Unit 5 - Renal, Endocrine, Male GU, Lower Urinary Tract

Question 1

Conjoined kidneys usually connected at lower pole

Answer 1

Horseshoe Kidney

Question 2

What does the horseshoe kidney get caught on during its ascent from pelvis to abdomen?

Answer 2

Inferior mesenteric artery

Question 3

Absent kidney formation

Answer 3

Renal agenesis

Question 4

What does unilateral renal agenesis lead to?

Answer 4

Hypertrophy of existing kidney, increased risk of renal failure later in life

Question 5

What does bilateral renal agenesis lead to?

Answer 5

Potter sequence [oligohydramnios with lung hypoplasia, flat face with low set ears, developmental defects of extremities]

Question 6

What is a dysplastic kidney?

Answer 6

Noninherited congenital abnormality of renal parenchyma characterized by cysts and abnormal tissue

Question 7

Inherited defect leading to bilateral enlarged kidneys with cysts in renal cortex and medulla

Answer 7

Polycystic Kidney Disease

Question 8

In PKD, autosomal ____ form presents in infants and autosomal ____ form presents in young adults

Answer 8

Recessive; dominant

Question 9

Presentation and associations of PKD in infant

Answer 9

Worsening renal failure and hypertension

Associated with congenital hepatic fibrosis and hepatic cysts

Question 10

Presentation and associations of PKD in young adult

Answer 10

Hypertension, hematuria, worsening renal failure

Associated with berry aneurysm, hepatic cysts, mitral valve prolapse

Question 11

What is medullary cystic kidney disease and how does it present?

Answer 11

Inherited defect leading to cysts in medullary collecting ducts
Presents as shrunken kidneys and worsening renal failure

Question 12

What is azotemia?

Answer 12

Increased BUN and creatinine

Question 13

Prerenal azotemia is caused by ______, postrenal azotemia is caused by _______

Answer 13

Decreased blood flow to kidneys; Obstruction of urinary tract downstream from kidneys

Question 14

Most common cause of acute renal failure

Answer 14

Acute Tubular Necrosis

Question 15

What causes decreased GFR in acute tubular necrosis?

Answer 15

Necrotic cells that plug tubules –> see brown granular casts in urine

Question 16

Lab findings with acute tubular necrosis

Answer 16

Serum BUN:Cr ratio

Question 17

Two main causes of Acute Tubular Necrosis

Answer 17

Ischemic damage - Proximal tubule and medullary segment of thick ascending limb

Nephrotoxic agents - proximal tubule

Question 18

Drug induced hypersensitivity involving interstitium and tubules that results in acute renal failure

Answer 18

Acute Interstitial Nephritis

Question 19

Clinical features of Acute Interstitial Nephritis

Answer 19

Oliguria, fever, rash days to weeks after starting drug

Eosinophils may be seen in urine

Question 20

Drugs that can cause Acute Interstitial Nephritis

Answer 20

NSAIDs, penicillin, diuretics

Question 21

How does renal papillary necrosis present?

Answer 21

Gross hematuria and flank pain

Question 22

Causes of Renal Papillary Necrosis

Answer 22

Chronic analgesic abuse, diabetes mellitus, sickle cell disease/trait, severe acute pyelonephritis

Question 23

Nephrotic syndromes are characterized by _____ resulting in _____, _____, _____, and ________

Answer 23

Characterized by proteinuria
Hypoalbuminemia - pitting edema
Hypogammaglobulinemia - risk of infection
Hypercoagulable state
Hyperlipidemia/hypercholesterolemia - fatty casts in urine

Question 24

What is Minimal Change Disease?

Answer 24

Most common cause of nephrotic syndrome in children, usually idiopathic (may be associated with Hodgkins Lymphoma)

Question 25

Results of H&E, EM, and immunofluorescence in Minimal Change Disease

Answer 25

H&E - normal glomeruli, may see lipid EM - effacement of foot processes Negative immunofluorescence

Question 26

What is Focal Segmental Glomerulosclerosis?

Answer 26

Most common cause of nephrotic syndrome in Hispanics and African Americans Usually idiopathic, may be associated with HIV, heroin use, sickle cell disease

Question 27

H&E, EM and immunofluorescence results in Focal Segmental Glomerulosclerosis

Answer 27

H&E - focal and segmental sclerosis EM - effacement of foot processes Negative IF

Question 28

Most common cause of nephrotic syndrome in Caucasian adults, may be associated with Hep B or C, solid tumors, SLE, or drugs

Answer 28

Membranous Nephropathy

Question 29

Results of H&E, EM, and IF for membranous nephropathy

Answer 29

H&E - thick glomerular basement membrane EM - subepithelial immune complex deposits with spike and dome appearance IF - positive, granular

Question 30

What are the 2 types of Membranoproliferative Glomerulonephritis and their associations?

Answer 30

``` Both types can cause nephritic, nephrotic, or both syndromes Type I (subendothelial) - associated with HBV, HCV Type II (intramembranous) - associated with C3 nephritic factor ```

Question 31

H&E and IF results for Membranoproliferative Glomerulonephritis

Answer 31

H&E - tram track appearance due to immune complex deposition Positive granular IF

Question 32

How does Diabetes Mellitus cause nephrotic syndrome?

Answer 32

Hyaline arteriosclerosis affects efferent arteriole more than afferent - high GFR pressure Injury leads to microalbuminuria Eventually progresses to nephrotic syndrome

Question 33

Results of H&E stain for Diabetic Nephropathy

Answer 33

Sclerosis of mesangium, formation of Kimmelstiel-Wilson nodules

Question 34

How does systemic amyloidosis cause nephrotic syndrome?

Answer 34

Amyloid deposits in mesangium

Question 35

Nephritic Syndromes are characterized by _____ and _____, leading to _____, ______, ______, and _____

Answer 35

Characterized by glomerular inflammation and bleeding Leads to limited proteinuria oliguria/azotemia salt retention with periorbital edema/HTN RBC casts/dysmorphic RBCs in urine