Renal path 1 Flashcards
T/F You don’t see casts w/ cystitis, bladder cancer, or kidney stones.
True. B/c they form in the kidney calyx.
Which type of cast is normal?
hyaline
What do the following indicate?
Fatty cast
granular (muddy brown) cast
waxy cast
fatty-nephrotic syndrome
muddy brown cast-acute tubular necrosis
waxy-end stage renal disease, low urine output
What is the most common type of kidney stone? What is its shape, X-ray findings, and pH?
Calcium stones! Calcium phosphate increases pH Calcium oxalate decreases pH Radiopaque on xray envelope or dumbbell shaped
What are some causes of calcium oxalate stones?
Vit C abuse
ethylene glycol (antifreeze)
malabsorption-Crohn’s
What is the most common kidney stone presentation and treatment?
calcium oxalate stone in pt w/ hypercalciuria from high PTH or something and normocalcemia
Treatment: thiazide diuretic (retain calcium in blood), hydration, citrate
Describe the pH, X-ray findings and shape of ammonium magnesium phosphate stones?
aka struvite stones, can form stag horn calculi
increase pH
radioopaque
coffin lid
How do ammonium magnesium phosphate stones form?
urea–>ammonia via urease
can happen w/ urease + bugs (proteus mirabilis, staph saprophytic us, klebsiella, pseudomonas)
ammonium binds up magnesium or phosphate
What’s the deal w/ uric acid kidney stones?
decrease pH
radiolucent
rhomboid or rosette shape
**visible on CT and ultrasound, but not X-ray
What is the treatment for uric acid stones?
alkalization of the urine
allopurinol
What’s the deal with cystine stones?
seen in children
decrease pH
hexagonal shape (sixtine has six sides)
can also form stag horn calculi
What can cause cystine stones and what can treat them?
aut recessive loss of fcn of PCT transporter of cystine reabsorption
sodium cyanide nitroprusside test +
treat w/ alkalization of the urine
What is the most common primary renal malignancy? Patients that usu get it?
Renal cell carcinoma
men in 50-70s who are obese and smoke
Which cell type does RCC originate from ?
polygonal clear cells of renal tubular cells (PCT)
What is the usual presentation of RCC?
can be silent and catch w/ metastasis to lung or bone
or can present w/ hematuria, palpable mass, secondary polycythemia from EPO release, flank pain, weight loss, fever.
Aside from EPO release, what else can be released w/ RCC?
ACTH, PTHrP, Prolactin
What is the genetic association w/ RCC?
Von Hippel Lindau Dx
Chromosome 3
What can happen once you get RCC?
invade renal vein and IVC and spread via blood to bone or lung
What is the most common renal malignancy in children? What is its genetic association?
Wilms tumor
WT1 or WT2 on Chromosome 11. loss of fcn mutation on tumor suppressor genes.
How does Wilms tumor present?
large palpable mass unilateral
hematuria
What are 2 conditions that Wilms tumor may be a part of?
- Beckwith Widemann Syndrome
2. WAGR complex
What are the features of beck with wiedemann syndrome?
Wilms tumor
macroglossia
organomegaly
hemihypertrophy
What are the features of WAGR complex?
wilms tumor
aniridia (congenital absence of the iris)
genitourinary malformation
retardation (ID)
What is the most common tumor of the urinary tract system? How does it present?
Transitional Cell Carcinoma
painless hematuria
**can occur from renal calyx to the bladder
Which substances predispose to transitional cell carcinoma?
Pee SAC Phenacetin Smoking Aniline Dyes Cyclophosphamide (can also cause hemorrhagic cystitis)
Aut Dom Polycystic Kidney Dx presents how?
bilateral enlarged kidneys
flank pain, hematuria
What is the genetic association of ADPKD?
PKD1 (chromosome 16)
PKD2 (chromosome 4)
Which possibly fatal associations are there w/ ADPKD?
berry aneurysms
mitral valve prolapse
benign hepatic cysts
What’s the deal with aut recessive polycystic kidney dx?
seen in infants
Potter sequence: oligohydramnios. See absent or small bladder.
sonogram: bilaterally enlarged hypoechoic kidneys
**associated w/ congenital hepatic fibrosis
What is the dx that is inherited, shows tubulointerstitial fibrosis, progressive renal insufficiency, and shrunken kidneys on US?
Medullary cystic dx
Which types of cysts do you remove for fear of progression to renal cell carcinoma?
complex cysts
Where are simple cysts usu found?
outer cortex of the kidney
