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Renal Flashcards

1
Q

horseshoe kidney

A

normal ascension will be blocked

kidney will be located abnormally low - stuck on root of IMA

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2
Q

oligohydramnios due to?
complications?
what “sequence” occurs? due to oligohydramnios

A

bilateral agenesis
lung hypoplasia
flat face w/ low set ears, extremity defects (Potter sequence)

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3
Q

dysplastic kidney
what’s the risk of developing the same in a subsequent pregnancy?
unilateral/bilateral?

A

noninherited malformation of parenchyma characterized by abnormal tissue (cartilage)
on exams: BILATERAL (b/c then must distinguish btw inherited PKD)

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4
Q

PKD

A

inherited
bilateral enlarged kidneys
cysts in cortex/medulla

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5
Q

ADPKD (assoc w?)

ARPKD (assoc w?)

A

ADPKD: young adults, HTN, hematuria, renal failure, APKD1/APKD2, inc renin
berry aneurysm, hepatic cysts, MVP

ARPKD: infants, renal failure and HTN, Potter sequence
hepatic fibrosis/hepatic cysts (will see portal HTN)

*INFANT w portal HTN –> think ARPKD

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6
Q

medullary cystic kidney disease

A

inherited dominant
cysts are in medullary CDs
fibrosis –> shrunken kidneys

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7
Q

hallmark of acute renal failure?

A

azotemia w/oliguria

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8
Q

prerenal injury

A

BUN/Cr >15 (bc RAAS activated and BUN reabs inc)

FENa 500

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9
Q

postrenal injury

early v late phase

A

BUN/Cr >15 (bc RAAS activated and BUN reabs inc)
FENa 500

late: BUN/Cr 2%, osm <500

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10
Q

ATN

what do you see on histo?

A

dirty brown, granular casts
necrotic cells plug tubules, dec GFR
cells lose nuclei and detach from BM
BUN/Cr 2%, osm <500

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11
Q

ischemic ATN

which tubules are particularly susceptible?

A

PT and medullary segment of TAL

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12
Q

causes of toxic ATN
*HAREM U
what else will you see?

A 
heavy metals
aminoglycosides
radiocontrast
ethylene glycol
myoglobinuria
urate (tumor lysis)

hyperkalemia with AGMA

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13
Q

when ATN reversed, oliguria continues for?

A

2-3 weeks

PT cells are stable cells (need time to regenerate)

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14
Q 
AIN
what agents can cause this?
what on histo?
presentation?
may progress to?
A 
drug-induced HSR resulting in ARF
NSAIDS/PEN/diuretics
inflammatory infiltrate in interstitium
tubules look normal
oliguria, fever, rash, EOS in urine, resolves after stopping drug
renal papillary necrosis
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15
Q

renal papillary necrosis
presentation?
causative agents? (4)

A

gross hematuria and flank pain
long term phenacetin/aspirin use
diabetes, sickle cell, acute pyelonephritis

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16
Q

nephrotic syndrome

A 
>3.5g protein
hypoalbuminemia
hypogammaglobulinemia
hypercoagulable state (AT3)
hyperlipidemia/cholesterolemia
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17
Q

MCD
what causes damage?
findings?

A 
most common cause of Nephrotic in children, usually idiopathic
can be assoc w Hodgkin's lymphoma
cytokines --> podocytes
normal glomeruli on H&E
EM: effacement of foot processes
No immune complex deposits
Negative IF
responsive to steroids
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18
Q

FSGS

most common in whom? (2)

A 
hispanics/af-am's
idiopathic, *HIV*, heroin, sickle cell
no immune complxs, negative IF
effacement of foot processes
poor response to steroids
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19
Q

HIV/sickle cell pt who develops nephrotic syndrome?

A

FSGS

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20
Q

membranous nephropathy
most common in whom?
see what?

A 
caucasian adults
HEP B/C, tumors, SLE, drugs
thick BM on H&E
immune deposition (granular IF)
sub epithelial "spike & dome" on EM
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21
Q

SLE pt develops which nephrotic syndrome?

A

membranous nephropathy

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22
Q

MPGN
type 1 (cause, assoc?)
type 2
nephritic nephrotic or both?

A

thick capillary membranes on H&E
“tram-track” appearance
immune-complex deposition (granular on IF)

type 1: subendothelial (hep B/C), more often assoc w tram-tracks

type 2: deposition of IC’s in BM, C3 nephritic factor that stabilizes C3 convertase, so more C3 around –> inflammation + damage

all of the above!

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23
Q

diabetes
which vessel affected most?
tx?
hallmark pathognomonic finding?

A

high serum glucose –> NEG of BM –> hyaline arteriolosclerosis –> nephrotic –> sclerosis of mesangium and formation of K-W nodules
efferent more affected than afferent (up GFR

tx: ACEi slow hyperfiltration damage

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24
Q

systemic amyloidosis
most common organ?
amyloid deposits where?

A

kidney most commonly involved
mesangium –> nephrotic
apple-green on polarized

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25
nephritic syndrome | what seen on biopsy?
protein s
26
PSGN virulence factor? presentation? hallmark on EM?
``` GBS in kids M protein hematuria (cola-color), oliguria, HTN, periorbital edema granular on IF antigen-ab complexes sub-endothelially hallmark: subepithelial hump on EM rarely progresses most common renal disease in SLE ```
27
RPGN | what seen on biopsy?
seen in adults | on biopsy: crescents composed of FIBRIN and MP's (not collagen)**
28
3 conditions with negative IF (pauci-immune)
Wegener Microscopic polyangiitis Churg-Strauss
29
knee-jerk on boards for Goodpasture's BUT with sinus infections/sinusitis
not good pastures but WEGENERS linear IF for GP C-ANCA with Wegener (no IF)
30
P-ANCA
either microscopic polyangiitis | or Churg-Strauss
31
3 things to distinguish Churg-Strauss from MP?
granulomatous inflammation eosinophillia asthma
32
IgA nephropathy
``` mesangial deposition of IgA following mucosal infections childhood RBC casts slowly progresses to failure after multiple bouts w infections ```
33
Allport syndrome | what other two sx?
type IV collagen thinning of BM only hematuria can have hearing loss and ocular disturbances
34
cystitis sx? labs? gold std?**
``` inflammation of the bladder dysuria frequency/urgency/suprapubic pain no systemic signs cloudy urine w >10 WBCs/hpf, +LE, nitrites, **>100k colony FU's on culture** ```
35
UTI etiology
E. coli, S. saprophyticus, klebsiella, proteus, E. faecalis
36
sterile pyuria (w negative culture)
think urethritis | Chlamydia, Neisseria gonorrhoeae
37
``` pyelonephritis risk inc w? what sx? UA looks like? most common bugs? ```
risk w vesicoureteral reflux fever, flank pain, WBC casts, leudocytosis E. coli, klebsiella, E. faecalis
38
chronic pyelonephritis
``` could be malformation of ureter cortical scarring (upper and lower poles, which is char of vesiculouretal reflux) and blunting of calyces ```
39
atrophic tubules containing eosinophilic proteinacious material see what in urine?
thyroidization of the kidney | waxy casts
40
colicky pain w hematuria and unilateral flank tenderness
kidney stone presentation
41
CaOx, CaP seen w which disease? tx?
exclude hypercalcemia check for idiopathic hypercalcuria Crohns hydrochlorothiazide
42
second most common results in stag horn caliculus tx?
ammonium Mg P stone infection w urease bugs (kleb, proteus) organism and surgical removal
43
3rd most common stone that is radiolucent, not seen on CxR most common in pts w/ what conditions? tx?
hot arid climates, low urine, acidic pH gout, hyperuricemia (leukemia/myeloproliferative) hydration, alkalinization, allopurinol
44
cysteine stones defect in kids? tx?
can cause nephrolithiasis in kids staghorn caliculi cystinuria --> genetic defect results in decreased cysteine reabsorption hydration/alkalinization
45
staghorn caliculi in adults? | staghorn caliculi in kids?
Ammonium Mg P | Cysteine
46
most common causes of ESRD (3)?
diabetes HTN glomerular disease
47
sx of uremia?
nausea, anorexia, pericarditis, plt dysfxn, encephalopathy w asterixis, urea crystals in skin
48
features of ESRD
salt/water retention --> HTN hyperkalemia NAGMA --> AGMA (cannot excrete organic acids) anemia hypocalcemia renal osteodystrophy (OFC, osteomalacia, osteoporosis)
49
EPO produced by which cells?
renal peritubular interstitial cells
50
osteomalacia
when blasts lay down osteoid that cannot be calcified due to lack of calcium
51
cysts that develop on shrunken kidneys on dialysis?
ESRD pts, not PKD
52
patients on dialysis have an increased risk for what in their shrunken kidneys?
renal cell carcinoma
53
angiomyolipoma composed of? | increased frequency with which condition?
blood vessels, adipose, smooth muscle | tuberous sclerosis
54
renal cell carcinoma classic presenting triad? gross exam reveals? most common variant?
malignant epithelial tumor arising from the kidney tubules Hematuria, palpable mass, flank pain also fever, wt loss, paraneoplastic (EPO, renin, PTHrP, ACTH) yellow mass clear cell (clear cytoplasm)
55
may present with left -sided varicocele
renal cell carcinoma
56
pathogenesis of renal cell carcinoma | what is lost? then increased what?
loss of VHL (3p) suppressor gene increased IGF-1 increased HIF --> VEGF/PDGF
57
sporadic renal cell carcinoma? who? | hereditary renal cell? who?
single tumor at upper pole of kidney --> adult smokers multiple/bilateral tumors younger pts
58
VHL disease
dominant disorder inactivation of VHL gene inc risk of hemangioblastoma of cerebellum and RCC
59
T & N of renal tumor staging
T: size/involvement of renal vein N: retroperitoneal nodes
60
Wilms tumor seen in who? comprised of? presentation?
WT1 mutation malignant, common in kids (~3) blastema, primitive glomeruli/tubules/stromal cells large unilateral flank mass w/ hematuria and HTN (renin)
61
WAGR Syndrome
Wilms tumor Aniridia Genital abnormalities Retardation (mental/motor)
62
Beckwith-Wiedemann syndrome
Wilms tumor Neonatal hypoglycemia Muscular hemihypertrophy Organomegaly (e.g. tongue)
63
urothelial carcinoma risk factors? presentation?
malignant via lining of renal most common type pelvis, ureter, bladder (most common), urethra RF: cigarrettes (PAHs), naphtylamine, azo dyes, cyclophosphamide, phenacetin painless hematuria two pathways: flat (high grade --> invades, early p53 mutations), papillary (low grade --> HG --> invades)
64
field defect
entire urothelium has been hit with carcinogens, so multiple tumors can develop/recur
65
squamous cell carcinoma
malignant bladder must first develop squamous metaplasia RF: chronic cystitis, schistosoma hematobium, long-standing nephrolithiasis common theme: irritation/inflammation of urothelium --> squamous metaplasia
66
adenocarcinoma
malignant glands/bladder urachal remnant (fetal bladder to yolk sac; this cancer would be found at the DOME OF THE BLADDER), cystitis gladularis (chronic inflammation --> columnar metaplasia), exstrophy (failure to form lower portion of bladder wall/abdomen, exposing bladder to outside world)

Pathoma (5 decks)

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