Renal Path Flashcards
RBC casts seen in
Glomerulonephritis
Ischemia
Malignant HTN
WBC casts seen in
Tubulointerstitial inflammartion
acute pyelonephritis
Transplant rejection
Fatty Casts seen in
Nephrotic Syndromes
Muddy Brown (Granular Casts) seen in
Acute tubular necrosis
Waxy casts seen in
advanced renal disease
chronic renal failure
Hyaline Casts
Non-specific
Can be normal finding
Nephritic Syndromes
Acute Postreptococcal GN
Rapidly Progressive GN
Berger’s IgA Glomerulonephropathy
Alport Syndrome
Nephrotic Syndromes
Focal Segmental Membranous Minimal ∆ Amyloidosis Diabetic Glomerulonephropathy
Mixed nephritic/nephrotic
Diffuse proliferative GN
Memranoproliferative GN
Nephrotic Characteristics
Massive Proeinuria (> 3.5 g/day) Hyperlipidemia Fatty Casts Edema Inc. risk of infxn Hypercoagulable State
Nepthritic Characteristics
Inflammatory Process Proteinuria (< 3.5 g/day) Hematuria RBC Casts HTN oliguria azotemia
Effacement of foot processes
Hyalinosis and segmental sclerosis
HIV
Black pt.
Focal Segmental GN
Focal Segmental GN associated with
Black/Hispanic
HIV Heroin Massive obesity Interferon Tx Chronic Kidney disease--agenesis or removal
Nephrotic syndromes with foot process effacement
Focal Segmental
Minima ∆
Spike and Dome on EM with subepithelial deposits
Granular IF
Nephrotic Syndrome
Membranous Nephropathy
SLE kidney diseases
1–Diffuse Proliferative GN (nephritic)
Membranous (nephrotic)
Membranous Nephropathy associated with
SLE
Solid Tumors
Rx
Infxn
1 Nephrotic Syndrome in adults
Membranous
1 nephrotic syndrome in kids
Minimal ∆
Congo Red stain with Apple Green Birefringence
Underlying Chronic Condition
Nephrotic Syndrome
Amyloidosis
Amyloidosis associated with
Multiple Myeloma (1º)
TB, RA (2º)
Normal glomeruli on LM
EM shows effacement of foot processes
Kid
Nephrotic Syndrome
Minimal ∆
minimal ∆ Tx
Coritcosteroids
Nephrotic Syndromes associated with HBV/HCV
Focal Segmental
Type I Membranoproliferative
Subendothelial IC deposition Granular IF Tram Track appearance GBM splitting due to mesangial ingrowth HBV/HCV
Type I membranoproliferative
INTRAmembranous immune complex deposition
Dense deposits
C3 nephrotic Factor
Type II membranoproliferative
Nonenzymatic glycosylation of GBM
Deposition of hyaline in efferent arterioles of kidney
Kimmelstiel Wilson lesion
Diabetic GN
Kimmelstiel Wilson Lesion
eosinophilic nodular glomerulosclerosis seen in diabetic GN
Subepithelial Humps seen on EM hypercellular neutorphils with lumpy bumpy appearance Child with recent pharyngitis Granular IF Nephritic Syndrome
Acute Poststreptococcal GN
Immune complexes deposited in PSGN
IgM
IgG
C3
Along GBM and Mesangium
Nephritic Syndrome
Crescent moon shaped lesion on LM and IF
deteriorating condition in days to weeks
Rapidly Progressive GN (RPGN)
RPGN deposition
Fibrin and plasma proteins
Macrophages, parietal cells, monocytes
Syndromes that cause RPGN
Goodpasture’s (hematuria and hemoptysis)
Wegener’s (c-ANCA)
Microscopic Polyangiitis (p-ANCA)
Wire looping of capillaries Subendothelial/intramembranous IgG immune complexes C3 deposition Nephritic Factor SLE Granular IF
Diffuse Proliferative
Can be nephritic and nephrotic concurrently
Mesangial Proliferation
Mesangial IC deposits
IgA deposits in mesangium
URI or GI infection
Berger’s Disease
IgA nephropathy
Mutation of Type IV collagen split basement membrane X-linked Hearing deficits Visual disturbances Nephritic syndrome
Alport Syndrome
Most common Kidney Stone
Calcium
Phosphate–high pH
***Oxalate–low pH
Tx for Ca stones
Thiazides and citrate
Most common presentation of Ca stone pt.
hypercalciuria
Normal serum Ca
Calcium oxalate stone
Causes of Ca stones
Crohn’s
Vit. C abuse
Ethylene Glycol
Staghorn stone in adults
Ammonium Mg Phosphate
Struvite stones
Cause of Struvite stones
Proteus
Klebsiealla
Staph
Urease+ bugs alkalinize the urine
Radiolucent Kidney Stone
Uric acid stone
visible on CT and US but not Xray
Tx Uric Acid Stones
Alkalization of urine
Tx Staghorn stones
Surgery
Clear infxn
Staghorn stone in children
Cystine Stone
Forms at Low pH
Tx cystine stones
Alk. urine
Cause of Cystine stones
2º to cystinuria
low pH urine
Hydronephrosis
Back up of urine into kidney–dilation of renal pelvis and calyces proximal to obstruction
vesicoureteral reflux can cause too
50-70 year old fat smoker
Renal Mass filled with clear cells and lipids/carbohydrates
Paraneoplastic Syndrome
Renal cell CA
RCC gene association
VHL gene on Chromosome 3 (von Hippel-Lindau) for inherited
Paraneoplastic syndromes associated with RCC
EPO
ACTH
PTHrH
RCC Tx
Surgery
Resists chemo and radiation
Child (2-4) with huge unilateral mass on flank
Hematuria
Wilm’s Tumor
Wilm’s Tumor composed of
Blastema–embryonic glomerular stxrs
Gene associated with Wilm’s Tumor
WT1 on Chromosome 11
WAGR complex
Wilm’s Tumor
Aniridia
Genitourinary Malformations
Retardation (motor/mental)
Wilm’s tumor syndromes
WAGR
Beckwith-Wiedemann Syndrome
Most common tumor of lower urinary tract
Urothelial (transitional cell) CA
Presentation of Urothelial CA
Painless hematuria
No casts
Urothelial CA risk factors
Smoking
Phenacetin
Aniline Dyes (hair dresser)
Cyclophasphamide
Fever Costovertebral Angle tenderness Cx effected but glomeruli spared N/V White casts in urine
Acute Pyelonephritis
Cause of chronic pyelonephritis
Recurrent episodes of acute PN
Vesicouretal reflux
Chronic Obstruction
Chronic Pyelonephritis findings of kidney
Coarse, asymmetric corticomedullary scarring
Blunted Calyx
Eosinophilc Casts in tubules
Thyoroidization of kidney
Acute interstitial renal inflammation Pyuria azotemia Recent Rx started fever, rash, hematuria CVA tenderness
Rx Induced Interstitial Nephritis
Tubulointerstitial nephritis
Rx Induced Interstitial Nephritis causes
Diuretics Penicillin NSAIDS sulfonamides rifampin
Diffuse Cortical Necrosis
Cortical infaction due to:
Vasospasm
DIC
OB catastrophe
Septic Shock
Most common cause of intrinsic renal failure
Acute Tubular Necrosis
Stages of Acute tubular necrosis
- Inciting event
- Maintenance phase–oliguria for 1-3 weeks, hyperkalemia risk
- Recovery phase–polyuric, BUN/Creatinine fall, hypokalemia risk
Causes of Acute Tubular necrosis
renal ischemia
crush injury (myoglobinuria)
Rx
Toxins
most common COD in SLE
Diffuse Proliferative GN
Gross Hematuria and proteinuria
recent infection or immune stim.
Renal Papillary Necrosis
Renal Papillary Necrosis associations
DN
Acute Pyelonephritis
Chronic Phenacetin (acetaminophen is a derivative)
Sickle Cell anemia/trait
abrupt decline in renal fxn
increased Creatinine and BUN
Acute Renal Failure
Urine Osmolality > 500
Urine Na < 20
FeNA < 1%
Serum BUN:Cr > 20
Prerenal Azotemia
Urine Osmolality 40
FeNA > 2%
Serum BUN:Cr < 15
Intrinsic Renal Azotemia
Urine Osmolality 40
FeNA > 2%
Serum BUN:Cr > 15
Post renal Azotemia
Prerenal Azotemia causes
decreased RBF–heart, hemorrhage, etc.
Anything before the kidney blood flow
Postrenal Azotemia
Urine flow obstruction
Stones, BPH, neoplasia, congenital anomalies
BILATERAL
Intrarenal azotemia mechanism
patchy necrosis –> debris obstructs tubule
backflow across necrotic tubule –> dec. GFR
Urine has epithelial granular casts
Uremia
Increased Nitrogen waste products in blood
Nausea/anorexia percarditis Asterixis encephalopathy Plt. Dysfxn
Renal osteodystrophy
Failure of Vit. D hydroxylation –> decresed Ca abs. in gut
Hypo-Ca, Hyper-Pi 2º to hyperparathyroidism
Hyper-Pi precipitates Ca and deposits in tissues
ADPKD
Presents in young adult
Multiple large cysts on both kidneys that destroy parenchyma
Flank pain, hematuria, progressive renal failure, urinary infxn, HTN–high renin
ARPKD associated with
Hepatic Cysts and fibrosis
ADPKD mutation
Autosomal Dominant
PKD1 or PKD2
ADPKD complicaitons
Berry aneurysm
MVP
Benign Hepatic Cysts
ARPKD Presentation
Infant Significant renal failure HTN Portal HTN progressive renal insufficiency Enlarged kidney
Medullary Cystic Disease
Tubulointerstitial fibrosis and progressive renal insufficienc with inability to concentrate urine
Medullay cysts
SHRUNKEN kidney
Poor prognosis
