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Pathophys Semester 2 > Renal-Part 2 schoenwald > Flashcards

Renal-Part 2 schoenwald Flashcards

1
Q

Asymptomatic Hematuria aka _______

A

Painless hematuria

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2
Q

Painless hematuria in smoker is ______ CA until proven otherwise

A

bladder

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3
Q

Most forms of asymptomatic hematuria caused by glomerular disease are due to ______

A

basement membrane abnormalities

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4
Q

MC cause of asymptomatic hematuria is:

A

IgA nephropathy–>caused by immune complex formation

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5
Q

List the 4 MC conditions causing asymptomatic hematuria:

A

IgA nephropathy, Henoch-Schonlein purpura, Alport syndrome and thin basement membrane disease

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6
Q

IgA nephropathy= a defect in production and clearance of ___

A

IgA

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7
Q

What is the MC primary cause of glomerulonephritis?

A

IgA nephropathy

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8
Q

IgA nephropathy:

-Sx: 40-50% of Pts have _______

A

asymptomatic hematuria

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9
Q

IgA nephropathy:

  • Pt demographic?
  • Age?
A
  • Ages 15-35 yrs

- More common in caucasions

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10
Q

IgA nephropathy is associated with celiac disease and ______

A

Henoch-Schonlein purpura

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11
Q

IgA Nephropathy:

-Light microscopy findings:

A

Focal segmental glomerulosclerosis of crescentic glomerulonephritis

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12
Q

IgA Nephropathy:

-Immunofluorescence (findings):

A

Granular pattern with IgA and complement

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13
Q

IgA Nephropathy:

-Electron microscopy (findings):

A

IgA immune complexes present

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14
Q

Henoch Schonlein Purpura= IgA mediated ______

A

vasculitis

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15
Q

Henoch Schonlein Purpura:

-Demographic?

A

Most common in children ages 3-8 years

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16
Q

Henoch Schonlein Purpura often follows streptococcal or _____ infection

A

viral

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17
Q

Henoch Schonlein Purpura:

  • Sx?
  • Classic finding=
A

GI bleeding, abdominal pain and arthralgias

**Classic rash is palpable purpura on the legs and buttocks

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18
Q

What % of Pts with Henoch Schonlein Purpura have renal involvement?

A

50% have renal involvement with hematuria

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19
Q

What is Palpable Purpura?

  • blanch?
  • characteristics?
A

If it does not blanch– it remains the color of the lesion
–palpable purpura DOES not blanch

Characteristics: touch it (palpate it) and you feel a nodular/tough surface underneath

-Henoch schonlein IS palpable

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20
Q

Tubulointerstitial Disease involves renal tubules and _________

A

interstitium

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21
Q 
Tubulointerstitial Disease: 
4 categories (list)
A
  • Acute Tubulointerstitial Disease
  • Acute Interstitial Nephritis
  • Chronic Tubulointerstitial Disease
  • Acute Tubular Necrosis
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22
Q

Acute Tubulointerstitial Disease= acute renal failure over a period of days to _____

A

weeks

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23
Q

Acute Tubulointerstitial Disease: Sx?

A

-hematuria

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24
Q

Acute Tubulointerstitial Disease:

IF due to a drug interaction what Sx and lab findings will happen?

A

rash, fever, eosinophilia and elevated IgE present

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25
Acute Tubulointerstitial Disease: | -microscopic findings?
edema of cells, neutrophils, and focal necrotizing infiltrates
26
Acute Tubulointerstitial Disease: | -list 4 causes
- drugs - systemic infections - Primary renal infections - immune disorders
27
Acute Tubulointerstitial Disease: etiology | -list specific drugs that cause ATD
Penicillins, rifampin , sulfonamides, ciprofloxacin
28
Acute Tubulointerstitial Disease: etiology | -list ex's of systemic infections
Legionnaire disease, streptococcal infections, CMV, mono
29
Acute Tubulointerstitial Disease: etiology | -Primary renal infections ex's
Acute bacterial pyelonephritis
30
Acute Tubulointerstitial Disease: etiology | -Immune disorders?
SLE and Sjogren’s
31
Acute Interstitial Nephritis (AIN) usually refers to noninfectious causes of _____
Acute Tubulointerstital Nephritis
32
AIN is usually drug induced: (list Ex's)
induced-penicillins and sulfonamides at top of list
33
Tubules have a high metabolic rate due to active transport systems and are sensitive to _______
injury
34
AIN: | -microscopic bx findings: ?
Interstitial lymphocytes and macrophages, eosinophils. Sometimes giant cells and granulomas
35
AIN: | -Pt presents with ? (list Sx)
hematuria, acute renal failure, rash, eosinophilia, proteinuria
36
Chronic Tubulointerstitial Disease: | -describe the clinical picture
renal insufficiency, hypertension, anemia, and non-nephrotic proteinuria occurring over years.
37
Chronic Tubulointerstitial Disease can develop after longterm ______ use
**NSAID= Analgesic nephropathy
38
Chronic Tubulointerstitial Disease: | -microscopic findings ?
cellular infiltrate composed of lymphocytes and macrophages. Interstitial fibrosis present
39
Chronic Tubulointerstitial Disease: | -Causes ?
- Urinary Tract Obstruction - Chronic pyelonephritis and reflux nephropathy - Drugs: NSAIDs, cisplatin, cyclosporine - Vascular Disease: HTN, atherosclerosis - Heavy Metals: Lead, Cadmium - Malignancies: Multiple Myeloma
40
Acute Tubular Necrosis (ATN)= rapid onset of necrosis of the tubular epithelium with subsequent acute loss of _____
renal fx
41
ATN is the MOST common cause of _____
acute renal failure
42
Tubular injury and ______ GFR leads to ATN
decreased
43
ATN: is associated with ________ casts***
**Protein casts in urine-Tamm Horsfall protein
44
ATN: | - Ischemic Causes: (list)
trauma with blood loss, sepsis
45
ATN: | - Toxic Causes: (list)
Aminoglycosides, IV contrast, mercury, ethylene glycol poisoning, hyperuricemia (high cell turnover with malignancies)
46
List ex's of aminoglyosides
gentamycin, tobramycin, and these have good pseudamonas coverage **Aminoglycosides are KNOWN to be nephrotoxic!
47
Acute Tubular Necrosis: | -list the 3 stages
- initiating - maintenance - Recovery
48
ATN: | -Describe Initiating Phase
Event that causes, no change in renal output
49
ATN: | -Describe Maintenance Phase
Oliguria, renal flow slows to <400 mls of urine, starts within 24 hours of initiating event
50
ATN: | -Describe Recovery Phase
Increased urine output, Up to 3 L, electrolyte disturbances at this time leads to increased risk of death.
51
Diabetic Nephropathy= microvascular changes in the capillaries of the kidneys that results in accelerated _______
degeneration and turnover of connective tissue
52
Diabetic Nephropathy: Capillary walls become ______ which leads to nephrotic syndrome
porous
53
Diabetic nephropathy: | -Arteriosclerotic changes at ?
the afferent and efferent arterioles--> ischemia
54
Cystitis= infection of the ______
bladder
55
Cystitis: clinical presentation?
Dysuria Urinary frequency and urgency Suprapubic discomfort
56
Cystitis: | -UA findings ?
Leukocyte esterase and nitrates (+) on UA
57
Acute Pyelonephritis= inflammation of the _____ due to infection
kidney
58
Acute Pyelonephritis: | Causes: (hint infection)
Ascending infection or hematogenous spread
59
Acute Pyelonephritis: | -MC bacteria ?
E coli, Proteus, Enterobacter
60
Acute Pyelonephritis: | -clinical Sx?
-Acute onset of fevers, chills, rigors, back pain with **CVA tenderness
61
Acute Pyelonephritis: | -associated with _____ casts
White cell casts
62
Acute pyelonephritis: | -risk factors for ascending infection (list)
- Obstruction - Vesicoureteral reflux - Diabetes - Other
63
Acute pyelonephritis: | -Ex's of obstruction
BPH and uterine prolapse impair voiding
64
Acute pyelonephritis | -How can DM cause acute pyelo?
Bladder dysfunction due to nerve damage, increased risk of infection
65
Acute pyelonephritis: | -other causes
Renal lesions, immunosuppression, trauma, intercourse, pregnancy
66
Acute Pyelonephritis: | -Complications?
- Pyelonephritis--> Because of obstruction, renal pelvis fills with neutrophils and bacteria - Emphysematous pyelonephritis--> Diabetics, gas production within the renal parenchyma, due to E coli -Papillary necrosis
67
Describe how papillary necrosis can occur 2/2 acute pyelonephritis
- Necrosis of renal papillae - Caused by ischemia, infection or obstruction - All patients with pyelonephritis are at risk - **Sickle cell anemia patients at risk
68
Nephrolithiasis=
kidney stones
69
What is the MC kidney stone made of?
Calcium Oxalate->50% of cases, idiopathic
70
Nephrolithiasis: | -uric acid stones are the only ________ stone
radiolucent (dont show up on xray)
71
Nephrolithiasis: | -uric acid stones are associated with ______
leukemia and lymphoma due to rapid cell turnover
72
Nephrolithiasis: | Struvite stones=
staghorn calculi
73
Nephrolithiasis: | Struvite stones are associated with ______ (hint: 3 P's)
Proteus, Providencia and Pseudomonas infection
74
Cystic Diseases of Kidney: | -how are they diagnosed?
Common incidental findings on radiology studies and autopsy
75
Simple cysts=
fluid filled in cortex of kidney, benign
76
Polycystic Kidney Disease: - etiology ? - Renal failure can occur in ____%
- Hereditary - Onset during adulthood - **Renal failure can occur in 50%
77
Polycystic Kidney Disease: - Sx? - Associated with ______
- Hypertension - Chronic uti - **Associated with Berry aneurysms-source of subarachnoid hemorrhage
78
Renal Neoplasms--> there are many different forms but the MC are ______
renal cell carcinoma in adults and Wilms tumor in children
79
Renal Cell Carcinoma (RCC): - occurs in which decades of life ? - M:F ratio ?
- Occurs in 6th and 7th decade of life | - Male to female 2:1
80
RCC: | -risk factors?
smoking, cadmium exposure and chronic dialysis
81
RCC: | -MC histiologic subtype?
Clear Cell renal carcinoma most common histiologic subtype
82
RCC has a propensity to invade the _____ and metastasize to _______
**renal vein, metastasize to the heart
83
RCC produce ________
**erythropoietin--> resulting in polycythemia
84
RCC: classic triad that is only seen in 10% of Pts
**hematuria, flank pain and palpable mass
85
RCC is associated with ________ syndrome
**Paraneoplastic syndrome associated –
86
triad of Sx of Paraneoplastic Syndrome
Polycythemia, hypercalcemia and HTN
87
Describe bladder diverticuli: - begin as ? - caused by ? - incidence is greater in men or women?
- Begin as small outpouchings or evaginations of the bladder wall - Caused by bladder outlet obstruction - Incidence greater in men
88
"urinating sand"
“urinating sand”= stones have broken down and now they are coming out
89
Neurogenic Bladder=
Impairment of bladder function as result of various conditions
90
What is a MAJOR risk factor for neurogenic bladder?
MS
91
Pts with Neurogenic bladder are at increased risk of _____
chronic infections
92
Transitional Cell Carcinoma (Bladder Cancer): - demographic? - risk factors ?
- Male predominance - 50-80 years of age - Risk factors- smoking, long term analgesic use, chronic cystitis
93
TCC of the bladder: | -describe the lesions
Many lesions are **papillary and can be removed without removing the whole bladder
94
TCC: | -Classic Sx?
**Painless hematuria
95
TCC: | -Schistosomiasis= is linked to ?
**Schistosomiasis (S hematobium) linked with squamous cell carcinoma of bladder (urinary schistosomiasis) -(linked to ppl swimming)

Pathophys Semester 2 (12 decks)

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