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Pathophys > Renal 3 > Flashcards

Renal 3 Flashcards

1
Q

3 causes/triggers of dz for disorders of glomerular function

A

immunologic, nonimmunologic, or hereditary

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2
Q

3 names for glomerular diseases

A

proliferative, membranous, or sclerotic

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3
Q

what is the third leading cause of end stage kidney failure worldwide?

A

glomerulonephritis

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4
Q

what is glomerulonephritis?

A

inflammatory process involving the glomerular structures

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5
Q

two types of conditions OF glomerulonephritis

A

primary- glomerular abnormality is the only disease present

secondary- glomerular abnormality results from another dz (such as DM or SLE)

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6
Q

what type of syndrome is diffuse proliferative glomerulonephritis?

A

nephrITIC; mesangial/endothelial cell proliferation and large, irregularly spaced sub-epithelial deposits (“lumpy bumpy”)

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7
Q

what type of syndrome is membranous glomerulopathy? what is seen on microscopy?

A

nephrOTIC; thickening of GBM and small, evenly spaced sub epithelial deposits (“fine granularity”)

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8
Q

five glomerular syndromes

A

1) . acute nephritic syndrome
2) . rapidly progressive glomerulonephritis
3) . nephrotic syndrome
4) . asymptomatic disorders of urinary sediment (hematuria, proteinuria)
5) . chronic glomerulonephritis

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9
Q

what is acute nephritic syndrome?

A

acute proliferative inflammation that occludes the glomerular capillary lumen and damages capillary wall

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10
Q

what does acute nephritic syndrome present as? (4)

A

sudden onset hematuria, positive for RBC casts or dysmorphic RBCs, tea colored urine, salt and water retention causing edema or HTN

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11
Q

what disease is most common after group A beta hemolytic strep infection?

A

post infectious glomerulonephritis

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12
Q

interventions to prevent or slow progression of CKD (3)

A

1) . target BP less than 140/90 (130/90 if DM or proteinuria)
2) . A1C target of 7% with T2DM
3) . CKD stage 4 & 5: reduced protein intake might reduce risk of death

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13
Q

tx of CKD comorbidities (2- anemia and CVD)

A

1) . consider ESA to tx anemia with target Hb levels > 12

2) . prevent/tx CVD with statin and asp therapy

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14
Q

which two drugs should you reduce dose by 50% when GFR < 30 in CKD?

A

fluoroquilolones and trimethoprim

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15
Q

ACE/ARB for CKD: start at lower dose with GFR < ____, and assess _____ and _____ 1 week after starting

A

45; GFR and K+

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16
Q

NSAIDS for CKD: avoid GFR < _____ and avoid prolonged therapy when GFR < ______

A

30; 60

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17
Q

metformin for CKD: review use when GFR is less than ____ and avoid when GFR is less than ____

A

45; 30

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18
Q

med adjustments for CKD: may dec insulin when GFR < _____; adjust gabapentin when GFR < ____

A

30; 60

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19
Q

when using warfarin in a CKD pt, there is an increased risk of what when GFR < 30?

A

bleeding

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20
Q

post infectious glomerulonephritis: most common in ___________, characterized by _____ infection; tx with _____ to help infection; excellent ______ and ______ causes KD; kids resolve within ___-____ weeks, adults take a bit _____

A

children; strep; ABX; prognosis rarely; 6-8 weeks; longer

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21
Q

rapidly progressive glomerulonephritis: presents with progression of _____ _____ over ____ to _____, in most cases in the context of _______ ___________

A

renal failure; days to weeks; NEPHRITIC PRESENTATION

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22
Q

rapidly progressive glomerulonephritis is also called: _____________ _____________. why?

A

crescentic glomerulonephritis, bc pathologic findings of glomerular crescent formation

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23
Q

rapidly progressive glomerulonephritis does not have a _______. if left _____, it rapidly progresses to ______ ______ ______ and ____ within a few months

A

cause; untreated; acute renal failure; death

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24
Q

Good pasture syndrome is associated with what disease? what is GPS?

A

rapidly progressive glomerulonephritis; its when antibodies attack the glomeruli basement membranes

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25
Q

GPS’s staining hallmark is what? what might these pts present with?

A

diffuse (smooth) linear staining of glomerular BM’s for IgG; present with coughing up blood

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26
Q

characteristics of nephrotic syndrome (4)

A

1) . nephrotic range proteinuria: >3.5g/day in adults
2) . hypoalbuminemia (<3)
3) . hyperlipidemia
4) . lipiduria: free fat, urine foam, fatty casts, oval bodies

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27
Q

Nephrotic syndrome is NOT a specific ______________ disease, but a constellation of clinical findings that results from what two things?

A

glomerular; loss of plasma proteins and inc in glomerular permeability

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28
Q

pts with nephrotic syndrome are at an increased risk of what? it develops as a ______ or ________ disorder

A

thrombotic complications; primary or secondary

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29
Q

nephrITIC: 5 things
nephrotic: 3 things

A

ITIC: inflammatory, hematuria, edema, HTN, lower degree of proteinuria (<3.5g in 24 hrs)
OTIC: noninflammatory, protein >3.5g, increased lipids in blood and urine

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30
Q

two asymptomatic disorders of urinary sediment

A

Alport syndrome and IgA nephropathy

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31
Q

pts with asymptomatic disorders of urinary sediment present with what two asymptomatic things?

A

hematuria and/or proteinuria

32
Q

what is IgA nephropathy? what does this lead to? what syndrome is it a form of?

A

presence of glomerular IgA immune complex deposits in mesangial cells of glomerulus; leads to damage in the basement membrane, which allows blood and proteins to pass through; form of nephritic syndrome

33
Q

tx for IgA nephropathy

A

no great tx’s

34
Q

what is Alport syndrome?

A

hereditary defect of GBM which results in hematuria and might progress to chronic renal failure

35
Q

Alport syndrome: _____ are more commonly affected and typically progress to _______ ________ as adults

A

men; renal failure

36
Q

how to dx Alport syndrome

A

made by UA of a child who comes from a family of Alport syndrome (maybe microscopic hematuria/proteinuria)

37
Q

most Alport syndrome pts have _________ _______ and _____ diseases

A

sensorineural deafness and eye dz

38
Q

tx for Alport syndrome

A

ACEI for pts with proteinuria. maybe ARB and statin

those with CRF, transplant

39
Q

chronic glomerulonephritis is characterized by ______ kidneys with __________ glomeruli. develops _________ and has _______ __________; slowly progresses to ________ _________

A

small; sclerosed; insidiously; PERSISTENT PROTEINURIA; kidney disease

40
Q

what are three types of glomerular lesions associated with systemic dz?

A

systemic lupus erythematous glomerulonephritis, diabetic glomerulosclerosis, and hypertensive glomerular dz

41
Q

systemic lupus erythematous glomerulonephritis is ____________ ______________; _______ disease is the most common complication. these pts will need _____ ______ and routine UAs if anything is abnormal. Tx is _____ and _____

A

tubulointerstitial inflammation; renal disease; RENAL BIOPSIES; steroids and ACEIs

42
Q

diabetic glomerulosclerosis: look for ______________. tx: control ________, start _____ and ______

A

MICROALBUMINURIA (30-300 mg in 24 hrs); glucose, ACEI and ARBs

43
Q

Hypertensive Glomerular Dz: mild to moderate HTN causes ______ changes in renal arterioles and small arteries….this leads to what? tx are what meds?

A

sclerotic; leads to poor perfusion of kidneys’ lower BP, ACEI/ARBs

44
Q

IgA Nephropathy is what type of syndrome?

A

nephritic

45
Q

acute tubular necrosis: death of _______ _________ cells in the renal tubules. presents with ______ ________ ______ and is one of the most common causes of ________ AKI (85%)

A

tubular epithelial; acute renal failure; intrinsic

46
Q

two common causes of ATN

A

hypotension with ischemia and use of nephrotoxic drugs

47
Q

ATN: presence of “________ _______ _______”. BUN/Cr will be less than ____ and urine Na will be less than _____

A

MUDDY BROWN CASTS; 20, 40

48
Q

management of ATN relies on aggressive tx of factors that ___________ ATN; overall prognosis is ______ if the cause is corrected. recovery within ___-____ days

A

precipitated; good; 7-21 days

49
Q

acute pyelonephritis (APN): _______ infection of the ______ urinary tract. most common by ______, ____, _________ and __________

A

bacterial; upper; causes by E coli, Klebsiella, Enterobacter, pseudomonas

50
Q

APN: kidneys can become infected via what two ways?

A

ascending infection from lower urinary tract or through blood stream

51
Q

APN: _____ onset of infection with _____, _____, constant ache in the ______, _____ pain, positive _____ tenderness

A

acute; chills, fever, flank; abdominal; CVA

52
Q

diagnosis of APN: positive ____, ____ elevated, CT indicates what

A

pos UA, WBC elevated, pyelo +/- abscess

53
Q

what two pt populations ALWAYS get admitted for APN?

A

pregnant women and kids

54
Q

chronic pyelonephritis: scarring and deformation of renal ______ and _______, along with ____ of the overlying cortex

A

calyces and pelvis; atrophy

55
Q

chronic pyelonephritis involves a ______ or ________ bacterial infection superimposed on _____, ___ _____, or both

A

recurrent or persistent; UTI, urine reflex

56
Q

chronic pyelonephritis: involves one or both sides? what is tx?

A

can be bilateral; tx: determine the source and tx, ABX

57
Q

what four drugs can cause ACUTE PRERENAL FAILURE?

A

1) . diuretics
2) . IV dye
3) . immunosuppressive drugs (tacro/cyclosporine)
4) . NSAIDS

58
Q

acute drug-related hypersensitivity reactions produce _________ ________. associated with what drugs? (4) ____% of the time, pt has a rash

A

tubulointerstitial nephritis; sulfa, methicillin, beta lactams. Lasix/thiazides; 25%

59
Q

chronic analgesia nephritis is associated with _____ ____

A

analgesic abuse (pain killers)

60
Q

ARF is caused by _______ _____ use, especially _______ or _____

A

illicit drug use; cocaine or NSAIDs

61
Q

what are the three cystic diseases of the kidney?

A

1) . polycystic kidney dz (ADPKD or ARPKD)
2) . nephronophthisis- Medullary cystic disease complex
3) . simple and acquired renal cysts

62
Q

PKD is an ________ disorder with many cyst sacs or segments in the _______ structures of the kidney

A

inherited; tubular

63
Q

ADPKD: _____ common, appears when pt is an _____, ___-___% of pts have an associated aneurysm; ____ is preferred method for diagnosis

A

most; adult; 10-30%; US

64
Q

tx for ADPKD

A

supportive: control HTN and UTI prevention, pain control (dialysis/transplant for those to progress to renal failure)

65
Q

ARPKD: cystic _____ of the ______ and _________ collecting tubules. this disease is ____

A

dilation; cortical and medullary; rare

66
Q

ARPKD: infant presents with bilateral ______ _____, severe _____ failure, ______ fibrosis, impaired _____ development. ____ ______ may be present

A

flank masses; renal; liver; lung; potter facies

67
Q

ARPKD: ___% of infants die during the perinatal period

A

75%

68
Q

tx of ARPKD

A

supportive, aggressive ventilator support, renal transplant

69
Q

nephronophthisis- Medullary cystic disease complex: group of ________ ______ and ________ disorders with _______ onset

A

autosomal dominant and recessive; childhood

70
Q

what happens to the kidneys in nephronophthisis- Medullary cystic disease complex? what is present on the kidneys?

A

small and shrunken, presence of numerous cysts at corticomedullary junction

71
Q

progression of dz in what happens to the kidneys in nephronophthisis

A

progress to azotemia (high levels of nitrogen compounds in the blood) and renal failure within 5-10 yrs

72
Q

simple cysts: single or _______, unilateral or ______, confined to the _____. if symptomatic, they can cause _____ pain, hematuria, infection. common in people

A

multiple, bilateral; cortex; flank; 50 yrs

73
Q

acquired cysts: forms in people with ____ who have undergone prolonged _____ tx

A

CKD; dialysis

74
Q

acquired cysts are typically _____, but may have cysts that ______, causing ____. what might develop in the walls of the cysts?

A

asymptomatic; bleed, causing hematuria; tumors might develop in the walls

75
Q

what type of syndrome is FSGS? _____ urine due to ____ levels of protein; ____ and chronic _____ impairment

A

nephrOTIC; foamy; high; HTN and chronic renal impairment

76
Q

microscopy for FSGS shows what?

A

focal and segmental glomerular sclerosis

Pathophys (13 decks)

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