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320 Cards in this Set
- Front
- Back
|
Define Acute Renal Failure?
|
Abrupt decline in renal function w/ inc. BUN and inc. Creatinine over several days
|
|
|
Define renal failure.
|
Failure to make urine and excrete nitrogenous wastes
|
|
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How do you treat Minimal change disease?
|
Responds well to steroids
|
|
|
How does acute poststreptococcal glomerulonephritis resolve?
|
Spontaneously
|
|
|
How does renal cell carcinoma spread metastically?
|
Invades the IVC and spreads hematogenously
|
|
|
How does transitional cell carcinoma present?
|
Hematuria and may spread to adjacent tissue
|
|
|
How does Wilms' tumor present?
|
Huge, palpable flank mass, hemihypertrophy
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|
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How long does it take to recover from Acute Tubular Necrosis?
|
Recovery is 2-3 weeks
|
|
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In what population group is renal cell carcinoma most common?
|
Men ages 50-70
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|
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Is Acute Tubular Necrosis reversible?
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Yes it is reversible, but fatal if left untreated
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T/F: Ammonium magnesium phosphate kidney stones are radiopaque
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TRUE
|
|
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T/F: Calcium kidney stones are radiopaque.
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TRUE
|
|
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T/F: Calcium kidney stones do not recur.
|
FALSE
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T/F: Cystine kidney stones are radiopaque.
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FALSE, cystine stones are radiolucent
|
|
|
T/F: Incidence of renal cell carcinoma increases after long-term dialysis?
|
TRUE
|
|
|
T/F: Postrenal Acute Renal failure occurs with unilateral obstruction?
|
False; develops only with bilateral obstruction
|
|
|
T/F: Transitional cell carcinoma is cured by surgical removal.
|
False, transitional cell carcinoma often recurs after removal
|
|
|
T/F: Uric acid kidney stones are radiopaque
|
FALSE, uric acid stones are radiolucent
|
|
|
What additional symptoms are seen in pts with acute streptococcal glomerulonephritis?
|
Peripheral/periorbital edema
|
|
|
What age group is poststreptococcal glomerulonephritis most common?
|
Children
|
|
|
What are 2 common associations with Diffuse Cortical Necrosis?
|
Obstetric catastrophes (abruptio placentae); septic shock
|
|
|
What are 3 categories of Acute Renal Failure?
|
1.Prerenal Azotemia 2.Intrinsic renal 3.Postrenal
|
|
|
What are 3 causes of Acute Tubular Necrosis?
|
1.Renal ischemia 2.Crush injury 3.Toxins
|
|
|
What are 4 causes of hypoventilation (causing respiratory acidosis)?
|
1.Acute lung disease 2.Chronic lung disease 3.Opioids, narcotics, sedatives 4.Weakening of respiratory muscles
|
|
|
What are 5 nephrotic syndromes?
|
1.Membranous glomerulonephritis 2.Minimal change disease (lipoid nephrosis) 3.Focal segmental glomerular sclerosis 4.Diabetic nephropathy 5.SLE
|
|
|
What are 6 Nephritic syndromes?
|
1.Acute poststreptococcal glomerulonephritis 2.Rapidly progressive (crescentic) glomerulonephritis 3.Goodpasture's syndrome 4.Membranoproliferative glomerulonephritis 5.IgA nephropathy (Berger's disease) 6.Alport's Syndrome
|
|
|
What are the 2 forms of renal failure?
|
Acute; Chronic
|
|
|
What are the 2 main symptoms present in Goodpasture's syndrome?
|
Hemoptysis, hematuria
|
|
|
What are the 4 major types of kidney stones?
|
1.Calcium 2.Ammonium magnesium phosphate (struvite) 3.Uric acid 4.Cystine
|
|
|
What are the causes and signs of calcium ion deficiency?
|
Kids: rickets; Adults: osteomalacia, Contributes to osteoporosis, Tetany
|
|
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What are the causes and signs of phosphate toxicity (high serum phosphate)?
|
Metastatic calcification; renal stones
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|
|
What are the causes of chloride ion deficiency?
|
Secondary to emesis, diuretics, renal disease
|
|
|
What are the causes of Metabolic Acidosis?
|
Diabetic ketoacidosis; Diarrhea; Lactic Acidosis; Salicylate OD; Acetazolamide OD
|
|
|
What are the causes of Respiratory Acidosis?
|
COPD; Airway obstruction
|
|
|
What are the causes of Respiratory Alkalosis?
|
High altitude; Hyperventilation
|
|
|
What are the characteristics of acute poststreptococcal glomerulonephritis seen with immunofluorescence?
|
Granular pattern
|
|
|
What are the characteristics of acute poststreptococcal glomerulonephritis seen with the electron microscope?
|
Subepithelial humps
|
|
|
What are the characteristics of acute poststreptococcal glomerulonephritis seen with the light microscope?
|
Glomeruli enlarged and hypercellular, neutrophils, 'lumpy-bumpy'
|
|
|
What are the characteristics of rapidly progressive (crescentic) glomerulonephritis seen on LM and IF?
|
Crescent-moon shape
|
|
|
What are the clinical features of renal cell carcinoma?
|
Hematuria, Palpable mass, Secondary polycythemia, Flank pain, Fever
|
|
|
What are the clinical symptoms of a nephritic syndrome?
|
I'= inflammation; hematuria, hypertension, oligouria, azotemia (increased bloon BUN/creatinine)
|
|
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What are the clinical symptoms of Nephrotic syndromes?
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O= proteinuria, Hypoalbuminemia, Peripheral/periorbital edema, Hyperlipidemia
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What are the consequences of renal failure?
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1.Anemia 2.Renal osteodystrophy 3.Hyperkalemia 4.Metabolic acidosis 5.Uremic encephalopathy 6.Sodium and water excess 7.Chronic pyelonephritis 8.HTN
|
|
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What are the factors associated with Metabolic Acidosis?
|
Decreased pH; Decreased PCO2; Decreased HCO3-
|
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What are the factors associated with Metabolic Alkalosis?
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Increased pH; Increased PCO2; Increased HCO3-
|
|
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What are the factors associated with Respiratory Acidosis?
|
Decreased pH; Increased PCO2; Increased HCO3-
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|
|
What are the factors associated with Respiratory Alkalosis?
|
Increased pH; Decreased PCO2; Decreased HCO3-
|
|
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What are the functions of calcium ion?
|
Muscle contraction; Neurotransmitter release; Bones; teeth
|
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What are the functions of sodium ion?
|
Extracellular fluid; Maintains plasma volume; Nerve/muscle function
|
|
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What are the functions of the chloride ion?
|
Fluid/electrolyte balance; Gastric acid; HCO3/Cl shift in RBC
|
|
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What are the functions of the magnesium ion?
|
Bones; teeth; Enzyme cofactor
|
|
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What are the functions of the phosphate ion?
|
ATP; nucleic acids; Phosphorylation; Bones; teeth
|
|
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What are the functions of the potassium ion?
|
Intracellular fluid; Nerve/muscle function
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What are the signs of calcium ion toxicity (high serum Ca2+)?
|
Delirium, renal stones, abdominal pain
|
|
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What are the signs of high serum Cl-?
|
Secondary to non-anion gap acidosis
|
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What are the signs of high serum Mg2+?
|
Delirium; dec. DTRs; cardiopulmonary arrest
|
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What are the signs of low serum Ca2+?
|
Tetany, neuromuscular irritability
|
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What are the signs of low serum Cl-?
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Secondary to metabolic alkalosis
|
|
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What are the signs of low serum K+?
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U waves; flattened T waves; arrhythmias; paralysis
|
|
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What are the signs of low serum Mg2+?
|
Neuromuscular irritability; arrhythmias
|
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What are the signs of low serum Na+?
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Disorientation; stupor; coma
|
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What are the signs of low serum phosphate?
|
Bone loss
|
|
|
What are the signs of phosphate deficiency?
|
Kids: rickets; Adults: osteomalacia
|
|
|
What are the signs of potassium ion toxicity (high serum K+)?
|
Peaked T waves; arrhythmias
|
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What are the signs of sodium ion toxicity (high serum Na+)?
|
Neurologic: irritability, delirium, coma
|
|
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What bugs cause ammonium magnesium phosphate kidney stones?
|
Urease-positive bugs such as Proteus vulgaris or Staphylococcus
|
|
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What calcium molecules form calcium kidney stones?
|
Calcium Oxalate, Calcium Phosphate, or both
|
|
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What can excess Na and water cause?
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CHF and pulmonary edema
|
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What can the hyperkalemia (failure to secrete K+) associated with renal failure lead to?
|
Cardiac arrhythmias
|
|
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What causes metabolic alkalosis?
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1.Vomiting 2.Diuretic use 3.Antacid use 4.Hyperaldosteronism
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|
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What causes renal osteodystrophy?
|
Failure of active vitamin D production
|
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What characteristics of Berger's disease are seen with IF and EM?
|
Mesangial deposits of IgA
|
|
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What characteristics of Focal segmental glomerular sclerosis are seen with the LM?
|
Segmental sclerosis and hyalinosis
|
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What characteristics of Goodpasture's syndrome are seen with IF?
|
Linear pattern, Anti-glomerular basement membrane antibodies (anti-GBM antibodies)
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What characteristics of Membranoproliferative glomerulonephritis are seen with the EM?
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Subendothelial humps, 'tram track'
|
|
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What characteristics of membranous glomerulonephritis are seen with IF?
|
Granular pattern
|
|
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What characteristics of Membranous glomerulonephritis are seen with the EM?
|
'Spike and Dome'
|
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What characteristics of Membranous glomerulonephritis are seen with the LM?
|
Diffuse capillary and basement membrane thickening
|
|
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What characteristics of Minimal change disease are seen with the EM?
|
Foot process effacement
|
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What characteristics of Minimal change disease are seen with the LM?
|
Normal glomeruli
|
|
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What characteristics of SLE are seen with the LM?
|
Wire-loop appearance with extensive granular subendothelial basement-membrane deposits in membranous glomerulonephritis pattern
|
|
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What defect(s) is seen with Alport's Syndrome?
|
Collagen IV mutation; Nerve deafness/ocular disorders
|
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What defines metabolic acidosis?
|
pH < 7.4; PCO2 less than 40 mm Hg
|
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What defines metabolic alkalosis with compensation?
|
pH > 7.4; PCO2 greater than 40 mm Hg
|
|
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What defines Respiratory acidosis?
|
pH < 7.4; PCO2 greater than 40mm Hg
|
|
|
What defines respiratory alkalosis?
|
pH > 7.4; PCO2 less than 40 mm Hg
|
|
|
What diseases often cause uric acid kidney stones?
|
Diseases with increased cell proliferation and turnover, such as leukemia and myeloproliferative disorders
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|
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What disorders can lead to hypercalcemia and thus kidney stones?
|
1.Cancer 2.Increased PTH 3.Increased vitamin D 4.Milk-alkali syndrome
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What disorders cause metabolic acidosis and normal anion gap?
|
1.Diarrhea 2.Glue sniffing 3.Renal tubular acidosis 4.Hyperchloremia
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What disorders cause metabolic acidosis with an Increased anion gap?
|
MUD PILES: Methanol, Uremia (chronic renal failure), Diabetic ketoacidosis, Paraldehyde (or Phenformin), Iron tablets (or INH), Lactic acidosis, Ethylene Glycol, Salicylates
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|
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What disorders make up the WAGR complex?
|
Wilms' tumor; Aniridia (missing part of iris); Genitourinary malformation; Mental-motor Retardation
|
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What do you find in the urine with Intrinsic Acute Renal failure?
|
Epithelial/granular casts
|
|
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What factors are associated with transitional cell carcinoma?
|
Pee SAC: Phenacetin, Smoking, Aniline dyes, Cyclophosphamide
|
|
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What finding do you get w/ Chronic Pyelonephritis?
|
Tubules contain eosinophilic casts
|
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What genetic disorder and mutation are associated with renal cell carcinoma?
|
Associated with von Hippel-Lindau and gene deletion in chromosome 3
|
|
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What genetic disorder is associated with Wilms' tumor?
|
Deletion of tumor suppression gene WT-1 on chromosome 11
|
|
|
What is a cause of Intrinsic Acute Renal failure?
|
Acute Tubular Necrosis; Ischemia; Toxins
|
|
|
What is a cause of Postrenal Acute Renal failure?
|
Outflow obstruction (stones, BPH, neoplasia)
|
|
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What is a cause of Prerenal Azotemia in Acute Renal failure?
|
Decreased renal blood flow (hypotension)-> dec. GFR; Na+/H2O rentention
|
|
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What is acute renal failure often due to?
|
Hypoxia
|
|
|
What is Berger's disease?
|
IgA nephropathy; Mild disease, often postinfectious
|
|
|
What is chronic renal failure due to?
|
HTN and diabetes
|
|
|
What is Diffuse Cortical Necrosis?
|
Acute generalized infarction of cortices of both kidneys
|
|
|
What is Renal Papillary Necrosis associated with?(3)
|
1.Diabetes Mellitus 2.Acute Pyelonephritis 3.Chronic Phenacetin use
|
|
|
What is the 2nd most common type of kidney stone?
|
Ammonium magnesium phosphate (struvite)
|
|
|
What is the Acute Respiratory acidosis compensatory formula?
|
Acute= inc. 1mEq/L HCO3 for every inc. 10mmHg PCO2
|
|
|
What is the Acute Respiratory Alkalosis compensatory formula?
|
Acute= dec. 2mEq/L HCO3 for every dec. 10mmHg PCO2
|
|
|
What is the BUN/Cr ratio for: Prerenal, Renal, and Postrenal Acute Renal failure?
|
Prerenal= >20; Renal= <15; Postrenal= >15
|
|
|
What is the cause of magnesium ion deficiency?
|
Secondary to malabsorption
|
|
|
What is the cause of Metabolic Alkalosis?
|
Vomiting
|
|
|
What is the cause of potassium ion deficiency?
|
Secondary to injury, illness or diuretics
|
|
|
What is the cause of sodium deficiency?
|
Secondary to injury or illness
|
|
|
What is the Chronic Respiratory acidosis compensatory formula?
|
Chronic= inc. 3.5mEq/L HCO3 for every inc. 10mmHg PCO2
|
|
|
What is the Chronic Respiratory Alkalosis compensatory formula?
|
Chronic= dec. 5mEq/L HCO3 for every dec. 10mmHg PCO2
|
|
|
What is the compensatory mechanism of Metabolic Alkalosis?
|
Hypoventilation
|
|
|
What is the compensatory mechanism of Respiratory Alkalosis?
|
Renal HCO3- secretion
|
|
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What is the compensatory response to Metabolic Acidosis?
|
Hyperventilation
|
|
|
What is the compensatory response to Respiratory Acidosis?
|
Renal HCO3- reabsorption
|
|
|
What is the course of membranoproliferative glomerulonephritis?
|
Slowly progresses to renal failure
|
|
|
What is the course of rapidly progressive (crescentic) glomerulonephritis?
|
Rapid course to renal failure from one of many causes
|
|
|
What is the equation of Anion Gap?
|
Anion Gap= Na - (Cl + HCO3); Normal= 10 +/-2
|
|
|
What is the FeNa (fraction excretion of Na) for: Prerenal, Renal, and Postrenal Acute Renal failure?
|
Prerenal= <1%; Renal= >2%; Postrenal= >4%
|
|
|
What is the Henderson-Hasselbalch equation?
|
pH = pKa + log [(HCO3-)/(0.03*PCO2)]
|
|
|
What is the likely cause of Diffuse Cortical Necrosis?
|
Combination of vasospasm/DIC
|
|
|
What is the main characteristic of Alport's Syndrome?
|
Split basement membrane
|
|
|
What is the Metabolic acidosis compensatory formula?
|
Winter's formula: PCO2= 1.5(HCO3) +8 +/-2
|
|
|
What is the Metabolic Alkalosis compensatory formula?
|
PCO2 inc. 0.7 mmHg for every inc. 1mEq/L HCO3
|
|
|
What is the most common cause of acute renal failure?
|
Acute Tubular Necrosis
|
|
|
What is the MOST common cause of adult nephrotic synd
|
Membranous glomerulonephritis
|
|
|
What is the MOST common cause of childhood nephrotic syndrome?
|
Minimal change disease (lipoid nephrosis)
|
|
|
What is the most common renal malignancy of early childhood (ages 2-4)?
|
Wilms' tumor
|
|
|
What is the most common renal malignancy?
|
Renal cell carcinoma
|
|
|
What is the most common tumor of the urinary tract system?
|
Transitional cell carcinoma
|
|
|
What is the pathology of Acute Pyelonephritis?
|
Affects cortex w/ relative sparing of glomeruli/vessels
|
|
|
What is the pathology of Chronic Pyelonephritis?
|
Coarse, asymmetric corticomedullary scarring
|
|
|
What is the pathophysiology of Intrinsic Acute Renal failure?
|
Patchy necrosis leads to debris obstructing tubule and fluid backflow across necrotic tubule-> dec. GFR
|
|
|
What is the primary disturbance in respiratory acidosis?
|
Increased PCO2
|
|
|
What is the primary disturbance of metabolic acidosis?
|
HCO3- decrease
|
|
|
What is the primary disturbance of metabolic alkalosis?
|
Increased HCO3-
|
|
|
What is the primary disturbance of respiratory alkalosis?
|
Decreased PCO2
|
|
|
What is the Urine Na+ for: Prerenal, Renal, and Postrenal Acute Renal failure?
|
Prerenal= <10; Renal= >20; Postrenal= >40
|
|
|
What is the Urine Osmolality for: Prerenal, Renal, and Postrenal Acute Renal failure?
|
Prerenal= >500; Renal= <350; Postrenal= <350
|
|
|
What is uremia?
|
Clinical syndrome marked by inc. BUN and inc. Creatinine
|
|
|
What lab result do you find w/ Acute Pyelonephritis?
|
White cells casts in urine
|
|
|
What lesions are seen on the LM in Diabetic nephropathy?
|
Kimmelstiel-Wilson lesions, basement membrane thickening
|
|
|
What Paraneoplastic syndromes are associated with renal cell carcinoma?
|
Ectopic EPO, ACTH, PTHrP, and prolactin
|
|
|
What risk factor increases the incidence of renal cell carcinoma?
|
Smoking
|
|
|
What severe complications may kidney stones lead to?
|
Hydronephrosis; Pyelonephritis
|
|
|
What should you suspect if the calculated compensatory values do not match the actual values?
|
Mixed disorder
|
|
|
What type of Hypersensitivity contributes to the pathogenesis of Goodpasture's syndrome?
|
Type II hypersensitivity
|
|
|
When does death occur with Acute Tubular Necrosis?
|
Initial oliguric phase
|
|
|
Where can transitional cell carcinoma occur?
|
Renal calyces; Renal pelvis; Ureters; Bladder
|
|
|
Where does renal cell carcinoma originate?
|
Renal tubule cells-> polygonal Clear Cells
|
|
|
Which kidney stone is often secondary to cystinuria?
|
Cystine
|
|
|
Which kidney stone is strongly associated with hyperuricemia (gout)?
|
Uric acid kidney stones
|
|
|
Which of the Nephrotic syndromes is worse in HIV pts?
|
Focal segmental glomerular sclerosis
|
|
|
Which type of kidney stones constitute the majority of kidney stones (80-85%)?
|
Calcium
|
|
|
Why are ammonium magnesium phosphate kidney stones often associated with UTIs?
|
Ammonium magnesium phosphate stones can form large struvite calculi that can be a nidus for UTIs
|
|
|
Why does renal failure cause anemia?
|
Failure of EPO production
|
|
|
Why does renal failure cause metabolic acidosis?
|
Due to decreased acid secretion and decreased generation of HCO3-
|
|
|
Define Acute Renal Failure?
|
Abrupt decline in renal function w/ inc. BUN and inc. Creatinine over several days
|
|
|
Define renal failure.
|
Failure to make urine and excrete nitrogenous wastes
|
|
|
How do you treat Minimal change disease?
|
Responds well to steroids
|
|
|
How does acute poststreptococcal glomerulonephritis resolve?
|
Spontaneously
|
|
|
How does renal cell carcinoma spread metastically?
|
Invades the IVC and spreads hematogenously
|
|
|
How does transitional cell carcinoma present?
|
Hematuria and may spread to adjacent tissue
|
|
|
How does Wilms' tumor present?
|
Huge, palpable flank mass, hemihypertrophy
|
|
|
How long does it take to recover from Acute Tubular Necrosis?
|
Recovery is 2-3 weeks
|
|
|
In what population group is renal cell carcinoma most common?
|
Men ages 50-70
|
|
|
Is Acute Tubular Necrosis reversible?
|
Yes it is reversible, but fatal if left untreated
|
|
|
T/F: Ammonium magnesium phosphate kidney stones are radiopaque
|
TRUE
|
|
|
T/F: Calcium kidney stones are radiopaque.
|
TRUE
|
|
|
T/F: Calcium kidney stones do not recur.
|
FALSE
|
|
|
T/F: Cystine kidney stones are radiopaque.
|
FALSE, cystine stones are radiolucent
|
|
|
T/F: Incidence of renal cell carcinoma increases after long-term dialysis?
|
TRUE
|
|
|
T/F: Postrenal Acute Renal failure occurs with unilateral obstruction?
|
False; develops only with bilateral obstruction
|
|
|
T/F: Transitional cell carcinoma is cured by surgical removal.
|
False, transitional cell carcinoma often recurs after removal
|
|
|
T/F: Uric acid kidney stones are radiopaque
|
FALSE, uric acid stones are radiolucent
|
|
|
What additional symptoms are seen in pts with acute streptococcal glomerulonephritis?
|
Peripheral/periorbital edema
|
|
|
What age group is poststreptococcal glomerulonephritis most common?
|
Children
|
|
|
What are 2 common associations with Diffuse Cortical Necrosis?
|
Obstetric catastrophes (abruptio placentae); septic shock
|
|
|
What are 3 categories of Acute Renal Failure?
|
1.Prerenal Azotemia 2.Intrinsic renal 3.Postrenal
|
|
|
What are 3 causes of Acute Tubular Necrosis?
|
1.Renal ischemia 2.Crush injury 3.Toxins
|
|
|
What are 4 causes of hypoventilation (causing respiratory acidosis)?
|
1.Acute lung disease 2.Chronic lung disease 3.Opioids, narcotics, sedatives 4.Weakening of respiratory muscles
|
|
|
What are 5 nephrotic syndromes?
|
1.Membranous glomerulonephritis 2.Minimal change disease (lipoid nephrosis) 3.Focal segmental glomerular sclerosis 4.Diabetic nephropathy 5.SLE
|
|
|
What are 6 Nephritic syndromes?
|
1.Acute poststreptococcal glomerulonephritis 2.Rapidly progressive (crescentic) glomerulonephritis 3.Goodpasture's syndrome 4.Membranoproliferative glomerulonephritis 5.IgA nephropathy (Berger's disease) 6.Alport's Syndrome
|
|
|
What are the 2 forms of renal failure?
|
Acute; Chronic
|
|
|
What are the 2 main symptoms present in Goodpasture's syndrome?
|
Hemoptysis, hematuria
|
|
|
What are the 4 major types of kidney stones?
|
1.Calcium 2.Ammonium magnesium phosphate (struvite) 3.Uric acid 4.Cystine
|
|
|
What are the causes and signs of calcium ion deficiency?
|
Kids: rickets; Adults: osteomalacia, Contributes to osteoporosis, Tetany
|
|
|
What are the causes and signs of phosphate toxicity (high serum phosphate)?
|
Metastatic calcification; renal stones
|
|
|
What are the causes of chloride ion deficiency?
|
Secondary to emesis, diuretics, renal disease
|
|
|
What are the causes of Metabolic Acidosis?
|
Diabetic ketoacidosis; Diarrhea; Lactic Acidosis; Salicylate OD; Acetazolamide OD
|
|
|
What are the causes of Respiratory Acidosis?
|
COPD; Airway obstruction
|
|
|
What are the causes of Respiratory Alkalosis?
|
High altitude; Hyperventilation
|
|
|
What are the characteristics of acute poststreptococcal glomerulonephritis seen with immunofluorescence?
|
Granular pattern
|
|
|
What are the characteristics of acute poststreptococcal glomerulonephritis seen with the electron microscope?
|
Subepithelial humps
|
|
|
What are the characteristics of acute poststreptococcal glomerulonephritis seen with the light microscope?
|
Glomeruli enlarged and hypercellular, neutrophils, 'lumpy-bumpy'
|
|
|
What are the characteristics of rapidly progressive (crescentic) glomerulonephritis seen on LM and IF?
|
Crescent-moon shape
|
|
|
What are the clinical features of renal cell carcinoma?
|
Hematuria, Palpable mass, Secondary polycythemia, Flank pain, Fever
|
|
|
What are the clinical symptoms of a nephritic syndrome?
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I'= inflammation; hematuria, hypertension, oligouria, azotemia (increased bloon BUN/creatinine)
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What are the clinical symptoms of Nephrotic syndromes?
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O= proteinuria, Hypoalbuminemia, Peripheral/periorbital edema, Hyperlipidemia
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What are the consequences of renal failure?
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1.Anemia 2.Renal osteodystrophy 3.Hyperkalemia 4.Metabolic acidosis 5.Uremic encephalopathy 6.Sodium and water excess 7.Chronic pyelonephritis 8.HTN
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What are the factors associated with Metabolic Acidosis?
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Decreased pH; Decreased PCO2; Decreased HCO3-
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What are the factors associated with Metabolic Alkalosis?
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Increased pH; Increased PCO2; Increased HCO3-
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What are the factors associated with Respiratory Acidosis?
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Decreased pH; Increased PCO2; Increased HCO3-
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What are the factors associated with Respiratory Alkalosis?
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Increased pH; Decreased PCO2; Decreased HCO3-
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What are the functions of calcium ion?
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Muscle contraction; Neurotransmitter release; Bones; teeth
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What are the functions of sodium ion?
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Extracellular fluid; Maintains plasma volume; Nerve/muscle function
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What are the functions of the chloride ion?
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Fluid/electrolyte balance; Gastric acid; HCO3/Cl shift in RBC
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What are the functions of the magnesium ion?
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Bones; teeth; Enzyme cofactor
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What are the functions of the phosphate ion?
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ATP; nucleic acids; Phosphorylation; Bones; teeth
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What are the functions of the potassium ion?
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Intracellular fluid; Nerve/muscle function
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What are the signs of calcium ion toxicity (high serum Ca2+)?
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Delirium, renal stones, abdominal pain
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What are the signs of high serum Cl-?
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Secondary to non-anion gap acidosis
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What are the signs of high serum Mg2+?
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Delirium; dec. DTRs; cardiopulmonary arrest
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What are the signs of low serum Ca2+?
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Tetany, neuromuscular irritability
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What are the signs of low serum Cl-?
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Secondary to metabolic alkalosis
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What are the signs of low serum K+?
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U waves; flattened T waves; arrhythmias; paralysis
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What are the signs of low serum Mg2+?
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Neuromuscular irritability; arrhythmias
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What are the signs of low serum Na+?
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Disorientation; stupor; coma
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What are the signs of low serum phosphate?
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Bone loss
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What are the signs of phosphate deficiency?
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Kids: rickets; Adults: osteomalacia
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What are the signs of potassium ion toxicity (high serum K+)?
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Peaked T waves; arrhythmias
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What are the signs of sodium ion toxicity (high serum Na+)?
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Neurologic: irritability, delirium, coma
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What bugs cause ammonium magnesium phosphate kidney stones?
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Urease-positive bugs such as Proteus vulgaris or Staphylococcus
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What calcium molecules form calcium kidney stones?
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Calcium Oxalate, Calcium Phosphate, or both
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What can excess Na and water cause?
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CHF and pulmonary edema
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What can the hyperkalemia (failure to secrete K+) associated with renal failure lead to?
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Cardiac arrhythmias
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What causes metabolic alkalosis?
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1.Vomiting 2.Diuretic use 3.Antacid use 4.Hyperaldosteronism
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What causes renal osteodystrophy?
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Failure of active vitamin D production
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What characteristics of Berger's disease are seen with IF and EM?
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Mesangial deposits of IgA
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What characteristics of Focal segmental glomerular sclerosis are seen with the LM?
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Segmental sclerosis and hyalinosis
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What characteristics of Goodpasture's syndrome are seen with IF?
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Linear pattern, Anti-glomerular basement membrane antibodies (anti-GBM antibodies)
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What characteristics of Membranoproliferative glomerulonephritis are seen with the EM?
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Subendothelial humps, 'tram track'
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What characteristics of membranous glomerulonephritis are seen with IF?
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Granular pattern
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What characteristics of Membranous glomerulonephritis are seen with the EM?
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'Spike and Dome'
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What characteristics of Membranous glomerulonephritis are seen with the LM?
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Diffuse capillary and basement membrane thickening
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What characteristics of Minimal change disease are seen with the EM?
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Foot process effacement
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What characteristics of Minimal change disease are seen with the LM?
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Normal glomeruli
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What characteristics of SLE are seen with the LM?
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Wire-loop appearance with extensive granular subendothelial basement-membrane deposits in membranous glomerulonephritis pattern
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What defect(s) is seen with Alport's Syndrome?
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Collagen IV mutation; Nerve deafness/ocular disorders
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What defines metabolic acidosis?
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pH < 7.4; PCO2 less than 40 mm Hg
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What defines metabolic alkalosis with compensation?
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pH > 7.4; PCO2 greater than 40 mm Hg
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What defines Respiratory acidosis?
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pH < 7.4; PCO2 greater than 40mm Hg
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What defines respiratory alkalosis?
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pH > 7.4; PCO2 less than 40 mm Hg
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What diseases often cause uric acid kidney stones?
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Diseases with increased cell proliferation and turnover, such as leukemia and myeloproliferative disorders
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What disorders can lead to hypercalcemia and thus kidney stones?
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1.Cancer 2.Increased PTH 3.Increased vitamin D 4.Milk-alkali syndrome
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What disorders cause metabolic acidosis and normal anion gap?
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1.Diarrhea 2.Glue sniffing 3.Renal tubular acidosis 4.Hyperchloremia
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What disorders cause metabolic acidosis with an Increased anion gap?
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MUD PILES: Methanol, Uremia (chronic renal failure), Diabetic ketoacidosis, Paraldehyde (or Phenformin), Iron tablets (or INH), Lactic acidosis, Ethylene Glycol, Salicylates
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What disorders make up the WAGR complex?
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Wilms' tumor; Aniridia (missing part of iris); Genitourinary malformation; Mental-motor Retardation
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What do you find in the urine with Intrinsic Acute Renal failure?
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Epithelial/granular casts
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What factors are associated with transitional cell carcinoma?
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Pee SAC: Phenacetin, Smoking, Aniline dyes, Cyclophosphamide
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What finding do you get w/ Chronic Pyelonephritis?
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Tubules contain eosinophilic casts
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What genetic disorder and mutation are associated with renal cell carcinoma?
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Associated with von Hippel-Lindau and gene deletion in chromosome 3
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What genetic disorder is associated with Wilms' tumor?
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Deletion of tumor suppression gene WT-1 on chromosome 11
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What is a cause of Intrinsic Acute Renal failure?
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Acute Tubular Necrosis; Ischemia; Toxins
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What is a cause of Postrenal Acute Renal failure?
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Outflow obstruction (stones, BPH, neoplasia)
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What is a cause of Prerenal Azotemia in Acute Renal failure?
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Decreased renal blood flow (hypotension)-> dec. GFR; Na+/H2O rentention
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What is acute renal failure often due to?
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Hypoxia
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What is Berger's disease?
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IgA nephropathy; Mild disease, often postinfectious
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What is chronic renal failure due to?
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HTN and diabetes
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What is Diffuse Cortical Necrosis?
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Acute generalized infarction of cortices of both kidneys
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What is Renal Papillary Necrosis associated with?(3)
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1.Diabetes Mellitus 2.Acute Pyelonephritis 3.Chronic Phenacetin use
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What is the 2nd most common type of kidney stone?
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Ammonium magnesium phosphate (struvite)
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What is the Acute Respiratory acidosis compensatory formula?
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Acute= inc. 1mEq/L HCO3 for every inc. 10mmHg PCO2
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What is the Acute Respiratory Alkalosis compensatory formula?
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Acute= dec. 2mEq/L HCO3 for every dec. 10mmHg PCO2
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What is the BUN/Cr ratio for: Prerenal, Renal, and Postrenal Acute Renal failure?
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Prerenal= >20; Renal= <15; Postrenal= >15
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What is the cause of magnesium ion deficiency?
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Secondary to malabsorption
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What is the cause of Metabolic Alkalosis?
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Vomiting
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What is the cause of potassium ion deficiency?
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Secondary to injury, illness or diuretics
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What is the cause of sodium deficiency?
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Secondary to injury or illness
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What is the Chronic Respiratory acidosis compensatory formula?
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Chronic= inc. 3.5mEq/L HCO3 for every inc. 10mmHg PCO2
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What is the Chronic Respiratory Alkalosis compensatory formula?
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Chronic= dec. 5mEq/L HCO3 for every dec. 10mmHg PCO2
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What is the compensatory mechanism of Metabolic Alkalosis?
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Hypoventilation
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What is the compensatory mechanism of Respiratory Alkalosis?
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Renal HCO3- secretion
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What is the compensatory response to Metabolic Acidosis?
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Hyperventilation
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What is the compensatory response to Respiratory Acidosis?
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Renal HCO3- reabsorption
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What is the course of membranoproliferative glomerulonephritis?
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Slowly progresses to renal failure
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What is the course of rapidly progressive (crescentic) glomerulonephritis?
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Rapid course to renal failure from one of many causes
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What is the equation of Anion Gap?
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Anion Gap= Na - (Cl + HCO3); Normal= 10 +/-2
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What is the FeNa (fraction excretion of Na) for: Prerenal, Renal, and Postrenal Acute Renal failure?
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Prerenal= <1%; Renal= >2%; Postrenal= >4%
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What is the Henderson-Hasselbalch equation?
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pH = pKa + log [(HCO3-)/(0.03*PCO2)]
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What is the likely cause of Diffuse Cortical Necrosis?
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Combination of vasospasm/DIC
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What is the main characteristic of Alport's Syndrome?
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Split basement membrane
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What is the Metabolic acidosis compensatory formula?
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Winter's formula: PCO2= 1.5(HCO3) +8 +/-2
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What is the Metabolic Alkalosis compensatory formula?
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PCO2 inc. 0.7 mmHg for every inc. 1mEq/L HCO3
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What is the most common cause of acute renal failure?
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Acute Tubular Necrosis
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What is the MOST common cause of adult nephrotic synd
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Membranous glomerulonephritis
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What is the MOST common cause of childhood nephrotic syndrome?
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Minimal change disease (lipoid nephrosis)
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What is the most common renal malignancy of early childhood (ages 2-4)?
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Wilms' tumor
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What is the most common renal malignancy?
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Renal cell carcinoma
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What is the most common tumor of the urinary tract system?
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Transitional cell carcinoma
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What is the pathology of Acute Pyelonephritis?
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Affects cortex w/ relative sparing of glomeruli/vessels
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What is the pathology of Chronic Pyelonephritis?
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Coarse, asymmetric corticomedullary scarring
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What is the pathophysiology of Intrinsic Acute Renal failure?
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Patchy necrosis leads to debris obstructing tubule and fluid backflow across necrotic tubule-> dec. GFR
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What is the primary disturbance in respiratory acidosis?
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Increased PCO2
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What is the primary disturbance of metabolic acidosis?
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HCO3- decrease
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What is the primary disturbance of metabolic alkalosis?
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Increased HCO3-
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What is the primary disturbance of respiratory alkalosis?
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Decreased PCO2
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What is the Urine Na+ for: Prerenal, Renal, and Postrenal Acute Renal failure?
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Prerenal= <10; Renal= >20; Postrenal= >40
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What is the Urine Osmolality for: Prerenal, Renal, and Postrenal Acute Renal failure?
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Prerenal= >500; Renal= <350; Postrenal= <350
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What is uremia?
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Clinical syndrome marked by inc. BUN and inc. Creatinine
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What lab result do you find w/ Acute Pyelonephritis?
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White cells casts in urine
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What lesions are seen on the LM in Diabetic nephropathy?
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Kimmelstiel-Wilson lesions, basement membrane thickening
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What Paraneoplastic syndromes are associated with renal cell carcinoma?
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Ectopic EPO, ACTH, PTHrP, and prolactin
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What risk factor increases the incidence of renal cell carcinoma?
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Smoking
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What severe complications may kidney stones lead to?
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Hydronephrosis; Pyelonephritis
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What should you suspect if the calculated compensatory values do not match the actual values?
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Mixed disorder
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What type of Hypersensitivity contributes to the pathogenesis of Goodpasture's syndrome?
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Type II hypersensitivity
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When does death occur with Acute Tubular Necrosis?
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Initial oliguric phase
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Where can transitional cell carcinoma occur?
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Renal calyces; Renal pelvis; Ureters; Bladder
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Where does renal cell carcinoma originate?
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Renal tubule cells-> polygonal Clear Cells
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Which kidney stone is often secondary to cystinuria?
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Cystine
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Which kidney stone is strongly associated with hyperuricemia (gout)?
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Uric acid kidney stones
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Which of the Nephrotic syndromes is worse in HIV pts?
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Focal segmental glomerular sclerosis
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Which type of kidney stones constitute the majority of kidney stones (80-85%)?
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Calcium
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Why are ammonium magnesium phosphate kidney stones often associated with UTIs?
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Ammonium magnesium phosphate stones can form large struvite calculi that can be a nidus for UTIs
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Why does renal failure cause anemia?
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Failure of EPO production
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Why does renal failure cause metabolic acidosis?
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Due to decreased acid secretion and decreased generation of HCO3-
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