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DIT topics > renal casts + stones + cysts + tumors + failure > Flashcards

renal casts + stones + cysts + tumors + failure Flashcards

1
Q

cylindrical structure that forms in distal convoluted tubule + collecting duct

A

renal cast (cellular + acellular casts)

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2
Q

RBC casts

A

glomerular damage: glomerulonephritis
ischemia/infarction of kidney
malignant HTN: end-organ kidney damage

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3
Q

WBC casts

A

acute pyelonephritis

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4
Q

bacterial casts

A

pyelonephritis

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5
Q

epithelial cell casts

A

acute tubular necrosis

toxic ingestion: mercury, DEG, salicylates

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6
Q

waxy casts

A

chronic renal failure

low urine flow

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7
Q

hyaline casts

A 
most common type
substance secreted from tubular epithelial cells
concentrated urine (dehydrated person)
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8
Q

fatty casts “oval fat bodies”

A

nephrotic syndrome

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9
Q

granular casts “muddy brown”

A

chronic renal disease

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10
Q

yellow, brown in color

cylindrical

A

RBC cast = pathology in kidney (vs RBCs = pathology anywhere in urinary tract)

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11
Q

pyuria

no casts

A

acute cystitis

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12
Q

hematuria

no casts

A

bladder cancer

kidney stones

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13
Q

complications of obstruction of stone in ureter/ureterovesicular junction → black flow of urine into glomerulus

A

hydronephrosis: expansion of pelvis of kidney
pyelonephritis
chronic renal failure, if untreated

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14
Q

most common type of renal stone

A

calcium stone

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15
Q

radiopaque (see on xray)
calcium oxalate +/- calcium phosphate
associated with hypercalciuria

A

calcium stone

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16
Q

causes of hypercalciuria

A

hypercalcemia: cancer, ↑ PTH

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17
Q

causes of calcium oxolate stones

A 
ethylene glycol (antifreenze) ingestion
vitamin C abuse (>2000 mg/day for long period)
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18
Q

prevent calcium stones

A

hydrochlorothiazide: decreases Ca in urine (loops loose, thiazides retain Ca)

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19
Q

urease + bugs (proteus mirabilis, staph, klebsiella, pseudomonas): urea →ammonia + H20
ammonia → ammonium binds to Mg, phosphate →”staghorn calculi”

A

ammonium magnesium phosphate stones (struvite stones)

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20
Q

staghorn calculi: outlines renal pelvis

A

ammonium magnesium phosphate stones (struvite stones) or

cystine stones

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21
Q

treatment of ammonium magnesium phosphate stones (struvite stones)

A

surgical removal of stone

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22
Q

only stone that is radiolUcent (use US or CT)

associated with hyperuricemia and gout

A

Uric acid stones

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23
Q

children with cystinuria

“staghorn calculi”

A

cystine stones

24
Q

treatment of cystine stones

A

alkalinize urine

25
Q

multiple BILATERAL cysts of ENLARGED kidneys

associated with LIVER cysts

A

ADPKD

26
Q 
flank pain
hematuria
urinary infections
HTN
progressive renal failure
A

ADPKD

27
Q 
in utero/infants
fetal US: 
BILATERAL ENLARGED, echogenic kidneys
absent or small bladder
oligohydramnios → potter sequence
A

ARPKD

28
Q

inherited
SMALL shrunken kidneys
fibrosis + progressive renal insufficiency

A

medullary cystic disease

29
Q

common

usually outer cortex: inconsequential

A

simple cysts

30
Q

multiple or thick/septated walls
follow or remove due to ↑ risk renal cell carcinoma
associated with dialysis

A

complex cyst

31
Q

most common primary renal malignancy

A

renal cell carcinoma

32
Q

cancer originates in renal tubular cells

polyglonal clear cells full of lipids + carbs

A

renal cell carcinoma

33
Q

men 50-70 yo
hematuria
palpable flank mass
associated with paraneoplastic syndromes:
ectopic EPO → polycythemia
ectopic ACTH → cushing syndrome
ectopic PTHrP → hypercalcemia
↑ prolactin → hypogonadism, ↓ libido, galactorrhea
if invades IVC → spread in blood → mets to lung + bone
risk factor: smoking, obesity

A

renal cell carcinoma

34
Q

associated with von Hippel Lindau syndrome

A

wilms tumor

35
Q

most common renal malignancy of childhood (2-4 yo)

contain embryological glomerular structures

A

wilms tumor

36
Q

child: 2-4 yo
huge palpable flank mass
hematuria

A

wilms tumor

37
Q

associated with deletion of tumor suppressor gene WT1 on chrom 11
WAGR complex associated with gene mutation:
Wilms tumor
Aniridia (lack of iris)
GU malformations
Retardation (mental/motor)

A

wilms tumor

38
Q

most common tumor of urinary system: renal calcyes, renal pelvis, ureters, bladder (transitional cells here)

A

transitional cell carcinoma

39
Q

PAINLESS hematuria
risk factors: smoking (biggest), cyclophosphamide (can cause hemorrhagic cystitis and also induce TCC), aniline dye exposure

A

transitional cell carcinoma

40
Q 
WBC or WBC casts in urine
fever
nausea
painful urination
CVA
AMS: elderly
tx: empiric abx
A

acute pyelonephritis

41
Q

eosinophilc casts → dilate tubules (thyroidization of kidneys)

A

chronic pyelonephritis

42
Q 
causes acute renal failure 
presentation: fever, rash, eosinophilia, azotemia
common causes:
*NSAIDs*
penicillin
cephalosporin, sulfonamides (TMP-SMX, furosemide)
ciprofloxacin
cimetidine
allopurinol
proton-pump inhibitors
indinavir
mesalamine
A

drug-induced interstitial nephritis (acute interstitial nephritis)

43
Q

treatment of acute interstitial nephritis (drug-induced)

A

2 wks of CS

stop offending drug

44
Q

common cause of acute renal failure in hospitals
cause:
muscle breakdown from seizures, crush injuries, cocaine use or statin drug use → rhabdomyolysis, myoglobinuria (myoglobin into kidney)
ischemia
radiocontrast dye (prevent with fluids + naHCO3)
nephrotoxic drugs: aminoglycosides
cephalosporins
polymyxins

A

acute tubular necrosis

45
Q 
sloughing of papillae
gross hematuria
flank pain
proteinuria
ischemic causes:
sickle cell disease
analgesia use: acetaminophen, nsaids
diabetes
pyelonephritis
A

renal papillary necrosis

46
Q

types of acute renal failure

A

prerenal
intrsinisc
postrenal

47
Q 
insufficient blood flow to kidneys:
hypovolemia
hypotension
shock
renal vasoconstriction via NSAIDs
kidneys try to compensate for low blood flow: BUN/Cr ratio >20
A

prerenal acute renal failure

48
Q 
intrinsic renal diseases that can lead to:
acute interstitial nephritis
acute pyelonephritis
glomerulonephritis
acute tubular necrosis
DIC
A

intrinsic acute renal failure

49
Q 
obstruction of urine:
stones
BPH- blocks urethra
neoplasia
congenital anomalies
A

postrenal acute renal failure

50
Q

BUN/Cr ratio >20

A

prerenal azotemia: prerenal acute renal failure

51
Q

complications of renal failure

A 
fluid retention (can't produce urine): peripheral edema, HTN, heart failure, pulmonary edema
hyperkalemia (retain K+)
metabolic acidosis (high H+)
anemia (low epo)
low Ca
uremia:high BUN, Cr
52
Q

symptoms of uremia

A 
manifestations of severe azotemia: ↑BUN/Cr
nausea
anorexia
pericarditis
asterixis
encephalopathy
platelet
dysfunction
53
Q

acute generalized cortical infarction of both kidneys
due to vasospasm + DIC
associated with multi-organ failure, ARDS, DIC (all can be caused by septic shock)

A

diffuse cortical necrosis

54
Q

no vitamin D activation → less Ca reabsorption in gut → 2° hyperparathyroidism → degrade bones to ↑ Ca
tx: vitamin D + Ca in renal failure patients

A

renal osteodystrophy

55
Q

differential diagnosis for blood/red urine

A

rifampin
excessive ingestion of beets
UTI, kidney stones, bladder cancer

DIT topics (115 decks)

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