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99 Cards in this Set
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- Back
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ureter crosses anterior to the origin of what artery to enter the pelvis?
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external iliac
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ovoid, PAS-positive hyaline masses
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Kimmelstiel-Wilson nodule - most specific lesion of diabetic glomerulosclerosis
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nephrotic syndrome in IV drug user or HIV nephropathy
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focal segmental glomerulosclerosis
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renal pathology associated with DIC?
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diffuse cortical necrosis
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Potter's syndrome?
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bilateral renal agenesis - oligohydraminos, limb & facial deformities,pulmonary hypoplasia
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cause of Potter's syndrome?
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malformation of ureteric bud
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why do kidneys stay low in abdomen in horseshoe kidney?
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get trapped under IMA
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RBC casts in urine
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glomerular inflammation (nephritic syndromes), ischemia, or malignant hypertension
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WBC casts in urine
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tubulointerstitial disease, acute pyelonephritis, glomerular disorders
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granular casts in urine
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acute tubular necrosis
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waxy casts in urine
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advanced renal disease/CRF
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hyaline casts in urine
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nonspecific
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LM: glomeruli enlarged and hypercellular, neutrophils, lumpy-bumpy; EM: subepithelial humps; IF: granular pattern
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acute postreptococcal glomerulonephritis
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LM and IF: crescent moon shape
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rapidly progressive (crescentic) glomerulonephritis
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finding on immunofluorescence in Goodpasture's?
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linear pattern, anti-GBM IgG Abs
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IF and EM findings in Berger's disease?
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mesangial IgA deposits (Berger's also known as IgA nephropathy)
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split basement membrane with nerve deafness and lens dislocation or cataracts
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Alport's syndrome
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mutation in Alport's? characteristic findings?
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collagen IV; nerve deafness and ocular disorders
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hematuria, hypertension, oliguria, azotemia
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nephritic syndrome
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findings in nephrotic syndrome
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massive proteinuria, hypoalbuminemia, peripheral and periorbital edema, hyperlipidemia
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LM: diffuse capillary and BM thickening; IF: granular pattern; EM: spike and dome
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membranous glomerulonephritis
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findings in minimal change disease/lipoid nephrosis?
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LM: normal glomeruli; EM: foot process effacement
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LM: segmental sclerosis and hyalinosis
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focal segmental glomerular sclerosis - most severe disease in HIV patients
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findings in diabetic nephropathy
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LM: Kimmelstiel-Wilson lesions, basement membrane thickening, glomeruli appear like golf balls
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findings in membranous glomeruloneprhitis in SLE
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wire-loop lesion with subepithelial deposits
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most common type of kidney stones?
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calciium oxalate, calcium phosphate, or both
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second most common type of kidney stone; can form staghorn calculi that can be nidus for UTIs
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ammonium magnesium phosphate (struvite)
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infection with what type of organism leads to struvite kidney stones?
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urease-positive bugs - proteus vlugaris, staph, klebsiella
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kidney stones often seen as a result of diseases with increased cell turnover, such as leukemia and myeloproliferative disorders
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uric acid
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types of radiolucent kidney stones?
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uric acid and cystine
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gene association with renal cell carcinoma?
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deletion of VHL gene on chromosome 3
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where does renal cell carcinoma originate?
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renal tubule cells (polygonal clear cells)
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renal cell carcinoma is associated with what syndromes?
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paraneoplastic (ectopic EPO, ACTH, PTHrP, and prolactin)
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gene association with Wilm's tumor?
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deletion of tumor suppressor WT1 on chromosome 11
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WAGR complex?
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Wilm's tumor, Aniridia, genitourinary malformation, and mental-motor retardation
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most common tumor of the urinary tract system?
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transitional cell carcinoma
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transitional cell carcinoma is associated with what?
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problems in your Pee SAC:
phenacetin, smoking, analine dyes, and cyclophosphamide |
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white cell casts in urine are pathognomonic for what?
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acute pyelonephritis
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chronic pyelonephritis clinical manifestations?
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coarse, asymmetric corticomedullary scarring and blunted calyces; tubules can contain eosinophilic casts (thyroidization of the kidney)
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most common cause of acute renal failure?
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acute tubular necrosis
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what is acute tubular necrosis associated with?
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renal ischemia (e.g. shock), crush injury (myoglobinuria), toxins
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when does death most often occur in ATN?
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during initial oliguric stage
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what is renal papillary necrosis associated with?
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diabetes, acute pyelonephritis, chronic phenacitin use, sickle cell anemia
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what is uremia?
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clinical syndrome marked by increased BUN and creatinine and associated symptoms
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metabolic consequences seen in renal failure?
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1. Anemia (decreased EPO)
2. Renal osteodystrophy (failure of active vitamin D production) 3. Hyperkalemia 4. metabolic acidosis due to decreased acid secretion and decreased HCO3- generation 5. Uremic encephalopathy 6. Sodium and H2O excess --> CHF and pulmonary edema 7. Chronic pyelonephritis 8. Hypertension |
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low serum chloride concentration is caused by what?
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is secondary to metabolic alkalosis, hypokalemia, hypovolemia, increased aldosterone
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high serum chloride concentration is secondary to what?
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non-anion gap acidosis
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most common cause of nephrotic syndrome in adults?
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membranous glomerulonephritis
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Obese male aged 50-70 years, smoker, with hematuria and palpable mass, fever, weight loss. what is diagnosis?
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Renal cell carcinoma
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loop diuretic indicated for the treatment of edema associated with CHF, cirrhosis, and renal disease?
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furosemide (also HTN and hypercalcemia)
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two principal causes of rapidly progressive glomerulonephritis?
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anti-glomerular basement membrane and primary systemic vasculitis
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drugs implicated in the pathogenesis of acute interstitial nephritis?
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NSAIDs, beta-lactam antibiotics (penicillins and cephalosporins), sulfonamides, diuretics (furosemide and thiazides), phenytoin, cimetidine, methyldopa
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EM: subendothelial humps, mesangial proliferation (splits BM)
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membranoproliferative glomerulonephritis
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What does the presence of casts in the urine indicate?
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hematuria/pyuria is of renal origin
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What do RBCs in urine with no casts indicate?
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Bladder cancer
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What does WBCs in urine with no casts inddicate?
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Acute cystitis
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This nephritic syndrome is most frequently seen in children and presents with peripheral and periorbital edema
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Acute poststreptococcal glomerulonephritis. resolves spontaneously
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Outcome of Membranoproliferative glomerulonephritis?
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slowly progresses to renal failure
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outcome of Rapidly progressive glomerulonephritis?
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rapid course to renal failure. number of crescents indicates prognosis
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this is a common cause of recurrent hematuria in young patients
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IgA nephropathy (Berger's disease)
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Immunofluorescent congo red stain of glomeruli show apple-green birefringence. What is the diagnosis?
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Amyloidosis
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Amyloidosis is associated with what conditions?
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multiple myeloma, chronic conditions, TB, rheumatoid arithritis
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Which conditions may lead to hypercalciuria and stones?
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hypercalcemic conditions: cancer, increased PTH, increased vitamin D, milk-alkali syndrome
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child aged 2-4 presents with huge, palpable flank mass, hemihypertrophy. The mass contains embryonic glomerular structures. What is the tumor?
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Wilms' tumor
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What causes diffuse cortical necrosis?
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likely due to a combination of vasospasm and DIC. Associated with obstetric catastrophes and sepsis
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acute interstitial renal inflammation with fever, rash, eosinophilia and hematuria beginning 2 weeks after taking what drugs?
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Drug-induced interstitial nephritis; penicillins, NSAIDS, diuretics
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Patient presents with acute renal failure. labs show Urine osmolality >500, Urine Na <10, Fe(Na) <1% and BUN/Cr >20. Where is the problem
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Prerenal
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Patient presents with acute renal failure. labs show Urine osmolality <350, Urine Na >20, Fe(Na) >2% and BUN/Cr <15. Where is the problem
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Renal
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Patient presents with acute renal failure. labs show Urine osmolality <350, Urine Na >40%, BUN/Cr >15. What is the cause?
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post-renal; generally outflow obstruction due to stones, BPH or neoplasia
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What is Fanconi's syndrome? What are its complications?
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Defect in proximal tubule transport. Complications include rickets, osteomalacia, hypokalemia, metabolic acidosis
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patient presents with flank pain, hematuria, hypertension, urinary infection and progressive renal failure. US shows multiple, large, bilateral renal cysts. What is the underlying cause?
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APKD from AD mutation in APKD1 gene
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low serum Na causes what?
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disorientation, stupor, coma
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high serum Na causes what?
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neurologic: irritability, delirium, coma
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low serum K causes what?
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U waves on ECG, flattened T waves, arrhythmias, paralysis
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high serum K causes what?
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peaked T waves, wide QRS, arrhythmias
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low serum Ca causes what?
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tetany, neuromuscular irritability
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high serum Ca causes what?
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delirium, renal stones, abdominal pain, not necessarily calciuria
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low serum Mg causes what?
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neuromuscular irritability, arrhythmias
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high serum Mg causes what?
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delirium, decreased DTRs, cardiopulmonary arrest
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low serum PO4 causes what?
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low-mineral ion product causes bone loss, osteomalacia
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high serum PO4 causes what?
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high-mineral ion product causes metastatic calcification, renal stones
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mechanism of mannitol?
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osmotic diuretic, increased tubular fluid osmolarity, producing increased urine flow. works in PCT
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mannitol contraindications?
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anuria, CHF
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mechanism of acetazolamide?
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Carbonic anhydrase inhibitor. Acts in PCT. depletion of HCO3
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major toxicity of acetazolamide?
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hyperchloremic metabolic acidosis
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mechanism of furosemide?
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loop diuretic. inhibits Na/K/Cl cotransport in thick ascending limb. reduces hypertonicity of medulla preventing concentration of urine in the collecting tubule. also promotes loss of Ca due to decreased electrochemical gradient
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major toxicity of furosemide?
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OH DANG!
Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis (interstitial), Gout |
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mechanism of ethacrynic acid
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loop diuretic blocks Na/K/Cl cotransporter, reduces ability to concentrate urine
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major toxicity of ethacrynic acid
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gout
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mechanism of hydrochlorothiazide
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thiazide diuretic. inhibits NaCl reabsorption in early distal tubule, reducing diluting capacity of nephron. decreases Ca excretion
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toxicities of hydrochlorothiazide
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hypokalemic metabolic acidosis, hypercalcemia, sulfa allergy
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What are the K sparing diuretics?
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Spironolactone, Triamterene, Amiloride, eplerenone
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Mechanism of spironolactone?
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competitive aldosterone receptor antagonist in cortical collecting tubule
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mechanism of Triamterene and amiloride?
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block Na channels in CCT
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toxicity of K-sparing diuretics?
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hyperkalemia, antiandrogenic effects
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mechanism of ACE inhibitors?
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inhibit ACE, reducing angiotensin II and preventing inactivation of bradykinin. Results in increased renin release
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major toxicities of ACE inhibitors?
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cough, increased renin, hyperkalemia
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What are the ACE inhibitors?
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Captopril, Enalapril, Lisinopril
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mechanism of Losartan
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angiotensin II receptor inhibitor (does not produce cough)
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