Renal 2 Flashcards
pathogenesis of diabetic nephropathy
constriction of efferent arteriole due to non-enzymatic glycosylation –> increased GFR –> mesangial expansion
hallmarks of diabetic nephropathy (2)
- mesangial expansion
2. nodular glomerulosclerosis (Kimmelstein-Wilson lesion)
diabetic nephropathy: nephritic or nephrotic?
nephrotic
what characteristics are present in pre-diabetic nephropathy? (2)
inceased GFR, increased renal size
what drugs can cause a decrease in GFR but are renoprotective in the long-term?
ACE inhibitors (captopril, lisinopril, enalapril) and ARBs (losartan)
Alport syndrome: pathogenesis
X-linked, mutation in type IV collagen which leads to thinning and splitting of GBM, hematuria, deafness
amyloidosis: nephritic or nephrotic?
nephrotic
Alport syndrome: nephritic or nephrotic?
nephritic
X-linked, mutation in type IV collagen, hematuria
Alport syndrome
how does proteinuria cause edema?
glomerular disease –> glomerular proteins leak and overwhelms tubular reabsorption –> albumin cannot be reabsorbed –> low plasma oncotic pressure –> edema
what do muddy brown casts in urine indicate?
acute tubular necrosis
diagnostic criteria of acute kidney injury
ONE of these:
- increase in serum creatinine of 0.3 mg/dL
- more than a 1.5-fold increase of serum creatinine
- reduction in urine output less than 500 mL in 24 hours
define oliguria
urine output less than 400-500 mL/day
describe the autoregulation of GFR that happens in response to decreased perfusion pressure (2)
- increased vasodilatory prostaglandins dilate afferent arterioles
- increased angiotensin II constricts efferent arterioles
pathogenesis of prerenal azotemia
decreased RBF –> decreased GFR; increased retention of sodium, water, and urea causes oliguria, and increased BUN/creatinine ratio
which azotemia: decreased GFR, oliguria, increased BUN/creatinine ratio
prerenal azotemia
BUN/creatine ratio is ______ in prerenal azotemia and ______ in renal azotemia
increased, decreased
FENa in acute tubular necrosis (renal azotemia)
greater than 2% (tubules are injured, so sodium reabsorption is impaired)
FENa in prerenal azotemia
less than 1%, sodium reabsorption should be increased
hydronephrosis on ultrasound –> what is the diagnosis
post-renal azotemia
common cause of acute interstitial nephritis
hypersensitivity reaction to drugs
common cause of acute pyelonephritis
ascending UTI
caused by hypersensitivity to drugs, eosinophilia in blood and urine, hematuria
acute interstitial nephritis
kidney disease caused by ascending UTI
acute pyelonephritis
