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DIT Nephrology > Ren 8 - Other Renal Pathology > Flashcards

Ren 8 - Other Renal Pathology Flashcards

1
Q

What would be the cause of RBC casts?

A

Glomerular damage: glomerulonephritis, infarction, malignant hypertension.

  • They are yellowish brown.
  • Not RBC.
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2
Q

What would be the cause of WBC cast?

A

Acute pyelonephritis.

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3
Q

What would be the cause of Bacterial cast?

A

Pyelonephritis.

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4
Q

What would be the cause of epithelial cell cast?

A
  • ACT (acute tubular necrosis).
  • Toxic ingestion (mercury, dyetheline glycol, salicilates).
  • Difficult to distinguish from white blood cell casts.
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5
Q

What would be the cause of Waxy cast?

A

Chronic renal failure.

-Low urine flow cases.

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6
Q

What would be the cause of Hyaline cast?

A
  • Most common cast type.
  • Solidified mucal proteins.
  • Secreted from tubular epithelial cells.
  • Do not necessarily indicate pathology can be seen in dehydration.
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7
Q

What are renal casts?

A

Cylindrical structures that form in the distal tubules and collecting ducts of the nephrons that are present in renal diseases.
-There can be cellular casts and acellular casts.

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8
Q

What would be the cause of fatty cast?

A

Nephrotic syndrome.

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9
Q

What would be the cause of Granular cast?

A
  • Chronic renal disease.

- ATN (Acute tubular necrosis).

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10
Q

What is a common site of kidney stones to get stuck?

A

Ureterovesicular junction (UVJ).

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11
Q

What is the most common type of renal stone?

A

Calcium stone.

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12
Q

Which type of kidney stone is radiopaque (see them on Xray)?

A

Calcium stone.

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13
Q

What are the two types of calcium stones?

A
  1. Calcium phosphate.

2. Calcium oxalate.

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14
Q

What are the causes of hypercalciuria?

A

Anything that elevates serum calcium levels:

  • Cancer.
  • Increase in PTH.
  • Ethylene glycol (Calcium oxalate).
  • Megadoses of vitamin C (calcium oxalate).
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15
Q

How can we prevent calcium stones?

A

Hydrochlorothiazides.

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16
Q

What is another name for ammonium magnesium phosphate stone?

A

Struvite stone.

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17
Q

What is the substance that enhances formation of ammonium magnesium phosphate stones? Which two main bacteria produce this substance?

A

Urease.

  • Proteus.
  • Klebsiella.
  • Staph
  • Pseudomonas.
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18
Q

Which type of renal stone is formed from hyperuricemia and related to gout?

A

Uric acid stone.

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19
Q

How can we image uric acid stones?

A

Seen on ultrasound and CT. They are radiolucent (can’t be seen on X-ray).

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20
Q

How can we treat cystine stones?

A

Alkalinizing urine.

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21
Q

What is the most common type of renal cancer?

A

Renal cell carcinoma.

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22
Q

What are two risk factors for renal cell carcinoma?

A
  • Smoking.

- Obesity.

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23
Q

What hormones are secreted in renal cell carcinoma?

A
  • Ectopic erythropoietin: causing polycythemia.
  • Ectopic ACTH: Cushing syndrome.
  • PTH-related-peptide: Hypercalcemia.
  • Prolactin: Hypogonadism, decreased libido, galactorrhea.
24
Q

What is the root of metastasis of renal cell carcinoma?

A

Hematogenously by invading the inferior vena cava.

25
Q

What syndrome is associated with renal cell carcinoma?

A

It is associated with von Hippel Lindau syndrome.

26
Q

Which organs does renal cell carcinoma prefer to metastasize?

A

Lung and bone.

27
Q

What is the most common renal malignancy of children aged 2 to 4?

A

Wilms tumor.

28
Q

What are the symptoms of Wilms tumor?

A

Hematuria and large flank mass.

29
Q

What is the cause of Wilms tumor?

A

Deletion of WT1 (or WT2) on chromosome 11.

30
Q

What syndrome is associated with deletion of WT1 (or WT2) on chromosome 11?

A

[WARG]

  • Wilms tumor.
  • Aniridia.
  • Retardation.
  • Genitourinary malformation.
31
Q

What is the most common type of cancer of the urinary tract?

A

Transitional cell carcinoma.

32
Q

What substances are related in increasing transitional cell carcinoma?

A
  • Smoking.
  • Cyclophosphamide.
  • Aniline dyes.
33
Q

What is the clinical symptom of transitional cell carcinoma?

A

Painless hematuria.

34
Q

What are the symptoms of acute pyelonephritis?

A
  • White blood cells and white blood cell casts.
  • Fever.
  • Painful urination.
  • Urgency.
  • Altered mental status (elderly).
  • Costovertibral angel (CVA) tenderness.
35
Q

What happens to the kidneys in chronic pyelonephritis?

A

Thyroidization of kidneys: eosinophilic casts that dilate the tubules, so the they look more like thyroid cells.

36
Q

What is another name for acute interstitial nephritis?

A

Drug-induced interstitial nephritis.

37
Q

What is the classic presentation of acute interstitial nephritis?

A
  • Fever.
  • Eosinophilia.
  • Azotemia.
  • Maybe rash.
38
Q

What are some drugs that cause acute interstitial nephritis?

A
  • NSAIDs.
  • PCN/cephalosporins (esp. Methicillin).
  • Sulfonamides (TMP-SMX, furosemide).
  • Ciprofloxacin.
  • Cimetidine.
  • Allopurinol.
  • PPIs.
  • Indinavir.
  • Mesalamine.
39
Q

What is the treatment for acute interstitial nephritis?

A

-2 weeks of corticosteroids.

40
Q

What pathologies are associated with diffuse cortical necrosis?

A
  • Multiorgan failure.
  • ARDS.
  • DIC.
  • Septic shock.
41
Q

What drugs are associated with acute tubular necrosis?

A
  • Aminoglycosides.
  • Cephalosporins.
  • Polymyxins.
42
Q

What are some causes of Acute tubular necrosis?

A
  • Drugs: aminoglycosides, cephalosporins, polymyxins.
  • Radiograph contrast dye (prevent with fluids, NaHCO3).
  • Rhabdomyolysis/myoglobinuria: Due to muscle breakdown from seizure disorder, cocaine, or crush injuries. Findings: 4+ blood in urine, no RBC on urine cell count, renal failure and elevated CPK.
43
Q

What are the clinical presentations of renal papillary necrosis?

A
  • Gross hematuria.
  • Flank pain.
  • Protein in the urine.
44
Q

What are the three categories for acute renal failure etiologies?

A
  • Pre-renal.
  • Intrinsic renal.
  • Post-renal.
45
Q

What are the causes of pre-renal azotemia?

A
  • Hypovolemia.
  • Shock.
  • Hypotension.
  • Renal vasoconstriction with NSAIDs.
46
Q

What is a lab clue that can help suggest that it is a pre-renal cause of acute renal failure?

A

-BUN/creatinine ratio greater than 20.

47
Q

What are some causes of intrinsic renal disease?

A
  • Acute interstitial necrosis.
  • Glomerulonephritis.
  • Acute tubular necrosis.
  • DIC.
  • Acute pyelonephritis.
48
Q

What are some causes of post-renal disease?

A
  • Stones.
  • BPH.
  • Neoplasia.
  • Congenital abnormalities.
49
Q

What are the consequences of renal failure?

A
  • Peripheral edema.
  • Heart failure.
  • Pulmonary edema.
  • Hypertension.
  • Hyperkalemia.
  • Metabolic acidosis.
  • Uremia.
  • Anemia.
50
Q

What are some causes of renal cysts?

A
  • Autosomal dominant polycystic kidney disease.
  • Autosomal recessive polycystic kidney disease.
  • Dialysis.
  • Simple cysts.
  • Multiple cysts.
  • Medullary cystic disease.
51
Q

What lab results would be altered in a renal failure?

A
  • Elevated potassium.
  • Decreased calcium.
  • Elevated BUN and Cr.
52
Q

RFF: Red cell casts.

A

Acute glomerulonephritis.

53
Q

RFF: Waxy casts.

A

Chronic renal failure.

54
Q

RFF: Thyroid-like appearance of kidney.

A

Chronic pyelonephritis.

55
Q

RFF: Most common renal tumor.

A

Renal cell carcinoma.

56
Q

RFF: Most common type of renal stone.

A

Calcium Stone.

57
Q

RFF: Type of renal stone associated with Proteus vulgaris.

A

Struvite stone.

DIT Nephrology (9 decks)

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