First Aid Renal Pathology

Front 1

Patient presents with hematuria, hypertension, oliguria and azotemia

Nephrotic or nephritic syndrome

Back 1

Nephritic syndrome

Front 2

Inflammation is associated with nephrotic or nephritic syndrome

Back 2

Nephritic

Front 3

Light microscopy reveals enlarged glomeruli and hypercellular neutrophils "lumpy bumpy". Electron microscopy shows subepithelial humps. Immunofluorescence shows granular pattern

Back 3

Acute poststreptococcal glomerulonephritis

Front 4

This disease presents most frequently in children as peripheral and periorbital edema, resolves spontaneously

Back 4

Acute poststreptococcal glomerulonephritis

Front 5

Light microscopy and immunofluorescence show crescent moon shape, rapid course to renal failure

Back 5

Rapidly progressive (crescentic) glomerulonephritis

Front 6

Patient presents with hemoptysis and hematuria, immunofluorescence shows linear pattern and anti GBM antibodies

Back 6

Goodpastures syndrome type II hypersensitivity

Front 7

EM shows subendothelial humps, "tram track", slowly progresses to renal failure

Back 7

Membranoproliferative glomerulonephriits

Front 8

IF and EM show mesangial deposits of IgA, mild disease often post infectious

Back 8

IgA nephropathy (Bergers disease)

Front 9

Split basement membrane, collagen IV mutation, causes nerve deafness and ocular disorders

Back 9

Alports syndrome

Front 10

Massive proteinuria, hypoalbuminemia, peripheral and periorbital edema and hyperlipidemia

Nephrotic or nephritic

Back 10

Nephrotic syndrome

Front 11

Proteinuria associated with nephritic or nephrotic syndrome

Back 11

Nephrotic

Front 12

LM shows diffuse capillary and basement membrane thickness, IF shows granular pattern, EM shows :spike and dome

Common cause of adult nephrotic syndrome

Back 12

Membranous glomerulonephritis

Front 13

LM shows normal glomeruli, EM shows foot process effacement, most common cause cause of childhood nephrotic syndrome, responds well to steroids

Back 13

Minimal change disease (lipoid nephrosis)

Front 14

LM shows segmental sclerosis and hyalinosis, more severe disease in HIV patients

Back 14

Focal segmental glomerular sclerosis

Front 15

LM shows Kimmelstiel Wilson lesions, basement membrane thickening

Back 15

Diabetic nephropathy

Front 16

LM shows wire loop appearance with extensive granular subendothelial basement membrane deposits in membranous glomerulonephritis pattern

Back 16

SLE

Front 17

Can lead to severe complications such as hydronephrosis and pyelonephritis

Back 17

Kidney stones

Front 18

4 types of kidney stones

Back 18

Calcium
Ammonium magnesium phosphate (struvite)
Uric acid
Cystine

Front 19

Constitute majority of kidney stones (80-85%), stones are RADIOPAQUE, associated with such diseases as cancer, increased PTH increased vit D and milk-alkali syndrome, tend to reccur

Back 19

CALCIUM

Front 20

2nd most common kidney stone, RADIOPAQUE and urease positive bugs such as Proteus or Staphylococcus, can form staghorn calculi that can be a nidus for UTI

Back 20

Ammonium magnesium phosphate (struvite)

Front 21

Kidney stones, strong associateion with gout, often seen as result of diseases with increased cell proliferation and turnover such as leukemia and myeloproliferative disorders, RADIOLUSCENT

Back 21

Uric acid stones

Front 22

Radioluscent kidney stones, secondary to cystinuria

Back 22

CYSTINE

Front 23

Most common renal malignancy, most common in men 50-70 years old, increased incidence in smokers, associated with von Hippel Lindau and gene deletion in chromosome 3. Originates in renal tubular cells - polygonal clear cells

Back 23

Renal cell carcinoma

Front 24

Patient presents with hematuria, palpable mass, secondary polycythemia, flank pain and fever

Back 24

Renal cell carcinoma

Front 25

Renal cell carcinoma invades _ and spreads hematogenously. Associated with paraneoplastic syndromes (ectopic EPO, ACTH, PTHrP and prolactin), increased incidence after long term dialysis

Back 25

IVC

Front 26

Most common renal malignancy of childhood (ages 2-4), presents with huge palpable flank mass and hemihypertrophy, deletion of tumor suppressor gene WT1 on chromosome 11

Back 26

Wilms tumor

Front 27

WAGR complex

Back 27

Wilms tumor
Aniridia
Genitourinary malformation
mental-motor Retardation

Front 28

Most common tumor of urinary tract system (can occur in renal calyces, renal pelvis, ureters and bladder). Often recurs after removal. Presents with hematuria and may spread to adjacent tissue.

Back 28

Transitional cell carcinoma

Front 29

Transitional cell carcinoma associated with what conditions

Back 29

Pee SAC

Phenacetin
Smoking
Aniline dyes
Cyclophosphamide

Front 30

pH decreased

PCO2 decreased

Bicarb decreased

Acid base problem? Which is primary disturbance?

Back 30

Metabolic acidosis

Bicarb is primary

Front 31

Causes of metabolic acidosis

Back 31

DKA
Diarrhea
Lactic acidosis
Salicylate OD
Acetozolamide OD

Front 32

Compensatory response for metabolic acidosis

Back 32

Hyperventilation

Front 33

pH decreased

PCO2 increased

Bicarb increased

Acid-base problem? Which one is primary

Back 33

Respiratory acidosis

PCO2 is primary

Front 34

Causes of respiratory acidosis

Back 34

COPD, airway obstruction

Front 35

Compensatory response for respiratory acidosis

Back 35

Renal bicarb reabsorption

Front 36

pH increased

PCO2 decreased

Bicarb decreased

Acid base disturbance? Primary disturbance?

Back 36

Respiratory alkalosis

PCO2 is primary

Front 37

Causes of respiratory alkalosis

Back 37

High altitude and hyperventilation

Front 38

Compensatory response to respiratory alkalosis

Back 38

Renal bicarb secretion

Front 39

pH increased

PCO2 increased

HCO3 increased

Acid Base disturbance? Primary?

Back 39

Metabolic alkalosis

Bicarb primary

Front 40

Cause of metabolic alkalosis

Back 40

Vomitting

Front 41

Compensatory pattern for metabolic alkalosis

Back 41

Hypoventilation

Front 42

Henderson Hesselbach equation

Back 42

pH = pKa + log [HCO3]/ 0.03 PCO2

Front 43

pH < 7.4

PCO2 > 40

Diagnosis?

Back 43

Respiratory acidosis

Front 44

pH < 7.4

pCO2 < 40

Diagnosis

Back 44

Metabolic acidosis with compensation

Front 45

Patient is diagnosed with metabolic acidosis with compensation, you check anion gap and patient has increased anion gap - causes?

Back 45

MUD PILES

Methanol
Uremia
DKA

Paraldehyde (Phenoformin)
Irone tablets (INH)
Lactic acidosis
Ethylene glycol
Salicylates

Front 46

Anion gap

Back 46

Na - (Cl + HCO3)

Front 47

Patient with metabolic acidossi with compensation, check anion gap, its normal (8-12)

Causes?

Back 47

Diarrhea
Glue sniffing
Renal tubular acidosis
Hyperchloremia

Front 48

pH > 7.4

PCO2< 40

Diagnosis?

Back 48

Respiratory alkalosis (hyperventilation, aspirin ingestion early on)

Front 49

pH > 7.4

PCO2 > 40

Diagnosis

Back 49

Metabloic alkalosis (vomitting, diuretic use, antacid use, hyperaldosteronism)

Front 50

Affects cortex with relative sparing of glomeruli/vessels. White cell casts in urine are pathognomonic

Back 50

Acute pyelonephritis

Front 51

Coarse, asymmetric corticomedullary scarring, tubules can contain eosinophilic casts (thyroidization of kidney)

Back 51

Chronic pyelonephritis

Front 52

Acute generalized infarction of cortices of both kidneys, likely due to combination of vasospasm and DIC, associated with obstetric catastrophes and septic shock

Back 52

Diffuse cortical necrosis

Front 53

Most common cause of acute renal failure. Reversible but fatal if left untreated. Associated with renal ischemia (shock), crush injury (myoglobinuria), toxins. Death most often occurs during initial oliguric phase. Recovery in 2-3 weeks

GRANULAR CASTS IN URINE

Back 53

Acute tubular necrosis

Front 54

Renal papillary necrosis is associated with 3 conditions

Back 54

Diabetes mellitus

Acute pyelonephritis

Chronic phenacetin use

Front 55

Abrupt decline in renal function with increased creatinine and increased BUN over period of several days

Back 55

Acute renal failure

Front 56

3 types of acute renal failure

Back 56

Prerenal azotemia

Intrinsic renal

Postrenal

Front 57

Decreased RBF (hypotension) that results in decreased GFR. Na/H2O retained by kidneys

Back 57

Prerenal azotemia

Front 58

Generally due to acute tubular necrosis or ischemia/toxins, patchy necrosis leads to debris obstructing tubules and fluid backflow across necrotic tubule results in decreased GFR, urine has epithelial/granular casts

Back 58

Acute renal failure

Front 59

Caused by outflow obstruction (stones, BPH, neoplasm), develops only with bilateral obstruction

Back 59

Postrenal failure

Front 60

Name electrolyte disturbance

Disorientation, stupor, coma

Back 60

Low Na

Front 61

Name electrolyte disturbance

Neurologic - irritability, delirium, coma

Back 61

High Na

Front 62

Name electrolyte disturbance

2ndary to metabolic alkalosis

Back 62

Low Cl

Front 63

Name electrolyte disturbance

2ndary to non anion gap acidosis

Back 63

High Cl

Front 64

Name electrolyte disturbance

U waves on EKG, flattened T waves, arrhythmias, paralysis

Back 64

Low K

Front 65

Name electrolyte disturbance

Peaked T waves, arrhythmia

Back 65

High K

Front 66

Name electrolyte disturbance

Tetany, neuromuscular irritability

Back 66

Low Ca

Front 67

Name electrolyte disturbance

Delirium, renal stones, abdominal pain

Back 67

High Ca

Front 68

Name electrolyte disturbance

Neuromuscular irritability, arrhythmias

Back 68

Low Mg

Front 69

Name electrolyte disturbance

Delirium, decreased DTR, cardiopulmonary arrest

Back 69

High Mg

Front 70

Name electrolyte disturbance

Low mineral ion product causes bone loss

Back 70

Low PO4

Front 71

Name electrolyte disturbance

High mineral ion product metastatic calcification, renal stones

Back 71

High PO4