Renal Path Flashcards
RBC casts?
GN, Ischemia, malignant HTN
WBC casts?
Tubulointerstitial inflammation, acute pyelonephritis, transplant rejection
Oval Fat bodies
aka fatty casts. Nephrotic syndrome
Muddy brown casts
aka granular casts. Acute tubular necrosis
Waxy casts
Advanced renal disease/chronic renal failure
Haline casts
Nonspecific
Pt with Significant Proteinuria. Increased risk of?
Nephrotic syndrome.
1) Thromboembolism (due to Antithrombin 3 loss in urine)
2) Infection (Loss of immunoglobulins)
Significant Proteinuria. EM shows effacement of foot processes. Pt started on steroids. No improvement. Biopsy would show?
FSGS (LM would show segmental scelorsis and hyalinosis) or MCD (LM looks normal)
African American/Hispanic with HIV gets nephrotic syndrome. Also seen in what other pts?
FSGS. Obese, Sickle cell, congential absence of kidney
Significant Proteinuria. LM shows diffuse capillary and GBM thickening. EM shows?
Membranous neuropathy. “spike and dome” with subepithelial IC deposits
Has kidney syndrome and significant proteinuria.. Treated with corticosteroids. Mech of damage?Increased risk of developing?
MCD. Cytokins damage foot processes). Hodgkin’s lymphoma.
Amyloidosis in kidney. Associated with?
Multiple myeloma, TB, RA
Significant Proteinuria. patient has Hep B/C. Where are the deposits?
MPGN type I. Subendothelial IC deposits.
Significant Proteinuria. Kidney biposy shows intramembranous IC deposits. Associated with?
MPGN type II. C3 nephritic factor. Stabilizes complement converting enzyme - see decreased C3 and increased C3a/C3b
Significant Proteinuria. Kidney biopsy shows mesangial expansion with eosinophilic nodular glomerulosclerosis. caused by?
Diabetic glomerulonephropathy. Non-Enzymatic Glycosylation of efferent arterioles (increases GFR)
Pt with 3.5+ grams of protein in urine. Also will have?
Edema
Hyperlipidema/Hypercholesterolemia
Pt comes in after infection. Edema and hyperlipidemia. Damage due to? Loss of?
MCD. Cytokins. Albumin loss from GBM polyanion loss. NO Immunoglobulin loss.
PT with a solid tumor presents with nephrotic syndrome? Also seen in?
Membranous nephropathy. Lupus
Granular IF in?
Membranous nephropathy
MPGN
“membranous” = IC deposits
Also post strep
Pt with biopsy showing GBM splitting caused by mesangial ingrowth
MPGN type I (type I has more splitting than type II)
Pt with HTN, and periorbital edema. Urine finding?
Nephritic syndrome. See RBC casts in urine from glomerular bleeding.
Child with periorbital edema, dark urine, and HTN a week after having a sore throat. What virulence factor is responsible?
Poststreptococcal glomerulonephritis. M-protein. (dark urine is hematuria)
Pt with hematuria. EM shows subepithelial hump. Treatment?
Poststrep GN. Deposits work their way out. Supportive therapy
Pt with hematuria and rapidly deteriorating renal function. Glomeruli consist of?
Rapidly progressive (crescentic) glomerulonephritis.
Fibrin AND macrophages
ALso plasma proteins, glomerular parietal cells, monocytes
Pt with crescentic glomeronephritis. FL could show?
Linear (goodpastures)
Granular (Post-strep in adults)
Nothing/Pauciimmune (wegners, microscopic polyangiitis, Churg-strauss)
Hematuria following mucosal infection? Will likely flare with?
IgA-mesangial nephropathy. Flares with URI/gastroenteritis.
Pt with hematuria, hearing loss and some ocular distrubances. Mech?
Alport. Defect in type 4 collagen. X-linked
Pt with cloudy urine and leukocyte esterase and nitrites?
Bacterial UTI (bacteria convert nitrates to nitrites)
Pt with sterile pyuria?
Urethritis (chlamydia/gonorrhoeae)
Pt with fever, flank pain and vomiting. Type of cast? What part of kidney is affected?
Acute pyelonephritis. WBC cast. Cortex with sparing of glomeruli
Child with corticomedullary scarring and blunted calyx. Tubules contain?
Chronic pyelonephritis. Tubules contain. Eosinophillic casts.
Thyroidization of kidney. Cause?
Chronic pyelonephritis. Vesicoureteral reflux (pulls up bacteria)
Pt taking too much vitamin C. Stone precipitates at what ph?
Calcium oxalate stone. Low pH
Pt with hyperPTH. Kidney stone precipitates at what pH?
Calcium phosphate. High pH
This radiopaque stone that precipitates at high pH may be caused by these organisms?
NH4-Mg-PO4 “struvite” stone. Urease-positive bugs - proteus, staphylococcus, klebsiella
Stone visible on CT but not X-ray. Seen in these diseases.
Uric acid (radiolUcent). Seen in gout and leukemia (high cell turnover)
Treat these stones with alkalinization of urine.
Uric acid and cystine
Pt with stone tests positive for nitroprusside cyanide test. Shape of stones?
Cystine stones. Hexagonal crystals
Crohn’s disease. Type of stone? Tx?
Ca-Oxalate. thiazides to decrease Ca in urine.
Pt with urine osmolality over 500,
urine Na under 20
Fe(Na) under 1%
BUN/Cr? Mech?
Prerenal azotemia. BUN/Cr>20
decreased RBF leads to decreased GFR. Over filtration of BUN so high BUN in serum.
Pt with urine osmolality under 350, urine Na over 40 Fe(Na) over 2% BUN/Cr<15 Mech?
Intrinsic renal failure. Due to ATN/ischemia. Necrosis blocks tubule, decreasing GFR. BUN reabsorption is impaired. Low serum BUN/Cr (under 15)
Pt with urine osmolality under 350, urine Na over 40 Fe(Na) over 2% BUN/Cr>15 Mech?
Postrenal azotemia due to obstruction. Only in bilateral obstruction. increased BUN reabsorption, so BUN/Cr over 15.
Pt in end stage renal stage renal failure. Effects on bone?
1) Osteitis Fiborsis Cystica (increased PTH)
2) Osteomalacia
3) Osteoporosis (from buffering acid with bone loss)
Chronic Renal Failure - Consequences?
Think: Kidney, Blood, Brains, Bone, Heart
Filtration problems: HTN (Na retention), Hyper K, Uremia
Creation problems: Anemia (No EPO from peritubular interstitial cells)
Bone Problems
Heart problems: Pericarditis (Uremia), CHF
Neuro Problems: Asterixis and encephalopathy (Uremia)
Mass in kidney consisting of vessels, SMCs, and adipose. Seen in what disease?
Angiomyolipoma. Tuberous sclerosis.
60 year old male pt presents with hematuria, fever, palpable mass and flank pain. Histo?
RCC. From PCT tubules cells - polygonal clear cells filled with lipids and carbs.
Pt with neoplam consisting on clear cells filled with lipids. Spreads how? where?
invades renal vein - IVC - Hematogenous spread, esp to lungs and bone
Pt with lung mass and polycythemia. Tumor? Can also secrete?
RCC secreting EPO. Can also secrete PHT, ACTH.
RCC. Genetics?
Mutation in Chromosome 3. VHL
3 year old with palpable flank mass and hematuria. Gene/Chromosome?
Wilms tumor. WT1 on Chromosome 11.
Child with palpable flank mass. May also present with?
WAGR. Wilms tumor
Aniridia (no iris)
Genitourinary malformation
Retardation
Pt with painless hematuria without casts? WIth casts?
Transitional cell tumors. Bladder Cancer.
Renal calyces, renal pelvis, ureters, bladder.
Pt with transitional cell tumor. Causes?
Tumor of the Pee SAC Phenacetin Smoking Aniline Dyes Cyclophosphamide
Pt with RA started taking NSAIDs months ago. Presents with fever, rash, hematuria, costovertebral angle tenderness. IInflammation of?
interstitial renal inflammation with pyruia and azotemia. r
Pt with nephritis 1-2 weeks after beginning drugs. What drugs? What cells in urine?
PRiDES
Diuretics, penicillins, sulfamides, rifampin. Eosinophils
Pt after abruptio placentae or septic shock goes into kidney failure. Cause?
Diffuse cortical necrosis. Combination of vasospasm and DIC
Pt with crush injury. Stages of kidney injury? When is pt most likely to die? Electrolytess?
ATN.
1 Maintenance phase - oligouric (1-3 weeks). Most likely to die
2 Recovery phase (polyuric)
Diabetic with SIckle cell taking acetaminophen has gross hematuria and proteinuria?
Renal papillary necrosis. Sloughing of renal papillae
Pt with flank pain, hematuria, and progressive kidney failure. Heart murmur?
ADPKD. Mitral valve prolapse.
Pt with inability to concentrate urine and shrunken kidneys?
Fibrosis of?
Medullary cystic disease. Tubulointerstital fibrosis.
