Renal First Aid Pathology I Flashcards
Defect in collecting tubule’s ability to excrete H+; urine pH > 5.5;
hypOkalemia.
Type I RTA (distal)
As a result of increased urine pH and bone resorption, Type I RTA increases the risk of
calcium phosphate stones
Defect in PCT HCO3- reabsorption.
May be seen with Fanconi’s syndrome.
Urine ph < 5.5.
HypOkalemia
Type 2 RTA (proximal)
Hypoaldosteronism or lack of collecting tubule response to aldosterone. HypERkalemia impairs ammoniagenesis in PCT –> decreased buffering capacity and decreased urine pH.
Type 4 (hyperkalemic)
What does the presence of casts in the urine tell you?
Hematuria is of renal (vs. bladder) origin
RBC casts
Glomerulonephritis, ischemia, or malignant HTN
WBC casts
Tubulointersitial inflammation,
Acute pyelonephritis,
Transplant rejection
Fatty casts (“oval fat bodies”)
Nephrotic syndrome
Granular muddy brown casts
Acute tubular necrosis
waxy casts
advanced renal disease/chronic renal failure
hyaline casts
nonspecific, can be a normal finding
hematuria with no RBC casts
bladder cancer, kidney stones
pyuria with no casts
acute cystitis
Involves only glomeruli, thus a primary disease
of the kidney
1° glomerular disease (MCD)
Involves glomeruli and other organs, thus a disease of another organ system, or a systemic disease that has impact on the kidney
2° glomerular disease (SLE, diabetic nephropathy)
< 50% of glomeruli are involved
Focal (eg FSGN)
> 50% of glomeruli are involved
Diffuse (eg DPGN)
Hypercellular glomeruli
Proliferative (eg mesangial proliferative)
Thickening of glomerular basement membrane
Membranous (eg membranous nephropathy)
4 pure nephritic syndromes
Acute post streptococcal GN
Rapidly progressive GN
Berger’s IgA glomerulonephropathy
Alport syndrome
5 pure nephrotic syndromes
MCD Focal segmental glomerulosclerosis Membranous nephropathy Diabetic nephropathy Amyloidosis
2 mixed nephrotic/nephritic
Diffuse proliferative GN
Membranoproliferative GN
Associated with HIV infection, heroin abuse, massive obesity, interferon treatment, and chronic kidney disease due to congenital absence or surgical removal. Most common cause of nephrotic syndrome in adults.
Focal segmental glomerulosclerosis
SLE’s nephrotic presentation. Can be
idiopathic or caused by drugs, infections, SLE, solid tumors.
Membranous nephropathy
