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USMLE GAME TIME > Renal - Grab Bag > Flashcards

Renal - Grab Bag Flashcards

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USMLE® Step 1 flashcards
1
Q

Granulomatosis with polyangiits treatment

A

Cyclophosphamide and prednisone

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2
Q

Goodpasture’s treatment

A

Immediate plasmapheresis

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3
Q

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

A

Type 1 - Subendothelial ICs with granular IF

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

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4
Q

Nephritic vs nephrotic syndrome definition by cause

A

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

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5
Q

Most common subtype of glomerular disease in SLE?

A

DPGN

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6
Q

Which disease is Hodgkin’s associated with?

A

Minimal change disease

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7
Q

Which disease is associated with HIV?

A

FSGS

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8
Q

Which kidney diseases are HBV and HCV associated with?

A

Type I MPGN; membranous nephropathy

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9
Q

Which disease is associated with sickle cell anemia?

A

FSGS

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10
Q

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

A

Membranous nephropathy

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11
Q

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

A

FSGS

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12
Q

What is the most common primary renal malignancy?

A

Renal cell carcinoma

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13
Q

Most common tumor of the urinary tract system?

A

Transitional cell carcinoma

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14
Q

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

A

Wilms tumor (nephroblastoma)

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15
Q

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

A

Wilms tumor

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16
Q

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

A

Beckwith-Wiedemann syndrome

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17
Q

Wilms tumor
Aniridia
Genitourinary abnormalities
Retardation

A

WAGR complex

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18
Q

What is the WAGR complex?

A

Wilms tumor, Aniridia, Genitourinary abnormalities, Retardation

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

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19
Q

What are risk factors for transitional cell carcinoma?

A

Phenacetin, Smoking, Aniline dyes, Cyclophosphamide

20
Q

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

A 
Chronic irritation of the urinary bladder
Schistosoma
Chronic cystitis
Smoking
Chronic nephrolithiasis
21
Q

Drugs that induce TIN versus drugs that cause ATN?

A

TIN - Diuretics, Penicillins, Sulfonamides, Rifampin, NSAIDs

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

22
Q

Type 1 RTA

A

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

Increase urine pH –> increase risk for Ca phosphate stones

23
Q

Type 2 RTA

A

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

Urine pH is normal

24
Q

Causes of Type 1 RTA?

A

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

25
Q

Causes of Type 2 RTA?

A

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

26
Q

Type 4 RTA

A

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

27
Q

RBC casts

A

Glomerulonephritis, ischemia, or malignant hypertension

28
Q

WBC casts

A

TIN, Acute pyelo, transplant rejection

29
Q

Fatty casts / oval fat bodies / maltese cross

A

Nephrotic syndrome

30
Q

Granular (muddy brown) casts

A

Acute tubular nephrosis

31
Q

Waxy casts

A

Advanced renal disease / chronic renal failure

32
Q

Hyaline casts

A

Nonspecific, normal finding, often seen in concentrated urine samples

33
Q

Liddle syndrome

A

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.

34
Q

Microscopy for IgA nephropathy

A

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

35
Q

Microscopy for DPGN

A

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

36
Q

Microscopy for RPGN

A

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

37
Q

Microscopy for Acute poststrep

A

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

38
Q

Microscopy for FSGS

A

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

39
Q

Microscopy for Membranous

A

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

40
Q

Minimal change microscopy

A

LM - normal
IF - negative
EM - foot process effacement

41
Q

Amyloidosis microscopy

A

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

42
Q

Membranoproliferative type I microscopy

A

subendothelial immune complex deposits with granular IF

Tram track appearance due to GBM splitting

43
Q

Type II membranoproliferative

A

Intramembranous IC deposits - dense deposits

44
Q

Which kidney diseases are associated with lupus?

A

DPGN

Membranous glomerulonephritis

45
Q

Diabetes microscopy

A

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

46
Q

Hypokalemia leads to

A

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

47
Q

Hypocalcemia

A

Tetany, seizure, QT prolongation

USMLE GAME TIME (46 decks)

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