Renal Review

Question 1

Define Azotemia
2 lab changes
Represents what change
3 Forms

Answer 1

Lab Test Abnormality
Elevated Creatinine and BUN
Represents Decrease in GFR
Pre-Renal, Renal, Post-Renal

Question 2

Define Uremia

Answer 2

Signs and symptoms secondary to azotemia

Question 3

3 signs of uremia

Answer 3

Gastroenteritis
Neuropathy
Fibrinous pericarditis

Question 4

Anti-GBM antibodies give us what two diseases

Answer 4

Anti-GBM disease

Goodpasture’s

Question 5

Anti-Megalin like antibodies gives what disease

Appearance

Answer 5

Membranous GN

Granular pattern

Question 6

Cell-mediated injury appears how?

Associated with what

Answer 6

Pausi-Immune appearance

RPGN

Question 7

Renal Ablation Glomerulopathy define

Answer 7

Start losing nephrons and reach 50% you damage the remaining and progress to renal failure

Question 8

Define Nephrotic Syndrome

Answer 8

Loss of glomeruli –> Can’t filter –> Lose protein

Question 9

3 Blood/urine findings of Nephrotic

1 physical finding

Answer 9

Proteinuria > 3.5/day
Hypoalbuminemia <3 gram
Lipidemia

Edema due to low albumin

Question 10

Number systemic disease cause of nephrotic syndrome?

Answer 10

Diabetes mellitus

Question 11

A child presents with proteinuria of mainly albumin. There are no changes under LM. Under EM, we see an effacement of foot processes. IF finds nothing. Steroids prescribed have had a benefit.

Answer 11

Minimal Change Disease

Question 12

Caucasian adult presents with proteinuria. LM shows thickened capillary walls. EM shows thickened BM, subepithelial deposits, and effacement of foot processes. IF shows granular subepithelial deposits. Silver stain LM deposits show a spike-and-dome appearance. Anti-Megalin-like antibodies are found

Answer 12

Membranous Nephropathy

Question 13

African-American presents with non-selective proteinuria and hypertension. Some glomeruli deisplay partial sclerosis under LM. Injury of visceral epithelial cells is documented. Patient is a HIV individual with a history of IV heroin use. Disease does not respond well to steroids.

Answer 13

FSGS

Question 14

Patient presents with microscope ifndings of thickened BM, proliferating mesangial cells and matrix. LM shows a tram-track appearance of BM with PAS and silver stains. Patient has hepatitis B. EM shows subendothelial deposits of C3 and IgG.

Answer 14

Type 1 Membranoproliferative Glomerulonephritis

Question 15

Patient presents with microscope ifndings of thickened BM, proliferating mesangial cells and matrix. LM shows a tram-track appearance of BM with PAS and silver stains. Patient has hepatitis C. EM shows lamina densa deposits of electron-dense material.

Answer 15

Type 2 Membranoproliferative Glomerulonephritis

Question 16

4 Findings of Nephritic Syndromes

Answer 16

1. Hematuria
2. Oliguria
3. Azotemia
4. HTN

Question 17

3 Morphological signs of Nephritic syndromes

Answer 17

1. Proliferation of glomerular cells
2. Inflammatory cells in glomerulus
3. RBC casts in urine

Question 18

Child presents with dark colored urine and is hypertensive with some periorbital edema. He had a sore throat that cleared up 2 weeks ago. Anti-streptolysin O and anti-DNAase tests are positive.

Answer 18

Post Streptococcal GN

Question 19

Patient presents with a rapid loss of renal function. Crescents are found in Bowman’s space on microscopy. Anti-GBM antibodies with linear IgG deposition. Pulmonary hemorrhaging has been occurring.

Answer 19

Type 1 RPGN with Goodpasture’s

Question 20

Patient presents with a rapid loss of renal function. Crescents are found in Bowman’s space on microscopy. IF shows immune complex deposition in granular pattern.

Answer 20

Type 2 RPGN

Question 21

Patient presents with a rapid loss of renal function. Crescents are found in Bowman’s space on microscopy.Vasculitis is seen. IF is negative. ANCA positive

Answer 21

Type 3 RPGN

Question 22

Young healthy patient presents with hematuria and reports a recent GI/UR infection. Patient has also been diagnosed recently with Henoch-Schonlein Purpura. Staining shows IgA deposits in mesangium.

Answer 22

IgA Disease/Berger’s Disease

Question 23

Young adult male patient presents with hematuria, deafness, and eye disturbances. It is determined he has a X-linked mutation for alpha5 chain of type IV collagen.

Answer 23

Alport Syndrome/Hereditary Nephritis

Question 24

Patient presents with hematuria but recovers quickly. Patient has heterozygous genotype for abnormality in type IV collagen.

Answer 24

Benign Familial Hematuria/ Thin Basement Membrane Disease

Question 25

Patient presents with microtubular arrays, deposits throughout the kidney, wire loops, and Full House IF staining. Immune complex deposition is determined to be the underlying pathology.

Answer 25

SLE Nephropathy

Question 26

This is the #1 cause of end stage renal disease in US

Answer 26

Diabetic Associated Renal Disease

Question 27

This is the #1 cause overall for nephrotic syndrome in adults in US.

Answer 27

Diabetic Associated Renal Disease

Question 28

Patient presents with Nodular glomerulosclerosis with Kimmelstiel-Wilson nodules on staining.

Answer 28

Glomerular Disease of Diabetic Associated Renal Disease

Question 29

Patient presents with hyaline arteriolosclerosis.

Answer 29

Renal Arteriolosclerosis of Diabetic Associated Renal Disease

Question 30

Patient presents with increased infections from glycosuria, bladder stasis, and altered immune status.

Answer 30

Pyelonephritis of Diabetic Associated Renal Disease

Question 31

This is the most common cause of papillary necrosis

Answer 31

Diabetes

Question 32

Patient presents with deposits in glomeruli that has damaged all glomeruli equally. The damage began in the mesangium. The deposits stain salmon pink under Congo Red Stain and apple green birefringence on polarization.

Answer 32

Amyloidosis

Question 33

Patient with existing multiple myeloma presents with nodular pattern of deposition under LM. Bence Jones proteins are detected in urine. IF shows high Kappa Light chain deposition.

Answer 33

Light Chain Deposition Disease

Question 34

Patient with existing multiple myeloma presents with renal dysfunction due to giant cell reaction around distal tubules. Distal tubules are shown to have light chain casts with TH protein involved.

Answer 34

Light Chain Cast Nephropathy

Question 35

Patient with Hepatitis C presents with palpable purpura, arthralgias and Raynaud’s. Histology shows circulating immunoglobulins that precipitate when cool and become soluble when warm.

Answer 35

Cryoglobulinemic Nephritis

Question 36

Patient presents with nephrotic syndrome that looks like amyloid but does not stain amyloid.

Answer 36

Fibrillary Immunotactoid glomerulonephritis

Question 37

African-American presents with FSGS of the collapsing variant.

Answer 37

HIV nephropathy

Question 38

Patient rejects a kidney transplant on the operating table.

Answer 38

Hyperacute Rejection

Question 39

Patient rejects a kidney transplant due to preformed antibodies against the graft.

Answer 39

Hyperacute Rejection

Question 40

Patient has CD8 cytotoxic T cells attack the endothelial cells of his or her kidney transplant.

Answer 40

Acute - Cellular

Question 41

Patient has rejection vasculitis months after transplant of new kidney.

Answer 41

Acute - Humoral

Question 42

Patient presents with a slow steady increase in serum creatinine while slowly losing renal function.

Answer 42

Chronic

Question 43

Patient presents years after kidney transplant and is now seeing a loss in tissue of his transplant. He was immunosuppressed heavily during his transplant surgery.

Answer 43

Polyoma Virus (BK)

Question 44

Patient presents with a rapid decline in renal function over 24 hours. Urine Cr is greater than 100. FE Na+ is less than 1%. Urine Na is less than 20. BUN/Creatinine is greater than 20:1. Specific gravity is higher than normal.

What is treatment

Answer 44

Pre-Renal ARF

Hydration/Volume expansion

Question 45

Patient presents with a rapid decline in renal function over 24 hours. Urine Cr is less than 70. FE Na+ is greater than 3%. Urine Na is greater than 30.

What is treatment

Answer 45

Renal ARF

Supportive (NOT HYDRATION)

Question 46

Patient presents with rapid decline in renal function over 24 hours. A surgical operation cures the problem.

Answer 46

Post-Renal ARF.

Question 47

Patient presents with hypertension and uremia. GFR is less than 20% of normal. Ultrasound shows small kidneys. Blood tests show anemia, metabolic acidosis, and secondary hyperparathyroidism. Bleeding disorder is present as well.

Answer 47

Chronic Renal Failure

Question 48

Hospitalized patient presents with a reduction of renal function. Morphologically there is evidence of tubular injury with tubular cell casts in urine. Patient tests positive for hypotension and toxins.

Answer 48

Acute Tubular Necrosis