Uworld - Renal VII Flashcards
muddy brown casts
acute tubular necrosis
clear cell
renal cell carcinoma
MC kidney tumor
risk fx - smoking and obesity
origin of renal cell carcinoma
epithelial cells of prox renal tubules
MC nephrotic in adults
membranous glomerulopathy
-thick glomerular BM - spike and dome appearance
granular deposits IgG and C3
net filtration pressure
(Pc - Pi) - (Oc - Oi)
diabetic nephropathy
MC cause of nodular glomerulosclerosis
kimmelstein wilson nodules - PAS positive
uric acid crystals
with gouty arthritis
negative birefringement
hep C
with MPGN
HIV and drug users
focal segmental glomerulosclerosis
solid tumors
membranous glomerulonephritis
MC kidney stone
calcium oxalate and P
50% idiopathic hypercalciuria - with normocalcemia
prader willi/angelman genetics
genomic imprinting
trinucleotide repeat diseases
fragile X
huntington disease
myotonic dystrophy
X-linked recessive
ducennes
hemophilia A
establish corticomedullary concentration gradient
reabsorption in thick portion ascending loop - Na/K/2Cl
overactive bladder tx
antimuscarinic - M3 receptors
M3 receptors
bladder detrusor muscle - stimulation urine release
M1 receptors
brain
M2 receptors
heart
decreased HR and atrial contraction
M3 receptors
lung, bladder, eye, GI, skin
M3 receptors in eyes
miosis and accomodation
lead intoxication
tubulointerstitial nephritis - renal failure
multiple myeloma
easy fatigue - anemia
constipation - hyperCa
bone pain
renal failure
myeloma kidney - cast nephropathy -bence jones proteins
precipitate with tam horsfall proteins - eosinophilic casts
amphotericin B
most toxic antifungal
causes hypoK and hypoMg
-severe hypoK - get T wave flattening, ST depression, and U waves
-premature A and V contractions - Vtach and Vfib
drugs with pulmonary fibrosis
busulfan and bleomycin
drugs with liver necrosis
acetaminophen and halothane
phases of acute tubular necrosis
initiation - original insult
maintenance - injury established - GFR low 1-2 weeks
recovery - re-epithelialization of tubules - polyuria and normalizing GFR
drug induced interstitial nephritis
fever, rash, oliguria
-after take beta-lactam - one cause
plasma cells and eosinophilia
IgE hypersensitivity
painless hematuria
bladder tumor
renal potassium handling
100% filtered at glomerulus
65% reabsorbed prox tube
25% reabsorbed ascending loop
5-100% secreted collecting duct - regulator - principal cells
hypoK - more K reabsorbed alpha intercalated cells
hyperK - principal cells secrete K
concentrations with no ADH
most concentrated bottom of loop
most dilute - collecting duct
hexagonal crystine crystal stones
cysturia
cyanide-nitroprusside test
test for cysteine in urine
tx of cystinuria
hydration and urinary alkalinization (acetazolamide)
microalbuminuria
cannot be detected on urine dipstick
conns syndrome
primary hyperaldosteronism
aldosterone secreting tumor - adenoma
tx - aldosterone antagonist - spironolactone
HTN, hypoK, metabolic alkalosis, decreased plasma renin activity
tx of conns
spironolactone - aldosterone antagonist
type 1 RPGN
goodpastures
type 2 RPGN
immune complex mediated
PSGN, SLE, IgA nephropathy, HSP
type 3 RPGN
pauci-immune - no Ig or complement deposits on BM
ANCA - wegeners
carbonic anhydrase
reforms H2CO3 intracellularly
acid buffers
2 in urine
-HPO4 and NH3
trap H+ and allow secretion
secondary hyperaldosteronism
increased renin - renin tumor - rare B9 tumor - JG cells
lytes with pheochromocytoma
hypoK - beta2 stimulation
mets of renal cell carcinoma
lungs
polyuria with acute tubular necrosis
during recovery phase
can get hypoK
maintenance stage of acute tubular necrosis
can get anion gap metabolic acidosis
hyperP
volume overload
MC cause pyelonephritis
gram negative rods
nephrotic syndrome and coag
hypercoag state
-loss of anticoag factors - antithrombin III
left side varicocele
left testicular vein to renal vein
-right to IVC directly
loss of antithrombin III - thrombotic occlusion of renal vein - with nephrotic syndrome
risk with radical hysterectomy surgery
damage ureter
can get secondary hydronephrosis if ligate ureter
MC cause hydronephrosis
BPH - flow obstruction
muddy brown casts
acute tubular necrosis
MC cause intrinsic renal failure in hosp patients
chronic renal transplant rejection
3 months or more
worsening HTN and rising serum Cr
obliterative fibrous intimal thickening and mononuclear infiltrate of surrounding tissue
uric acid stones
not seen on Xray
need abdominal U/S or CT
struvite stones
Mg ammonia sulfate