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30 Cards in this Set
- Front
- Back
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How is pitting edema graded? |
Press on a bony protuberance for 5 seconds. 2mm is grade 1 and each grade is an additional 2 mm. |
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What are hyaline casts? |
Tamm-Horsfall protein agglutination in nephron tubule that manifests in urine as a result of glomerular disease |
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What is reduced when serum BUN and creatinine are high? |
Glomerular Filtration Rate |
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Why would heart failure lead to edema? |
Venous hydrostatic pressure increases as a result of heart failure |
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What is a sign of glomerular damage in the kidney? (2) |
Large proteins and RBCs in urine |
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How is asymptomatic hematuria and proteinuria detected? (2) |
>2 RBCs per high-power field and protein in urine; dysmorphic (aka Mickey Mouse) RBCs (20%)
(acanthocytes may be seen too) |
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What does a red blood cell cast in urine indicate? |
RBCs are from the glomerulus, because the cast came from the nephron tubule. |
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What diagnoses may lead to dysmorphic RBCs in urine? (2) |
IgA nephropathy or thin basement membrane disease leading to small breaks in the BM |
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How much protein in urine per day puts a patient in the category of nephrotic proteinuria? |
>3.5g/day |
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What is a normal amount of protein in urine per day? albumin? |
<150 mg/day in which <30 mg/day is albumin |
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What is microalbuminuria? |
Urine albumin of 30-300 mg/day detected by special dipsticks or assays that detect early diabetic nephropathy and CV risk in patients with HTN |
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How is proteinuria standardized for number of times a patient urinates daily? |
Divide urine protein concentration with serum creatinine |
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What are 3 categories of overt proteinuria? |
1) Overflow proteinuria: multiple myeloma 2) Tubular proteinuria: tubulointerstitial disease 3) Glomerular proteinuria: abnormal filtration of albumin |
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Describe Functional Proteinuria. |
Transient and benign, usually with fever, heart failure, post-exercise due to increased nephron flow and pressure |
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Describe orthostatic proteinuria. |
Usually in children and young adults, no protein in urine in morning due to lying supine during sleep, but present after standing; benign |
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Describe Glomerular Proteinuria. |
Damage to the glomerulus, may need biopsy |
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What are the 5 clinical presentations of Nephrotic Syndrome? |
1) Proteinuria (>3.5g/day) 2) Hypoalbuminemia (<3.5g/dL) 3) Edema 4) Hypercholesterolemia 5) Lipiduria |
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Why does the liver make VLDL as a result of proteinuria in nephrotic syndrome? |
To compensate for loss of oncotic pressure in blood |
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What complications occur as a result of nephrotic syndrome? (6) |
1) Severe edema 2) Malnutrition 3) Hypercoagubility 4) Hyperlipidemia 5) Infection 6) Vitamin D Deficiency |
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What does urine look like from a patient with Nephritic syndrome? |
Coca-cola or dark tea colored urine |
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What causes the dark urine presentation in nephritic syndrome? |
microscopic hematuria and RBC casts |
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What are the clinical presentations of nephritic syndrome? (5) |
- coca-cola urine - proteinuria - hypertension - slight edema (periorbital) - decreased GFR (increasing creatinine) |
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Can nephritic syndrome present without hematuria? |
No |
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Which glomerular disease constitutes a nephrological emergency? |
Rapidly Progressive Glomerulonephritis (RPGN) |
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Why is the glomerulus leaking protein and blood during RPGN? |
Either an immune response attacking the glomerulus or high pressure injury both leading to fibrosis |
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How do mesangial cells respond to glomerular damage? |
production of cytokines |
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How does an immune complex disease affect podocytes? |
Saturates them |
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What is the crescent seen under histology for RPGN? |
fibrosis |
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What growth factors are produced as a response of glomerular damage? (3) |
- TGF-beta - PDGF - VEGF |
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What changes the basement membrane charge in the glomerulus? |
Cytokines |
