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Pathoma > Renal > Flashcards

Renal Flashcards

1
Q

Where does horseshoe kidney get stuck?

A

IMA

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2
Q

Where is horseshoe kidney adjoined?

A

Lower Poles

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3
Q

Potter Syndrome

A
  1. lung hypoplasia
  2. flat face with low set ears
  3. Limb defects

All due to oligohydraminos from bilateral renal agenesis

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4
Q

How to DDx Dysplastic Kidney disease from PKD

A

Dysplastic Kidney Disease is NOT inherited and can be uni or bilateral

PKD is always bilateral

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5
Q

Autosomal Recessive PKD presentation

A

BILATERAL enlarged kidneys w/ cysts in medulla/Cx

Presents in infants with renal failure and HTN
May have Potter Syndrome

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6
Q

ARPKD associated with

A

Congenital hepatic fibrosis and hepatic cysts

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7
Q

Autosomal dominant PKD presentation

A

young adult with HTN (high renin), hematuria, worsening renal failure

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8
Q

ADPKD associations

A

Berry anneurysms, hepatic cysts, MVP

Think cysts in vessels, heart, and liver

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9
Q

ADPKD genetic mutations

A

APKD1 & APKD2 gens

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10
Q

Medullary Cystic Kidney Disease

A

Cysts in medullary collecting ducts

parenchymal fibrosis leads to SHRUNKEN kidney and worsening renal failure

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11
Q

Acute renal failure hallmarks

A

Azotemia (increased BUN and Creatinine) often with oliguria

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12
Q

Prerenal Azotemia

A

Decreased blood flow to kidney

leads to decreased GFR, azotemia, and oliguria

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13
Q

Prerenal azotemia labs

A

BUN:Creatinine > 15 (normal 15)
FENa < 1%
Urine Osmolarity > 500 mOsm/kg

Kidney is still functioning so some BUN is reabsorbed

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14
Q

Postrenal Azotemia

A

Urinary Tract obstruction increases back pressure decreasing GFR
Also forces BUN back into blood
azotemia and oliguria

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15
Q

Early Postrenal azotemia Labs

A

BUN:Creatinine > 15
FENa < 1%
Urine Osmo > 500

looks just like prerenal azotemai

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16
Q

Late postrenal azotemia labs

A

BUN:creatinine < 15
FENa > 2%
Urine Osmo < 500

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17
Q

Acute Tubular Necrosis

A

Injury/necrosis of tubular epithelial cells
Plug tubules decreasing GFR

Brown Casks in urine

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18
Q

Acute Tubular Necrosis Labs

A

BUN:Creatinine < 15
FENa > 2%
Urine Osmo <500

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19
Q

Etiology of Acute tubular necrosis

A

Ischemia, Nephrotoxic (Rx, heavy metals, urate, etc.)

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20
Q

Clinical features of Acute tubular necrosis

A

oliguria with brown casts
elevated BUN and Creatinine
Hyperkalemia
Metabolic Acidosis (increased anion gap)

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21
Q

Tx acute tubular necrosis

A

dialysis, remove toxin
2-3 week recovery

tubular cells are stable cells so they take time to reenter cell cycle

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22
Q

Acute Interstitial Nephritis

A

Rx induced hypersensitivity involving interstitium and tubules
NSAIDs, penicillin, diuretics

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23
Q

Acute Interstitial Nephritis Sx

A

Fever, oliguria, rash days to weeks after start of Rx

Eosinophils in urine

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24
Q

Acute Interstitial nephritis Tx

A

Stop Rx

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25
Q

Renal Papillary Necrosis

A

Necrosis of renal papillaries

Gross hematuia and flank pain

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26
Q

Renal Papillary Necrosis Causes

A

DM, analgesic abuse, Sickle cell, acute pyelonephritis

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27
Q

Minimal Change Disease associated with

A

hodgkins lymphoma

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28
Q

1 Nephrotic Syndrome in kids

A

Minimal Change Disease

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29
Q

Histo of Minimal Change disease

A

Effacement of foot processes which leads to selective proteinuria (only albumin)

Glomerulus pretty much looks normal

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30
Q

Tx or Minimal Change Disease

A

Steroids

Due to pathogenesis: Cytokines mediate damage

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31
Q

Nephrotic Syndromes associated with HBV and HCV

A

Focal Segmental Glomerulonephritis

Type I membranoproliferative glomerulonephritis

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32
Q

Nephrotic syndromes with foot process effacement

A

Minimal change disease

Focal Segmental glomerulosclerosis

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33
Q

Focal segmental glomerulosclerosis findings

A

Some glomeruli (focal)
involving only part of glomerulus (segmental)
sclerosis
effacement of foot processes

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34
Q

Spike and Dome appearance

Grainy Immunofluorescence

A

Membranous Nephropathy
Complex deposition is subepithelial
No response to steroids

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35
Q

Nephrotic Syndromes with negative immunofluorescence

A

Focal segmental glomerulosclerosis

Minimal change disease

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36
Q

Who gets Focal Segmental Glomerulosclerosis? Associations?

A

Hispanics and Af. Am.

Sickle Cell, Heroin, HIV

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37
Q

Most common nephrotic syndrome in Caucasian adults

A

Membranous Nephropathy

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38
Q

Membranous Nephropathy associations

A

Whites
HBV/HCV
SLE
Rx (NSAIDs, Penicillamine)

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39
Q

Subendothelial complex deposition
Tram track appearance
HBV/HCV associated

A

Membranoproliferative disease type I

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40
Q

Intramembranous complex deposition
Associated with C3 nephrotic factor
unregulated complement

A

Membranoproliferative Type II

C3 nephrotic factor stablizes C3 convertase –> complement does not get shut off

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41
Q

Membranoproliferative histo

A

Thick glomerular basement membrane due to complex deposition

poor response to steroids

Think of thickening (proliferation) of the basement membrane (membranous)

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42
Q

DM Nephrotic findings

A

HYALINE ARTERIOLOSCLEROSIS

High serum glucose leads to nonenzymatic glycosylation of vascular basement membrane

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43
Q

Tx of DM nephrotic Sx

A

ACE

Hyaline deposits in efferent arteriole. ACE prevents Angiotensin II vasocontriction of efferent arteriole decreasing Sx

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44
Q

Kimmelstiel Wilson Nodules

A

Diabetes Mellitis

sclerosis of mesangium

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45
Q

Apple Green apple birefringenc after Congo Red stain

Deposits in mesangium

A

Systemic Amyloidosis

Kidney is most common organ involved

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46
Q

Why are nephritic syndromes hypercellular?

A

Immune complexes deposit activating complement.

C5a attracts neutrophils mediating damage to kidney

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47
Q

Poststreptococcal Glomerulonephritis Sx

A 
Nephritic Syndrome
Coke-colored urine (blood)
oliguria
HTN
periorbital edema

Lumpy bumpy IF–type III hypersensitivity

48
Q

Poststreptococcal Glomerulonephritis buzz word

A

Subepithelial hump on EM

49
Q

Nephrogenic Strep organisms

A

Must have M protein–mediates damage
Group A ß-hemolytic Strep
other bugs can do it too

50
Q

Poststrep GN Tx

A

Supportive–disease is self limiting in kids

In adults could progress to Rapidly progressive glomerularnephritis–very bad

51
Q

Nephritic Syndrome that progresses to renal failure in weeks to months

A

Rapidly progressive glomerularnephritis

52
Q

Rapidly Progressive glomerulonephritis buzz

A

Crescents in Bowman space

composed of Macrophages and Fibrin

53
Q

Immune Complex in messangium
recent mucosal infection
RBC casts in urine
Child

A

IgA Nephropathy (Berger Disease)

54
Q

X-Linked
Defect in Type IV collagen
Thinning of glomerular basement membrane

A

Alport Syndrome

55
Q

Alport Syndrome Sx

A

Sensory hearing loss
Isolated hematuria
Ocular disturbances

56
Q

Rapidly Progressive GN with Linear IF

A

Goodpasture syndrome

Ab against collagen of alveolar and glomerular basement membrane
Hematuria, hemoptysis
young adult male

57
Q

Rapidly Progressive GN with Granular IF

A

PSGN

Diffuse Proliferative GN

58
Q

Rapidly Progressive GN with negative IF

A

Wegener granulomatosis
microscopic polyangiitis
Churg-Strauss Syndrome

59
Q

DDx Churg-Strauss from microscopic polyangiitis

A

CS has

  1. Granulomatous inflammation
  2. Eosinophilia
  3. Asthma

Not found in Microscopic polyangiitis

60
Q

Most common renal disease in SLE

A

Diffuse Poliferative glomerulonephritis (nephritic)

Membranous Nephropathy (#1 nephrotic) is not as common as DPGN

61
Q

Labs to DDx Wegener from Churg-Strauss

A

Weg–c-ANCA

CS–p-ANCA

62
Q

UTI bugs

A 
E. coli
S. saprophyticus
Klebsiella
Proteus
enterococcus faecalis
63
Q

Dysuria, urinary frequency, urgency, suprapubic pain, NO systemic signs

A

Cystitis (bladder infxn)

64
Q

most common type of spread for UTI development

A

Ascending spread

females more common due to short urethra

65
Q

UTI Dx gold standard

A

Culture > 100,000 colony forming units

66
Q

Dipstick findings for cystitis

A

Positve leukocute esterase and nitrites

67
Q

Sterile Pyuria

A

suggests urethritis

  1. Chlamydia
  2. Neisseria gonorrhoeae
68
Q

Pyelonephritis cast

A

WBC Cast

69
Q

Pyelonephritis Sx

A

Cystitis Sx +

Fever, FLANK pain, WBC casts, Leukocytosis

70
Q

Pyelonephritis bugs

A

E. coli
Klebsiella
E. faecalis

71
Q

Chronic Pyelonephritis findings

A

Interstitial fibrosis and atrophy of tubulesdue to multiple infxns.

Cortical scarring with blunted calyces (scarring of upper and lower pole (reflux)

Eosinophilic proteinaceous material resembling thyroid

waxy casts in urine

72
Q

Etiology of chronic pyelonephritis

A 
Vesicoureteral reflux (kids)
obstruction (BPH, cervical CA)
73
Q

Thyroidization of the kidney

A

Chronic pyelonephritis

74
Q

Most common type of kidney stone

A

Ca oxalate or Ca phosphate

75
Q

Tx Ca stones

A

hydrochlorothiazide

76
Q

Causes of Ca stones

A

Idiopathic hypercalciuria
hypercalcemia
Crohn’s Disease

77
Q

Ammonium Magnesium Phosphate stone etiology

A

infection with urease + bugs –> alkalinizes the urine

  1. Proteus
  2. Klebsiella
78
Q

Stone that cannot be seen on x-ray (radiolucent)

A

Uric Acid Stones

Dx with US

79
Q

Risk factors for Uric Acid stones (7)

A 
Hot arid climates
low urine Volume
acidic pH
Gout
hyperuricemia
leukemia 
myeloproliferative diseases
80
Q

Staghorn Stone in Kids

A

Cysteine Stone

associated with cysteinuria

81
Q

Tx of Cysteine Stone

A

Hydration

Alkalinize urine

82
Q

Tx Uric acid stones

A

Allopurinol

K+ HCO3- (alk. urine)

83
Q

Tx Ammonium Magnesium Phosphate Stones

A

Surgery

Clear infxn

84
Q

Most common causes of End Stage Kidney Failure

A

DM
HTN
Glomerular Disease

85
Q

Uremia

A

Increased nitrogen waste in blood

Sx: nausea, anorexia, pericarditis, plt. dysfxn, encephalopathy w/ asterixis, deposition of urea chrystals in skin

86
Q

Sx of Chronic Renal Failure

A 
Uremia
HTN--due to high renin (Na and water retension)
hyperkalemia with metabolic acidosis
anemia due to decreased erythropoeitin
hypocalcemia
renal osteodystrophy
87
Q

Sight of erythropoietin production

A

renal peritubular interstitial cells

88
Q

Mechanism of hypocalcemia with renal failure

A

decreased 1-alpha-hydroxylation of Vit. D by proximal tubule cells

hyperphosphatemia

89
Q

Renal osteodystrophy

A

2º to Hyperparathyroidism, osteomalacia, and osteoporosis

90
Q

Tx of Renal failure

A

dialysis or kidney transplant

91
Q

Increased risk at end stage kidney failure

A

Renal Cell CA

Cysts develop in shrunken kidney during dialysis

92
Q

Hamartoma comprised of blood vessels, smooth mm., adipose tissue

A

Angiomyolipoma

93
Q

Angiomyolipoma frequency is increased with

A

tuberous sclerosis

94
Q

Mutation with RCC

A

Loss of VHL tumor suppressor gene

leads to increased IGF-1 (promotes growth) and HIF transcription factor (inc. VEGF and PDGF)

95
Q

RCC classic triad

A
  1. Hematuria
  2. Palpable Mass
  3. Flank Pain
96
Q

RCC presentations

A

Fever, weight loss, or paraneoplastic syndrome (EPO, renin, PTHrP, ACTH

Left Sided varicocele due to hematogenous spread into Left renal vein

97
Q

Gross and Micro findings of RCC

A

Gross–yellow mass

Micro–clear cytosol (most common type is clear cell)

98
Q

Sporadic RCC

A

Unilateral
Single mass in upper pole
Smoking is main risk factor

99
Q

Hereditary RCC

A

Von Hippel-Lindau (Autosomal Dominant)
inactivation of VHL gene

Hemangioblastoma in cerebellum and RCC

100
Q

Wilm’s Tumor is comprised of

A

Blastema–embryologic kidney mesenchyme

primitive glomeruli, tubules, and stromal cells (blastema forms all of it)

101
Q

Wilm’s tumor presentation

A

Large, unilateral mass with hematuria and HTN (renin)

102
Q

WAGR Syndrome

A

Wilm’s tumor
Aniridia
Genital Abnormalities
Retardation–mental/motor

103
Q

Wilm’s Tumor Gene mutation

A

WT1

104
Q

Beckwith-Wiedermann Syndrome

A

Wilm’s Tumor
Neonatal hypoglycemia
muscular hemihypertrophy (muscular asymmetry)
Organomegally (tongue)

105
Q

1 tumor of lower urinary tract and location

A

Urothelial CA

most commonly in bladder

106
Q

Urothelial CA presentation

A

Painless hematuria

107
Q

Major risk factors for urothelial CA

A

Smoking (polycyclic aromatic hydrocarbons)
naphtylamine
azo dyes (hair dresser)
Long term cyclophosphamide or phenacetin

108
Q

Flat urothelial CA

A

develops high grade then invades

early p53 mutation

109
Q

Papillary urothelial CA

A

Develops low grade –> high –> then invades

No p53 mutation

110
Q

Squamous Cell CA of the bladder risk factors

A 
Schistosoma hematobium (Egytian Male)
long standing nephrolithiasis

Chronic irritation to bladder

111
Q

Squamous cell CA of the lower Genitourinary tract most common site

A

malignant proliferation of squamous cell

bladder most common

112
Q

Adenocarcinoma of the lower urinary tract associated with (3)

A
  1. Urachal Remnant (dome of bladder)
  2. Cystitis glandularis
  3. Extrophy of the bladder
113
Q

Malignant proliferation of glands involving the bladder

A

adenocarcinoma

finger-like projections

114
Q

Nephrotic Syndrome Characteristics

A

Gross Hematuria
Proteinuria > 3.5 grams/day
Hyperlipidemia
Fatty Casts
Thromboembolism (loss of protein C/S in urine)
Increased Risk of Infection (Ig protein loss in urine)

115
Q

Nephritic Syndrome Characteristics

A 
Hematuria
RBC casts
Proteinuria < 3.5 g/day
Oliguria
HTN
Azotemia

Inflammatory process involving glomeruli

116
Q

1º Amyloidosis is associated with

A

Multiple Myeloma

117
Q

2º Amyloidosis is associated with

A

TB

RA

Pathoma (3 decks)

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