5 mg/dl
Women: creatinine = or > 1.4 mg/dl

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2
Q

What is Goldblatt’s Kidney?

A

Flea-bitten kidney (ruptured capillaries from high blood pressure)

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3
Q

What is Azotemia?

A

high levels of BUN and/or creatinine (because they indicate high levels of nitrogen

Increased BUN/Creatinine ratio
renal failure

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4
Q

What is uremia?

A

Azotemia= “high level of nitrogen” (urea, creatinine)

(renal failure) with symptoms

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5
Q

What is Nephritic Kidney Disease?

A

Inflammation with protein loss <3.5 in urine

Increased size of Fenestrations, RBC casts, HTN

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6
Q

What is Nephrotic Kidney Disease?

A

Lost basement membrane charge
Proteinuria >3.5
hypercoagulable
lipiduria

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7
Q

What is seen in Rapidly Progressive Glomerulonephritis (RPGN)?

A

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)

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8
Q

What is Drug Induced Hypersensitivity?

A

Eosinophils in the urine

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9
Q

What is Poststreptococcal glomerulonephritis (PSGN)?

A

Most common in kids, lumpy bumpy, granular

Subepithelial humps (IgG/C3/C4 deposition) 
ASO antibodies (deposition on glomerulus basement membrane and mesangium)

Nephritis syndrome

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10
Q

What is Membranous glomerulonephritis (Membranous Nephropathy)?

A

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

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11
Q

What is Membrano-proliferative glomerulonephritis (MPGN)?

A

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.

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12
Q

What is Minimal Change Disease (MCD)?

A

Most common nephrotic in kids, fused foot processes, no renal failure, loss of charge barrier
**excellent response to corticosteroids

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13
Q

What is Focal Segmental glomerulosclerosis (FSGS)?

A

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

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14
Q

What are the Vasculitis associated with LOW C3? (6 total)

A 
"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
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15
Q

What is the Most Common Cause of Kidney Stones?

A

Dehydration

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16
Q

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?

A

Calcium Oxalate/calcium phosphate = 83% of stones

MCC: idiopathic, followed by primary hyperparathyroidism

radio-opaque on both

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17
Q

What type of Kidney Stones have Coffin-Lid Crystals?

How common

A 
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

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18
Q

What type of kidney stones have Rosette Crystals?

How common?

Most common causes

Appearance on imaging

A

Uric acid = 7% of stones
Associated with Gout, leukemia/chemo
low pH conditions of urine facilitate
Radiolucent on xray; low visibility on CT

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19
Q

What type of kidney stones have hexagonal crystals?

A

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

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20
Q

What type of kidney stones have envelope or dumbbell-shaped crystals?

A

Calcium oxalate

Correlated with ethylene glycol (antifreeze) ingestion, vitamin C abuse, hypocitraturia, and malabsorption (Crohns disease)

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21
Q

What disease has Aniridia?

A

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)

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22
Q

What disease has Iridocyclitis?

A

Inflammation of Iris

Juvenile rheumatoid Arthritis

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23
Q

What is Phimosis?

A

Foreskin scarred at penis head

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24
Q

What is Paraphimosis?

A

Foreskin scarred at base of the corona,

foreskin cant retract and will strangulate the glands penis

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25
Q

What is Urge incontinence?

A

Urgency leads to complete voiding detrusor spasticity leads to small bladder volume

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26
Q

What is Stress Incontinence?

A

Weak pelvic floor muscles, urinating when coughing, laughing, etc. Estrogen effect

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27
Q

What is Overflow Incontinence?

A

Cannot completely empty bladder

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28
Q

What structures have one-way valves?

A

Urethra and ejaculatory duct

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29
Q

What structures have Fake sphincters?

A

Ureters, LES, Ileocecal valve

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30
Q

What has WBC Casts?

A

Nephritis

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31
Q

What has WBC Casts ONLY?

A

Pyelonephritis

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32
Q

What has WBC casts and eosinophils?

A

Interstitial Nephritis (Allergies)

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33
Q

What has WBC Casts and RBC Casts?

A

Glomerulonephritis

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34
Q

What has Fat Casts?

A

Nephrotic Syndrome

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35
Q

What has Waxy Casts?

A

Chronic Renal Failure

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36
Q

What has Tubular Casts?

A

Acute Tubular Necrosis (ATN)

37
Q

What has Muddy Brown Casts?

A

Acute Tubular Necrosis (ATN)

38
Q

What has Hyaline Casts?

A

Normal sloughing

39
Q

What has Epithelial Casts?

A

Normal sloughing

40
Q

What has Crescents?

A

RPGN

41
Q

How do you measure afferent renal function?

A

Creatinine or Inulin

42
Q

How do you measure efferent renal function?

A

BUN or PAH (para-aminohippurate= renal plasma flow)

43
Q

What is the afferent arteriole’s job?

A

Monitor pressure (JG cells-Renin release)

44
Q

What is the efferent arteriole’s job?

A

To secrete

45
Q

What can you measure to test afferent arteriole’s function?

A

Glomerular filtration rate (GFR) or Inulin

46
Q

What can you measure to test afferent arteriole’s function?

A

Glomerular filtration rate (GFR) or Inulin

47
Q

How do you test efferent arteriole function?

A

Renal plasma flow (RPF) or PAH

48
Q

What is Pre-Renal Failure?

A

Low flow to kidney; BUN; Creatinine ratio >20/1 in the serum

49
Q

What is intra-Renal Failure?

A

Damaged Glomerulus or tubules; BUN: Creatinine Ratio <20/1

50
Q

What is Post-Renal Failure?

A

Obstruction (hydronephrosis)

51
Q

What is the job of the Proximal Convoluted Tubule?

A

Reabsorb Glucose, Amino Acids, Salt, Bicarb. >60-80% Reabsorption occurs here

52
Q

What is the job of the Thin Descending Loop of Henle?

A

Reabsorbs Water

53
Q

What is the job of the TAL of Henle?

A

Makes the concentration gradient by reabsorbing Na, K, Cl, Mg, and Ca without water. (Impermeable to H2O)

54
Q

What is the job of the early distal tubule?

A

Concentrate urine by reabsorbing NaCl

55
Q

What is the job of the late Distal Tubule and Collecting Duct?

A

Final concentration of urine by reabsorbing water and excretion of acid

56
Q

What does the Macula Densa do?

A

Measures osmolality (osmoles of solute-kg)

57
Q

What does the JGA do?

A

Measures volume, secretes renin (low volume state)

58
Q

What is Fanconi Syndrome?

A

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

59
Q

What is Bartter’s Syndrome?

A

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)

60
Q

What is Psychogenic Polydipsia?

A

Drinking a lot of water, diluting Na in blood

61
Q

What is Hepatorenal Syndrome?

A

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.

62
Q

What is Type I RTA (Renal Tubular Acidosis)?

A

Distal RTA: H/K in collecting duct is broken, high urine pH

63
Q

What is Type 2 RTA (Renal Tubular Acidosis)?

A

Proximal RTA: bad Carbonic Anhydrase, lost all HCO3-

64
Q

What is Central Pontine Myelinolysis?

A

“Locked-in Syndrome”

This happens when you correct serum sodium faster than 0.5 mEq/hr. (infarct the PONS- patient can only blink)

65
Q

What disease states have increased Anion Gap?

A 
"MUDPILES"
Methanol
Uremia
DKA
Paraldehyde/Phenoformin
INH/ Iron tablets
Lactic Acidosis
Ethylene Glycol
Salicylates
66
Q

What are the IgA Nephropathies?

A

HSP
Berger’s
Alport Syndrome

67
Q

What is the most common Nephrotic disease in diabetics?

A

Nodular Sclerosis

68
Q

What is the most common Nephrotic disease complication with cancer?

A

Amyloidosis

69
Q

What are the nephritic syndromes?

A

Post strep GN, Goodpastures, RPGN, IgA Nephropathies, Membranoproliferative GN

70
Q

What disease correspond to IF patterns

a) granular (non-linear)
b) smooth (linear)
c) crescent
d) mesangial

A

a) post strep
b) goodpastures
c) RPGN
d) IgA nephropathies

71
Q

What produces supepithelial bumps and which produce subendothelial bumps?

A

supEPithelial = post strep, subENDo = membranoproliferative GN

72
Q

What are the LM results for each nephritic syndrome?

A

post strep = hypercellular PMNs
goodpasture = hypercellular crescents
IgA nephropathy = hypercellular mesangial prolif
membranoprolif GN = hypercellular TRAM TACK BM splitting (silver stain)

73
Q

What are the nephrotic syndromes?

A

membranous GN, minimal change, focal seg, amyloidosis, nodular glomular sclerosis

74
Q

“basket weave”

A 
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
75
Q

“wire looping” of capillaries

A

diffuse prolf. glomerulonephritis

SLE associated, nephritic and nephrotic concurrently, subENDOthelial and intramembranous Ig-G-ICs with C3 deposition

76
Q

Granular IF

A

PSGN or DPGN

77
Q

Starry Sky IF

A

PSGN, and gramular

78
Q

RPGN:
linear IF due to….
negative IF due to…
Granular IF due to…

A

linear—goodpastures, type II hypersen.,
nothing if….no Ig/C3 dep–> (MPO, PR3 ANCAs)
granular if….PSGN, DPGN related

79
Q

Metabolic alkalosis
hypokalemia,
hypercalciuria

presents similar to a loop diuretic
failure to thrive
autosomal recessive

triangular facies

A

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

80
Q

metabolic alkalosis
hypokalemia
hypocalciuria
hypo-magnesemia

cramping/spasms
failure to thrive
autosomal recessive

A

Gitelman syndrome

reabsroption defect in NaCl in CT
presents similar to lifelong thiazide diuretic use

less severe than Bartter syndrome

81
Q 
metabolic acidosis (potentially)
weak bones
hypophosphatemia 
osteopenia 
failure to thrive
A

Fanconi syndrome

generalized defect in PCT
decreased reabsorption of glucose, amino acids, ions

82
Q 
Metabolic alkalosis 
hypokalemia 
hypertension
decreased aldosterone 
autosomal dominant

Symptoms are of hypertension, fluid retention, and metabolic alkalosis.

A

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.

83
Q 
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
A

SAME

syndrome of apparent mineralcorticoid excess

84
Q

one of the most common causes of nephrotic syndrome in adults and its etiologies

A

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

85
Q

most common cause of glomerulonephritis worldwide.

A

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.

86
Q

nephritic glomerular diseases: positive anti glomerular basement membrane antibodies

A

Goodpasture syndrome

hemoptysis and nephritic glomerulonepthritis (hematuria, renal failure)

87
Q

nephritic glomerular diseases:

increased blood eosinophils

A

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.

88
Q

nephritic glomerular diseases: positive c-ANCA

A

granulomatosis with polyangiitis

small vessel vasculitis that causes upper respiratory (sinus) and lung inflammation, plus glomerulonephritis

89
Q

nephritic glomerular diseases: positive ASO or anti hyaluronidase A titers

A

post streptococcal GN

tsomkapQ (117 decks)

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