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135 Cards in this Set
- Front
- Back
Gross hematuria, Nephritic or Nephrotic?
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NephrItic
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Red Cell Casts, Nephritic or Nephrotic?
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NephrItic
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HTN, Nephritic or Nephrotic?
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NephrItic
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Caused by inflammatory diseases, Nephritic or Nephrotic?
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NephrItic
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Proteinuria, Nephritic or Nephrotic?
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NephrOtic
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Definition of Proteinuria
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> 3.5 gm/24 hrs
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Hypoalbuminemia, Nephritic or Nephrotic?
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NephrOtic
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Edema, Nephritic or Nephrotic?
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NephrOtic
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Hyperlipidemia, Hyperlipiduria, Nephritic or Nephrotic?
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NephrOtic
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Damage to visceral epithelial cell (podocytes), Nephritic or Nephrotic?
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NephrOtic
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Type of strep that causes APSG?
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Group A Strep
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Acute Poststreptococcal Glomerulonephritis, Nephritic or Nephrotic?
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NephrItic
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Subepithelial humps on EM
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APSGN
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Peripheral and periorbital edema
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APSGN
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Increased ASLO titers
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APSGN
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Serum antiDNase B high
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APSGN
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Crescent-moon shape
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RP (Crescentic) GN
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What are crescents?
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proliferations of parietal epithelial cells of Bowman's capsule
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Large, pale kidneys with petechiae
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RPGN
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RPGN, Nephritic or Nephrotic?
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NephrItic
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Hypercoaguable state, Nephritic or Nephrotic?
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NephrOtic (small proteins like anticoagulants are lost first)
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Membranous GN, Nephritic or Nephrotic?
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NephrOtic
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Granular deposits along the GBM
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Membranous GN
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Spike and Dome; subepithelial spike
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Membranous GN
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Pathogenesis of Membranous GN?
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An-Ab mediated
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Minimal Change Disease (Lipoid Nephrosis), Nephritic or Nephrotic?
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NephrOtic
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Homogenous, diffuse, linear pattern
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Anti-GBM GN
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classic subepithelial humps, but may also have subendothelial and itramembranous deposits
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APSGN
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Type I RPGN
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anti-GBM w/ diffuse, linear deposits
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Type II RPGN
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IC mediated, lumpy bumpy, granular pattern
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Type III RPGN
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Pauci-Immune type; lack of IF staining
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Severe oliguria
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RPGN (Nephritic)
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May be associated with atopy (eczema, rhinitis)
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Minimal Change Disease
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Normal glomeruli, no staining
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Minimal Change
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Associated with HIV, Heroin addiciton, Sickle cell and morbid obesity
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FSGS
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Most common cause of nephrotic syndrome in adults
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FSGS
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Foamy Lipid cells
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Minimal change and FSGS
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How do you make the Dx of FSGS?
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Light Microscopy
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HIV Nephropathy most common renal complication
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FSGS
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May be associated with atopy (eczema, rhinitis)
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Minimal Change Disease
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Normal glomeruli, no staining
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Minimal Change
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Associated with HIV, Heroin addiciton, Sickle cell and morbid obesity
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FSGS
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Most common cause of nephrotic syndrome in adults
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FSGS
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Dense Deposit Disease
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Type 2 MPGN
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Activation of the alternative complement pathway and normal complement pathway
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Type 2 MPGN
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Type of MPGN that occurs most often post transplant
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Type 2 MPGN
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Recurrent hematuria associated with URI
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IgA Nephropathy (Berger Disease)
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Henoch-Schonlein purpura
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overlapping features iwth IgA Nephropathy
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Mesangium association
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IgA Nephropathy
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Dx IgA Nephropathy
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IF staining with IgA deposition
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Diseases occuring most often post-transplantation
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IgA, Membranous Proliferative (esp Type 2) and FSGS
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Hypercoagulable state
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NephrOtic
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Uniform, diffuse thickening of capillary wall (looks like cheerios)
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Membranous GN
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90% if kids respond to coricosteriod therapy
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Minimal Change
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Adaptive response to loss of renal tissue
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FSGS
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Sclerosis caused by entrapped plasma proteins
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FSGS
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Proliferation of glomerular cells and leukocyte infiltration, and changes in the GBM
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Memraboproliferative GN
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Associated with chronic IC diseases like SLE, Hep, Endocarditis
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Memraboproliferative GB
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Possible T cell dysfunction and release of cytokines that damage the podocytes
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Minimal Change
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No renal failure, often no HTN
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Minimal Change
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Associated with hematopoietic malignancies
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Membranous GN
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How do you distinguish between Type 1 and 2 of Membranoproliferative GN?
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IF, EM (Look the same microscopically!)
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Large, hypercellular glomeruli with a lobular architecture and thickened GBM
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Type 1 or 2 of Membranoproliferative GN (look the same microscopically)
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Silver stains show "tram-track" or "double contour" due to mesangial cell interposition into the GBM
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Membranoproliferative GN
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Causes 2/3 of MPGN
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Type 1
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Type of MPGN with lots of complement staining
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Type 1
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Activation of classic and alternative complement pathways
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Type 1 MPGN
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Shows Granular C3 of IF ONLY
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Type 2 MPGN
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Type of MPGN with subendothelial deposits
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Type 1
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Dense deposits on EM; type of MPGN
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Type 2
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Lamina densa of the GBM is ribbon-like
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Type 2 of MPGN
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Tx of MPGN
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steroids and immunosuppressive drugs are not helpful
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Causes recurrent hematuria
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IgA nephropathy (Berger Disesase)
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Mesangial deposition of IgA
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IgA Nephropathy
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Name the 2 hereditary nephritis'
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Alport and Thin membrane
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Associated with nerve deafness, eye disorders
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Alport
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Which are affected most often in Alport?
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Males (X-linked dominant)
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Persistance of fetal like glomeruli
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Alport
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Foam cells present in what 3
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minimal change, Alport and FSGS
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Irregular thick and think GBM
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Alport
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Splitting of the lamina densa
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Alport
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What must the changes be in Alport?
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Diffuse and widespread
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Where is the mut in Alport?
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Defective GBM synthesis, mut in the gene encoding the alpha 5 chain of type IV collagen
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EM shows diffuse thinning of the GBM
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Thin Membrane Disease (Benign Familial Hematuia)
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RBC casts
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Nephritic
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WBC casts
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Acute pyelo, AIN due to drugs, excludes a lower UTI
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Renal tubular casts
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ATN
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Waxy or Broad casts
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CRF
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Hyaline casts
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Proteinuria (insignificant in the absence of proteinuria)
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Fatty casts with maltese crosses
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nephrotic
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Thick membranes
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Membranous
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Thick membranes and hypercellular
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Membranoproliferative
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What makes IF "lumpy bumpy"
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if ICs are present (APSGN)
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Loss of the negatively charged GBM
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Minimal Change
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Associated with IC diseases like SLE, Hep, Endocarditis
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Membranoproliferative GN
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CORRECT: Activation of classic and alternative Complement pathways
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Type I MPGN
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Globally hyalinized glomeruli
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Chronic Glomerulonephritis
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Purpuric skin lesions, ab pain, GI issues, IgA deposition in the mesangium
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Henoch Schonlein purpura (Chronic GN)
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> GFR and glomerular hypertrophy earlin in disease: cap BM thickening, diffuse mesangial sclerosis
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Diabetic nephropathy
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Capillary BM thickening detected by EM, diffuse mesangial sclerosis (AAteriole thickening too) and Nodular glomerulosclerosis (Hylaine masses at the periphery of the glom)
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Diabetic Nephropathy
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Ischemic or toxic injury to the tubules leads to what
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ATN and ARF
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Inlammatory reactions of the tubules and interstitium lead to what?
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TIN
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Morphology of ACUTE pyelo
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Intratubular aggregates of PMNs and Tubular necrosis; papillary necrosis (Also seen in pts with diabetes and pts with obstruction)
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Pelvocalyceal damage present
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Chronic pyelo and analgesic nephropathy (Only ones that damage calyces)
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Causes of chronic pyelo
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Chronic reflux or obstruction (Does NOT have to have bacteria)
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irregularly, asymmetric scars in the upper and lower poles of the kidney
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Chronic Pyelo
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Focal tubular atrophy with thyroidization (tubules filled with collloid casts)
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Chronic Pyelo
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Pts undergoing chemo are often given choltersine to prevent what?
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Urate nephropathy (Tubulointerstitial disease)
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What 3 things may cause Tubulointerstitial disease?
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Urate nephropathy (chemo), Hypercalcemia/nephrocalcinosis, Multiple Myeloma
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What do you see in benign nephrosclerosis
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hyaline arteriosclerosis; suface of kidney has a fine, even granularity
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Flea bitten kidney, fibrinoid necrosis with thrombosis, Onion skinning on silver stain of vessels
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Malignant nephrosclerosis
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What begins the path of TTP and HUS
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endothelial damage that secrete large von Willebrand factor multimers induce agg
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75% if childhood HUS is caused by what
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e coli
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Inherited deficiency of the complement regulatory protein Factor H
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Familial HUS
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Fever, neruo sx, hemolytic anemia, purpura; patchy r diffuse renal cortical necrosis
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Idiopathic TTP
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What is the defect in Idiopathic TTP?
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ADAMTS-13, a protease that normally cleaves large von Willebrand multimers
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Cortical necrosis with thickened glomeruli, deposits of fibrin in cap lumens, subendo & mesangium, fibrinoid necrosis of arterioles with thrmobi
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Idiopathic TTP
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Type of obstruction that presents with inability to concentrate the urine (polyuria and nocturia)
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Bilateral partial
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Type of obstruction that presents with anuria
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Bilateral complete
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Enlargement of the kidney, interstitial inflammation leading to fibrosis and tubular atrophy
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obstruction of the kidney
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MC stone
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Calcium oxalate and phosphate
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Struvite stones formed mainly after infections by urea splitting bacteria (Proteus and some staph)
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Mg Ammonium Ph stones (bacteria convert urea to ammonia with resulting alkaline urine); can produce staghorn calculi (LARGE) stones in the renal pelvis
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Name 2 benign renal tumors
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Angiomyolipoma and Oncocytoma
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Tumor composed of vessels, SM and fat; associated with tuberus sclerosis
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Angiomyolipoma
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AD syndrome associated with CNS and retinal hamartomas; associated with angiomyolipoma (benign)
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Tuberus sclerosis
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Mahogany brown tumor
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Oncocytoma
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EM shows abundant mito in cells; arise form CD
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Oncocytoma (Benign)
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Syndrome associated with RCC
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Von-Hippel-Lindau (Hemangioblastomas of the cerebellum and retina)
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Where is the defect in Von Hippel Lindau Syndrome? (Assoc with RCC)
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VHL gene on chromo 3p25.3 (Normally a tumor suppressor gene that encodes for ubiquitin ligase complex)
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Name the 2 types of RCC
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Clear cell (MC) and Papillary
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Losses of chromo 3p; Bright yellow tumor
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Clear Cell RCC
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Cuboidal cells with a papillary growth pattern and foam cells in papillary cores
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Papillary RCC (NOT assoc with a 3p loss)
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Where does RCC like to met?
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IVC, lung (MC) and and bone (25% of pts will present with mets)
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Why does RCC commonly cause paraneoplastic syndromes?
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Overproduce erythropoietin and RBCs
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What carcinoma does analgesic nephropathy put you at risk for?
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Urothelial
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