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120 Cards in this Set
- Front
- Back
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RBC casts means
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glomerulonephritis
ischemia malignant hypertension |
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WBC casts means
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tubulointerstitial inflammation
acute pyelonephritis transplant rejection |
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granular "muddy brown" casts means
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acute tubular necrosis
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waxy casts means
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advanced renal disease/CRF
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presence of casts means that
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hematuria/pyuria is of renal origin
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bladder cancer, kidney stones
have _ but not _ acute cystitis --> |
hematuria
no casts pyuria no casts |
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focal vs. diffuse
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focal -- a few glomeruli involved
diffuse -- all glomeruli |
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segmental vs. global
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some capillaries in a glomerulus are involved
all capillaries in a glomerulus are involved |
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proliferative means
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hypercellular glomeruli
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membranous means
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thickening of glomerular basement membrane
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RBC casts means
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glomerulonephritis
ischemia malignant hypertension |
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WBC casts means
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tubulointerstitial inflammation
acute pyelonephritis transplant rejection |
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granular "muddy brown" casts means
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acute tubular necrosis
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waxy casts means
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advanced renal disease/CRF
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presence of casts means that
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hematuria/pyuria is of renal origin
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bladder cancer, kidney stones
have _ but not _ acute cystitis --> |
hematuria
no casts pyuria no casts |
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focal vs. diffuse
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focal -- a few glomeruli involved
diffuse -- all glomeruli |
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segmental vs. global
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some capillaries in a glomerulus are involved
all capillaries in a glomerulus are involved |
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proliferative means
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hypercellular glomeruli
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membranous means
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thickening of glomerular basement membrane
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nephritic syndrome (7)
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inflammatory
hematuria RBC casts azotemia oliguria hypertension proteinuria < 3.5 g/day |
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nephritic syndrome includes what conditions?
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AR DBA:
acute poststreptococcal g. rapidly progressive (crescentic) g. diffuse proliferative g. Berger's Alport's |
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diffuse proliferative g. is due to
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SLE or MPGN
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berger's disease is aka
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IgA glomerulopathy
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acute poststreptoccal g
LM |
glomeruli enlarged and hypercellular
neutrophils "lumpy-bumpy" appearance |
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acute poststreptoccal g
EM |
subepithelial immune complex humps
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acute poststreptoccal g
IF |
granular
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acute poststreptoccal g
sxs |
peripheral and periorbital edema
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RPGN
crescents consist of |
fibrin
plasma proteins e.g. C3b glomerular parietal cells monocytes macrophages |
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acute poststreptococcal g course
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resolves spontaneously
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RPGN prognosis
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poor prognosis
rapidly deteriorating renal function (days to weeks) |
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several disease processes may result in RPGN, including
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Goodpasture syndrome
Wegener's granulomatosis Microscopic polyangiitis |
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goodpasture's syndrome is type _ hypersensitivity
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type II
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diffuse proliferative g
LM |
"wire loop" thickening of capillaries
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diffuse proliferative g
EM |
subendothelial DNA-anti-DNA immune complexes
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besides acute poststreptoccal g., another nephritic syndrome is associated with infection
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Berger's disease
often presents/flares with a URI or acute gastroenteritis |
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alport's syndrome
pathophys |
mutation in type IV collagen
--> split basement membrane |
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alport's syndrome genetics
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x linked dominant
mutation in type IV collagen |
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alport's syndrome sxs
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nerve disorders
ocular disorders deafness + renal |
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nephrotic syndrome sxs
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massive proteinuria
> 3.5 g/day --> (frothy urine) hyperlipidemia fatty casts edema |
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nephrotic syndrome is associated with
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thromboembolism
^ risk of infections |
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nephrotic syndrome
conditions |
membranous g
minimal change amyloidosis diabetic glomerulonephropathy focal segmental glomerulosclerosis membranoproliferative g |
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_ is listed as a nephrotic syndrome but may also present as a nephritic syndrome
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membranoproliferative
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_ seems to be strongly associated with SLE
but so is _ (both are glomerular problems) |
diffuse proliferative g
membranous g |
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membranous glomerulonephritis
LM |
diffuse capillary and basement membrane thickening
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membranous glomerulonephritis
EM |
spike and dome appearance
subepithelial deposits |
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membranous glomerulonephritis
IF |
granular
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most common cause of adult nephrotic syndrome
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membranous glomerulonephritis
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membranous glomerulonephritis
causes |
don't DISS me (MEmbranous)
drugs infections SLE solid tumors |
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minimal change disease
histopathology |
LM -- normal
EM -- foot process effacement |
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two nephrotic syndromes
associated with infection (one probably more strongly associated than the other) |
membranous g
minimal change disease (probably more strongly associated) |
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minimal change disease
cause |
recent infection
immune stimulus |
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minimal change disease pathophys
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selective loss of albumin
not globulins due to basement membrane polyanion loss |
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amyloidosis is assocaited with _
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chronic conditions e.g.
multiple myeloma TB RA |
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amyloidosis LM
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congo red stain
apple-green birefringence |
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diabetic glomerulonephropathy
LM |
mesangial expansion
basement membrane thickening nodular glomerulosclerosis (aka Kimmelstiel-Wilson lesion) |
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focal segmental glomerulosclerosis
histopath |
LM
segmental sclerosis and hyalinosis |
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MPGN
IF |
subendothelial IC deposits
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MPGN type 1
EM |
"tram track" appearance due to basement membrane splitting caused by mesangial ingrowth
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MPGN type II
EM |
"dense deposits"
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split basement membrane seems to occur in _
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membranoproliferative
alport's |
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_ is associated with C3 nephritic factor
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type II MPGN
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type II MPGN associations
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C3 nephritic factor
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type I MPGN associations
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HBV
HCV |
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this nephrotic syndrome classified condition
may also present as nephritic |
membranoproliferative
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kidney stones
complications |
hydronephrosis
pyelonephritis |
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4 types of kidney stones
in order of frequency |
calcium
ammonium magnesium phosphate uric acid cystine |
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which kidney stone type is radiolucent?
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radiolUcent
Uric acid stones |
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calcium stone types
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calcium oxalate
calcium phosphate |
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a couple major ways of causing calcium stones
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cancer, ^ PTH
--> hypercalciuria |
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oxalate crystals can result from...
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ethylene glycol or vitamin C abuse
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ammonium magnesium phosphate stones
causes |
infection by urease-positive bugs
proteus mirabilis staphylococcus klebsiella |
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ammonium magnesium phosphate stones
associations |
can form staghorn calculi--> nidus for UTIs
worsened by alkaluria |
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one kidney stone is worse with alkaline urine
one is treated by alkalinzation of urine |
worsened by alkaline urine: ammonium magnesium phosphate stones
treated by alkaline urine: cystine stones |
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uric acid stones
causes |
gout (hyperuricemia)
diseases with ^ cell turnover e.g. leukemia |
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cystine stones
comments |
most often 2^ cystinuria
hexagonal |
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treatment for cystine stones
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alkalinization of urine
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staghorn calculi what type of stone?
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ammonium magnesium phosphate
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renal cell carcinoma
comes from _ cells looks like _ |
renal tubular cells
polygonal clear cells |
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renal cell carcinoma
epi |
most common renal malignancy
men 50-70 yrs |
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renal cell carcinoma sxs (6)
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hematuria
palpable mass 2^ polycythemia flank pain fever weight loss |
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renal cell carcinoma
genetic associations |
von Hippel-Lindau syndrome
and gene deletion 3p |
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renal cell carcinoma is associated with
_ conditions |
paraneoplastic syndromes: ectopic
EPO ACTH PTHrP prolactin |
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renal cell carcinoma
spread |
invades IVC
spreads hematogenously metastasizes to lung and bone |
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Wilms tumor genetics
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deletion of WT1 on 11p
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wilms tumor epi
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most common renal malignancy of early childhood (2-4 yrs)
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wilms tumor
sxs |
huge palpable flank mass
and/or hematuria |
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wilms tumor
histopathology |
embryonic glomerular structures
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wilms tumor may be part of _ complex
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WAGR
wilms' tumor aniridia genitourinary malformation mental-motor retardation |
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__ suggests bladder cancer
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painless hematuria
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transitional cell carcinoma is associated with
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problems in your Pee SAC
phenacetin smoking aniline dyes cyclophosphamide |
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_ is a classic lab finding re: pyelonephritis
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WBC casts in urine
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acute pyelonephritis sxs
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fever
CVA tenderness nausea vomiting |
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acute pyelonephritis
affects what parts of kidney, how |
affects cortex
relative sparing of glomeruli/vessels |
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chronic pyelonephritis
affects what parts of kidney, how |
coarse
asymmetric corticomedullary scarring blunted calyx tubules can contain eosinophilic casts (thyroidization of kidney) |
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drug-induced interstitial nephritis
sxs |
1-2 weeks after administration of drugs...
pyuria (typically eosinophils) and azotemia fever rash hematuria CVA tenderness |
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drug-induced interstitial nephritis
mechanism |
drugs act as haptens, inducing hypersensitivity
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drug-induced interstitial nephritis
what drugs? |
diuretics
NSAIDs penicillin derivatives sulfonamides rifampin |
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diffuse cortical necrosis
is |
acute bilateral cortical infarction
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diffuse cortical necrosis
mechanism |
2^ a combination of vasospasm and DIC
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diffuse cortical necrosis
associations |
obstetrics e.g. abruptio placenta
septic shock |
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acute tubular necrosis
when does death most often occur? |
during initial oliguric phase
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acute tubular necrosis
is associated with |
renal ischemia (shock, sepsis)
crush injury (myoglobinuria) toxins |
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acute tubular necrosis
key finding |
granular ("muddy brown") casts
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acute tubular necrosis
3 stages |
inciting event
maintenance (low urine output) recovery (2-3 weeks) |
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renal papillary necrosis
is |
sloughing of renal papillae -->
gross hematuria proteinuria |
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renal papillary necrosis
causes |
recent infection or
immune stimulus associated with diabetes acute pyelonephritis chronic phenacetin use (acetaminophen is a phenacetin derivative) sickle cell |
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acute renal failure
prerenal lab values |
osmolality > 500
urine Na < 10 Fe(Na) < 1% BUN/Cr > 20 |
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acute renal failure
renal lab values |
osmolality < 350
urine Na > 10 Fe(Na) > 2% BUN/Cr < 15 |
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acute renal failure
postrenal lab values |
osmolality < 350
urine Na > 40 Fe(Na) > 4% BUN/Cr > 15 |
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consequences of renal failure (8)
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Na+ / H2O retention
hyperkalemia metabolic acidosis uremia anemia renal osteodystrophy dyslipidemia (esp ^ triglycerides) growth retardation and developmental delay in kids |
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uremia sxs (5)
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nausea and anorexia
pericarditis asterixis encephalopathy platelet dysfunction |
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conditions that cause renal cysts
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ADPKD
ARPKD dialysis cysts simple cysts medullary cystic disease |
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ADPKD
sxs (5) |
flank pain
hematuria hypertension urinary infection progressive renal failure |
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ADPKD death is from
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chronic kidney disease
or hypertension due to ^ renin |
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ADPKD is associated with
|
polycystic liver disease
berry aneurysms mitral valve prolapse |
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ARPKD is associated with
|
congenital hepatic fibrosis
renal failure in utero can cause Potter's syndrome |
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ARPKD
concerns beyond neonatal period include |
hypertension
portal hypertension progressive renal insufficiency |
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dialysis cysts location
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cortical and medullary
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medullary cystic disease
features (5) |
sometimes -->
fibrosis progressive renal insufficiency urine concentrating defects ultrasound shows small kidney poor prognosis |
