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Renal > Pathology > Flashcards

Pathology Flashcards

1
Q

Underfill Edema (Pitting)

A

Def: Edema with a low EABV
Etiology: heart failure, altered starling’s forces (decreased albumin, increased porosity), change in volume/capacitance ratio (pregnancy, liver failure, drugs)
Physiology: Low EABV stimulated RAAS, causing salt and water retention

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2
Q

Overfill Edema (Pitting)

A

Def: Edema with a high EABV
Etiology: Renal failure, drugs (NSAIDS)
Physiology: Low GFR causes salt and water retention which increases the EABV, causing edema

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3
Q

Localized Pitting Edema

A

Def: Edema due to a venous issue
Etiology: DVT, mass, venous insufficiency

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4
Q

Lympadema

A

Def: Edema due to damage to lymphatic system

non-pitting

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5
Q

myxedema

A

Def: Edema due to protein accumulation under the skin

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6
Q

What are the mechanisms of hyponatremia?

A
  1. Reduced filtration
  2. Increased PCT reabsorption
  3. Impaired desalination
  4. Antidiuresis
  5. Water intake too high for osmoles
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7
Q

Hyponatremia

A

Definition: Too mich water in the extracellular compartment fluid compaired to Na+. Serum Na

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8
Q

What is SIADH and what causes it?

A
  1. Syndrome of innappropriate ADH: gives hyponatremia

2. Causes: cancer, CNS disorders, drugs, pulmonary infections, post-op, HIV

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9
Q

What is the best indicator of ECF volume contraction?

A

Chlorine, especially in vomiting

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10
Q

What are the three main categories of hypernatremia?

A
  1. Increased sodium (rare): hyperaldosteronemia
  2. Increased water loss
  3. Decreased water intake
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11
Q

What are the three common causes of polyuria and polydipsia?

A
  1. Primary polydipsia
  2. Central DI
  3. Nephrogenic DI
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12
Q

What are the causes of secondary hypertension?

A
  1. Renal parenchyma
  2. Mineral corticosteroids
  3. Vasoconstrictors
  4. Anatomical changes
  5. Metabolic
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13
Q

What are the typical presentations of secondary hypertension?

A
  1. Age less than 30 or greater than 55
  2. Resistant to three or more medications
  3. Hypertensive urgency or emergency
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14
Q

What are important questions to ask in a polyuria history?

A
  1. Is it waking them up at night?

2. Do they drink at night?

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15
Q

Hypertensive emergency

A
  1. BP severely high with target organ damage, OR recent accelerated rise with some vascular damage evidence
  2. Immediate HTN diagnosis
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16
Q

Hypertensive urgency

A
  1. Systolic over 210
  2. OR diastolic over 120
  3. AND no target organ damage
17
Q

Target blood pressure for diabetics

A

Less than 130/80

18
Q

Target blood pressure for general population

A

Less than 140/90

19
Q

Signs of target organ damage in hypertension?

A
  1. Renal: proteinuria
  2. Vascular/eyes: papilloedema
  3. Heart: signs of failure
20
Q

Typical causes of secondary hypertension

A
  1. Vascular: aortic coarctation, renal artery stenosis
  2. Drugs: cocaine, steroids, lithium, amphetamines, NSAIDs, licorice
  3. Endocrine: hyperaldosteronemia, pheochromocytoma, cushings, conns, hypercalcemia, thyroid
  4. Renal: parenchymal disease, renovascular HTN
21
Q

What does the presence or absence of a nocturnal dip on 24h ambulatory BP measurements tell us?

A

Presence: happens in essential HTN
Absence: happens in secondary HTN

22
Q

What does the presence or absence of a nocturnal dip on 24h ambulatory BP measurements tell us?

A

Presence: happens in essential HTN
Absence: happens in secondary HTN

23
Q

Why do elderly tend to develop primarily systolic HTN?

A
  1. Less elasticity in vessels, especially aorta- fails to buffer force of systole, leading to higher pressures
24
Q

How do ACE inhibitors impact kidney function?

A
  1. Dilate efferent arterioles, which decreases flow through glomerulus
  2. This decreases GFR and increases creatinine
  3. Up to 30 % increase in CR expected
25
Q

What is a finding on physical exam of renal artery stenosis?

A
  1. Renal bruits
26
Q

Which features favour acute kidney injury?

A
  1. Large kidneys
  2. No broad casts
  3. No hx of kidney disease, HTN, abnormal urinalysis
27
Q

What are the symptoms of uremia?

A

Lethargy, malaise, fatigue
Anorexia, nausea, vomit
Confusion
Myoclonus, seizures, coma

28
Q

What are the main causes of interstitial nephritis?

A
  1. Drugs: NSAIDS, beta lactams
  2. Infections
  3. Autoimmune
29
Q

What are the characteristics of acute interstitial nephritis vs chronic?

A

Acute: rapid, interstitial infiltrate and ended a

Chronic: slow, interstitial fibrosis and scarring

30
Q

What is the classic tried of interstitial nephritis presentation?

A

Fever
Rash
Eosinophilia

Renal (14 decks)

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