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Pathoma > Renal > Flashcards

Renal Flashcards

1
Q

What part(s) of the nephron are most susceptible to ischemic acute tubular necrosis?

A

Proximal Tubule

Medullary segment of the thick ascending limb

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2
Q

What part(s) of the nephron are most susceptible to nephrotoxic acute tubular necrosis?

A

Proximal Tubule

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3
Q

What are the agent(s) that can cause nephrotoxic acute tubular necrosis?

A
  1. Aminoglycosides (GNATS: Gentamycin, Neomycin, Amikacin, Tobramycin, Streptomycin)
  2. Myoglobinuria (from crush injury)
  3. Ethylene glycol (this is antifreeze; is blue & sweet; oxalate crystals in urine)
  4. Radiocontrast dyes
  5. Heavy metals (Lead)
  6. Urate (tumor lysis syndrome)
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4
Q

What is used to decrease the risk of urate-induced acute tubular necrosis?

A
  1. Hydration

2. Allopurinol

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5
Q

What can be seen in the urine of people who have ingested ethylene glycol?

A

Oxalate crystals

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6
Q

A patient presents with oliguria with brown granular casts; elevated BUN and creatinine; and hyperkalemia with metabolic acidosis. What is the diagnosis?

A

Acute tubular necrosis

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7
Q

What do you see in the urine of a patient with acute tubular necrosis?

A

Brown granular casts (these are the dead epithelial cells that are passed in the urine)

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8
Q

What are the the 3 drugs that cause the drug-induced hypersensitivity reaction responsible for acute interstitial nephritis?

A
  1. NSAIDs
  2. Diuretics
  3. Penicillin
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9
Q

A patient presents with oliguria, rash, fever and eosinophils in their urine. What is the diagnosis?

A

Acute interstitial nephritis

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10
Q

What may be seen in the urine of a patient with acute interstitial nephritis?

A

Eosinophils

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11
Q

What condition can progress to renal papillary necrosis?

A

acute interstitial nephritis

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12
Q

What is the presentation of a patient with renal tubular necrosis?

A

Gross hematuria and flank pain

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13
Q

What are the causes of renal tubular necrosis?

A
  1. Acute interstitial nephritis
  2. Chronic analgesic abuse (phenacetin or aspirin)
  3. Diabetes mellitus
  4. Sickle cell disease or trait
  5. Severe acute pyelonephritis
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14
Q

What are the 5 general characteristics of nephrotic syndrome?

A
  1. Proteinuria greater than 3.5g/ day
  2. Hypoalbuminemia –> pitting edema
  3. Hypoglobulinemia –> increased infection risk
  4. Hypercoagulable state –> due to loss of anti-thrombin III
  5. Hyperchorolemia and hyperlipidemia –> can lead to fatty casts in the urine
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15
Q

what is the most common cause on nephrotic syndrome in children?

A

Minimal Change Disease (MCD)

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16
Q

List the 8 characteristics of minimal change disease

A
  1. most common cause of nephrotic syndrome in children
  2. Glomeruli are normal on H&E stain
  3. lipids may be seen in proximal tubule
  4. Effacement (flattening) of foot processes in electron microscopy
  5. no immune complex deposits –> Immunofluorescence is negative
  6. selective proteinuria: loss of albumin but no loss of immunoglobulins
  7. excellent response to steroids because it is caused by cytokines released by T cells
  8. idiopathic and associated with hodgkin lymphoma
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17
Q

Why is Hodgkin Lymphoma associated with minimal change disease?

A

The reed sternberg cells in hodgkin lymphoma produce massive amounts of cytokines. The cytokines then go on and cause loss of the foot processes of the podocytes (epithelial cells)

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18
Q

What is the only nephrotic syndrome in which you get an excellent response to treatment?

A

Minimal Change Disease

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19
Q

What is the most common cause of nephrotic syndrome among hispanics and african americans?

A

Focal Segmental Glomerulosclerosis(FSGS)

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20
Q

List the 6 characteristics of Focal Segmental Glomerulosclerosis

A
  1. Most common cause of nephrotic syndrome among hispanics and african americans
  2. idiopathic but associated with HIV, heroin use, sickle cell disease
  3. focal and segmental sclerosis on H& E
  4. Effacement (flattening) of foot processes on electron microscopy
  5. no immune complexes –> negative immunofluorescence
  6. Poor response to steroids –> progresses to chronic renal failure
21
Q

What is the most common cause of nephrotic syndrome among caucasians?

A

Membranous nephropathy

22
Q

List the 5 characteristics of membranous nephropathy

A
  1. most common cause of nephrotic syndrome in caucasian adults
  2. immune complex deposits –> granular IF
  3. subepithelial deposits with cause spike and dome appearance on EM
  4. Thickened glomerular basement membrane on H&E
  5. idiopathic but associated with Hep B, Hep C, SLE, solid tumors, or drugs (NSAIDs or penicilamine)
  6. Poor response to steroids –> progresses to chronic renal failure
23
Q

Biopsy of a patient with kidney disease shows a thickened glomerular basement membrane and “train track” appearance on H&E. What is the diagnosis?

A

Membranoproliferative Glomerulonephritis

24
Q

What diseases are associated with Type i and Type II membranoproliferative glomerulonephritis?

A 
Type I(subendothelial deposits): hep b and hep c
Type II (intramembranous: c3 nephritic complement --> stabilizes c3 convertase --> overactivation of C3 --> decreased C3 levels in plasma
25
Q

What type of membranoproliferative glomerulonephritis is more commonly associated with “tram track” appearance on H&E?

A

Type I

26
Q

What is the mechanism behind Diabetes mellitus nephrotic syndrome?

A

increase serum glucose –> non enzymatic glycosylation of vascular basement membrane –> hyaline arteriolosclerosis of efferent> afferent arteriol –> increased glomerular filtration P –> hyperfiltration induced injury –> microalbuminuria

27
Q

You receive the results of a kidney biopsy that finds Kimmelsteil-Wilson nodules. What is the diagnosis?

A

Diabetes Mellitus Nephrotic Syndrome

28
Q

What medication can be used to slow the progression of diabetes mellitus nephrotic syndrome and why does it work?

A

ACE inhibitors. They work bc diabetic patients with nephrotic syndrome have increased arterioloscelrosis of the efferent arteriole. Angiotensin II also clamps down on the efferent arteriole, which further increases the glomerular filtration P, leading to additional hyperfiltration injury

29
Q

What is a sign of glomerular bleeding?

A

Red blood cells casts

30
Q

What is the histopathological hallmark of pst-strep glomerulonephritis?

A

subepithelial humps on EM

31
Q

What is the most common cause of renal disease in patients with SLE?

A

Diffuse Proliferative Glomerulonephritis

32
Q

If a patient with SLE presents with nephrotic syndrome, which specific type is it?

A

Membranous Nephropathy

33
Q

How do you differentiate Goodpasture Syndrome frome Wegener Syndrome?

A

Both will present with hematuria and hemoptysis. However, wegener presents with additional sinus/ nasal symptoms.

Goodpasture Syndrome will have linear IF, while Wegener’s Syndrome will have negative IF

Wegener’s Syndrome will be c-ANCA positive

34
Q

A patient present with hematuria, renal function that has declined over the last few weeks and hemoptysis. Biopsy shows linear IF. What is your diagnosis?

A

Goodpasture Syndrome

35
Q

A patient present with hematuria, renal function that has declined over the last few weeks, hemoptysis and has a history of sinusitis. Biopsy shoes negative IF and +c-ANCA. What is your diagnosis?

A

Wegener’s Syndrome

36
Q

What is the histopathological hallmark of IgA nephropathy?

A

IgA immune complex deposition in the mesangium of the glomerulus on EM

37
Q

What is the histopathological hallmark of Alport Syndrome?

A

Thinning and splitting on the glomerular basement membrane on H&E

38
Q

A patient presents with isolated hematuria, sensory hearing loss and ocular disturbances. His father has the same syndrome. What is your diagnosis?

A

Alport Syndrome

39
Q

From most common to least common, what are the 5 bugs that cause UTI’s?

A
  1. E.coli
  2. Staph saprophyticus
  3. Klebsiella pneumoniae
  4. Proteus mirabilis (alkaline urine w/ ammonia scent)
  5. E. faecalis
40
Q

A patient presents with a urinary tract infection. Their urine is alkaline, smells like ammonia and has swarming motility on agar. What is the bacterial species responsible for her UTI?

A

Proteus mirabilis

41
Q

A patient presents with dysuria. You run some labs and find that the patient was more than 10 WBC/hpf and positive leukocyte esterase but a negative urine culture (sterile pyruia). What 2 organisms may be causing the symptoms?

A

Sterile pyuria suggests urethritis due to Chlamydia trochomatis or Neisseria gonorrhoea

42
Q

What 2 lab tests indicate pyuria?

A
    • leukocyte esterase

2. >10 wbc/hpf

43
Q

What are 2 important causes of calcium oxalate and calcium phosphate kidney stones?

A
  1. idiopathic hypercalciuria (most common cause; patients excrete lots of Ca in urine but plasma Ca will be normal)
  2. Crohn’s disease (damaged small intestine –> increased reabsorption of oxalate)
44
Q

What is the treatment for calcium kidney stones?

A

Hydrochlorothiazide, a Ca-sparing diuretic that functions in the proximal tubule. It increases Ca reabsorption into the blood and decreases its excretion in the urine.

45
Q

What are 2 organisms that can cause ammonium magnesium phosphate stones?

A

urease + organisms such as proteus and klebsiella. They alkalinize the urine, leading to formation of a staghorn calculi in the renal calyces. Must be surgically removed and pathogens must be eradicated

46
Q

Klebsiella and Proteus can cause what type of kidney stone?

A

Staghorn calculi. Must be surgically removed and causative agents must be eradicated to prevent recurrence

47
Q

You have a patient with staghorn calculi. How does the diagnosis change if the patient is an adult vs a child?

A

Adults get staghorn calculi due to organisms that alkalinize the urine such as Proteus and Klebsiella. Treatment is surgical removal

Children get staghorn calculi due to cystinuria (decreased cystine reabsorption). Treatment is hydration and alkalization of the urine

48
Q

From most common to least common, list the types of kidney stones

A
  1. Calcium oxalate or calcium phosphate (idiopathic hypercalciuria, hypercalcemia, crohn’s disease)
  2. Ammonium magnesium phosphate (urease + organisms such as klebsiella and proteus –> staghorn calculi)
  3. Uric acid: gout; hyperuricemia; hot, arid climates; low urine volume; low urine pH

Pathoma (1 decks)

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