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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
Q

Complications of chronic renal failure:

-GI?

A

-N/V, Anorexia

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26
Q

Complications of chronic renal failure:

-Cardiac ?

A

Pericarditis, CHF, hypertension

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27
Q

Complications of chronic renal failure:

-Hematologic ?

A

normocytic, normochromic anemia, platelet dysfunction, increased susceptibility to infection

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28
Q

Complications of chronic renal failure:

-CNS?

A

Polyneuropathy, encephalopathy

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29
Q

Segmental=

A

A portion of the glomerulus is involved

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30
Q

Global=

A

ALL of the glomerulus is involved

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31
Q

Focal=

A

Some of the glomeruli are involved

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32
Q

Diffuse=

A

All or almost all of the glomeruli are involved

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33
Q

Techniques to evaluate glomeruli:

  • Describe Light Microscopy: what is utilized?
  • PAS highlights ?
  • Trichome highlights ?
  • Silver highlights ?
A
  • Microscopy–>**stains utilized
  • Periodic Acid Schiff (PAS)-highlights basement membrane and mesangium
  • Trichrome-highlights fibrosis
  • Silver- highlights basement membrane
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34
Q

Techniques to evaluate glomeruli:

  • Describe Immunofluorescence (what does it use?)
  • Linear pattern=
  • Granular pattern=
A
  • **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
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35
Q

Techniques to evaluate glomeruli:

-Electron microscopy–>

A

structure and immune complex deposition (rarely used)

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36
Q

Linear pattern=

A

**Good pasture syndrome

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37
Q

Granular pattern=

A

more common w immune complex formations in the setting of lupus

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38
Q

Clinical manifestations of Glomerular disease (**5 things)

A
  • Nephrotic syndrome
  • Nephritic syndrome
  • Rapidly progressive glomerulonephritis
  • Chronic renal failure
  • Asymptomatic hematuria
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39
Q

Most glomerular diseases are ______ in nature

A

immunologic

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40
Q

Glomerular diseases are the result of either deposition of immune complexes or the result of _____

A

antibodies directly binding to antigens in the kidney

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41
Q

Glomerular diseases:

-immune complexes activate _______

A

compliment

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42
Q

If immune complexes are short lived (ie infection) renal fx is ______

A
  • *recovered

- -if not –>chronic renal failure

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43
Q

Nephrotic Syndrome: Pathogenesis

-Damage of glomeruli results in _____

A

**leakage of protein-much of which is albumin-resulting in hypoalbuminemia

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44
Q

Nephrotic Syndrome: Pathogenesis

-hypoalbuminemia causes decreased _______

A

**osmotic pressure–> edema

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45
Q

Nephrotic Syndrome is associated with what kind of edema ?

A

**Edema is generalized=anasarca, edema decreased the amount of fluid in the vascular space=decreased blood pressure

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46
Q

In nephrotic syndrome, decreased BP stimulates:

A

kidney production of renin, ultimately, aldosterone retains sodium and water causing worsening edema

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47
Q

Nephrotic syndrome:

-liver responds to loss of albumin by increasing production of _______

A

**apolipoprotein to compensate for low serum osmotic pressure=hyperlipidemia

48
Q

Nephrotic Syndrome:

-infections?

A

may result due to loss of Immunoglobulin(protein)

49
Q

Nephrotic syndrome:

-4 components (list) KNOW!

A
  1. proteinuria(>3.5g/day)
  2. Hypoalbuminemia
  3. Generalized edema
  4. Hyperlipidemia
50
Q

Nephrotic syndrome:

-clinical findings/sx?

A

Nausea, vomiting, periorbital edema, frothy urine

51
Q

Nephrotic syndrome:

-Labs? (urine findings and which type of cast)

A
  • Proteinuria
  • **Hypoalbuminemia
  • **Waxy casts and oval fat bodies in urine
52
Q

Nephrotic Syndrome:

-Oval fat bodies in urine have which appearance under polarized microscopy?

A

**Lipid droplets have maltese cross appearance with polarized microscopy

53
Q

Nephrotic syndrome: dx?

A

biopsy of kidney required to find specific cause of nephrotic syndrome

54
Q

Maltese cross (under polarized microscopy) =

A

nephrotic syndrome!!

55
Q

Specific Causes of Nephrotic Syndrome (list 4)

A

Minimal Change Disease
Focal Segmental Glomerulosclerosis
Membranous Glomerulonephropathy
Diabetic Nephropathy

56
Q

Minimal Change Disease (MCD):

-Demographic?

A

=MCC of nephrotic syndrome in children (ages 2-8 yrs) 2:1 male to female

57
Q

MCD causes selective proteinuria and is treated with ______

A

steroids

58
Q

MCD in adults, is associated with ______, _______, and _____ usage

A

lymphomas, leukemias and NSAID usage

59
Q

MCD:Microscopy/histology

-Light microscopy:

A
  • No abnormalities in glomeruli

- Proximal convoluted tubule laden with lipid and protein

60
Q

MCD:Microscopy/histology

-Immunofluorescence:

A

no abnormalities

61
Q

Focal Segmental Glomerulosclerosis is the 2nd MCC of ________ _______ in children

A

nephrotic syndrome

62
Q

Focal Segmental Glomerulosclerosis (FSGS) is the MCC of _______ ________ in adults

A

nephrotic syndrome

63
Q

T/F: FSGS is not immunologic in origin

A

true! origin-IgM and C3 are trapped causing injury to epithelial cells

64
Q

FSGS:

which Pt population is at 30x increased risk when compared to the rest of the population?

A

**IV heroin usage has 30x risk

65
Q

FSGS: tx?

A

no tx.

–leads to chronic glomerulonephritis and end stage renal disease within 10 years

66
Q

FSGS:

-light microscopy ?

A

Segmental sclerosis of a few glomeruli

67
Q

FSGS:

-Immunofluorescence: is (+) for ____

A

Positive for IgM and C3

68
Q

FSGS:

-electron microscopy

A

no immune complexes

69
Q

Membranous Glomerulonephropathy causes non selective _______

A

proteinuria

70
Q

Membranous Glomerulonephropathy is usually 2/2:

A

other processes: Syphilis, malaria, Hepatitis B or C, carcinoma of lung and colon, melanoma, lupus, drug therapy (NSAIDs)
–85% of cases idiopathic

71
Q

Membranous Glomerulonephropathy:

-describe the 1/3 rule

A

**1/3 undergo remission, 1/3 proteinuria but stable renal function, 1/3 progress to end stage renal disease in 5-10 yrs

72
Q

Membranous Glomerulonephropathy:

  • Light microscopy
    (findings) –> silver stain shows ______
A

thickened basement membrane extending between immune complexes “spike and dome” formation

73
Q

Membranous Glomerulonephropathy:

-immunofluorescence shows:

A

Granular pattern, positive for IgG

74
Q

Membranous Glomerulonephropathy:

-electron microscopy (shows?)

A

Subepithelial immune complexes

75
Q

Diabetic Nephropathy is the single MCC of ______

A

**end stage renal disease in US (40% of pts with end stage renal disease have diabetes)

76
Q

Diabetic Nephropathy:

-clinical Sx: persistent _______ and ____

A

albuminuria and hypertension

77
Q

Diabetic Nephropathy: what happens to GFR?

A

progressive DECREASE in GFR

78
Q

________ test predicts development of diabetic nephropathy

A

Microalbumin

79
Q

What is the Mc light microscopy finding associated with Diabetic Nephropathy?

A

is diffuse glomerulosclerosis=thickening of the basement membrane

80
Q

Nephritic Syndrome is characterized by acute renal failure, _____, and __________

A

acute renal failure (increased BUN, Creat with oliguria), HTN, and hematuria

81
Q

Nephritic Syndrome:

Are edema and proteinuria more or less as compared to nephrOtic syndrome?

A

Edema and proteinuria are present but much less than with nephrotic syndrome

82
Q

T/F: Damage of glomerulus is much more severe than with nephrotic syndrome

A

True

83
Q

Nephrotic= leakage of ______

A

protein

84
Q

Nephritic= leakage of _____

A

RBCs

85
Q

In nephritic syndrome, the immune complex deposition triggers proliferation of _______

A

glomerular cells and stimulates arrival of neutrophils

86
Q

Nephritic syndrome: Sx

A

Edema
Oliguria
Hypertension

87
Q

Nephritic Syndrome:

  • Lab findings?
  • _____ casts
A
  • Hematuria–>cola colored or smoky brown appearance
  • Proteinuria (<3g/day), elevated BUN, Creat

-Nephritic syndrome= RBC casts

88
Q

waxy casts=

A

nephrotic syndrome

89
Q

Serum compliment is LOW with:

A

postinfectious glomerulonephritis, SLE, bacterial endocarditis and membranoproliferative glomerulonephritis

90
Q

Normal level of serum compliment in:

A

IgA nephropathy, antiglomerular basement membrane disease (Goodpasture syndrome

91
Q

Nephritic Syndrome: Etiology (list 3 causes)

A

Postinfectious glomerulonephritis
Rapidly progressive glomerulonephritis
Membranoproliferative glomerulonephritis

92
Q

Postinfectious Glomerulonephritis MC occurs ____ weeks after Group A strep pharyngitis OR impetigo

A

1-4 weeks

93
Q

Postinfectious Glomerulonephritis: other causes?

A

staph infections, mumps, measles, Hepatitis B or C and chickenpox(varicella zoster)

94
Q

Postinfectious Glomerulonephritis: about ____% recover completely

A

90-95%

95
Q

Postinfectious Glomerulonephritis: some Pts progress to:

A

rapidly progressive glomerulonephritis which results in chronic glomerulonephritis

96
Q

Postinfectious Glomerulonephritis:

-serum compliment levels ?

A

LOW

97
Q

Postinfectious Glomerulonephritis:

-List 2 Ex’s of markers of a pervious strep indection

A

**ASO titer and antiDNAse B

98
Q

Postinfectious Glomerulonephritis:

-Light microscopy findings: (silver stain shows?)

A
  • All glomeruli have increased number of cells

- Silver stain “lumpy bumpy” appearance caused by staining of basement membrane growing around immune complexes

99
Q

Postinfectious Glomerulonephritis:

-Immunofluorescence (findings?)

A

Granular pattern, positive for IgG,M and complement

100
Q

Postinfectious Glomerulonephritis:

-electron microscopy (findings?)

A

Immune complex deposition

101
Q

Rapidly Progressive Glomerulonephritis can occur on it’s own, but is one of the main causes of _______

A

nephritic syndrome

102
Q

Rapidly Progressive Glomerulonephritis characterized by _____ cells in bowman capsule

A

**crescent

103
Q

3 different types of Rapidly Progressive Glomerulonephritis:
-describe type 1

A
  • IgG binding directly to glomerular basement membrane

- Goodpasture syndrome (anti glomerular basement membrane disease)

104
Q

3 different types of Rapidly Progressive Glomerulonephritis:
-describe type 2

A
  • Immune complex related

- Postinfectious glomerulonephritis, Ig A nephropathy, SLE, Henoch-Schonlein purpura

105
Q

3 different types of Rapidly Progressive Glomerulonephritis:
-describe type 3

A
  • No immune complexes

- Wegener granulomatosis

106
Q

Anti-glomerular basement membrane disease= antibody directed against the ______

A

glomerular basement membrane

107
Q

Anti-glomerular basement membrane disease:

-describe Good Pasture Syndrome (what is seen on imunofluorescence)

A
  • 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
Q

2 types of Membranoproliferative Glomerulonephritis:

-Type 1 associated with _____

A

Hepatitis B and C, lupus

109
Q

2 types of Membranoproliferative Glomerulonephritis:

-Type 2 associated with _____

A

hypocomplementemia

110
Q

Membranoproliferative Glomerulonephritis:

about 50% of Pts progres to _____

A

chronic renal failure within 10 years

111
Q

Chronic Glomerulonephritis results from _____

A

long term damage to glomeruli

112
Q

Chronic Glomerulonephritis:

  • characterized by:
  • clinical Sx:
A
  • sclerosis of glomeruli

- Clinically, Sx of renal insufficiency

113
Q

Chronic Glomerulonephritis:

-Gross pathology (findings?)

A

**cortex is often pale and swollen due to lipid deposition and interstitial edema

114
Q

Chronic Glomerulonephritis:

-common causes?

A

Diabetes, lupus nephritis, RPGN, FSGS and membranoproliferative glomerulnephritis

115
Q

Nephrotic syndrome:

  • Proteinuria=
  • Edema=
  • oliguria=
  • hematuria=
  • Other features=
A

Nephrotic syndrome:

  • Proteinuria= >3.5 g/day
  • Edema= yes
  • oliguria= NO
  • hematuria= NO
  • Other features= HypOalbuminemia and HYPERlipidemia
116
Q

Nephritic syndrome:

  • Proteinuria=
  • Edema=
  • oliguria=
  • hematuria=
  • Other features=
A

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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