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STEP 1 > Renal Path > Flashcards

Renal Path Flashcards

1
Q

Bladder cancer and Kidney stones present with:

A

Hematuria

no casts

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2
Q

acute cystitis
shows what on UA
what type of cast are present, if any?

A

pyuria (WBCs in pee)

no casts

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3
Q

Hypertensive emergency can precipitate Glomerulonephritis.

What type of casts can be seen?

A

RBC casts

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4
Q

Tubulo-interstitial inflammation
acute pyelonephritis
transplant rejection

what type of casts form?

A

WBC casts

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5
Q

Acute tubular necrosis (ATN)
Rhabdomyelosis
what type of casts form?

A

Granular Casts
Can be “muddy-brown” in appearance
*Tubular epithelial cell debri

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6
Q

NephrOtic syndrome casts

Associated with “Maltese cross” sign

A

Fatty casts
aka oval fat bodies

(Look like target sign with a dark cross super imposed)

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7
Q

End-stage renal disease/chronic kidney disease/ chronic pyelonephritis
what type of casts form?

A

Waxy Casts

(Fat/broad rectangles, a little granular/ rough looking
can also be tortuous, but still wide/finely grainy)

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8
Q

Nonspecific, can be a normal finding.

Benign urinary cast

A

Hyaline casts

(can be long skinny smooth rectangles or tortuous, skinny, smooth cylinders)

*made of Tomm-Horsefall mucoprotein

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9
Q

Form via solidification of Tamm-Horsfall mucoprotein (secreted by renal tubular cells)

A

Hyaline casts

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10
Q

Thickening of glomerular basement membrane (GBM)

A

Membranous Nephropathy

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11
Q 
Ureteral dilation
recurrent flank pain (acute)
Hydro-nephrosis
Normal RBC morphology
\+/– Calyceal dilation
A

Ureterolithiasis

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12
Q

2 nephritic-nephrotic syndromes

A

Diffuse proliferative glomerulonephritis (DPGN)

Membrano–proliferative glomerulonephritis (MPGN)

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13
Q

Specific gravity < 1.005 =

Specific gravity > 1.015 =

A

dilute pee
concentrated pee

normal range for urine specific gravity is 1.005 to 1.015

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14
Q

Specific gravity > 1.015

A

concentrated pee

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15
Q

NSAIDs, Diuretics, Penicillins, PPIs, Sulfa drugs, Rifampin can all cause

A

Allergic (Acute) Interstitial Nephritis

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16
Q

Fever, Maculopapular Rash, new/recent Drug taken

eosinophilia in urine

A

Allergic (Acute) Interstitial Nephritis

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17
Q 
Hematuria
Flank Pain
associated with:
chronic NSAIDs
Diabetes
Sickle Cell Disease, 
severe Pyelonephritis
A

Renal Papillary necrosis

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18
Q

Hypoalbuminemia (edema)
Hypogammaglobinemia (infections)
Hypercoagulable (loss of ATIII)
Hyperlipidemia/Hypercholesterolemia (fat casts)

A

Nephrotic Syndrome

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19
Q

Associated with Hodkins Lymphoma (HY)

A

Minimal change disease

*Most common cause of NEPHROTIC in kids

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20
Q

Effaced/Flatten podocytes

CYTOKINES fault

A

Minimal change

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21
Q

H&E: Normal
EM: Effacement of foot processes
IF: Negative

A

Minimal Change

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22
Q

Selective proteinemia loss of albumin
HYPOalbuminemia (other protein levels ok)
excellent response to steroids

A

Minimal Change

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23
Q

Hispanics, Blacks, HIV, Heroin, Sickle cell

A

FSGS

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24
Q

EM: Effacement of foot process

H&E: some glomeruli has parts that have a pink & plain, acellular areas.

Poor response to steroids

A

FSGS

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25
Q

part of glomeruli is just a flat, empty pink

A

FSGS

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26
Q

Caucasian white boys
(H&E): Thick/dark outlines on the glomeruli basement
Don’t fuck with steroids

A

Membranous Nephropathy

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27
Q

LUPUS, HBV, HCV, Syphilis, Solid Tumors, Drugs (NSAIDs/ Penicillins)

A

Membranous Nephropathy

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28
Q

EM : Spike and Dome
(Ig blobs in the light grey area underneath black podocyte aka subepithelial layer)

IF: Granular (Ig-Immune complex deposits )

H&E: Swollen/puffy , packed pink cells

A

Membranous Nephropathy

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29
Q

Nephritic & Nephrotic Syndrome:

Mesangial cell proliferation separates the immune complex deposits
creates a tram-track appearance on H&E and PAS
due to BM splitting

Large, Hypercellular Glomeruli

A

Membranoproliferative Glomerulonephritis (MPGN)

H&E: the hot pink outline of the cells are now 2 separate/ split pink outlines with light pink in the middle)

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30
Q

Granular IF
Tram-Track H&E
Subendothelial deposits on EM
HBV/HCV association

A

Type 1

Membranoproliferative Glomerulonephritis

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31
Q

Granular IF
Tram-Track H&E
Intramembranous (inside the BM) deposits on EM

A

Type 2
Membranoproliferative Glomerulonephritis

aka dense deposit disease

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32
Q

associated with C3 nephritic factor
overactivation of complement
low levels of circulating C3

A

Type 2

Membranoproliferative Glomerulonephritis

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33
Q

Hyaline arteriosclerosis from _______ of vascular basement eventually leading to a HYPERFILTRATION injury of the kidney

(↑ GFR due to ↑permeability despite thickened membrane)

A

non-enzymatic glycosylation

Diabetic Nephropathy

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34
Q

Hyaline arteriosclerosing has a predilection towards the ____ arteriole thus narrowing the lumen & causing hyper-filtration resulting in _____

A

efferent

Microalbuminemia

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35
Q

Eosinophilic acellular nodules from glomerular sclerosis.

A

Kimmelstiel-Wilson Nodules

Diabetic Nephropathy

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36
Q

What can help slow the progression of Diabetic Nephropathy

A

ACE-I

ARBs

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37
Q

Oliguria and Azotemia

A

Nephritic syndrome

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38
Q

Hypercellular, inflammed glomeruli

A

Nephritic syndrome

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39
Q

PERIORBITAL edema

HTN

A

Nephritic syndrome

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40
Q

Immune complex deposition + C5a attracting neutrophils

A

Nephritic syndrome

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41
Q

EM: SubEPIthelial (under podocytes) HUMPS IC

IF: Granular (blobs–Starry sky–lumpy bumpy) due to IgG, IgM, and C3 deposits on GBM/ mesangium

H&E: Hypercellular glomeruli with HOT pink outlines

A

PSGN

Blood → Foot process → subepithelial → GBM (intramembranous) → subendothelium→ Endothelium → Tubular lumen

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42
Q

Periorbital edema
dark urine
recent infection
Kid

A

PSGN

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43
Q

Crescents in bowman’s space of RPGN made up of (2)

A

Fibrin and MQs

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44
Q

Nephritic syndrome that may progress to Renal Failure in a few days

A

RPGN

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45
Q

List 6 RPGNs

A 
Goodpastures
PSGN
Diffuse Proliferative GN
Wegener's 
Churg-Strauss
Microscopic polyangiitis
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46
Q

Linear IF RPGN

A

Goodpastures

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47
Q

Granular IF RPGN

A

PSGN

Diffuse Proliferative GN

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48
Q 
Negative IF (Pauci-Immune) RPGN
c-ANCA
A

Granulomatosis with Polyangiitis

Wegener

49
Q 
Negative IF (Pauci-Immune) RPGN
MPO/ p-ANCA
A

Microscopic polyangiitis

Eosinophilic Granulomatosis with Polyangiitis (Churg- Strauss)

50
Q 
Negative IF (Pauci-Immune) RPGN
P-ANCA
esosinophilia
granulomatous inflammation
asthma
A

Churg-Strauss

51
Q

anti-type 4 collagen in alveoli and renal BM

A

Goodpastures

52
Q

most common type of renal disease in SLE

subendothelial Ig-Ic deposits

A

Diffuse Proliferative Glomerulonephritis

53
Q

IgA deposits in Mesangium seen in IF

A

Berger’s (IgA nephropathy)

54
Q

Most common nephropathy world wide

A

Berger’s (IgA nephropathy)

55
Q

Child with episodic hematuria after getting sick with mucosal (respiratory or GI like Diarrhea) infection

A

Berger’s (IgA nephropathy)

56
Q

Berger’s (IgA nephropathy) is a Type ___ HSR

A

3 *so is PSGN

57
Q

X-linked
DEFECTIVE type 4 collagen
thinning splitting of GBM
Irregular thickening (Basket Weave) of GBM

A

Alport Syndrome

*eye problems, sensorineural deficits
+/– hemturia

58
Q

Hematuria
Hearing Loss
Ocular disturbances

A

Alport Syndrome

*findings might only be seen in family tree

59
Q

+Leukocyte esterase (Bacterial infection)
+nitrites (Gram – bacteria)
cloudy pee

A

Cystitis (bladder infection)

60
Q

dysuria, urgency, frequency, suprapubic pain

A

Cystitis

61
Q

Alkaline pee with an ammonia scent caused by what microbe

A

Proteus Mirabilis

62
Q

Top 4 UTI causing microbes

A 
E coli
Saphrophyticus
Klebsiella
Proteus
Pseudomonas
Enteroccous
63
Q

Ascending infection
increased risk with Vesicoureteral reflux (HY)
increased risk with posterior ureters (BOYS ONLY)

A

Pyelonephritis

64
Q

Fever, CVA tenderness, WBCs, Leukocytosis

dysuria, urgency, frequency, suprapubic pain

A

Pyelonephritis

65
Q

interstitial fibrosis and atrophy of tubules

A

Chronic Pyelonephritis

66
Q

Due to Vesicoureteral reflux in kids
or
obstruction in adults (BPH, Cervical tumor)

A

Chronic Pyelonephritis

67
Q

Cortical Scarring, blunted Calyces

A

Chronic Pyelonephritis

68
Q

Eosinophilic proteinaceous material resembling THYROID
(OMG PLESASE DON’T FORGET THIS) in Kidney tubules
+/– waxy casts

A

Chronic Pyelonephritis

69
Q

Unilateral Flank pain
Colicky pain
Hematuria

A

Nephrolithiasis

70
Q

Stones associated with Chron’s disease

A

Calcium oxalate/phosphate

71
Q

Hydrochlorothiazide treats what Stones

A

Calcium oxalate/phosphate

72
Q

Calculi caused by infection with a urease positive organism

A

Microscopic: Ammonium, Magnesium, Phosphate (Coffin lid rectangle studs) STRUVITE

Gross: Staghorn Calculi

73
Q

Radiolucent kidney stone

seen in leukemia and myeloproliferative diseases

A

Uric acid

romboid/rosette/ parallelogram/ diamond shaped

74
Q

Hydrate and alkalanize urine with potassium bicarb to treat what stones

A

Uric Acid

*Allopurinol with Gout

75
Q

Cysteine stones may form ____ calculi

A

Staghorn (Gross)

Hexagonal 6 sided (Micro)

76
Q

Cysteinuria results in what shape of stones?

Gross and Microscopic

A

Staghorn

Hexagonal Cystine stones

77
Q

2 common causes of end-stage-renal failure

A

(Malignant) HTN

Diabetes

78
Q

Uremia cause Urea crystals in skin and (3)

A

encephalitis
Nausea
Asterixis

79
Q

Hyperkalemia with anion gap can be a sign of

A

End Stage Renal Failure

80
Q

Why does End Stage Renal Failure present with anemia sometimes?

A

JGC make less EPO

81
Q

Why does End Stage Renal Failure present with Hypocalcemia sometimes?

A

decreased 1 alpha hydroxylation of
Vit. D by PCT cells

*hyperphosphatemia due to decreased excretion

82
Q

CKD can cause what related to elevated pTHr?

3

A

elevated pTHr
causes Renal Osteodystrophy
Osteomalacia
Osteoporosis

83
Q

Cysts often develop in CKD during Dyalisis which increases the risk of _____

A

RCC

Cysts
Kancer
Dialysis

84
Q

Renal Neoplasm associated with Tuberous Sclerosis

A

Angiomyolipoma

85
Q

RCC classic triad, GO:

A

painless Hematuria
palpable Mass
pain in the Flank

86
Q

Left Renal vein can be blocked by RCC causing

A

Varicocele

*right spermatic vein drains to IVC not the renal vein like left one does

87
Q

Loss of VHL in RCC causes increased IGF & HIF which are transcription factors for (2)

A

VEGF

PDGF

88
Q

Major risk factor of random RCC not from VHL is

A

Smoking

89
Q

VHL mutation causes RCC & what other illnesses

A

Cerebellar Hemangioblastoma of cerebellum

Pheochromacytoma

90
Q

Most Common Renal Tumor in children

A

WILMS Tumor

91
Q

HTN, Renin, Unilateral Mass, Child

A

WILMS Tumor

92
Q

Smoking, Napthylamine, Hair dyes,

CYCLOPHOSPHAMIDE and PHENACETIN

use can all cause

A

Urothelial cancer of
Renal pelvis, Ureter, bladder, and/or urethra

Painless Hematuria

93
Q

p53 mutant

flat lamina propia tumor

A

Urothelial cancer

pathway 1

94
Q

Papillary tumor that becomes a high grade papillary tumor

A

Urothelial cancer

pathway 2

95
Q

Multifocal tumor that can reoccur due to field defect

A

Urothelial cancer

96
Q

Young Middle Eastern EGYPTIAN) or AFRICAN Man
Schistosoma H. infection

or

women with Chronic Cystitis

Has an Increased risk for what malignancy & where?

A

Squamous cell carcinoma of Lower UT

97
Q

Tumor from Urachal remnant
DOME of bladder
increases risk of what cancer where?

A

Adenocarcinoma of Lower UT

98
Q

Extrophy (congenital failure to form top part of anterior abd/bladder wall) can increase risk of what type of cancer and where?

A

Adenocarcinoma of Lower UT

99
Q

Hematuria
Clear Cytoplasm on Histo
Yellow Mass

A

RCC

100
Q

Hyperkalemia
granular casts
elevated BUN:CRE
Oliguria

A

ATN

*takes 2-3 weeks for tubular stable cells to regenerate
so oliguria can last as long

101
Q

BUN:CR MORE than 15

A

Pre-Renal Azotemia (early intrinsic)

102
Q

BUN:CR LESS THAN 15

A

Post-Renal Azotemia (late intrinsic)

103
Q

FeNa >2%

FeNa <1%

A

Post-Renal Azotemia (ATN)

Pre-renal Azotemia (Early intrinsic)

104
Q

Urine Osm>500

Urine Osm<500

A

Pre-renal Azotemia (Early intrinsic)
Post-Renal Azotemia (ATN)

> 500 (concentrated)
<500 (dilute)

105
Q

Pre-renal Azotemia from

A

low RBF

cardiac failure, stenosis

106
Q

6 Things that can cause ATN

A 
Aminoglycosides
Heavy Metal (lead)
Myoglobinuria (crush injury/ over exertion)
Ethylene Glycol (Anti freeze)
Radiocontrast Dye
Urate (Tumor Lysis Syndrome)
107
Q

How to prevent ATN with Tumor Lysis Syndrome

A

Hydration
Allopurinol
Rasberrycase (Rasburicase)

108
Q

Flat Face, Low Ears, Bad lungs

A

POTTERS from Oligohydraminos

109
Q

non-inherited

Cysts and weird tissue in kidneys

A

Dysplastic kidney

110
Q

Bilateral enlarged Kidneys with Cysts everywhere
HTN, Portal HTN, Fibrotic- cystic liver
+/- POTTERS

A

AR-PKD-1/2

111
Q

Renin, HTN, Bilateral enlarged Kidneys with Cysts everywhere. Associated with Berry Aneurysm, MVP, and Hepatic Cysts
YOUNG ADULT

A

AD-PKD-1/2

112
Q

What 3 illnesses present with Hematuria and/or Pyuria

but NO casts?

A

Cystitis (bladder infection)
Bladder cancer
Kidney stones

*Casts= glomerular or tubular illness

113
Q

Kidney problems associated with

HBV & HCV

A

Membranous nephropathy

Membrano–proliferative Glomeurolnephritis I

114
Q

Forms rhomboid/rosette/ parallelogram/ diamond

shaped shaped renal calculi

A

Uric Acid

Radiolucent (seen on US)

115
Q

Forms dumbbell/envelope/stud
Radiopaque
shaped shaped renal calculi

A

Calcium Oxalate

116
Q

Forms Wedged shaped/Prism
Radiopaque
shaped shaped renal calculi

A

Calcium phosphate

117
Q

Forms Coffin lid/ rectangle studs
Radiopaque
shaped shaped renal calculi

A

Ammonium, Magnesium, Phosphate

STRUVITE

118
Q

Forms Staghorn Calculi

A

Cysteinuria

Ammonium, Magnesium, Phosphate (STRUVITE)

STEP 1 (88 decks)

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