Renal #1 Flashcards
Acute glomerulonephritis is characterized by what four things?
- Hypertension
- Hematuria (RBC casts)
- Azotemia (elevated BUN/CR, normal is 8-20)
- Proteinuria (Edema)
What is another description of hematuria in acute glomerulonephritis?
Hematuria (Cola or Tea-Colored Urine)
What is the MCC of acute glomerulonephritis?
IgA Nephropathy (Berger’s Disease)
Explain what IgA nephropathy is
Often affects young males within days after URI or GI infection
Explain what the patient will be with Post-Infectious Glomerulonephritis
-After Group A Strep infection. 10-14 days after skin (Impetigo) or Pharyngeal infection.
2-14 year old boy with facial edema after Strep with scanty, cola-colored dark urine
rapidly progressive glomerulonephritis (RPGN) is associated with a poor prognosis and rapidly progresses to end stage renal disease. There is _____ on renal biopsy with this type.
Crescent formation
Any cause of AGN can present with RPGN. However, this type ONLY presents with RPGN.
Goodpasture’s Disease
In a patient with Goodpasture’s Disease, what do they present with?
Acute glomerulonephritis + hemoptysis
Renal biopsy for acute glomerulonephritis. What is seen with the following types.
IgA nephropathy: _______
Poststreptococcal: _______
Goodpasture Syndrome: ______
- Iga: IgA mesangial deposits
- Poststreptococcal: Increased anti-strep titers, Low serum complement, immune humps of IgG, IgM, and C3
- Goodpasture Syndrome: anti-GBM antibodies
Treatment for IgA nephropathy or proteinuria
ACE inhibitors (Enalapril or Losartan) +/- Corticosteroids/Glucocorticoids
What are some other treatment recommendations for acute glomerulonephritis
- Salt and fluid restriction
- Dialysis should be performed if symptomatic azotemia
- ACE/ARBs are renoprotective
In poststreptococcal glomerulonphritis, _______ is used instead of ACEI (ACE may cause hyperkalemia)
Nifedipine (CCB)
Nephrotic Syndrome is kidney disease characterized by what four things?
- Proteinuria
- Hyperlipidemia
- Edema
- Hypoalbuminemia (normal is 3-5)
What is the primary etiology of nephrotic syndrome in children
Minimal change disease
What is the most common primary cause in Caucasian males > 40 of nephrotic syndrome?
Membranous nephropathy
With nephrotic syndrome, the MC secondary cause in adults is
Diabetes Mellitus
-Other causes include: SLE, Amyloidosis, Sarcoidosis, infections
Symptoms of nephrotic syndrome
- Generalized edema (periorbital in children) usually worse in morning
- Frothy urine
- Ascites
- DVT (loss of protein C, S, and antithrombin III)
On UA, the initial diagnostic for nephrotic syndrome, what is seen?
Oval Maltese cross-shaped fat bodies (fatty casts)
What is the gold standard diagnostic for nephrotic syndrome, though?
24-hour urine protein > 3.5g/day
What gives a definitive diagnosis for nephrotic syndrome?
renal biopsy
Renal biopsy results:
- Minimal change disease: ______
- Membranous Nephropathy: _________
- Minimal change: podocyte damage seen on electron micropscope
- Membranous nephropathy: thick basement membrane
Treatment for nephrotic syndrome
- Proteinuria reduction: ACEi or ARB
- Edema reduction: Thiazide diuretics
- Glucocorticoids: first line for minimal change disease
What is an important determinant of prognosis for minimal change disease?
Steroid responsiveness
During acute kidney injury (acute renal failure), what happens?
Sudden decrease in renal function. Kidneys cannot filter the blood like it should. Build up of waste (BUN, Cr) in the blood. Fluid buildup because kidneys cannot remove excess fluid. Electrolyte imbalances as well.
Prerenal acute kidney injury is characterized by
Decreased renal perfusion
MC type of kidney injury overall
Causes of prerenal kidney injury
- Cardiac issue: decreased blood pumping (MI, CHF, low EF)
- Blood loss
- Dehydration: Hypovolemia
- Burns
- Afferent arteriole vasoconstriction: NSAIDs, IV contrast
- Efferent arteriole vasodilation: ACEi, ARB
- Hypotension
Symptoms of prerenal acute kidney injury
- Weak
- Decreased urine output
- Dizziness
- Sunken Eyes
- Tachycardia
- Orthostatic blood pressure changes
Diagnostics for prerenal kidney injury
- Evidence of water and electrolyte conservation
- -Increased BUN:Cr (> 20:1)
- -Fractional excretion of sodium (FENA) < 1%
- -Concentrated urine: high urine specific gravity (>1.020)
Treatment for prerenal kidney failure
-Volume repletion to restore volume and renal perfusion
Postrenal Azotemia (AKI) is characterized by
Obstruction of passage of urine
will have no or low urine output and suprapubic pain
Causes of post renal kidney failure?
-This is rare because BOTH kidneys need to be obstructed
Kidney stones, tumors, BPH, prostate cancer
What is the initial imaging test to look for causes of post-renal kidney failure?
US to look for signs of obstruction and hydronephrosis
Treatment for post-renal kidney failure
Removal of the obstruction (readily reversible if corrected quickly)
MCC of acute interstitial nephritis
-Drug hypersensitivity: NSAIDs, Penicillins, Sulfa Drugs (Furosemide, Thiazides)
Symptoms of AIN
- Fever
- Eosinophilia
- Maculopapular Rash
- Arthralgias
What is on UA for AIN that is pathognomic?
WBC casts and eosinophiluria
Treatment for AIN
- Remove offending agent to allow for spontaneous recovery
- Most recover kidney function within 1 year
MC type of intrinsic acute kidney injury
Acute Tubular Necrosis (ATN)
What are some causes of ATN
- Contrast dye (immediate)
- Aminoglycosides (Gentamicin, Tobramycin)
What is shown on UA of ATN?
-Epithelial cell casts and granular (muddy brown) casts
Treatment for ATN
Remove offending agents and IVF
Polycystic kidney disease is a ________ disorder due to mutations of either genes _____ or ______
Autosomal dominant disorder
PKD1 or PKD2
What exactly is polycystic kidney disease?
Multisystemic progressive disorder characterized by formation and enlargement of kidney cysts and cysts in other organs (liver, spleen, pancreas)
Symptoms of polycystic kidney disease
- Abdominal and flank pain
- Hematuria
- Cerebral “berry” aneurysm
- Mitral Valve Prolapse
- Colonic Diverticula
- Palpable flank masses or large palpable kidneys
- Hypertension
What is the most widely used diagnostic imaging study for polycystic kidney disease?
Renal US
If the patient has multiple cysts, what is the treatment for PKD?
Supportive
Increased fluid intake
HTN control
Risk factors for a horseshoe kidney
- Turner Syndrome
- Trisomy 13, 18, 21
- Associated with ureteropelvic junction obstruction
Urine stasis with horseshoe kidney leads to _______ and ______
Pyelonephritis and kidney stone formation
Furthermore, with a horseshoe kidney, there is an increased risk for
renal cell carcinoma
Best initial test to evaluate anatomy and relative renal function for a horseshoe kidney
CT urography
