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renal Flashcards

1
Q

RBC casts?

A

glomerulonephritis

malignant HTN

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2
Q

WBC casts

A

tubulointerstitial
pyelo
transplant rejection

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3
Q

fatty casts?

A

nephrotic syndrome

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4
Q

muddy brown casts?

A

aka granular casts

ATN

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5
Q

waxy casts?

A

ESRD, CRF

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6
Q

hyaline casts?

A

concentrated urine

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7
Q

focal vs diffuse glomerular process?

A

under/over 50%

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8
Q

pathogenesis of nephritic syndrome?

A

GBM disruption

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9
Q

pathogenesis of nephrotic syndrome?

A

podocyte disruption –> charge barrier impaired

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10
Q

LM findings in post strep glomerulonephritis?

A

hypercellular enlarged glomeruli

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11
Q

IF findings in post strep glomerulonephritis?

A

starry sky granular appearance - lumpy bumpy

IgG, IgM, C3 deposition in GBM and mesangium

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12
Q

EM findings in post strep glomerulonephritis?

A

subepithelial immune complex humps

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13
Q

what kind of reaction is post strep glomerulonephritis?

A

type III hypersensitivity

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14
Q

LM/IF findings in RPGN?

A

crescents!

consist of fibrin, plasma proteins (C3b), glomerular parietal cells, monocytes, macrophages

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15
Q

dz that cause RPGN?

A 
Goodpasture (type II hypersensitivity; anti GBM and alveolar Abs)
Wegeners (c-ANCA)
microscopic polyangiitis (p ANCA)
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16
Q

LM findings in DPGN?

A

wire looping of capillaries

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17
Q

IF findings in DPGN?

A

granular

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18
Q

EM findings in DPGN?

A

subendothelial IgG based immune complexes

often with C3 deposition

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19
Q

cause of DPGN?

A

SLE (MCC of death)
MPGN

** often copresents as nephrotic syndrome

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20
Q

LM findings in IgA nephropathy?

A

mesangial proliferation

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21
Q

IF findings in IgA nephropathy?

A

IgA based IC deposits in mesangium

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22
Q

EM findings in IgA nephropathy?

A

mesangial IC deposits

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23
Q

presentation of IgA nephropathy?

A

renal insufficiency or acute gastro
episodic hematuria with RBC casts

** same pathology as HSP

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24
Q

can’t see, can’t pee, can’t hear a bee?

A

Alport - XL mtn in type IV collagen

thinning and splitting of GBM = basket weave on EM

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25
findings in type I MPGN?
subendothelial IC deposits, granular IF | tram track on PAS/H&E due to GBM splitting
26
causes of type I MPGN?
HBV HCV idiopathic
27
findings in type II MPGN?
intramembranous IC deposits | dense deposits
28
causes of type II MPGN?
C3 nephritic factor --> stabilizes C3 convertase --> decreased C3 levels
29
mechanism of hypercoagulability in nephrotic syndrome?
loss of ATIII in urine
30
LM findings in FSGS?
segmental sclerosis and hyalinosis
31
IF findings in FSGS?
nonspecific | focal deposits of IgM, C3, C1
32
EM findings in FSGS?
foot process effacement
33
causes of FSGS?
MC nephrotic syndrome in AfAm, Hispanic idiopathic or 2ary - HIV, sickle cell, heroin use inconsistent steroid response
34
LM/IF findings in MCD?
nada
35
EM findings in MCD?
foot process effacement
36
causes of MCD?
MC nephrotic syndrome in children idiopathic, possible trigger by recent infection/immunization RARE: 2/2 lymphoma good steroid response
37
LM findings in membranous nephropathy?
diffuse capillary and GBM thickening
38
IF findings in membranous nephropathy?
granular - IC deposition
39
EM findings in membranous nephropathy?
spike and dome - subepithelial deposits
40
causes of membranous nephropathy?
MC nephrotic syndrome in Caucasians idiopathic 2ary: drugs, HBV, HCV, SLE, tumors poor steroid response
41
LM findings in renal amyloid?
Congo red stain --> apple red birefringence
42
LM findings in diabetic nephropathy?
mesangial expansion GBM thickening eosinophilic nodular glomerulosclerosis = Kimmelstiel Wilson lesions
43
envelope or dumbbell shaped kidney stones?
calcium! (phosphate or oxalate) alkaline pee favors phosphate, acidic pee favors oxalate ethylene glycol, vit C, hypocitraturia, malabsorption --> oxalate stones ** tx: hydration, thiazides, citrate
44
coffin shaped kidney stones?
struvite = NH4 Mg Ph infx with urease + bugs staghorn calculi precipitate with alkaline pee ** tx: treat infection, surgical removal
45
rhomboid or rosette shaped kidney stones?
uric acid RADIOLUCENT - seen on CT, US acidic pee favors precipitation assoc with decreased urine vol, hyperuricemia, leukemia ** tx: alkalinization of urine, allopurinol
46
hexagonal shaped kidney stones?
cystine RADIOLUCENT acidic pee favors precipitation AR - defect in PCT transporter that reabsorbs cystine --> cystinuria * * dx: sodium cyanide nitroprusside test * * tx: alkalinize urine
47
renal biopsy: polygonal clear cells filled with lipids and carbs?
renal cell carcinoma originates from PCT cells increased in smoking, obesity, older men hematuria, palpable mass, flank pain, 2ary polycythemia * * invades renal vein --> IVC --> hematogenous spread * * resistant to chemo or rads
48
genetics of renal cell carcinoma?
deletion of RCC on chrom 3 | either sporadic or assoc with VHL
49
paraneoplastic syndromes of renal cell carcinoma?
EPO ACTH PTHrP
50
renal biopsy: large eosinophilic cells, abundant mitochondria, no perinuclear clearing?
renal oncocytoma benign epithelial cell tumor painless hematuria, flank pain, abdominal mass ** often resected to r/o malignancy
51
child with large palpable unilateral flank mass, +/- hematuria?
wilms tumor | loss of function mtn of WT1 or WT2 (chrom 11) - tumor suppressor
52
Beckwith Wiedemann?
Wilms macroglossia organomegaly hemihypertrophy
53
WAGR?
Wilms aniridia GU malformation mental retardation
54
transitional cell carcinoma?
MC tumor of urinary system painless hematuria ** phenacetin (NSAID), smoking, aniline dyes, cyclophosphamide
55
risk factors for squamous cell ca of bladder?
Schistosomiasis chronic cystitis smoking chronic nephrolithiasis
56
kidney with coarse asymmetric corticomedullary scarring, blunted calyx; tubules containing eosinophilic casts?
chronic pyelo | usually requires predisposing factor
57
diffuse cortical necrosis?
acute generalized cortical infarction of B/L kidneys 2/2 combo of DIC and vasospasm ** obstetric catastrophes, shock
58
stages of ATN?
1) inciting event 2) maintenance: oliguria, risk of hyperK, met acidosis, uremia 3) recovery: polyuria, risk of hypoK
59
which cells of kidney susceptible to ischemic injury?
PCT | thick ascending limb
60
which cells of kidney susceptible to toxic substances?
PCT
61
sudden gross hematuria and proteinuria?
renal papillary necrosis may be triggered by recent infx or immune stimulus ** assoc with sickle cell, acute pyelo, NSAIDs, DM
62
lab findings in prerenal azotemia?
FENa < 1% increased BUN/Cr ratio (> 20) UOsm > 500 UNa < 20
63
lab findings in intrinsic renal failure?
FENa > 2% decreased BUN/Cr ratio (< 15) UOsm < 350 UNa > 40
64
lab findings in postrenal azotemia?
FENa > 1% or > 2% if severe UOsm < 350 UNa > 40
65
signs/sx of uremia?
``` nausea, anorexia pericarditis asterixis encephalopathy platelet dysfunction ```
66
B/L enlarged kidneys with many cysts, flank pain, hematuria, HTN?
ADPKD - mtn in PKD1 (chrom 16) or PKD2 (chrom 4) death from CKD complications or HTN ** assoc with berry aneurysms, MVP, benign hepatic cysts
67
infant with significant oliguric renal failure, possible Potter sequence in utero?
ARPKD assoc with congenital hepatic fibrosis systemic HTN, progressive renal insufficiency, portal HTN
68
shrunken kidneys on US, progressive renal insufficiency with inability to concentrate urine?
medullary cystic kidney disease inherited tubulointerstitial fibrosis, medullary cysts poor prognosis
69
kidney cysts filled with ultrafiltrate?
simple cysts anechoic on US benign
70
septated, enhanced, or solid kidney cysts?
complex | require f/u or removal to r/o renal cell carcinoma

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