Renal - Specific Findings Flashcards
Muddy brown or granular casts
Sloughed tubular epithelial cells
Seen in acute tubular necrosis in the setting of intrinsic renal failure
Pre-renal azotemia - Labs
Increased BUN/Creatinine ratio (>20)
High urine osmolarity (>500)
Low Urine Na+ (<1%)
Intrinsic renal failure - Labs
Decreased BUN/Creatinine ratio (< 350
High urine Na+ (>40) and High FENa (>2%)
Post-renal azotemia - Labs
BUN Creatinine ratio 15-20
Urine osmolarity < 350
Urine Na+ > 40
FENa >1% (mild) or >2% (severe)
Differential diagnosis of nephritic syndrome
Acute post-streptococcal glomerulonephritis
Rapidly progressive glomerulonephritis
Berger disease (IgA glomerulonephropathy)
Alport syndrome
Which glomerular diseases can present as either Nephrotic OR Nephritic syndrome?
Diffuse proliferative glomerulonehphritis
Membranous nephritis
Differential diagnosis of nephrotic syndrome
Focal segmental glomerulosclerosis
Membranous nephropathy
Minimal change disease
Amyloidosis
Diabetic glomerulonephropathy
Berger’s Disease - Biopsy findings
IgA immune complex deposition in the mesangium with mesangial proliferation
*Also seen with Henloch-Schonlein purpura
Minimal Change Disease - Biopsy findings
IF shows no abnormal changes
EM shows effacement of foot processes
Acute post-streptococcal glomerulonephritis - Biopsy findings
IF shows “starry sky” granular appearance due to “lumpy-bumpy” deposition of immune complexes along the GBM and mesangium
EM shows subepithelial immune complex deposition
Rapidly progressive glomerulonephritis (RPGN)
LM and IF shows crescent formation, comprised of fibrin and plasma proteins as well as glomerular parietal cells, monocytes, and macrophages
“Subepithelial humps” on EM
Post-infectious glomerulonephritis
Mesangial deposits on EM
IgA Nephropathy
RBC casts
Seen in the setting of glomerular inflammation (nephritic syndromes)
Waxy casts
Seen in advanced renal disease, i.e. chronic kidney failure
