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CPR II > Week 8 (Exam 3) > Flashcards

Week 8 (Exam 3) Flashcards

1
Q

Etiology of Lower Urinary Tract Symptoms (LUTS)

A

probably from both bladder outlet obstruction from BPH

And detrusor muscle overactivity secondary to BOO somehow

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2
Q

ANCA associated Small Vessel Vasculitises

A

Microscopic Polyangiitis
Granulomatosis with Polyangiitis (Wegener’s)
Eosinophilic Granulomatosis with Polyangiitsi (Churg-Strauss)

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3
Q

Indications for Cyclophosphamide

A

Malignancies
Minimal Change Nephrotic Syndrome in Pediatric patients who are confirmed on bx and cant take /don’t respond to adrenocorticosteroids

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4
Q

Which ADPKD is involved in Cell-Cell or Cell-Matrix Interaction?

A

Defective PDK1 on Chr 16p13.3 (polycystin 1): integral membrane glycoprotein
85% of cases

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5
Q

Medium Vessel Vasculitises

A

Polyarteritis Nodosa

Kawasaki Disease

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6
Q

Adverse reactions of Rituximab

A

Lymphoid malignancies, RA, renal toxicity w/ Cisplatin

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7
Q

What staging of bladder cancer is bad?

A

T2-T4: muscle invasion is the major prognostic factor

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8
Q

Associated conditions of Nephritic Syndrome

A

SLE
Bacterial Endocarditis: Acute Proliferative Glomerulonephritis
Goodpasture: Rapidly Progressive Glomerulonephritis
HSP: IgA Nephropathy

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9
Q

What is renal scarring and what are the complications?

A

Loss of parenchyma between the calyces and renal capsule

HTN, decreased renal function, proteinuria, ESRD

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10
Q

Renal US findings in CKD

A

Atrophic or small kidneys
Cortical thinning
Increased Echogenicity
Elevated resistive indices

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11
Q

Nephrotic syndrome complications

A 
Edema
Hyperlipidemia
Infection (from loss of IgG)
Thrombosis
Vitamin D Deficiency (urinary loss of Vit D)
Anemia (loss of transferrin and EPO)
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12
Q

Urinary pattern of ATN

A

Renal tubular epithelial cells
Transitional epithelial cells
Granular or Waxy casts

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13
Q

Clinical manifestations of AKI

A

Rapid decline in GFR
Most severe forms have oliguria or anuria
Maybe from glomerular, interstitial, vascular, ATN
Reversible or goes to CKD

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14
Q

Pathogenesis of Membranous Nephropathy

A 
In Situ Immune Complex Formation 
PLA2R Ag (mostly primary disease)
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15
Q

Nephrotic/Nephritic Syndrome Diagnostic method

A

Renal Biopsy

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16
Q

Which diseases often progress to Chronic GN?

A

90% Crescentic GN
50-80% Focal Segmental Glomeruloscerosis
50% Membranoproliferative GN

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17
Q

Kidney Stone Recurrence Likelihood over time

A

15% at 1 year
35-40% at 5 years
50% at 10 years

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18
Q

ESRD clinical manifestations

A

GFR blow 5% of normal

End stage of uremia

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19
Q

What 4 drug classes are used for managing BPH?

A

a1 blockers: improves in 1-2 weeks
5a-Reductase inhibitors: improves in 6-12 months
Anticholinergic agents
Phosphodiesterase-5 inhibitors

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20
Q

Treat a UTI

A

Not acutely ill: cefixime, cefdinir 3-4 days

Acutely ill: Ceftriaxone 10-14 days

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21
Q

Fosfomycin

A

Single dose tx for UTI

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22
Q

Hypersthenuria

A

Consistently high specific gravity

Due to deprivation of water

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23
Q

Urinary pattern of vasculitis or GN

A

Dysmorphic RBCs, RBC casts

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24
Q

Hyposthenuria

A

Consistently low specific gravity (<1.007)

From Concentration problem

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25
Q

Genes associated with bladder cancer

A

CDKN2A (encodes p16/INK4a and ARF for p53 fxn)
PTCH (negative to hedgehog)
TSC1 (negative to mTOR)
FGFR3 and RAS (on chronic 9, two-pathway model)

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26
Q

Pathalogic diagnosis of anti-GBM disease requirement

A

Diffuse linear IgG staining along the GBMs in the setting of crescentic glomerulonephritis on immunofluorescence

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27
Q

Contraindications of cyclophosphamide

A

hypersensitivity, urinary outflow obstruction

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28
Q

ANCA staining patterns

A

PR3 causes C-ANCA with Cytoplasmic pattern

MPO causes P-ANCA with Perinuclear pattern

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29
Q

Main complications of Anti-GBM disease

A

Lungs: Hemoptysis from Diffuse Alveolar Hemorrhage
Respiratory Failure
Crescentic, rapidly progressive glomerulonephritis

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30
Q

EGPA / Churg-Strauss symptoms

A

Necrotizing vasculitis with granulomas in the upper and lower respiratory tract with asthma symptoms and eosinophilia
MPO Abs

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31
Q

Imaging findings of advanced renal hyaline arteriolosclerosis

A

Thickened, tortuous afferent arteriole

Amorphous (thickened) vascular wall

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32
Q

Why does urea go up in dehydration?

A

ADH binds V2R, increasing cAMP and therefore AQP-2 and Urea transporters on collecting duct

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33
Q

Pharmacologic treatments for Overflow Incontinence

A

Alpha Adrenergic Antagonists

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34
Q

Urinary pattern of Non-specific, prerenal azotemia

A

Hyaline Cast

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35
Q

Isosthenuria

A

Fixed specific gravity of 1.010

Indicates poor tubular reabsorption

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36
Q

Large Vessel Vasculitises

A

Takayasu and Giant Cell Arteritis

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37
Q

Criteria for UTI diagnosis

A

clean catch with both pyuria and 50K colonies at least

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38
Q

Clinical presentation of Goodpastures

A

Hematuria

High BP, Foamy urine, leg swelling

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39
Q

Normal Urine Volume

A

800-1000 ml/day

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40
Q

Nitrofurantoin

A

5 day lasting treatment of UTIs

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41
Q

Standard treatment for ANTI-GBM disease

A

Plasmapharesis + High dose corticosteroids + Cyclophosphamide

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42
Q

Non-seminomatous testicular cancers by least to most differentiated

A

Embryonal carcinoma
Choriocarcinoma
Yolk Sac Tumor (endodermal sinus)
Teratoma

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43
Q

How is polyuria induced by hypercalcemia?

A

Basolateral Calcium Sensor (CaSR) degrades AQP-2 channels by autophagosomes

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44
Q

Hexagonal crystals on urine microscopy

A

Cystine Crystals

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45
Q

Urinary findings of glomerular hematuria

A 
Maybe RBC casts
Dysmorphic RBCs
Maybe Proteinuria
No Clots
Red or brown color
46
Q

Treatment of AKI by etiology

A

Prerenal gets IV fluid
ATN gets supportive care
GN maybe gets immunosuppression or plasmapheresis
AIN needs getting off the offending agent

47
Q

Favorable Wilms tumor Histomorphology

A

Usually Triphasic: mimics germinal development of normal kidney with Blastemal, Epithelial (tubular), and Stromal cells

48
Q

Bladder tumors often present with just hematuria. What may follow if the ureteral orifice is involved?

A

Pyelonephritis or Hydronephrosis

49
Q

Palpable vs non-palpable purpura

A

Palpable is suggestive of Vasculitis

Non-Palpable is suggestive of thrombocytopenia

50
Q

How long does a dose of Bactrim last for a UTI?

A

3 Days

51
Q

Urinary pattern of Nephritic Syndrome

A

Proteinuria <3.5g/day
Hematuria
Dysmorphic RBC and RBC casts

52
Q

Associated conditions of Nephrotic Syndrome

A 
Proteinuria
Diabetic Nephropathy
SLE
Hep C
HIV Nephropathy: Focal Segmental Glomerulosclerosis
53
Q

UI interventions for women with urogenital atrophy and LUTS

A

Vaginal Estrogen

54
Q

Envelope shaped crystals on urine microscopy

A

Calcium oxalate dehydrate crystals

55
Q

Urinary pattern of AIN

A

WBC, WBC cast, or Urine Eosinophils

56
Q

Classic presentation of cystitis

A

Dysuria, Urinary frequency, urinary urgency

57
Q

GPA symptoms

A

Necrotizing vasculiutis with granulomas in the upper and lower respiratory tract with no asthma or eosinophilia
PR3 Abs
ENT sx more common here

58
Q

Coffin-Lid crystals on urine microscopy

A

Struvite (magnesium ammonium phosphate crystals)

59
Q

Immune complex small vessel vasculitises

A

Cryoglobulinemic Vasculitis
IgA Vasculitis (HSP)
Hypocomplementemic Urticarial Vasculitis

60
Q

Tx for Diabetes Insipidus

A

Central: Vasopressin
Nephrogenic: Thiazide diuretics, NSAIDs, Vasopresin
Hypernatremia: Replace free water deficit

61
Q

Pharmacologic treatments for Urge Incontinence

A

Antimuscarinics
Intravaginal Estrogen
Mirabegron

62
Q

Rhombic plates or rosette-shaped crystals on urine microscopy

A

Uric Acid Crystals

63
Q

Diabetes Insipidus

A

Polyuria over 3L/day
Solute Diuresis: Glucosuria, Urea, Sodium, Mannitol
Water Diuresis

64
Q

Extra-renal manifestations of ADPKD

A

82% have diverticular disease of the colon
40% have hepatic cysts
25% have mitral valve prolapse (normally 2%)
4-10% have subarachnoid hemorrhage from Berry A

65
Q

Urinary findings of extra-glomerular hematuria

A 
No RBC casts
Uniform RBC morphology
No Proteinuria
Maybe clots
Maybe Red color
66
Q

Labs to obtain on all patients with AKI

A

UA with microscopy
Urine Albumin:cr or Protein:cr
(renal US also common)

67
Q

Unfavorable Wilms tumor Histomorphology

A

Focal (not always bad) or Diffuse (always bad)

Associated with p53 mutations, chemo resistance

68
Q

Clinical presentation of Cystitis

A

ALL of them: Frequency + Abdominal Pain + Dysuria

69
Q

Etiology of Sporadic papillary renal cell carcinoma

A

trisomy 7 (also 16 and 17, but mainly 7)
Loss of Y
Mutated, activated MET

70
Q

Targets in the Lamina Densa

A

Type 4 collagen: a3 (Anti-GBM abs) and a5 (Alport mut)

71
Q

HSP preentation

A

Gross hematuria, abdominal pain, hives, emesis, diarrhea etc

72
Q

Active Urinary Sediment and Bland Urinary Sediment

A

Nephritic Syndrome and Nephrotic Syndrome

73
Q

Urine Culture with sensitivities

A

True UTIs have >10^3 CFU (colony forming units)

74
Q

Rituximab Warnings

A

Black Box: fatal infusion reactions, tumor lysis syndrome, severe mucocutaneous reactions, progressive multifocal leukoencephalopathy

75
Q

Serum albumin is normal in setting of nephrotic range proteinuria

A

not true nephrotic syndrome but instead has nephrotic range proteinuria

76
Q

Indications for Dialysis

A

AEIOU: Severe acidosis, Elecrolyte disturbance, Ingestion, Overload of volume, Uremia

77
Q

Hypercalciuria

A

urine calcium:creatinine ratio above 0.2

78
Q

Etiology of hereditary papillary renal cell carcinoma

A

Trisomy 7

mutated, activated MET

79
Q

When do you do imaging after a pediatric UTI

A

Boys after 1st, girls after 2nd
VCUG if there’s abnormalities, >39C + non-Ecoli, poor growth + HTN
Look for vesicoureteral reflux (scars ureters)

80
Q

Major clinical finding of IgA nephropathy

A

Recurrent Hematuria

81
Q

Complications of UTIs

A 
Sepsis, Septic Shock
AKI
Perinephric Abscesses
Emphysematous Pyelonephritis
Papillary Necrosis
82
Q

Clinical presentation of Nephritic Syndrome

A

New Onset HTN and Hematuria
AKI
Proteinuria below 3.5/day with foamy urine

83
Q

PUNLMP vs Papilloma

A

PUNLMP has thicker urothelium, larger than papillomas

84
Q

Dx of prostatitis

A

Digital rectal exam, Urinalysis, Urine culture

test for gonorrhea, chlamydia

85
Q

95% of renal cell carcinomas are sporadic clear cell. What’s the etiology?

A

Deletions on Chr 3
Loss of VHL
inactivated, mutated, hypermethylated VHL

86
Q

Rituxibam MOA

A

antiCD20 Ab

87
Q

Typical presentation of acute prostatitis

A

Often appear acutely ill!
Obstructive sx, suprapubic perineal pain, etc
Chronic is usually more mild appearing

88
Q

Classic presentation of pyelonephritis

A

Fever/chills/rigors, flank pain, CVA tenderness on exam, fatigue, N/V/Anorexia

89
Q

Urinary pattern of Nephrotic syndrome

A

Heavy proteinuria >3.5g/day
Lipiduria
Minimal Hematuria

90
Q

Diagnostic imaging for kidney stones

A

Non-Contrast CT abdomen and pelvis (renal stone protocol CT)

91
Q

Clinical presentations of UTIs

A

See: Cystitis, pyelonephritis

Can also have altered mental status in older adults

92
Q

How long do you take different antibiotics for prostatitis?

A

Fluoroquinolone (Cipro) and Bactrim, 4-6 weeks

93
Q

Microscopic Polyangiitis symptoms

A

Necrotizing vasculitis WITHOUT granulomas or asthma symptoms or eosinophilia
MPO Abs

94
Q

Immunofluorescence findings of acute proliferative glomerulonephritis

A

Granular IgG, IgM, C3 deposits in mesangium along GBM, corresponding to sub epithelial “humps” found on electron microscopy

95
Q

Pulmonary-Renal Syndrome

A

Alveolar hemorrhage and glomerulonephritis
ANCA-Associated vasculitis
Anti-GBM disease (good pasture)

96
Q

Complications of AKI

A

Hypervolemia (P. Edema, HF)

Electrolyte abnormalities, Hyperuricemia, Uremia, Pericarditis, Metabolic Acidosis, Bleeding, need for dialysis

97
Q

UI interventions for women with contraindications

A

B3 adrenergic agonists

98
Q

Microalbuminuria

A

Urinary excretion of 30-300 mg/24 hours of albumin in urine
Eariles sign of renal damage in DM
Independent risk factor for CV risk factor in DM

99
Q

Diagnostics of DI

A

24 hour urine volume collection
Urine osmolality below 300mOsm/kg
Water deprivation test

100
Q

Main causes of Nephrogenic Diabetes Insipidus

A

Lithium Toxicity

Hypercalcemia

101
Q

Contraindications of Azathioprine

A

Pregnancy (malignancy)

102
Q

Azathioprine Indications

A

Adjunct for preventing homorenal transplant rejection

RA management

103
Q

Major bacteria in prostatitis

A

G-: E COLI, Klebsiella, proteus, pseudomonas

G+: Enterococcus, normal skin flora

104
Q

3 simple tests to identify most CKD patients

A

eGFR
Urine albumin:creatinine or protein:creatinine
Urinalysis

105
Q

Maintenance Therapy for ANCA associated vasculitis

A
  1. Azathioprine or Mycophenolate or Rituximab

2. Methotrexate

106
Q

Induction therapy for ANCA associated vasculitis

A

High dose glucocorticoids (IV prednisone) and Rituximab

High dose glucocorticoids and Cyclophosphamide

107
Q

Dumbell-shaped crystals on urine microscopy

A

Calcium Oxalate monohydrate crystals

108
Q

Clinical manifestations of CKD

A

Mild is silent, moderate is uremia
Persistently GFR below 60ml/min/1.73m for at least 3 mo
OR persistent Albuminuria
CKD is generally irreversible

109
Q

Imaging findings in diffuse and nodular diabetic glomerulosclerosis

A

Diffuse increase in mesangial matrix (sclerosis)
Thickened glomerular basement membranes
Characteristic Acellular PAS-positive nodules

110
Q

Urinary pattern of UTI

A

WBC, RBC, Bacteria

111
Q

Polycystin 2

A

Ca2 permeable cation channel coded by PKD2 gene on Chr 4q13-p23
Mutation leads to 15% of ADPKD cases (better Px)

CPR II (8 decks)

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