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Pathophys Semester 2 > Renal Part 1-schoenwald > Flashcards

Renal Part 1-schoenwald Flashcards

1
Q

Kidneys are primary regulators of the ______

A

internal environment

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2
Q

Kidneys: fx

  • how many liters of fluid are filtered per day?
  • how many liters of urine are made per day?
A
  • fluid regulation

- Filter 180 liters/day while making 1.5 liters or urine per day

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3
Q

Normal kidney function requires ?

A

well regulated blood flow

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4
Q

What is important in determining kidney pathology?

A

Microscopy and biopsy important in determining pathology

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5
Q

Acute Renal Failure (Acute kidney injury):
-onset?
-

A

Rapid in onset

-azotemia

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6
Q

azotemia=

A

elevated BUN and Creat +/- anuria

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7
Q

3 types of AKI:

A
  • prerenal
  • renal
  • post renal
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8
Q

Prerenal: originates proximal to the ______

A

kidney

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9
Q

Prerenal AKI:

-causes ?

A

Low volume stimulus-hypovolemia,heart failure, sepsis and

renal vascular pathology-stenosis, atherosclerosis

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10
Q

Prerenal AKI:

-Kidney fx?

A

Kidney functions normally but responds to a low volume stimulus by reabsorption of Na (FENa <1%), water and urea

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11
Q

Prerenal: Creat is secreted by _____ but BUN filtered and reabsorbed= (what is the BUN: Cr ratio?)

A
  • tubules

- **BUN increase out of proportion to Creat BUN:CR ratio >20:1

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12
Q

Renal:

-Source of problem originates within the ______

A

kidney

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13
Q

Renal AKI:

-causes?

A
  • acute tubular necrosis, glomerular disease, acute interstitial nephritis
  • Implies dysfunction of the kidney itself
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14
Q

Renal AKI:

-impaired tubular fx results in FENa: _____ and BUN:Cr ratio of ____

A

FENa >1%, BUN:Cr ration <20:1

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15
Q

AKI: postrenal

  • MC cause?
  • dx test of choice in eval=
A
  • Obstruction, kidney stones major cause

- Obstruction can cause hydronephrosis, renal ultrasound test of choice in evaluation

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16
Q

Clinical Symptoms of AKI

A 
Electrolyte disturbances
Decreased urine output
Lethargy
Fatigue
Nausea
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17
Q

Prerenal Lab summary:

  • FENa=
  • BUN/Cr ratio=
  • Urine sodium=
  • Urine Osmolality=
  • Specific gravity=
A
  • FENa= <1%
  • BUN/Cr ratio= >20:1
  • Urine sodium= <20 mEq/L
  • Urine Osmolality= >500 Osm/kg
  • Specific gravity= >1.02
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18
Q

Renal labs summary:

  • -FENa=
  • BUN/Cr ratio=
  • Urine sodium=
  • Urine Osmolality=
  • Specific gravity=
A
  • FENa= >1%
  • BUN/Cr ratio= <20:1
  • Urine sodium= >20 mEq/L
  • Urine Osmolality= <400 Osm/kg
  • Specific gravity= <1.01
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19
Q

What are the MC causes of Chronic renal failure?

A

diabetes mellitus, HTN, glomerulonephritis

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20
Q

Chronic Renal Failure: sx?

A
  • Symptoms of acute renal failure but with longer duration

- Fatigue, nausea/ vomiting, edema

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21
Q

4 stages of CRF:

-Stage 1=

A

Diminished renal reserve-GFR=50%

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22
Q

4 stages of CRF:

-Stage 2=

A

Renal insufficiency-GFR=20-50% of normal, signs include-hypertension, anemia and polyuria(decreased concentrating ability)

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23
Q

4 stages of CRF:

-Stage 3=

A

Renal failure –GFR<20% of normal, edema and metabolic acidosis

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24
Q

4 stages of CRF:

-Stage 4=

A

End stage renal failure-GFR<5%

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25
Complications of chronic renal failure: | -GI?
-N/V, Anorexia
26
Complications of chronic renal failure: | -Cardiac ?
Pericarditis, CHF, hypertension
27
Complications of chronic renal failure: | -Hematologic ?
normocytic, normochromic anemia, platelet dysfunction, increased susceptibility to infection
28
Complications of chronic renal failure: | -CNS?
Polyneuropathy, encephalopathy
29
Segmental=
A portion of the glomerulus is involved
30
Global=
ALL of the glomerulus is involved
31
Focal=
Some of the glomeruli are involved
32
Diffuse=
All or almost all of the glomeruli are involved
33
Techniques to evaluate glomeruli: - Describe Light Microscopy: what is utilized? - PAS highlights ? - Trichome highlights ? - Silver highlights ?
- Microscopy-->**stains utilized - Periodic Acid Schiff (PAS)-highlights basement membrane and mesangium - Trichrome-highlights fibrosis - Silver- highlights basement membrane
34
Techniques to evaluate glomeruli: - Describe Immunofluorescence (what does it use?) - Linear pattern= - Granular pattern=
- **uses IgG, IgM and IgA) - Linear pattern=reaction directed against antigen in glomerular basement membrane (Goodpasture syndrome) - Granular pattern=reaction against antigen/antibody immune complexes in glomerular basement membrane-SLE
35
Techniques to evaluate glomeruli: | -Electron microscopy-->
structure and immune complex deposition (rarely used)
36
Linear pattern=
**Good pasture syndrome
37
Granular pattern=
more common w immune complex formations in the setting of lupus
38
Clinical manifestations of Glomerular disease (**5 things)
- Nephrotic syndrome - Nephritic syndrome - Rapidly progressive glomerulonephritis - Chronic renal failure - Asymptomatic hematuria
39
Most glomerular diseases are ______ in nature
immunologic
40
Glomerular diseases are the result of either deposition of immune complexes or the result of _____
antibodies directly binding to antigens in the kidney
41
Glomerular diseases: | -immune complexes activate _______
compliment
42
If immune complexes are short lived (ie infection) renal fx is ______
* *recovered | - -if not -->chronic renal failure
43
Nephrotic Syndrome: Pathogenesis | -Damage of glomeruli results in _____
**leakage of protein-much of which is albumin-resulting in hypoalbuminemia
44
Nephrotic Syndrome: Pathogenesis | -hypoalbuminemia causes decreased _______
**osmotic pressure--> edema
45
Nephrotic Syndrome is associated with what kind of edema ?
**Edema is generalized=anasarca, edema decreased the amount of fluid in the vascular space=decreased blood pressure
46
In nephrotic syndrome, decreased BP stimulates:
kidney production of renin, ultimately, aldosterone retains sodium and water causing worsening edema
47
Nephrotic syndrome: | -liver responds to loss of albumin by increasing production of _______
**apolipoprotein to compensate for low serum osmotic pressure=hyperlipidemia
48
Nephrotic Syndrome: | -infections?
may result due to loss of Immunoglobulin(protein)
49
Nephrotic syndrome: | -4 components (list) KNOW!
1. proteinuria(>3.5g/day) 2. Hypoalbuminemia 3. Generalized edema 4. Hyperlipidemia
50
Nephrotic syndrome: | -clinical findings/sx?
Nausea, vomiting, periorbital edema, frothy urine
51
Nephrotic syndrome: | -Labs? (urine findings and which type of cast)
- Proteinuria - **Hypoalbuminemia - **Waxy casts and oval fat bodies in urine
52
Nephrotic Syndrome: | -Oval fat bodies in urine have which appearance under polarized microscopy?
**Lipid droplets have maltese cross appearance with polarized microscopy
53
Nephrotic syndrome: dx?
biopsy of kidney required to find specific cause of nephrotic syndrome
54
Maltese cross (under polarized microscopy) =
nephrotic syndrome!!
55
Specific Causes of Nephrotic Syndrome (list 4)
Minimal Change Disease Focal Segmental Glomerulosclerosis Membranous Glomerulonephropathy Diabetic Nephropathy
56
Minimal Change Disease (MCD): | -Demographic?
=MCC of nephrotic syndrome in children (ages 2-8 yrs) 2:1 male to female
57
MCD causes selective proteinuria and is treated with ______
steroids
58
MCD in adults, is associated with ______, _______, and _____ usage
lymphomas, leukemias and NSAID usage
59
MCD:Microscopy/histology | -Light microscopy:
- No abnormalities in glomeruli | - Proximal convoluted tubule laden with lipid and protein
60
MCD:Microscopy/histology | -Immunofluorescence:
no abnormalities
61
Focal Segmental Glomerulosclerosis is the 2nd MCC of ________ _______ in children
nephrotic syndrome
62
Focal Segmental Glomerulosclerosis (FSGS) is the MCC of _______ ________ in adults
nephrotic syndrome
63
T/F: FSGS is not immunologic in origin
true! origin-IgM and C3 are trapped causing injury to epithelial cells
64
FSGS: | which Pt population is at 30x increased risk when compared to the rest of the population?
**IV heroin usage has 30x risk
65
FSGS: tx?
no tx. | --leads to chronic glomerulonephritis and end stage renal disease within 10 years
66
FSGS: | -light microscopy ?
Segmental sclerosis of a few glomeruli
67
FSGS: | -Immunofluorescence: is (+) for ____
Positive for IgM and C3
68
FSGS: | -electron microscopy
no immune complexes
69
Membranous Glomerulonephropathy causes non selective _______
proteinuria
70
Membranous Glomerulonephropathy is usually 2/2:
other processes: Syphilis, malaria, Hepatitis B or C, carcinoma of lung and colon, melanoma, lupus, drug therapy (NSAIDs) --85% of cases idiopathic
71
Membranous Glomerulonephropathy: | -describe the 1/3 rule
**1/3 undergo remission, 1/3 proteinuria but stable renal function, 1/3 progress to end stage renal disease in 5-10 yrs
72
Membranous Glomerulonephropathy: - Light microscopy (findings) --> silver stain shows ______
thickened basement membrane extending between immune complexes “spike and dome” formation
73
Membranous Glomerulonephropathy: | -immunofluorescence shows:
Granular pattern, positive for IgG
74
Membranous Glomerulonephropathy: | -electron microscopy (shows?)
Subepithelial immune complexes
75
Diabetic Nephropathy is the single MCC of ______
**end stage renal disease in US (40% of pts with end stage renal disease have diabetes)
76
Diabetic Nephropathy: | -clinical Sx: persistent _______ and ____
albuminuria and hypertension
77
Diabetic Nephropathy: what happens to GFR?
progressive DECREASE in GFR
78
________ test predicts development of diabetic nephropathy
Microalbumin
79
What is the Mc light microscopy finding associated with Diabetic Nephropathy?
is diffuse glomerulosclerosis=thickening of the basement membrane
80
Nephritic Syndrome is characterized by acute renal failure, _____, and __________
acute renal failure (increased BUN, Creat with oliguria), HTN, and hematuria
81
Nephritic Syndrome: | Are edema and proteinuria more or less as compared to nephrOtic syndrome?
Edema and proteinuria are present but much less than with nephrotic syndrome
82
T/F: Damage of glomerulus is much more severe than with nephrotic syndrome
True
83
Nephrotic= leakage of ______
protein
84
Nephritic= leakage of _____
RBCs
85
In nephritic syndrome, the immune complex deposition triggers proliferation of _______
glomerular cells and stimulates arrival of neutrophils
86
Nephritic syndrome: Sx
Edema Oliguria Hypertension
87
Nephritic Syndrome: - Lab findings? - _____ casts
- Hematuria-->cola colored or smoky brown appearance - Proteinuria (<3g/day), elevated BUN, Creat -Nephritic syndrome= RBC casts
88
waxy casts=
nephrotic syndrome
89
Serum compliment is LOW with:
postinfectious glomerulonephritis, SLE, bacterial endocarditis and membranoproliferative glomerulonephritis
90
Normal level of serum compliment in:
IgA nephropathy, antiglomerular basement membrane disease (Goodpasture syndrome
91
Nephritic Syndrome: Etiology (list 3 causes)
Postinfectious glomerulonephritis Rapidly progressive glomerulonephritis Membranoproliferative glomerulonephritis
92
Postinfectious Glomerulonephritis MC occurs ____ weeks after Group A strep pharyngitis OR impetigo
1-4 weeks
93
Postinfectious Glomerulonephritis: other causes?
staph infections, mumps, measles, Hepatitis B or C and chickenpox(varicella zoster)
94
Postinfectious Glomerulonephritis: about ____% recover completely
90-95%
95
Postinfectious Glomerulonephritis: some Pts progress to:
rapidly progressive glomerulonephritis which results in chronic glomerulonephritis
96
Postinfectious Glomerulonephritis: | -serum compliment levels ?
LOW
97
Postinfectious Glomerulonephritis: | -List 2 Ex's of markers of a pervious strep indection
**ASO titer and antiDNAse B
98
Postinfectious Glomerulonephritis: | -Light microscopy findings: (silver stain shows?)
- All glomeruli have increased number of cells | - Silver stain "lumpy bumpy” appearance caused by staining of basement membrane growing around immune complexes
99
Postinfectious Glomerulonephritis: | -Immunofluorescence (findings?)
Granular pattern, positive for IgG,M and complement
100
Postinfectious Glomerulonephritis: | -electron microscopy (findings?)
Immune complex deposition
101
Rapidly Progressive Glomerulonephritis can occur on it's own, but is one of the main causes of _______
nephritic syndrome
102
Rapidly Progressive Glomerulonephritis characterized by _____ cells in bowman capsule
**crescent
103
3 different types of Rapidly Progressive Glomerulonephritis: -describe type 1
- IgG binding directly to glomerular basement membrane | - Goodpasture syndrome (anti glomerular basement membrane disease)
104
3 different types of Rapidly Progressive Glomerulonephritis: -describe type 2
- Immune complex related | - Postinfectious glomerulonephritis, Ig A nephropathy, SLE, Henoch-Schonlein purpura
105
3 different types of Rapidly Progressive Glomerulonephritis: -describe type 3
- No immune complexes | - Wegener granulomatosis
106
Anti-glomerular basement membrane disease= antibody directed against the ______
glomerular basement membrane
107
Anti-glomerular basement membrane disease: | -describe Good Pasture Syndrome (what is seen on imunofluorescence)
- Characterized by lung hemorrhage and severe, **rapidly progressing glomerulonephritis - Immunofluorescence shows a linear pattern of distribution of complement and IgG along the basement membrane
108
2 types of Membranoproliferative Glomerulonephritis: | -Type 1 associated with _____
Hepatitis B and C, lupus
109
2 types of Membranoproliferative Glomerulonephritis: | -Type 2 associated with _____
hypocomplementemia
110
Membranoproliferative Glomerulonephritis: | about 50% of Pts progres to _____
chronic renal failure within 10 years
111
Chronic Glomerulonephritis results from _____
long term damage to glomeruli
112
Chronic Glomerulonephritis: - characterized by: - clinical Sx:
- sclerosis of glomeruli | - Clinically, Sx of renal insufficiency
113
Chronic Glomerulonephritis: | -Gross pathology (findings?)
**cortex is often pale and swollen due to lipid deposition and interstitial edema
114
Chronic Glomerulonephritis: | -common causes?
Diabetes, lupus nephritis, RPGN, FSGS and membranoproliferative glomerulnephritis
115
Nephrotic syndrome: - Proteinuria= - Edema= - oliguria= - hematuria= - Other features=
Nephrotic syndrome: - Proteinuria= >3.5 g/day - Edema= yes - oliguria= NO - hematuria= NO - Other features= HypOalbuminemia and HYPERlipidemia
116
Nephritic syndrome: - Proteinuria= - Edema= - oliguria= - hematuria= - Other features=
Nephritic syndrome: - Proteinuria= <3.0 g/day - Edema= yes - oliguria= yes - hematuria= yes - Other features= HTN, **RBC casts in urine, Elevated BUN/Creat

Pathophys Semester 2 (12 decks)

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