Renal - FA, Pathoma Flashcards by Alex Hamidi

What is a malignant epithelial tumor arising from kidney tubules?

Presents how?

RCC

Hematuria, palpable mass, flank pain

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IgA nephropathy follows what?

Deposition where on IF?

Mucosal infection

Mesangium

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What part of the nephron is most susceptible to toxic agents?

What agents?

Prox tubule

Aminoglycosides, lead, myoglobinuria, ethylene glycol, radiocontrast dye, urate

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Silver stain to view which disorders?

Membranous

MPGN

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2nd MC cause of kidney stone?

Due to what?

Shape of stone?

Tx?

AMP (ammonium, magnesium, phosphate)

Proteus, Ureaplamsa, Klebsiella

Prism/coffin

Surgery

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What RCC has the best prognosis, stains darkly and is least aggressive?

Chromophobe

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MC cause of nephrotoxic ATN?

What do the crystals look like?

Tx?

Methicillin

Envelope shaped crystals w/low serum calcium

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B/l renal agenesis is due to failure of what?

Urteric buds

NO Budweiser NO pee

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Thyroidization of the kidney is pathognomonic for what?

Chronic pyelonephritis

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What can cause prerenal azotemia?

BUN:Cr ratio?

[FENa]?

Decreased blood flow, Dec GFR

> 15

< 1%

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DM affects the vasculature BM and causes what?

Hyaline arteriolosclerosis

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Which schistosoma has spine on lateral side?

Presents how? Where?

Mansoni

Pipestem fibrosis of liver
Intestines and liver

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MC cause of acute renal failure is what?

What sx?

Tx?

Acute tubular injury

Azotemia, metabolic acidosis, Hyperkalemia w/EKG changes

Furosemide, dialysis

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What are the CFs of ATN?

Oliguria w/brown granular casts
Elevated BUN and Cr
Hyperkalemia w/metabolic acidosis

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Long-standing obstruction causes what change in BUN:Cr?

FENa?

Urine osm?

< 15

> 2%

< 500, cannot [ ] urine

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C3 nephritic factor causes what kidney problem?

MPGN type 2

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MC kidney stone seen in kids is what?

Assoc w/what?

Stone looks how?

Cystine

Cystinuria, AR

Hexagonal crystals

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What kidney stone is NOT visible on xray?

Seen in what?

Uric acid

Acidic pH, leukemia, myeloproliferative

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Denys-drash sx?

Due to what?

Wilms, progressive renal disease, male pseudohermaphrodite

Mutation in WT1

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WAGR sx?

Due to what?

Wilms, Aniridia, genitals fucked, retard

DELETION of WT1

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What are the main CFs of nephritic syndrome?

Oliguria and azotemia
Edema, HTN
Rbc casts

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Acute pyelonephritis MC cause?

How can a kid get it?

E.coli #1
Enterococcus
Klebsiella

Vesicoureteral reflux

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Sterile pyuria in the presence of pyuria (- urine culture) suggests what?

Due to what?

Urethritis

C. Trachomatis or N. Gonorrhea

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MPGN due to what?

Deposits where?

What proliferates?

C3 deficiency

Subendothelial type 1
Intramembranous - Dense deposits - type 2

Mesangial cells

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Is ATN reversible?

YES

What RCC has bad prognosis and is resistant to chemo and radiation? Tx?

Clear cell type Surgery, immunotherapy

What MPGN is assoc. w/HepB and HepC? Where are the deposits?

Type 1 Subendothelial

Scarring at the upper and lower poles of the kidney indicates what?

Vesicourteral reflux

Age demographic for RCC? M or F? RFs? If b/l then likely what?

50-70, Males Smoking, analgesics, chronic renal failure VHL mutation in clear cell type

Wilms tumor B9 or Mal? Mutations? MC cause?

Mal WT1 on ch. 11 PAX6 Sporadic

What cells make EPO?

Renal peritubular interstitial cells

How is BUN:Cr affected in ATN? FENa?

< 15 > 2%

Ethylene glycol causes what kind of stones?

Oxalate crystals

Urine showing pyuria and wbc casts mean what?

Acute pyelonephritis

Alport syndrome is a defect in what? Inheritance? Key CFs?

Type 4 collagen X-linked Hematuria, sensory hearing loss, ocular disturbance

Papillary urothelial tumor progression?

Low grade --> high grade --> invades

Where are the deposits located in Acute PSGN? IF shows what?

Subepithleial --> "lumpy bumpy humps" Granular deposits of IgG and complement

What is the most common type of renal disease in SLE? IF shows what? Deposits are where?

Diffuse proliferative GN Granular Subendothelial

What RCC is multifocal and b/l, cut surface is granular? gene mutation?

Papillary RCC MET, ch. 7 and 17

What is kidney disorder is associated w/Hep B, HepC, solid tumors, SLE, or drugs? What drugs?

Membranous nephropathy NSAID, penicillamine

Cystitis lab findings show what? Culture shows what?

+ leukocyte esterase Nitrites Greater than 100,000 colony forming units

MCD is associated with what other disease? How is the damage mediated?

HL Cytokines from T cells

What produces brown/muddy dirty epithelial casts?

Acute tubular injury

Presentation of ADPKD? Associated with what?

HTN (INC renin), hematuria, worsening renal failure Berry aneurysm, hepatic cysts, MVP

What paraneoplastic syndromes does HCC make?

``` PV HTN Cushing's Hypercalcemia Feminization/masculinization ```

What kidney problem is associated w/HIV, heroin use, and sickle cell disease?

FSGS

Mutation of WT2 causes what? Due to what? Sx?

Beckwith-Wiedemann, overexpressed IGF-2, pt has hypoglycemia Macroglossia and hemi-hypertrophy

How does renal papillary necrosis present? Causes?

Hematuria and flank pain Chronic ASA use, DM, Sickle cell, severe acute pyelonephritis

What causes Acute interstitial nephritis?

NSAID PCN Diuretics

How does dysplastic kidney arise? Characterized by what?

Noninherited, congenital malformation Cysts and abnormal tissue - CARTILAGE

What presents w/parenchymal fibrosis and shrunken kidneys, leads to worsening renal failure

Medullary cystic kidney disease

EM finding of FSGS? Tx?

Effacement of foot process Poor response to steroids, progresses to chronic renal failure

MC cause of kidney stones? Seen in what? Tx?

Calcium oxalate idiopathic hypercalciuria HCTZ

What is the most commonly involved organ in systemic amyloidosis? Where are the deposits located?

Kidney Mesangium

Angiomyolipoma seen in what syndrome? Color?

Tuberous sclerosis Yellow

PSGN can progress to what? What else progresses to this?

RPGN (25%) Goodpasture's, Wegener's, Churg-Strauss, microscopic polyangitis

How to view Membranous GN? Shows what?

Silver stain Spike and dome

Flat pathway of urothelial carcinoma progression? Due to what?

High grade --> invasion P53 mutation

What can be used to slow progression of hyperfiltration induce-damage of DM? What is affected most in this process?

ACE-I's Efferent arteriole --> high GF pressure

Which schistosoma has a tail? Lays eggs where?

Haemotobium Bladder

Medullary sponge kidney is good or bad prognosis? Inc risk for what?

Good - spongeBOB will never hurt you Uti and stones

Crescents in Bowman space seen in what disease? What are they made of?

RPGN Fibrin, macrophages, podocytes

What is abnormal in nephrotic syndrome?

Hypoalbuminemia Hypogammaglobulinemia Hypercoaguable state --> loss of ATIII Hyperlipidemia and hypercholesterolemia

Colicky pain w/Hematuria and u/l flank pain is what?

Nephrolithiasis

What segments of the nephron are most susceptible to ischemia?

Prox tubule | Medullary segment of TAL

Tubules that are dilated and filled with colloid indicate what?

Chronic pyelonephritis

How does a RCC appear grossly? Can cause what?

Solitary yellow areas of necrosis and hemorrhage Left varicocele

Presentation of AIN? Pathognomonic finding? Can progress to what?

Oliguria, fever, rash Eosinophils in urine Renal papillary necrosis

Adenocarcinoma of the bladder due to what congenital defects? What else can cause it?

Urachal remnant --> develops at dome of bladder Exstrophy of bladder Cystitis grandularis

What causes postrenal azotemia? GFR changes? BUN:Cr?

Obstruction of urinary tract downstream from kidney Dec > 15

What pts get pyelonephritis?

``` Young women Men with BPH Kids w/reflux Pregnant women Diabetics ```

Acute tubular necrosis affects the GFR how? What is seen in the urine?

DEC Brown, granular casts

SCC of bladder RFs?

Chronic cystitis Schistosoma haematobium Nephrolithiasis

What mediates damage in nephritic syndrome? Due to what?

Neutrophils Immune complex deposition which activates complement C5a

What color are oncocytomas? Have what inside? B9 or Mal?

Brown/mahogany Pink cytoplasm w/tons of mitochondria which have lots of IRON B9

Where does the horseshoe kidney get stuck as it ascends? What spinal level?

IMA L3 aka MEL Gibson 3

ARPKD is associated with what?

Hepatic fibrosis and hepatic cysts | Signs and symptoms of portal HTN

Oligohydramnios causes what?

Lung hypoplasia | Potter sequence

Alport syndrome inheritance? EM shows what?

Drinking a COLT45 on the runaway, tell it not to CROSS (X) Basketweave appearance

Membranous GN IF shows what? EM? What does Membranous GN look like?

Granules w/IgG and C3 Subepithelial deposits Post-strep GN

Afferent arteriole constriction: Describe the following: GFR RPF FF

Dec Dec Unchanged

Efferent arteriole constriction: Describe the following: GFR RPF FF

INC Dec INC

Inc plasma protein [ ]: Describe the following: GFR RPF FF

Dec Unchanged Dec

Dec plasma protein [ ]: Describe the following: GFR RPF FF

Inc Unchanged Inc

Constriction of ureter: Describe the following: GFR RPF FF

Dec Unchanged Dec

Dehydration: Describe the following: GFR RPF FF

Dec HUGE Dec INC

RTA type 1 urine pH? Defect is what? Assoc w/what? Inc risk for what? Cause?

> 5.5, a-intercalated cells cannot secrete H+, hypokalemia Calcium kidney stones Amphotericin B, obstruction

RTA type 2 urine pH? Defect in what? Hypo/hyperkalemia? Inc risk for what? Causes?

< 5.5, defect in PCT HCO3 reabsorption, hypokalemia HypoPO4 rickets Fanconi syndrome, CAI's

RTA type 4 urine pH? Due to what? Hypo/hyperkalemia? Causes?

> 5.5, hypoaldosteronism, hyperkalemia ACEI, ARB, NASAID, heparin, K+ sparing diuretics, TMP/SMX

Fatty casts in urine indicate what?

Nephrotic syndrome, Maltese cross sign

Granular muddy brown casts indicate what?

Acute tubular necrosis

Waxy casts indicate what?

ESRD/renal failure