Renal - Grab Bag

Question 1

Granulomatosis with polyangiits treatment

Answer 1

Cyclophosphamide and prednisone

Question 2

Goodpasture’s treatment

Answer 2

Immediate plasmapheresis

Question 3

What is the difference between Type 1 and Type 2 MPGN on EM?

Answer 3

Type 1 - Subendothelial ICs with granular IF

Type II - diffuse intramembranous deposits (dense deposit disease); EM shows tram tracks.

Question 4

Nephritic vs nephrotic syndrome definition by cause

Answer 4

Nephritic - glomerular injury is primarily due to neutrophils
Nephrotic - glomerular injury is due to cytokines, not neutrophils and the negative charge on the GBM is lost

Question 5

Most common subtype of glomerular disease in SLE?

Answer 5

DPGN

Question 6

Which disease is Hodgkin’s associated with?

Answer 6

Minimal change disease

Question 7

Which disease is associated with HIV?

Answer 7

FSGS

Question 8

Which kidney diseases are HBV and HCV associated with?

Answer 8

Type I MPGN; membranous nephropathy

Question 9

Which disease is associated with sickle cell anemia?

Answer 9

FSGS

Question 10

Which disease is the most common cause of primary nephrotic syndrome in caucasian adults?

Answer 10

Membranous nephropathy

Question 11

What is the most common cause of nephrotic syndrome in African Americans and Hispanics?

Answer 11

FSGS

Question 12

What is the most common primary renal malignancy?

Answer 12

Renal cell carcinoma

Question 13

Most common tumor of the urinary tract system?

Answer 13

Transitional cell carcinoma

Question 14

Most common renal malignancy of early childhood (age 2-4)?

Answer 14

Wilms tumor (nephroblastoma)

Question 15

Huge palpable flank mass and/or hematuria in a 2-4 year old?

Answer 15

Wilms tumor

Question 16

Congenital abdominal wall defects, large tongue, large body/long limbs (macrosomia), midline abdnominal wall defect (omphalocele/exomphalos), ear crease, ear it, neonatal hypoglycemia, Wilms tumor

Answer 16

Beckwith-Wiedemann syndrome

Question 17

Wilms tumor
Aniridia
Genitourinary abnormalities
Retardation

Answer 17

WAGR complex

Question 18

What is the WAGR complex?

Answer 18

Wilms tumor, Aniridia, Genitourinary abnormalities, Retardation

Usually due to a mutation on tumor suppressor gene WT1 or WT2 on chromosome 11.

Question 19

What are risk factors for transitional cell carcinoma?

Answer 19

Phenacetin, Smoking, Aniline dyes, Cyclophosphamide

Question 20

What are risk factors for squamous cell carcinoma of the bladder?

Answer 20

Chronic irritation of the urinary bladder
Schistosoma
Chronic cystitis
Smoking
Chronic nephrolithiasis

Question 21

Drugs that induce TIN versus drugs that cause ATN?

Answer 21

TIN - Diuretics, Penicillins, Sulfonamides, Rifampin, NSAIDs

ATN - Sisters Lead a Mean Radio - Cisplatin, Lead, Aminoglycosides, Radiocontrast agents (proximal tubule is esp susceptible)

Question 22

Type 1 RTA

Answer 22

Defect in alpha-intercalated cells to secrete H+ results in no new bicarb generation

Increase urine pH –> increase risk for Ca phosphate stones

Question 23

Type 2 RTA

Answer 23

Defect in proximal tube HCO3- reabsorption results in increased excretion of bicarb

Urine pH is normal

Question 24

Causes of Type 1 RTA?

Answer 24

Amphoteracin B toxicity, Analgesic nephropathy, Multiple myeloma, congenital obstruction of the urinary tract

Question 25

Causes of Type 2 RTA?

Answer 25

Fanconi syndrome (Wilson's??), chemical toxins to proximal tubule (lead, aminoglycoside), carbonic anhydrase inhibitors

Question 26

Type 4 RTA

Answer 26

Hypoaldosteronism, aldosterone resistance, or K+ sparing diuretics - resulting hyperkalemia impairs ammoniagenesis in the proximal tubule and decreases buffering capacity and H+ excretion into urine.

Question 27

RBC casts

Answer 27

Glomerulonephritis, ischemia, or malignant hypertension

Question 28

WBC casts

Answer 28

TIN, Acute pyelo, transplant rejection

Question 29

Fatty casts / oval fat bodies / maltese cross

Answer 29

Nephrotic syndrome

Question 30

Granular (muddy brown) casts

Answer 30

Acute tubular nephrosis

Question 31

Waxy casts

Answer 31

Advanced renal disease / chronic renal failure

Question 32

Hyaline casts

Answer 32

Nonspecific, normal finding, often seen in concentrated urine samples

Question 33

Liddle syndrome

Answer 33

Increased Na reabsorption in the distal and collecting tubules - increased activity of epithelial sodium channel. Autosomal dominant. Results in hypertension, hypokalemia, metabolic alkalosis, decreased aldosterone. Treat with amiloride.

Question 34

Microscopy for IgA nephropathy

Answer 34

LM - mesangial proliferation EM - mesangial IC deposits IF - IgA based IC deposits in mesangium

Question 35

Microscopy for DPGN

Answer 35

LM - wire looping of capillaries IF - granular EM - subendothelial and sometimes intramembranous IgG ICs with C3

Question 36

Microscopy for RPGN

Answer 36

LM and IF - crescent moon shape (fibrin and plasma proteins, C3B with glomerular parieal cells, monocytes, macrophages)

Question 37

Microscopy for Acute poststrep

Answer 37

LM - glomeruli enlarged and hypercellular IF - starry sky granular appearance (lumpy bumpy) due to IgG, IgM, and C3 deposition along GBM EM - subepithelial immune complex bumps

Question 38

Microscopy for FSGS

Answer 38

LM - segmental sclerosis and hyalinosis IF - negative EM - foot process effacement

Question 39

Microscopy for Membranous

Answer 39

LM - diffuse capillary and GBM thickening IF - granular due to immune complex deposition EM - spike and dome appearance with subepithelial deposits

Question 40

Minimal change microscopy

Answer 40

LM - normal IF - negative EM - foot process effacement

Question 41

Amyloidosis microscopy

Answer 41

LM - congo red stain shows apple green birefringence under polarized light

Question 42

Membranoproliferative type I microscopy

Answer 42

subendothelial immune complex deposits with granular IF | Tram track appearance due to GBM splitting

Question 43

Type II membranoproliferative

Answer 43

Intramembranous IC deposits - dense deposits

Question 44

Which kidney diseases are associated with lupus?

Answer 44

DPGN | Membranous glomerulonephritis

Question 45

Diabetes microscopy

Answer 45

Mesangial expansion, GBM thickening, eosinophilic nodular glomerulosclerosis with Kimmelsteil wilson lesions

Question 46

Hypokalemia leads to

Answer 46

U-waves on ECG, flattened T waves, arrhythmias, muscle weakness

Question 47

Hypocalcemia

Answer 47

Tetany, seizure, QT prolongation