Ren 8 - Other Renal Pathology Flashcards
What would be the cause of RBC casts?
Glomerular damage: glomerulonephritis, infarction, malignant hypertension.
- They are yellowish brown.
- Not RBC.
What would be the cause of WBC cast?
Acute pyelonephritis.
What would be the cause of Bacterial cast?
Pyelonephritis.
What would be the cause of epithelial cell cast?
- ACT (acute tubular necrosis).
- Toxic ingestion (mercury, dyetheline glycol, salicilates).
- Difficult to distinguish from white blood cell casts.
What would be the cause of Waxy cast?
Chronic renal failure.
-Low urine flow cases.
What would be the cause of Hyaline cast?
- Most common cast type.
- Solidified mucal proteins.
- Secreted from tubular epithelial cells.
- Do not necessarily indicate pathology can be seen in dehydration.
What are renal casts?
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.
What would be the cause of fatty cast?
Nephrotic syndrome.
What would be the cause of Granular cast?
- Chronic renal disease.
- ATN (Acute tubular necrosis).
What is a common site of kidney stones to get stuck?
Ureterovesicular junction (UVJ).
What is the most common type of renal stone?
Calcium stone.
Which type of kidney stone is radiopaque (see them on Xray)?
Calcium stone.
What are the two types of calcium stones?
- Calcium phosphate.
2. Calcium oxalate.
What are the causes of hypercalciuria?
Anything that elevates serum calcium levels:
- Cancer.
- Increase in PTH.
- Ethylene glycol (Calcium oxalate).
- Megadoses of vitamin C (calcium oxalate).
How can we prevent calcium stones?
Hydrochlorothiazides.
What is another name for ammonium magnesium phosphate stone?
Struvite stone.
What is the substance that enhances formation of ammonium magnesium phosphate stones? Which two main bacteria produce this substance?
Urease.
- Proteus.
- Klebsiella.
- Staph
- Pseudomonas.
Which type of renal stone is formed from hyperuricemia and related to gout?
Uric acid stone.
How can we image uric acid stones?
Seen on ultrasound and CT. They are radiolucent (can’t be seen on X-ray).
How can we treat cystine stones?
Alkalinizing urine.
What is the most common type of renal cancer?
Renal cell carcinoma.
What are two risk factors for renal cell carcinoma?
- Smoking.
- Obesity.
What hormones are secreted in renal cell carcinoma?
- Ectopic erythropoietin: causing polycythemia.
- Ectopic ACTH: Cushing syndrome.
- PTH-related-peptide: Hypercalcemia.
- Prolactin: Hypogonadism, decreased libido, galactorrhea.
What is the root of metastasis of renal cell carcinoma?
Hematogenously by invading the inferior vena cava.
What syndrome is associated with renal cell carcinoma?
It is associated with von Hippel Lindau syndrome.
Which organs does renal cell carcinoma prefer to metastasize?
Lung and bone.
What is the most common renal malignancy of children aged 2 to 4?
Wilms tumor.
What are the symptoms of Wilms tumor?
Hematuria and large flank mass.
What is the cause of Wilms tumor?
Deletion of WT1 (or WT2) on chromosome 11.
What syndrome is associated with deletion of WT1 (or WT2) on chromosome 11?
[WARG]
- Wilms tumor.
- Aniridia.
- Retardation.
- Genitourinary malformation.
What is the most common type of cancer of the urinary tract?
Transitional cell carcinoma.
What substances are related in increasing transitional cell carcinoma?
- Smoking.
- Cyclophosphamide.
- Aniline dyes.
What is the clinical symptom of transitional cell carcinoma?
Painless hematuria.
What are the symptoms of acute pyelonephritis?
- White blood cells and white blood cell casts.
- Fever.
- Painful urination.
- Urgency.
- Altered mental status (elderly).
- Costovertibral angel (CVA) tenderness.
What happens to the kidneys in chronic pyelonephritis?
Thyroidization of kidneys: eosinophilic casts that dilate the tubules, so the they look more like thyroid cells.
What is another name for acute interstitial nephritis?
Drug-induced interstitial nephritis.
What is the classic presentation of acute interstitial nephritis?
- Fever.
- Eosinophilia.
- Azotemia.
- Maybe rash.
What are some drugs that cause acute interstitial nephritis?
- NSAIDs.
- PCN/cephalosporins (esp. Methicillin).
- Sulfonamides (TMP-SMX, furosemide).
- Ciprofloxacin.
- Cimetidine.
- Allopurinol.
- PPIs.
- Indinavir.
- Mesalamine.
What is the treatment for acute interstitial nephritis?
-2 weeks of corticosteroids.
What pathologies are associated with diffuse cortical necrosis?
- Multiorgan failure.
- ARDS.
- DIC.
- Septic shock.
What drugs are associated with acute tubular necrosis?
- Aminoglycosides.
- Cephalosporins.
- Polymyxins.
What are some causes of Acute tubular necrosis?
- 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.
What are the clinical presentations of renal papillary necrosis?
- Gross hematuria.
- Flank pain.
- Protein in the urine.
What are the three categories for acute renal failure etiologies?
- Pre-renal.
- Intrinsic renal.
- Post-renal.
What are the causes of pre-renal azotemia?
- Hypovolemia.
- Shock.
- Hypotension.
- Renal vasoconstriction with NSAIDs.
What is a lab clue that can help suggest that it is a pre-renal cause of acute renal failure?
-BUN/creatinine ratio greater than 20.
What are some causes of intrinsic renal disease?
- Acute interstitial necrosis.
- Glomerulonephritis.
- Acute tubular necrosis.
- DIC.
- Acute pyelonephritis.
What are some causes of post-renal disease?
- Stones.
- BPH.
- Neoplasia.
- Congenital abnormalities.
What are the consequences of renal failure?
- Peripheral edema.
- Heart failure.
- Pulmonary edema.
- Hypertension.
- Hyperkalemia.
- Metabolic acidosis.
- Uremia.
- Anemia.
What are some causes of renal cysts?
- Autosomal dominant polycystic kidney disease.
- Autosomal recessive polycystic kidney disease.
- Dialysis.
- Simple cysts.
- Multiple cysts.
- Medullary cystic disease.
What lab results would be altered in a renal failure?
- Elevated potassium.
- Decreased calcium.
- Elevated BUN and Cr.
RFF: Red cell casts.
Acute glomerulonephritis.
RFF: Waxy casts.
Chronic renal failure.
RFF: Thyroid-like appearance of kidney.
Chronic pyelonephritis.
RFF: Most common renal tumor.
Renal cell carcinoma.
RFF: Most common type of renal stone.
Calcium Stone.
RFF: Type of renal stone associated with Proteus vulgaris.
Struvite stone.
