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171 Cards in this Set
- Front
- Back
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What is the significance of Hyaline casts?
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No significance in the absence of proteinuria (i.e. they are non-specific).
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What is indicated by the presence of RBC casts?
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Nephritic type of glumerulonephritis (i.e. poststreptococcal glomerulonephritis)
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What findings characterize nephritic syndrome (i.e. nephritic type of glumerulonephritis)?
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- Moderate proteinuria ( > 150 mg/24 hrs but < 3.5 g/24hrs)
- RBC casts |
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What etiologies are associated with WBC casts?
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- Acute pyelonephritis
- Acute tubulointerstitial nephritis |
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What etiology is associated with renal tubular cell casts?
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Acute tubular necrosis
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What etiology is associated with fatty casts?
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Nephrotic syndrome (i.e. minimal change disease)
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What renal crystal is pH independent and associated with Crohn Disease, small bowel resection, rhubarb spinach, and nuts?
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Calcium oxalate crystal (most common renal crystals)
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What renal crystal is associated with urea splitting organisms (i.e. Proteus mirabilis) that increase urine pH?
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Struvite/Magnesium ammonium phosphate crystals
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Which anatomical portion of the kidney is relatively vulnerable to ischemia?
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Renal Medulla (due to decreased blood supply)
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Which anatomical portion of the kidney receives ~90% of the organs blood supply?
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Renal Cortex
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What class of drugs increases the risk of ischemic damage to the medulla?
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NSAID - they inhibits production of PGE2 which is the vasodilator that controls affferent blood flow, causing intrarenal blood flow to be controlled by the efferent arterial which is controlled by ATII.
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What is the composition of the Glomerular basement membrane?
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Type IV collagen
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What is responsible for the negative charge of the glomerular basement membrane?
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Heparin sulfate
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What is the relative permeability of the glomerular basement membrane?
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GBM is permeable to water, LMW proteins, and cationic proteins
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What cell is primarily responsible for the production of GBM?
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Visceral epithelial cells (VEC) - they contain podocytes
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What are the main determinants of GBM protein filtration?
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Size and charge are the main determinants of GBM protein filtration
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What histopathological finding is present in all glomerular diseases than present with a nephrotic syndrome?
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Fusion of the podocytes
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What type of renal disease is indicated by Linear IF?
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Anti-GBM disease (i.e. Good-pasture's syndrome)
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What type of renal disease is indicated by granular "lump bumpy" IF?
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Immunocomplex type of glumerulonephritis (i.e. Poststreptococcal glomerulonephritis)
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What is the pathogenesis of immunocomplex type of glomerulonephritis?
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ICs deposit in glomeruli and activate the complement system. C5a is then produced which is chemotactic to neutrophils. Neutrophils then damage the GBM?
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What findings characterize nephrotic syndrome?
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- Marked proteinuria (>3.5g/24hrs)
- Fatty casts - Generalized pitting edema and ascites due to hypoalbuminemia |
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What glomerular disorder is the result of proliferation of parietal epithelial cells around glomerulus?
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Crescentic glomerulonephritis
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What glomerular disorder is characterized by a thick GBM and hypercellular glomeruli?
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Membranoproliferative glomerulonephritis
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What glomerular disorder is characterized by a thick GBM with no proliferative change?
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Membranous glomerulopathy
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What is the most common glomerulonephritis?
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IgA glomerulopathy (Berger's Disease) - increased mucosal synthesis and decreased clearance of IgA with IgA IC mesangial deposition (Granular IF)
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What is the most common type of postinfectious glomerulonephritis?
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Poststreptococcal glomerulonephritis
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What is the most common cause of increased serum BUN?
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Congestive heart failure
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What is azotemia?
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- Increased BUN and creatinine
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What glomerular pathology has subendothelial DNA-anti-DNA IC deposition resulting in wire-looping of the capillaries?
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Diffuse proliferative glomerulonephritis (due to SLE)
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What is the most common cause of death in SLE?
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Diffuse proliferative glomerulonephritis
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What group of glomerular disorders is characterized by proliferation of glomerular cells and leukocytic influx due to immune complexes?
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Acute proliferative glomerulonephritis
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What is the most common cause of postinfectious glomerulonephritis?
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Poststreptococcal glomerulonephritis
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What laboratory findings are associated with poststreptococcal GN?
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- Hematuria (cocoa-colored urine)
- RBC casts - Azotemia - Oliguria - Mild proteinuria - Increased antistreptococcal Ab titers - Decreased serum complement level |
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What glomerular disease presents 1 to 4 weeks after a streptococcal infection, with abrupt malaise, fever, nausia, oliguria, hematuria, periorbital edema, and moderate HTN?
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Poststreptococcal glomerulonephritis
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What EM findings are suggestive of poststreptococcal glomerulonephritis?
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Subepithelial IC deposits with granular "lumpy bumpy" IF (ICs activate alternative complement pathway)
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What LM findings are suggestive of acute poststreptococcal glomerulonephritis?
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Enlarged hypercellular glomeruli with neutrophilic infiltrate.
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What are some of the causes of Non-streptococcal glomerulonephritis?
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- Staphylococcal endocarditis
- Pneumococcal pneumonia - Meningiococcemia - HBV or HCV - Varicella - Infectious mononucleosis - Malaria - Toxoplasmosis |
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What is the histological picture associated with rapidly progressive glomerulonephritis (RPGN)?
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Accumulation of cells in Bowman's space ("crescents")
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What is the composition of the crescents that form in RPGN?
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Fibrin and plasma proteins with glomerular parietal cells, monocytes, and macrophages
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What disease is considered to be Type I RPGN?
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Goodpasture syndrome (antiGBM disease, linear deposits of IgG and C3 in GBM)
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What RPGN disease is considered to be male dominant and characterized by hematuria and hemoptysis?
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Goodpasture syndrome
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What type of RPGN is characterized by linear deposits of IgG and C3?
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Type I RPGN (Goodpasture Syndrome)
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What type of RPGN has a granular pattern on IF and can be a complication of any immune nephritis?
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Type II RPGN (IC mediated disease)
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What type of RPGN lacks anti-GBM Ab or immune complexes?
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Type III RPGN
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What vasculitis diseases are associated with Type III RPGN?
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- Wegener's granulomatosis (c-ANCA)
- Microscopic polyarteritis (p-ANCA) |
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What type of nephritic glomerular disorder is marked by recurrent hemoptysis or life-threatening pulmonary hemorrhages?
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Goodpasture syndrome
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What are the key morphological features of nephrotic syndrome?
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- Massive proteinuria (>3.5g/day)
- Fatty cases - Hyperlipidemia - Hypoalbuminemia - Generalized edema |
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What is the most common nephrotic syndrome in children?
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Minimal change disease
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What is the most common cause of nephrotic syndrome in adults?
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Membranous glomerulonephritis
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What LM finding is suggestive of Membranous glomerulonephritis (i.e. Membranous Nephropathy)?
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Thickened glomerular capillary loops
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What EM findings are suggestive of Membranous Nephropathy?
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"Spike and dome" appearance with subendothelial deposits (granular IF).
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What are some potential secondary causes of membranous nephropathy?
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- Drugs
- SLE - Infections - Solid tumors |
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What LM findings is associated with Minimal change disease?
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Normal glomeruli
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What nephrotic syndrome disease presents with selective proteinuria of albumin?
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Minimal change disease
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What EM findings is associated with Minimal change disease?
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Podocyte effacement
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What nephrotic syndrome disease responds well to corticosteroid therapy?
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Minimal change disease
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What is the most common glomerular disease in HIV patients?
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Collapsing Variant of Focal Segmental Glomerulosclerosis (FSGS)
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What LM findings are associated with Focal Segmental Glomerulosclerosis (FSGS)?
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Segmental sclerosis and hyalinosis
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What EM finding is associated with the collapsing variant of FSGS?
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Tubuloreticular inclusions (modified endoplasmic reticulum within endothelial cells)
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What LM findings are associated with Membranoproliferative glomerulonephritis (MPGN)?
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Thickened GBM, hypercellular glomerulus with lobular accentuation, and "tram-track" appearance of glomerular capillary wall.
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What type of MPGN is referred to as the "dense deposit" disease?
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Type II MPGN (due to
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Which Type of MPGN strong associations with HBV and HCV?
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Type I MPGN (HBV>HCV)
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What LM and IF finding is indicative of Berger's disease (IgA glumerulopathy)?
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IC deposition in mesangium (increase in mesangial matrix and cellularity)
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What characterizes IgA glomerulopathy (Berger's disease)?
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IgA complex deposition in the mesangium
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What nephritic glomerular disorder often presents/flares with a URI or acute gastroenteritis?
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IgA glomerulopathy (Berger's Disease)
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What nephritic syndrome disorder is associated with nerve disorders, ocular disorders, and deafness?
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Alport's Syndrome
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What is the underlying etiology of Alport's Syndrome?
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X-linked mutations cause abnormal assembly of type IV collagen.
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What glomerular disorder is associated with diffuse thinning of GBM?
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Benign Familial Hematuria (most are heterozygous)
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What LM findings are associated with diabetic nephropathy?
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- Thickened GBM
- Diffuse mesangial sclerosis - Nodular glomerulosclerosis (Kimmelstiel-Wilson disease) |
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What is the pathogenesis of diabetic nephropathy?
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Nonenzymatic glycosylation of GBM results in increased permeability and thickening of GBM. Also NEG of efferent arterioles increases GFR resulting in mesangial expansion.
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Hyaline arteriosclerosis is associated with which glomerular disorder?
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Diabetic Nephropathy
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What gross renal morphology is associated with amyloidosis?
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Kidneys enlarged, pale gray, waxy, and firm
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What LM findings are associated with Amyloidosis of the kidneys?
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- Congo Red Positive
- Apple-green birefringence (under polarized light) |
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What disease has a strong association with amyloidosis?
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Plasma Cell Myeloma (Multiple Myeloma)
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What is the LM finding associated with Chronic glomerulonephritis?
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Hyalinized glomeruli
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What is the most common cause of acute renal failure?
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Acute Kidney Injury (Acute Tubular Necrosis)
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What characterizes acute kidney injury (aka ATN)?
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- Acute depression of renal function (24hrs)
- Accompanied by anuria or oliguria (<400mL/24hrs) |
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What toxin associated with AKI causes ballooning and vascular degeneration of proximal convoluted tubule with calcium oxalate crystals in lumens?
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Ethylene glycol
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What toxin associated with AKI causes severe injury with large acidophilic epithelial inclusions?
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Mercuric chloride
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What toxin associated with AKI causes the accumulation of neutral lipids in injured cells?
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Carbon tetrachloride
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What type of AKI is associated with oxalate crystals?
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Toxic AKI as a result of ingestion of ethylene glycol.
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What are the three phases associated with acute kidney injury (acute tubular necrosis)?
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- Initiating Phase
- Maintenance (oliguria) - Recovery (2-3 weeks) |
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What group of individuals have a poor prognosis from acute kidney injury?
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- Shock/sepsis
- Burns - Multiorgan failure |
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What is the most common type of acute kidney injury?
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Ischemic AKI (Ischemic ATN)
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What type of casts is associated with ischemic acute kidney injury?
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Renal Tubular cell casts
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What is the most common cause of nephrotoxic acute kidney injury (nephrotoxic acute tubular necrosis)?
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Aminoglycosides (i.e. gentamicin & streptomycin)
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What are some causes of tubulointerstitial nephritis?
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- Acute pyelopnephritis
- Drugs - Infections (Legionella pneumophila, leptospirosis) - SLE - Urate nephropathy - Plasma Cell Myeloma |
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What is the most common cause of tubulointerstitial nephritis?
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Acute pyelonephritis
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What group of microorganisms is associated acute pyelonephritis?
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Intestinal gram-negative bacilli (E. coli, proteus, klebsiella, enterobacter)
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What group of individuals can get viral pyelonephritis (Polyomavirus, CMV, adenovirus)?
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Kidney transplant patients
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What are the risk factors associated with pyelonephritis?
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- Pregnancy
- Preexisting renal lesions - Diabetes mellitus - Immunosuppression, immunodeficiency |
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What renal disease is associated with granular "muddy brown" casts?
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Acute Kidney Injury (Acute tubular necrosis).
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What are the three potential complications of acute pyelonephritis?
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- Papillary necrosis
- Pyonephrosis - Perinephric abscess |
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What histopathological finding is associated with polyomavirus nephropathy (acute pyelonephritis)?
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Ground glass intranuclear viral inclusions (infects tubular epithelial cells).
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What renal disorder occurs in early childhood and is the result of congenital vesicoureteral and intrarenal reflux?
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Chronic pyelonephritis
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What renal disease is associated with diffuse interstitial fibrosis and proteinacious casts forming within the tubular lumen?
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Chronic pyelonephritis
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What term refers to dilatation of renal pelvis and calyces associated with progressive atrophy of kidney owing to obstruction of outflow of urine?
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Hydronephrosis
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What type of obstruction tends to remain silent for a extended period of time?
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Unilateral Obstruction
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The GFR is not suppressed in association with which type of obstruction?
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Subtotal or intermittent obstruction
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What type of obstruction is associated with a decrease in GFR and a mild dilatation of pelvis & calyces.
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Sudden and complete obstruction
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What type of obstruction presents with oliguira or anuria, and is incompatible with long survival unless relieved?
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Complete bilateral obstruction
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What type of obstruction is associated with TIN and polyuria?
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Bilateral Partial Obstruction
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What is the most common type of urolithiasis?
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Calcium oxalate stones
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What cystic disease has autosomal dominant inheritance?
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Adult polycystic kidney disease
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What are the pathological features associated with adult polycystic kidney disease?
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- Large multicystic kidneys
- Liver cysts - Berry aneurysms |
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What is the typical outcome of adult polycystic kidney disease?
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Chronic renal failure beginning at 40-60 yrs of age.
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What symptoms presenting the 4th to 5th decade of life are associated with adult cystic kidney disease?
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- Flank pain
- Hematuria - Renal Failure - Urine concentrating defect |
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What mutation is associated with 85% of the cases of adult cystic kidney disease?
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- PKD1 gene mutations (Chromosome 16p13.3, Encodes Protein polycystin 1)
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What extrarenal congenital anomalies are associated with autosomal dominant polycystic kidney disease?
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- Polycystic Liver disease (40%)
- Intracranial berry aneurysms (16.6%) - Mitral valve prolapse (20-25%) |
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What is the most common cause of death associated with adult polycystic kidney disease?
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CAD or HTN Heart Disease
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What cystic kidney has an autosomal recessive inheritance?
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Childhood polycystic kidney disease
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Which subcategory of autosomal recessive PKD develop congenital hepatic fibrosis?
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Infatile and Juvenile forms of autosomal recessive PKD (Less common and hepatic picture predominates in older children)
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What are the pathological features of childhood polycystic kidney disease?
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Enlarged, cystic kidneys at birth
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What cystic kidney disease is the result of end-stage renal disease with prolonged dialysis?
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Acquired (Dialysis-Associated) Cystic Disease
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What are the clinical features or complications associated with acquired renal cystic disease?
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- Hemorrhage
- Erythrocytosis - Neoplasia |
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What renal tumors is a small discrete renal cortical tumor that arises from tubular epithelium and is well-circumscribed?
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Renal papillary adenoma
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What renal neoplasia has a strong association with tuberous sclerosis?
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Angiomyolipoma (Mutations in TSC1 and TSC2 tumor suppressor genes)
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What renal neoplasia is a benign tumor that may spontaneously hemorrhage?
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Angiomyolipoma (Composed of vessels, smooth muscle, and adipose)
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What renal neoplasia is associated with abundant eosinophilic cytoplasm and numerous mitochondria (EM)?
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Oncocytoma
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What is the cell of origin associated with oncocytoma?
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Intercalated cells of collecting duct
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What renal neoplasia is referred to as a yellow tumor with renal vein invasion?
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Renal Cell Carcinoma
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What is the most common risk factor associated with renal cell carcinoma?
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Smoking
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What autosomal dominant familial cancer is associated with MET proto-oncogene?
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Hereditary papillary carcinoma
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What autosomal dominant syndrome is associated with bilateral renal cell carcinoma?
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Von Hippel-Lindau Syndrome (Hemangioblastomas of cerebellum and retinas as well as bilateral renal cell carcinoma in 50-60% of the cases.
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What is the most common type of renal cell carcinoma?
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Clear Cell Carcinoma (Non-papillary with clear or granular cytoplasm)
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What type of renal cell carcinoma is associated with trisomies 7, 16, 17?
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Papillary Carcinoma (Papillary growth, frequently multfocal)
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What is the classic triad associated with renal cell carcinoma?
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- Costovertebral pain
- Palpable mass - Hematuria |
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What paraneoplastic syndrome associated with renal cell carcinoma is the result of ectopic secretion of erythropoietin?
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Polycythemia
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What paraneoplastic syndrome associated with renal cell carcinoma is the result of parathyroid hormone-related protein secretion?
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Hypercalcemia
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What type of renal neoplasia may present early because of hematuria and potential to block outflow or cause palpable hydronephrosis and flank pain?
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Urothelial carcinoma of renal pelvis
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What is the pathenogenesis associated with minimal change disease?
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Lymphokine production of T-cells thought to damage polyanions leading to selective loss of albumin (associated with lymphoma and leukemia) most common nephrotic syndrome in children.
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What is uremia?
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Symptomatic renal failure
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What term refers to urine output < 400-500 mL/day?
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Oliguria
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What term refers to urine output < 100 mL/day?
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Anuria
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What medications block creatinine secretion and may cause falsely elevated creatinine?
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Cimetidine & Trimethoprim
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What substances/medications interfere with creatinine assay and may cause falsely elevated creatinine?
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-Cefoxitine
-Flucytosine -Acetoacetate |
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What medications can result in acute elevations in BUN?
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-Catabolic steroids
-Tetracycline antibiotics |
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Which type of renal failure is much more common in the hospital setting?
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Intrinsic renal failure (most common is acute tubular necrosis)
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Which type of renal failure is usually community acquired?
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Pre-renal failure
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Which type of renal failure is characterized by a FENa of < 1%?
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Prerenal azotemia (pre-renal failure)
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What medications can falsely elevated FENa?
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- Diuretics
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What procedure can cause falsely decreased FENa?
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Recent contrast procedure
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What is the most common etiology associated with hospital-acquired acute kidney injury?
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Radiocontrast nephropathy
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What U/A microscopic finding is indicative of rhabdomyolsis?
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Urine looks hematuric, but under the microscope no RBCs are found.
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What classic triad characterizes acute interstitial nephritis?
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- Fever
- Rash - Eosinophilia **Only present in 30% of pts** |
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What treatments are recommended for acute interstitial nephritis?
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- D/C offending drug or drugs
- Glucocorticoid therapy |
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What renal pathology should always be considered in a pt with severe and progressive renal failure of recent onset?
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Rapidly Progressive Glomerulonephritis (Crescentic glomerulonephritis)
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What acute renal vascular syndrome occurs with bad atherosclerosis or abdominal aortic aneurysm?
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Renal artery dissection
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What is the most common acute renal vascular syndrome?
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Atheroembolic disease
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Which acute renal vascular syndrome is commonly confused with radiocontrast glomerulonephritis?
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Atheroembolic disease (however occurs 2-3 weeks after procedure as opposed to 2-3 days following a procedure).
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What cutaneous findings are associated with atheroembolic disease?
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- Livedo reticularis (mottled appearance)
- Digital ischemia |
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What visual findings may be associated with atheroembolic disease?
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- Amaurosis fugax (transient monocular vision loss)
- Retinal Cholesterol emboli |
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What treatment should be avoided in atheroembolic disease?
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Anticoagulation and vascular interventions should be avoided because you want clots to stabilize?
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What disease is associated with Bence-Jones protein deposition (i.e. Bence-Jones proteinuria)?
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Multiple Myeloma (Plasma cell myeloma)
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What syndrome is associated with acute urate nephrotoxicity?
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Tumor lysis syndrome
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What medications are associated with intratubular crystal deposition?
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- Acyclovir
- Indinavir |
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When should you suspect abdominal compartment syndrome?
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Tensely distended abdomen with oliguria
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What are the indications for Dialysis (AEIOU)?
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- Acidosis
- Electrolyte abnormalities (K > 6.5meq/L) -Ingestions (ethylene glycol and methanol) - Overload (fluid) - Uremic symptoms (pericarditis, encephalopathy) |
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What should be considered if the kidneys are asymmetric or 1 is very small?
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Reflux nephropathy or renal vascular disease
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What laboratory finding is associated with chronic kidney disease (CKD, CRF, CKI)?
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Elevated creatinine > 3
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What renal pathology is defined by damage to kidneys with/without decline in kidney function?
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Chronic Kidney Disease (CKD, CRF, CKI)
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What renal pathology is defined by insufficient kidney function to sustain life?
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End-stage renal disease
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What are the most common causes of chronic kidney disease?
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- Diabetes (40%)
- HTN (27%) |
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People with obesity tend to develop which type of nephrotic renal syndrome?
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- Focal segmental glomerulosclerosis (FSGS)
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What is the most important change in GFR?
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From 1 to 2 because 50-60% of kidney function is lost.
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What GFR equation is best for pts > 65 years of age>
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MDRD equation (more accurate at lower clearances)
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What GFR equation is preferrable in pts < 65 years of age?
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Cockroft-Gault equation (CG equation)
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What is the oral hypoglycemic of choice is diabetics with chronic kidney disease?
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Glipizide
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What oral hypoglycemic should be avoided in pts with GFR < 50 due to risk of lactic acidosis?
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Metformin
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What is the #1 way to control the progression of chronic kidney disease?
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Decreasing blood pressure
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When should dialysis begin in chronic kidney disease?
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Dialysis when GFR < 15
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