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93 Cards in this Set
- Front
- Back
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Henderson Hasselbach equation
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pH = pKa + log [HCO3] / .03 PCO2
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Winter's formula
for Compensation of metabolic acidosis |
PCO2 = 1.5 (HCO3) + 8 (+/-2)
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Metabolic alkalosis compensation
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PCO2 increases 0.7 mmHg for every 1 mEq/L HCO3-
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Respiratory acidosis acute compensation
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increase 1 mEq/L HCO3- for every 10 mm Hg increase in pCO2
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Respiratory acidosis chronic compensation
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increase 3.5 mEq/L HCO3- for every 10 mmHg increase in PCO2
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Respiratory alkalosis acute compensation
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decrease 2.0 mEq/L HCO3- for every 10 mmHg decrease in PCO2
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Respiratory alkalosis chronic compensation
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decrease 5 mEq/L HCO3- for every 10 mmHg decrease in PCO2
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Potter's syndrome
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bilateral renal agenesis --> oligohydramnios --> limb deformities, facial deformities, pulmonary hypoplasia
caused by malformation of the ureteric bud not compatible with life decrease in amniotic fluid leads to renal system that fails to excrete fluid swallowed by fetus |
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Horseshoe kidney
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inferior poles of both kidneys fuse
as they ascend from the pelvis during fetal development, horseshoe kidneys get trapped under the inferior mesenteric artery and remain low in the abdomen kidney functions normally |
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RBC casts
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glomerular inflammation (nephritic syndromes), ischemia, or malignant hypertension
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WBC casts
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tubulointerstitial disease, acute pyelonephritis, glomerular disorders
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Granular ('muddy brown') casts
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acute tubular necrosis
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Waxy casts
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advanced renal disease/chronic renal failure
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Hyaline casts
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nonspecific
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What do you see in urine of a patient with bladder cancer?
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RBCs, no casts
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What do you see in urine of a patient with acute cystitis?
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WBCs, no casts
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Focal segmental glomerular sclerosis
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LM: segmental sclerosis and hyalinosis
clinically similar to minimal change disease, but happens in older patients sclerosis within capillary tufts of deep juxtamedullary glomeruli with focal or segmental distribution more severe disease in HIV patients |
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spike and dome appearancw
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neprhotic...membranous glomerulonephritis
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Membranous glomerulonephritis
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immune complex disease of unknown etiology
major primary cause of nephrotic syndrome teenagers and young adults suspect with nephrotic syndrome and azotemia THICKENED CAPILLARY WALLS (diffuse capillary and BM thickening) IF: granular pattern EM: spike and dome immune complexes in intramembranous and epimembranous (subepithelial) locations granular immunoflourescence: IgG or C3 (granular is general characteristic for immune complex diseases) associations can sometimes be seen in hep B, syphilis, or malaria infections |
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most common cause of neprhotic syndrome
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membranous glomerulonephritis
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Diabetic nephropathy
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nephrotic syndrome
EM: striking increase in thickness of the glomerular BM; increase in mesangial matrix...diffuse glomerulosclerosis and NODULAR GLOMERULOSCLEROSIS: KIMMELSTEIN WILSON NODULES (nodular accumulations of mesangial matrix...acellular ovoid nodules in the periphery of the glomerulus) basement membrane thickening |
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Renal amyloidosis
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IF: congo red stain, apple-green birefringence
subendothelial and mesangial amyloid deposits characteristic criss-cross fibrillary pattern of amyloid by EM most often associations with chronic inflammatory disease such as RA, TB or plasma cell disorders (like MM) |
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Lupus nephropathy
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renal component of SLE!
severity of renal lesion often determines overall prognosis in patients with SLE NEPHROTIC has 5 different patterns LM: membranous glomerulonephropathy WIRE LOOP LESION; resulting from immune complex deposition and gross thickening of teh GBM as well as endothelial cell proliferation subendothelial immune complex deposition |
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Nephrotic syndrome in general
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massive proteinuria (frothy urine), hypoalbuminemia, peripheral and periorbital edema, hyperlipidemia
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Nephritic syndrome (in general)
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inflammatory rupture of the glomerular capillaries, with resultant bleeding into the urinary space
Oliguria, azotemia, hypertension, hematuria |
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Hematuria in nephritic syndrome
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from leakage of red cells directly from glomerular capillaries into the Bowman space; many of the red cells are aggregated into the shape of the renal tubules and embedded in a proteinaceous matrix forming red cell casts that can be observed in urine
SMOKY BROWN URINE...red cell casts can degenerate and become pigmented granular casts |
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Acute poststreptococcal glomerulonephritis
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NEPHRITIC SYNDROME
LM: glomeruli enlarged and hypercellular, neutrophils LUMPY BUMPY EM: subepithelial humps IF: granular pattern |
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LUMPY BUMPY
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acute poststreptococcal glomerulnephritis
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most often follows or accompanies infection (tonsillitis, streptococcal impetigo, infected insect bites) with nphritogenic strains of group A beta hemolytic streptococci
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poststreptococcal glomerulonephritis (acute proliferative glomerulonephritis)
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Urinary red cells and red cell casts, azotemia, decreased serum C3 and increased titers of antistreptococcal antibodies (antistreptolysin..ASO), anti-DNAase B...
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poststreptococcal glomerulonephritis
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Lumpy bumpy
subepithelial localization electron dense humps glomerular BM of normal thickness and uniformity despite the extensive inflammatory changes |
poststreptococcal glomerulonephritis (acute proliferative glomerulonephritis)
...most frequently seen in children; peripheral and periorbital edema; resolves spontaneously |
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Rapidly progressive (crescentic) glomerulonephritis
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NEPHRITIC!
crescent moon shape rapid course to renal failure; the number of crescents indicates prognosis |
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Goodpasture's syndrome
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Type II hypersensitivity
NEPHRITIC IF: linear pattern, anti GBM antibodies pneumonitis with hemoptysis (hemorrhagic pneumonitis); peak incidence is men in their 20's RPGN crescenteric morphology with linear immunofluorescence hemoptysis and hematuria |
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Alport's syndrome
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hereditary nephritis
nerve deafness and ocular disorders such as lens dislocation and cataracts split basement membrane collagen IV mutation |
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Berger's disease
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IgA nephropathy
IF and EM: mesangial deposits most often characterized by benign recurrent hematuria in children, usually following infection, lasting 1-2 days, and usually of minimal significance mild disease; often postinfectious; common cause of recurrent hematuria in young patients |
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Membranoproliferative glomerulonephritis
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EM: subendothelial humps
NEPHRITIC TRAM TRACKS slowly progresses to renal failure; disease is marked by reduplication of glomerular BM into two layers, due to expansion of mesangial matrix into the glomerular capillary loops...results in a characteristic tram-track appearance...best seen with silver stains |
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Tram tracks
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membranoproliferative glomerulonephritis
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Calcium stones
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most common kidney stones (75-85%)
calcium oxalate, calcium phosphate or both... conditions that cause hypercalcemia: cancer, increased PTH, increased vitamin D, milk-alkali syndrome can lead to hypercalciuria and stones tends to recur |
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Radiopaque...can result from antifreeze or vitamin C abuse
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oxalate crystals
(calcium oxalate crystals) |
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Ammonium magnesium phosphate stones
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2nd most common kidney stone
caused by infection with urease-positive bugs (proteus vulgaris, staphylococcus, Klebsiella) can form staghorn calculi that can be a nidus for UTIs formed in alkaline urine worsened by alkaluria |
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2nd most common kidney stone
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ammonium magnesium phosphate
struvite staghorn calculi nidus for UTIs |
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Staghorn calculi
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ammonium magnesium phosphate
struvite 2nd most common kidney stone urease positive bugs: proteus vulgaris, staphylococcus, klebsiella |
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Uric acid stones
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stong association with hyperuricemia (like gout); often seen as a result of diseases with increased cell turnover, such as leukemia and myeloproliferative disorders
CANNOT be seen on x-ray or CT |
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Cystine stones
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most often secondary to cystinuria
hexagonal shape faintly radiopaque treat with alkalinization of urine |
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most common renal malignancy
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Renal cell carcinoma
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Renal cell carinoma
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frequently invades renal veins or IVC and spreads hematogenously
most common in men ages 50-70 increased incidence with smoking and obesity originates in renal tubule --> polygonal clear cells |
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associated with von-Hippel-Lindau
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RCC!!
gene deletion in chromosome 3 |
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Clinical manifestations of RCC
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hematuria, palpable mass, secondary polycythemia, flank pain, fever and weight loss
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Associated paraneoplastic syndromes with RCC
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EPO, ACTH, PTHrP and prolactin
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Wilms' tumor
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most common renal malignancy of early childhood (2-4 years old)
presents with huge, palpable flank mass, hemihypertrophy contains embryonic glomerular structures (primitive glomeruli, fibrous CT, cartilage, bone, striated muscle) |
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Deletion of tumor suppressor gene on chromosome 11
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WT1 on chromosome 11
Wilms tumor!! |
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WAGR complex
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Wilms tumor, aniridia, genitourinary malformation and mental motor retardation
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Transitional cell carcinoma
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most common tumor of the urinary tract system (can occur in renal calyces, renal pelvis, ureters and bladder)
painless hematuria is suggestive of bladder cancer in renal pelvis: phenacetin phenacetin, smoking, aniline dyes and cyclophosphamide |
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Associated with phenacetin, smoking, aniline dyes and cyclophosphamide
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transitional cell carcinoma
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Affects cortex with relative sparing of glomeruli/vessels
white cell casts in urine is pathognomonic presents with fever, CVA tenderness |
acute pyelonephritis
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coarse, asymmetric corticomedullary scarring, blunted calyx
tubules can contain eosinophilic casts thyroidization of kidney lymphocytes |
chronic pyelonephritis
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acute generalized infarction of cortices of both kidneys
likely due to a combination of vasospasm and DIC associated with obstetric catastrophes (like abruptio placentae) and septic shock |
diffuse cortical necrosis
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drug induced interstitial nephritis
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acute interstitial renal inflammation
fever, rash, eosinophilia, hematuria 2 weeks after administration drugs (like penicillin derivatives, NSAIDs, diuretics) act as haptens including hypersensitivity |
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Acute interstitial renal inflammation
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acute drug induced interstitial nephritis...think penicillins
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most common cause of acute renal failure
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acute tubular necrosis
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acute tubular necrosis
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REVERSIBLE!
but fatal if left untreated associated with renal ischemia (like shock), crush injury (myoglobinuria), toxins death most often occurs during initial oliguric phase (cardiac standstill from hyperkalemia...needs to be distinguished from oliguria due to prerenal causes like reduced blood volume or dehydration) recovery in 2-3 weeks direct toxicities: mercuric chloride, gentamicin and ethylene glycol |
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Microscopic stuff with acute tubular necrosis
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loss of cell polarity, epithelial cell detachment, necrosis, granular (muddy brown) casts
three stages: inciting event --> maintenance (low urine) --> recovery |
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renal papillary necrosis
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ischemic necrosis of the tips of the renal papillae
associated with: diabetes mellitus, acute pyelonephritis, chronic phenacetin use (acetaminophen is a phenacetin derivative), and sickle cell anemia |
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prerenal azotemia
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decrease in renal blood flow (like hypotension) leads to decrease in GFR
Na/H2O and urea are retained by kidney Urine osmolality is increased; urina sodium is <10; Fe Na is less than 1%; BUN/Cr ratio is greater than 20 |
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Intrinsic renal (acute renal failure)
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generally due to acute tubular necrosis or ischemia/toxins...patchy necrosis leads to debris obstructing tubule and fluid backflow across necrotic tubules...this leads to decreased GFR...urine has epithelial/granular casts
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urine osmolality is <350, urine Na is > 20, Fe Na is greater than 2%; BUN/Cr ratio is less than 15
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intrinsic renal stuff
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Post renal
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outflow obstruction (stones, BPH, neoplasia)
develops only with bilateral obstruction urine osmolality is less than 350, urine Na is greater than 40, Fe Na is >4% and BUN/Cr ratio is greater than 15 (prerenal is greater than 20) |
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2 forms of renal failure
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acute: often due to acute tubular necrosis
chronic: due to hypertension and diabetes |
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uremia
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clinical syndrome marked by increase in BUN and increase in creatinine and associated symptoms
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Consequences of renal failure
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1. anemia (failure of EPO production)
2. renal osteodystrophy (failure of active vitamin D production) 3. hyperkalemia, which can lead to cardiac arrhythmias 4. metabolic acidosis due to decrease in acid secretion and decrease in generation of HCO3- 5. uremic encephalopathy 6. sodium and water excess which leads to CHF and pulmonary edema 7. chronic pyelonephritis 8. hypertension |
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Fanconi's syndrome
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defect in proximal tubule transport of amino acids, glucose, phosphate, uric acid, protein and electrolytes
complications include rickets, osteomalacia, hypokalemia and metabolic acidosis (proximal renal tubules...impaired resorption of glucose, amino acids, phosphate and bicarbonate) |
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Clinical manifestations of Fanconi syndrome
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glycosuria, hyperphosphaturia and hypophosphatemia, aminoaciduria and sytemic acidosis
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Coarse, asymmetric corticomedullary scarring
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chronic pyelonephritis
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Adult polycystic kidney disease
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multiple, large bilateral cysts that ultimately destroy the parenchyma; presents with flank pain, hematuria, hypertension, urinary infection, progressive renal failure
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AD mutation in APKD1
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adult polycystic renal disease!
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death from uremia or hypertension
associated with polycystic liver disease, berry aneurysms and mitral valve prolapse |
PCKD
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infantile polycystic kidney disease
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infantile presentation in parenchyma
AR asspociated with hepatic cysts and fibrosis |
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cortical and medullary cysts resulting from long-standing dialysis
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dialysis cysts
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benign, incidental finding...cortex only
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simple cysts
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Medullary cystic disease
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medullary cysts
ultrasound shows small kidney poor prognosis |
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Medullary sponge disease
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collecting duct cysts
good prognosis multiple small medullary cysts; impaired tubular function without renal failure |
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Disorientation, stupor, coma
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low serum Na
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Neurologic: irritability, delirium and coma
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high serum Na
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secondary to metabolic alkalosis, hypokalemia, hypovolemia and increase aldosterone
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low serum Cl-
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secondary to non-anion gap acidosis
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high serum Cl-
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U waves on ECG, flattened T waves, arrhythmias, paralysis
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low serum K+
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peaked T waves,wide QRS and arrhythmias
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high serum K+
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tetany, neuromuscular irritability
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low serum calcium concentration
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delirium, renal stones, abdominal pain, not necessarily calciuria
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high serum Ca++
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neuromuscular irritability, arrhythmias
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low serum magnesium
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delirium, decreased DTRs, cardiopulmonary arrest
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high serum Mg++
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Low mineral ion product causes bone loss, osteomalacia
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low serum phosphate
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High mineral ion product causes metastatic calcification, renal stones, met calcifications
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high serum phosphate
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