Renal Phys - Pathology2

Front 1

2 severe complications of Kidney stones:

Back 1

-Hydronephrosis (swell)
-Pyelonephritis (bacterial inf)

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4 types of kidney stones:

Back 2

-Calcium
-Ammonium Mg PO4 - Struvite
-Uric Acid
-Cystine

Front 3

Most common type of Kidney stone?

Back 3

Calcium

Front 4

Radiolucent kidney stones?

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Uric acid

Front 5

Faintly radiopaque:

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Cystine

Front 6

2 KINDS of calcium kidney stones:

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-Calcium oxalate/phosphate

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4 conditions that lead to calcum stones:

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-Cancer
-Increased PTH
-Increased Vit D
-Milk-Alkali syndrome

Front 8

2nd most common kidney stone:

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Struvites - NH3/Mg/PO4

Front 9

What are Struvite stones caused by?

Back 9

Infections with Urease-pos bugs

Front 10

3 Urease-pos bacteria:

Back 10

-P vulgaris
-Staphylococcus
-Klebsiella

Front 11

What are the hallmark findings in Struvite calculi?

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Staghorn calculi - may increase UTIs

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What makes Struvite stones worse?

Back 12

ALKALURIA

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3 conditions in which Uric Acid crystals may be seen:

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-Gout
-Myeloproliferative disorder
-Leukemia
(increased cell turnover)

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What makes Uric acid stones worse?

Back 14

ACIDURIA

Front 15

What makes Uric acid stones unique?

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Radiolucent

Front 16

Most common renal malignancy:

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RCC - renal cell carcinoma

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Most common sex/age of RCC:

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Men age 50-70

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2 risk factors for RCC?

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-Smoking
-Obesity

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Genetic association with RCC:

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Von hippel lindau - Ch'3

Front 20

Where in the kidney does RCC originate? Cell type?

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Renal tubule cells - Polygonal Clear Cells

Front 21

6 presenting signs of Renal cell carcinoma:

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-Hematuria
-Palpable mass
-2ndry Polycythemia vera (EPO)
-Fever/weightloss/FLANK PAIN

Front 22

How does RCC metastasize?

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Invades the renal VEIN - hematogenously

Front 23

4 Common associations with RCC:

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Paraneoplastic syndromes
-EPO
-ACTH
-PTHrP
-Prolactin

Front 24

Most common renal malignancy of childhood: Age?

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Wilm's tumor - 2-4 yrs old

Front 25

How does Wilm's tumor present?

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HUUUUGE palpable flank mass

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Genetic association with Wilm's tumor:

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WT gene on Ch' 11 - deletion of tumor suppressor gene

Front 27

WAGR complex:

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-Wilm tumor
-Aniridia
-GU malformations
-Retarded - mental/motor

Front 28

Painless Hematuria, think:

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Transitional Cell Carcinoma of the BLADDER

Front 29

Is transitional Cell carcinoma only seen in the bladder?

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No it can be seen in the renal calyces, pelvis, ureters, and bladder.

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Acronym for risk fx's associated with Transitional Cell Carcinoma of the bladder:

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Pee SACS

Front 31

Pee SACS:

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-Phenacetin
-Smoking
-Aniline dyes
-Cyclophosphamide
-Schistosomiasis

Front 32

White cell casts in urine:

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Acute pyelonephritis!

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What part of the kidney is primarily affected in acute pyelonephritis? Spared?

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Affects Cortex
Spares glomeruli/vessels

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2 sx of acute pyelonephritis:

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-Fever
-Flank pain

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Coarse/assymetric corticomedulla scarring and blunted calyx:

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Chronic pyelonephritis

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Major difference between what you'll see on LM in acute vs chronic pyelonephritis:

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Acute - WBCs
Chronic - mononuclears

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How will vasospasm/DIC affect the kidneys?

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Bilateral diffuse necrosis of the CORTICES

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What are 2 common settings in which such destruction of the cortices may be seen?

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-Abruptio placentae
-Septic shock

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Common cause of acute INTERSTITIAL renal inflammation:

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DRUGS

Front 40

When after drug administration will the interstitial inflammation be seen? 4 findings?

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2 weeks later
-Hematuria
-Eosinophila
-Fever
-Rash

Front 41

How do drugs cause interstitial nephritis?

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Act as haptens to induce hypersensitivity

Front 42

3 common drugs that cause this acute interstitial inflammation:

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-Penicillin
-Diuretics
-NSAIDs

Front 43

Most common cause of ARF - acute renal failure:

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ATN - Acute tubular necrosis

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3 things associated with ATN:

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-Renal ischemia (shock)
-Crush injury
-Toxins

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Why do crushing injuries lead to ATN?

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Due to all the myoglobinuria

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If left untreated what will Acute tubular necrosis lead to?

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Death during the oliguric phase

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When will recovery occur if ARF due to ATN is treatd?

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2-3 weeks

Front 48

4 histologic findings in ATN:

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-Loss of cell polarity
-Epithelial cell detachment
-Necrosis
-Granular casts

Front 49

What are the 3 stages of ARF?

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1. Inciting event
2. Maintainence (oliguria)
3. Recovery

Front 50

4 conditions that cause/associated with Renal Papillary necrosis:

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DACS
-Diabetes mellitus
-Acute pyelonephritis
-Chronic phenacetin use
-Sickle cell anemia

Front 51

What is ARF defined as?

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Abrupt decrease in renal function with increased Creatinine and BUN over a few DAYS

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3 TYPES of acute renal failure:

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-Prerenal
-Renal
-Postrenal

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Cause of PRErenal ARF:

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Reduced RBF due to hypotension leads to low GFR, retaining Na/H2O in the kidney.

Front 54

What is RENAL ARF generally caused by? 3

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Acute tubular necrosis
Toxins
Ischemia

Front 55

What will you find in the urine in ATN?

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Epithelial cells
Granular casts

Front 56

Cause of postrenal ARF:

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Outflow obstruction
-Stones
-BPH
-Tumor

Front 57

What has to occur for an outflow obstruction to cause ARF?

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It has to be bilateral

Front 58

Which type of ARF has a BUN:Cr ratio >20? <15? >15?

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>20 = Pre
<15 = Renal
>15 = Postrenal

Front 59

How does fractional excretion of sodium change with each type of ARF?

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Pre - <1%
Renal - >2%
Post - >4%

Front 60

So what are the 2 forms of renal failure? What is each commonly due to?

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Acute = hypoxia

Chronic = diabetes/hypertension

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Why does the body fail in general in renal failure?

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-Fail to make urine
-Fail to excrete nitrogenous wastes

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What IS uremia?

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The clinical syndrome of
-Increased BUN
-Increased creatinine
and associated symptoms

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8 consequences of RENAL FAILURE:

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HARMSUCH
-Hypertension
-Anemia (no EPO)
-Renal osteodystrophy (no vit D)
-Metabolic acidosis (retain H)
-Sodium/H2O excess -> CHF
-Uremic encephalopathy
-Chronic pyelonephritis
-Hyperkalemia

Front 64

What is Fanconi syndrome?

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Failure of PCT transport of AA, glucose, phosphate, uric acid, proteins and electrolytes!! Basically fail to reabsorb ALL

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Flank pain, hematuria, hypertn, urinary infections, progressive renal failure in a 45 yr old:

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Adult polycystic kidney disease

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If it's an older adult with PKD, you automatically know it's:

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Auto Dominant - ADPK1

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What are the gross findings in ADPK1?

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BILATERAL multiple large cysts that destroy the kidneys!

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3 other common hallmark findings in patients with ADPK1 mutations:

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-Liver polycystic disease
-Berry aneurysms
-Mitral valve prolapse

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If an INFANT presents with polycystic kidney disease we know:

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Autosomal recessive - ARPKD

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What are 2 associated findings in ARPKD in infants?

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-Fibrosis
-Hepatic cysts

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What are end stage cysts? Where in the kidneys?

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Cysts caused by long-standing dialysis - cortex and medulla

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Simple cysts:

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Benign, only in the cortex

Front 73

Medullary cystic disease
-Where
-Hallmark finding
-Prognosis

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-Medulla only
-SMALL kidney on ultrasound
-Poor prognosis

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Medullary sponge disease
-Where
-Prognosis

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Collecting ducts
Good prognosis!