Renal Pathology

Question 1

What are the warning signs of kidney disease?

Answer 1

A Cr and BUN outside the normal range, GFR less than 60, blood and/or protein in the urine, HTN, more frequent urination particularly at night (difficult or painful urination), puffiness around the eyes, swelling of the hands and feet

Question 2

What are the principle fluid and electrolyte manifestations of acute or chronic kidney dysfunction?

Answer 2

dehydration, edema, hyperkalemia, metabolic acidosis

Question 3

What are the principle Ca, phosphate and bone manifestations of acute or chronic kidney dysfunction?

Answer 3

Hyperphosphatemia, hypocalcemia, secondary hyperparathyroidism, renal osteodystrophy

Question 4

What are the principle hematologic manifestations of acute or chronic kidney dysfunction?

Answer 4

anemia, bleeding diathesis

Question 5

What are the principle cardiopulmonary manifestations of acute or chronic kidney dysfunction?

Answer 5

HTN, CHF, cardiomyopathy, pulmonary edema, uremic pericarditis

Question 6

What are the principle GI manifestations of acute or chronic kidney dysfunction?

Answer 6

N/V, bleeding, esophagitis/gastritis/colitis

Question 7

What are the principle neuromuscular manifestations of acute or chronic kidney dysfunction?

Answer 7

myopathy, peripheral neuropathy, encephalopathy

Question 8

What are the principle dermatologic manifestations of acute or chronic kidney dysfunction?

Answer 8

sallow color, pruritus, dermatitis

Question 9

What is the ideal ratio of BUN to Cr?

Answer 9

Between 10 to 1 and 20 to 1

Question 10

What is usually a manifestation of subtle or mild glomerular abnormalities?

Answer 10

asymptomatic hematuria or proteinuria, or a combination of these two

Question 11

What causes pre-renal azotemia?

Answer 11

CHF, burns, hemorrhage in GIT, shock and stress, dehydration

Question 12

What causes renal azotemia?

Answer 12

glomerulonephritis, pyelonephritis, DM, nephrotoxic drugs, renal failure, anabolic steroids use

Question 13

What causes post renal azotemia?

Answer 13

urinary tract obstruction (stones, neoplasms, bladder or urethral abnormality, bladder outlet obstruction)

Question 14

What are the 3 sites where constrictions in the ureters normally appear?

Answer 14

at the ureteropelvic junction, crossing the external iliac A and/or pelvic brim, as the ureter traverses the bladder wall

Question 15

What can cause tubulointersitial nephritis?

Answer 15

Infections (acute or chronic bacterial pyelonephritis, other infections), toxins, metabolic disease (urate nephropathy, nephrocalcinosis, oxalate nephropathy), physical factors (chronic urinary tract obstruction, neoplasms, multiple myeloma), immunologic reactions, vascular diseases

Question 16

What is the empiric treatment for an uncomplicated UTI caused by proteus?

Answer 16

outpatient treatment with either a 3 day course of trimethoprim/sulfamethoxazole (TMP/SMZ) or an oral fluoroquinolone (ciprofloxacin)

Question 17

What is the treatment for a pt presenting with complicated UTI (e.g. pt with an underlying condition that may increase the risk of failure of therapy)?

Answer 17

May be treated in an outpatient setting with oral abx for 10-21 days as log as they receive adequate follow up

Question 18

Acute uncomplicated pyelonephritis can be treated on an outpatient basis with what abx?

Answer 18

Fluoroquinolone although a regimen of 7-14 days is recommended; an alternative to this treatment is a one time dose of ceftriaxone or gentamicin followed by either TMP/SMZ, an oral fluoroquinolone or cephalosporin for 7-14 days

Question 19

What is the function of uromodulin (Tamm-Horsfall protein)?

Answer 19

Multifunctional protein critical for modulating renal ion channel activity, salt/water balance, renal and systemic inflammatory responses, intertubular bacterial adhesion

Question 20

Mutations in Tamm-Horsfall cause what?

Answer 20

a group of inherited kidney diseases and altered THP expression is associated with increased risks of UTI, kidney stones, HTN, hyperuricemia, and acute/chronic kidney disease

Question 21

What is hepatorenal syndrome?

Answer 21

A form of renal failure occurring in individuals with liver failure in whom there is no intrinsic morphologic or functional cause for kidney dysfunction

Question 22

The onset of hepatorenal syndrome is marked by what?

Answer 22

a drop in urine output and increasing levels of urea and Cr in the blood

Question 23

What is the triggering event of hepatorenal syndrome?

Answer 23

Portal HTN and secondary increased production of vasodilators such as NO by endothelial cells in the splanchnic vasculature which leads to systemic vasodilation and diminished renal perfusion which is sensed by the kidney provoking activation of RAAS –> renal failure