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Renal > Renal Path > Flashcards

Renal Path Flashcards

1
Q

Congenital anomaly associated with Turner Syndrome

A

Horseshoe Kidney

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2
Q

Bilateral Agenesis of kidneys, lung hypoplasia, flat face, low set ears, extremity defects.

A

Potter Sequence

-still birth or early fatality

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3
Q

2 year old patient presents with bilateral enlarged kidneys with cortical and medullary cysts. Renal failure is iminate with HTN. Mode of inheritance of this condition and an associated finding.

A

Polycystic Kidney Disease

  • in younger kids it is autosomal recessive
  • it can lead to congenital hepatic fibrosis and cysts (portal HTN also)
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4
Q

Patient presents with HTN, hematuria, and progressing renal failure. What are 3 things associated with this condition?

A

Polycystic Kidney Disease

  • autosomal dominant in adults
  • can lead to berry aneurysm, hepatic cysts, mitral valve prolapse
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5
Q

Patient presents with increased BUN and creatinine with Oliguria over the past couple days.

A

Acute Renal Failure

-Azotemia (increased BUN and creatinine)

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6
Q

Patient presents with symptoms of acute renal failure. What kind of tests would indicate this is Prerenal Azotemia?

A

Serum BUN:Cr ratio greater than 15 (due to increased absorption of BUN
Tubular function is intact so fractional excretion of sodium (FENa) is still less than 1%. Normal urine osmolality

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7
Q

Patient presents with symptoms of acute renal failure. What tests would indicate Postrenal Azotemia?

A

Initial testing would be the same as prerenal because tubular function is still intact.
Chronic obstruction would lead to tubular damage. Eventually the BUN:Cr would decrease below 15, the FENa would increase above 2% and the urine osmolality would drop

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8
Q

Patient presents with symptoms of acute renal failure. What tests would indicate Intrarenal Azotemia?

A

(AKA) Acute Tubular Necrosis

  • decreased BUN:Cr (less than 15)
  • increased FENa (greater than 2%)
  • inability to concentrate urine
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9
Q

Patient presents with symptoms of acute renal failure. Brown granular casts are seen in the urine. What is the most likely medication the patient was taking?

A

Acute Tubular Necrosis

-etiology is nephrotoxic caused by aminoglycosides

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10
Q

Patient presents with fever, oliguria, and rash. Eosinophils are seen in the urine. What are 3 possible drugs that may cause this?

A

Acute Interstitial Nephritis

  • drug induced hypersensitivity reaction (Type 1)
  • NSAIDs, penicillin, diuretics
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11
Q

Patient presents with gross hematuria and flank pain. History reveals the patient is from Africa. What is most likely diagnosis?

A

Renal Papillary Necrosis

-common in diabetes mellitus, sickle cell trait or disease, severe acute pyelonephritis, or chronic analgesic use

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12
Q

4 characteristics resulting from Nephrotic Syndrome.

A

Proteinuria of greater than 3.5 grams/day results in:

  1. Hypoalbuminemia (pitting edema)
  2. Hypogammaglobulinemia (infections)
  3. Hypercoagulable State (loss of Antithrombin III)
  4. Hyperlipidemia and Hypercholesterolemia
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13
Q

Child presents with nephrotic syndrome. Effacement of the foot processes is seen on electron microscopy but no Immune complexes seen on IF. What is the ideal treatment option?

A

Minimal Change Disease

  • Steroids are used because the condition is mediated by cytokines from T cells
  • most common nephrotic syndrome in kids, loss of only albumin
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14
Q

Hispanic women presents with nephrotic syndrome. Effacement of foot processes is seen in EM, IF is negative. What would be seen on H&E and what 3 things are associated with this condition?

A

Focal Segmental Glomerulosclerosis (FSGS)

  • Hispanic and AA
  • associated with HIV, heroin, or Sickle Cell
  • H&E will show some glomeruli normal, and the affected ones will have only parts affected
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15
Q

Patient presents with nephrotic syndrome. History is positive for Hepatitis C. What would be seen on EM?

A

Membranous Nephropathy

  • most common in Caucasian adults
  • Spike and Dome appearance on EM
  • immune complexes of IF
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16
Q

Patient presents with nephrotic syndrome. H&E shows a Tram-Track appearance. What would may be relevant in the history?

A

Membranoproliferative Glomerulonephritis

  • immune complexes in basement membrane causes scarring
  • Assocaited with HBV or HCV or C3 nephritic factor
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17
Q

Patient presents with nephrotic syndrome. Microalbuminuria results from high glomerular filtration pressure. H&E reveals Kimmelstiel Wilson Nodules. What is the pathology of this condition?

A

Diabetes Mellitus causing renal failure
-high serum glucose leads to glycosylation of the vascular basement membrane of the efferent arteriole increasing GFR and glomerular pressure

18
Q

Patient presents with nephrotic syndrome. biopsy of the kidney has apple-green firefringence under polarized light after congo red stain.

A

Systemic Amyloidosis

19
Q

Characteristics of Nephritic Syndrome

A

Less than 3.5 grams of proteinuria/day

  • azotemia, oliguria
  • salt retention, periorbital edema, HTN
  • RBC casts
20
Q

Patient presents with gross hematuria (cola colored urine), oliguria, HTN, and periorbital edema. What is the pathogenesis of his disease if subepithelial “humps” are seen on EM?

A

Poststreptococcal Glomerulonephritis

  • nephritic syndrome
  • M protein virulence factor from Strep pyogenes infection forms immune complexes with Abs causing type III HS reaction as they accumulate in the basement membrane of the glomerulus
  • the complexes activate complement and mediate inflammation and damage
21
Q

Patient is being seen for Nephritic syndrome that is rapidly progressing to renal failure. There are crescents in the bowmans space on H&E. The patient is p-ANCA positive without granumomatous inflammation.

A

Microscopic Polyangiitis

-no IF (pauci immune)

22
Q

Patient is being seen for Nephritic syndrome that is rapidly progressing to renal failure. There are crescents in the bowmans space on H&E. The patient also has asthma. The patient is p-ANCA positive with granulomatous inflammation.

A

Churg-Strauss Syndrome

-no IF (pauci immune)

23
Q

Patient is being seen for Nephritic syndrome that is rapidly progressing to renal failure. The patient is pauci immune and is c-ANCA positive.

A

Wegener Granulomatosis

24
Q

Patient presents with nephritic syndrome rapidly progressing to renal failure. Hematuria and hemoptysis are starting to arise and his IF shows a linear pattern.

A

Goodpasture Syndrome

  • anti-basement membrane antibodies
  • can affect glomerular basement membrane and alveolar basement membrane (hematuria and hemoptysis)
25
Q

Patient presents with hematuria, HTN, and oliguria with azotemia. Patchy deposition on IF is observed and the patient has a history of recent gastroenteritis.

A

Berger Disease (IgA nephropathy)

  • occurs often following mucosal surface infection where IgA is highly proliferated
  • IgA immune complexes deposit in the mesangium
26
Q

Patient presents with hematuria, sensory hearing loss and trouble seeing.

A

Alport Syndrome

  • defect in Type IV collagen production
  • X-linked
27
Q

Patient presents with suprapubic pain, fever, cloudy urine with more than 10 WBCs/hpf. What is the most likely cause and what would the urine dipstick show?

A

Cystitis

  • E. coli
  • dipstick shows leukocyte esterase and nitrites
28
Q

Patient presents with symptoms of bladder infection. Dipstick is positive for esterase and nitrites but culture is negative. Causative agent is?

A

Chlamydia or Gonorrhea

29
Q

5 year old presents with fever, flank pain, and WBC casts in the urine. Most common cause and a risk factor.

A

Pyelonephritis

  • E. coli
  • Vesicoureteral Reflux is a common risk factor
30
Q

Patient presents with what appears to be frost on his scalp. He also has nausea, anorexia, and asterixis.

A

Uremia due to chronic renal failure

31
Q

How does chronic renal failure lead to anemia?

A

Descruction of peritubular interstitial cells in the kidney leads to decreased EPO production

32
Q

How does chronic renal failure lead to hypocalcemia?

A

Decreased 1-alpha hydroxylase enzyme for activating Vit D . Prevents calcium absorption

33
Q

Patient presents with flank pain that makes it difficult for him to breathe. He says it occurs when he has severe diarrhea related to his Crohns Disease. What is the best treatment?

A

Nephrolithiasis with Calcium Oxalate stones

-use Hydrochlorothiazide (calcium sparing diuretic)

34
Q

Patient presents with severe flank pain. Urinalysis reveals alkaline urine that reeks of ammonia. What is the treatment for this condition.

A

Nephrolithiasis with Amoonium Magnesium Phosphate stones

  • caused by Proteus vulgaris or other urease (+) bugs
  • Staghorn calculi often form that need surgical removal and antibiotics needed to treat the infection
35
Q

Patient presents with fever, unintentional weight loss, and gross hematuria. What is the pathogenesis of this condition?

A

Renal Cell Carcinoma

  • loss of VHL tumor suppressor gene (Von Hippel Linau)
  • risk factor is cigarette smoking
36
Q

Most common metastasis site for renal cell carcinoma.

A

Lungs and bone by way of the renal veins

37
Q

3 year old is brought to the office with hematuria. Testing reveals HTN and a palpable unilateral flank mass. Eye exam reveals aniridia. Please describe…

A

WAGR syndrome

  • Wilms Tumor
  • Aniridia
  • Genital Abnormalities
  • Retardation (mental and motor)
38
Q

What is a Wilms Tumor?

A

Unilateral kidney tumor in kids. Mutation in WT1 tumor suppressor gene. Involves immature mesenchymal tissue.

39
Q

Patient presents with painless hematuria. History of weight loss and smoking. Ultrasound of the kidneys reveals no masses or tumors.

A

Urothelial Carcinoma

  • transitional cells
  • p53 mutations form flat or papillary invasive tumors
40
Q

Biggest risk factor for squamous cell carcinoma of the bladder.

A

Schistosoma hematobium infection

Renal (2 decks)

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