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step 1 - path > renal > Flashcards

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
Q

findings in type I MPGN?

A

subendothelial IC deposits, granular IF

tram track on PAS/H&E due to GBM splitting

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26
Q

causes of type I MPGN?

A

HBV
HCV
idiopathic

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27
Q

findings in type II MPGN?

A

intramembranous IC deposits

dense deposits

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28
Q

causes of type II MPGN?

A

C3 nephritic factor –> stabilizes C3 convertase –> decreased C3 levels

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29
Q

mechanism of hypercoagulability in nephrotic syndrome?

A

loss of ATIII in urine

30
Q

LM findings in FSGS?

A

segmental sclerosis and hyalinosis

31
Q

IF findings in FSGS?

A

nonspecific

focal deposits of IgM, C3, C1

32
Q

EM findings in FSGS?

A

foot process effacement

33
Q

causes of FSGS?

A

MC nephrotic syndrome in AfAm, Hispanic
idiopathic or 2ary - HIV, sickle cell, heroin use

inconsistent steroid response

34
Q

LM/IF findings in MCD?

A

nada

35
Q

EM findings in MCD?

A

foot process effacement

36
Q

causes of MCD?

A

MC nephrotic syndrome in children
idiopathic, possible trigger by recent infection/immunization
RARE: 2/2 lymphoma

good steroid response

37
Q

LM findings in membranous nephropathy?

A

diffuse capillary and GBM thickening

38
Q

IF findings in membranous nephropathy?

A

granular - IC deposition

39
Q

EM findings in membranous nephropathy?

A

spike and dome - subepithelial deposits

40
Q

causes of membranous nephropathy?

A

MC nephrotic syndrome in Caucasians
idiopathic
2ary: drugs, HBV, HCV, SLE, tumors

poor steroid response

41
Q

LM findings in renal amyloid?

A

Congo red stain –> apple red birefringence

42
Q

LM findings in diabetic nephropathy?

A

mesangial expansion
GBM thickening
eosinophilic nodular glomerulosclerosis = Kimmelstiel Wilson lesions

43
Q

envelope or dumbbell shaped kidney stones?

A

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
Q

coffin shaped kidney stones?

A

struvite = NH4 Mg Ph
infx with urease + bugs
staghorn calculi
precipitate with alkaline pee

** tx: treat infection, surgical removal

45
Q

rhomboid or rosette shaped kidney stones?

A

uric acid
RADIOLUCENT - seen on CT, US
acidic pee favors precipitation
assoc with decreased urine vol, hyperuricemia, leukemia

** tx: alkalinization of urine, allopurinol

46
Q

hexagonal shaped kidney stones?

A

cystine
RADIOLUCENT
acidic pee favors precipitation
AR - defect in PCT transporter that reabsorbs cystine –> cystinuria

    • dx: sodium cyanide nitroprusside test
    • tx: alkalinize urine
47
Q

renal biopsy: polygonal clear cells filled with lipids and carbs?

A

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
Q

genetics of renal cell carcinoma?

A

deletion of RCC on chrom 3

either sporadic or assoc with VHL

49
Q

paraneoplastic syndromes of renal cell carcinoma?

A

EPO
ACTH
PTHrP

50
Q

renal biopsy: large eosinophilic cells, abundant mitochondria, no perinuclear clearing?

A

renal oncocytoma
benign epithelial cell tumor
painless hematuria, flank pain, abdominal mass

** often resected to r/o malignancy

51
Q

child with large palpable unilateral flank mass, +/- hematuria?

A

wilms tumor

loss of function mtn of WT1 or WT2 (chrom 11) - tumor suppressor

52
Q

Beckwith Wiedemann?

A

Wilms
macroglossia
organomegaly
hemihypertrophy

53
Q

WAGR?

A

Wilms
aniridia
GU malformation
mental retardation

54
Q

transitional cell carcinoma?

A

MC tumor of urinary system
painless hematuria

** phenacetin (NSAID), smoking, aniline dyes, cyclophosphamide

55
Q

risk factors for squamous cell ca of bladder?

A

Schistosomiasis
chronic cystitis
smoking
chronic nephrolithiasis

56
Q

kidney with coarse asymmetric corticomedullary scarring, blunted calyx; tubules containing eosinophilic casts?

A

chronic pyelo

usually requires predisposing factor

57
Q

diffuse cortical necrosis?

A

acute generalized cortical infarction of B/L kidneys
2/2 combo of DIC and vasospasm

** obstetric catastrophes, shock

58
Q

stages of ATN?

A

1) inciting event
2) maintenance: oliguria, risk of hyperK, met acidosis, uremia
3) recovery: polyuria, risk of hypoK

59
Q

which cells of kidney susceptible to ischemic injury?

A

PCT

thick ascending limb

60
Q

which cells of kidney susceptible to toxic substances?

A

PCT

61
Q

sudden gross hematuria and proteinuria?

A

renal papillary necrosis
may be triggered by recent infx or immune stimulus

** assoc with sickle cell, acute pyelo, NSAIDs, DM

62
Q

lab findings in prerenal azotemia?

A

FENa < 1%
increased BUN/Cr ratio (> 20)
UOsm > 500
UNa < 20

63
Q

lab findings in intrinsic renal failure?

A

FENa > 2%
decreased BUN/Cr ratio (< 15)
UOsm < 350
UNa > 40

64
Q

lab findings in postrenal azotemia?

A

FENa > 1% or > 2% if severe
UOsm < 350
UNa > 40

65
Q

signs/sx of uremia?

A 
nausea, anorexia
pericarditis
asterixis
encephalopathy
platelet dysfunction
66
Q

B/L enlarged kidneys with many cysts, flank pain, hematuria, HTN?

A

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
Q

infant with significant oliguric renal failure, possible Potter sequence in utero?

A

ARPKD
assoc with congenital hepatic fibrosis
systemic HTN, progressive renal insufficiency, portal HTN

68
Q

shrunken kidneys on US, progressive renal insufficiency with inability to concentrate urine?

A

medullary cystic kidney disease
inherited
tubulointerstitial fibrosis, medullary cysts
poor prognosis

69
Q

kidney cysts filled with ultrafiltrate?

A

simple cysts
anechoic on US
benign

70
Q

septated, enhanced, or solid kidney cysts?

A

complex

require f/u or removal to r/o renal cell carcinoma

step 1 - path (12 decks)

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