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70 Cards in this Set
- Front
- Back
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How many nephrons drain into one collecting duct? |
10-12 |
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What is the most common cause of acute kidney injury? |
Acute tubular necrosis |
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What two precipitating events lead to acute tubular necrosis? |
- Ischemia - Toxic exposure to tubular cells |
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What are 5 causes of ischemic injury to tubules? |
- Burns - Hemorrhage - Prolonged dehydration - Advanced congestive heart failure - Septic shock |
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What are some common exogenous nephrotoxins? (6) |
- Antimicrobials - Immunosuppresants - Chemotherapy - IV contrast media - Heavy metals - Organic solvents |
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What are some common endogenous nephrotoxins? (2) |
- Hemoglobin - Myoglobin |
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What are the proposed molecular mechanisms of cellular injury in acute tubular necrosis? (5) |
- ATP depletion - Increased intercellular calcium - Disruption of cytoskeleton and CAMs - ROS - Direct toxic damage |
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Why is the PCT the most susceptible area for acute tubular necrosis? |
High levels of active transport means high ATP demand |
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Why does creatinine increase so dramatically when acute tubular necrosis begins? (3) |
- Salt is not reabsorbed by PCT, so macula densa signal to vasoconstrict arterioles
- Casts block the nephron and lower GFR
- Tubular cells die and slough off, so filtrate goes straight into interstitial space |
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Relatively, how much sodium is in urine from a healthy kidney? |
Very little |
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How do damaged PCT cells appear under a light microscope? (3) |
- Loss of brush border - Cytoplasm blebs into lumen - Vacuolization occurs |
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What term refers to debris clogging the tubular lumen? |
ectasia |
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How long does the initiation phase of acute tubular necrosis last? |
36 hours |
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What occurs during the maintenance phase of acute tubular necrosis? (5) |
- oliguria - elevated BUN and creatinine - sodium and water overload - elevated potassium - acidosis |
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How is Acute Tubular Necrosis (ATN) managed? (4) |
- Monitoring fluids and assessing drugs - Na, K, water restriction - Diuretics - Nutrition |
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Why is there polyuria after recovering from ATN? (2) |
- Solute diuresis to get rid of accumulated water and wastes - No countercurrent multiplication yet |
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What bacterium constitutes the majority of cases of acute pyelonephritis from the bladder?
From the blood? |
Bladder - E. coli
Blood - Staph aureus |
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What kind of casts can be found in acute pyelonephritis?
What do casts mean in terms of infection source? |
WBC casts
Infection is in kidney and not necessarily bladder |
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What appears on the gross view of a kidney suffering acute pyelonephritis? |
Microabscesses |
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What are 3 complications of acute pyelonephritis? |
- Papillary necrosis - Perinephric abscesses - Pyonephrosis |
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In what 2 ways does Drug-Associated Acute Interstitial Nephritis lead to kidney damage? |
humoral and cell-mediated autoimmunity |
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How long does it take for renal failure to develop after exposure to a drug? |
1-2 weeks |
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What are two autoimmune diseases that can cause glomerular damage? |
- SLE - Sjogren |
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What antimicrobials can lead to drug-induced acute interstitial nephritis? (6) |
- Methicillin - Ampicillin - Penicillin - Ciprofloxacin - Rifampins - Sulfonamides |
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What NSAIDS can lead to drug-induced acute interstitial nephritis? (4) |
- Aspirin - Ibuprofen - Naproxen - Indomethicin |
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What other drugs have been reported to cause drug-induced acute interstitial nephritis? (5) |
- Furosemide - Cimetidine - Omeprazole - Allopurinol - Phenytoin |
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What symptoms are associated with drug-induced acute interstitial nephritis? (5) |
- Fever - Rash - Flank pain - Eosinophilia - Leukocyturia |
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What does kidney histology look like under light microscope in a case of drug-induced acute interstitial nephritis? |
Significant interstitial infiltration of PMNs |
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How is drug-induced acute interstitial nephritis treated? |
Most cases self-resolve 1-2 months after medication is withdrawn; corticosteroids can be used if severe |
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Which light-chain is responsible for tubular damage associated with multiple myeloma? |
Kappa |
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What symptoms are associated with multiple myeloma and associated kidney damage? (6) |
- Bone pain (in back) - Fatigue - Weight loss
- Bence-Jones proteins in urine - High protein/Cr level in urine while low albumin dipstick level - M-spike in electrophoresis |
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What band does an M-spike occur to confirm monoclonal proliferation? |
Gamma band |
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What can be seen in light microscopic histology of multiple myeloma damaged kidneys? (2) |
Waxy casts and giant cells |
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Between lambda and kappa, which light chain would show stain in the tubule for IF of multiple myeloma? |
kappa |
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What GU disorder does hypercalcemia cause? |
Diabetes insipidus |
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What is thrombotic microangiopathic anemia? |
Thrombocytopenia and hemolytic anemia and organ injury due to platelet thrombosis in microcirculation |
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What is the source of the disease in thrombotic microangiopathy? (3) |
- Platelet aggregation - Vascular thrombosis - Vasospasm |
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What damages the endothelium in Hemolytic Uremic Syndrome (HUS)? |
Shigatoxin from E. coli (O157:H7 from EHEC) |
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What is the cause of thrombotic thrombocytopenic purpura? |
Deficiency in ADAMTS13, which cleaves vWF (has neurological symptoms) |
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What does HUS look like under light microscope histology? (3) |
- Damaged RBCs - Glomerular thrombi - Capillaries clogged with platelets and fibrin |
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What is the treatment for shigatoxin in children?
In adults? |
- Children: Supportive bc of spontaneous self-resolution
- Adults: plasma exchange |
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How is thombotic thrombocytopenic purpura treated? |
Plasma exchange with fresh frozen plasma |
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What mab drug can help treat atypical HUS? |
Eculizumab |
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What is the pathogenesis of atheroembolic renal vascular disease? |
Blood vessel catheterization knocks off cholesterol, which embolizes in small vessels including renal capillaries; can also occur spotaneously |
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What is the hallmark for cholesterol emboli under light microscope histology? |
Cholesterol needles (clefts) |
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What are the symptoms and signs of malignant hypertension? (6) |
- Hx of HTN - Papilledema - Neurological signs - Headache - Congestive heart failure - Acute kidney failure |
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What 2 phenomena amid malignant hypertension leads to kidney disease? |
- renal ischemia - activation of RAAS |
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What is the gross view of the kidney notable for under malignant hypertension? |
Petechiae |
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What is seen in the histological view of the kidney under light microscope for malignant hypertension? (4) |
- Onion-skin lesions (due to repeated damage) - Fibrinoid necrosis in tubule lumen - Thromboses - Widening urinary space |
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What heart symptom is the most common cause of renal infarcation? |
Atrial fibrillation |
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What are the symptoms of renal infarction? (6) |
- Sudden onset flank/loin or ab pain - Hematuria - Accelerated HTN - Oliguria - Fever - Hx of a-fib, vascular dz, or trauma |
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What values are elevated in labs for renal infarction? |
- Leukocyte count - LDH - Transaminase - Creatine kinase |
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How is renal infarction diagnosed? |
Imaging |
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What is seen under light microscope histology of a kidney after renal infarction? |
Coagulative necrosis |
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From what can renal vein thrombosis occur? (2) |
- Nephrotic syndrome - Renal trauma |
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What is the clinical presentation of renal vein thrombosis? (4) |
- Flank pain - Hematuria - Worsening proteinuria - Swollen kidney |
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What is chronic interstitial nephropathy? |
Progressive scarring of the tubulointerstitium with atrophy, macrophage and lymphocytic infiltration, and fibrosis |
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Is chronic interstitial nephropathy reversible? |
No |
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What is it called when there is pyuria, but urine blood culture is negative? |
Sterile pyuria |
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When should chronic interstitial nephropathy be suspected? (5) |
- Proteinuria - Hematuria - Pyuria - Polyuria - Change in K and H are disproportionate to GFR |
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What analgesics and stimulant can cause chronic interstitial nephropathy when used in combination? (5) |
- Phenacetin - Aspirin - Caffeine - Acetaminophen - Codeine |
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What is the primary cause of injury for chronic interstitial nephropathy? |
medullary ischemia |
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Which analgesic increase ROS by decreasing cellular glutathione? |
Acetaminophen |
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What does chronic interstitial nephropathy also engender risk for? |
uroepithelial malignancy |
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What is the cause of chronic pyelonephritis? |
Reflux nephropathy associated with renal obstruction and bacterial infection |
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What does a kidney suffering chronic pyelonephritis look like under ultrasound? |
Hyperechoic cortex |
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How does chronic pyleonephritis in the kidney appear under light microscopy? (2) |
- Interstitial fibrosis - Chronic inflammatory cells |
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What is hypertensive nephrosclerosis? |
Sclerosis of small arteries/arterioles of the kidney |
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In what race is hypertensive nephrosclerosis more common?
With what gene is it associated? |
African Americans
Apolipoprotein L1 |
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What occurs in arterioles in hypertensive nephrosclerosis? |
Hyalinosis |
