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112 Cards in this Set
- Front
- Back
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In order for second hydroxylation of vitamin D to occur, what enzyme is required?
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1-alpha-hydroxylase in proximal tubule
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What is the most common upper urinary tract cause of hematuria?
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Renal stone
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What is the most common cause of lower urinary tract hematuria?
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Infection
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What is the most common noninfectious cause of lower urinary tract hematuria?
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Transitional cell carcinoma bladder
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What is the most common cause of microscopic hematuria in adult males?
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BPH
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What is the most common drugs causing hematuria?
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Anticoagulants
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What does persistent proteinuria usually indicate?
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intrinsic renal disease
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What is the most common cause of increased serum BUN?
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CHF
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What is end-product of creatine metabolism?
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Creatinine
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Why is creatinine an excellent metabolite for renal clearance testing?
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Filtered; not reabsorbed or secreted
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What does creatine supplements increase?
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serum creatinine
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What is increase in serum BUN and creatinine called?
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Azotemia
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What is filtered, but partly reabsorbed?
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Urea
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What are key findings in prerenal azotemia?
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- decreased Cardiac Output
- decreased GFR - ratio > 15 |
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What are key findings in renal azotemia?
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- intrinsic renal disease
- extrarenal loss of urea - ratio <15 |
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What are key findings in postrenal azotemia?
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- obstruction behind kidney
- initial ratio >15 - If obstruction persists, <15 |
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CCr normally decreases with ____
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age
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Increased CCr is seen in:
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- normal pregnancy
- early diabetic glomerulopathy |
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What is the gold standard test to evaluate renal disease?
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Urinalysis
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The renal _____ is relatively ischemic
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medulla
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What vasodilates afferent arteriole?
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Renal PGE2
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What vasoconstricts efferent arteriole?
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ATII
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What determines protein filtration?
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GBM's
- size - charge |
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_____ has a negative charge; it is repelled by negatively charged GBM.
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Albumin
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Fusion of podocytes is a sign of :
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nephrotic syndrome
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What are crescents?
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proliferations of parietal epithelial cells
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Horseshoe kidney is associated with:
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Turner's Syndrome
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What is the most common cystic disease in children?
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Renal dysplasia
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Linear ImmunoFluorescence indicates:
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anti-GBM disease (Goodpasture Syndrome)
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Granular pattern on Immunofluorescence indicates:
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immunocomplex type of glomerulonephritis
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Under an Electron microscope, immunocomplex deposits are _____
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electron-dense
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What is the most common mechanism causing glomerulonephritis?
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immunocomplex
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What does immunocomplexes do?
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1. activate complement
2. C5a produced 3. attract neutrophils |
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Nephritic syndrome is a _____-related injury to glomeruli
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neutrophil
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Does pitting edema distinguish nephritic from nephrotic syndrome?
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NO
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What are features of nephritic syndrome?
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- moderate proteinuria (<3.5)
- dysmorphic RBC - RBC cast |
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Nephrotic Syndrome is a _____ injury to podocytes, leading to loss of negative charge on GBM
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cytokine
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What are features of nephrotic syndrome?
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- proteinuria >3.5
- fatty casts |
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Which syndrome has less glomerular inflammation?
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Nephrotic syndrome
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Diabetic glomerulopathy is more common in type ___ diabetes
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type 1 diabetes
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What is the most common cause of diabetic glomerulopathy?
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poor glycemic control
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In nonenzymatic glycosylation, there is a _______ to protein
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high vessel/tubular permeability
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There is increase in what in osmotic damage to glomerular capillary endothelial cells?
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sorbitol
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What does hyaline arteriolosclerosis of efferent arteriole increase?
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GFR, producing hyperfiltration injury
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What increases in microangiopathy?
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deposition type IV collagen
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What is the first sign of diabetic glomerulopathy?
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microalbuminuria
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What slows progression of nephropathy in type 1/type 2 diabetes?
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ACE inhibitor/receptor blockers
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What are features of Alport's syndrome?
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- hereditary nephritis
- sensorineural hearing loss - ocular defects |
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What occurs in thin basement membrane disease?
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persistant hematuria
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What is the most common cause of chronic glomerulonephritis?
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Rapidly progressive glomerulonephritis (RPGN)
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What is the most common cause of Acute Renal failure?
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Acute Tubular Necrosis (ATN)
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What is the most common type of Acute Tubular Necrosis (ATN)?
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Ischemic Acute Tubular Necrosis
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What is the most common cause of ischemic ATN?
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prerenal azotemia
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What cast is seen in ATN?
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Renal tubular cell cast
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What is the most common cause of nephrotoxic ATN?
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aminoglycosides
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What are features of ATN?
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- BUN:Cr ratio <15
- hyperkalemia - metabolic acidosis |
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What is the most common cause of Tubulointerstitial nephritis (TIN)
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Acute pyelonephritis (APN)
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APN occurs more in ______
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females
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What is the most common cause of APN?
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E. Coli
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What is Vesicoureteral reflux?
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urine refluxes into the ureters during micturition
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What is the most common mechanism for upper/lower UTIs in females?
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Ascending infections
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What are findings in APN and not lower UTIs?
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- fever
- flank pain - WBC casts in urine |
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What are causes of Chronic Pyelonephritis (CPN)?
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- VUR in young girls
- chronic hydronephrosis |
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What is visible with IVP in CPN?
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cortical scars that overlie blunt calyces
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What are features of CPN?
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- glomerular scarring
- tubular atrophy (thyroidization) |
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What is a cause of hypertension in children?
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Reflux nephropathy
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What are acute drug-induced TIN?
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- methicillin
- NSAID - rifampin - sulfonamides |
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What are features of acute drug-induced TIN?
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- abrupt onset fever
- oliguria - rash |
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Analgesic nephropathy occurs from chornic use of _____
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acetaminophen + aspirin (causes renal papillary necrosis)
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What is visibly seen on IVP of Renal Papillary necrosis?
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'ring defect' from sloughing of papilla
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How do you prevent urate nephropathy?
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allopurinol BEFORE aggressive cancer therapy
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What are features of Chronic lead poisoning?
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proximal tubules with nuclear acid-fast inclusions
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What casts does Bence Jones Protein produce?
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tubular casts with foreign body giant cell reaction
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What anemia does Chronic Renal Failure produce?
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normocytic anemia (qualitative platelet defect)
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Chronic Renal Faiure produces renal osteodystrophy due to?
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- secondary HPTH
- osteomalacia - osteoporosis |
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What does Chronic renal failure produce?
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- hypertension
- pericarditis - CHF - atherosclerosis |
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What are features of CRF?
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- high anion gap metabolic acidosis
- high serum phosphorus/potassium - low serum calcium |
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What is a biomarker of kidney function?
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Cystatin C
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What is free water clearance in CRF?
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zero
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What casts are sign of CRF?
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waxy casts
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___ is kidney of essential hypertension, due to hyaline arteriolosclerosis.
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Benign nephrosclerosis
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What is the most common cause of malignant hypertension?
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pre-existing Benign Nephrosclerosis
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What are features of malignant hypertension?
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- >210/120 mm Hg
- encephalopathy - renal failure |
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what is initial treatment for malignant hypertension?
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nitroprusside
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What is the most common cause of renal infarction?
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emboli
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What are features of renal infarction?
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- hematuria
- flank pain |
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What are features of sickle cell nephropathy?
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- loss concentration
- hematuria - renal papillary necrosis - APN |
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What are features of diffuse cortical necrosis?
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- anuria followed by ARF in pregnant women
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What is the most common complication of upper urinary tract obstruction?
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hydronephrosis
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What is the most common cause o fupper urinary tract obstruction?
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Renal stone
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What is the most common metabolic abnormality causing calcium stones?
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hypercalciuria
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What increases reabsorption of calcium out of urine?
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thiazides
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What is the most common renal stone?
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calcium oxalate
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What are renal stones?
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- calcium oxalate
- calcium phosphate |
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What are struvite stones?
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- Magnesium ammonium phosphate (MAP)
- urease producers - alkaline urine pH |
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What are features of renal stones?
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- ipsilateral colicky pain in flank radiating to the groin
- hematuria |
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In plain film, 80% stones are ____
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radioplaque
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What is the best overall sensitivity and specificity in renal stones?
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spiral CT
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What detects hydronephrosis, not stones?
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ultrasound
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What is very important to prevent stones?
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hydration
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What is the Rx for calcium stones?
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hydrochlorothiazide
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What is hamartoma associated with tuberous sclerosis?
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Angiomyolipoma
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_____ is a yellow tumor with renal vein invasion
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Renal cell carcinoma
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Renal cell carcinoma derives from ____ cell
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proximal tubule cell
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What is the msot common cause of renal cell carcinoma?
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smoking
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Renal cell carcinoma invades ___
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renal vein
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What is the triad for renal cell carcinoma?
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- hematuria
- flank pain - abdominal mass |
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Renal cell carcinoma has ectopic secretion of:
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- EPO
- PTH-related peptide |
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What is the most common cause of transitional cell carcinoma (TCC)?
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smoking
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What is the msot common primary renal tumor in children?
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Wilm's tumor
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What are features of Wilm's tumor?
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- child with unilateral flank mass
- hypertension |
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Wilm's tumor causes hypertension how?
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Hypertension due to renin secretion
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