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Rapid Review Step 1 > Renal System > Flashcards

Renal System Flashcards

1
Q

Acute Kidney Injury
(Pre-Renal)

A

Caused by decr renal perfusion;
BUN/creatinine ratio typically >20:1
Fractional excreti Na+ <1%
Urine osmolality >500 mOsm/kg
Microscopy Hyaline casts

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2
Q

Acute Kidney Injury
(Post-Renal)

A

Caused by urinary tract obstruction with normal nephron capacity. Etiologies include bilateral calculi, enlarged prostate, or a renal tumor in an individual with a sole functional kidney.
Bilateral Hydronephrosis is also seen.

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3
Q

Acute Kidney Injury
(Intra Renal)

A

Aka Acute Tubular Necrosis
Renal ischemia (eg, hemorrhage, sepsis) or nephrotoxins (eg, aminoglycosides, radiocontrast)
Can also present in setting of cardiac ischemia due likely episode of Hypotension.
BUN/Cr Typically ~10-15
Fractional excretion Na+ >2%
Urine Osm ~300 mOsm/kg
Microscopy Muddy brown casts

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4
Q

PSGN
(Post Streptococcal Glomerluonephritis)

A

Aka Proliferative glomerulonephritis/ Acute glomerulonephritis
After streptococcal inf i.e Strep Pyogenes (2 wks) can present as 1-3 wks of red urine after sore throat.

Periorbital Edema
Hypertension
Micro/Gross Hematuria
Type-3 Hypersenstivity reaction (Antigen-Antibody complex that form in blood and deposit in kidney)
child recovers well, poor prognosis in adults

LM: hypercellular enlarged glomeruli.
IF: Granular deposits of IgG, IgM, C3 on GBM & Mesangium (lumpy-bumpy).
EM: Subepithelial humps b/w podocytes and GBM

Increase Anti-streptolysin-O & Anti-DNase B-titers
Decrease complement protien C3

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5
Q

Fanconi syndrome

A

Polyuria, renal tubular acidosis type II, growth retardation, electrolyte imbalances, hypophosphatemic rickets
(multiple combined dysfunction of the PCT)

Impaired PCT reabsorbtion of AA, Glucose, PO4–, HCO3–.
Caused by consumption of expired Tetracyclines.

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6
Q

HUS (Hemolytic-uremic syndrome)

A

In children, Predominately caused by Shiga toxin–producing
Escherichia coli (STEC) infection (serotype O157:H7)
- Thrombocytopenia
- Hemolytic Anemia
- Acute kidney Injury
- Bloody Diarrhea

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7
Q

ADPKD
( Autosomal dominant polycystic kidney disease )

A

Genetic mutation in polycystin ( PKD1 , PKD2 )
Multiple large cysts in kidneys due to structural abnormalities in renal tubules.
Inherited with complete penetrance & Variable expressivity.
Can present with:
Flank pain, Hematuria, HTN, Progressive CKD.

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8
Q

PSGN

A

most common in kids;
sub epithelial humps - IgG, C3, and C4 deposition;
lumpy bumpy on EM;
ASO antibodies

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9
Q

Membranous Proliferative Glomerulonephritis

A

tram-tracks on LM, basement splitting

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10
Q

Urge Incontinence

A

urgency leads to complete voiding,
detrusor spasticity leads to small bladder volume;
PVRV: 5-10mL

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11
Q

RTA Type-2

A

Inability of PCT to reabsorb bi-carb (HCO3–).
proximal RTA = bad carbonic anhydrase, lost all bicarb in urine

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12
Q

Focal Segmental Glomerulonephritis

A

Seen in
IV drug abusers, African Americans, Hispanics, and HIV patients

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13
Q

Overflow Incontinence

A

cannot completely empty bladder
PVRV: residual volume > 100ml

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14
Q

Minimal Change Disease

A

Most common nephrotic syndrome in kids
fused foot processes on EM, no renal failure, loss of charge barrier

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15
Q

Membranous Glomerulonephritis

A

Most common nephrotic syndrome in adults
LM: BM spikes,
EM: sub epithelial spikes and domes
IF: granular/ linear

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16
Q

Stress Incontinence

A

weak pelvic floor muscles
urinating when coughing, laughing, etc.
estrogen effect;

PVRV = 50ml

17
Q

RTA Type-1

A

Inability of DCT to secrete Proton (H+).
distal (DCT) RTA = H+/K+ exchange in collecting duct is broken,
high urine pH (low H+ in urine)

18
Q

Barter Syndrome

A

@ ascending loop
JG cell hyperplasia with renin excess;
no increase in blood pressure;
defect in kidney’s ability to reabsorb potassium

–presents like chronic loop diuretic use–

19
Q

SIADH
( Syndrome of Inappropriate Anti-Diuretic Harmone )

A

Too much ADH (Vasopressin)
ADH is produced by supraoptic nucleus of hypothalamus and stored in posterior pituitary.

ADH increases water reabsorption in medullary collecting duct.

↓Serum Osmolality , ↓Serum specific gravity
↓ serum Na (< 135)

↑ Urine osmolality , ↑ Serum specific gravity

Tx :
– Demeclocycline (tetracycline causes insenstivity to ADH).
– Conivaptan & Tolvaptan (ADH receptor antagonists).

20
Q

Types of renal tubular acidosis (RTA)

A
  • Type 1 (distal):
    Reduced ability to secrete (H+) in distal tubule (ie, H+ retention). Autoimmune diseases (eg, lupus, Sjögren syndrome) and amphotericin B toxicity.
  • Type 2 (proximal):
    Reduced ability to (reabsorb) (bicarbonate) in proximal tubule (ie, bicarbonate wasting). Carbonic anhydrase inhibitors, multiple myeloma, and Fanconi syndrome.
  • Type 4:
    Reduced production and/or response to (aldosterone). Diabetes mellitus, ACE inhibititors, nonsteroidal anti-inflammatory drugs, and heparin.
21
Q

4 most common causes of renal papillary necrosis.

A
  1. Sickle cell disease/trait
  2. Chronic analgesic use (eg, nonsteroidal anti-inflammatory drugs)
  3. Diabetes mellitus
  4. Acute pyelonephritis
22
Q

Lupus nephritis occurs primarily due to?

A

Deposition of DNA/anti-DNA immune complexes within the glomerulus (e.g., mesangium, subendothelial or subepithelial space).

23
Q

Occupational exposures to rubber, plastic, and aromatic amines are risk factors for which cancer?

A

Urothelial bladder cancer

24
Q

Extrarenal manifestations of autosomal dominant polycystic kidney disease.

A
  1. Liver: cysts
  2. Neurovascular: intracranial berry aneurysms
25
Q

Poststreptococcal glomerulonephritis

A

Shows a (granular) pattern of immunofluorescence composed of IgG, IgM, & C3 deposits along the glomerular basement membrane and mesangium.

26
Q

Bartter syndrome

A

Characterized by a reabsorption defect in the (thick ascending loop of Henle) (Na/K/2Cl transporter) and mimics chronic (loop) diuretic use (alkalosis, hypokalemia, hypercalciuria).

27
Q

Gitelman syndrome

A

Characterized by a reabsorption defect in the (distal convoluted tubule) and mimics chronic (thiazide) diuretic use (alkalosis, hypokalemia, hypercalciuria).

28
Q

Renal cell carcinoma is often associated with paraneoplastic syndromes involving ectopic production of the following hormones (PEAR mnemonic).

A
  1. Parathyroid hormone-related protein (hypercalcemia)
  2. Erythropoietin (erythrocytosis)
  3. Adrenocorticotropic hormone (Cushing syndrome)
  4. Renin (hypertension)
29
Q

List 4 common symptoms of acute cystitis.

A
  1. Dysuria,
  2. Suprapubic pain,
  3. Urinary frequency,
  4. Urinary urgency.
30
Q

Acute Interstitial Nephritis

A

White blood cell casts, sterile pyuria, and urine eosinophils

31
Q

Causes of hypophosphatemia

A
  1. Internal redistribution
  2. Decreased intestinal absorption
  3. Increased urinary excretion

Rapid Review Step 1 (24 decks)

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