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;
68 Cards in this Set
- Front
- Back
|
What are the 3 stages in ATN?
|
Initiating, maintenance, and recovery
|
|
|
What occurs at the initiating phase (of ATN)?
|
Urine output decline and a rise in BUN
|
|
|
What occurs in the maintenance stage (of ATN)?
|
oliguria, rising BUN, salt and water overload, metabolic acidosis, and hyperkalemia.
50% do not have oliguria, "non-oliguria AKI" |
|
|
What occurs in the recovery phase (of ATN)?
|
increase in urine (2-3 liters), dangerous electrolyte swings, and hypokalemia.
|
|
|
What can CMV and multiple myeloma cause?
|
Tubulointersitial nephritis, causing increased creatinine and increased BUN.
|
|
|
What is most special about acute pyelonephritis?
|
It is an ascending infection coming from vesicoureteral reflux.
|
|
|
What does a gross pic of acute pyelonephritis look like?
|
Small white bumps, with one yellow bump on the right side. The histo slide shows a lot of neutrophils in the tubules and interstitium.
|
|
|
What are two causes of vesicoureteral reflux?
|
The flap sticks to the bladder wall and does not act as a valve. Or there is a short intravesicular ureter.
|
|
|
What does a gross pic of chronic pyelonephritis look like?
|
Multiple, large lobes with broad scars OR a tan kidney with a large granuloma on the upper left side because of TB. On histo slide, it has periglomerular fibrosis almost looking like onion skin.
|
|
|
What does a gross pic of Xanthogranulomatous pyelonephritis look like?
|
Almost like vertebrae are on the kindey.
|
|
|
What is polyoma virus pyelonephritis?
|
A latent infection that manifests itself in transplants. It causes internuclear inclusions and an inflammatory reaction.
|
|
|
What can penicillins, diuretics, sulfa drugs, and NSAIDS cause?
|
Tubulointerstitial nephritis, with fever, eosinphilia, rash, azotemia, and oliguria.
|
|
|
What can anti-prostaglandins, analgesics, phenactetnin, tylenol, and metabolites cause "PMAT"?
|
Chronic tubulonephritis
|
|
|
What does chronic tubulointerstitial nephritis look like on gross pic?
|
Two renal pelvises on the left side are filled with papillary necrosis.
|
|
|
What does uric acid nephropathy look like on gross pictures?
|
Buldging and swollen renal medullas.
|
|
|
What are two important things about polycystic kidney disease?
|
It is present in 10% of dialysis patients. Also, 20-25% of pts with the disease will die from berry aneurysms.
|
|
|
What does urolitthiasis look like on gross pics?
|
White stuvite stone on left side and hydronephrosis (dilation of the calyces) on the right side. Also, one with a large mass on the left side (that almost looks like a piece of the liver).
|
|
|
When is someone classified as having chronic KD?
Which GFR is considered kidney failure? |
Kidney damage or GFR less than 60 for at least 3 months.
15% |
|
|
What is the most reliable measure for CKD?
|
Progressive increases in creatinine levels.
|
|
|
What size of kidneys usually means AKD?
|
Normal to enlarged.
|
|
|
Does AKD or CKD have problems with erytropoetin?
|
CKD
|
|
|
Which disease are subperiostal lesions and band keratinopathy found in?
|
CKD
|
|
|
Which disease are oliguria and daily increases in BUN and creatinine found in?
|
AKD
|
|
|
How does high-turnover bone disease (osteitis fibrosa) occur?
|
Because of the CKD, hydrogen and phosphate excretion decrease (hyperphosphatemia). Hypocalcemia occurs because there is less reabsorption at the intestines and the kidney isn't activating vitamin D. The decrease in calcium increases PTH cell proliferation. Then parathyroid cells secrete hormone that removes phosphrous, Ca, and Mg from the bones, and into the tissues. This can result in calcification.
|
|
|
What is the main way K+ is excreted?
|
Using the sodium-potassuim pump. It resets the membrane potential by bringing K back into the cell against its gradient. (Potassium concentration is usually higher inside the cell)
|
|
|
What can be used to quickly resolve hyperkalemia (to buy time for a better treatment)?
|
NaHCO and insulin because they force potassium back into the cells.
|
|
|
What are examples of nephrOtic syndromes? (nOn proliferative)
|
Minimal Change Disease (MCD), Membranous Glomerulonephritis (MGN), Focal Segmental Glomerulosclerosis (FSGS), Lupus, Amyloidosis, and Diabetes.
|
|
|
Which cells does renal oncocytoma arise from?
What color is it, and why? |
Intercalated cells of the collecting duct.
It is mahogany brown stuffed full of mitochondria. |
|
|
Name two important things about angiomyolipoma.
|
Present in 25-50% of tuberous scelrosis patients AND occurs because of a LOF mutation in TSC1 and TSC2.
|
|
|
What does a histo slide of angiomyolipoma look like?
|
White vacoules on the left side and two glomeruli with thrombi inside.
|
|
|
What are the symptoms of tuberous sclerosis?
|
mental retardation, seizures, skin lesions, and hamartomatous lesions in many organs.
|
|
|
What does xanthogranulomatous pyelonephritis normally get confused with?
|
renal cell carcinoma or Wilms tumor.
|
|
|
What are the characterisitics of xan. pyelonephritis?
|
chronic inflamm, infection, macrophages, lipid accumulation, and granulomas.
|
|
|
How does one calculate the 24 hours protein value?
|
protein/creatinine. If it comes out more than 3000, could be nephrotic syndrome.
|
|
|
What occurs to ICF and ECF in diarrhea?
|
Same ICF
Smaller volume of ECF |
|
|
What occurs to ICF and ECF in water deprivation?
|
Smaller volume in ICF and ECF.
High osmolarity in ICF and ECF. |
|
|
What occurs in ICF and ECF in adrenal insufficiency?
|
Higher volume in ICF
Lower volume in ECF (Aldosterone cannot be released to increase ECF volume.) |
|
|
What occurs to ICF and ECF during infusion of isotonic NaCl?
|
ICF stays the same
ECF volume increases |
|
|
What occurs to ICF and ECF in high NaCl intake?
|
ICF loses volume but increases osmolarity.
ECF increases volume and osmolarity. (Water will leave the cells to equilibrate with the increased solute outside) |
|
|
What occurs to ICF and ECF in SIADH?
|
Both volumes increase
Both osmolarities decrease |
|
|
What is the equation for clearance?
|
Ucr x V (urine flow) divided by Pcr.
|
|
|
What is the equation for RBF?
|
RPF/ 1-Hct
|
|
|
What ECG changes occur in hypokalemia?
|
ECG changes of ST segment depression, inverted T waves
|
|
|
What occurs in Bartter's syndrome?
|
An inherited defect in the thick ascending limb of the loop of Henle.
It is characterized by low potassium levels (hypokalemia), increased blood pH (alkalosis), and normal to low blood pressure |
|
|
What are characteristics of Post-streptococcal GN?
|
IgG deposits, occurs 10 d- 2 weeks later.
|
|
|
What are characteristics of Henoch-Schlonein purpura?
|
belly pain, joint pain, and a rash
|
|
|
What are characteristics of Berger's disease?
|
IgA nephropathy with mesangial cell proliferation, comes on quickly post-strept.
|
|
|
What are symptoms of Goodpasture's?
|
attacking lung and glomerular membranes, hemoptysis, hematuria, IgG, linear immunofluorescence
|
|
|
What are characteristics of SLE?
|
ENDOGENOUS antigens trapped by circulating Ab that lodge along the GBM in a linear pattern.
|
|
|
What are characteristics of post-strepto?
|
EXOGENOUS antigens trapped by circulating Ab that lodge along the GBM in a granular pattern.
|
|
|
What occurs in Wegener's?
|
ANCA antibodies bind glomerular endothelial cells and activate circulating neutrophils to release their enzymes and free radicals.
|
|
|
What are characteristics of Alport syndrome?
|
Splitting of the GBM, deafness, near blind vision, hematuria
|
|
|
What are the four main traits of nephritc syndrome?
|
Inflamm, hematuria, RBC casts, and mild proteinuria.
|
|
|
What are the nephritic syndromes?
|
Post-strept GN
Berger Disease Henoch-Schonlein purpura Alport syndrome Benign familial hematuria/thin BM disease RPGN Crescentric: Goodpasture's, Wegener, Churg -Strauss, and microscopic polyarteritis |
|
|
What are the three main traits of nephrotic syndrome?
|
PROTEINURIA, hypoalbuminemia, and edema
|
|
|
What are the nephrotic syndromes?
|
Minimal change, focal segmental, diabetic nephropathy, amyloid
|
|
|
What are characteristics of Diffuse prolif. GN?
|
Considered both nephrotic and nephritic, ANA, anti-DNA, wire loops, granular IgG and IgM, C3 deposits.
|
|
|
Where do the deposits occur in PSGN and membranous GN?
|
Subepithelial
|
|
|
Where do the deposits occur in diffuse proliferative, ad membranoproliferative?
|
Subendothelial
|
|
|
Where do the deposits occur in Berger's?
|
At the mesangial cells
|
|
|
Which diseases have granular immunoflourescence?
|
PSGN, focal segmental, and membranous
|
|
|
What do you see in the glomerulus in Diffuse proliferative?
|
Increased neutrophils and mesangial cells
|
|
|
What are found in diabetic glomeruli?
|
KW nodules and hyaline arteriosclerosis
|
|
|
What is found in the glomerulus in membranous GN?
|
Uniformly thickened membrane without proliferation
|
|
|
When is BUN:Cr equal to 15
When is BUN:Cr more than 15 When is BUN:Cr less than 15 |
Normal
Prerenal azotemia and postrenal Renal azotemia |
|
|
When does pre-renal AKI occur?
What do the labs look like? |
In shock and stenosis
Low urine sodium and FE of sodium less than 1%. |
|
|
When does renal AKI occur?
What do the labs look like? |
ATN, ischemia, toxins, and GN
FE of sodium more than 2% Impaired BUN reabsorption |
|
|
When does post-renal ADI occur?
What do the labs look like? |
Stones, BPH, tumors
FE of sodium is more than 4% |
