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RRPA Pathophysiology II > 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 magnesium
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
Q

Most glomerular diseases are _____ in nature

A

Immunologic

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26
Q

4 components of nephrotic syndrome?

A

Proteinuria (>3.5g/day)
Hypoalbuminemia
Generalized edema (anasarca)
Hyperlipidemia

27
Q

Lipid droplets with maltese cross appearance with polarized microscopy indicates?

A

Nephrotic syndrome

28
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

29
Q

What patient population is most susceptible to MCD?

A

males age 2-8 years

2:1 male to female ratio

30
Q

What is associated with MCD in adults?

A

Lymphomas, leukemias, and NSAID use

31
Q

Treatment for MCD?

A

Steroids

32
Q

Findings of MCD on microscopy?

A

Proximal convoluted tubule laden with lipid and protein

33
Q

T/F? Immunofluorescence has no abnormalities in MCD.

A

True

34
Q

Second most common cause of nephrotic syndrome in children?

A

FSGS

35
Q

Most common causes of nephrotic syndrome in adults?

A

FSGS

36
Q

Is FSGS immunologic in origin?

A

No

37
Q

What patient population has a ridiculously increased risk of FSGS?

A

Heroin users.

30x risk compared to rest of pop.

38
Q

What is the treatment for FSGS?

A

haha tricked you there is no treatment

39
Q

Prognosis for FSGS?

A

Bad. End stage renal disease within 10 years.

40
Q

What are the microscopy findings in FSGS?

A

Segmental sclerosis of a few glomeruli on light microscopy

Positive for IgM and C3 on immunofluorescence

41
Q

Non selective proteinuria is a finding in?

A

Membranous glomerulonephropathy

42
Q

Membranous glomerulonephropathy is most often caused by?

How about some other causes?

A

Most often idiopathic.

Other causes: syphilis, malaria, Hep B or C, carinoma of lung and colon, melanoma, lupus, NSAIDS

43
Q

Microscopy findings in membranous glomerulonephropathy?

A

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
Q

The single most common cause for end stage renal disease?

A

Diabetes!

45
Q

What is the most common finding on light microscopy for patients with ESRD and diabetes?

A

Diffuse glomerulosclerosis

46
Q

Nephritic syndrome is characterized by what symptoms?

A

Renal failure, hypertension, and hematuria.

47
Q

Is proteinuria and edema associated more with nephrotic syndrome of nephritic syndrome?

A

Nephrotic

48
Q

What casts are present in nephritic syndrome?

A

RBC casts

49
Q

Do casts form when there is an issue at, above, or below the kidney?

A

At the kidney

50
Q

Is glomerulonephropathy associated with nephrotic or nephritic syndrome?

A

nephrotic

But remember, glomerulonephritis is associated with nephritic syndrome.

51
Q

Postinfectious glomerulonephritis most commonly occurs after what infection?
How long after?

A

Group A step

1-4 weeks after

52
Q

Other causes of postinfectious glomerulonephritis include?

A

Staph infections, mumps, measles, Hep B and C, chicken pox

53
Q

Prognosis for postinfectious glomerulonephritis?

A

Good! 90-95% recover completely

54
Q

What would you expect serum complement level, ASO titer, and antiDNAse B to be in postinfectious glomerulosnephritis?

A

Low serum complement

High ASO titer and antiDNAse B

55
Q

T/F? Postinfectious glomerulonephritis has positive findings on only light and electron microscopy?

A

F - + findings on light, electron and immunofluorescence

56
Q

Findings on light microscopy for Postinfectious glomerulonephritis?

A

All glomeruli have increased number of cells

Silver stain “lumpy bumpy” - caused by staining of basement membrane growing around immune complexes

57
Q

Findings on immunofluorescence in Postinfectious glomerulonephritis?

A

granular pattern, psotive for IgG, IgM, and complement

58
Q

Findings for electron microsocopy in Postinfectious glomerulonephritis?

A

Immune complex deposition

59
Q

________ is characterized by lung hemorrhage and severe rapidly progressing glomerulonephritis

A

Good Pasture Syndrome

60
Q

Describe the findings on immunofluorescence of Goodpasture syndrome.

A

Linear pattern of distribution of complement and IgG along the basement membrane

61
Q

There are two types of membranoproliferative glomerulonephritis. What are they are what are they associated with?

A

Type I - associated with hep B and C, and lupus

Type II, associated with hypocomplementemia

62
Q

Prognosis for membranoproliferative glomerulonephritis?

A

Not great. 50% progress to chronic renal failure within 10 years

63
Q

Chronic glomerulonephritis is characterized by?

A

sclerosis of glomeruli

64
Q

Describe to gross pathology of the kidneys in chronic glomerulonephritis.

A

Pale and swollen cortex due to lipid deposition and interstitial edema

RRPA Pathophysiology II (16 decks)

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