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Internal Medicine > Renal > Flashcards

Renal Flashcards

1
Q

Four features of nephritic syndrome

A
  1. Microscopic hematuria 2. HTN 3. Edema 4. Proteinuria
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2
Q

Four features of nephrotic syndrome

A
  1. Proteinuria (> 3.5 g/24 hr) 2. Hypoalbuminemia 3. Edema 4. Hyperlipidemia **increased risk of infection, hypercoagulability
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3
Q

What are three primary glomerular disorders that typically cause nephrotic syndrome?

A

-Minimal change disease -Focal segmental glomerulosclerosis -Membranous glomerulonephritis (glomerulopathy)

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4
Q

What is the most common cause of nephrotic syndrome in adults? Second most common?

A

FSGS is most common. Membranous glomerulonephritis is 2nd.

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5
Q

Minimal change disease features

A

-Only finding on biopsy is podocyte effacement -Usually in kids and young adults -Treat with steroids (don’t need to biopsy) -associated with NHL and Hodgkin’s

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6
Q

FSGS is more common in what groups?

A

Black people, Hispanic people

HIV, obesity, heroin use

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7
Q

FSGS often presents with what?

A

HTN and hematuria in addition to nephrotic syndrome features

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8
Q

What are the primary and secondary causes of membranous glomerulopathy?

A

Primary: idopathic Secondary: Hep B, Hep C, malaria, drugs (e.g. gold), neoplasm (e.g. lung, colon, CLL), autoimmune d/o (e.g. SLE)

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9
Q

What are some causes of nephritic syndrome/hematuria?

A

-IgA nephropathy (Berger’s) -Post-strep GN -Goodpasture’s (anti-GBM) -Lupus nephritis -ANCA-associated -Membranoproliferative GN

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10
Q

What is the deal with IgA nephropathy?

A

Presents SHORTLY after a URI -most common cause of recurrent hematuria, but renal function is just fine in most patients

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11
Q

When does post-strep GN occur?

A

10-21 days after the strep URI or impetigo C3 will be decreased but C4 normal self limited course

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12
Q

Goodpasture’s syndrome consists of

A

Proliferative GN, pulmonary hemorrhage, anti-GBM antibody. Treat with plasmapheresis, immunosuppression *linear deposits

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13
Q

What are the ANCA-associated causes of nephritis?

A

Granulomatosis with polyangiitis, polyarteritis nodosa

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14
Q

What are the causes of membranoproliferative GN?

A

Hep C, also Hep b, syphilis, lupus. Associated with cyroglobulinemia

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15
Q

What’s the difference between MPGN and membranous GN?

A

Membranous is usu nephrotic, and deposits are subepithelial. MPGN is usually nephritis and deposits are subendothelial

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16
Q

Other important secondary glomerular diseases?

A

HTN nephropathy Diabetic nephropathy Lupus Sickle cell nephropathy Amlyoidosis HIV nephropathy

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17
Q

HIV nephropathy

A

Proteinuria, edema, hematuria. Tx: prednisone, Ace-I and HAART. Hist resembles collapsing form of FSGS

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18
Q

Acute interstiital nephritis features

A

-recent infection or start of new med -may have fever, rash, eosinophilia, eosinophiluria -AKI

19
Q

Acute vs. chronic interstitial nephritis

A

Acute: AKI with interstitial lymphs or eosinophils Chronic: indolent course assoc with tulointerstitial fibrosis and atrophy

20
Q

What are the causes of renal papillary necrosis?

A
  1. Analgesic nephropathy [may cause sterile [pyuria]
  2. Sickle cell disease
  3. UTI or urinary tract obstruction
  4. Chronic alcoholism
  5. Transplant rejection
21
Q

Renal tubular acidosis (RTA) type 1

A

Type 1 (distal): cannot excrete H+ in distal tubule so cannot acidify urine –> hypokalemia, metabolic acidosis, renal stones, rickets in children

tx: sodium bicarb, phosphate salts
causes: lithium, amphotericin B, SLE, SCD, hepatitis

22
Q

RTA type 2

A

Type 2 (proximal): cannot absorb bicarb in proximal tubule –> metabolic acidosis, hypokalemia

tx: Na restriction (increases proximal Na reabsorption and thus bicarb absorption)
causes: myeloma, Fanconi syndrome, amyloid, autoimmune

23
Q

RTA1 and RTA2 both lead to what type of metabolic acidosis

A

Hypokalemic, hyperchloremic non-anion gap metabolic acidosis

24
Q

RTA type 4

A

Type 4: Any condition assoc with hypoaldosteronism –> hyperkalemia, hyponatremia. Dec Na absorption + dec K and H excretion in distal tubule. Acidic urine in presence of metabolic acidosis.

causes: majority caused by diabetes. also- Addison’s, sickle cell

25
Q

ADPKD

A

Hematuria, HTN, palpable kidneys.

Tx: tx HTN and eventual transplant

Extra-renal manifestations: hepatic cysts (most common), intracranial aneurysm (do not screen), colonic diverticula, abdominal hernia, valvular heart dz

26
Q

ARPKD

A

Liver involvement always present and may be the major feature. Pulmonary hypolasia 2/2 enlarged kidneys in utero, can cause Potter syndrome.

27
Q

Hartnup syndrome

A

AR defect of amino acid transporter –> decreased intestinal and renal reabsorption of amino acids such as tryptophan –> nicotinamide deficiency

28
Q

Fanconi syndrome

A

Hereditary or acquired proximal tubule dysfunction –> glucosuria, phosphaturia (leads to bone problems), proteinruia, polyuria, hpokalemia, type 2 RTA tx: supplement phos, alkali, salt, K, hydrate

29
Q

Acute tubular necrosis causes

A
  1. Ischemic AKI 2. Nephrotoxic AKI (e.g. abx, toxins, myoglobinuria, NSAIDs)
30
Q

ATN urine microscopy

A

Muddy brown casts

31
Q

Diabetic nephropathy pathology

A

GFR elevation –> basement membrane thickening –> mesangial expansion –> glomerulosclerosis.

Nodular glomerulosclerosis of pathognomic but diffuse is more common. Hyalinosis affecting BOTH afferent and efferent arterioles is also pathognomic.

32
Q

Most common type of kidney stone?

A

Calcium oxalate (envelope shaped)

33
Q

What is the pathophys of membranoproliferative GN type 2?

A

Type 2: dense deposit disease. Due to persistent activation of complement pathway

other types caused by immune complex deposititon

34
Q

Renal cell carcinoma physical exam

A

Classic triad (not common): flank pain, hematuria, palpable flank mass

Left-sided varicocele that doesn’t drain when recumbent

Paraneoplastic: anemia, thrombocytosis, hypercalcemia, cachexia

Dx: CT scan

35
Q

What antibiotics are particularly nephrotoxic?

A

Aminoglycosides (e.g. gentamicin, amikicin, neomycin)

36
Q

Methanol ingestion causes what symptom?

A

Blindness

37
Q

Cyanide poisioning

A

HIGH lactate levels, bitter almond taste

Antidote: sodium thiosulfate, hydroxocobalamin

38
Q

What drugs can commonly cause hyperkalemia?

A
  • Bactrim
  • Heparin
  • NSAIDs
  • Digoxin
  • Acei/arbs
  • Beta blockers
  • Succinylcholine (NM blocker used in intubation)
  • Cyclosporine
39
Q

What cause of nephrotic syndrome is most often assoc with renal vein thrombosis?

A

Membanous nephropathy, most often in association with adenocarcinoma

40
Q

Waxy or broad casts = ?

A

Chronic renal failure

41
Q

WBC casts = ?

A

Interstitial nephritis or pyelonephritis

42
Q

Fatty casts = ?

A

Nephrotic syndrome

43
Q

Alport’s syndrome

A

Mutation in type IV collagen. Family history. Hematuria, basket weaving on electron microscopy.

Internal Medicine (6 decks)

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