Renal Flashcards
Goodpasture Synrdome - IF appearance?
Linear
Goodpasture Synrdome - Presentation?
Hematuria & Hemoptysis
Acute Poststreptococcal Glomerulonephritis - IF appearance?
Granular
Diffuse Proliferating Glomerulonephritis - IF appearance?
Granular
Characteristics of Nephritic Syndrome?
- Inflammatory process
- Hematuria & RBC casts
- Azotemia, Oliguria, Hypertension
- Proteinuria (<3.5 g/day)
Characteristics of Nephrotic Syndrome?
- Massive proteinuria (>3.5 g/day, frothy urine)
- Hyperlipidemia, fatty casts, edema
Ass’d w/ :
- Thromboembolism/hypercoagulable state
- ↑ risk of infection (loss of immunoglobulins)
Dx?
- “Spike & Dome” appearance w/ subepithelial deposits on EM
- Diffuse capillary & GBM thickening on LM
Membranous nephropathy
- IF = Granular
- SLE’s nephrotic presentation
What is SLE’s nephrotic presentation?
Membranous nephropathy
Membranous Nephropathy - IF appearance?
Granular
Dx?
LM = Normal glomeruli
EM = Foot process effacement
Minimal change disease
(Nephrotic)
- Selective loss of albumin, not immunoglobulins
Most common cause of nephrotic syndrome in adults?
Focal segmental glomerulosclerosis
2nd most common is membranous nephropathy
Dx?
LM = segmental sclerosis & hyalinosis
EM = effacement of foot processes
Focal segmental glomerulosclerosis
Nephrotic
Dx?
Congo red stain shows apple-green birefringence under polarized light
Amyloidosis
(Nephrotic)
- ass’d w/ chronic conditions
(e. g. multiple myeloma, TB, RA)
Dx?
- Subendothelial IC deposits w/ granular IF
- “Tram track” appearance
Membranoproliferative Glomerulonephritis
(Nephrotic)
- “Tram track” appearance due to GBM splitting caused by mesangial ingrowth
Diabetic Glomerulonephropathy can cause non-enzymatic glycosylation of GBM & ______ arterioles.
efferent
Dx?
LM = Glomeruli enlarged & hypercellular, neutrophils, "lumpy bumpy" appearance EM = Subepithelial immune complex humps
Acute Poststreptococcal Glomerulonephritis
Dx?
Most frequently seen in children. Presents w/ peripheral & periorbital edema, dark urine, & hypertension. Resolves spontaneously.
Acute Poststreptococcal Glomerulonephritis
“sore throat (1 wk ago), face bloat, piss coke”
Acute Poststreptococcal Glomerulonephritis - IF appearance?
Granular
- due to IgG, IgM, & C3 deposition along GBM & mesangium
Dx?
LM & IF = Crescent-moon shape
Rapidly progressive glomerulonephritis (RPGN)
(really just a description, not a separate disease)
- Crescents consist of Fibrin & Macrophages
- Potengial outcome of various renal pathologies in adults
What is SLE’s nephritic presentation?
Diffuse Proliferative Glomerulonephritis
due to SLE or MPGN
Dx?
LM = "wire looping" of capillaries EM = subendothelial & sometimes intramembranous IgG-based ICs often w/ C3 deposition
Diffuse Proliferative Glomerulonephritis
(Nephritic)
IF = granular
What is the most common cause of death in SLE?
Diffuse Proliferative Glomerulonephritis
Nephritic syndrome related to Henoch-Schonlein purpura?
Berger’s Disease (IgA Nephropathy)
LM = Mesangial proliferation EM = Mesangial IC deposits IF = IgA-based IC deposits in mesangium
Dx?
LM = Mesangial proliferation
EM = Mesangial IC deposits
- Often presents/flares w/ a URI or acute gastroenteritis
Berger’s disease (IgA nephropathy)
follows mucosal infection b/c of ↑IgA to fight off infection
Dx?
- Mutation in type IV collagen → split basement membrane
- X-linked
Alport Syndrome
- Glomerulonephritis, deafness
- Eye problems (less commonly)
PTH actions on renal tubules?
Early Proximal Tubule:
- Inhibits Na+/phosphate co-transport → phosphate excretion
Early Distal Convoluted Tubule:
- ↑Ca(2+)/Na+ exchange → Calcium absorption
Amiloride - MOA?
Blocks Sodium absorption in Principals cells of Collecting tubules
Triamterene - MOA?
Blocks Sodium absorption in Principals cells of Collecting tubules
Thiazide Diuretics - MOA?
Block Na/Cl co-transporters in Distal Convoluted Tubule
Loop Diuretics - MOA?
Block Na/K/2Cl co-transporters in Thick Ascending Limb (Loop of Henle)
Angiotensin II actions on renal tubules?
Stimulates Na/H exchange in Proximal Tubules
→ ↑Na+, H2O, HCO3- reabsorption
Causes: ↑anion gap metabolic acidosis
Methanol (formic acid), Uremia, Diabetic ketoacidosis, Propylene glycol, Iron tablets, INH, Lactic acidosis, Ethylene glycol (oxalic acid), Salicylates (late)
“MUDPIILES”
Causes: ↓anion gap metabolic acidosis
Hyperalimentation (↑Cl-), Addison’s disease (↓aldosterone), Renal tubular acidosis, Diarrhea, Acetazolamide, Spironolactone, Saline infusion (dilutes bicarbonate)
“HARD-ASS”
What does the presence of casts indicate?
That hematuria/pyuria is of renal (vs. bladder) origin
