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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
Q

RTA Type 4 (“HYPERkalemic”)

Def’n, Causes (3, incl 2 drugs), Labs (2)?

A

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
Q

Nephritic Sx

A

Proteinuria

26
Q

Glomerulonephritis

Causes (2)?

A

CAUSES:

  • Bacterial Endocarditis
  • Wegener Granulomatosis
27
Q

Acute Post-Streptococcal Glomerulonephritis

Locations Affected (2), Mech, H-S Type,
Micro Findings (LM + EM + IF),
Pres (Epi + CLUE), Labs (2), Urine (CLUE)
Prog?

A
  • 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
Q

RPGN

Def'n, 
Micro Findings (LM + IF), Antibodies, 
Seen In (3), Prog?
A

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
Q

Diffuse Proliferative Glomerulonephritis

Locations (2), Mech, Causes (2),
Findings (LM + EM)?

A
  • 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
Q

Berger’s IgA Nephropathy

Location, Mech,
Pres,
Seen In?

A

Mesangium.

MECH: IgA IC deposition.

PRES = often alongside a mucosal infection (ie URI or gastroenteritis).

SEEN IN:
- Henoch-Schonlein Purpura

31
Q

Alport Sx

Location, Inher, Genetics, Mech (2 steps), Pres (2)?

A

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
Q

Nephrotic Sx Proteinuria > 3.5 g / day

Location, Mech (2 = 2 Subtypes), Assoc (2),
Micro Finding (CLUE), Labs / Pres (4), Urine (2),
Comp (2)?
A

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
Q

MPGN

Location, Def’n, Subtype Division?

A

Glom BM.

THICK Glom BM due to IC deposition.

Divided into 2 subtypes based on LOCATION of IC depositions.

34
Q

MPGN Type 1

Location of IC Deposits,
Micro Finding?

A

SUBENDOTHELIAL IC deposits.

FINDINGS:
- “Tram-Track” appearance of Glom BM

35
Q

MPGN Type 2

Location of IC Deposits, Assoc,
Micro Finding?

A

INTRAMEMB IC deposits.

ASSOC:
- C3 Nephritic Factor
(stabilizes C3 Convertase -> OVERACTIVE Complement ->↓serum C3)

FINDINGS:
- “Dense deposits”

36
Q

Membranous Nephropathy

Def’n, Assoc (4),
Micro Findings (EM), Pres (Epi), Antibodies
Comp?

A

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
Q

Diabetic Glomerulonephropathy

Mech / Locations (2 NEG pathways), 
Micro Findings (CLUE)?
A

MECH:

  • NEG of Vascular BM -> E.A + Mesangial Hyaline Sclerosis
    - >↑GFR -> Hyperfiltration
  • NEG of Glom BM -> Thickening +↑Permeability (->Microalbuminuria)

FINDINGS:
- Kimmelstiel-Wilson nodules

39
Q

Focal Segmental Glomerulosclerosis

Path (2), Assoc (6)
Micro Findings (EM), Pres (Epi),
Comp?

A

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
Q

Amyloidosis

Location, Def'n, Assoc, 
Micro Findings (LM)?
A

Mesangium.

Amyloid deposits in mesangium.

ASSOC:
- Chronic conditions (ie RA, TB, Multiple Myeloma)

FINDINGS:
- LM: Apple-Green birefringence on Congo Red stain

40
Q

Minimal Change Disease (Lipid Nephrosis)

Location, Def’n, Mech (of Proteinuria), Assoc (2),
Micro Findings (EM), Pres (Epi),
RX?

A

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
Q

Kidney Stones

Seen In, Pres (3)?

A

SEEN IN:
- MEN I

PRES:

  • Unilateral flank tenderness
  • Colicky pain radiating to groin
  • Hematuria
42
Q

Ca Oxalate Kidney Stones

Causes / Assoc (5)?

A

CAUSES / ASSOC:

  • Hypercalciuria
  • RTA Type 1
  • Crohn Disease
  • Vitamin C abuse
  • Ethylene Glycol poisoning
44
Q

UT Obstruction

Causes (4), Comp (2)?

A

CAUSES:

  • Injury to Ureter
  • Renal Stones
  • BPH
  • Cervical Cancer

COMP:

  • Hydronephrosis
  • Pyelonephritis
45
Q

Renal Failure

Def’n, Comp (* “MAD HUNGER”)?

A

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
Q

Acute Renal Failure

Def’n, Labs (4)?

A

Acute / abrupt decline in renal function (within days).

LABS:

  • ↓GFR and
  • ↑BUN + Creatinine
  • Azotemia
  • Oliguria
47
Q

Hydronephrosis

Location, Path, Causes (3)?

A

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
Q

Renal Oncocytoma

Def’n,
Micro Finding,
RX?

A

Benign epithelial cell tumor of kidney tubules.

FINDINGS:
- Large eosinophilic cells with abundant mitochondria, round nuclei and
NO perinuclear clearing.

RX = Nephrectomy

49
Q

Renal Cell Carcinoma (RCC)

Def’n, Inher (General), Genetics, Assoc (4),
Micro Findings, Pres (Epi + 4), Labs, Urine,
Mets, Rx (2)?

A

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
Q

Renovascular Htn

Causes (3)?

A

CAUSES:

  • Renal art stenosis
  • Nephrotic Sx
  • Chronic Renal Failure
50
Q

Transitional Cell Carcinoma

MC Location, Assoc (4: * “P SAC” *), Prognosis?

A

MC location = Bladder.

ASSOC:

  • Phenacetin
  • Smoking
  • Aniline dyes (industrial, precursor to polyurethane)
  • Cyclophosphamide

PROG: Tumors often multifocal and tend to recur.

51
Q

Squamous Cell Carcinoma of Bladder

Mech (4 steps), RF (4), Pres?

A

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
Q

Wilms Tumor (Nephroblastoma)

Def’n, Genetics, Assoc (2), Composition (3),
Pres (Epi + 2), Urine?

A

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
Q

WAGR Sx

Pres (* “WAGR” *)?

A

PRES:

  • Wilms Tumor
  • Aniridia (absence of iris)
  • Genitourinary malformation
  • Retardation

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