Renal 3 Flashcards
Simple renal cysts are almost always benign, asymptomatic, and treatment is ____.
They appear smooth, homogenous, and dark grey (no contrast enhancement) on imaging.
Not needed.
Features concerning for malignant renal mass include a multilocular septated mass, irregular walls, ____ texture, and have contrast ____.
Heterogenous
enhancement (bright white mass)
____ commonly presents with hypertension, hematuria, and recurrent flank pain in patients in their 30s or 40s.
Autosomal dominant polycystic kidney disease
Treatment of Autosomal dominant polycystic kidney disease is mostly supportive (____, ____) , although _____ may slow disease progression in some patients.
Aggressive control of risk factors for CV & CKD
ACE inhibitors for hypertension
vasopressin-2 receptor antagonists ( tolvaptan)
Hypertension in autosomal dominant polycystic kidney disease results from cyst expansion leading to localized renal ischemia and consequent increased ___ production
renin
Tx: ACE inhibitors (eg, lisinopril).
_____ is a progressive disease that presents with recurrent hematuria (microscopic or gross) in boys age <10,
Nephropathy,
± Hypertension,
Bilateral sensorineural hearing loss,
Anterior (lens protrusion)
Family history of renal failure and/or hearing loss is present.
Alport syndrome
Complement levels are normal
Renal biopsy shows longitudinal splitting of the glomerular basement membrane
Presents with ± Hypertension and Hematuria in young boys
Alport Syndrome
Autosomal dominant polycystic kidney disease is commonly associated with _____ that may rupture and lead to intracranial bleeding.
cerebral aneurysms
ATN (or instrinsic kidney damage) is characterized by high urine sodium (typically > __ mEq/L) and fractional excretion of sodium (>__) due to tubular damage limiting reabsorptive capacity.
BUN/creatinine ratio tends to be ____.
> 40
> 2%
(~10-15:1)
Presents with AKI.
On UA: Hematuria, pyuria & crystals
in inpatient pts on medication. Diagnosis?
crystal-induced acute kidney injury
Acyclovir
Ethylene glycol toxicity
Uric acid (tumor lysis syndrome)
Sulfonamides, Methotrexate
Mcc of crystal-induced acute kidney injury
Acyclovir
_____ toxicity
_____
Sulfonamides, Methotrexate
Uric acid (tumor lysis syndrome)
Ethylene glycol
____ inhibit prostaglandin synthesis, which can cause prerenal azotemia in volume depleted patients.
NSAIDs
Gastroenteritis (typically from ____) can trigger hemolytic uremic syndrome, a form of thrombotic microangiopathy in children.
Shiga toxin–producing Escherichia coli)
(or Shiga toxin produced by Shigella)
Syndrome causes intrinsic renal disease via deposition of thrombi within glomerular capillaries in children
Labs reveal a BUN/Cr ratio of <20:1 and
UA reveals RBCs (schistocytes) and protein.
Hemolytic Uremic Syndrome
Labs indicate evidence of hemolysis (↓ haptoglobin, ↑ LDH, ↑ indirect/unconjugated bilirubin, ↑ reticulocytes) + schistocytes
The typical presentation is a preschooler who has had a **diarrheal illness ** for the past 5–10 days and presents with fatigue, pallor, petechiae
(thrombocytopenia), jaundice (hyperbilirubinemia), and impaired renal function (Hematuria, proteinuria, Oliguria)
Hemolytic Uremic Syndrome
Red/ Brown Urine with only 0-2 RBCs/hpf is NOT Hematuria. It is either Hemoglobinuria (obtain ___) or Myoglobinuria (obtain ___)
Hemoglobinuria (intravascular hemolysis)→ CBC
Myoglobinuria (Rhabdomyolysis) → Creatinine Kinase
In the setting of renal dysfunction, urine white blood cells and WBC casts suggest ____ s/t Analgesic nephropathy
(mcc: Aspirin, NSAID, or Tylenol use)
tubulointerstitial nephritis
History of chronic pain (headaches, lower back pain)
Urinalysis: WBCs & WBC casts ± mild proteinuria
Imaging: small kidneys ± papillary calcification & irregular contours
Diagnosis?
Analgesic nephropathy
UA shows Hematuria & urine RBCs if c/b papillary necrosis)
Analgesic nephropathy (tubulointerstitial nephritis) can be complicated by ___.
Renal Papillary Necrosis
Anion gap metabolic acidosis in a patient with altered mental status, sweet-smelling breath, envelope-shaped urinary crystals (eg, calcium oxalate crystals), and acute kidney injury is consistent with a toxic ingestion of ____.
ethylene glycol
Early:
CNS sedation & inebriation, + osmolar gap
Late:
anion gap metabolic acidosis, compensatory tachypnea
Ocular toxicity (____ toxicity)
Urine oxalate crystals, hypocalcemia, AKI (____ toxicity)
methanol (Ocular toxicity)
ethylene glycol (urine oxalate crystals)
Treatment for Ethylene Glycol or Methanol Toxicity
(3)
Fomepizole (inhibits ADHase) 1st Line
Ethanol solution (if no fomepizole)
IV sodium bicarbonate for acidemia (pH <7.3)
Hemodialysis for severe cases (end-organ damage)
_____: windshield wiper fluid, contaminated homemade liquor
____: automotive coolant/antifreeze, brake fluid
Industrial solvents & deicing solutions may contain either toxic alcohol
Methanol
Ethylene glycol
Patients with chronic obstructive pulmonary disease often have chronic CO2 retention, resulting in respiratory acidosis and compensatory metabolic alkalosis. Diuretics are often administered to treat cor pulmonale symptoms but must be used cautiously as they can lead to a reduction in cardiac output and subsequent development of prerenal acute renal injury.
EDIT
Hepatorenal syndrome is characterized by a decrease in glomerular filtration in the absence of other causes of renal dysfunction, minimal hematuria, and lack of improvement with volume resuscitation. It occurs due to splanchnic arterial dilation, decreased vascular resistance, and local renal vasoconstriction with decreased perfusion.
EDIT
What antibiotic can cause acute kidney injury in the form of toxic acute tubular necrosis?
Aminoglycosides (eg, amikacin)
Acute _____ toxicity is often triggered by impaired hepatic clearance of the drug and presents with hypertension and prerenal acute kidney injury.
calcineurin inhibitor (Taco)
