Schoenwald - Renal Flashcards
1
Q
fxn’s of the kidneys (3)
A
primary regulators of internal environment
fluid regulation
filtration/urine concentration
2
Q
kidneys filter __ L of fluid/day
and produce __ L of urine/day
A
180
1.5
3
Q
what is used to determine kidney pathology
A
microscopy
bx
4
Q
3 types of ARF/AKI
A
prerenal
renal
postrenal
5
Q
azotemia involves elevated
A
BUN
Creatinine
+/- anuria
6
Q
pathology behind prerenal ARF
A
low volume stimulus
7
Q
causes of prerenal aRF
A
hypovolemia
heart failure
sepsis
renal vascular pathology → stenosis, atherosclerosis
8
Q
kidney function is not impaired in prerenal ARF, but responds to low volume by (3)
A
reabsorption of Na, water, urea
9
Q
in ARF, __ is secreted by the tubules
but __ is reabsorbed
resulting in __
A
Cr
BUN
BUN:Cr ratio > 20:1
10
Q
renal ARF originates __
and indicates __
A
within the kidney
kidney dysfxn
11
Q
causes of renal ARF (3)
A
ATN
glomerular dz
AIN
12
Q
impaired tubular fxn is indicated by what lab values (2)
A
FENa > 1%
BUN:Cr ratio < 20:1
13
Q
postrenal failure is caused by __
and the major cause is __
A
obstruction
stones
14
Q
obstruction causes __
and __ is the preferred evaluation test
A
hydronephrosis
US
15
Q
sx of ARF/AKI (5)
A
lyte disturbances
decreased urine output
lethargy
fatigue
nausea
16
Q
lab summary of pre vs post ARF/AKI
A
17
Q
mc causes of CKD
A
DM
HTN
glomerulonephritis
18
Q
sx of CKD
A
same as AKI/ARF but longer duration →
fatigue, n/v, edema
19
Q
stages of CKD (CRF)
A
diminished renal reserve
renal insufficiency
renal failure
esrd
20
Q
sx of renal insufficiency (3)
A
htn
anemia
polyuria
21
Q
sx of renal failure
A
edema
metabolic acidosis
22
Q
GI complications of CKD/CRF
A
n/v
anorexia
23
Q
cardiac complications of CKD/CRF (3)
A
htn
CHF
pericarditis
24
Q
hematologic complications of CKD/CRF
A
normocytic, normochromic anemia (anemia of chronic dz)
platelet dysfxn
increased infxn
25
CNS complications of CKD (2)
polyneuropathy
encephalopathy
26
glomerular d.o can be __ (4)
segmental
global
focal
diffuse
27
a portion of the glomerulus is involved in dz
segmental
28
some of the gomeruli are involved in CKD
focal
29
3 techniques to evaluate glomeruli
light microscopy
immunofluorescence (IgG, IgM, IgA)
electron microscopy
30
types of light microscopy technique
periodic acid schiff (PAS)
trichrome
silver
31
type of light microscopy that highlights the basement membrane and mesangium
periodic acid schiff (PAS)
32
type of light microscopy that highlights fibrosis
trichrome
33
type of electron microscopy that highlights the basement membrane
silver
34
types of immunofluorescence (2)
linear pattern
granular pattern
35
type of immunofluorescence rxn directed against antigen in glomerular basement membrane
linear pattern
36
what do you think when you see goodpasture syndrome
linear pattern immunofluorescence
37
type of immunofluorescence rxn that is against Ag/Abs immune complexes in glomerular basement membrane
granular pattern
38
what condition do you think of when you see linear pattern immunofluorescence
SLE
39
electron microscopy shows (2)
structure
immune complex deposition
40
linear pattern → Good Pasture
41
granular pattern
SLE
42
clinical manifestations of glomerular dz (5)
nephrotic syndrome
nephritic syndrome
rapidly progressive glomerulonephritis
CKD/CRF
asymptomatic hematuria
43
most glomerular dz's are __ in nature
and are the result of either \_\_
or \_\_
immunologic
immune complex deposition
Abs-Ag binding
44
what do immune complexes activate
complement
45
short lived immune complexes cause \_\_
long lived immune complexes cause \_\_
infxn
CKD/chronic failure
46
damage of glomeruli results in leakage of protein (mainly albumin) → hypoalbuminemia
nephrotic syndrome
47
how does nephrotic syndrome cause edema
hypoalbuminuria → decreased osmotic pressure → edema
48
how does edema affect blood pressure
decreased fluid in vascular space → decreased bp
49
how does decreased bp worsen edema
decreased bp → simulates renin → aldosterone causes Na and water retention → worse edema
50
in response to hypoalbuminuria, the liver produces \_\_
to compensate for decreased \_\_,
which causes \_\_
apolipoprotein
osmotic pressure
hyperlipidemia
51
why does infxn risk increase w. nephrotic syndrome
decreased Ig production
52
quad of nephrotic syndrome
proteinuria
hypoalbuminemia
anasarca
hyperlipidemia
53
in nephrotic syndrome, proteinuria is \> \_\_/day
3.5 g
54
sx of nephrotic syndrome (3)
n/v
periorbital edema
frothy urine
55
UA findings of nephrotic syndrome besides proteinuria (2)
waxy casts
oval fat bodies
56
lipid droplets in urine for nephrotic syndrome have __ appearance w. polarized light microscopy
maltese cross
57
preferred dx test for nephrotic syndrome to find specific cause
kidney bx
58
what is this showing
light microscopy
lipid droplet → maltese cross
59
4 specific causes of nephrotic syndrome
minimal change dz
focal segmental glomerulosclerosis
membranous glomerulonphropathy
diabetic nephropathy
60
mc cause of nephrotic syndrome in kids 2-8 yo; 2:1 m:f
minima change dz
61
minimal change dz causes __ proteinuria
and is treated w. \_\_
selective
steroids
62
in adults, minimal change dz is associated w. (3)
lymphomas
leukemias
NSAIDs
63
light microscopy findings of minimal change dz (2)
no abnormalities in glomeruli → “minimal change”
PCT laden w. lipid and protein
64
immunofluorescence findings of minimal change dz
no abnormalities → “minimal change”
65
2nd mc cause of nephrotic syndrome in kids
and mc cause of nephrotic syndrome in adults
focal segmental glomerulosclerosis
66
focal segmental glomerulosclerosis is NOT __ in origin
immunologic
67
pathophys of focal segmental glomerulosclerosis
IgM and C3 are trapped → injury to epithelial cells
68
what pt population is 30x higher risk for focal segmental glomerulosclerosis
IV heroin users
69
is there a tx for focal segmental glomerulosclerosis
no! → leads to esrd in w.in 10 years
70
light microscopy findings of focal glomerulosclerosis
segmental sclerosis of a few glomeruli
71
immunofluorescence for focal segmental glomerulosclerosis
(+) IgM and C3
72
electron microscopy findings for focal segmental glomerulosclerosis
no immune complexes
73
type of nephrotic syndrome that is 2/2 to other processes
membranous glomerulonephropathy
74
membranous glomerulonephropathy causes __ proteinuria
selective
75
common causes of membranous glomerulonephropathy (7)
syphilis
malaria
hep B or C
lung carcinoma
melanoma
SLE
drugs → NSAIDs
76
85% of cases of membranous glomerulonephropathy are
idiopathic
77
membranous glomerulonephropathy outcomes:
⅓:
⅓:
⅓:
⅓: remission
⅓: proteinuria w. stable renal fxn
⅓: esrd in 5-10 years
78
light microscopy findings of membranous glomerulonephropathy
silver stain:
thickened basement membrane btw immune complexes
spike and dome formation
79
immunofluorescence findings of membranous glomerulonephropathy
granular pattern
(+) IgG
80
electron microscopy findings of membranous glomerulonephropathy
subepithelial immune complexes
81
mc cause of esrd in US
diabetic nephropathy
*40% of esrd pt's have DM*
82
diabetic nephropathy causes **\_\_** albuminuria,
\_\_,
and decrease in \_\_
persistent
htn
GFR
83
what test predicts development of diabetic nephropathy
microalbumin
84
mc light microscopy findings of diabetic nephropathy
diffuse glomerulosclerosis → thickening of basement membrane
85
increased BUN/Cr, oliguria, htn, hematuria
nephritic syndrome
86
\_\_ and
\_\_ are present w. nephritic syndrome, but less severe
proteinuria
edema
87
\_\_ is much more severe w. nephritic syndrome than nephrotic syndrome
damage of glomeruli
88
nephrotic syndrome involves leakage of \_\_
nephritic syndrome involves leakage of \_\_
protein
RBC
89
in nephritic syndrome, __ deposition triggers proliferation of glomerular cells
and stimulates \_\_
immune complex
neutrophils
90
clinical presentation of nephritic syndrome
edema
oliguria
htn
hematuria
proteinuria
91
cola colored/smoky brown urine
nephritic syndrome
92
nephritic syndrome casts are
RBC
93
serum complement will be low w. __ glomerulonephritis, including (3)
postinfectious:
SLE
bacterial endocarditis
membranoproliferative glomerulonephritis
94
complement will be normal w. nephritic syndrome caused by (2)
IgA nephropathy
antiglomerular basement membrane dz
95
antiglomerular basement membrane dz is same-same
goodpasture syndrome
96
3 causes of nephritic syndrome
postinfectious
rapidly progressive
membranoproliferative
97
mc occurs 1-4 weeks after GAS or impetigo infxn
postinfectious glomerulonephritis
98
other infxns associated w. postinfectious GN
staph
mumps/measles
hep B or C
chickenpox
99
post infectious GN can progress to
\_\_,
which causes \_\_
rapidly progressing GN
chronic GN
100
2 tests for past GAS infxn
ASO titer
antiDNAse B
101
lumpy bumpy appearance from basement membrane growing around immune complexes
light microscopy silver stain findings of post infectious GN
102
immunofluorescence findings of post infectious GN
granular pattern
(+) IgM and complement
103
electron microscopy findings of post infectious GN
immune complex deposition
104
\_\_ can occur alone,
but is one of mc of nephritic syndrome
rapidly progressive GN
105
crescent cells in bowman capsules
rapidly progressive GN
106
rapidly progressive GN is classified in to
types I-III
107
type I rapidly progressive GN
IgG binds directly to glomerular basement membrane
good pasture syndrome
108
type II rapidly progressive GN
immune complex related
post infectious GN, IgA nephropathy, SLE, henoch-schonlein purpura
109
type III rapidly progressive GN
no immune complexes
wegener granulomatosis
110
abs directed against the glomerular basement membrane
lung hemorrhage
severe rapidly progressing GN
anti-glomerular basement membrane dz - good pasture
111
immunofluorescence findings of goodpasture shows __ distribution of complement
and __ along basement membrane
linear pattern
IgG
112
membranoproliferative GN is classified in to
typeI and II
113
which type of membranoproliferative GN is associated w. hep B/C and SLE
type I
114
which type of membranoproliferative GN is associated w. hypocomplementemia
type II
115
\_\_% of membranoproliferative GN progresses to renal failure w.in 10 years
50
116
sclerosis of glomeruli, sx of renal insufficiency
chronic GN
117
pale, swollen cortex dt lipid deposition and interstitial edema
chronic GN
118
5 common causes of chronic GN
DM
SLE nephritis
RPGN
FSGS
membranoproliferative GN
119
nephrotic vs nephritic syndromes
