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37 Cards in this Set
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- Back
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mesangial expansion, glomerular basement membrane thickening, & glomerular sclerosis?
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diabetic nephropathy
if glomercular sclerosis is nodular --> kimmelstiel-wilson lesion (look up images) |
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what can nephropathies can occur from analgesic abuse?
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characterized by marked thickening of the vasa recta capillaries & intermittent tubular necrosis
eventually papillary necrosis, focal & segmental glomerulosclerosis, & interstitial infiltration and fibrosis can occur |
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heminephrectomy, what happens to other kidney GFR in response?
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increases so total GFR is ~80% of previous
4-6 weeks within 1 week already to 65-70% |
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what does bradykinin do to the kidney?
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produced by kidney when adrenergic/RAAS stimulated, locally constricts veins & dilates arterioles --> increse renal perfusion, metabolized by ACE
implicated as cause of angioedema (risk for pts on ACE inhibitors) |
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Inulin vs PAH?
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Inulin - estimates GFR
PAH - estimates Renal Perfusion |
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immunofluorescence lighting up neutrophil cytoplasm?
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that is a positive c-ANCA test
"cytoplastmic antineutrophil antibody" directed against lysozymal enzymes of human neutrophils & monocytes Wegener's hemoptysis & hematuria (RPGN type III) |
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pt w/MI is resuscitated, next day develop oliguria & muddy brown casts - where is damage most likely?
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Acute Tubular Necrosis - proximal tubules in thick ascending limb of Henle
MUDDY BROWN CASTS pathognomonic for ATN |
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muddy brown casts?
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acute tubular necrosis
proximal tubules most likely in ischemic causes |
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how does renal osteodystrophy work?
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Chronic renal dz
decreased phosphate excretion results in elevated serum levels, which bind up Ca++ decreasing its availability also, loss of parenchyma result in decrease calcitriol production (vitamin D) PTH rises (MCC 2ndary hyperPTH) causing bone resorption (renal osteodystrophy) - bone pain & signs of osteopenia & soft tissue calcification |
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what are calcitonin levels in chronic renal failure?
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despite relative hypocalcemia, calcitonin levels are increased b/c excretion of calcitonin is impaired
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excessive ACTH stimulation causes hypertrophy or hyperplasia of adrenals? Which layer?
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hyperPLASIA of zona fasciculata
Conn's dz (primary aldo) has hypertrophy of zona glomerulosa |
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findings in diabetes insipidus for serum Na? after deprivation test expect osms to be? Cutoff pt in response to ADH to distinguish central DI from nephrogenic?
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expect HYPERnatremic (>142) in someone w/DI
expect their urine osms to be < 300-500 after water deprivation test expect central DI to have > 50% increase in Uosms to ADH, and nephrogenic to have < 50% response **note, in primary polydipsia are HYPOnatremia, and response to ADH is < 10% increase in Uosms (unsure if this is b/c administered at end of water deprivation test necessarily, or if they're overloaded & ANP / BNP are overriding) |
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possible tx for nephrogenic DI?
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hydrochlorothiazide has a paradoxic antidiuretic effect in nephrogenic DI
indomethacin is sometimes used b/c prostaglandins inhibit ADH |
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hematuria in sickle cell trait? Also seen in?
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Papillary necrosis
also seen in - diabetes, analgesic nephropathy, severe obstructive pyelo "acute colickly flank pain, gross hematuria, passage of tissue fragments" |
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Renal cell carcinoma (clear cell) arises from what part of the kidney? What does it look like macroscopically? Microscopically?
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epithelial cells of proximal renal tubules
macro - golden yellow mass micro - cells w/abundant clear cytoplasm (lipid filled) & eccentric nuclei |
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what is the action of vasopressin on kidney?
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acts at V2 receptor mediating increased permeability to water AND UREA at the inner medullary collecting duct
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where is Calcium absorbed in the kidney?
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50-60% of Ca filtered is passively abosrbed in PROXIMAL TUBULAR paracellular pathway
further reabsorption occurs in distal tubule, dependent upon PTH |
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factors promoting renal calculi? Preventing?
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promoting - increased Ca, phosphate, oxalate, uric acid
prevent - increased citrate, high fluid acidification is necessary for formation of uric acid, cysteine, and calcium oxalate stones calcium phosphate stones are inhibited in acidic environments, require alkaline (struvite stones) |
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man w/colon cancer has nephrotic syndrome, glomerular capillary wall thickening w/o increased cellularity - what is wrong w/kidney? Other associations?
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membranous glomerulopathy
1.) systemic dz - diabetes, solid tumors (lung, colon), immunologic disorders (SLE) 2.) drugs - gold, penicillamine, NSAID 3.) infections - hep B, hep C, malaria, syphilis most cases are idopathic histology - uniform, diffuse thickening of glomerular capillary wall on light microscopy w/o increased cellularity dense deposits between basement membrane & epithelial cells, protrusions rememble "spikes" when stained w/silver - IgG and C3 |
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what happens to K+ at each portion of the kidney?
PCT loop Henle collecting duct |
PCT - absorption of ~2/3 of filtered K
loop of Henle - further reabsorption (~20% of filtered load) the above are at fixed rate, do not play significant role in regulation cortical collecting duct extra potassium is reabsorbed via H/K ATPases, but secretion can be promoted by: -high dietary K -aldosterone -alkalosis (to preserve H+, which freely exchanges) -thiazide diuretics (increased flow) potasium is regulated in cortical collecting ducts, other sites are relatively constant |
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antibiotic that can cause acute tubular necrosis?
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aminoglycosides
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cystic dilations of medullary collecting ducts? Complications?
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Medullary sponge kidney (MSK)
-relatively common, benign can get KIDNEY STONES, painless hematuria, or UTI DON’T confused w/ADPKD, cysts in ADPKD are not confined to the medullary ducts |
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recurrent kidney stones in young patient, urine sample shows hexagonal crystals (pathognomonic) and the sodium cyanide-nitroprusside test turns red/purple?
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Cystinuria
defect in renal proximal tubules, decreased resorption of aa cystine these crystals form in acidic urine tx is to alkalinize urine think about inborn error of metabolism w/recurrent kidney stones in young patient |
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patient w/anemia, kidney biopsy shows eosinophilic casts & atrophic tubules, elevated creatinine?
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Multiple Myeloma
eosinophilic casts = bence jones proteins precipitated w/Tamm Horsfall prtn (NOT eosinophilic CELLS) also are directly toxic to tubules, showing atrophy |
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what are the 3 types of Rapidly Progressing Glomerular Nephritis? Examples?
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RPGN 1 - anti-glomerular basement membrane antibodies
-linear GBM deposits of IgG & C3 found on immunoflourescense -Goodpastures RPGN2 - immune complex mediated -"lumpy bumpy" granular pattern of staining on immunofluorescence -post-strept glom neph, SLE, IgA nephropathy, or Henoch Schonliem RPGN 3 - "pauci immune", no immunoglobulin or complement deposition in BM -most pts have ANCA in the serum -granulomatosis w/polyangitis (Wegener's), can also be idiopathic |
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how to calculate flow thru a hollow tube?
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Flow = (P1 - P2) / R
where R = nL/r^4, n = viscosity |
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smoker w/tumor presents w/edema & severe proteinuria? Histology?
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Membranous glomerulonephritis assoc/solid tumors
glomc ap basement membrane thickened & displays spike-like projections from deposition of immune complexes in subepithelial space |
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patient with HIV, heroin, or sickle cell dz develops nephrotic syndrome?
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Focal Segmental Glomerulosclerosis
MC in hispanics & African Americans |
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patient w/lupus gets nephrotic syndrome?
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Membranous Nephropathy
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MCC nephrotic syndrome in caucasian adults?
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Membranous Nephropathy
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nephrotic syndrome w/hep B, C, or solid tumors?
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Membranous Nephropathy
or type 1 membranoproliferative (underneath endothelial) |
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Nephrotic syndrome w/some drugs? (NSAIDs, penicillamine)
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Membranous Nephropathy
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location of immune complex deposition and corresponding glomerulonephropathy?
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below foot processes, above endothelium - Membranous
within endothelium - Type II emmbranoproliferative (tram track) below endothelium - Type I membranoproliferative |
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how to think about the 6 nephrotic dz in groups of 2?
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1st group - foot processes, Minimal Change (kids after infection, associated w/Hodgkins) & focal segmental (HIV, heroin, sickle cell)
Immune complexes - membranous & membranoproliferative then diabetes & amyloid - diabetes is deposition of hyaline arterosclerosis, get big blebs in certain parts, tx w/ace i -amyloid get deposits in mesangium, apple green birefringence |
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cola colored urine?
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Post strept glomerular nephritis
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what does urine chloride help with?
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assessing volume status…weird question
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what is a condition that might mimic nephrogenic diabetes insipidus by its effects on kidney?
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Hypercalcemia
adversely affects renal concentrating ability & may produce polyuria, polydipsia, & dilute urine |
