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RENAL Flashcards

0
Q

Cellular “crescents” in Bowman Capsule

A

RPGN

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1
Q

“Horseshoe” Kidney

Seen In?

A

Turner Sx

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2
Q

“Linear IgG deposition” on glom BM

A

Goodpasture Sx

Anti-BM ab -> Necrotizing glomerulonephritis

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3
Q

“Lumpy bumpy” appearance of glom on IF

A

Acute Post-Streptococcal Glomerulonephritis

Immune complex deposition of IgG + C3b

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4
Q

“Nodular hyaline deposits” in glom

A

Kimmelstiel-Wilson nodules: acellular nodules in glom

SEEN IN:
- Diabetic Nephropathy

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5
Q

“Podocyte fusion / effacement” on EM (2)

A
  • Focal Segmental Glomerulosclerosis

- Minimal Change Disease (CHILD with Nephrotic Sx)

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6
Q
  • “Spikes” on BM (irregular dense deposits)

- “Dome-like” subepithelial deposits

A

Membranous Glomerulonephritis

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7
Q

“Shrunken Kidneys” on U/S

A

Medullary Cystic Disease

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8
Q

“Thyroid-like appearance” of Kidney

A

Chronic Bacterial Pyelonephritis

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9
Q

“Tram-track” (ie double contour) appearance of capillary loops of BM on LM

A

Membranoproliferative Glomerulonephritis

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10
Q

“Wire loop” appearance of glomerular capillaries on LM

A

Lupus Nephropathy / Nephritis

(Thickened capillary BM due to IC deposition.
Type 3 H-S.)

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11
Q
  • Male, 50-70 years, obese + smoker

- Von Hippel-Lindau Sx

A

Renal Cell Carcinoma

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12
Q

EXCESS Na / H2O Retention

Conseq (3)?

A

CONSEQ:

  • Htn
  • Pulm Edema
  • CHF
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13
Q

Edematous States (4)

A
  • Pulm Edema
  • CHF
  • Cirrhosis
  • Nephrotic Sx
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14
Q

Edema of Renal Origin

Pres?

A

PRES = Usually first manifests around eyes + face

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15
Q

Normal Pregnancy

Urine (2)?

A

URINE:

  • Glucosuria
  • Aminoaciduria
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16
Q

Hartnup Disease

Inher, Mech (3 steps), Pres, Urine, Rx (2)?

A

AR.

MECH:
↓Neutral A.A Transporters in PCT ->↓A.A REABS from gut ->
Neutral Aminoaciduria.

PRES:
- Pellagra-like

URINE:
- Neutral Aminoaciduria

RX:

  • High Protein diet
  • Nicotinic acid
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17
Q

Fanconi Sx (PCT reabsorption defect)

Mech (↑Excr of 4), Causes (3), Pres (5)?

A

PCT reabs defect ->
↑EXCRETION of Glucose, A.A, HCO3 + Phosphate.

CAUSES:

  • Hereditary defects (ie Wilson Disease)
  • Ischemia
  • Drugs (nephrotoxic)

PRES:

  • Polyuria
  • Proximal Renal Tubular Acidosis (Type 2)
  • Electrolyte imbalances
  • Growth failure
  • Hypophosphatemic Rickets
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18
Q

Bartter Sx

Def’n, Inher, Labs (3)?

A

TAL reabsorption defect affecting Na/K/2 Cl Cotransporter.

AR.

LABS:

  • Metabolic Alkalosis
  • HYPOkalemia
  • HYPERcalciuria
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19
Q

Gitelman Sx

Def’n, Inher, Pres?

A

DCT reabsorption defect of NaCl.

AR.

PRES = Same as Bartter Sx (Metabolic Alkalosis + HYPOkalemia), however WITHOUT Hypercalciuria and less severe.

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20
Q

Liddle Sx

Def’n, Mech, Pres (4), RX?

A

↑Na reabs in Collecting Duct.

MECH:↑activity of Na channel.

PRES:

  • Htn
  • Metabolic Alkalosis
  • HYPOkalemia
  • ↓Aldosterone (THINK: Aldosterone not needed if Na reabs is already increased.)

RX:
- Amiloride (inhibits Na channel in Collecting Duct)

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21
Q

Renal Tubular Acidosis (RTA)

Mech, Path, Labs, RX (3 main lines)?

A

MECH: Kidneys not appropriately acidifying urine.

PATH: Normal AG Metabolic Acidosis

LABS: HYPERkalemia

RX: Correction of pH + electrolyte imbalances (esp HYPERkalemia)

  • Alkaline agents
  • Electrolytes
  • K restriction / K-wasting Diuretics
22
Q

RTA Type 1 (Urine pH > 5.5) RARE

Def’n, Mech (2), Causes (4), Conseq (3), Labs (2), Urine?

A

Defect in H/K Antiporter of a-intercalated cells in Distal Tubule.

MECH:

  • No H SECR -> New HCO3 can’t be generated -> Metabolic Acidosis.
  • No K REABS -> HYPOkalemia.

CAUSES:

  • Congenital anomalies -> OBSTRUCTION of urinary tract
  • Amphotericin B Toxicity
  • Analgesic Nephropathy
  • Multiple Myeloma (light chain)

CONSEQ:

  • ↑Urine pH > 5.5 (b/c no H excr)
  • ↑Bone turnover (bone BUFFERS acid in bl + releases Ca Phosphate)
  • ↑risk of Ca Phosphate Kidney Stones (for 2 above reasons)

LABS:
- HCO3↓(

23
Q

RTA Type 2 RARE

Def’n, Mech (General -> 2 Conseq), Causes (3),
Urine (2: pH + excr),
Conseq?

A

Defect in PCT HCO3 REABS.

MECH: ↑HCO3 in tubular fluid (TF):

  • > ↑HCO3 EXCRETION in urine -> Metabolic Acidosis.
  • > TF more negatively charged -> Attracts K -> Hypokalemia.

CAUSES:

  • Drugs / Chemicals toxic to PCT (ie Aminoglycosides, Expired Tetracycline, Lead)
  • Fanconi Sx
  • Light-Chain Multiple Myeloma

URINE:
- pH > 7 if plasma HCO3 normal ; pH

24
RTA Type 4 ("HYPERkalemic") Def'n, Causes (3, incl 2 drugs), Labs (2)?
Abnormal Aldosterone production or response -> *↓K + H EXCRETION *. CAUSES: - Dysfunction of 'RAA Axis' (ie due to Nephropathies) - ACE Inhibitors - K-Sparing Diuretics LABS: - HYPERkalemia - Metabolic Acidosis (↓H EXCR =>↓NH3 EXCR)
25
Nephritic Sx
Proteinuria
26
Glomerulonephritis Causes (2)?
CAUSES: - Bacterial Endocarditis - Wegener Granulomatosis
27
Acute Post-Streptococcal Glomerulonephritis Locations Affected (2), Mech, H-S Type, Micro Findings (LM + EM + IF), Pres (Epi + CLUE), Labs (2), Urine (CLUE) Prog?
- GBM - Mesangium MECH: IgG / IgM IC + C3 deposition along GBM and Mesangium. Type 3 H-S. FINDINGS: - LM: enlarged + hypercellular glomeruli - EM: subEPIthelial IC "humps" - IF: "lumpy-bumpy" and "starry sky" granular appearance PRES: MC in Children - "Approx 2 wks after Group A Strep infection of skin or pharynx" LABS: - Anti-DNase B↑ - Complement levels↓ URINE: - Dark "cola-colored" urine PROG: Resolves spontaneously
28
RPGN ``` Def'n, Micro Findings (LM + IF), Antibodies, Seen In (3), Prog? ```
Nephritic Sx that progresses to Renal Failure in weeks. FINDINGS: - LM + IF: "Crescents" AB: - C-ANCA + P-ANCA SEEN IN: - Goodpasture Sx - Wegener's Granulomatosis - Microscopic Polyangitis PROG: Progresses to Renal Failure in WEEKS.
29
Diffuse Proliferative Glomerulonephritis Locations (2), Mech, Causes (2), Findings (LM + EM)?
- SubENDOthelial - Intramembranous (sometimes) MECH: IgG IC + C3 deposition. CAUSES: (THINK: other 2 conditions in middle of venn diagram in FA) - Membranoproliferative Glomerulonephritis - SLE FINDINGS: - LM: "wire looping" of capillaries - EM: subENDOthelial ICs
30
Berger's IgA Nephropathy Location, Mech, Pres, Seen In?
Mesangium. MECH: IgA IC deposition. PRES = often alongside a mucosal infection (ie URI or gastroenteritis). SEEN IN: - Henoch-Schonlein Purpura
31
Alport Sx Location, Inher, Genetics, Mech (2 steps), Pres (2)?
Glom BM. XR (MC). Mutation -> Defective Type IV Collagen. MECH: Thin + split Glom BM -> Defective ability to FILTER BL. PRES: - Deafness - Cataracts / ocular disturbances
32
Nephrotic Sx *Proteinuria > 3.5 g / day* ``` Location, Mech (2 = 2 Subtypes), Assoc (2), Micro Finding (CLUE), Labs / Pres (4), Urine (2), Comp (2)? ```
Glom BM. MECH: Thickening of Glom BM: - Due to IC deposition (Membranous types) - Due to NEG (Diabetic Glomerulonephropathy) ASSOC: - Hep B + Hep C - Systemic Amyloidosis FINDINGS: - Kimmelsteil-Wilson nodules in glom * Preferential involvement of EFFERENT arterioles* LABS / PRES: - Loss of Antithrombin III (-> Hypercoag state, DIC) - ↓Albumin (-> Pitting Edema) - ↓Globulins (->↑risk of infection) - ↑Lipids + Cholesterol ('Fatty Casts' in urine) URINE: - Proteinuria > 3.5 g / day - Fatty Casts COMP: - Renovascular Htn - 2ry Hyperaldosteronism
33
MPGN Location, Def'n, Subtype Division?
Glom BM. THICK Glom BM due to IC deposition. Divided into 2 subtypes based on LOCATION of IC depositions.
34
MPGN Type 1 Location of IC Deposits, Micro Finding?
SUBENDOTHELIAL IC deposits. FINDINGS: - "Tram-Track" appearance of Glom BM
35
MPGN Type 2 Location of IC Deposits, Assoc, Micro Finding?
INTRAMEMB IC deposits. ASSOC: - C3 Nephritic Factor (stabilizes C3 Convertase -> OVERACTIVE Complement ->↓serum C3) FINDINGS: - "Dense deposits"
36
Membranous Nephropathy Def'n, Assoc (4), Micro Findings (EM), Pres (Epi), Antibodies Comp?
THICK Glom BM due to IC deposition. ASSOC: - Infections (ie Hep B + Hep C) - SLE - Solid tumors - Drugs (ie NSAIDS + Penicillamine) FINDINGS: - EM: "spike and dome" appearance of IC deposits PRES: Caucasion Adults AB: COMP: (poor response to steroid therapy) - May progress to Chronic Kidney Disease
37
Diabetic Glomerulonephropathy ``` Mech / Locations (2 NEG pathways), Micro Findings (CLUE)? ```
MECH: - NEG of Vascular BM -> E.A + Mesangial Hyaline Sclerosis - >↑GFR -> Hyperfiltration - NEG of Glom BM -> Thickening +↑Permeability (->Microalbuminuria) FINDINGS: - Kimmelstiel-Wilson nodules
39
Focal Segmental Glomerulosclerosis Path (2), Assoc (6) Micro Findings (EM), Pres (Epi), Comp?
PATH: - Hyalinosis - Segmental Sclerosis ASSOC: - Massive Obesity - Sickle Cell Disease - Chronic Kidney Disease - HIV - Heroin abuse - Interferon treatment FINDINGS: - EM: Foot process effacement PRES: African-American or Hispanic Adults COMP: (inconsistent response to steroid therapy) - May progress to Chronic Kidney Disease
39
Amyloidosis ``` Location, Def'n, Assoc, Micro Findings (LM)? ```
Mesangium. Amyloid deposits in mesangium. ASSOC: - Chronic conditions (ie RA, TB, Multiple Myeloma) FINDINGS: - LM: Apple-Green birefringence on Congo Red stain
40
Minimal Change Disease (Lipid Nephrosis) Location, Def'n, Mech (of Proteinuria), Assoc (2), Micro Findings (EM), Pres (Epi), RX?
Glom BM. Glom BM POLYANION loss. MECH: Grade 1 glom injury = Selective Proteinuria = Albuminuria. ASSOC: - Recent infection or immune stimulus (eg immunization) - Hodgkin Lymphoma (cytokine-mediated damage from T cells) FINDINGS: - EM: Foot process effacement PRES: Children RX = Corticosteroids (excellent response)
41
Kidney Stones Seen In, Pres (3)?
SEEN IN: - MEN I PRES: - Unilateral flank tenderness - Colicky pain radiating to groin - Hematuria
42
Ca Oxalate Kidney Stones Causes / Assoc (5)?
CAUSES / ASSOC: - Hypercalciuria - RTA Type 1 - Crohn Disease - Vitamin C abuse - Ethylene Glycol poisoning
44
UT Obstruction Causes (4), Comp (2)?
CAUSES: - Injury to Ureter - Renal Stones - BPH - Cervical Cancer COMP: - Hydronephrosis - Pyelonephritis
45
Renal Failure Def'n, Comp (* "MAD HUNGER")?
Inability to make urine and excrete nitrogenous wastes. COMP: - Metabolic Acidosis - Dyslipidemia (esp↑triglycerides) - Hyperkalemia, Hyperphosphatemia, HYPOcalcemia. Hyperaldosteronism, Hyperparathyroidism. - Uremia - Na / H20 Retention - Growth Retardation / Devel Delay (in children) - Erythropoietin synthesis failure - Renal Osteodystrophy
46
Acute Renal Failure Def'n, Labs (4)?
Acute / abrupt decline in renal function (within days). LABS: - ↓GFR and - ↑BUN + Creatinine - Azotemia - Oliguria
47
Hydronephrosis Location, Path, Causes (3)?
Renal Pelvices + Calyces PROXIMAL to site of pathology. PATH: Distension / dilation -> Compression Atrophy. *** Only impairs renal function if bilateral or if patient only has 1 kidney *** CAUSES: - UT obstruction - Vesicoureteral reflux - Retroperitoneal fibrosis
48
Renal Oncocytoma Def'n, Micro Finding, RX?
Benign epithelial cell tumor of kidney tubules. FINDINGS: - Large eosinophilic cells with abundant mitochondria, round nuclei and NO perinuclear clearing. RX = Nephrectomy
49
Renal Cell Carcinoma (RCC) Def'n, Inher (General), Genetics, Assoc (4), Micro Findings, Pres (Epi + 4), Labs, Urine, Mets, Rx (2)?
Malignant epithelial cell tumor arising from kidney tubules. Sporadic or Inherited. Deletion of VHL gene. ASSOC: - Obesity - Smoking - Paraneoplastic Sx: Ectopic ACTH, EPO, Prolactin + PTH - Varicocele (L-sided RCC) FINDINGS: - Polygonal CLEAR cells, filled with accumulated carbs + lipids PRES: Male 50-70 yrs - Fever - Weight loss - Flank pain - Palpable mass LABS: - 2ry Polycythemia URINE: - Hematuria METS: Invades IVC -> Hematogenous spread. RX: - Resection (if localized) - Immunotherapy (if metastatic)
49
Renovascular Htn Causes (3)?
CAUSES: - Renal art stenosis - Nephrotic Sx - Chronic Renal Failure
50
Transitional Cell Carcinoma MC Location, Assoc (4: * "P SAC" *), Prognosis?
MC location = Bladder. ASSOC: - Phenacetin - Smoking - Aniline dyes (industrial, precursor to polyurethane) - Cyclophosphamide PROG: Tumors often multifocal and tend to recur.
51
Squamous Cell Carcinoma of Bladder Mech (4 steps), RF (4), Pres?
MECH: Chronic bladder irritation -> Squamous METAPLASIA -> Squamous DYSPLASIA -> Squamous Carcinoma. RF: - Smoking - Chronic Cystitis - Chronic Kidney Stones - Schistosoma haemotobium infection (Middle East) PRES: - Painless hematuria
52
Wilms Tumor (Nephroblastoma) Def'n, Genetics, Assoc (2), Composition (3), Pres (Epi + 2), Urine?
Malignant renal tumor. WT1 or WT2 (tumor suppressor genes, chr 11) "loss of function" mutations. ASSOC: - WAGR Sx - Beckwith-Wiedemann Sx COMPOSITION: - EMBRYONIC glom / tubular structures - 'Blastema' (immature kidney mesenchyme) - Stromal cells PRES: Children 2-4 yrs - HUGE palpable flank mass and/or Hematuria - Htn (Renin) URINE: - Hematuria
53
WAGR Sx Pres (* "WAGR" *)?
PRES: - Wilms Tumor - Aniridia (absence of iris) - Genitourinary malformation - Retardation

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