Renal Flashcards
1
Q
Where does horseshoe kidney get stuck?
A
IMA
2
Q
Where is horseshoe kidney adjoined?
A
Lower Poles
3
Q
Potter Syndrome
A
- lung hypoplasia
- flat face with low set ears
- Limb defects
All due to oligohydraminos from bilateral renal agenesis
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
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
6
Q
ARPKD associated with
A
Congenital hepatic fibrosis and hepatic cysts
7
Q
Autosomal dominant PKD presentation
A
young adult with HTN (high renin), hematuria, worsening renal failure
8
Q
ADPKD associations
A
Berry anneurysms, hepatic cysts, MVP
Think cysts in vessels, heart, and liver
9
Q
ADPKD genetic mutations
A
APKD1 & APKD2 gens
10
Q
Medullary Cystic Kidney Disease
A
Cysts in medullary collecting ducts
parenchymal fibrosis leads to SHRUNKEN kidney and worsening renal failure
11
Q
Acute renal failure hallmarks
A
Azotemia (increased BUN and Creatinine) often with oliguria
12
Q
Prerenal Azotemia
A
Decreased blood flow to kidney
leads to decreased GFR, azotemia, and oliguria
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
14
Q
Postrenal Azotemia
A
Urinary Tract obstruction increases back pressure decreasing GFR
Also forces BUN back into blood
azotemia and oliguria
15
Q
Early Postrenal azotemia Labs
A
BUN:Creatinine > 15
FENa < 1%
Urine Osmo > 500
looks just like prerenal azotemai
16
Q
Late postrenal azotemia labs
A
BUN:creatinine < 15
FENa > 2%
Urine Osmo < 500
17
Q
Acute Tubular Necrosis
A
Injury/necrosis of tubular epithelial cells
Plug tubules decreasing GFR
Brown Casks in urine
18
Q
Acute Tubular Necrosis Labs
A
BUN:Creatinine < 15
FENa > 2%
Urine Osmo <500
19
Q
Etiology of Acute tubular necrosis
A
Ischemia, Nephrotoxic (Rx, heavy metals, urate, etc.)
20
Q
Clinical features of Acute tubular necrosis
A
oliguria with brown casts
elevated BUN and Creatinine
Hyperkalemia
Metabolic Acidosis (increased anion gap)
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
22
Q
Acute Interstitial Nephritis
A
Rx induced hypersensitivity involving interstitium and tubules
NSAIDs, penicillin, diuretics
23
Q
Acute Interstitial Nephritis Sx
A
Fever, oliguria, rash days to weeks after start of Rx
Eosinophils in urine
24
Q
Acute Interstitial nephritis Tx
A
Stop Rx
25
Renal Papillary Necrosis
Necrosis of renal papillaries
| Gross hematuia and flank pain
26
Renal Papillary Necrosis Causes
DM, analgesic abuse, Sickle cell, acute pyelonephritis
27
Minimal Change Disease associated with
hodgkins lymphoma
28
#1 Nephrotic Syndrome in kids
Minimal Change Disease
29
Histo of Minimal Change disease
Effacement of foot processes which leads to selective proteinuria (only albumin)
Glomerulus pretty much looks normal
30
Tx or Minimal Change Disease
Steroids
| Due to pathogenesis: Cytokines mediate damage
31
Nephrotic Syndromes associated with HBV and HCV
Focal Segmental Glomerulonephritis
| Type I membranoproliferative glomerulonephritis
32
Nephrotic syndromes with foot process effacement
Minimal change disease
| Focal Segmental glomerulosclerosis
33
Focal segmental glomerulosclerosis findings
Some glomeruli (focal)
involving only part of glomerulus (segmental)
sclerosis
effacement of foot processes
34
Spike and Dome appearance
| Grainy Immunofluorescence
Membranous Nephropathy
Complex deposition is subepithelial
No response to steroids
35
Nephrotic Syndromes with negative immunofluorescence
Focal segmental glomerulosclerosis
| Minimal change disease
36
Who gets Focal Segmental Glomerulosclerosis? Associations?
Hispanics and Af. Am.
Sickle Cell, Heroin, HIV
37
Most common nephrotic syndrome in Caucasian adults
Membranous Nephropathy
38
Membranous Nephropathy associations
Whites
HBV/HCV
SLE
Rx (NSAIDs, Penicillamine)
39
Subendothelial complex deposition
Tram track appearance
HBV/HCV associated
Membranoproliferative disease type I
40
Intramembranous complex deposition
Associated with C3 nephrotic factor
unregulated complement
Membranoproliferative Type II
C3 nephrotic factor stablizes C3 convertase --> complement does not get shut off
41
Membranoproliferative histo
Thick glomerular basement membrane due to complex deposition
poor response to steroids
Think of thickening (proliferation) of the basement membrane (membranous)
42
DM Nephrotic findings
HYALINE ARTERIOLOSCLEROSIS
| High serum glucose leads to nonenzymatic glycosylation of vascular basement membrane
43
Tx of DM nephrotic Sx
ACE
Hyaline deposits in efferent arteriole. ACE prevents Angiotensin II vasocontriction of efferent arteriole decreasing Sx
44
Kimmelstiel Wilson Nodules
Diabetes Mellitis
sclerosis of mesangium
45
Apple Green apple birefringenc after Congo Red stain
| Deposits in mesangium
Systemic Amyloidosis
Kidney is most common organ involved
46
Why are nephritic syndromes hypercellular?
Immune complexes deposit activating complement.
| C5a attracts neutrophils mediating damage to kidney
47
Poststreptococcal Glomerulonephritis Sx
```
Nephritic Syndrome
Coke-colored urine (blood)
oliguria
HTN
periorbital edema
```
Lumpy bumpy IF--type III hypersensitivity
48
Poststreptococcal Glomerulonephritis buzz word
Subepithelial hump on EM
49
Nephrogenic Strep organisms
Must have M protein--mediates damage
Group A ß-hemolytic Strep
other bugs can do it too
50
Poststrep GN Tx
Supportive--disease is self limiting in kids
In adults could progress to Rapidly progressive glomerularnephritis--very bad
51
Nephritic Syndrome that progresses to renal failure in weeks to months
Rapidly progressive glomerularnephritis
52
Rapidly Progressive glomerulonephritis buzz
Crescents in Bowman space
| composed of Macrophages and Fibrin
53
Immune Complex in messangium
recent mucosal infection
RBC casts in urine
Child
IgA Nephropathy (Berger Disease)
54
X-Linked
Defect in Type IV collagen
Thinning of glomerular basement membrane
Alport Syndrome
55
Alport Syndrome Sx
Sensory hearing loss
Isolated hematuria
Ocular disturbances
56
Rapidly Progressive GN with Linear IF
Goodpasture syndrome
Ab against collagen of alveolar and glomerular basement membrane
Hematuria, hemoptysis
young adult male
57
Rapidly Progressive GN with Granular IF
PSGN
| Diffuse Proliferative GN
58
Rapidly Progressive GN with negative IF
Wegener granulomatosis
microscopic polyangiitis
Churg-Strauss Syndrome
59
DDx Churg-Strauss from microscopic polyangiitis
CS has
1. Granulomatous inflammation
2. Eosinophilia
3. Asthma
Not found in Microscopic polyangiitis
60
Most common renal disease in SLE
Diffuse Poliferative glomerulonephritis (nephritic)
Membranous Nephropathy (#1 nephrotic) is not as common as DPGN
61
Labs to DDx Wegener from Churg-Strauss
Weg–c-ANCA
| CS–p-ANCA
62
UTI bugs
```
E. coli
S. saprophyticus
Klebsiella
Proteus
enterococcus faecalis
```
63
Dysuria, urinary frequency, urgency, suprapubic pain, NO systemic signs
Cystitis (bladder infxn)
64
most common type of spread for UTI development
Ascending spread
| females more common due to short urethra
65
UTI Dx gold standard
Culture > 100,000 colony forming units
66
Dipstick findings for cystitis
Positve leukocute esterase and nitrites
67
Sterile Pyuria
suggests urethritis
1. Chlamydia
2. Neisseria gonorrhoeae
68
Pyelonephritis cast
WBC Cast
69
Pyelonephritis Sx
Cystitis Sx +
| Fever, FLANK pain, WBC casts, Leukocytosis
70
Pyelonephritis bugs
E. coli
Klebsiella
E. faecalis
71
Chronic Pyelonephritis findings
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
Etiology of chronic pyelonephritis
```
Vesicoureteral reflux (kids)
obstruction (BPH, cervical CA)
```
73
Thyroidization of the kidney
Chronic pyelonephritis
74
Most common type of kidney stone
Ca oxalate or Ca phosphate
75
Tx Ca stones
hydrochlorothiazide
76
Causes of Ca stones
Idiopathic hypercalciuria
hypercalcemia
Crohn's Disease
77
Ammonium Magnesium Phosphate stone etiology
infection with urease + bugs --> alkalinizes the urine
1. Proteus
2. Klebsiella
78
Stone that cannot be seen on x-ray (radiolucent)
Uric Acid Stones
Dx with US
79
Risk factors for Uric Acid stones (7)
```
Hot arid climates
low urine Volume
acidic pH
Gout
hyperuricemia
leukemia
myeloproliferative diseases
```
80
Staghorn Stone in Kids
Cysteine Stone
| associated with cysteinuria
81
Tx of Cysteine Stone
Hydration
| Alkalinize urine
82
Tx Uric acid stones
Allopurinol
| K+ HCO3- (alk. urine)
83
Tx Ammonium Magnesium Phosphate Stones
Surgery
| Clear infxn
84
Most common causes of End Stage Kidney Failure
DM
HTN
Glomerular Disease
85
Uremia
Increased nitrogen waste in blood
Sx: nausea, anorexia, pericarditis, plt. dysfxn, encephalopathy w/ asterixis, deposition of urea chrystals in skin
86
Sx of Chronic Renal Failure
```
Uremia
HTN--due to high renin (Na and water retension)
hyperkalemia with metabolic acidosis
anemia due to decreased erythropoeitin
hypocalcemia
renal osteodystrophy
```
87
Sight of erythropoietin production
renal peritubular interstitial cells
88
Mechanism of hypocalcemia with renal failure
decreased 1-alpha-hydroxylation of Vit. D by proximal tubule cells
hyperphosphatemia
89
Renal osteodystrophy
2º to Hyperparathyroidism, osteomalacia, and osteoporosis
90
Tx of Renal failure
dialysis or kidney transplant
91
Increased risk at end stage kidney failure
Renal Cell CA
Cysts develop in shrunken kidney during dialysis
92
Hamartoma comprised of blood vessels, smooth mm., adipose tissue
Angiomyolipoma
93
Angiomyolipoma frequency is increased with
tuberous sclerosis
94
Mutation with RCC
Loss of VHL tumor suppressor gene
leads to increased IGF-1 (promotes growth) and HIF transcription factor (inc. VEGF and PDGF)
95
RCC classic triad
1. Hematuria
2. Palpable Mass
3. Flank Pain
96
RCC presentations
Fever, weight loss, or paraneoplastic syndrome (EPO, renin, PTHrP, ACTH
Left Sided varicocele due to hematogenous spread into Left renal vein
97
Gross and Micro findings of RCC
Gross–yellow mass
| Micro–clear cytosol (most common type is clear cell)
98
Sporadic RCC
Unilateral
Single mass in upper pole
Smoking is main risk factor
99
Hereditary RCC
Von Hippel-Lindau (Autosomal Dominant)
inactivation of VHL gene
Hemangioblastoma in cerebellum and RCC
100
Wilm's Tumor is comprised of
Blastema–embryologic kidney mesenchyme
primitive glomeruli, tubules, and stromal cells (blastema forms all of it)
101
Wilm's tumor presentation
Large, unilateral mass with hematuria and HTN (renin)
102
WAGR Syndrome
Wilm's tumor
Aniridia
Genital Abnormalities
Retardation–mental/motor
103
Wilm's Tumor Gene mutation
WT1
104
Beckwith-Wiedermann Syndrome
Wilm's Tumor
Neonatal hypoglycemia
muscular hemihypertrophy (muscular asymmetry)
Organomegally (tongue)
105
#1 tumor of lower urinary tract and location
Urothelial CA
most commonly in bladder
106
Urothelial CA presentation
Painless hematuria
107
Major risk factors for urothelial CA
***Smoking*** (polycyclic aromatic hydrocarbons)
naphtylamine
azo dyes (hair dresser)
Long term cyclophosphamide or phenacetin
108
Flat urothelial CA
develops high grade then invades
early p53 mutation
109
Papillary urothelial CA
Develops low grade --> high --> then invades
No p53 mutation
110
Squamous Cell CA of the bladder risk factors
```
Schistosoma hematobium (Egytian Male)
long standing nephrolithiasis
```
Chronic irritation to bladder
111
Squamous cell CA of the lower Genitourinary tract most common site
malignant proliferation of squamous cell
bladder most common
112
Adenocarcinoma of the lower urinary tract associated with (3)
1. Urachal Remnant (dome of bladder)
2. Cystitis glandularis
3. Extrophy of the bladder
113
Malignant proliferation of glands involving the bladder
adenocarcinoma
finger-like projections
114
Nephrotic Syndrome Characteristics
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
Nephritic Syndrome Characteristics
```
Hematuria
RBC casts
Proteinuria < 3.5 g/day
Oliguria
HTN
Azotemia
```
Inflammatory process involving glomeruli
116
1º Amyloidosis is associated with
Multiple Myeloma
117
2º Amyloidosis is associated with
TB
| RA
