Renal Pathology Flashcards
1
Q
Angiotensin II
A
Vasoconstricts peirpheral resistance arterioles and efferent arterioles, stimulates synthesis and release of aldosterone
2
Q
Renal derived PGE2
A
Vasodilates the afferent arterioles
3
Q
1-alpha-hydroxylase is synthesized in where of kidney? What does it do?
A
- Proximal renal tubule cells
2. converts 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol
4
Q
Two functions of vitamin D
A
- increase GI absorption of calcium and phosphate
2. promotes bone mineralization (release of alkaline phosphatase from osteoblasts)
5
Q
Hematuria: upper urinary tract
A
- renal stone
- GN
- Renal cell carcinoma
6
Q
Hematuria: lower urinary tract
A
- infection
- transitional cell carcinoma (in absence of infection)
- benign prostatic hyperplasia (microscopic hematuria in males)
7
Q
Drugs associated with hematuria
A
- anticoagulants
2. cyclophosphamide: hemorrhagic cystitis
15
Q
Dipstick detects what?
A
albumin
16
Q
SSA detects what?
A
albumin and globulins
17
Q
Normal serum BUN level
A
7-18mg/dL
18
Q
Where is BUN absorbed? What does it depend on?
A
Proximal tubule, flow dependent.
19
Q
Decreased GFR = more or less BUN absorbed
A
More
20
Q
Increased GFR = more or less BUN absorbed
A
Less
21
Q
Most common cause of increased serum BUN level?
A
CHF
22
Q
Normal serum creatinine level
A
0.6 to 1.2 mg/dL
23
Q
Non-selective proteinuria with loss of albumin and globulin
A
post-streptococcal glomerulonephritis
24
Q
Loss of negative charge on GBM, selective proteinuria with loss of only albumin
A
minimal change disease
25
Q
Nephritic or nephrotic: <3.5g/24 hours of protein loss
A
Nephritic
26
Q
Inability to reabsorb glucose, amino acids, uric acid, phosphate, and bicarbonate - leading to proteinuria
A
Fanconi syndrome
27
Q
Defect in reabsorption of neutral AA (tryptophan) in GI and kidney - leading to proteinuria
A
Hartnup disease
28
Q
Decreased cardiac output: increase or decrease BUN
A
Increase. low CO=low GFR=more absorption in proximal
29
Q
Third degree burns: increase or decrease serum BUN
A
increase. increased aa degradation.
30
Q
Causes of pre-renal Azotemia: Serum BUN:Cr >15
A
- decrease in CO
- hypoperfusion and decrease in GFR
- blood loss, CHF
31
Q
Acute GN (poststreptococcal GN): increase or decrease serum BUN
A
increase
32
Urinary tract obstruction: increase or decrease BUN
increase.
33
Increase plasma volume (pregnancy): increase or decrease BUN
decrease, increase plasma volume, increases GFR, decreases serum BUN
34
Kwashiorkor: BUN level increase or decrease
decrease serum BUN
35
Azotemia
increase in serum BUN and creatinine
36
Normal serum BUN:creatinine ratio
15
37
Why use creatinine for renal clearance testing?
it is filtered, not reabsorbed or secreted
40
Causes of Renal Azotemia: Ratio <15
parenchymal damage, ATN, chronic renal failure
41
Postrenal Azotemia: ration>15 initially, <15 if obstruction persists
obstruction below the kidneys
42
Ccr equation
Ccr=Ucr x V/Pcr
43
Smoky-colored urine
nephritic type of GN
44
Black urine after exposure to light
alkaptonuria, increase in homogentisic acid in the urine
45
Vegan urine pH
alkaline,
46
Meat eater urine pH
acidic
47
Absent urine UBG, increase urine bilirubin
obstructive jaundice
48
Increase urine UBG, absent urine bilirubin
extravascular hemolytic anemia
49
increase urine UBG, increase urine bilirubin
hepatitis
50
4 types of kidney stones
1. calcium oxalate
2. uric acid
3. triple phosphate
4. cystine
51
Oval fat bodies
nephrotic syndrome
52
Hyaline cast without proteinuria
no significance
53
RBC Cast
nephritic type of GN (poststreptococcal GN)
54
WBC Cast
acute pyelonephritis, acute tubulointerstitial nephritis
55
Renal tubular cell cast
acute tubular necrosis
56
Fatty cast
nephrotic cast
57
Waxy cast
sign of chronic renal failure
58
Calcium oxalate
renal stone, ethylene glycol poisoning
59
Cystine hexagonal crystal
cystinuria
63
Vasoconstrictor of efferent arterioles
ATII
64
What produces negative charges of GBM?
Heparin sulfate
65
fusion of podocytes
nephrotic syndrome
66
Proliferation of parietal epithelial cells
Crescents
67
Horseshoe Kidney
Congenital disorder: fused at lower lobe. kidney trapped behind inferior mesenteric artery.
68
Increased incidence with Turner's syndrome
Horseshoe kidney
69
Most common cystic disease in children. abnormal development of one or both kidneys
renal dysplasia
70
AR inheritance, cysts bilaterally cortex and medulla, hepatic fibrosis, maternal oligohydramnios
juvenile polycystic kidney disease
71
AD inheritance, chromosome 16, bilateral cystic disease by 20-25 years, cysts in liver, pancreas, and spleen, intracranial berry aneurysms, intracerebral hemorrhage, CRF by 40-60
adult polycystic kidney disease
72
Swiss-cheese appearance, multiple cysts of collecting ducts in medulla
medullary sponge kidney
73
Most common cause is renal dialysis
acquired polycystic kidney disease
74
Linear IF
anti-GBM, goodpasture syndrome
75
Only a few glomeruli ar abnormal
Focal GN
76
All glomeruli are abnormal
Diffuse glomerulonephritis
77
4 types of nephritic glomerular disease
1. IgA glomerulopathy (Bergers disease)
2. Acute proliferative GN/post-streptococcal GN
3. DIffuse proliferative GN (SLE)
4. Rapidly progressive crescentic GN
78
>100 nuclei in affected glomeruli
Proliferative GN
79
Thick GBM, no proliferative change
membranous glomerulopathy
80
Thick GBM, hypercellular glomeruli
membranoproliferative GN
81
Fibrosis involving only a segment of the involved glomerulus
focal segmental glomerulosclerosis
82
Proliferation of parietal epithelial cells around glomerulus
crescentic GN
83
Inovlves only glomeruli and no other target organs (MCD)
primary glomerular disease
84
involves glomeruli and other target organs
secondary glomerular disease
85
Granular irregular deposits in the capillaries
poststreptococcal GN
86
Fusion of podocytes
All nephrotic disease (like MCD)
87
Subendothelial immunocomplex deposits
proliferative GN due to SLE
88
Subepitheial immunocomplex deposits, hypercellular
posttreptococcal GN
89
5 Types of Nephrotic Glomerular Disease
1. MCD
2. Focal segmental glomerulosclerosis
3. diffuse membranous gloemropathy
4. Type I MPGN
5. Type II MPGN
90
Nephritic Syndrome
Neutrophil-related injury to glomeruli, hypertension (salt retention), oliguria, hematuria (dysmorphic RBCs), RBC casts, proteinuria 15
94
Overlapping features with Henoch-Schonlein purpura
IgA glomerulopathy
95
Episodic bouts of hematuria following an upper respiratory infection
IgA glomerulopathy
96
Increaed anti-DNase B titers, ASO not increased
Acute proliferative GN/post-streptococcal GN
97
Wire looping, serum ANA test positive with anti-dsDNA antibodies,
DIffuse proliferative GN (SLE)
98
ARF over days, Goodpastures syndrome, Wegener's granulomatosis (c-ANA), hemoptysis and ends with renal failure
Rapidly progressive crescentic GN
99
Cytokine injury to podocytes, loss of negative charge on GBM, proteinuria >3.5, fatty casts
nephrotic syndrome
100
Pitting edema due to hypoalbuminemia
Nephrotic syndrome
101
Pitting edema due to salt rentention
Nephritic syndrome
102
Hypercholesterolemia, hypogammaglobulinemia
nephrotic syndrome
103
Kimmelstiel-Wilson disease
Diabetic glomerulopathy
104
Diabetic glomerulopathy is type of systemic disease in nephrotic or nephritic syndrome?
Nephrotic syndrome
105
Two types of ATN
1. ischemic
| 2. nephrotoxic
109
Most common nephrotic syndrome in children, selective proteinuria, Hodgkin's lymphoma as secondary cause, negative IF, fusion of podocytes,
MCD
110
What is the treatment for MCD?
Steroid therpy
111
Negative IF, HIV secondary cause, nonselective proteinuria, hypertension early, poor prognosis
Focal Segmental Glomerulosclerosis
112
Most common nephrotic syndrome in adults, diffuse thickening of membranes (spikes and domes) beneath subepithelial deposits, subepithelial with granular ICs,
diffuse membranous gloemropathy
113
Common causes of oliguria
1. prerenal azotemia
2. acute GN
3. ATN
4. postrenal azotemia
114
Most common type of MPGN, HBV, HCV, subendothelial ICs with granular IF, tram tracks splitting of GBM, hypertension, hematuria
Type I MPGN
115
C3 nephritic factor, dense deposit disease, tram tracks, hypertension, hematuria
Type II MPGN
116
Nonenzymatic glycosylation of GBM
Diabetic glomerulopathy
117
Osmotic damage in diabetic glomerulopathy is due to?
sorbitol
118
Afferent/efferent hyaline arteriolosclerosis, nodular masses in mesangial matrix
Diabetic glomerulopathy
119
microalbuminuria as initial laboratory finding, what med should be prescribed in the begining?
Diabetic glomerulopathy
121
How is Alport inherited
X-linked, or autosomal dominant
122
autoantibodies to IV collagen in GBM, lipid accumulation in VECs-foam cells, sensorineural hearing loss and ocular abnormalities
Alport Syndrome
123
Persistent microscopic hematuria
Thin basement membrane disease (benign familial hematuria)
124
Most common cause of chronic glomerulonephritis
RPGN (rapidly progressive glomerulonephritis)
125
Most common cause of ARF
acute tubular necrosis (ATN)
128
Preprenal azotemia due to hypovolemia
Ischemic ATN
129
Ischemic ATN on endothelial cells
Net effect is vasoconstriction of afferent arterioles, which decreases GFR
130
Pigmented renal tubular cell casts
Ischemic ATN (in both types of ATN)
131
Aminoglycosides, heavy metals, damages in proximal tubule cells, tubular BM intact, hyperkalemia, increased BUN/creatinine
Nephrotoxic type of ATN
132
Acute pyelonephritis mos common cause
Tubulointerstitial nephritis (TIN)
133
What bacteria is most common cause of APN?
E. Coli
134
Vesicoureteral reflex (VUR)
Urine reflex into ureters during micturition
138
FENa equation
FENa=[(UNaxPcr)/(PnaxUcr)]x100
139
FENa < 1%
indicates good tubular function
140
FENa>2%
tubular dysfunction, highly predictive of ATN as cause of oliguria
141
Findings in APN and not lower UTIs
fever, flank pain, WBC casts in urine,
142
Treatment for APN
CIprofloxacin
143
Causes of chronic pyelonephritis (CPN)
VUR in young girls, lower urinary tract obstruction
144
U-shaped cortical scars overlying a blunt calyx, chronic inflammation, scarring, tubular atrophy, thyroidization
CPN
145
Acute drug-induced TIN
penicillin, methicillin, rifampin, sulfonamides, NSAIDs, diuretics
146
Reflux nehropathy causes what in children?
hypertension
147
abrupt onset fever, oliguria, rash, BUN:Cr ratio <15, eosinophilia
Acute drug-induced TIN
148
Chronic use of acetaminophen and aspirin for 3 or more years, renal papillary necrosis (medulla problem)
Analgesic nephropathy
149
Ring defect on IVP
Renal papillary necrosis of Analgesic nephropathy
150
Treatment for calcium stone, uric acid stone, struvite stone
1. HCTZ, cellulose phosphate (binds calcium in intestine)
2. allopurinol
3. surgery and antibiotics
151
How to prevent urate nephropathy?
Allopuriol before aggressive cancer therapy
152
Nuclear acid-fast inclusions in PCT
Chronic lead poisoning
153
Bence Jones Proteinuria produced tubular casts
Multiple Myeloma
154
What reaction dues BJ proteinuria produce?
casts with foreign body giant cell reaction
155
Nephrocalcinosis
multiple myeloma
156
Normocytic anemia; qualitative platelet defect: prolonged bleeding time
Chronic Renal Failure
157
Secondary hyperparathyroidism (HPTH)
Chronic Renal Failure
158
Hypertension, pericarditis, CHF, atherosclerosis
Chronic Renal Failure
159
Uremic frost (urea crystals deposit in skin)
Chronic Renal Failure
160
Hyperkalemia and metabolic acidosis, hypocalcemia, hyperphosphatemia
Chronic Renal Failure
161
Biomarker of kidney function
cystatin C
162
Free water clearance is zero (lack concentration and dilution), waxy/broad casts
Chronic Renal Failure
163
Most common renal disease in essential hypertension, hyaline arteriolosclerosis of arterioles in renal cortex, finely granular cortical surface due to atrophy of tubules, glomerular sclerosis
Benign Nephrosclerosis (BNS)
164
Most common cause of malignant hypertension
Pre-existing BNS
165
Onion skin appearance
Malignant hypertension
166
Initial treatment for malignant hypertension
IV nitroprusside
167
Most common cause of Renal infarction
emoblization from thrombi in left side of the heart
168
Hematuria, loss concentration, renal papillary necrosis, APN
sickle cell nephropathy
169
Anuria followed by ARF in pregnant women
Diffuse cortical necrosis
170
Dilated ureter and renal pelvis, with thinning of overlying cortex and medulla due to compression atrophy
Hydronephrosis
171
Most common metabolic abnormality causing calcium stones
hypercalciuria
172
Most common renal stone in adult
calcium oxalate
173
Most common renal stone in kids
calcium phosphate
174
Staghorn calculus, urease producers, urine is alkaline and smells like ammonia
magnesium ammonium phosphate (MAP)
177
Hamartoma associated with tuberous sclerosis
Angiomyolipoma
178
Von Hippel-Lindau disease (VHL), asbestos exposure,smoking, yellow tumor with renal vein invasion, PCT cells, poor prognosis, hemorragic
Renal cell carcinoma
179
Ectopic secretion EPO and PTH-related peptide
Renal cell carcinoma
180
Transitional cell carcinoma most common cause
smoking, phenacetin abuse, aniline dyes, cyclophosphamide
181
Squamous cell carcinoma
Renal pelvic cancer
182
Most common primary renal tumor in children
Wilm's tumor
183
Child with unilateral flank mass and hypertension
Wilm's Tumor
184
Genetic type associated with WIlm's Tumor
AD, chromosome 11,
185
WAGR w/ Wilm's tumor
Wilm's tumor, aniridia (absent iris), genital abnormalities, retardataion
186
Beckwith-Wiedemann Syndrome of Wilms Tumor
Wilm's tumor, enlarged body organs, hemihypertrophy of extremities
187
Wilm's tumor derived from
mesonephric mesoderm
