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59 Cards in this Set

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Potter's syndrome
bilateral renal agenesis-->oligohydramnios-->limb deformities, facial deformities, pulm hypoplasia
caused by malformation of utereric bud
Horseshoe kidney
inf poles of kidneys fuse; get trapped under IMA and remain low in abdomen
RBC casts
glomerular inflammation (nephrotic syndromes), ischemia, malignant hypertension
WBC casts
pyelonephritis, AIN
bacterial casts
pyelonephritis
epithelial cell cast
renal tubular damage
waxy cast
stasis of urine flow
advanced renal disease, CRF
fatty cast
nephrotic syndrome
granular cast
N/S, ATN
nephritic syndrome
hematuria, hypertension, oliguria, azotemia, mild proteinuria
PSGN
LM: glomeruli enlarged and hypercellular, neutrophils, lumpy bumpy
EM: subepi humps
IF: granular pattern
most often in children; peripheral and periorbital edema
RPGN (cresentic)
LM and IF: crescent moon shape
rapid course to renal failure
number of crescents indicates prognosis
Goodpastures (type II HS)
IF: linear pattern, anti-GBM AB
hemoptysis and hematuria
MPGN
EM: subendo humps, tram track
slow progress to renal failure
IgA nephropathy (Bergers)
IF and EM: mesangial deposits of IgA
mild disease, often post infectious
Alports
split basement membrane
collagen IV mutation
nerve deafness and ocular disorders
Nephrotic syndrome
massive proteinuria, hypoalbuminemia, peripheral and periorbital edema, hyperlipidemia (fatty casts)
membranous GN
LM: diffuse capillary and BM thickening
IF: granular pattern
EM: spike and dome
most common cause of adult nephrotic syndrome
MCD (lipoid nephrosis)
LM: normal glomeruli
EM: foot process effacement
most common cause of childhood nephrotic syndrome, responds well to steroids
FSGS
LM: segmental sclerossi and hyalinosis, more severe in HIV pts
Diabetic nephropathy
LM: Kimmelstiel Wilson wire loop lesions, BM thickening
expansion of mesangial matrix
SLE
LM: in membranous glomerulonephritis pattern, wire loop lesion with subendo deposits
Amyloidosis
IF: congo red stain, apple green birefringence
assoc with multiple myeloma, chronic conditions, TB, RA
Ca kidney stone
most common; CaOx or CaP
conditions that cause hyperCa
radioopaque
Struvite kidney stone
Ammonium magnesium phosphate
caused by infection with urease positive bugs (Proteus, Staph, Kleb)
staghorn calculi
radioopaque, worsened by alkaluria
Uric acid kidney stones
assoc with hyperuricemia or result of disease with increased cell turnover
radiolucent
worsened by aciduria
cysteine kidney stones
radioopaque
tx with bicarb
RCC
men 50-70; increased incidenced with smoking and obesity
assoc with VHL
hematuria, palpable mass, polycythemia, flank pain, fever, weight loss; heme spread by IVC
RCC paraneoplastic syndromes
ectopic EPO, ACTH, PTHrP and prolactin
Wilms tumor
ages 2-4; presents with huge palpable flank mass, hemihypertrophy; deletion of TSG WT1 on chromo 11; can be part of WAGR complex- Wilms tumor, aniridia, genitourinary malformation, MR
transitional cell carc
most common tumor of urinary tract system; painless hematuria
assoc: phenacetin, smoking, aniline dyes, cyclophosphamide, schistosomiasis
Pyelonephritis- acute
affects cortex with sparing of glomeruli/vessels
white cell casts in urine
fever, CVA tenderness
Pyelonephritis- chronic
coarse, assym corticomedullary scarring, blunted calyx; tubules contain eosinophilic casts (thyroidization of kidney)
DCN
acute generalized infarction of cortices of both kidneys; likely due to a combination of vasospasm and DIC
assoc with obstetic catastrophes and septic shock
drug induced interstitial nephritis (AIN)
acute interstitial renal inflammation
fever, rash, eosinophilia, hematuria 2 weeks after admin; drugs act as haptens inducing HS
drugs causing AIN
sulfa, cephalo, cipro, cimetidine, allopurinol, PPI, indinavir, salicylates
ATN
most common cause of ARF; reversible but fatal if untreated; assoc with renal ischemia (shock), crush injury (myoglobulinuria), toxins (AG, cephalo, polymixins, contrast dye)
ATN pathogenesis
loss of cell polaritiy, epithelial cell detachment, necrosis, granular casts
stages: inciting event, maintenance, recovery
death in oliguric phase
renal papillary necrosis associated with
diabetes, acute pyelonephritis, chronic phenacetin due, sickle ccell anemia
fanconi's syndrome
defect in proximal tubule transport of AA, glucose, phosphate, uric acid, protein and electrolytes
assoc with Rickets, osteomalacia, hypokalemia, met acid
APKD
multiple, large bilateral cysts that ultimately destroy parenchyma; presents with flank pain, hematuia, HTN, urinary infection, progressive renal failure
AD
assoc with polycystic liver dz, berry aneurysms, mitral valve prolapse
Infantile PKD
infantile presentation in parenchyma; AR
assoc with hepatic cysts and fibrosis
dialysis cysts
cortical and medulalry cysts resulting from long standing dialysis
simple cysts
benign, incidental finding
cortex only
medullary cystic disease
medullary cysts
U/S: small kidney
poor prognosis
medullary sponge disease
collecting duct cysts; good prognosis
low Na
disorientation, stupor, coma
high Na
neuro: irritability, delirum, coma
if you correct Na too quickly
central pontine myelinosis
low Cl
secondary to met alka
high Cl
secondary to non anion gap acidosis
low K
U waves on ECG; flattened T waves, arrythmias, paralysis
high K
peaked T waves, arrythmias
low Ca
tetany, NM irritability
high Ca
delirium, renal stones, ab pain
low Mg
NM irritability, arrythmias
high Mg
delirium, decr DTRs, cardiopulm arrest
low PO4
low mineal ion product causes bone loss
high PO4
high mineral ion product causes met calc, renal stones