Urology 3

Question 1

acute glomerulonephritis is characterized by

Answer 1

HTN
hematuria (RBC casts)
azotemia (increased BUN and creatinine)
proteinuria (edema)

Question 2

causes of acute glomerulonephritis

Answer 2

IgA nephropathy (Berger’s disease)
post-infectious glomerulonephritis
membranoproliferative glomerulonephritis
rapidly progressive glomerulonephritis - good pasture’s disease, microscopic polyangiitis, granulomatosis w polyangiitis

Question 3

sx acute glomerulonephritis

Answer 3

hematuria hallmark - cola or tea-colored urine

edema - peripheral or periorbital

fever, abdominal or flank pain, myalgia, oliguria (decreased output)

HTN!!!

Question 4

dx glomerulonephritis

whatis the standard for dx

Answer 4

UA - hematuria, RBC casts, dysmorphic RBCs (acanthocytes), proteinuria usually < 3 mg/day but can be in the nephrotic range, high specific gravity (> 1.020 osm)

increased BUN and creatinine
hyperkalemia

serology for hep c and hep c and HIV

LFTs

CRP

renal biopsy - standard, not needed in most cases

Question 5

what is the MC cause of acute glomerulonephritis in the US

Answer 5

IgA nephropathy - Berger’s disease

Question 6

sx IgA nephropathy / Berger’s disease

Answer 6

gross or microscopic hematuria within days after URI or GI infection

often accompanied by HTN

Question 7

biopsy for IgA nephropathy/ Berger’s disease

Answer 7

IgA mesangial deposits

Question 8

tx IgA nephropathy/Berger’s disease

Answer 8

ACE inhibitors

Question 9

epidemiology post-infectious glomerulonephritis

Answer 9

can occur after any infection most MC 1-3 weeks after streptococcal pharyngitis or 2-6 weeks after skin infection (impetigo)

Question 10

labs post-infectious GMN

Answer 10

low serum complement C3
recent GAS infection

Question 11

biopsy post-infectious GMN

Answer 11

enlarged hypercellular glomerulo w neutrophil infiltration

deposition of IgG, IgM, C3
glomerular dome-shaped sub epithelial immune-complex deposits (humps) of IgG, IgM, C3

Question 12

tx post-infectious GMN

Answer 12

supportive; diuretics for fluid overload
abx if active infection

Question 13

etiology membranoproliferative GMN

Answer 13

associated w viral hepatitis, autoimmune dz (SLE)

Question 14

biopsy membranoproliferative GMN

Answer 14

thickened basement membrane

Question 15

biopsy lupus nephritis

Answer 15

wire looping appearance of capillaries and granular appearance

Question 16

tx lupus nephritis

Answer 16

glucocorticoids + either mycophenolate or cyclophosphamide

Question 17

anti-glomerular basement membrane disease is also known as

Answer 17

good pasture’s syndrome

Question 18

anti-glomerular basement membrane disease/ good pastures disease is characterized by

Answer 18

glomerulonephritis and hemoptysis

Question 19

biopsy anti-glomerular basement membrane disease/good pastures disease

Answer 19

linear IgG deposits

Question 20

tx anti-glomerular basement membrane disease/goodpastures disease

Answer 20

glucocorticoids + cyclophosphamide + plasmapheresis

Question 21

granulomatosis with polyangiitis is also known as

Answer 21

wegener’s

Question 22

granulomatosis with polyangiitis/wegener’s is characterized by

Answer 22

small-sized artery vasculitis associated w positive C-ANCA

Question 23

granulomatosis with polyangiitis/wegener’s sx

Answer 23

triad of upper respiratory tract infection (sinusitis, saddle nose deformity, otitis media, bloody nose) + lower tract involvement (cough, dyspnea, wheezing) + nephritis (hematuria, proteinuria)

cutaneous involvement (purpura) + neurologic involvement (neuropathy or arthritis)

Question 24

tx granulomatosis with polyangiitis/wegener’s

Answer 24

organ or life threatening - glucocorticoids plus either rituximab or cyclophosphamide

Question 25

microscopic polyangiitis is characterized by

Answer 25

small sized artery vasculitis with positive P-ANCA

Question 26

rapidly progressive glomerulonephritis biopsy

Answer 26

crescent formation

Question 27

renal histology microscopic polyangiitis vs granulomttosis w polyangiitis

Answer 27

microscopic polyangiitis - focal necrotizing often crescentic, pauci-immune glomerulonephritis and small vessel vasculitis without granulomas (unlike granulomas seen in granulomatosis with polyangiitis)

Question 28

where is renal cell carcinoma located

Answer 28

tumor of the proximal convoluted renal tubule cells

Question 29

MC tumor originating in the kidney

Answer 29

clear cell renal cell carcinoma

Question 30

RF renal cell carcinoma

Answer 30

smoking HTN obesity men dialysis

Question 31

sx renal cell carcinoma

Answer 31

classic triad of hematuria, flank pain or abdominal pain, palpable abdominal or flank mass left sided varicocele METS - cannon ball mets to the lungs

Question 32

dx renal cell carcinoma

Answer 32

CT scan

Question 33

tx renal cell carcinoma

Answer 33

radical nephrectomy

Question 34

what is the most common abdominal mass in kids

Answer 34

nephroblastoma (wilms tumor)

Question 35

risk factors nephroblastoma/wilms

Answer 35

GU abnormalities (cryptorchidism, hypospadias, horseshoe kidney) WAGR - wilms tumor, aniridia, genitourinary malformations, mental Retardation

Question 36

sx nephroblastoma/wilms

Answer 36

palpable abdominal mass MC hematuria constipation

Question 37

dx nephroblastoma/wilms

Answer 37

abdominal US

Question 38

tx nephroblastoma

Answer 38

total nephrectomy followed by chemo