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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
Q

Acute Tubulointerstitial Disease:

-microscopic findings?

A

edema of cells, neutrophils, and focal necrotizing infiltrates

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26
Q

Acute Tubulointerstitial Disease:

-list 4 causes

A
  • drugs
  • systemic infections
  • Primary renal infections
  • immune disorders
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27
Q

Acute Tubulointerstitial Disease: etiology

-list specific drugs that cause ATD

A

Penicillins, rifampin , sulfonamides, ciprofloxacin

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28
Q

Acute Tubulointerstitial Disease: etiology

-list ex’s of systemic infections

A

Legionnaire disease, streptococcal infections, CMV, mono

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29
Q

Acute Tubulointerstitial Disease: etiology

-Primary renal infections ex’s

A

Acute bacterial pyelonephritis

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30
Q

Acute Tubulointerstitial Disease: etiology

-Immune disorders?

A

SLE and Sjogren’s

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31
Q

Acute Interstitial Nephritis (AIN) usually refers to noninfectious causes of _____

A

Acute Tubulointerstital Nephritis

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32
Q

AIN is usually drug induced: (list Ex’s)

A

induced-penicillins and sulfonamides at top of list

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33
Q

Tubules have a high metabolic rate due to active transport systems and are sensitive to _______

A

injury

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34
Q

AIN:

-microscopic bx findings: ?

A

Interstitial lymphocytes and macrophages, eosinophils. Sometimes giant cells and granulomas

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35
Q

AIN:

-Pt presents with ? (list Sx)

A

hematuria, acute renal failure, rash, eosinophilia, proteinuria

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36
Q

Chronic Tubulointerstitial Disease:

-describe the clinical picture

A

renal insufficiency, hypertension, anemia, and non-nephrotic proteinuria occurring over years.

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37
Q

Chronic Tubulointerstitial Disease can develop after longterm ______ use

A

**NSAID= Analgesic nephropathy

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38
Q

Chronic Tubulointerstitial Disease:

-microscopic findings ?

A

cellular infiltrate composed of lymphocytes and macrophages. Interstitial fibrosis present

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39
Q

Chronic Tubulointerstitial Disease:

-Causes ?

A
  • Urinary Tract Obstruction
  • Chronic pyelonephritis and reflux nephropathy
  • Drugs: NSAIDs, cisplatin, cyclosporine
  • Vascular Disease: HTN, atherosclerosis
  • Heavy Metals: Lead, Cadmium
  • Malignancies: Multiple Myeloma
40
Q

Acute Tubular Necrosis (ATN)= rapid onset of necrosis of the tubular epithelium with subsequent acute loss of _____

A

renal fx

41
Q

ATN is the MOST common cause of _____

A

acute renal failure

42
Q

Tubular injury and ______ GFR leads to ATN

A

decreased

43
Q

ATN: is associated with ________ casts***

A

**Protein casts in urine-Tamm Horsfall protein

44
Q

ATN:

- Ischemic Causes: (list)

A

trauma with blood loss, sepsis

45
Q

ATN:

- Toxic Causes: (list)

A

Aminoglycosides, IV contrast, mercury, ethylene glycol poisoning, hyperuricemia (high cell turnover with malignancies)

46
Q

List ex’s of aminoglyosides

A

gentamycin, tobramycin, and these have good pseudamonas coverage

**Aminoglycosides are KNOWN to be nephrotoxic!

47
Q

Acute Tubular Necrosis:

-list the 3 stages

A
  • initiating
  • maintenance
  • Recovery
48
Q

ATN:

-Describe Initiating Phase

A

Event that causes, no change in renal output

49
Q

ATN:

-Describe Maintenance Phase

A

Oliguria, renal flow slows to <400 mls of urine, starts within 24 hours of initiating event

50
Q

ATN:

-Describe Recovery Phase

A

Increased urine output, Up to 3 L, electrolyte disturbances at this time leads to increased risk of death.

51
Q

Diabetic Nephropathy= microvascular changes in the capillaries of the kidneys that results in accelerated _______

A

degeneration and turnover of connective tissue

52
Q

Diabetic Nephropathy: Capillary walls become ______ which leads to nephrotic syndrome

A

porous

53
Q

Diabetic nephropathy:

-Arteriosclerotic changes at ?

A

the afferent and efferent arterioles–> ischemia

54
Q

Cystitis= infection of the ______

A

bladder

55
Q

Cystitis: clinical presentation?

A

Dysuria
Urinary frequency and urgency
Suprapubic discomfort

56
Q

Cystitis:

-UA findings ?

A

Leukocyte esterase and nitrates (+) on UA

57
Q

Acute Pyelonephritis= inflammation of the _____ due to infection

A

kidney

58
Q

Acute Pyelonephritis:

Causes: (hint infection)

A

Ascending infection or hematogenous spread

59
Q

Acute Pyelonephritis:

-MC bacteria ?

A

E coli, Proteus, Enterobacter

60
Q

Acute Pyelonephritis:

-clinical Sx?

A

-Acute onset of fevers, chills, rigors, back pain with **CVA tenderness

61
Q

Acute Pyelonephritis:

-associated with _____ casts

A

White cell casts

62
Q

Acute pyelonephritis:

-risk factors for ascending infection (list)

A
  • Obstruction
  • Vesicoureteral reflux
  • Diabetes
  • Other
63
Q

Acute pyelonephritis:

-Ex’s of obstruction

A

BPH and uterine prolapse impair voiding

64
Q

Acute pyelonephritis

-How can DM cause acute pyelo?

A

Bladder dysfunction due to nerve damage, increased risk of infection

65
Q

Acute pyelonephritis:

-other causes

A

Renal lesions, immunosuppression, trauma, intercourse, pregnancy

66
Q

Acute Pyelonephritis:

-Complications?

A
  • 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
Q

Describe how papillary necrosis can occur 2/2 acute pyelonephritis

A
  • Necrosis of renal papillae
  • Caused by ischemia, infection or obstruction
  • All patients with pyelonephritis are at risk
  • **Sickle cell anemia patients at risk
68
Q

Nephrolithiasis=

A

kidney stones

69
Q

What is the MC kidney stone made of?

A

Calcium Oxalate->50% of cases, idiopathic

70
Q

Nephrolithiasis:

-uric acid stones are the only ________ stone

A

radiolucent (dont show up on xray)

71
Q

Nephrolithiasis:

-uric acid stones are associated with ______

A

leukemia and lymphoma due to rapid cell turnover

72
Q

Nephrolithiasis:

Struvite stones=

A

staghorn calculi

73
Q

Nephrolithiasis:

Struvite stones are associated with ______ (hint: 3 P’s)

A

Proteus, Providencia and Pseudomonas infection

74
Q

Cystic Diseases of Kidney:

-how are they diagnosed?

A

Common incidental findings on radiology studies and autopsy

75
Q

Simple cysts=

A

fluid filled in cortex of kidney, benign

76
Q

Polycystic Kidney Disease:

  • etiology ?
  • Renal failure can occur in ____%
A
  • Hereditary
  • Onset during adulthood
  • **Renal failure can occur in 50%
77
Q

Polycystic Kidney Disease:

  • Sx?
  • Associated with ______
A
  • Hypertension
  • Chronic uti
  • **Associated with Berry aneurysms-source of subarachnoid hemorrhage
78
Q

Renal Neoplasms–> there are many different forms but the MC are ______

A

renal cell carcinoma in adults and Wilms tumor in children

79
Q

Renal Cell Carcinoma (RCC):

  • occurs in which decades of life ?
  • M:F ratio ?
A
  • Occurs in 6th and 7th decade of life

- Male to female 2:1

80
Q

RCC:

-risk factors?

A

smoking, cadmium exposure and chronic dialysis

81
Q

RCC:

-MC histiologic subtype?

A

Clear Cell renal carcinoma most common histiologic subtype

82
Q

RCC has a propensity to invade the _____ and metastasize to _______

A

**renal vein, metastasize to the heart

83
Q

RCC produce ________

A

**erythropoietin–> resulting in polycythemia

84
Q

RCC: classic triad that is only seen in 10% of Pts

A

**hematuria, flank pain and palpable mass

85
Q

RCC is associated with ________ syndrome

A

**Paraneoplastic syndrome associated –

86
Q

triad of Sx of Paraneoplastic Syndrome

A

Polycythemia, hypercalcemia and HTN

87
Q

Describe bladder diverticuli:

  • begin as ?
  • caused by ?
  • incidence is greater in men or women?
A
  • Begin as small outpouchings or evaginations of the bladder wall
  • Caused by bladder outlet obstruction
  • Incidence greater in men
88
Q

“urinating sand”

A

“urinating sand”= stones have broken down and now they are coming out

89
Q

Neurogenic Bladder=

A

Impairment of bladder function as result of various conditions

90
Q

What is a MAJOR risk factor for neurogenic bladder?

A

MS

91
Q

Pts with Neurogenic bladder are at increased risk of _____

A

chronic infections

92
Q

Transitional Cell Carcinoma (Bladder Cancer):

  • demographic?
  • risk factors ?
A
  • Male predominance
  • 50-80 years of age
  • Risk factors- smoking, long term analgesic use, chronic cystitis
93
Q

TCC of the bladder:

-describe the lesions

A

Many lesions are **papillary and can be removed without removing the whole bladder

94
Q

TCC:

-Classic Sx?

A

**Painless hematuria

95
Q

TCC:

-Schistosomiasis= is linked to ?

A

**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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