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Phys/Patho Renal Exam > Schoenwald Renal Part One > Flashcards

Schoenwald Renal Part One Flashcards

1
Q

This type of kidney disease is characterized by Azotemia (= elevated BUN and Creat +/- anuria)

A

Acute renal failure/AKI (mean the same thing)

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2
Q

Are these causes of prerenal or renal failure?

Hypovolemia, heart failure, sepsis, stenosis, atherosclerosis

A

Prerenal

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3
Q

In prerenal failure, the kidney responds by __________ sodium, water and urea

A

reabsorption

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4
Q

In prerenal failure, the Cr is __________ by the tubules while the BUN is ______ and _______

A

secreted, filtered and absorbed

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5
Q

Are these causes of prerenal or renal failure?

Acute tubular necrosis, glomerular disease and acute interstitial nephritis

A

Renal

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6
Q

What type of renal failure is this?

Obstruction (could be from enlarged prostate, kidney stones, etc)

A

Post-renal failure

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7
Q

Obstruction of the kidneys can cause __________. The _______ is the TOC in evaluation

A

hydronephrosis (when fluid backs up and causes the kidneys to swell

U/S

**Do not want CT w/ contrast because hard on kidneys

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8
Q 
Tell me about the labs in prerenal failure: 
FENa- 
BUN: Cr- 
Urine sodium- 
Urine osmolality- 
Specific gravity-
A 
FENa- <1%
BUN: Cr- >20:1
Urine sodium- <20 
Urine osmolality- >500
Specific gravity- > 1.020
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9
Q 
Tell me about the labs in renal failure: 
FENa- 
BUN: Cr- 
Urine sodium- 
Urine osmolality- 
Specific gravity-
A 
FENa- >1%
BUN: Cr- <20:1
Urine sodium- >20
Urine osmolality- <400
Specific gravity- <1.010
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10
Q

What are three mc causes of chronic renal failure?

A
  1. HTN
  2. DM
  3. Glomerulonephritis
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11
Q

What is the first stage of CRF?

A

Diminished renal reserve- GFR = 50%

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12
Q

What is the second stage of CRF?

A

Renal insufficiency- GFR 20-50% of normal

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13
Q

What are signs of second stage CRF?

A

HTN, anemia, polyuria (decreased concentrating ability)

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14
Q

What is the third stage of CRF?

A

Renal failure- GFR <20% of normal, edema and metabolic acidosis

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15
Q

What is the fourth stage of CRF?

A

End stage renal failure- FGR <5%

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16
Q

What are GI complications of chronic renal failure?

A

N/v and anorexia

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17
Q

What are cardiac complications of chronic renal failure?

A

Pericarditis, CHF, HTN

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18
Q

What type of anemia might a patient with chronic renal failure have?

A

normocytic, normochronic anemia (anemia of chronic disease)

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19
Q

What are hematologic complications of chronic renal failure?

A

normocytic, normochronic anemia (anemia of chronic disease), platelet dysfunction, increased susceptibility to infection

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20
Q

What are CNS complications of chronic renal failure?

A

polyneuropathy and encephalopathy

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21
Q

Segmental and focal glomerular disorders involve a _______ glomerulus whereas global and diffuse glomerular disorders involve ________ glomeruli

A

single, multiple

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22
Q

When a portion of the glomerulus is involved this is called what?

A

segmental

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23
Q

When all of the glomerulus is involved this is called what?

A

global

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24
Q

When some of the glomerulus is involved this is called what?

A

focal

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25
Q

When all or almost all of the glomerulus is involved this is called what?

A

diffuse

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26
Q

There are three ways to evaluate the glomeruli microscopically. What are they?

A
  1. Light Microscopy stains
  2. Immunofluorescence (uses IgG, IgM, and IgA)
  3. Electron microscopy
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27
Q

What three stains are used in the light microscopy stains?

A

Please Tri Sex

  • Periodic acid schiff (basement membrane & mesangium)
  • Trichrome- highlights fibrosis
  • Silver- highlights the basement membrane
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28
Q

What highlights the basement membrane & mesangium?

A

Periodic acid schiff of light microscopy

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29
Q

What highlights fibrosis?

A

Trichrome of the light microscopy

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30
Q

What highlights the basement membrane only?

A

Silver in light microscopy

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31
Q

What two patterns are seen in the immunofluorescence staining?

A

Linear and granular pattern

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32
Q

This is a reaction directed against antigen in glomerular basement membrane (goodpasture syndrome)

A

Linear pattern of immunofluorescence

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33
Q

This is a reaction against antigen/antibody immune complexes in glomerular basement membrane (SLE)

A

Granular pattern of immunofluorescence

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34
Q

Goodpasture syndome is a type of ________ pattern

A

linear

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35
Q

SLE is a _________ pattern

A

granular

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36
Q

This technique to evaluate glomeruli is not clinically used often but shows structure and immune complex deposition

A

electron microscopy

37
Q

Most glomerular diseases are _________ and activate the ________

A

immunologic, activate the complement

*result of either deposition of immune complexes or result of antibodies directly binding to antigens in the kidney (kind of like garbage smashed together)

38
Q

You will most likely see hypoalbuminemia in nephritic or nephrotic syndrome?

A

Nephrotic

39
Q

Hypoalbuminemia causes ________(inc/dec) osmotic pressure resulting in _______

A

decreased, edema

40
Q

Nephrotic can lead to generalized edema called ________

A

anasarca

41
Q

How does the liver respond to loss of albumin in nephrotic syndrome?

A

Liver respons to loss of albumin by increasing apolipoprotein (ALP) to compensate for low serum osmostic pressure = hyperlipidemia

42
Q

Loss of albumin in liver in people with nephrotic syndrome ultimately leads to what?

A

hyperlipidemia

43
Q

What are the four components of nephrotic syndrome?

A
  1. Proteinuria >3.5
  2. Hypoalbuminemia
  3. Generalized edema
  4. Hyperlipidemia
44
Q

These are clinical findings of what disease?

N/V, periorbital edema, frothy urine

A

nephrotic syndrome

*frothy urine because so much protein in urine

45
Q

What will a UA analysis of nephrotic syndrome show?

A

Waxy casts and oval fat bodies in urine

-lipids have maltese cross appearance

46
Q

Waxy casts and oval fat bodies in urine

A

nephrotic syndrome

47
Q

How do you ultimately dx nephrotic syndrome?

A

bx of kidneys

48
Q

This disease is the most common cause of nephrotic syndrome in kids ages 2-8 yrs old and 2:1 male to female ratio

A

Minimal change disease

49
Q

Minimal change disease causes selective _________ and is treated with ________-

A

proteinuria, steroids

50
Q

Will minimal change disease show abnormalities in the glomeruli? What about immunofluorescence?

A

no abnormalities in glomeruli or immunofluorescence

51
Q

On light microscopy, proximal convoluted tubule laden with lipid and protein

A

Minimal change disease

52
Q

This is the second mc cause of nephrotic syndrome in children

A

Focal segmental glomerulosclerosis

53
Q

This is the mc cause of nephrotic syndrome in adults

A

Focal segmental glomerulosclerosis

54
Q

Is Focal segmental glomerulosclerosis immunologic in origin? Explain

A

Not immunologic in origin, however, IgM and C3 are trapped causing injury to epithelial cells

55
Q

What causes a 30x increased risk in Focal segmental glomerulosclerosis compared to the rest of the population?

A

IV heroin usage

56
Q

What is the outcome for Focal segmental glomerulosclerosis ?

A

No treatment, leads to chronic glomerulonephritis and end stage renal disease in 10 years

57
Q

What does light microscopy of Focal segmental glomerulosclerosis show?

A

Segmental sclerosis of a few glomeruli

58
Q

What does immunofluorescence of Focal segmental glomerulosclerosis show?

A

positive for IgM and c3

59
Q

_______ occurs when the small blood vessels in the kidney (glomeruli), which filter wastes from the blood, become damaged and thickened. As a result, proteins leak from the damaged blood vessels into the urine (proteinuria)

A

Membranous glomerulonephropathy

60
Q

________ causes nonselective proteinuria

A

Membranous glomerulonephropathy

61
Q

How many people in Membranous glomerulonephropathy undergo remission, have proteinuria but stable renal fxn, then progress to end stage renal dz in 5-10 years?

A

1/3 for each category

62
Q

Silver stain of this disease shows thickened basement membrane extending between immune complexes “spike and dome” formation

A

Membranous glomerulonephropathy

63
Q

immunofluorescence of this disease shows a granular patter, positive for IgG

A

Membranous glomerulonephropathy

64
Q

Electron microscopy of this disease shows subepithelial immune complexes

A

Membranous glomerulonephropathy

65
Q

This is the single most common cause of end stage renal disease in the US?

A

Diabetic nephropathy

66
Q

This disease presents clinically with albuminuria and hypertension

A

Diabetic nephropathy

*albuminuria is a sign of a damaged kidney (shouldn’t be peeing out albumin)

67
Q

This test predicts the development of diabetic neuropathy?

A

microalbumin

68
Q

A common light microscopy finding in this disease is diffuse glomerulosclerosis- thickening of the basement membrane

A

Dabetic nephropathy

69
Q

This disease is characterized by acute renal failure, hypertension and hematuria

A

Nephritic syndrome

70
Q

Leakage of protein

A

nephrotic

71
Q

Leakage of RBCs

A

nephritic

72
Q

What type of casts are present in nephrotic syndrome?

A

RBC casts

73
Q

Cola colored or smoky brown urine

A

nephritic syndrome

74
Q

Proteinuria <3 g/day

A

nephritic syndrome

75
Q

Difference between glomerulonephropathy and glomerulonephritis?

A

Glomerulopathy is any disease of these glomeruli. Glomerulonephritis is the result of infection elsewhere in the body, such as strep throat/scarlet fever, upper respiratory infection or tonsillitis.

76
Q

_________ has to do with glomerulonephritis whereas ________ has to do with glomerulonephropathy

A

nephritic, nephrotic

77
Q

Postinfectious glomerulonephritis mc occurs how many weeks after a group A strep infection?

A

1-4 weeks

78
Q

Those with Postinfectious glomerulonephritis have an increased or decreased serum complement?

A

decreased

79
Q

What are two markers of previous strep infection?

A

ASO and AntiDNAse B

80
Q

Silver stain shows “lumpy bumpy appearance”

A

Postinfectious glomerulonephritis

81
Q

Microscopy in rapidly progressive glomerulonephritis is characterized by _________ cells in bowman capsule?

A

crescent cells

82
Q

Goodpasture syndrome is type _____ glomerulonephritis where IgG binds directly to the glomerular basement membrane

A

Type I

83
Q

Postinfectious glomerulopenritis, IgA nephropathy, SLE, and henoch-Schonlein purpura are type ____ glomerulopnephritis? (immune complex related)

A

Type II

84
Q

Wegener granulomatosis is type ____ glomerulonephritis with no immune complexes

A

Type III

85
Q

This is a disease in which is body’s antibodies are directed against the glomerular basement membrane and attacks the lungs and kidneys

A

Goodpasture syndrome

86
Q

Type ___ membranoproliferative glomerulonephritis is associated with Hep B, C and lupus

A

I

87
Q

Type ___ membranoproliferative glomerulonephritis is associated with hypocomplementemia

A

II

88
Q

This disease results from long term damage to glomeruli and ultimately sclerosis of glomeruli

A

chronic glomerulonephritis

89
Q

On gross pathology for this disease, cortex is often pale and swollen due to lipid deposition and interstitial edema

A

chronic glomerulonephritis

Phys/Patho Renal Exam (4 decks)

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