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43 Cards in this Set
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- Back
- 3rd side (hint)
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What are the common clinical presentations of renal disease?
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Muerhcke's striae (nail bed)
Pain Urine changes Blood pressure changes Skin changes |
M-PUBS
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Normal SrCr
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1
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Normal BUN
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10
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Normal BP
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120/80
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Normal protein excretion
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<40-80 mg/d
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Abnormal albumin excretion
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>30mg/d
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Normal urine pH
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pH 4.6-8
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usually acidic
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location of disease: Fanconi syndrome
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PT reabsorption is impaired resulting in RTA Type 2 due to decreased reabsorption of HCO3
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location of disease: inherited/acquired defects in acid excretion
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Distal tubule
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location of disease: concentrating defects
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loop of henle
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What causes abrupt cessation of all nephron functions?
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1) mercuric chloride (MgCl)
2) ethylene glycol ingestion (ATN) |
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location of: high capacity isotonic reabsorption
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PCT
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Muerhcke's striae indicates:
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decreased protein synthesis or hypoalbuminemic states
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What do RBC casts indicate?
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Glomerular defect. RBCs get damaged when pushed through the "sieve" and clump together
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Pathognomic lesion found in SLE:
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hematoxylin body
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Pathognomic lesion found in amyloidosis:
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apple green fibrils in congo red stain with fluorescence
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Pathognomic lesion found in DM:
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Kimmelstiel-Wilson nodules
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What should be observed in urine?
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Color, Clarity, Odor, Sediment
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normal pH
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4.6 - 8
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Tested on a dipstick:
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BLOG PUNK
bilirubin leukocyte esterase osmolality glucose protein urobilinogen nitrites ketones |
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normal urine osmolality
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285 mOsm
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normal urine specific gravity
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1.016-1022
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What is isothenuria?
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urine whose specific gravity (concentration) is that of protein free plasma. (1.010)
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What is considered hypothenuric?
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urine specific gravity less than 1.007
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What are the manefestations of the nephrotic syndrome?
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MASSIVE proteinuria
hypoalbuminuria Edema Hyperlipidemia |
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Primary defect in nephrotic syndrome?
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glomerular disease casuing proteinuria
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Most common cause of nephrotic syndrome in adults
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membranous nephropathy
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What is membranous nephropathy?
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endothelial wall thickening, subendothelial deposits, THICKENING OF BASEMENT MEMBRANE
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What is the rule of 1/3's?
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for patient prognosis in membranous nephropathy:
- 1/3 enter spontaneous remission - 1/3 remain proteinuric without loss of renal function - 1/3 ESRF |
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What can cause secondary membranous nephropathy?
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DISTA
drugs, infection, SLE, tumor, AI |
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Most freguent cause of nephrotic syndrome in children
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minimal change disease
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Responds dramatically to corticosteroid therapy
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Minimal change disease
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Which nephrotic syndrome indicates an immunologic basis but does not exhibit immune deposits in the glomerulus
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minimal change disease
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Pathognomonic lesion in MCD
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diffuse effacement of podocyte foot processes WITH NORMAL GLOMERULI
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Causes of secondary FSGS?
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HIV, obesity, hereditary,
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What nephropathy is associated with HIV?
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collapsing variant of FSGS in 50-10% of HIV patients
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What is the prognosis in patients with FSGS?
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progression to glomerulosclerosis with 50% ESRF within 10 years
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Hereditary of FSGS involved proteins that code for what?
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slit diaphragm that normally maintains the normal GFR
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MPGN
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alteration in basement membrane and proliferation of glomerular cells, type I and II
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What causes secondary forms of MPGN?
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immune complex disorders
Hep B/C A1T deficiency complement deficiencies |
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Morphology of Type I MPGN
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doubling of basement membrane (tram-track)
subendothelial electron dense deposits (IgG andC3) |
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Morphology of Type II MPGN
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C3 in BM and mesangium, no IgG. extremely irregular, ribbon-like ELECTRON dense material in BM
thus the name dense-deposit disease |
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depositions in Type I vs Type II MPGN
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Type I - Ig, both complement paths
Type II - alternative complement pathway |
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