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98 Cards in this Set

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  • Back
What are podocytes?
visceral epithelial cells
What are the spaces between the podocytes called?
split pores
Which cells synthesis the glomerular BM?
visceral epithelial cells (podocytes)
What keeps albumin out of urine?
strong negative charge of Glomerular BM
What is responsible for charge of GBM?
Heparan Sulfate (strong negative charge)
damage to visceral epithelial cell results in what?
damage to BM and leaking of albumin into urine --> nephrotic syndrome
linear pattern outlining BM on Immunofluorescence
goodpasture syndrome
subendothelial immune complex deposits in glomeruli on EM (granular)
lupus
subepithelial immune complex deposits in glomeruli EM (granular)
post-strep glomerulonephritis
only glomerulonephritis one can diagnose with IF
IgA glomerulonephritis
granular pattern on IF. what does it mean?
immunocomplex type III disease
anti BM antibodies is what type of immune complex disease?
Type II
RBC casts in urine is unique to what class of diseases
nephritic syndromes
serum ANA shows rim pattern. what does that mean?
anti-DNA --> lupus
crescentic glomerulonephritis is most commonly seen in what syndrome?
goodpasture's syndrome
cholesterol casts in urine that when polarized look like maltese crosses. what is the diagnosis?
nephrotic syndrome
why does lipoid nephrosis occur (Minimal change disease)?
loss of negative charge of GBM
Nephrotic syndrome associated with HIV
FSGS
glomerular problem in HBV
diffuse membraneous glomerulonephritis
glomerular problem in HCV
Membranoproliferative glomerulonephritis
vasculitis associated with HBV
polyarteritis nodosa
large golf-ball appearing glomeruli on H&E
diabetic nephropathy
what happens to the GFR and creatinine clearance in early diabetic nephropathy?
hyalinization of efferent arterioles, so Cr clearance and GFR increase. Also nonenzymatic glycosylation of BM cause microalbuminuria
ACE inhibitors do what to glomerular arterioles?
less angiotensin II dilates efferent arteriole
mesangial cells split BM on EM. C3 deposited adjacent to but not within dense deposits. serum C3 is very low. what is the diagnosis?
Type II membranoproliferative glomerulonephritis
properties of BUN
blood urea nitrogen - secreted and reabsorbed in PCT
properties of Creatinine
end-product of creatine - only filtered in kidney, neither reabsorbed nor secreted in kidney (can be in other places in very high levels)
normal BUN and Cr levels
BUN - 9-10
Cr - 1 mg/dl
normal BUN/Cr
10
pre-renal azotemia
normal kidneys, but reduced Cardiac Output (e.g. CHF), ergo, GFR decreases. BUN/Cr >15
renal failure (oliguria, renal tubular casts)
affects BUN and Cr equally (increased BUN and Cr in equal proportion) BUN/Cr normal (10/1)
most common cause of acute renal failure
ischemic acute tubular necrosis
Cardiac output decreases and oliguria, what do you worry about most?
ischemic acute tubular necrosis
most common cause of ischemic acute tubular necrosis
not treating pre-renal azotemia
BUN:Cr ~ 10:1 with oliguria and renal tubular casts
acute tubular necrosis
Why does acute tubular necrosis have such a bad diagnosis?
ischemic cause also destroys basement membrane --> loss of structure --> can't regenerate renal tubular cell w/o BM. Even if one recovers, can never recover normal function
What parts of nephron is most susceptible to ischemia?
straight portion of proximal tubule and thick ascending limb (medullary part). Affects Na/K/Cl co-transport
Nephrotoxic drugs...what are they and where do they affect? prognosis?
gentamicin (aminoglycocides), dye from IV pyelograms; damages proximal tubule. prognosis good because they don't damage BM.
How do you separate pyelonephritis from low UTIs?
acute pyelonephritis is infection of kidney proper and has fever with flank pain (CVA tenderness) and WBC casts
what is the mechanism of all UTIs
ascending infection from introitus of urethra.
scarred kidney with blunted calyces (beneath scarring)
chronic pyelonephritis
fever with rash, oliguria, eosinophiluria after starting drug
acute drug-induced interstitial nephritis (methicillin)
what kinds of hypersensitivity are associated with acute drug-induced interstitial nephritis?
combination of type I and type IV hypersensitivities
empty space on IV pyelogram
analgesic nephropathy from acetaminophen and aspirin combo therapy long-term
what is the mechanism of analgesic nephropathy?
acetaminophen --> produces free radicals that damage tubular cells of medulla
aspirin blocks PGE2 so Angiotensin II is unopposed and peritubular capillaries have decreased blood flow causing ischemia in renal papillaries
causes of renal papillary necrosis
aspirin/acetaminophen long-term, diabetes, sickle-cell disease, acute pyelonephritis (from abscess formation)
BUN/Cr >10 for more than 3 months. what is the diagnosis?
Chronic renal failure
results of chronic renal failure
anemia, anion-gap metabolic acidosis, osteoporosis, osteomalacia, secondary hyperparathyroidism
uncontrolled essential hypertension (over ten years) causes what?
nephrosclerosis --> hyaline arteriolosclerosis (cobblestone appearance of kidney)
person with uncontrolled HTN, wakes up with bad HA, dizzy, blurred vision, BP 240/140, papilledema and flamed hemorrhages, hard and soft exudates, BUN/Cr 80/8. what is diagnosis?
malignant hypertension (shows petechia visible on surface of kidney)
Treatment of malignant hypertension?
IV nitroprusside
pale, depressed-looking lesions on gross examination of kidney. what do you see on LM?
pale infarction --> coagulation necrosis
causes of pale infarcts in kidneys in a patient with irregular irregular pulse?
A-fib, causes thromboemboli
little white dots and microabscesses on gross exam of kidneys probably caused by what?
pyelonephritis
hydronephrosis and increased pressure have what affect on renal cortex and medulla?
compression atrophy
staghorn calculi, alkaline urine and smells of ammonia, what is the cause?
urease (+) bacteria: proteus, klebsiella, staph
most common cause of compression atrophy?
stone
what is the composition of staghorn calculi
magnesium ammonium phosphate
mass in kidney adult what is it?
renal adenocarcinoma
mass in kidney in kid with hypertension?
wilm's tumor
cause of renal adenocarcinoma?
derived from proximal tubule; most common cause is smoking
what are results of renal adenocarcinoma?
produce ectopic EPO, PTH-like peptide, and like to invade renal vein
why hypertension in kid with Wilm's tumor?
the tumor makes renin
findings in Wilm's tumor?
embryonic kidney structures; aniridia and hemi-hypertrophy of an extremity --> sign that Wilm's tumor has genetic basis
genetic abnormality in Wilm's tumor?
WT-1 tumor-suppressor gene on chrom 11. AD
most common organism in cystitis?
E. coli
patient with increased urinary frequency, has positive leukocyte esterase, dysuria, neutrophils in urine, negative bacterial culture, negative nitrites. what is diagnosis?
Chlamydia
causes of sterile pyuria?
chlamydia, TB
most common cause of transitional cell carcinoma of bladder?
smoking
cyclophosphamide is used to treat what?
Wegener's
cyclophosphamide toxicity is prevented by what?
Mesna
hypospadias is caused by what?
failure of closure of urethral folds
most common cancer of penis is what? What is most common cause?
squamous cell carcinoma due to lack of hygiene in uncircumcised penis. (shmegma)
what are two phases of testicular descent?
tans-abdominal migration caused by mullerian inhibitory factor, and shortening of gubernaculum due to testosterone and dihydrotestosterone
undescended testicles before 2 years increased risk for what?
seminomas in both testicles (even if appears normal)
streak ovaries put woman at risk for what?
dysgerminomas
epididymitis at age <35 due to what?
neisseria gonorrhea, chlamydia
epididymitis at ages >35 due to what?
pseudomonas, E. coli
vericocoeles on what side and why?
left, due to the spermatic vein on left is connected to left renal vein.
most common cause of male infertility
vericocoele
what would happen if you block left renal vein?
increases pressure on spermatic vein and causes vericocoele.
torsion of spermatic cord causes what?
shortens the cord, so the testicle ascends into inguinal canal; pain; loss of cremasteric reflex
what is cremasteric reflex?
scratching of scrotum causes the cremaster muscle to contract
hydrocoele is what?
persistence of tunica vaginalis
painless enlargement of testicle has what on it's differential?
cancer, cancer, cancer, cancer
most common cause of testicular cancer
seminoma --> highly responsive to radiation
where do seminomas metastacize?
para-aortic LNs
most common testicular tumor in kid? what's the tumor marker?
yolk sac tumor (Alpha fetoprotein)
25 y/o male presents with unilateral gynecomastia and dyspnea. X-ray of lung shows numerous nodular masses. Where is the primary tumor and what kind?
choriocarcinoma of testicle
why do choriocarcinomas develop gynecomastia?
B-HCG is a leutinizing hormone analog --> acts like leutenizing hormone, so stimulates progesterone and causes duct growth in breast tissue
most common cause of testicular cancer in older men?
malignant lymphoma metastaces
where in prostate gland does hyperplasia occur?
periurethral area
where in prostate gland is cancer located?
periphery (that's why you can feel it with your finger on rectal)
75 y/o man has urinary retention and massive bladder with dribbling urine. what is cause?
BPH.
what hormone is totally responsible for prostate?
dihydrotestosterone
BPH and prostate cancer is under the control of what hormone?
dihydrotestosterone
how do you treat prostate cancer and BPH
5-alpha-reductase inhibitor
most common cancer in men?
prostate cancer