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Cam's Cards > Renal Pathophys Part 1 - Schoeny (exam 3) > Flashcards

Renal Pathophys Part 1 - Schoeny (exam 3) Flashcards

1
Q

Normal urine production per day?

A

1.5L

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2
Q

What is azotemia?

A

Elevated BUN and Cr +/- anuria

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3
Q

3 types of AKI?

A

Prerenal, renal, postrenal

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4
Q

Causes of prerenal AKI?

A

Low volume stimulus (hypovolemia, heart failure, sepsis)

Renal vascular pathology (stenosis, atherosclerosis)

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5
Q

Causes of intrinsic AKI?

A

ATN, glomerular disease, AIN

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6
Q

BUN:Cr in prerenal AKI?

A

> 20:1

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7
Q

BUN:Cr in intrinsic AKI?

A

<20:1

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8
Q

Causes of postrenal AKI?

A

Obstruction, kidney stones

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9
Q

Clinical symptoms of AKI?

A 
Electrolyte disurbances
Decreased urine output
Lethargy
Fatigue
Nausea
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10
Q

Urine findings in prerenal AKI?

A

FENa < 1%
Urine sodium <20
Urine osmolality >500
Urine SG > 1.020

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11
Q

Urine findings in intrinsic AKI?

A

FENa>1%
Urine sodium >20
Urine osmolality <400
Urine SG <1.010

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12
Q

Most common causes of chronic renal failure?

A

DM, HTN, glomerulonephritis

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13
Q

4 stages of chronic renal failure and % GFR remaining in each stage?

A

Diminished renal reserve - GFR = 50%
Renal insufficiency - GFR =20-50%
Renal failure -GFR <20%
End stage renal failure - GFR<5%

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14
Q

A segmental glomerular disorder describes what?

A

A disorder where only a portion of the glomerulus is involved.

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15
Q

A global glomerular disorder describes what?

A

A disorder where all of the glomerulus is involved.

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16
Q

A focal glomerular disorder describes what?

A

A disorder where some of the glomeruli are involved.

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17
Q

A diffuse glomerular disorder describes what?

A

A disorder where almost all of the glomeruli are involved.

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18
Q

Techniques to evaluate glomeruli include what 3 types microscopy?

A

Light microscopy
Immunofluorescence
Electron microscopy

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19
Q

What types of stains are used in light microscopy?

What are they used for?

A

Periodic Acid Schiff (PAS) - highlights basement membrane and mesangium
Trichrome - highlights fibrosis
Silver - Highlights basement membrane

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20
Q

Immunofluorescence uses what type of antibodies?

A

IgG, IgM, IgA

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21
Q

A linear pattern on immunofluorescence indicates?

A

Reaction directed against antigen in glomerular basement membrane -> goodpasture syndrome

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22
Q

A granular pattern on immunofluorescence indicates?

A

Reaction against antigen/antibody immune complexes in glomerular basement membranes -> SLE

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23
Q

What can be seen on electron microscopy?

A

Structure and immune complex deposition

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24
Q

Clinical manifestation of glomerular diseases include(5)?

A 
Nephrotic syndrome
Nephritic syndrome
Rapidly progressive glomerulonephritis
Chronic renal failure
Asymptomatic hematuria
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25
Most glomerular diseases are _____ in nature
Immunologic
26
4 components of nephrotic syndrome?
Proteinuria (>3.5g/day) Hypoalbuminemia Generalized edema (anasarca) Hyperlipidemia
27
Lipid droplets with maltese cross appearance with polarized microscopy indicates?
Nephrotic syndrome
28
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
29
What patient population is most susceptible to MCD?
males age 2-8 years | 2:1 male to female ratio
30
What is associated with MCD in adults?
Lymphomas, leukemias, and NSAID use
31
Treatment for MCD?
Steroids
32
Findings of MCD on microscopy?
Proximal convoluted tubule laden with lipid and protein
33
T/F? Immunofluorescence has no abnormalities in MCD.
True
34
Second most common cause of nephrotic syndrome in children?
FSGS
35
Most common causes of nephrotic syndrome in adults?
FSGS
36
Is FSGS immunologic in origin?
No
37
What patient population has a ridiculously increased risk of FSGS?
Heroin users. | 30x risk compared to rest of pop.
38
What is the treatment for FSGS?
haha tricked you there is no treatment
39
Prognosis for FSGS?
Bad. End stage renal disease within 10 years.
40
What are the microscopy findings in FSGS?
Segmental sclerosis of a few glomeruli on light microscopy | Positive for IgM and C3 on immunofluorescence
41
Non selective proteinuria is a finding in?
Membranous glomerulonephropathy
42
Membranous glomerulonephropathy is most often caused by? | How about some other causes?
Most often idiopathic. | Other causes: syphilis, malaria, Hep B or C, carinoma of lung and colon, melanoma, lupus, NSAIDS
43
Microscopy findings in membranous glomerulonephropathy?
Silver stain: thickened basement membrane extending between immune complexes ***spike and dome formation**** Immunofluorescence: granular pattern positive for IgG Electron microscopy: Subepithelial immune complexes
44
The single most common cause for end stage renal disease?
Diabetes!
45
What is the most common finding on light microscopy for patients with EDRD and diabetes?
Diffuse glomerulosclerosis
46
Nephritic syndrome is characterized by what symptoms?
Renal failure, hypertension, and hematuria.
47
Is proteinuria and edema associated more with nephrotic syndrome of nephritic syndrome?
Nephrotic
48
What casts are present in nephritic syndrome?
RBC casts
49
Do casts form when there is an issue at, above, or below the kidney?
At the kidney
50
Is glomerulonephropathy associated with nephrotic or nephritic syndrome?
nephrotic | But remember, glomerulonephritis is associated with nephritic syndrome.
51
Postinfectious glomerulonephritis most commonly occurs after what infection? How long after?
Group A step | 1-4 weeks after
52
Other causes of postinfectious glomerulonephritis include?
Staph infections, mumps, measles, Hep B and C, chicken pox
53
Prognosis for postinfectious glomerulonephritis?
Good! 90-95% recover completely
54
What would you expect serum complement level, ASO titer, and antiDNAse B to be in postinfectious glomerulosnephritis?
Low serum complement | High ASO titer and antiDNAse B
55
T/F? Postinfectious glomerulonephritis has positive findings on only light and electron microscopy?
F - + findings on light, electron and immunofluorescence
56
Findings on light microscopy for Postinfectious glomerulonephritis?
All glomeruli have increased number of cells | Silver stain "lumpy bumpy" - caused by staining of basement membrane growing around immune complexes
57
Findings on immunofluorescence in Postinfectious glomerulonephritis?
granular pattern, psotive for IgG, IgM, and complement
58
Findings for electron microsocopy in Postinfectious glomerulonephritis?
Immune complex deposition
59
________ is characterized by lung hemorrhage and severe rapidly progressing glomerulonephritis
Good Pasture Syndrome
60
Describe the findings on immunofluorescence of Goodpasture syndrome.
Linear pattern of distribution of complement and IgG along the basement membrane
61
There are two types of membranoproliferative glomerulonephritis. What are they are what are they associated with?
Type I - associated with hep B and C, and lupus | Type II, associated with hypocomplementemia
62
Prognosis for membranoproliferative glomerulonephritis?
Not great. 50% progress to chronic renal failure within 10 years
63
Chronic glomerulonephritis is characterized by?
sclerosis of glomeruli
64
Describe to gross pathology of the kidneys in chronic glomerulonephritis.
Pale and swollen cortex due to lipid deposition and interstitial edema

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