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Nephrology > Quick look at Renal Diseases > Flashcards

Quick look at Renal Diseases Flashcards

1
Q

Minimal Change Disease

A

Nephrotic syndrome (mostly kids)
Foot process effacement on EM–> Albuminuria
Steroids

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2
Q

FSGS

A

Nephrotic syndrome
Black adults
IgM and C3 IF
Steroids, not all respond

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3
Q

Membranous Glomerulopathy

A

Nephrotic syndrome (white adults most common nephrosis)
RVT and PE!
silver stain spikes
Antiphospholipase A2 receptor = antigen

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4
Q

Diabetic Glomerulosclerosis

A

Nephrotic Syndrome (most common kidney dz cause)
Diffuse, KW nodules, membrane thickening
BP reduction w/ ACE I

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5
Q

Amyloidosis

A

Nephrotic Syndrome
Rheum arthritis, gamma light chain stain w/ CONGO RED
2 cause: AL amyloid (primary) AA amyloid (SAA)
treat inflamed state, symptom tx

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6
Q

Nephrotic syndrome

A

U/A protein >3.5 g/day
Oval fat bodies/maltese cross
Low albumin, edema, hyperlipidemia

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7
Q

ATN

A

Tubulointerstitial disease
Ischemic or nephrotoxic kidney failure
muddy brown casts, high FeNa
Don’t biopsy

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8
Q

AIN

A

Tubulointerstitial disease
Mostly drug induced (beta lactams, NSAIDS, PPI)
Rash/hematuria, eosinophils

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9
Q

Acute pyelonephritis

A

Tubulointerstitial, unilateral; no biopsy
CVA T, fever, pyruia
Hematogenous vs ascending (more common)
85% gram neg (e coli)

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10
Q

Chronic pyelonephritis

A

Tubulointerstitial dz
Slow onset RF, scarring and inflammation, U scars
Usually from VUR (reflux/obstruction)
Relieve reflux

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11
Q

Papillary necrosis

A

Tubulointerstitial dz
Analgesis/NSAID abuse, flank pain
SODA: Sickle cell, obstructive pyelo, DM, analgesic abuse,

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12
Q

Post Strep (or infectious) GN

A

Nephritic syndrome (Glomerulonephritis)
Mostly kids, 10-14 day onset. Sub epithelial.
LOW COMPLEMENT, high ASLO titer
IF shows IgG/C3, humps/bumps

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13
Q

Nephritic Syndrome

A 
Hematuria (RBC Casts or deformed/crenated, acanthocytes)
Low GFR
Oliguria
Edema
HTN
Variable proteinuria
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14
Q

IgA Nephropathy

A 
Nephritic syndrome (GN)
IgA and C3 deposits in mesangium
Due to defective glycosylation of hinge region of IgA
Normal complement; biopsy
Treat w/ ACE I, steroids
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15
Q

Henoch Schonlein Purpura

A

Systemic version of IgA nephropathy

Abd pain, LE purpura, arthralgias

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16
Q

Lupus Nephritis

A

Nephritic Syndrome (GN)
“Full house staining” of IgA, IgG, IgM, C3, C1Q
LOW COMPLEMENT
ANA and anti dsDNA positive
Only treat Class III/IV focal and diff w/ steroids, most resolve, rituximab

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17
Q

Granulomatosis w/ polyangiitis

A 
Nephritic Syndrome (GN)
Aka "ANCA" and "Wegener's"; test for ANCA
RPGN, crescentic! Pauci-immune 
Cavitary lesion in lungs, post URI
Rituximab, steroids, plasmapheresis
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18
Q

Angi-GBM aka Goodpasture’s

A 
Nephritic Syndrome (GN)
RPGN, rare
Onset s/p URI or viral infx 
Linear IgG on IF
Steroids, plasmapheresis
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19
Q

Shiga Toxin HUS

A

TMA (Renal Vascular Disease)
D+, Mostly kids (hamburgers, petting zoo)
Gastroenteritis from E Coli
Acute TMA (fibrin deposition, RBC congestion)
Supportive care (dialysis, transfusion)

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20
Q

TMA

A 
Vascular = Thrombotic microangiopathy
Anemia (elevated LDH, low haptoglobin)
Schistocytes
Systemic organ damage from ischemia
Thrombocytopenia
Caused from endothelial injury and clot formation
FIBRIN on imaging
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21
Q

Atypical HUS

A

TMA (Renal Vascular Disease)
ESRD at young age, D-
Genetic or auto-immune against complement regulating Factor H, I or MCP
LOW COMPLEMENT, high recurrence in transplant
tx: eculizumab

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22
Q

TTP

A

TMA (Renal Vascular Disease) not always renal involvement
Low platelets, bruising, anemia, normal PT/aPTT
Neurologic symptoms (AMS)
Caused from genetic or acquired ADAMTS13 deficiency
Tx: Daily plasmapheresis, rituximab

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23
Q

APS (Anti phospholipid Ab syndrome)

A

TMA (Renal Vascular Disease)
Recurrent clots in multiple organs (e.g., placenta–> miscarriages)
Arthralgia/fever/malaise, SLE or lupus like
ANA pos, false VDRL, RBC casts
Fibrin thrombi

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24
Q

Renal Atheroembolic Disease

A

Renal Vascular Disease
Worsening HTN, usually following invasive arterial procedures (CABG)
Acute renal failure
Cholesterol emboli due to loosened plaque (needle shaped inclusions on biopsy)

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25
Pre-Renal Azotemia
Volume depletion, poor perfusion 2/2 sepsis or antihypertensives, heart failure. Low FeNa (kidneys working still) increased BUN:Cr Concentrated urine
26
Intrarenal causes (ATN specifically)
``` 2/2 ischemia or nephrotoxins Muddy brown casts Due to nephrotoxic drugs or pigments (Hgb, Mgb) Can see hyperK, oliguria, low GFR high FeNa, Normal BUN:Cr ```
27
Post-renal failure
Obstructive from stones, tumors, BPH | Anuria (
28
ADPKD
Cystic Kidney Disease Hetero AD mutation in PDK1 or PDK2, "2nd hit" causes disease (polycystins in cilia) Adult onset HTN (high RAAS) & gross hematuria Massively enlarged kidneys, bilateral Extrarenal: aneurysm, hepatic cysts (80%) Cardiac PFO or MV prolapse tx: Nephrectomy
29
MCKD
Cystic Kidney Disease AD mutation in MUC1 or UMOD Altered proteins trapped in ER --> damage and fibrosis Adult onset, polyuria, renal insufficiency Biopsy: chronic tubular interstitial nephritis, BM disruption Hyperuricemia and gout (due to low uric acid excretion)
30
NPHP
Cystic Kidney Disease AR Pleiotropic mutations in NPHP1-15 Most frequent genetic cause of ESRD in kids Retinitis pigmentosa, cerebellar vermis aplasia, liver fibrosis BLINDNESS
31
AR PKD
Cystic Kidney Disease AR mutation in PKHD1 (fibrocystin in biliary/renal cilia) very rare, echo genetic in utero Neonates w/ Potter's sequence, survivors have HTN, RF and liver disease. Potters: Lung hypoplasia, IUGR, characteristic face Liver fibrosis, portal HTN
32
Bartter's syndrome
Hypotension. Genetic disease resembling chronic furosemide use - chronic volume depletion, high renin/aldo - hypokalemia, met alkalosis - mutations in either: NKCC, ROMK (these ones won't have hypokalemia), CLC-Kb
33
Gittleman's syndrome
Hypotentsion. Genetic disease resembling thiazide abuse. Mutation in NaCl transporter in DCT, mild volume depletion, hypocalciuria, hypomagnesiuria
34
2 subepithelial diseases
Membranous | Post-infectious
35
3 Mesangial diseases
IgA, amyloidosis, lupus nephritis (LN can be pretty much anywhere)
36
4 diseases w/ low complement
LN, MPGN, Cryo, post-infx
37
Diabetes insipitus
ADH not made --> dilute urine
38
Nephrogenic Diabetes insipitus
ADH not sensed at kidney --> dilute urine. | If you give ADH and problem doesn't correct, it's this one
39
Glucocorticoid remedial aldosteronism (GRA)
AD mutation of chimeric aldo synthase w/ regulatory elements of 11beta-hydroxylase gene --> stimulation of aldo by ACTH instead of AT II --> loss off feedback - low renin, high aldo. Treat w/ corticosteroids
40
Apparent mineralcorticoid excess syndrome (AME)
Enzyme that converts cortisol to cortisone doesn't work --> elevated cortisol, stimulates aldo receptor --> elevated Aldo Mimicked by licorice!
41
Adrenal adenoma
Cushings --> cortisol secreting tumor --> same effect as AME | Also Conn syndrome (hyperaldo)
42
Congenital bilateral adrenal hyperplasia
Presents like Conn syndrome (hyperaldo) but congenital AR mutation. Treat w/ mineral corticoid antag.
43
Conn's syndrome
Primary hyperaldo from acquired somatic KCNJ5 mutation in K+ channel
44
Fibromuscular dysplasia
Multiple stenoses in renal arteries; young women usually, stenotic kidney w/ "bead" appearance
45
Pheochromocytoma
Adrenal medulla tumor secreting Epi and norepi + metabolites, SNS overdrive. . Will see increased urine catecholamine metabolites (metanephrine); remove surgically
46
Liddle's syndrome
Constitutively active ENaC in CD --> Na reabs independent of aldo stimulus Use amiloride to block enac channel
47
Renal agenesis
Unilateral -- decreased urine, in utero w/ potter sequence and resp insufficiency at birth Bilateral -- perinatal lethal due to lung hypoplasia
48
Primary VUR
intravesical ureter shortening--> reflux into kidney. | M>F, renal hypoplasia from scarring, can be prenatal (Hydronephrosis) or postnatal (post febrile illness or UTI)
49
Secondary VUR
Abnormal increase in bladder pressure 2/2 post urethral valves, neurogenic bladder, or functional bladder obstruction.
50
Renal-Coloboma Syndrome
AD Pax2 mutation --> renal hypoplasia renal sx, holes of optic nerve w/ visual impairment
51
Wilms' Tumor
Mutations in WT genes, embryonic cancer of developing kidney in children. Aka nephroblastoma
52
Nephrophthisis (NPH)
AR mutations in ciliary function and planar cell polarity, abnormal renal tubules, fibrosis --> ESRD, blindness, liver probs
53
Ascent abnormalities
Failure of unilateral ascent --> unilateral pelvic kidney (below IMA) Bloth stuck --> lower pole fusion, horseshoe kidney
54
Ureteropelvic junction obstruction (UPJ)
Often congenital aperistaltic segment or aberrant impinging crossing vessels
55
Ca Oxalate stones
70%, dietery oxalate absorbed in colon and bound by Ca2+. Urinalysis: folded envelope appearance Weird tidbit: low calcium diet actually increases stone risk.
56
Ca2+ phosphate stones
10-15%, risk: alkaline urine, hypercalciuria. Coffin lid appearance
57
Uric acid stones
10-15%. Risk factors: acidic urine, gout, metabolic syndrome, malignancy. Diamond shape.
58
Struvite stones
10-15%. Urease producing bacteria! UTI/chronic UTI. Staghorn stones Proteus, klebsiella, haemophilus
59
Cystine Stones
Less than 1% | Genetic defect plus acidic urine. Microhexagonal crystals
60
Medication caused stones
61
Stone inhibitors in urine
Mg2+, citrate, tartrate, etc.
62
Stone likely to pass if what size?
63
CDK-MBD
CKD caused low bit D and phosphate retention. Elevated serum P --> FGF23--> decreased P reabsorption and D production. Complications are calcification of arteries, stomach, anywhere alkaline cells exist. Hyperparathyroidism, ectopic calcification, fractures.
64
RTA I
Inability to secrete H+ in distal nephron
65
RTAII
Proximal tubular acidosis: Capacity to reabsorb bicarb is impaired.
66
RTA IV
Impaired ammoniagenesis, usually have hyperkalemia (hyporenin-hypoaldo)

Nephrology (7 decks)

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