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PANCE/EOC > Renal #1 > Flashcards

Renal #1 Flashcards

1
Q

Acute glomerulonephritis is characterized by what four things?

A
  • Hypertension
  • Hematuria (RBC casts)
  • Azotemia (elevated BUN/CR, normal is 8-20)
  • Proteinuria (Edema)
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2
Q

What is another description of hematuria in acute glomerulonephritis?

A

Hematuria (Cola or Tea-Colored Urine)

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3
Q

What is the MCC of acute glomerulonephritis?

A

IgA Nephropathy (Berger’s Disease)

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4
Q

Explain what IgA nephropathy is

A

Often affects young males within days after URI or GI infection

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5
Q

Explain what the patient will be with Post-Infectious Glomerulonephritis

A

-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

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6
Q

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.

A

Crescent formation

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7
Q

Any cause of AGN can present with RPGN. However, this type ONLY presents with RPGN.

A

Goodpasture’s Disease

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8
Q

In a patient with Goodpasture’s Disease, what do they present with?

A

Acute glomerulonephritis + hemoptysis

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9
Q

Renal biopsy for acute glomerulonephritis. What is seen with the following types.

IgA nephropathy: _______
Poststreptococcal: _______
Goodpasture Syndrome: ______

A
  • Iga: IgA mesangial deposits
  • Poststreptococcal: Increased anti-strep titers, Low serum complement, immune humps of IgG, IgM, and C3
  • Goodpasture Syndrome: anti-GBM antibodies
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10
Q

Treatment for IgA nephropathy or proteinuria

A

ACE inhibitors (Enalapril or Losartan) +/- Corticosteroids/Glucocorticoids

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11
Q

What are some other treatment recommendations for acute glomerulonephritis

A
  • Salt and fluid restriction
  • Dialysis should be performed if symptomatic azotemia
  • ACE/ARBs are renoprotective
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12
Q

In poststreptococcal glomerulonphritis, _______ is used instead of ACEI (ACE may cause hyperkalemia)

A

Nifedipine (CCB)

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13
Q

Nephrotic Syndrome is kidney disease characterized by what four things?

A
  • Proteinuria
  • Hyperlipidemia
  • Edema
  • Hypoalbuminemia (normal is 3-5)
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14
Q

What is the primary etiology of nephrotic syndrome in children

A

Minimal change disease

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15
Q

What is the most common primary cause in Caucasian males > 40 of nephrotic syndrome?

A

Membranous nephropathy

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16
Q

With nephrotic syndrome, the MC secondary cause in adults is

A

Diabetes Mellitus

-Other causes include: SLE, Amyloidosis, Sarcoidosis, infections

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17
Q

Symptoms of nephrotic syndrome

A
  • Generalized edema (periorbital in children) usually worse in morning
  • Frothy urine
  • Ascites
  • DVT (loss of protein C, S, and antithrombin III)
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18
Q

On UA, the initial diagnostic for nephrotic syndrome, what is seen?

A

Oval Maltese cross-shaped fat bodies (fatty casts)

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19
Q

What is the gold standard diagnostic for nephrotic syndrome, though?

A

24-hour urine protein > 3.5g/day

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20
Q

What gives a definitive diagnosis for nephrotic syndrome?

A

renal biopsy

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21
Q

Renal biopsy results:

  • Minimal change disease: ______
  • Membranous Nephropathy: _________
A
  • Minimal change: podocyte damage seen on electron micropscope
  • Membranous nephropathy: thick basement membrane
22
Q

Treatment for nephrotic syndrome

A
  • Proteinuria reduction: ACEi or ARB
  • Edema reduction: Thiazide diuretics
  • Glucocorticoids: first line for minimal change disease
23
Q

What is an important determinant of prognosis for minimal change disease?

A

Steroid responsiveness

24
Q

During acute kidney injury (acute renal failure), what happens?

A

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.

25
Q

Prerenal acute kidney injury is characterized by

A

Decreased renal perfusion

MC type of kidney injury overall

26
Q

Causes of prerenal kidney injury

A
  • 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
27
Q

Symptoms of prerenal acute kidney injury

A
  • Weak
  • Decreased urine output
  • Dizziness
  • Sunken Eyes
  • Tachycardia
  • Orthostatic blood pressure changes
28
Q

Diagnostics for prerenal kidney injury

A
  • 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)
29
Q

Treatment for prerenal kidney failure

A

-Volume repletion to restore volume and renal perfusion

30
Q

Postrenal Azotemia (AKI) is characterized by

A

Obstruction of passage of urine

will have no or low urine output and suprapubic pain

31
Q

Causes of post renal kidney failure?

-This is rare because BOTH kidneys need to be obstructed

A

Kidney stones, tumors, BPH, prostate cancer

32
Q

What is the initial imaging test to look for causes of post-renal kidney failure?

A

US to look for signs of obstruction and hydronephrosis

33
Q

Treatment for post-renal kidney failure

A

Removal of the obstruction (readily reversible if corrected quickly)

34
Q

MCC of acute interstitial nephritis

A

-Drug hypersensitivity: NSAIDs, Penicillins, Sulfa Drugs (Furosemide, Thiazides)

35
Q

Symptoms of AIN

A
  • Fever
  • Eosinophilia
  • Maculopapular Rash
  • Arthralgias
36
Q

What is on UA for AIN that is pathognomic?

A

WBC casts and eosinophiluria

37
Q

Treatment for AIN

A
  • Remove offending agent to allow for spontaneous recovery

- Most recover kidney function within 1 year

38
Q

MC type of intrinsic acute kidney injury

A

Acute Tubular Necrosis (ATN)

39
Q

What are some causes of ATN

A
  • Contrast dye (immediate)

- Aminoglycosides (Gentamicin, Tobramycin)

40
Q

What is shown on UA of ATN?

A

-Epithelial cell casts and granular (muddy brown) casts

41
Q

Treatment for ATN

A

Remove offending agents and IVF

42
Q

Polycystic kidney disease is a ________ disorder due to mutations of either genes _____ or ______

A

Autosomal dominant disorder

PKD1 or PKD2

43
Q

What exactly is polycystic kidney disease?

A

Multisystemic progressive disorder characterized by formation and enlargement of kidney cysts and cysts in other organs (liver, spleen, pancreas)

44
Q

Symptoms of polycystic kidney disease

A
  • Abdominal and flank pain
  • Hematuria
  • Cerebral “berry” aneurysm
  • Mitral Valve Prolapse
  • Colonic Diverticula
  • Palpable flank masses or large palpable kidneys
  • Hypertension
45
Q

What is the most widely used diagnostic imaging study for polycystic kidney disease?

A

Renal US

46
Q

If the patient has multiple cysts, what is the treatment for PKD?

A

Supportive
Increased fluid intake
HTN control

47
Q

Risk factors for a horseshoe kidney

A
  • Turner Syndrome
  • Trisomy 13, 18, 21
  • Associated with ureteropelvic junction obstruction
48
Q

Urine stasis with horseshoe kidney leads to _______ and ______

A

Pyelonephritis and kidney stone formation

49
Q

Furthermore, with a horseshoe kidney, there is an increased risk for

A

renal cell carcinoma

50
Q

Best initial test to evaluate anatomy and relative renal function for a horseshoe kidney

A

CT urography

PANCE/EOC (63 decks)

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