renal Flashcards
post strep glomerulonephritis (what happens, where, other symptoms)
- subepithelial immune complex deposits
- periorbital edema, dark urine, proteinuria
what do you think when you hear painless hematuria?
- transitional cell carcinoma of the bladder
- smoking, huge risk factor
ADPKD (what is is, how does it present, what is an important sequelae)
- autosomal dominant polycystic kidney disease
- multiple cysts of kidneys, pancreas, liver
- classic presentation is hematuria after trauma
- high risk for HTN and aneurysms in adults
what do WBC casts mean?
- acute pyelonephritis, typically due to ascending UTI (E.Coli)
- just WBC’s indicates lower urinary tract infection
- casts implies renal parenchymal involvement
- PMN’s are first cells around in acute inflammation
what keeps protein (and other negatively charged things) out of the glomerular filtrate?
- heparan sulfate, negatively charged
- loss of the heparin sulfate leads to proteinuria
what makes up the glomerular filtration barrier? (3 layers one coating)
- endothelial cells (fenestrated)
- glomerular basement membrane
- epithelial cells and their podocytes
- heparan sulfate coating
liddle syndrome
- genetic problem leading to constitutive activation of ENaC channels
- ENaC channels are normally activated by aldosterone
- leads to low renin/angiotensin, hypokalemia and HTN at an early age
berger’s disease
- IgA nephropathy, usually concurrent or a day or two after illness
- IgA deposits in the mesangium, causing nephritic syndrome
- hematuria during episodes is lifelong reality
BUN:Cr ratio (pre-renal, renal, post-renal)
- pre-renal: 20:1
- intrarenal: < 15:1
- post-renal: 15-20:1
prerenal azotemia (diagnosed by criteria involving 4 times)
- urine osmolarity > 500
- BUN:Cr >20
- FeNA< 20
kidney complication with chemo
- acute renal failure as cells die and lyse, dumping contents into the bloodstream, purines are metabolized to uric acid and when high levels reach kidney, can precipitate and cause damage
- tx: allopurinol
Wilms tumor (epidemiology, pathogenesis, genetics, associated issues (4))
- mutation on chromosome 11 resulting in deletion of WT1, tumor suppressor gene
- leads to Wilms tumor, most common renal malignancy of childhood
- WAGR complex: wilms, aniridia, genitourinary malformation, retardation
three features of hemolytic uremic syndrome
- anemia
- thrombocytopenia
- acute renal failure
angioedema
- mediated by bradykinin
- SE of ACE inhibitors (angiotensin II degrades kinins), when you suddenly block ACE, bradykinin builds
- increased vascular permeability–> facial edema
turner syndrome, associated renal defects (1 anatomical, leads to another)
- horseshoe kidney
- increases risk for Wilms tumor
horseshoe kidney (anatomic location and reason)
-stays low in the pelvis because as it tries to ascend, it runs into the inferior mesenteric artery
non anion gap (hyperchloremic) metabolic acidosis (three types)
- type 1, pH > 5.5, alpha intercalated cells don’t secrete H+ ions, HCO3- can’t be made
- type 2, defect in HCO3- reabsorption, leads to increased HCO3- excretion, hypoK
- type IV, some form of hypo-aldosterone (either production or resistance) or K sparing diuretics, leads to HYPER-K+ and resulting shifts of H+ into extracellular space
staghorn calculus
- UTI caused by urease producers
- proteus (most common), staph, klebsiella,
word association:
- RBC cast
- WBC cast
- Fatty cast
- Hyaline cast
- Epithelial cast
- nephritic syndrome
- pyelonephritis
- nephrotic syndrome
- NL (dehydration, concentrated urine, etc)
- ATN or toxic ingestion
atrial natriuretic peptide
-ANP released in response to atrial stretch (volume overload)
maple syrup urine disease
fill this out
crescentric glomerulonephritis (rapidly progressing, RPGN), name 3 causes and how to distinguish them…
- goodpastures- linear IgG
- granulomatosis with polyangiitis (wegners) - cANCA
- microscopic polyangiitis - pANCA
