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30 Cards in this Set
- Front
- Back
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calcium kidney stones
- make-up - appearance on imaging - conditions that cause them |
- MOST COMMON TYPE
- Calcium oxalate, calcium phosphate or both! conditions that cause hypercalcemia: - cancer - increased PTH - increased VitD - milk-alkali syndrome - TEND TO RECURR! - radiOPAQUE OXALATE crystals can result from antifreeze or VitC abuse |
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Ammonium magnesium phosphate kidney stones (STRUVITE)
- epi - cause - appearance on imaging - what worsens them |
- 2nd most common kidney stone!
- caused by infection with UREASE + BUGS (urease increases pH of urine and --> calculi formation) - proteus vulgaris - Staphylococcus - Klebsiella - can form STAGHORN CALCULI that can be a nidus for UTIs - Radiopaque or radiolucent - worsended by alkaluria! |
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Uric acid kidney stones
- associated with what conditions? - appearance on imaging |
- HYPERURICEMIA (eg - gout)
- seen in diseases that increase cell turnover - such as leukemia and myeloproliferative disorders - radioLUCENT |
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Cystine kidney stones
- cuase - shape - what we see on imaging - tx |
- most often secondary to cystinuria (AR defect in cystine reabs in PCT)
- hexagonal shape - faintly radiOPAQUE - Tx: alkalinization of urine (like acetazolamide) |
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RCC
- epi - how it spreads - risk factors - associated diseases - pathology - Cx |
MOST COMMON RENAL MALIG.
- men age 50-70 - invades IVC --> spreads hematogenously - increased incidence with SMOKING and OBESITY - assoc w/ VON-HIPPEL-LINDAU & gene deletion on chrom 3 - originates in renal tubule cells --> polygonal clear cells Cx: hematuria, palpable mass, secondary polycythemia, flank pain, fever, weight loss - associated with paraneoplastic syndromes (ectopic EPO, ACTH, PTHrP, prolactin) |
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Wilm's tumor
- epi - Cx - contents - genetics - associated conditions |
- most common renal malingnancy in early childhood:
- AGES 2-4 - presents with huge, palpable flank mass, hemihypertrophy - contains EMBRYONIC GLOMERULAR STRUCTURES - deletion of tumor suppression gene WT1 on chromosome 11 can be part of WAGR complex: - Wilm's tumor - Aniridia (absent/underdev iris) - GU malformation - mental-motor retardation |
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Transition cell carcinoma
- epi - cx - risk factors |
most common tumor of urinary sys
- can occur in renal calyces, renal pelvis, ureters, bladder - painless hematuria suggests bladder cancer (remember painless jaundice was cancer of the pancreatic head) risk factors: - phenacetin - smoking - aniline dyes - cyclophosphamide |
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pyelonephritis
- acute - chronic |
ACUTE
- affects CORTEX - sparking of glomeruli/vessels - WHITE CELLS IN CASTS are pathogmomonic risk factors - UT obstruction, tremors, pregnancy, DM, VUR - Cx: fever, CVA tenderness CHRONIC - coarse, asymmetric corticomedullary scarring - blunted calyx - tubules contain EOSINOPHILIC CASTS (thyroidization of kidney) |
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Diffuse cortical necrosis
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acute generalized infarction of cortices of both kidneys
- likely due to a combination or vasospasm and DIC - associated with obstetric catastrophes (abruptio placentae) and septic shock |
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Drug-induced interstitial nephritis
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- acute interstitial renal inflamm
- Cx: fever, rash, eosinophilia (like chronic pyelo) - hematuria 2 weeks after admin Drugs that cause it: - penicillin derivatives - NSAIDs - diuretics - Rifampin - Sulfonemides . . . these all act as haptens inducing hypersensitivity |
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Acute tubular necrosis
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most common cause of acute renal failure
- REVERSIBLE - FATAL IF UNTREATED associated with - RENAL ISCHEMIA (eg - shock) (azotemia due to hypovolemia and decreased GFR, detachment of PCT cells --> muddy brown casts!) - crush injury (myoglobinuria) - toxins (aminoglycosides like gentamycin, radiocontrast agents, metals like Pb and Hg, uranyl nitrate) Loss of cell polarity, epithelial cell detachment, necrosis, granular ("Muddy brown") casts 3 stages 1. inciting event: decreased bf and decreased GFR 2. maintenance (low urine volume - ie OLIGURIC phase)- 1-2 wks, low GFR stabilizes, granular tubular lamina, flattened tubule cells and epithelial necrosis 3. diuretic phase - increasing urine output until GFR returns to normal - death most often occurs during oliguric phase - recovery in 2-3 weeks - hypokalemia is impt cause of complications - REEPITHELIALIZATION |
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Renal paillary necrosis
- associated with 4 conditions |
1. DM
2. Acute pyelonephritis 3. Chronic phenacetin use (acetaminophen is phenacetin derivative) 4. Sickle cell anemia --> sickling in vasa recta --> patchy papillary necrosis --> proteinuria and rectal scarring |
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Acute renal failure
- define - name the 3 types |
ABRUPT decline in renal function with increase in creatinine and BUN over a period of several days
1. pre-renal azotemia 2. intrinsic renal failure 3. postrenal failure |
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Pre-renal azotemia
- due to? - urine osmolality - urine Na - FeNa - BUN/Cr ratio |
- decreased RBF (eg: hypotension)
- decreased GFR - Na/H2O and urea retained by kidney Urine osmolality >500 (HIGH) Urine Na <10 (LOW) FeNa <1% (LOW) BUN/Cr >20 (HIGH) |
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intrinsic renal failure -
- due to? - pathology - GFR - urine contents? - Urine osmolality - urine Na - FeNa - BUN/Cr ratio |
Intrinsic renal failure
- due to acute tubular necrosis or ischemia/toxins - patchy necrosis --> debris obstructing tubule and fluid backflow across necrotic tubule --> decreased GFR - urine has epithelial/granular casts - Urine osmololality <350 (LOW - can't respond to ADH) - Urine Na >20 - FeNa >2% - BUN/Cr ratio <15 causes: ATN, interstitial nephritis, glomerulonephritis, vascular disease |
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Postrenal failure
- cause - what is required for it to happen in terms of laterality of pathology? - urine osmolality - urine Na - FeNa - BUN/Cr ratio |
outflow obstruction (stones, BPH, neoplasia)
- develops only with bilateral obstruction - urine osmolality <350 - urine Na >40 - FeNa >4% - BUN/Cr ratio > 15 anuria common causes: BPH, prostate hypertrophy, gynecologic malignancy, kidney stones |
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consequences of renal failure
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- failure to make urine and excrete nigrogenous wastes
- uremia - clinical syndroem marked by increased BUN and increased Cr and associated sx's Acute Renal Failure (ARF) - most often due to ATN Chronic Renal Failure (CRF) - most often due to HTN and Diabetes! consequences: - anemia (failure of Epo porudction) - renal osteodystrophy (failure of active Vit D production) - HYPERKALEMIA (which can lead to cardiac arrhythmias) - metabolic acidosis due to decreased acid secretion and decreased generation of HCO3- - uremic encephalopathy - sodium and H2O excess --> CHF and pulmonary edema - chronic pyeloneprhitis - HTN |
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Fanconi's anemia
- defect? - complications? |
DEFECT in PCT transport of
- aa's - glucose - phosphate - uric acid - protein - electrolytes complications: - rickets - osteomalacia - hypokalemia - metabolic acidosis |
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Adult Polycystic Kidney Disease (APKD)
- pathology - cx - inheritance - cause of death - associated diseases? |
- multiple, large, bilateral cysts that ultimately DESTROY PARENCHYMA
Cx: - flank pain - hematuria - HTN - urinary infection - progressive renal failure AD mutation in APKD1 gene death from UREMIA or HTN --> intracerebral hemorrhage associated with: - polycystic liver disease - berry aneurysm - mitral valve prolapse |
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childhood/infantile PKD
- inheritance - pathology |
infantile presentation in parenchyma
- AR - associated with hepatic cysts and fibrosis - associated with maternal oligohydramnios (decreased amniotic fluid) |
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dialysis cysts
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cortical and medullary cysts resulting from long-standing dialysis
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simple cysts
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benign, incidental finding, cortex only
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medullary cystic disease
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medullary cysts
- US shows small kidney - poor prognosis |
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medullary sponge disease
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- collecting duct cysts
- good prognosis "swiss cheese appearance" |
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sodium
- low - high |
low - disorientation, stupor, coma
high - neurologic- irritability,delirium, coma |
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Cl
- low - high |
low - secondary to metabolic alkalosis, hypokalemia, hypovolemia, increased aldosterone
high - secondary to non-anion gap acidosis |
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K+
- low - high |
low - U waves on ECG, flattened T waves, arrhythmias, paralysis
high - peaked T waves, wide QRS, arrhythmias |
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Ca2+
- low - high |
low - tetany, NM irritability
high - delirium, renal stones, abd pain, not necessarily calciuria |
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Mg2+
- low - high |
low - neuromuscular irritability, arrhythmias
high - delirium, decreased DTRs, cardiopulmonary arrest |
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(PO4)3-
- low - high |
low - low-mineral iron product causes bone loss, osteomalacia
high - high mineral ion product causes metastatic calcification, renal stones |
