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Renal > Renal Path > Flashcards

Renal Path Flashcards

1
Q

RBC casts?

A

GN, Ischemia, malignant HTN

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2
Q

WBC casts?

A

Tubulointerstitial inflammation, acute pyelonephritis, transplant rejection

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3
Q

Oval Fat bodies

A

aka fatty casts. Nephrotic syndrome

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4
Q

Muddy brown casts

A

aka granular casts. Acute tubular necrosis

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5
Q

Waxy casts

A

Advanced renal disease/chronic renal failure

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6
Q

Haline casts

A

Nonspecific

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7
Q

Pt with Significant Proteinuria. Increased risk of?

A

Nephrotic syndrome.

1) Thromboembolism (due to Antithrombin 3 loss in urine)
2) Infection (Loss of immunoglobulins)

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8
Q

Significant Proteinuria. EM shows effacement of foot processes. Pt started on steroids. No improvement. Biopsy would show?

A

FSGS (LM would show segmental scelorsis and hyalinosis) or MCD (LM looks normal)

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9
Q

African American/Hispanic with HIV gets nephrotic syndrome. Also seen in what other pts?

A

FSGS. Obese, Sickle cell, congential absence of kidney

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10
Q

Significant Proteinuria. LM shows diffuse capillary and GBM thickening. EM shows?

A

Membranous neuropathy. “spike and dome” with subepithelial IC deposits

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11
Q

Has kidney syndrome and significant proteinuria.. Treated with corticosteroids. Mech of damage?Increased risk of developing?

A

MCD. Cytokins damage foot processes). Hodgkin’s lymphoma.

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12
Q

Amyloidosis in kidney. Associated with?

A

Multiple myeloma, TB, RA

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13
Q

Significant Proteinuria. patient has Hep B/C. Where are the deposits?

A

MPGN type I. Subendothelial IC deposits.

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14
Q

Significant Proteinuria. Kidney biposy shows intramembranous IC deposits. Associated with?

A

MPGN type II. C3 nephritic factor. Stabilizes complement converting enzyme - see decreased C3 and increased C3a/C3b

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15
Q

Significant Proteinuria. Kidney biopsy shows mesangial expansion with eosinophilic nodular glomerulosclerosis. caused by?

A

Diabetic glomerulonephropathy. Non-Enzymatic Glycosylation of efferent arterioles (increases GFR)

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16
Q

Pt with 3.5+ grams of protein in urine. Also will have?

A

Edema

Hyperlipidema/Hypercholesterolemia

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17
Q

Pt comes in after infection. Edema and hyperlipidemia. Damage due to? Loss of?

A

MCD. Cytokins. Albumin loss from GBM polyanion loss. NO Immunoglobulin loss.

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18
Q

PT with a solid tumor presents with nephrotic syndrome? Also seen in?

A

Membranous nephropathy. Lupus

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19
Q

Granular IF in?

A

Membranous nephropathy
MPGN
“membranous” = IC deposits

Also post strep

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20
Q

Pt with biopsy showing GBM splitting caused by mesangial ingrowth

A

MPGN type I (type I has more splitting than type II)

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21
Q

Pt with HTN, and periorbital edema. Urine finding?

A

Nephritic syndrome. See RBC casts in urine from glomerular bleeding.

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22
Q

Child with periorbital edema, dark urine, and HTN a week after having a sore throat. What virulence factor is responsible?

A

Poststreptococcal glomerulonephritis. M-protein. (dark urine is hematuria)

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23
Q

Pt with hematuria. EM shows subepithelial hump. Treatment?

A

Poststrep GN. Deposits work their way out. Supportive therapy

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24
Q

Pt with hematuria and rapidly deteriorating renal function. Glomeruli consist of?

A

Rapidly progressive (crescentic) glomerulonephritis.

Fibrin AND macrophages

ALso plasma proteins, glomerular parietal cells, monocytes

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25
Q

Pt with crescentic glomeronephritis. FL could show?

A

Linear (goodpastures)
Granular (Post-strep in adults)
Nothing/Pauciimmune (wegners, microscopic polyangiitis, Churg-strauss)

26
Q

Hematuria following mucosal infection? Will likely flare with?

A

IgA-mesangial nephropathy. Flares with URI/gastroenteritis.

27
Q

Pt with hematuria, hearing loss and some ocular distrubances. Mech?

A

Alport. Defect in type 4 collagen. X-linked

28
Q

Pt with cloudy urine and leukocyte esterase and nitrites?

A

Bacterial UTI (bacteria convert nitrates to nitrites)

29
Q

Pt with sterile pyuria?

A

Urethritis (chlamydia/gonorrhoeae)

30
Q

Pt with fever, flank pain and vomiting. Type of cast? What part of kidney is affected?

A

Acute pyelonephritis. WBC cast. Cortex with sparing of glomeruli

31
Q

Child with corticomedullary scarring and blunted calyx. Tubules contain?

A

Chronic pyelonephritis. Tubules contain. Eosinophillic casts.

32
Q

Thyroidization of kidney. Cause?

A

Chronic pyelonephritis. Vesicoureteral reflux (pulls up bacteria)

33
Q

Pt taking too much vitamin C. Stone precipitates at what ph?

A

Calcium oxalate stone. Low pH

34
Q

Pt with hyperPTH. Kidney stone precipitates at what pH?

A

Calcium phosphate. High pH

35
Q

This radiopaque stone that precipitates at high pH may be caused by these organisms?

A

NH4-Mg-PO4 “struvite” stone. Urease-positive bugs - proteus, staphylococcus, klebsiella

36
Q

Stone visible on CT but not X-ray. Seen in these diseases.

A

Uric acid (radiolUcent). Seen in gout and leukemia (high cell turnover)

37
Q

Treat these stones with alkalinization of urine.

A

Uric acid and cystine

38
Q

Pt with stone tests positive for nitroprusside cyanide test. Shape of stones?

A

Cystine stones. Hexagonal crystals

39
Q

Crohn’s disease. Type of stone? Tx?

A

Ca-Oxalate. thiazides to decrease Ca in urine.

40
Q

Pt with urine osmolality over 500,
urine Na under 20
Fe(Na) under 1%
BUN/Cr? Mech?

A

Prerenal azotemia. BUN/Cr>20

decreased RBF leads to decreased GFR. Over filtration of BUN so high BUN in serum.

41
Q 
Pt with urine osmolality under 350,
urine Na over 40
Fe(Na) over 2%
BUN/Cr<15
Mech?
A

Intrinsic renal failure. Due to ATN/ischemia. Necrosis blocks tubule, decreasing GFR. BUN reabsorption is impaired. Low serum BUN/Cr (under 15)

42
Q 
Pt with urine osmolality under 350,
urine Na over 40
Fe(Na) over 2%
BUN/Cr>15
Mech?
A

Postrenal azotemia due to obstruction. Only in bilateral obstruction. increased BUN reabsorption, so BUN/Cr over 15.

43
Q

Pt in end stage renal stage renal failure. Effects on bone?

A

1) Osteitis Fiborsis Cystica (increased PTH)
2) Osteomalacia
3) Osteoporosis (from buffering acid with bone loss)

44
Q

Chronic Renal Failure - Consequences?

A

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)

45
Q

Mass in kidney consisting of vessels, SMCs, and adipose. Seen in what disease?

A

Angiomyolipoma. Tuberous sclerosis.

46
Q

60 year old male pt presents with hematuria, fever, palpable mass and flank pain. Histo?

A

RCC. From PCT tubules cells - polygonal clear cells filled with lipids and carbs.

47
Q

Pt with neoplam consisting on clear cells filled with lipids. Spreads how? where?

A

invades renal vein - IVC - Hematogenous spread, esp to lungs and bone

48
Q

Pt with lung mass and polycythemia. Tumor? Can also secrete?

A

RCC secreting EPO. Can also secrete PHT, ACTH.

49
Q

RCC. Genetics?

A

Mutation in Chromosome 3. VHL

50
Q

3 year old with palpable flank mass and hematuria. Gene/Chromosome?

A

Wilms tumor. WT1 on Chromosome 11.

51
Q

Child with palpable flank mass. May also present with?

A

WAGR. Wilms tumor
Aniridia (no iris)
Genitourinary malformation
Retardation

52
Q

Pt with painless hematuria without casts? WIth casts?

A

Transitional cell tumors. Bladder Cancer.

Renal calyces, renal pelvis, ureters, bladder.

53
Q

Pt with transitional cell tumor. Causes?

A 
Tumor of the Pee SAC
Phenacetin
Smoking
Aniline Dyes
Cyclophosphamide
54
Q

Pt with RA started taking NSAIDs months ago. Presents with fever, rash, hematuria, costovertebral angle tenderness. IInflammation of?

A

interstitial renal inflammation with pyruia and azotemia. r

55
Q

Pt with nephritis 1-2 weeks after beginning drugs. What drugs? What cells in urine?

A

PRiDES

Diuretics, penicillins, sulfamides, rifampin. Eosinophils

56
Q

Pt after abruptio placentae or septic shock goes into kidney failure. Cause?

A

Diffuse cortical necrosis. Combination of vasospasm and DIC

57
Q

Pt with crush injury. Stages of kidney injury? When is pt most likely to die? Electrolytess?

A

ATN.
1 Maintenance phase - oligouric (1-3 weeks). Most likely to die
2 Recovery phase (polyuric)

58
Q

Diabetic with SIckle cell taking acetaminophen has gross hematuria and proteinuria?

A

Renal papillary necrosis. Sloughing of renal papillae

59
Q

Pt with flank pain, hematuria, and progressive kidney failure. Heart murmur?

A

ADPKD. Mitral valve prolapse.

60
Q

Pt with inability to concentrate urine and shrunken kidneys?

Fibrosis of?

A

Medullary cystic disease. Tubulointerstital fibrosis.

Renal (3 decks)

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