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183 Cards in this Set
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BUn/Cr >20 Fe Na < 1% Urine Osm > 500 Urine Na < 20 |
Pre renal azotemia (decrease RBF) |
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Bun/Cr > 15 Fe > 1% Urine Na > 40 Urine osm >500 decreased GFR Oligouria |
Post renal Azotemia Early tubular fx intact |
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Bun/Cr < 15 >2% FeNa Urine Na >40 Urine < 350 |
late post renal azotemia long standing obsturction |
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Urine osmolarity < 350 Urine Na > 40 FeNa> 2% BUn/Cr < 15 |
instrinic renal ATN or ishcemia |
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brown granulae casts Urine osm < 350 Urine Na> 40 fe Na >2% BUn/Cr < 15 decreased GFR (blockage by necrotic plugs) |
Intrinsic Renal dmaage ATN Ishemia : Blood supply PT/medually TAL Nephrotoxic Pt |
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ishemic ATN |
preceeded by prerenal azotemia |
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Nephrotoxic ATN |
aminoglycosides radiocontrast lead cisplatin ethylene glycol (oxalte crystals in urine) cursh injury myoglobinuria hemoglobinuria PCT susceptible Urate *Tumor lysis syndrome |
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gross hematuria proteinuria recent infections |
sickle clel disease aute pyelonphritits analgeiscis diabetes mellitius |
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olgiuria with brown granular casts elevated BUn and Creatine Hyperkaelmia metabolic acidosis increased anion gap |
ATN |
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recovery phase of ATN |
tubular stable cells regeneraiton within 2- 3 weeks BUn and Cr fall risk of hypokaelmia (excretion of K, Mg, Pov and Ca due to recovery) |
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acute interstiial nephritisi |
drug induced HSR within insterstium intra renal arf caused by NSAIds Pencillin Diuretics |
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eosinophils with oliguria fever rash after starting drugs |
acute interstiital nehpritis can preogress to renal papillary necorsis stop drugs |
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gross hematuria and flank pain |
Renal papillary necrosis necorsis of renal papillae chronic analgeisc abuse Daibeetes mellitus Sickle cell trait or disease Severe Acute pyelonephritis |
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nephrotic syndrome |
proteinuria <3. 5g/day Hypoalbuminemia- edema Hypogammaglobieuniemia -infections hypercoagulable state (loose ATIII) Hyperlipdeimia, hypercholesterlemia |
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neprhotic syndrome types |
minimal chaange disease |
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minimal change disease associated iwth |
hogkins lymphoma massive amoutns of cytokines |
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MCD |
effacement of foot processes via cytokines Normal HE No IF Selective albumin loss Excellent response to steroids |
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FSGS Focal segemental glomeroculoscerosis |
Nephrotic syndrome MC histpanics and AA HIV, Heroine Use, Sickle Cell Disease HE: Focal and segmental sclerosis EM: Effacement of Foot proceses on EM No IF Non responsive to steroids- progress to Chornic Renal |
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Membranous Nephropathy |
nephrotic syndrome in caucasian SLE, Hep B, Hepc C, drugs (SLE:MC cause of death, nephrotic syndrome) He: thick glomerular basement EM: Spike and dome SUBEPITHELIAL IF: granular Immune compelx deposition SUBEPITHELIAL |
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Membranoproliferative Glmerulonpheritits |
Nephritic/Nephrotic syndrome HE: Thick Capillary membrane on HE Tram Track: Mesangial cell proliferation IF: granular Immune complex IF Type I: subendothelial HBV HCV tYPe II: Basement membrane deposition: C3 nephritic factor |
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c3 nephritic factor |
stablizes C3 Type II Membranoproliferative gleruloneprhitis Decreased complement C3 serum |
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TYpe I MPGN |
subendothelial HBC HCV TraM track |
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granular IC |
Membranous Membranoporliferative I, II |
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Diabetes Mellitus |
Nonenzymatic glycosylation: hyaline arteriolosclerosis: decreased calibary of lumen (efferent) increased GFR; Scleorsis of mesagium : Nephortic syndrome Use ACE i |
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1st change of DM |
NEG of vascular basement membrane hyaline arteriolosclerosis |
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keimmsteil wilson nodues |
scleorsis of mesagium |
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sysetmic amylodiosis |
kidney most common organ nephroitc with congo red staining |
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Neprhitic |
glomerular inflaimaiotn limited proteinura oliguria azotemia salt retention - periorbital edema hypertension RBC casts and dysmorphic RBcs in urine |
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Biopsy of Nephritic |
c5a neutrophil hypercellular |
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PGSN |
post strep infection of (Mprotein virulsent factor) of neprhitigenic strains and non strep organisms |
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2-3 post strep infecitons Heamturia (cola colored) Oliguria Hypertension Periorbital edema Children |
PGSN |
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PGSN biops |
EM SUBEPTIHELIAL hump IC deposition: granular IF starry sky HE: Hypercellular Inflamed glomeruli rare progression to RPGN (only in adults) |
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PGSN labs |
decrease complement + anti DNase B titer Type III |
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RPGN |
cresent: macrophages and fibrin |
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cresent shape deposition linear IF Hematuria Hemoptysis |
Goood pasture |
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cresent shaped granular immune complex supepithelial hump |
PGSN |
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cresent shaped grannular immune complex subendothelial/intramembranous IgG wirelooping of capillaries |
Diffuse proliferative glomerulnephritis SLE |
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HE Mesangial proliferation EM: Mesangial Ic deposition IF IgA based IC depositions in mesangium Post infection (renal insuficency with acute gastroenteritis) Episodic hematuria |
Ig A nephroapthy Berger disease |
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Henoch Schonlen purpura |
puritis sin rash IgA mediated Hematuria (IgA mediated kidney and proteinuria) Abdominal pain GI inolemnt joint pain |
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retinopathy, lens disolcoation isolated hematuria sensorinueral deafness in a family |
Alport syndrome mutation in type IV collagen Xlinked |
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cresent deposition pauci immune +cANCA around cytoplasms |
Wegners (r/o Goodpastures: no nose involement in Goodpastures) |
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Cresent despoisiton puaci immune +pANCA |
micropscopic polyangitis churg strauss: churg straus + eosinophilia +asthma +granulomatous infalmation |
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cystistis |
no systemic syigns dysrua urinary frequency urgency suprapubic signs |
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cloudly urine +lukocyte esterase +nitrites culture >100,000 cfu |
cystitis E. coli > S. Saphropytiicso, Klebseilla, Proteus (amonia and alkaline urine) Enteroccuc faeclis |
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cloudy urine WBC + - culture |
Chalmydia trachomatis Neiserria ghonorrhoae |
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increased risk of pyelonerhitis |
vesicouretal reflex |
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fever, flank pain, wbc cast, luekocytosis dysruia frequency urgency |
pyelonephritiis |
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pyelonephiritis |
e coli klebseilla entercoccus |
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chornic pyelnophriits |
atrophy of tubules and interstila fiborisis most common due to vuj cortical scaring with bluttned calyxes (upper and low) thyroidization of kidney due to colloid |
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kidney stone |
colkely pain with heamturia unilateral flank tenderness |
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calcium oxolate |
precipates at low ph r/o hypercalcemia seen in chrons disease tx: hydrocholraziaide envelope shaped |
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calcium phspphate stone |
prescipates and high ph enveloped shaped tx: citrate, hydrocholthiazide hdyration |
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ammonium phosphate incrase ph |
infection struvite stone with coffein lides proiteusm sta. saphroticis kelbeisella staghorn calculi remove surgically |
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uric acid |
radiolucent decreased ph romboid or rosettes tones |
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risk factosr uric acid sontes |
luekemia, gout, hyperureciemia decrease urien flume arid climates |
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cystine stones |
radiolucent decrease ph STAGHORN CHILDREN AR condition affective cystien resportion cuasing cysteineura Hexagonal |
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sodium cyanide nitroprusside test |
cystine stones |
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angiomylipoma |
blood essels smooth muscle dapidpose tissue kidneys tuberslcorosis |
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rever, weight pain, paraneoplastic syndrome (EPO) hmeaturia, palpable mass, flank pain |
Renal cell carcinoma malignant epithelia tumor gross yellow mass clear cytoplasm |
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renal cell carcinoma |
loss of vhl increased igf promote growth increased hif vegf and pdgf increased |
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Von hipple lindau disease |
renal cellc aricnoma heamtngioblastoma of cerebellum |
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kidney mass in children blastema large unilateral flank mass with heamturia hyprenteion elevated renin |
wilms |
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wilmts tumor aniridia gential abnoralities retardation (mental and motor) |
WGAR deltion of WT1 tumor urepspser gene |
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Wilms tumor Progressive renal disease male psuedohermaorphtisis |
denydrash syndrome mutations of wt1 |
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wilms tumor neonatal hypoglycemia muscular hemihypertorphy organomegaly (tongue) |
BECKWITH WIEDERMANN
wt2 mtuations particular igf2 |
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urothelial carcinoma |
urethoelilin glining |
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risks for urhothelial carcinoma |
cigarette smoke azo dyes naphthylamien phenacetin long term cyclophsomis |
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painless hematuria |
papillary grwoth or flat grwoth of urthoelial carcineoma or flat |
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flat pathway |
early p53 mutations |
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squamous cell carcinoma |
metaplasia to dysplasia schistomsoma haemtoibium chornic ystistis long standing netohrplithisais |
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adenocarcinoma |
bladder joints urachal renmants DOME OF BLADDER cystis glanduliaris - columnar metaplasia exstorphy- exposure of bladder to outside wall |
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normal gap anion metabolicacidosis urine pH > 5.5 Hypokaelmia |
TYPE 1 alpha intercalated cells can't secret H no hco3 created Increased risk for calicum phosphate kidney sotnes |
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causes of type 1 rta |
amphtericin B analgestic nephorpathy congenital anomalies obstructive urinary tract |
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non anion gap metabolic acidosis HCO3 low Hypokaemia normal urine ph <5.5 |
type II defect in PCT Hco3 reabospriton inecrease excreption urine acidifiedby alpha intercalated calls increased risk of hypophosptemic rickets |
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causes of type II RTA |
fanconi syndrome CAHi |
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Hyperkaelmia non gap metabolic acidosis urine ph< 5.5 increased cl |
Hypoaldsteronisms-> hyperkaelmia leadig to decreased NH4 exertion |
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caues of type IV RTA |
decreased aldosterone acei, arbs, snaid, heaparine, cyclorphsine, aldoseronre resistance k sparing |
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ureteropelivic juncaiton |
most common site of obstruction last to canalyze |
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mesonephron gives off |
uteric bud ureter renal pelvis calyxes colletin tubulues |
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vesicuorureteral reflux |
increased uti |
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renal artery blood flow |
renal artery, semgeental artery, interlobar artery, arcuate artery, interlobular artery, affereter arterior gloermular arteriole efferent arteriolr peritubular arteiror interlobularvein arcuate vein interlobar vein renal vein ivc |
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gyentolcogical procedures damage cardinal ligmanet (uterine ligament) |
urtehtral obstruction |
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intracellular concetnration |
elevatedk elevated mg |
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volumes |
tbw 60% icf 40% ecf 20% plasma volume: 1/4 ECF (albumin) ECV (inulin) |
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gfr determiend by |
fenetrasted capillary endothelium -size fused basement membrane wtih hapran sulfate ( ngeatvei charge barrier) epithelial poodyctes |
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clearance is less than gfr |
net reabsorption |
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c > gfr |
net secretion |
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c= gfr |
no net secreition of reaboprtion |
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filtered laod |
gfr x Plasma concentration |
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excerted |
urine concentraiton x volume |
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reabsorbed |
filetered-excreted |
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secreted |
excreted-filtered |
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thin descending looop |
absorpbs h20 hypertonic |
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thick ascneding loop |
impermeable h20 reabosrobs water loop diruetics work atn k cl K back leak |
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dct |
thiazide diuretics work ehre at na cl channel makes urine more diulte pth increase cac aboroption here |
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aldosterone |
works on mineralocorticoid receptor increasing portein syntehsis principle K excreption alpha Increase H excretion |
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amiloride traiterene |
enac cells prevent na reabosprtion |
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adh |
v2 increased h20 |
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fanconi syndrome |
pt defect excreotion of all AA, glucose, Hco2 po3 METABOLIC ACIDOSIS caused by drugs and wilsons disaese |
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Bartter sydrnome |
AR mimics loop diuretics TAL Hypokaelmia Hypocalemia metabolic aclkaosis |
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Gitelman syndrome |
AR mimics thiazide diuretics DCT Hyperglycemia Hyperuricemia Hyperlipdeimia Hypercalcemia, hypomoagnemisa hypocalicuria metabolic alkaosis |
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Liddleman syndrome |
mimics aldosterone hypokaelmia meatbolic alkaosis hpertension AD defect GOF increased Na resportion in collecitng tubules |
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Syndrome of apparent miernabolacorticoid access |
defeicnecy in 11 beta hydroxteroid dehydrgenase increased meteraolocorticoid receptora tive hypertension hypokaelmia metabolic alksosi can be caused by licorice |
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t/p greater than 1 |
water aborsobed faster |
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hyperkaelmia |
digitatlis hyperosomlarity lysis of cells acidosis beta blocker high blood sugar (insulin loss) |
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tx for hyperkaelmia |
beta aonigst iv bicarb iv insuline with dextrose |
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hypokaelmia |
inuslin metabolic alkosos beta agonist hypoosmoarlity (thiaizide diuretics) loop diruetiecs |
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low serum na |
nausea maliase stupor comoa seizures |
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metabolic acidosis compensation? |
pco2 = 1.5 (hco3) + 8 +/-2= value |
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elevated anion gap metabolic acidosis |
methanol uremia dka propylene glycol isonaizid lactic acidosis ethyelne glycol asa (respriatory alkalosos) |
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resptiraotyr alkalosis |
hyperventilation |
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respitratory acidosis |
hypoventilation |
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nomrla aniona gap metabolic acidosis |
hyperalimetnaiton addisons disease RTA diarrhea Acetazolamide spirnolcactine saline infusion |
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metabolic alksosis with compenstation |
vomit atnacid hyperalodsterinsims loop diretics |
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rbc casts |
gloermulonephritis malignent hypretneison |
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wbc casts |
tubulointerstial inflamation acute pyelonprhitits transplant rejection |
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fatty casts |
nephortic syndrome |
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granular casts |
ATN |
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waxy casts |
end stage renal disease/chronic renal failure low ruine flow |
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hayline casts |
aka tam horsefall nonspeficif finding |
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renal oncocytoma |
benign eptiheal cell utmor that has largee osinophili cells with abdudant mitochonria without perinueclear clearing |
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oliriguria fever rash urine eosphinilphial cva tenderness |
drug induced interstitial nephritiis cauesd by syntehitic penicillins iduretics nsaids allopurinol cimitidine indiavir mesalamine |
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mannitol |
PT used for eelvated ICP drug overdose acute angle closure glaucoma -risks for pulmonary edema dehydration |
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acetazolamide |
sulfur drug working within the PT cuasing decreased HCO3 production, Metbolic acidosis (hypercloric) deydration Psuedotumor cerebri alkanize urine |
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loop diruetics |
max aobut of urine block na /k /cl decrease ca decrease Mg hypokaelmia, metabolic alkasosis otootxic gout has sulfa |
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ethacrynic acid |
no sulfa loop drug |
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thiazide diruetics |
hypercalcemia hyperglycemia hyperureciemia hyperlipedeimia hyponatremia hypokaelmia ematoblic alkaosis NDItx |
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spironolacone n epleronone |
tx for Hyperaldosteronism Hyperkaelmia |
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trimterene and amiloride |
k sparing |
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increased urine na |
all diruetics except acetazolamide |
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acedemia |
CAHi K sparing |
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alkalemia |
loop dueritics and thiazides via ATII (contraction alkaosos), K loss causing hypolaekmia |
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in low K state with thiazide and loop duritetics |
H is exhcanged for Na in cortical colelcting duct-> alksosis and paradoxic aciduria |
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acei with loop or htiasize |
first dose hypotension |
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ace i |
increased renin cough angeioedema teratogen increased creatine decreased gfr hyperkaelmia hypotension avoid in bilateral renal artery stenosis |
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arb |
no increase in bradykinin hypotension hyperkaelmia, decreased renal function use insetad for diabetic neprhotic |
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aliksirin |
direct irenin inbhitior hyperlkaemia hypotension |
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Hypertension and hypokaelmia with decrease renin and decrease aldosterone |
congeintal adrenal hyperplasia deoxciroticosterone producing adrenal tubmor cushing syndrome |
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type 1 diabetes and overflow inconteneice |
diabetic autnomic neuropathy affecting detrusor msucle innervation |
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dehydration |
plasma osmularity increases, ADH simtlated reabosrb water in collecting ducts maximally concentrate urine |
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decreased mortality in HF |
spirnolactone ace I /ARBs digoxin diuretic |
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digoxin clearance |
renaly excreted decrease in renal clearance by age, despite normal creatine : lower renally excreted drugs |
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reducse calcium stones |
hydrochorlothiazide |
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lactic acidosis |
increased anion gap metaoblic acidosis with respiratory alkaosis compensation
inadequate perfusion (hypoperfusion) causes decreased o2, shift pyruvuate from tca to ldh creating increased NAD+: lactatic acid builds up: attempt tomcpensatite by hyperventilating |
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DKA |
poly uria poly dipsia fruit order to breath/urine elevated anion gap metabolic acidosis (elevated ketones) compemsatnory restpiraotyr alkaosis hyperventiation |
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osteodystrophy |
decreased vit d decreased calicum 2 pth stimuatlion elevated phosprhus bone turn over osteotisis birosa cystica |
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PTT prolongation false positive RPR/VDLR |
antiphospholipid abx -risk for venous and ateriathromboembolism/unexplained recurrent miscarriages |
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erythropoitin from |
renal peritubular insterstial cell |
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macula densa cells |
NA cl snesors in dct release adenosine |
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jg cells |
modified smooth muscle of affert arteriors |
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antibiotides to phospholipase A 2 receptor |
membranous glmoerloneprhoatpy |
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precipitates at low ph |
calcium oxalate uric acid cysteine stones prevent via alkanization using allopuriol/acetazolamide |
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in presense of adh most concentrate urine found in |
colelcting ducts |
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in presence of adh least concentrate urine found in |
TAL, distal convoluted tubule |
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purpic sin rash hematuria proteiuria abodminal pain joint pain |
henoch schonlein purpura |
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RCC cytoplasms |
accumulated lipids and carbohhydrates |
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in absense of ADH highest osmularity within |
bottom of loop of henle |
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lowest osmularity without ADH found in |
CD |
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metabolic alkalsosis check volume and cl - hypochloremic hypotesnive |
correcti volume and cl with saline saline responsive (vomitting/nasogatric suctino cause) |
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metabolic alkalosis check volume and cl hyperchloremiuria with drug-> hypochloremiuria without |
correctiw tih saline and nacl saline responsive |
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metabolic alkalsosis nonsaline responsiev |
mineralochorloriticid excess too much aldosterone hyper cortlism hypertnesion increased cl in urine * not repsonsive to saline |
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Iga nepropathy versus PsGN |
PSGN: slower onset, IgG, IgM |
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origin of renal cell carcinoma |
epithelium of PCT polygonal clear cells filled with glycogen and lipid content |
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renal oncocytomas origin |
collecting duct cells larg well differnetiated noepalstic cells containing many mitochondria |
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diffusion equation |
(pressure difference x surface area x solubility)/ thickness of membrane x Squarerootof Moleculrweight |
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metabolic acidosis compensation by kidneys |
retain hco3 (reabsorb via CAH+ conversion of H2o and co2) increased H excreition via Na/H antiport Proxima nephren Distal tubular H/ATPase increased acid buffer excretion NH3 and HPo4 |
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ATII creation |
Renin secretion via JG cells in kidney - converts angiotensin into antiogensin I ACE in lungs converts angiotenisn I into ATII |
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consequences of using loop diuretics |
ototoxic hypotension hypokaelma mymagnesia hypocalicemia volume deplestion hyponatrea decrease gfr |
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indinavir risks |
protease inhibitor fat redistribution hyperglycemia hypertriglyerdemia kidney sontes |
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lamuvidine |
nrti peripheral neuroapthy lactic acidosis |
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Hypertension hypokaelmia elevated renin elevated aldosterone |
secondary hypoaldosnterinsm diuretic use renin secreting tumor: suspect if no RAS maglina hpertension renal artery stenosis |
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hypertension hypokaelmia elevated aldosteronone low renin |
ladosterone producing tumor bilateral adrenal hyperplasia |
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Hypertension Hypokaelmeia renin low aldosterone low |
congetinal adreanl hyperplaisa doexycoritocsterone producing adrenal tumor cushing syndrome exogenous mieralocroticodes |
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amphotercin B |
nephrotoxic causing hypokaelmiea hypomagnesmia via distal tubular perbaimlity increase NO efefct on cardiac cells |
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loop diuretic + nsaid
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decreased diuretic response due to (decreased prostaglanind release stimulated by loop) |
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characterized by presnse of mutiple cysts in varying size in kidney absence of normal pelvocalclceal system |
multicystic kidney dysplasia |
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eldery patient
easily faitguable constipation bone pain in bakc or ribs renal failure |
mutiple myeloma Hypercalcemia hyperuricemia infiltration of kidney by myeloma cells AL amyloidososis frequent infection myeloma cast neprhoatphy of excess free light chains bence jones proteins filtered by glomerulus resabosrbed in tubulues |
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eosinophilic casts in olderman |
bence jones proteins in mutiple melyoma numerous large glassy eosinophilic casts |
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papillary necrosis |
sickel cell disease acute pyelonephritis analgesics DM |
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negative repeat ct san with non contrast post subarachnoid hemorrage |
vasospasm r/o rebleed: seen on secondary repeat CT |
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child having light stools dark urine farm enlaregd liver increased direct bilirubin increased alk phosphtase increased ggt +marked intrahepatic bile ductule proliferaiton portal tract edema and fibrosis parenchymal cholestasis |
extrahepatic bilirary atresia : congential obsrruction of extrahepatic bile dcuts |
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mobile breast mass cellular myxoid stroma encricles pietheliaum lined galndular and cystic spaces |
fibroadenoma |
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sclerosing adneosis |
cetnra acidnar compresison and distortion surrounded by fiboritc tissue |
