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84 Cards in this Set
- Front
- Back
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ACUTE & CHRONIC
INTERSTITIAL NEPHRITIS - Characterized by what 2 pathologies? - Characterized by sparing what 2 anatomical structures? |
- Interstitial inflammation
- Tubular cell damage - Vascular structures - Glomeruli |
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ACUTE INTERSTITIAL NEPHRITIS
- occurs in 2 to 3% of all what? - now AIN is termed what? x2 |
- ALL renal biopsies
- Tubulointerstitial Nephritis or - Tubulointerstitial Nephropathy |
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ACUTE INTERSTITIAL NEPHRITIS
- MCC of AIN? (give %) - 1/3rd of the above MCC is what? |
- Drugs (71%)
- Antibiotics |
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ACUTE INTERSTITIAL NEPHRITIS
- #2 MCC? - #3 MCC? |
- infections (15%)
- idiopathic (8%) |
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ACUTE INTERSTITIAL NEPHRITIS
- #4 MCC & accounts for what %? - above is often presented how? x3 |
- TINU (5%)
(Tubulointerstitial Nephritis & Uveitis Syndrome) (UWA) - Uveitis - WBCs in urine - ARF |
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ACUTE INTERSTITIAL NEPHRITIS
- #5 MCC is what & what %? - above condition would present how? |
- Sarcoidosis (1%)
- Hyperkalemia - ARF - Granulomatous disease |
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ACUTE INTERSTITIAL NEPHRITIS
- list the drugs that can cause AIN? x10 |
(SPRAIN PM)
- Sulfonamides (inc.Bactrim & DIuretics) - PCN & Cephalosporins - Rifampin & Cipro - Allopurinol - Indinavir - NSAIDs - PPI - Mesalamine |
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ACUTE INTERSTITIAL NEPHRITIS
- what drug can cause AIN that is also used for Crohn's Disease? |
- Mesalamine
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ACUTE INTERSTITIAL NEPHRITIS
- AIN is dose dependent to what drug? - AIN can have what events occur when exposed 2nd time to same or similar drug? x2 |
- AIN is NOT dose dependent
- Reoccurences - Exacerbations |
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ACUTE INTERSTITIAL NEPHRITIS
- list the 5 pathologies associated |
(SMITE)
- Sparing of Glomeruli - Mononuclear infiltrates (varying degrees & distribution) - Interstial Volume increase (edema) - Tubular injury & degeneration - Eosinophils increase (likely with Abx-induced AIN) |
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ACUTE INTERSTITIAL NEPHRITIS
- what pathology varies in degrees & distribution? - what pathology is basically edema? - what pathology is associated with Antibiotic-induced AIN? |
- Mononulcear Infiltrates
- Interstitial volume increase - Eosinophils |
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ACUTE INTERSTITIAL NEPHRITIS
CLINICAL FEATURES - Describe the Signs & Symptoms of AIN |
- Variable
(Asymptomatic to ARF S/S) |
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ACUTE INTERSTITIAL NEPHRITIS
CLINICAL FEATURES - Describe the onset of AIN - What is the onset correlation with time after exposure? |
- Classically several days after exposure
- No absolute correlation with time post exposure |
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ACUTE INTERSTITIAL NEPHRITIS
CLINICAL FEATURES - Clinical Features (Triad) associated with DRUG-Induced AIN. x3 |
(Drugs induced by REFs)
- Rash - Eosinophilia - Fever |
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ACUTE INTERSTITIAL NEPHRITIS
LABS - generally list 6 lab results that suggest AIN |
(Labs ain't makin' Acute & PURE girls)
- Acute Renal Failure labs - Proteinuria - UA with RBC/WBC/WBC casts - RTA - Eosinophils in blood - Eosinophils in urine |
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ACUTE INTERSTITIAL NEPHRITIS
LABS - Flashback to L16: ARF labs is defined how? |
- Serum Creatinine increase above baseline
(0.5 if 1-2, 1.0 if 2-5, 1.5 if >5) |
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ACUTE INTERSTITIAL NEPHRITIS
LABS - describe the proteinuria in AIN |
- usually mild if AIN alone (< 1 g)
(shows up as +1 on dipstick usually) |
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ACUTE INTERSTITIAL NEPHRITIS
LABS - what would you see in the UA? x4 |
Any combo of:
- RBC - WBC (esp.) - WBC casts (esp.) - Eosinophils |
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ACUTE INTERSTITIAL NEPHRITIS
LABS - Eosinophils in urine is stained with? x2 |
- Hansels stain
- Wrights stain |
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ACUTE INTERSTITIAL NEPHRITIS
LABS - Renal Tubular Acidosis (RTA) labs are usually characterized how? |
- Low Serum Bicarb
with - Low Anion Gap |
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ACUTE INTERSTITIAL NEPHRITIS
DIAGNOSIS - mainly done how? x2 - confirmation (or alternate Dx method) how? - what imaging can you use? |
- History
- Supportive Labs - Steroid therapy - Gallium scan (not routinely done) |
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ACUTE INTERSTITIAL NEPHRITIS
DIAGNOSIS - Definitive diagnosis is done how? |
- Biopsy
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ACUTE INTERSTITIAL NEPHRITIS
DIAGNOSIS - though not routine, a Gallium scan is a nuclear medicine scan that will light up what? - helpful how? |
- WBC in kidney
(b/c its inflammatory process goin' on) - differentiates other causes of ARF like ATN, which does not light up. |
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ACUTE INTERSTITIAL NEPHRITIS
TREATMENT - First thing if you suspect allergic AIN? - what if above doesn't work and you are still sure of Dx? - Final, and experimental, last ditch effort? |
- Stop the offending agent
- Steroids - Immunosuppressants |
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CHRONIC TUBULOINTERSTITIAL NEPHRITIS
- define - involves what anatomical structures? x2 - describe the injury. x2 |
- chronic STRUCTURAL abnormality
- Renal tubules - Interstitium - Progressive Glomerular injury - Progressive Vascular injury |
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CHRONIC TUBULOINTERSTITIAL NEPHRITIS
- commonly associated with what other condition. (give %) |
- ESRD
(15 to 30%) |
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CHRONIC TUBULOINTERSTITIAL NEPHRITIS
- usually involves what prolonged history? |
- Exposure to Therapeutics or Environmental Agents
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CHRONIC TUBULOINTERSTITIAL NEPHRITIS
- pathology seen x3 |
(MIT)
- Mononuclear cell infiltrate in interstitium - Interstitial Edema - Tubular Basement membrane disruption |
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CHRONIC TUBULOINTERSTITIAL NEPHRITIS
- Chronicity is reflected by the presence of what? x3 |
(Chronic makes you FAT)
- Fibrosis - Atrophy - Tubular Ectasia |
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CHRONIC TUBULOINTERSTITIAL NEPHRITIS
- Eventually, chronic pathology will involve what changes in the kidney? x2 - which parts of the kidney are involved? |
- Fibrotic changes
- Sclerotic changes - Entire kidney is involved (usually smaller in US due to atrophy) |
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CHRONIC TUBULOINTERSTITIAL NEPHRITIS
- List the Therapeutic / Environmental agents that can cause CIN. x6 |
(Chronic after watching ACC & NHL)
- Analgesics - Cisplatin, Nitrosourea - Cyclosporin, Tacrolimus - NSAIDs - Heavy metals - Lithium |
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CHRONIC TUBULOINTERSTITIAL NEPHRITIS
- what heavy metal exposure over a prolonged period may cause CIN? x2 |
- Lead
- Cadmium |
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CHRONIC TUBULOINTERSTITIAL NEPHRITIS
- Immunologic conditions that can cause CIN. x7 |
(CRASS VW)
- Cryoglobulinemia - Renal allograft rejection - Amyloid - SLE - Sjogrens's syndrome - Vasculitis - Wegener's granulomatosus |
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CHRONIC TUBULOINTERSTITIAL NEPHRITIS
- Hematopoietic / Neoplastic causes of CIN. x4 |
(SMaLL)
- Sickle cell disease - Multiple Myeloma also - Light chain disease - Lymphoproliferative disease |
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CHRONIC TUBULOINTERSTITIAL NEPHRITIS
- Vascular diseases that causes CIN? x3 |
(Vascular HAR HAR!)
- HTN - Atheromatous emboli - Radiation nephritis |
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CHRONIC TUBULOINTERSTITIAL NEPHRITIS
- Hereditary / Genetic causes of CIN x3 |
(genetic means get an MPH)
- Medullary Cystic Dz - PKD - Hereditary Nephritis |
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CHRONIC TUBULOINTERSTITIAL NEPHRITIS
- Miscellaneous Diseases x4 |
- Chinese Herb nephropathy
- Balkan nephropathy - Sarcoidosis - Hypercalcemia |
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CIN : CLINICAL FEATURES
- Clinical features usually vary with what? x3 |
- Extent of Injury (diffuse or focal)
- Tubular segment (proximal or distal) - Degree of compensation (uninvolved segments) |
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CIN : CLINICAL FEATURES
- 2 Tubular segment types involved |
- Proximal
- Distal |
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CIN : CLINICAL FEATURES
- In Proximal CIN, what would you expect to see elevated in the urine? |
(Pro Chronic sold by US GAL)
- Uric acid - Sodium - Glucose - Amino acid - LMW protein |
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CIN : CLINICAL FEATURES
- in Proximal CIN, it can be associated with what other renal condition? - what is seen in the urine? |
- Proximal RTA
- Bicarbonaturia (w/ low serum anion gap) |
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CIN : CLINICAL FEATURES
- Renal defects from Distal CIN. - Urine expectancy from Distal CIN x2 |
- Concentration & Dilution Defect
Decreased EXCRETION of: - Titratable Acids - Urinary NH3 |
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CIN : CLINICAL FEATURES
- Distal CIN is also known as? |
- Type IV RTA
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CHRONIC INTERSTITIAL NEPHRITIS
URINALYSIS - what would you expect in the UA? x4 |
(CIN = PW LL)
- Proteinuria (trace to 1+) - WBC (occasional WBC casts or Granular casts) - Low Specific gravity - LMW Proteinuria |
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CHRONIC INTERSTITIAL NEPHRITIS
URINALYSIS - describe the proteinuria seen on UA in CIN. x3 |
Trace to 1+ on dipstick
< 1 g / 24 hour LMW proteinuria |
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CHRONIC INTERSTITIAL NEPHRITIS
URINALYSIS - what type of cells would you expect on UA in CIN? - what about Casts? is so what kind? |
- WBC
- occasionally see casts - WBC casts - Granular casts (from interstitial damage) |
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CHRONIC INTERSTITIAL NEPHRITIS
URINALYSIS - Low Specific Gravity suggests what defect? - Low MW proteinuria is associated with what protein specifically in CIN? |
- Concentration defect
- B2 Microglobin |
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LITHIUM
- list the renal diseases associated with Lithium x5 |
(Lithium for crazy CD ANN)
- CIN - Distal RTA - ATN - Nephrotic Syndrome - Nephrogenic Diabetes Insipidus |
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LITHIUM
- why does Lithium cause ATN? |
- due to Acute Lithium Toxicity
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LITHIUM
- why does Lithium cause Nephrotic Syndrome? |
- due to Minimal Change Disease
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RENAL PAPILLARY NECROSIS
- list the causes for RPN in order of MCC to LCC x6 |
(DU ASAP)
- DM (50-60%) - UTI (10-40%) - Analgesic Abuse (15 - 20%) - Sickle cell disease (10 - 15%) - Allograft Rejection (renals) (< 5%) - Pyelonephritis (<5%) |
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RENAL PAPILLARY NECROSIS
- discuss 2 things about the renal Papillary that predisposes it to RPN |
- Papillary tip has Small Terminal BV
- Poor blood supply to Papilla compared to rest of kidney |
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RENAL PAPILLARY NECROSIS
- what TYPES of diseases predispose to RPN? - give 2 examples of above type |
- Small vessel Occlusive Diseases
(or any vasocclusive dz) - DM |
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RENAL PAPILLARY NECROSIS
- describe the Papillary Tip normally - in RPN, what occurs at the Papillary Tip? |
- Small terminal BV
- Solutes & Nephrotoxins concentrate at the papillary tip |
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RENAL PAPILLARY NECROSIS
- list 3 things that can concentrate at the renal tip |
(My Tip Concentrates on that ASS)
- Analgesics (nephrotoxin) - Salicylates (nephrotoxin) - Solutes |
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RENAL PAPILLARY NECROSIS
- what imaging modality can help diagnose RPN? x2 - what is seen in the image? |
("RP"N = "R"etrograde "P"yelography)
- IV Urography (aka - IVP) - Retrograte Urography (aka RP) ("R"PN = "R"ing) - "Ring sign" |
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RENAL PAPILLARY NECROSIS
- what imaging modalities are considered less sensitive when compared to IV or Retrograde Urography (IVP or Retrograde Pyelography)? x2 |
- CT
- US |
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RENAL PAPILLARY NECROSIS
TREATMENT - Treatment involves what? x5 |
(DARTH)
- DM control - Analgesic avoidance - Relief of obstruction - Treatment of Infection - HTN control |
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RENAL PAPILLARY NECROSIS
TREATMENT - Control of HTN involves avoidance of what? x2 - what else should be avoided in general if someone has RPN |
- ACE-Inhibitors
- Beta-Blockers - Analgesics |
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CHINESE HERB NEPHROPATHY
- involves what herb compound? - pathology? - prognosis? |
- Aristolochic Acid
- Severe Interstitial Fibrosis - Generally IRREVERSIBLE |
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CHINESE HERB NEPHROPATHY
- Increased incidence of what bad conditions? - above condition occurs where? |
- Transition Cell Carcinoma
- Entire GU Tract |
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POLYCYSTIC KIDNEY DISEASE
- Most common what? - incidence? - probability of Dx? |
- Life Threatening Hereditary Dz
- 1 in 400 to 1000 live births - Less than HALF diagnosed during lifetime |
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POLYCYSTIC KIDNEY DISEASE
- PKD1 locus where? - PKD1 locus accounts for what % - PKD2 locus where? - PKD2 locus accounts for what % |
- Chr. 16
- 85% of families - Chr. 4 - 15% of families |
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POLYCYSTIC KIDNEY DISEASE
CLINICAL FEATURES - Clinical Features RENALLY. x5 |
(Rena is very FUR HH)
- Flank pain (acute & chronic) - Urinary Concentration ability decrease - Renal cysts - HTN - Hematuria |
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POLYCYSTIC KIDNEY DISEASE
CLINICAL FEATURES - Clinical Features EXTRA-renally. x6 |
(Extras for the CA VALID)
- Cerebral Aneurysms - Valvular Dz (cardiac) - Abdominal Wall HERNIA - Liver Cysts - Inguinal HERNIA - Diverticula (Colonic) |
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POLYCYSTIC KIDNEY DISEASE
DIAGNOSIS - diagnostic criteria for what 3 age ranges? |
15 to 30 y.o.:
30 to 59 y.o. > 60 to |
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POLYCYSTIC KIDNEY DISEASE
DIAGNOSIS - ADPKD Dx for 15 to 30 y.o.? - ADPKD Dx for 30 to 59 y.o.? - ADPKD Dx for > 60 y.o.? |
- 2 Unilateral cysts
- Bilateral cysts - 2 cysts in Each kidney - 4 cysts in Each kidney |
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POLYCYSTIC KIDNEY DISEASE
DIAGNOSIS - what is the US sensitivity for 15 to 30 year olds? - as pt gets older, describe the sensitivity - above sensitivity changes occur especially for which PKD Type? |
- 95% sensitivity
- Older the patient, the greater the US sensitivity - Especially for Type 1 |
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POLYCYSTIC KIDNEY DISEASE
DIAGNOSIS - Type 2 Dz often require what after US? - for what purpose? |
- Genetic Testing
- Confirmation |
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POLYCYSTIC KIDNEY DISEASE
DIAGNOSIS - what is the primary imaging modality for PKD? - any other options? x2 - above 2 options reliably detects what? - above 2 options useful when? |
- Ultrasound (US)
- Contrast enhanced CT - Contrast enhanced MRI - for 2 to 3 mm cysts - useful when US equivocal BUT there is NO Consensus about testing order |
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POLYCYSTIC KIDNEY DISEASE
SCREENING - Screening protocol changes based on? |
- Family history
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POLYCYSTIC KIDNEY DISEASE
SCREENING - in POSITIVE Family history, what is the primary screening used? - secondary screening? - when use secondary screening |
- US
- Genetic testing (Linkage/DNA analysis) - Required in Younger Patients in whom US does NOT Confirm |
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POLYCYSTIC KIDNEY DISEASE
SCREENING - Even with Positive History, Screening is NOT recommended for whom? - why? |
- Not recommended if < 18 y.o.
- Consequences far outweight benefits since NO Effective therapy |
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POLYCYSTIC KIDNEY DISEASE
SCREENING - for Positive History patients, what must you watch out for that is often underrecognized? |
- HTN
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POLYCYSTIC KIDNEY DISEASE
SCREENING - describe the scenario for a Negative Family History |
- Inherited Dz, but the parent Dead or Living with Mild form of Disease
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POLYCYSTIC KIDNEY DISEASE
SCREENING - what % of PKD with someone with a Negative Family Hx, has New Mutations? |
- 5%
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POLYCYSTIC KIDNEY DISEASE
SCREENING - with Negative Family Hx, what is the definitive diagnostic criteria? |
- There is none
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POLYCYSTIC KIDNEY DISEASE
SCREENING - with Negative Family Hx, the Diagnosis is Suggested by? x4 |
(Suggested Saved by the BELL)
- Bilateral cysts - Enlarged Kidney - Lots of (several) cysts - Liver cysts |
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POLYCYSTIC KIDNEY DISEASE
SCREENING - Complications of PKD x6 |
(Complication can occur @ LE RR IN)
- LVH with CHF - ESRD - Rupture of Intracranial Aneurysm with ICH - Rupture of Cyst with Hemorrhage - Infection of Cyst - Nephrolithiasis (hematuria, stone, colic) |
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POLYCYSTIC KIDNEY DISEASE
TREATMENT - what is involved for the ways of treating? x6 |
(SHIRE Extra)
- Screening for early dx - HTN control - Infection of cyst treatment - Renal Stone prevention - ESRD treatment - Extra-renal manifestation treatement |
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POLYCYSTIC KIDNEY DISEASE
TREATMENT - in HTN control, what is the target for BP? |
- less than 130 / 85
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POLYCYSTIC KIDNEY DISEASE
TREATMENT - for treating an Infection of a Cyst, what 2 options are there for drugs that can be used? - duration of therapy? |
(CysT)
- Ciprofloxacin - TMP-SX - 6 weeks |
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POLYCYSTIC KIDNEY DISEASE
TREATMENT - Renal Stone Prevention done with? |
(Prevention by PO Potassium)
PO K-citrate supplementation |
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POLYCYSTIC KIDNEY DISEASE
TREATMENT - ESRD treatment with what? x3 |
- HD
- PD - Renal Transplantation |
