Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
46 Cards in this Set
- Front
- Back
|
RBC casts
|
GN
ischemia Malignant HTN |
|
|
WBC casts
|
Tubulointerstital inflammation
Acute Pyelonephritis Transplant rejection |
|
|
Granular ('muddy brown') casts
|
ATN
|
|
|
Waxy casts
|
advanced renal disease/CRF
|
|
|
Bladder cancer, Kidney stones
|
HEMATURIA &
NO CASTS |
|
|
Acute poststreptococci GN
|
- GABHS - strep pyogenes skin infxn
LM = Diffuse, proliferative IF = Granular (IgG, IgM, C3) EM = subEPIthelial IC humps |
|
|
RPGN
|
- rapid progressive GN (crescentic)
- cresencts = fibrin, plasma proteins (C3b) w/ glomerular parietal cells, monocytes, and Macrophages - rapid deterioration of renal fxn (days to wks) |
|
|
Goodpasture
|
- type II HS
- antibodies to GBM (type IV collagen - alpha 3 chain) and alveolar BM IF = LINEAR |
|
|
Wegener's
Microscopic Polyangitis |
RPGN
Wegeners = c-ANCA Microscopic Polyangitis = p-ANCA |
|
|
Diffuse Proliferative GN
|
- Nephritic syndrome
- due to SLE or MPGN - MCC of death in SLE; SLE and MPGN can also present as nephrotic syndrome LM = Wire loopin of capillaries (Neuts and hyaline thrombi) EM = subENDOthelial DNA-anti-DNA ICs - acitvate classic complement IF = Granular |
|
|
Berger's disease
|
- Nephritic syndrome
Inc synthesis of IgA - LM and IF = IC's deposit in MESANGIUM - Focal Proliferative |
|
|
Alport's sydnrome
|
- XD = x-dominant
- mutation in type IV collagen -> SPLIT BM - Nerve disorders, ocular disorders, deafness |
|
|
Membranous Glomerulonephritis
|
- Nephrotic syndrome
- Diffuse Membranous glomerulopathy (primary or secondary) - Drugs (captopril, gold); Infxn (HBV, malaria, syphilis); SLE; Solid tumors LM - diffuse capillary and GBM thickening EM = "spike and dome" appearance w/ subEPIthelial depositis IF - granular, SLE's nephrotic presentation |
|
|
Minimal change disease (lipoid nephrosis)
|
- Nephrotic syndrome
- responds to corticosteroids - recent infxn or vaccination LM = Normal glomeruli EM- foot process effacement - selective loss of albumin, not globulins due to GBM polyanion loss |
|
|
Amyloidosis
|
Nephrotic syndrome
- MM, TB, RA |
|
|
Diabetic Glomerulopathy
|
- Nephrotic syndrome
- Nonenzymatic glycosylation of GBM -> inc permeability, thickening NEG of efferent -> Inc GFR -> mesangial expansion LM = mesangital expansion, GBM thickening, NODULAR GLOMERULOSLCEROSIS (Kimmelsteil-Wilson) Other kidney disease in DM = Renal Papillary Necrosis, Pyelonephrosis |
|
|
Focal Segmental Glomerulosclerosis
|
Nephrotic syndrome
- segmental sclerosis and hyalinosis HIV patients and heroin abuse |
|
|
MPGN
|
SubENDOthelial ICs w/ granular IF
- can also present as nephritic syndrome Type I EM = "tram-track" appearance due to GBM splitting caused by mesangial ingrowth (IF have C1) - assoc w/ HBV, HCV (cryoglobinemia) Type II EM = "dense deposits" - only C3 in depositis - due to C3 nephritic factor = autoab binds C3 convertase prevents degradation = only alternative pathway activated |
|
|
Subendothelial deposits
|
-SLE- Nephritic = Diffuse proliferative GN
Type 1 MPGN = HBV, HCV, cryoglobinemia |
|
|
Subepithelial deposits
|
- Acute GN = GABHS
- Membranous GN - drugs, cancer, SLE (nephrotic); spike and dome |
|
|
Nephrotic syndrome
|
- inc infarction = loss of antithrombin
- inc infxn = loss of Ig's - inc cholesterol in serum |
|
|
Calcium stones
|
- colorless, octahedron
- 75-85% of stones - radiopaque (does appear on Xray) Calcium oxalate = ethelene glycol (antifreeze) or VIT C ABUSE Calcium phosphate Conditions that cause HYPERcalcemia (cancer, inc PTH) can -> hypercalciuria and stones Citrate can bind Ca preventing precipitation |
|
|
Ammonium MgPhosphate
|
- Rectangular prism; coffin-lids
- 15% of stones - Alkalkline precipitation - Radiopaque (appear bright) - urease-positive bugs (Proteus, Staph, phosphate klebsiella) -staghorn calculi that can be a nidus for UTIs - worsened by alkaluria |
|
|
Uric Acid crystals
|
- yellow, red-brown, diamond or rhombus
- Radiolucent (do no appear on US or CT) - Acid precipitation = most acidc part of nephron is CD & distal tubule |
|
|
Cystine
|
- yellow hexagone
- Radiopaque (bright) - acid precipitate Most often 2ndary to cystinuria - defect in AA transporter: AR - cystine, ornithine, lysine, Arginine - precipitates in acid Tx = acetazolamide is treatment |
|
|
RCC
|
= VHL (3p)
- inc incidence w/ smoking and obesity - hematuria, palpable mass Paraneoplastic = EPO, ACTH, PTHrP, and PRL - invades IVC and spreads hematogenously to lung and bone - Left sided varicocele |
|
|
Wilm's tumor
|
- nephroblastoma
- deletion of WT1 on Chrom 11p - EMBRYONIC GLOMERULAR STRUCTURES - huge palpable flank mass WAGR = Wilms, Aniridia (no iris), GU malformation, mental-motor RETARD Beckwidth-wideman - Wilms; large organs; hemihypertrophy |
|
|
Transitional Cell Carcinoma
|
MCC tumor of urinary tract system
- can occur in Renal calyces, renal pelvis, ureters, and bladder - painless hematuria suggests bladder cancer Pee SAC Phenacetin Smoking Aniline dyes Cyclophosphamide - schistoma haematobium |
|
|
Chronic Pyelonephritis
|
- Coasrse, asymmetric corticomedullary scarring
- Scarring - BLUNTED CALYX - tubule can contain EOSINOPHILIC casts (THYROIDIZATION of kidney) |
|
|
Drug-induced interstitial nephritis
|
- acute interstitial renal inflammation
- Pyruria (typical EOSINOPHILS and azotemia 1-2 wks after administration of drugs - diuretics, NSAIDs, penicillin, sulfonamide, rifampin act as haptens |
|
|
Analgesic nephropathy
|
- acetaminophen (free radicals -> medulla)
- Aspirin (no PGE2 therefore dec blood to medulla) - renal papillary necrosis |
|
|
Diffuse Cortical necrosis
|
- acute generalized cortical infarction of both kidneys
- due to vasospasm and DIC - Assoc w/ obstetric catastrophes (abruptio placentae) and septic shock |
|
|
ATN
|
- ischemic
- Nephrotoxic (Aminoglycosides, Radiocontrast, Heavy metals, crush injuries myoglobinuria) MCC of acute renal failure in hospital -death occurs during initial oliguric phase 3 stages: inciting event -> maintenance (low urine output) -> recovery (2-3 wks) KEY FINDING = GRANULAR "MUDDLE BROWN" CASTS |
|
|
RENAL PAPILLARY NECROSIS
|
- medulla is susceptible to ischemic injury; RING DEFECT
- sloughing of renal papillae -> gross hematuria, proteinuria - triggered by infxn or immune stimulus 1.) DM 2.) Acute pyelonephritis 3.) Chronic phenacetin use (acetaminophen is phenacetin derivative) 4.) Sickle cell anemia |
|
|
Nephrosclerosis
|
Essential HTN = hyaline arteriolosclerosis of arteriole in renal cortex
- leads to tubular atrophy, interstitial fibrosis, glomerulosclerosis |
|
|
Malignant HTN
|
- Flea-bitten kidney & hyperplastic arteriolosclerosis
- rapid BP inc >210/120 - HTN encephalopathy Tx = nitroprusside |
|
|
Uosm; Urine Na+; Fe Na+; Serum BUN/ Cr
Prerenal |
Uosm = > 500 (concentrated)
Urine Na+ = < 10 Fe Na+ = < 1% Serum BUN/ Cr = > 20 - hyaline or fine granular cast |
|
|
Uosm; Urine Na+; Fe Na+; Serum BUN/ Cr
Renal |
Uosm = < 350 dilute
Urine Na+ = > 20 Fe Na+ = > 2% Serum BUN/ Cr = < 15 Renal tubular cells = granular & muddy casts |
|
|
Uosm; Urine Na+; Fe Na+; Serum BUN/ Cr
Postrenal |
Uosm = < 350
Urine Na+ = > 40 Fe Na+ = > 4% Serum BUN/ Cr = > 15 |
|
|
Fe Na+
|
Fe Na+ = (U na/P na)/(U cr/ P cr)
|
|
|
Consequence of renal failure
|
- acute (ATN) and chronic (HTN and DM)
- Na+/H2O retention (CHF, pulmonary edema, HTN) - Hyperkalemia, Metabolic acidosis - Uremia = nausea & anorexia, pericarditis, asterixis, encephalopathy, platelet dysfxn - Anemia (failure of EPO production) - RENAL OSTEODYSTROPHY (failure of Vit. D hydroxylation); Ca+2 wasting and PO4 -> 2ndary HPTH -> cystic lesions of jaw - Dyslipidemia (especially inc TGs) - Growth retardation adn developmental delay (in children) |
|
|
ADPKD
|
- AD; chrom 16
- Flank pain, hematuria, HTN, urinary infxn, progressive renal failure - APKD1 (chrom 16) & APKD2 (chrom 6) - death from complications of chronic kidney disease or HTN (due to inc. RENIN production) = assoc w/ polycystic liver disease; berry aneurysms, MVP - Cysts = hepatic, pancreatic, colonic, ovary |
|
|
ARPKD
|
- AR
- infantile presentation in parenchyma - assoc w/ CONGENITAL HEPATIC FIBROSIS - significant renal failure IN UTERO can lead to POTTER's - neonatal period include HTN, portal HTN, and progressive renal insufficiency |
|
|
Dialysis
|
Cortical and medullary cysts
|
|
|
Simple cysts
|
Benign, common, incidental
-thin, nonenhancing, cortical, fluid-filled |
|
|
Medullary Cystic Disease
|
- Medullary cysts sometime lead to fibrosis and progressive renal insufficiency w/ urinary concentrating defects
US shows small kidney Poor prognosis |
