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PATHOMA renal Flashcards

1
Q

name the congenital renal abnormalities

A
  1. Horseshoe kidney
  2. Renal agensis
  3. Dysplastic kidney
  4. PKD
  5. Medually cystic kidney disease
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2
Q

presentation of ARPKD

A

portal HTN in infants

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3
Q

presentation of ADPKD

A

hematuria and worsening renal failureprobably with headaches

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4
Q

associations of ADPKD

A

hepatic cysts, berry aneurysms and mitral valve prolapse

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5
Q

medullary cystic kidney diseease genetics and presentation

A
  1. Autosomal dominant

2. It has shrunken kidney due to parenchymal fibrosis while all other cyctic kidney diseases have an enlarged kidney

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6
Q

hallmark of ARF

A
  1. azotemia

2. oliguria

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7
Q

normal BUN:Cr ratio

A

15:1

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8
Q

reasons for ARF

A
  1. Azotemia (pre,intra,post)
  2. Acute interstitial nephritis
  3. Renal papillary necrosis
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9
Q

whivh parts of the renal tubulae are most susseptible to ischemis

A

PCT & medullary segment of thick ascending loop

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10
Q

what is associated with ethylene glycol intake

A

oxalate stones

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11
Q

why supportive dialysis is necessary during ongoing acute tubular necrosis therapy

A

bcoz PCT cells are stable (take time to regenrate)

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12
Q

acute interstitial nephritis causes

A

NSAIDS, PCN and diuretics. It is a drug indiced HSR

Chronic use may lead to papillary necrosis.

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13
Q

causes od renal papillary necorsis

A

NSAIDS, DM, sickle cell trait and severe acute pyelonephritis

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14
Q

nephrotoxic causes of acute tubular necrosis

A

HRU AME

  1. Heavy metals (lead)
  2. Radioactive dye
  3. Urate (tumor lysis syndrome)
  4. Aminoglycosides
  5. Myoglobin (crush injuries)
  6. Ethylene glycol
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15
Q

name the nephrotic syndromes

what conditions cause nephrotic syndrome

A
  1. Minimal change desease
  2. Focal segmantal glomeruloscleosis
  3. Membranous nephropathy
  4. Membranoproliferative glomerulonephrosis
  5. DM
  6. SLE
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16
Q

characters of nephrotic syndrome

A
  1. Hypoalbuminemia (edema)
  2. Hypogammaglobulinemia (infections)
  3. Hypercoaguable state (AT III loss)
  4. Hyperlipidemia & hypercholesterolemia
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17
Q

what is MCD associated with

A

Hodkins lymphome (redd sternberg cells produce and release cytokines which are the main cause of the disease and since it is due to cytoines, this is the only nephrotic syndrome that is very responsive to steroids)

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18
Q

presentation of MCD

A

selective albuminuria

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19
Q

differencebetween MCD & FSGS

A

MCD is very responsive to steroids but FSGS inst

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20
Q

associations of FSGS

A

sickle cell anemia, HIV & heroin usage

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21
Q

association od membranous nephropathy

A

Hep B & C , solid tumors, SLE, drugs (NSAIDS, PCN)

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22
Q

MPGN type I associations

A

HBV & HCV

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23
Q

what is C3 nephrtic factor

A

it is an antibody that is produced in MPGN type II and it stabilized the C3 convertase that breaks down C3 into C3a and C3b and this causes overactivity of the complement system
It results in infalmmation and low circulating levels of C3 in the blood

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24
Q

what are kimmelstein nodules

A

They are mesangeal sclerotic nodules seen in diabetic neohrpathy

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25
How does DM cause nephrotic syndrome
by NEG (non enzymatic glycosylation). It causes the glucose to attach to the glomerular memebrane without the enzyme necessary for the process and it leads to leaky memebranes and the protein and fluid from the glomerulus leaks into it and causes hyaline atherosclerosis that leads to a decrease in lumen calibre (mostlyin the efferent vessel) and it initially causes fluid retention in the gloerulus nad it causes hyperfiltration and microalbuminuria and in chronic state causes fluid backup and mesangeal sclerosis (Kimmelstein Wilson Nodules) and ot leads to nephrotic syndorme
26
where does amyloid deposit in the kidney
In the mesangeum
27
tram track appearance
seen in MPGS type II
28
spike and dome appearance
seen in MPGS type I
29
characters of nephritic syndrome
1. protein less than 3.5 g/day 2. oliguria & azotemia 3. salt retention & periorbital edema 4. RBC casts & deformed RBC in urine
30
biopsy of glomerulus in nephritic syndrome
1. Immune complex deposition (which activates compliment nd this causes C5a increase tht attracts neutrophils) 2. hypercellular (due to neutrophils), inflammed glomeruli
31
types of nephritic syndrome
1. PSGN 2. RPGN 3. IgA nephropathy 4. Alport syndrome
32
what are cresents
they are a mass of macrophages & fibrin in d glomerulus in RPGN
33
How to diff the etiology og RPGN
IF test
34
IgA nephropathy aka
BERGER disease
35
where do IgA deposit in IgA nephropathy
in the mesangium. So the IF shows light in the mesangeum
36
what is Alport syndrome
X linked type IV collagen defect
37
characteristics of UTI with proteus
alkaline urine with ammnia smell
38
what organisms cause cystitis
1. E coli 2. S saprophyticus 3. Klebsiella 4. Proteus 5. Enterococcus fecalis
39
causes of urethritis
chlamydia nisseria
40
what does dip stick indiaicate in a UTI
positive for leukocyte esterase and positive for nitrite
41
what does chronic pyelonephritis cause
interstitial fibrosis with tubular atrophy due to multiple bouts of pyelonephritis
42
what is the most common cause of calcium stones and its Rx
isiopathic hypercalciuria | Rx : hydrochlorothoazide
43
which nephrolith is radiolucent
uric acid stone
44
characters of end stage kidney failure
1. Uremia 2. Hyperkalemia with metabolic acidosis 3. Hypocalcemia 4. Salt and water rentension with HTN 5. Anemia 6. Osteodystrophy
45
where is EPO produced
in renal peritubular interstitial cells
46
characteristics of uremia
nausea, pericarditis, urea crystals in the skin, encehalopathy with asterixis, anorexia and platelet dysfunction (ureima inhibits both platelet aggregation and platelet adhesion)
47
where does 1 alpha hydroxilation take place
in PCT cells
48
what risks are aassociated with dyalsis
1. Renal cell carcinoma | 2. dyalisis shrinks kidney upon which cysts may occur
49
name the renal neoplasias
1. RCC 2. Angiolipomyoma 3. Wilms tumor
50
what is tuberous sclerosis and what is it associated with
tuberous sclerosis - development of benign tumors all over the body. It is a genetic condition It is a risk factor for angiolipomyoma
51
what is the RCC triad
1. palpable mass 2. hemturia 3. flank pain
52
associations of RCC
left sided varicocele
53
pathophysiology of RCC
inhibited VHL gene causes over activity of IGF-1 & increased transcription of HIF gene (increases PDGF & VEGF)
54
gross appearance of RCC
yellow colored
55
Most common subtype of RCC
clear cell carcinoma
56
what is blastema
immature kidney mesenchyme
57
what is wilms tumor
it is a malignant tumor is usually 3yr old children which is made up of blastema, primitive glomeruli, tubules and stromal cells
58
presentation of wilms tumor
large unilateral flank mass , hematuria nad HTN (dur o renin secretion)
59
name the sporadic syndromes
1. WAGR - it is due to deletion of WT1 at 11p13. It presents with wilms tumor, aniridia, genital abnormalities and mental and motor retardation 2. Denys Drash - It is due to mutated WT1 gene It presents with wilms tumor, progressive renal (glomerular) disease and male pseudohermaphroditism 3. Beckwith Whitemann - it is due to WT-2 gene cluster mutation especially IGF-2 (imprinted 11q15.5) It presents with wilms tumor, organomegaly, muscular hemihypertropgy and neonatal hypoglycemia
60
what are the lower urinary tract carcinomas
1. Urothelil carcinoma 2. Squamous cell carcinoma 3. adenocarcinoma
61
risk factors for uroepithelial (transitional cell) carcinoma
cigarette smoe (napthylamine), azo dyes, nephrolitilasis long term usage of cyclophoaphamine and phenacetin
62
what are the pathways from which the uroepithelial tumora may develop
1. Papillary pathway - it s a fibrovascular growth with blodd vessels in it and epithelium in it top. It is not associated with p53 gene mutation. It starts as low grade, progresses to high grade and then invades 2. Flat pathway - it is associated with p53 gene mutation. It starts as a growth of cella layer by layer and it is flat. It starts as high grade ans then invades
63
what is a feild defect and where is it seen
It is seen in uroepithelial carcinoma. | It is multifocal and recurrent tumor develoment
64
risk factors for squamous cell carcinoma
chronic cystitis, long standing nephrolithiasis and Schistosomiasis hematobium
65
causes of adenocarcinoma of the lower urinary tract
1. Urachal remnant 2. Bladder extrophy 3. cystitis glandularis
66
what is cyctitis glandularis
It is the dyslasia of te bladder epithelium to coloumnar cells due to chronic and recurent infections of the bladder

usmle step 1 (3 decks)

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