Renal Flashcards
Kidney stones
Idiopathic hypercalcuria is the most common cause of calcium kidney stone disease.
Normal serum calcium with hypercalcuria
Hemolytic uremic syndrome
Common cause of acute real failure in children. Triad of hemolytic anemia, thrombocytopenia and acute kidney injury. Most cases develop following a diarrheal illness caused by Shiga toxin- producing organisms (E. Coli 0157:H7, shigella)
Microthrombi form on damaged endothelium
Cystinuria
Autosomal recessive disorder caused by defective transportation of cystine, ornithine, arginine and lysine (COLA) across the renal tubular epithelium. Recurrent nephrolithiasis. Urinanalysis shows hexagonal cystine crystals
Primary thrombotic micorangiopathy (TMA) syndromes
Platelet activation and diffuse micro thrombosis in arterioles and capillaries. TMA syndromes present with hemolytic anemia with shistocytes, thrombocytopenia and organ injury (i.e. Brain, kidney, heart)
Chronic renal graft allograft rejection
Manifests months to years after transplantation and presents w worsening HTN and slowly progressive rise in serum creatinine. It is mediated by a chronic, indirect immune response against donor alloantigens and results in obliterative intimacy thickening, tubular atrophy and interstitial fibrosis
PAH
Primarily secreted into the nephron by the proximal tubule, but some is also freely filtered by the glomerulus. PAH is not reabsorbed by any portion of the nephron. Therefore, tubular fluid concentration of PAH is lowest in Bowmans space.
Diabetic autonomic neuropathy
Common in type 1 diabetics and can cause overflow incontinence due to the inability to sense a full bladder and incomplete emptying. Post void residual testing w ultrasound or catheterization can confirm inadequate bladder emptying
Hyaline arteriolosclerosis
Deposition of eosinophilic hyaline material in the intima and media of the small arteries and arterioles. Typically seen in patients with poorly controlled HTN or diabetes.
Homogenous, glassy material in the sub endothelial space that stains pink with PAS stain.
Multiple myeloma
Easy fatigability, constipation, back pain, elevated serum protein and azotemia in an elderly pt should raise suspicion for multiple myeloma. Large eosinophilic casts composed of Bence-Jones proteins are seen in the tubular lumen in myeloma cast nephropathy
Common side effects of ACE inhibitors
Decreased GFR, hyperkalemia, and cough. Angioedema is a rare but life threatening side effect.
Transitional cell carcinoma
Carcinoma of the bladder that typically presents as gross hematuria in an elderly man. Hx of smoking or occupational exposure to rubber, plastics, aromatic amine-containing dyes, textiles or leather increases the risk of developing transitional cell carcinoma
Ureter path to bladder
Under the ovarian (gonadal) vessels, over the common iliac bifurcation (internal/external) and under the uterine artery or vas deferens
Grapefruit juice
Inhibits cytochrome P450 3A and raises circulating drug levels
ADH
Acts on the medullary segment of the collecting duct to increase urea and water reabsorption, allowing for the production of maximally concentrated urine.
***meduallary interstitium is the region of highest osmolarity in the kidney
Erythropoesis-stimulating agent
Improves anemia sx, avoiding the need for blood transfusions in CKD and dialysis pts. However, ESAs are associated with increased risk for HTN and thromboembolic events
