Renal Flashcards
Rash, abd pain, arthralgia, GN
Henoch-Scholein Purpura
gross hematuria 1-2 days post URI-onset, proteinuria
IgA nephropathy/Berger’s dz
most common systemic vasculitis in kids
HSP
1-3 weeks post-strep infection, + ASO titers
Poststreptococcal GN
lab finding in lupus
Anti-dsDNA Abs
GN w/ ENT manifestations
Granulomatosis w/ polyangiitis
systemic, ANCA-associated small vessel vasculitis
expected biopsy finding?
Pauci-immune GN
absence of immune deposits on biopsy
necrotizing granulomatous infection in lower & upper resp. tract, GN
Granulomatosis w/ polyangiitis (Wegener’s)
pulm. hemorrhage & GN
Anti-GBM GN
circulating autoantibodies directed at the GBM manifestations?
pulmonary hemorrhage & GN
Anti-GBM GN tx? (2)
plasmapheresis
immunosuppression
segmental transmural inflammation of muscular aa.
Polyarteritis nodosa
ANCA-, lung sparing, no RBC casts
Polyarteritis nodosa
ANCA+, no granuloma formation, small vessel vasculitis, multiorgan involvement
microscopic polyangiitis (MPA)
eosinophil-rich granulomatous inflammation & vasculitis
EGPA/Churg-Strauss
pauci-immune GN assoc. w/ hx asthma &/or eosinophilia
EGPA/Churg-Strauss
3 phases of EGPA
Prodrome (atopic disease)
Eosinophilic Phase
Vasculitic phase
IgA deposits affecting small vessels in kids
HSP
PE findings for glomerulonephritis (3)
HTN
periorbital edema
sacral edema
drug tx for glomerulonephritis (3)
ACE-i or ARB
corticosteroids
cytotoxic agents
polyarteritis nodosa complication
infarction
multiple cysts on kidneys bilaterally
PCKD
volume depletion in pts leads to which AKI etiology
inadequate perfusion
causes of pre-renal AKI (broad-2)
true: bleeding out, GI loss, DKA, burns
effective: low CO, sepsis
drugs that can affect pre-renal AKI (2)
NSAIDs
ACE-i/ARBs
pathognomonic of tubular injury
muddy brown casts
severity: Risk in AKI
Cr increase x 1.5 or GFR decreased by >25%
UO < 0.5 ml/kg/hr x 6 hr
severity: Injury in AKI
increased Cr x 2 or decreased GFR > 50%
UO < 0.5 ml/kg/hr x 12 hour
severity: Failure in AKI
increased Cr x 3 or decreased GFR > 75%
UO < 0.3 ml/kg/hr x 24 h
or anuria x 12 hours
severity: Loss in AKD
persistent acute renal failure x 4 weeks
how to prevent contrast nephropathy (3)
hydration
acetylcysteine
bicarb
tubular epithelial cell toxicity & renal medullary ischemia in AKI could indicate
Contrast nephropathy
FENa for pre-renal disease
<1%
FENa for intrarenal disease
> 3%
Post-renal AKI is?
obstruction
eosinophils w/ decreased GFR indicates
acute interstitial nephritis
normal serum Cr
0.5 - 1.2
normal BUN
10-20
normal PSA
< 4ng/mL
CKD duration
30 or more mo.
Stage 1 CKD
GFR > 90 w/ persistent albuminuria
Stage 2 CKD
GFR 60-89 w/ persistent albuminuria
Stage 3 CKD
GFR 30-59
Stage 4
GFR 15-29
Stage 5 CKD
GFR <15 or dialysis
nephrotoxic medications? (4)
aminoglycosides
Amphotericin B
Cisplatin
Contrast
causes of ischemic AKI? (2)
hypotension
Sepsis
causes of intrarenal AKI (4)
glomerular
interstitial
vascular
tubular
small bilateral kidneys indicates?
CKD
indications for dialysis (5)
Acid-base disturbance Electrolyte abn (hyperkalemia w/ EKG changes) Ingested toxins Overload refractory to diuretics Uremia (AMS, seizure, pericarditis)
complications of AKI (5)
hyperkalemia hypocalcemia hyperphosphatemia metabolic acidosis uremia
first line of CKD
ACE-i/ARBs
causes of CKD (5)
DM HTN glomerular disease PKD chronic tubulointerstitial disorders
dialysis indicated at what GFR
< 30
dialysis complications (4)
hypotension
dialysis disequilibrium syndrome
arrhythmias
clotting/bleeding
refer to nephrology at what stage kidney disease
stage 4
GFR < 30
chronic tubulointerstitial disorders (4 things)
kidney size is small/contracted
decreased urinary concentrating ability
hyperchloremic metabolic acidosis
reduced GFR
3 chronic tubulointerstitial disorders
obstructive uropathy
reflux nephropathy
analgesic nephropathy
nephrotic syndrome
non-inflammatory damage to the glomerular capillary wall
proteinuria (>3.5 g/dl), hypoalbuminemia, edema, hyperlipidemia, lipiduria
nephrotic syndrome
edema, HTN, proteinuria (<3.0/day), cola-colored urine, hematuria, RBC casts, decreased GFR
glomerularnephritis
signs of nephrotic syndrome (3)
edema
ascites
foamy urine
malaise, anorexia, dyspnea, abd. distension, wt gain, orthostatic hypotension
symptoms of nephrotic syndrome
tx for nephrotic syndrome 1st line
ACE-i/ARBs
proteinuria (>3.5 g/d), hypoalbuminemia, minimal changes to renal biopsy, children
minimal change disease
nephrotic
nephrotic syndr. from an injury to the glomerular foot processes
minimal change dz
GBM thickening w/ immune complex deposition on the subepithelial surface of the GBM
Membranous Nephropathy
tx minimal change disease
prednisone
injury to the podocytes leading to scarring
asymptomatic proteinuria
Focal Segmental Gloerulosclerosis
nephrotic
most common cause of ESRD in the US
diabetic nephropathy
extracellular deposition of an abnormally folded protein in the glomeruli, leading to proteinuria, decreased GFR, nephrotic syndrome
amyloidosis
screening for amyloidosis
serum & urine protein electrophoresis