Week 8 (Exam 3) Flashcards
(111 cards)
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
2
Q
ANCA associated Small Vessel Vasculitises
A
Microscopic Polyangiitis
Granulomatosis with Polyangiitis (Wegener’s)
Eosinophilic Granulomatosis with Polyangiitsi (Churg-Strauss)
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
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
5
Q
Medium Vessel Vasculitises
A
Polyarteritis Nodosa
Kawasaki Disease
6
Q
Adverse reactions of Rituximab
A
Lymphoid malignancies, RA, renal toxicity w/ Cisplatin
7
Q
What staging of bladder cancer is bad?
A
T2-T4: muscle invasion is the major prognostic factor
8
Q
Associated conditions of Nephritic Syndrome
A
SLE
Bacterial Endocarditis: Acute Proliferative Glomerulonephritis
Goodpasture: Rapidly Progressive Glomerulonephritis
HSP: IgA Nephropathy
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
10
Q
Renal US findings in CKD
A
Atrophic or small kidneys
Cortical thinning
Increased Echogenicity
Elevated resistive indices
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)
12
Q
Urinary pattern of ATN
A
Renal tubular epithelial cells
Transitional epithelial cells
Granular or Waxy casts
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
14
Q
Pathogenesis of Membranous Nephropathy
A
In Situ Immune Complex Formation PLA2R Ag (mostly primary disease)
15
Q
Nephrotic/Nephritic Syndrome Diagnostic method
A
Renal Biopsy
16
Q
Which diseases often progress to Chronic GN?
A
90% Crescentic GN
50-80% Focal Segmental Glomeruloscerosis
50% Membranoproliferative GN
17
Q
Kidney Stone Recurrence Likelihood over time
A
15% at 1 year
35-40% at 5 years
50% at 10 years
18
Q
ESRD clinical manifestations
A
GFR blow 5% of normal
End stage of uremia
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
20
Q
Treat a UTI
A
Not acutely ill: cefixime, cefdinir 3-4 days
Acutely ill: Ceftriaxone 10-14 days
21
Q
Fosfomycin
A
Single dose tx for UTI
22
Q
Hypersthenuria
A
Consistently high specific gravity
Due to deprivation of water
23
Q
Urinary pattern of vasculitis or GN
A
Dysmorphic RBCs, RBC casts
24
Q
Hyposthenuria
A
Consistently low specific gravity (<1.007)
From Concentration problem
25
Genes associated with bladder cancer
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)
26
Pathalogic diagnosis of anti-GBM disease requirement
Diffuse linear IgG staining along the GBMs in the setting of crescentic glomerulonephritis on immunofluorescence
27
Contraindications of cyclophosphamide
hypersensitivity, urinary outflow obstruction
28
ANCA staining patterns
PR3 causes C-ANCA with Cytoplasmic pattern
| MPO causes P-ANCA with Perinuclear pattern
29
Main complications of Anti-GBM disease
Lungs: Hemoptysis from Diffuse Alveolar Hemorrhage
Respiratory Failure
Crescentic, rapidly progressive glomerulonephritis
30
EGPA / Churg-Strauss symptoms
Necrotizing vasculitis with granulomas in the upper and lower respiratory tract with asthma symptoms and eosinophilia
MPO Abs
31
Imaging findings of advanced renal hyaline arteriolosclerosis
Thickened, tortuous afferent arteriole
| Amorphous (thickened) vascular wall
32
Why does urea go up in dehydration?
ADH binds V2R, increasing cAMP and therefore AQP-2 and Urea transporters on collecting duct
33
Pharmacologic treatments for Overflow Incontinence
Alpha Adrenergic Antagonists
34
Urinary pattern of Non-specific, prerenal azotemia
Hyaline Cast
35
Isosthenuria
Fixed specific gravity of 1.010
| Indicates poor tubular reabsorption
36
Large Vessel Vasculitises
Takayasu and Giant Cell Arteritis
37
Criteria for UTI diagnosis
clean catch with both pyuria and 50K colonies at least
38
Clinical presentation of Goodpastures
Hematuria
| High BP, Foamy urine, leg swelling
39
Normal Urine Volume
800-1000 ml/day
40
Nitrofurantoin
5 day lasting treatment of UTIs
41
Standard treatment for ANTI-GBM disease
Plasmapharesis + High dose corticosteroids + Cyclophosphamide
42
Non-seminomatous testicular cancers by least to most differentiated
Embryonal carcinoma
Choriocarcinoma
Yolk Sac Tumor (endodermal sinus)
Teratoma
43
How is polyuria induced by hypercalcemia?
Basolateral Calcium Sensor (CaSR) degrades AQP-2 channels by autophagosomes
44
Hexagonal crystals on urine microscopy
Cystine Crystals
45
Urinary findings of glomerular hematuria
```
Maybe RBC casts
Dysmorphic RBCs
Maybe Proteinuria
No Clots
Red or brown color
```
46
Treatment of AKI by etiology
Prerenal gets IV fluid
ATN gets supportive care
GN maybe gets immunosuppression or plasmapheresis
AIN needs getting off the offending agent
47
Favorable Wilms tumor Histomorphology
Usually Triphasic: mimics germinal development of normal kidney with Blastemal, Epithelial (tubular), and Stromal cells
48
Bladder tumors often present with just hematuria. What may follow if the ureteral orifice is involved?
Pyelonephritis or Hydronephrosis
49
Palpable vs non-palpable purpura
Palpable is suggestive of Vasculitis
| Non-Palpable is suggestive of thrombocytopenia
50
How long does a dose of Bactrim last for a UTI?
3 Days
51
Urinary pattern of Nephritic Syndrome
Proteinuria <3.5g/day
Hematuria
Dysmorphic RBC and RBC casts
52
Associated conditions of Nephrotic Syndrome
```
Proteinuria
Diabetic Nephropathy
SLE
Hep C
HIV Nephropathy: Focal Segmental Glomerulosclerosis
```
53
UI interventions for women with urogenital atrophy and LUTS
Vaginal Estrogen
54
Envelope shaped crystals on urine microscopy
Calcium oxalate dehydrate crystals
55
Urinary pattern of AIN
WBC, WBC cast, or Urine Eosinophils
56
Classic presentation of cystitis
Dysuria, Urinary frequency, urinary urgency
57
GPA symptoms
Necrotizing vasculiutis with granulomas in the upper and lower respiratory tract with no asthma or eosinophilia
PR3 Abs
ENT sx more common here
58
Coffin-Lid crystals on urine microscopy
Struvite (magnesium ammonium phosphate crystals)
59
Immune complex small vessel vasculitises
Cryoglobulinemic Vasculitis
IgA Vasculitis (HSP)
Hypocomplementemic Urticarial Vasculitis
60
Tx for Diabetes Insipidus
Central: Vasopressin
Nephrogenic: Thiazide diuretics, NSAIDs, Vasopresin
Hypernatremia: Replace free water deficit
61
Pharmacologic treatments for Urge Incontinence
Antimuscarinics
Intravaginal Estrogen
Mirabegron
62
Rhombic plates or rosette-shaped crystals on urine microscopy
Uric Acid Crystals
63
Diabetes Insipidus
Polyuria over 3L/day
Solute Diuresis: Glucosuria, Urea, Sodium, Mannitol
Water Diuresis
64
Extra-renal manifestations of ADPKD
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
Urinary findings of extra-glomerular hematuria
```
No RBC casts
Uniform RBC morphology
No Proteinuria
Maybe clots
Maybe Red color
```
66
Labs to obtain on all patients with AKI
UA with microscopy
Urine Albumin:cr or Protein:cr
(renal US also common)
67
Unfavorable Wilms tumor Histomorphology
Focal (not always bad) or Diffuse (always bad)
| Associated with p53 mutations, chemo resistance
68
Clinical presentation of Cystitis
ALL of them: Frequency + Abdominal Pain + Dysuria
69
Etiology of Sporadic papillary renal cell carcinoma
trisomy 7 (also 16 and 17, but mainly 7)
Loss of Y
Mutated, activated MET
70
Targets in the Lamina Densa
Type 4 collagen: a3 (Anti-GBM abs) and a5 (Alport mut)
71
HSP preentation
Gross hematuria, abdominal pain, hives, emesis, diarrhea etc
72
Active Urinary Sediment and Bland Urinary Sediment
Nephritic Syndrome and Nephrotic Syndrome
73
Urine Culture with sensitivities
True UTIs have >10^3 CFU (colony forming units)
74
Rituximab Warnings
Black Box: fatal infusion reactions, tumor lysis syndrome, severe mucocutaneous reactions, progressive multifocal leukoencephalopathy
75
Serum albumin is normal in setting of nephrotic range proteinuria
not true nephrotic syndrome but instead has nephrotic range proteinuria
76
Indications for Dialysis
AEIOU: Severe acidosis, Elecrolyte disturbance, Ingestion, Overload of volume, Uremia
77
Hypercalciuria
urine calcium:creatinine ratio above 0.2
78
Etiology of hereditary papillary renal cell carcinoma
Trisomy 7
| mutated, activated MET
79
When do you do imaging after a pediatric UTI
Boys after 1st, girls after 2nd
VCUG if there's abnormalities, >39C + non-Ecoli, poor growth + HTN
Look for vesicoureteral reflux (scars ureters)
80
Major clinical finding of IgA nephropathy
Recurrent Hematuria
81
Complications of UTIs
```
Sepsis, Septic Shock
AKI
Perinephric Abscesses
Emphysematous Pyelonephritis
Papillary Necrosis
```
82
Clinical presentation of Nephritic Syndrome
New Onset HTN and Hematuria
AKI
Proteinuria below 3.5/day with foamy urine
83
PUNLMP vs Papilloma
PUNLMP has thicker urothelium, larger than papillomas
84
Dx of prostatitis
Digital rectal exam, Urinalysis, Urine culture
| test for gonorrhea, chlamydia
85
95% of renal cell carcinomas are sporadic clear cell. What's the etiology?
Deletions on Chr 3
Loss of VHL
inactivated, mutated, hypermethylated VHL
86
Rituxibam MOA
antiCD20 Ab
87
Typical presentation of acute prostatitis
Often appear acutely ill!
Obstructive sx, suprapubic perineal pain, etc
Chronic is usually more mild appearing
88
Classic presentation of pyelonephritis
Fever/chills/rigors, flank pain, CVA tenderness on exam, fatigue, N/V/Anorexia
89
Urinary pattern of Nephrotic syndrome
Heavy proteinuria >3.5g/day
Lipiduria
Minimal Hematuria
90
Diagnostic imaging for kidney stones
Non-Contrast CT abdomen and pelvis (renal stone protocol CT)
91
Clinical presentations of UTIs
See: Cystitis, pyelonephritis
| Can also have altered mental status in older adults
92
How long do you take different antibiotics for prostatitis?
Fluoroquinolone (Cipro) and Bactrim, 4-6 weeks
93
Microscopic Polyangiitis symptoms
Necrotizing vasculitis WITHOUT granulomas or asthma symptoms or eosinophilia
MPO Abs
94
Immunofluorescence findings of acute proliferative glomerulonephritis
Granular IgG, IgM, C3 deposits in mesangium along GBM, corresponding to sub epithelial "humps" found on electron microscopy
95
Pulmonary-Renal Syndrome
Alveolar hemorrhage and glomerulonephritis
ANCA-Associated vasculitis
Anti-GBM disease (good pasture)
96
Complications of AKI
Hypervolemia (P. Edema, HF)
| Electrolyte abnormalities, Hyperuricemia, Uremia, Pericarditis, Metabolic Acidosis, Bleeding, need for dialysis
97
UI interventions for women with contraindications
B3 adrenergic agonists
98
Microalbuminuria
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
Diagnostics of DI
24 hour urine volume collection
Urine osmolality below 300mOsm/kg
Water deprivation test
100
Main causes of Nephrogenic Diabetes Insipidus
Lithium Toxicity
| Hypercalcemia
101
Contraindications of Azathioprine
Pregnancy (malignancy)
102
Azathioprine Indications
Adjunct for preventing homorenal transplant rejection
| RA management
103
Major bacteria in prostatitis
G-: E COLI, Klebsiella, proteus, pseudomonas
| G+: Enterococcus, normal skin flora
104
3 simple tests to identify most CKD patients
eGFR
Urine albumin:creatinine or protein:creatinine
Urinalysis
105
Maintenance Therapy for ANCA associated vasculitis
1. Azathioprine or Mycophenolate or Rituximab
| 2. Methotrexate
106
Induction therapy for ANCA associated vasculitis
High dose glucocorticoids (IV prednisone) and Rituximab
| High dose glucocorticoids and Cyclophosphamide
107
Dumbell-shaped crystals on urine microscopy
Calcium Oxalate monohydrate crystals
108
Clinical manifestations of CKD
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
Imaging findings in diffuse and nodular diabetic glomerulosclerosis
Diffuse increase in mesangial matrix (sclerosis)
Thickened glomerular basement membranes
Characteristic Acellular PAS-positive nodules
110
Urinary pattern of UTI
WBC, RBC, Bacteria
111
Polycystin 2
Ca2 permeable cation channel coded by PKD2 gene on Chr 4q13-p23
Mutation leads to 15% of ADPKD cases (better Px)
