In dieser Lektion befinden sich 89 Karteikarten
USMLE First Aid
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- Nephroblastoma (Wilms tumor) Most common renal malignancy of early childhood (ages 2-4). Contains embryonic glomerular structures. - Presents with large, palpable, unilateral flank mass and/or hematuria. - Loss of function mutation ...
- Transitional cell carcinoma Also known as urothelial carcinoma.Most common tumor of urinary tract system (can occur in renal calyces, renal pelvis, ureters, and bladder). - Can be suggested by painless hematuria (no casts). Associated ...
- Autosomal dominant polycystic kidney disease Numerous cysts in cortex and medulla causing bilateral enlarged kidneys ultimately destroy kidney parenchyma - Presents with flank pain, hematuria, hypertension, urinary infection, progressive renal failure ...
- Potter's sequence (syndrome) Oligohydramnios → compression of developing fetus → limb deformities, facial deformities (eg, low-set ears and retrognathia, flattened nose), compression of chest and lack of amnionic fluid aspiration ...
- Horseshoe kidney - Inferior poles of both kidneys fuse abnormally. - As they ascend form pelvis during fetal development, horseshoe kidneys get trapped under inferior mesenteric artery and remain low in the abdomen. - ...
- Course of ureters Course of ureter: arises from renal pelvis, travels under gonadal arteries → over common iliac artery → under uterine artery/vas deferens (retroperitoneal). Gynecologic procedures (eg, ligation of ...
- Changes in glomerular dynamics Afferent arteriole constriction: ↓ RPF, ↓ GFR, FF unchanged Efferent arteriole constriction: ↓ RPF, ↑ GFR, FF ↑ ↑ plasma protein concentration: RPF unchanged, GFR ↓, FF ↓ ↓ plasma ...
- Amino acid clearance Sodium-dependent transporters in proximal tubule reabsorb amino acids. Hartnup's disease = dificiency of neutral amino acid (tryptophan) transporter; results in pellagra (the 3 D's: Dermatitis, Diarrhea, ...
- Prostaglandins Paracrine secretion vasodilates the afferent arterioles to ↑ GFR
- Potassium shifts Shifts K+ out of cell (causing hyperkalemia)- Digitalis- Hyper-osmolarity- Lysis of cells (eg, crush injury, rhabdomyolysis, tumor lysis syndrome)- High blood surgar (insulin deficieny)- Acidosis- β-blockers- ...
- Electrolyte disturbances Na+- Low serum concentration: Nausea and malaise, stupor, coma- High serum concentration: Irritability, stupor, coma K+- Low serum concentration: U waves and flattened T waves on ECG, arrhythmias, muscle cramps, ...
- ↑ anion gap MUDPILES:MethanolUremiaDiabetic ketoacidosisPropylene glycolIron tablets Lactic acidosisEthylene glycolSalicylate
- Normal anion gap (8-12 mEq/L) HARD-ASS:HyperalimentationAddison's diseaseRenal tubular acidosisDiarrheaAcetazolamideSpironolactoneSaline infusion
- Renal tubular acidosis (RTA) Type 1 ("distal"): Inability of α-intercalated cells to secrete H+ → no new HCO3- is generated → metabolic acidosis.- Urine pH >5.5.- Serum K+ ↓- Causes: Amphotericin B toxicity, analgesic ...
- Glomerular diseases Nephritic syndrome: Due to GBM disruption. Hypertension, ↑ BUN and creatinine, oliguria, hematuria, RBC casts in urine. Proteinuria often in the subnephrotic range (<3.5 g/day) but in severe cases ...
- Nephrotic syndrome Massive proteinuria (>3.5 g/day) with hypoalbuminemia, resulting edema, hyperlipidemia. Frothy urine with fatty casts.- Disruption of glomerular filtration charge barrier may be 1° (eg, direct sclerosis ...
- Focal segmental glomerulosclerosis - Most common cause of nephrotic syndrome in African Americans and Hispanics.- Can be 1° (idiopathic) or 2° to other conditions (eg, HIV infection, sickle cell disease, heroin abuse, massive obesity, ...
- Membranous nephropathy - Most common cause of 1° nephrotic syndrom in Caucasian adults.- Can be 1° (eg, antibodies to phospholipase A2 receptor) or 2° to drugs (eg, NSAIDs, penicillamine, gold), infections (eg, HBV, HCV), ...
- Minimal change disease (lipoid nephrosis) - Most common cause of nephrotic syndrome in children.- Often 1° (idiopathic) and may be triggered by a recent infection, immunization, immune stimulus, insect sting/bite.- Rarely, may be 2° to lymphoma ...
- Amyloidosis Kidney is the most commonly involved organ (systemic amyloidosis). - Associated with chronic conditions that predispose to amyloid deposition (eg, AL amyloid, AA amyloid). LM – Congo red stain shows ...
- Membranoproliferative glomerulonephritis MPGN is a nephritic syndrom that often co-presents with nephrotic syndrome.- Mostly affects young individuals. Type I may be 2° to hepatitis C > B infection. May also be idiopathic.- Subendothelial ...
- Diabetic glomerulonephropathy Most common cause of ESRD in the United States. - Hyperglycemia → nonenzymatic glycosylation of tissue proteins → mesangial expansion; GBM thickening and ↑ permeability. - Hyperfiltration (glomerular ...
- Nephitic syndrome Inflammatory process. When it involves glomeruli, it leads to hematuria and RBC casts in urine. - Associated with azotemia, oliguria, hypertension (due to salt restriction), and proteinuria (<3.5 g/d) ...
- Alport syndrome Mutation in type IV collagen → thinning and splitting of basement membrane.- X-linked dominant - Glomerulonephritis (EM – "Basket weave" appearance)- Sensorineural deafness- Eye problems (eg, retinopathy, ...
- IgA nephropathy (Berger disease) Episodic hematuria that occurs concurrently with respiratory or GI tract infections (IgA is secreted by mucosal linings). Renal pathology of IgA vasculitis (Henoch-Schönlein purpura). LM – Mesangial ...
- Diffuse proliferative glomerulonephritis (DPGN) Often due to SLE. DPGN and MPGN often present as nephrotic syndrome and nephritic syndrome concurrently. LM – "Wire looping" of capillariesIF – GranularEM - Subendothelial and sometimes intramembranous ...
- Rapidly progressive (crescentic) glomerulonephritis ... Poor prognosis, rapidly deteriorating renal function (days to weeks).- LM – Crescent-moon shape. Crescents consist of fibrin and plasma proteins (eg, C3b) with glomerular parietal cells, monocytes, ...
- Acute poststreptococcal glomerulonephritis - Most frequently seen in children.- ~2-4 weeks after group A streptococcal infection of pharynx or skin.- Resolves spontaneously in most children; may progress to renal insufficiency in adults.- Type ...
- Kidney stones - Uric acid About 5% of all stones. - Risk factors: ↓ urine volume, arid climates, acidic pH.- Strong association with hyperuricemia (eg, gout). Often seen in diseases with ↑ cell turnover, (eg, leukemia). ...
- Kidney stones - Calcium Calcium stones most common (80%); calcium oxalate > calcium phosphate Calcium oxalate:- Precipitates with hypocitraturia (eg, distal RTA). Hypocitraturia often associated with ↓ urine pH. - Can result ...
- Kidney stones - Ammonium magnesium phosphate Also known as struvite; account for 15% of stones. - Caused by infection with urease ⊕ bugs (eg, Proteus mirabilis, Staphylococcus saphrophyticus, Klebsiella) that hydrolyze urea to ammonia → urine ...
- Kidney stones - Cystine Hereditary (autosomal recessive) condition in which cystine-resorbing PCT transporter loses function, causing cystinuria. Transporter defect also results in poor absorption of ornithine, lysine, arginine. ...
- Renal cell carcinoma Polygonal clear cells filled with accumulated lipids and carbohydrates. Often golden-yellow due to ↑ lipid content.Originated from PCT → invades renal vein (may develop varicocele if left sided) → ...
- Pyelonephritis Acute:- Neutrophils infiltrate renal interstitium.- Affects cortex with relative sparing of glomeruli/vessels.- Presents with fever, flank pain (costovertebral angle tenderness), nausea/vomiting, chills.- ...
- Acute interstitial nephritis (tubulointerstitial nephritis) ... Acute interstitial renal inflammation.Pyuria (classically eosinophils) and azotemia occuring after administration of drugs that act as haptens, inducing hypersensitivity. - Nephritis typically occurs ...
- Diffuse cortical necrosis Acute generalized cortical infarction of both kidneys. - Likely due to a combination of vasospasm and DIC. - Associated with obstetric catastrophes (eg, abruptio placentae), septic shock.
- Acute kidney injury Formerly known as acute renal failure. Acute kidney injury is defined as an abrupt decline in renal function as measured by ↑ creatinine and ↑ BUN or by oliguria/anuria. Prerenal azotemia: Due to ↓ RBF ...
- Consequences of renal failure Decline in renal filtration can lead to excess retained nitrogenous waste products and electrolyte disturbances. - Na+/H2O retention (HF, pulmonary edema, hypertension)- Hyperkalemia- Metabolic acidosis- ...
- Renal osteodystrophy Failure of vitamin D hydroxylation, hypocalcemia, and hyperphosphatemia → 2° hyperparathyroidism. - High serum phosphate can bind with Ca2+ → tissue deposits → ↓ serum Ca2+. - ↓ 1,25-(OH)2D3 → ...
- Autosomal dominant polycystic kidney disease Numerous cysts in cortex and medulla causing bilateral enlarged kidneys that ultimately destroy kidney parenchyma. - Presents with flank pain, hematuria, hypertension, urinary infection, progressive ...
- Autosomal recessive polycystic kidney disease Cystic dilation of collecting ducts. - Often presents in infancy. - Associated with congenital hepatic fibrosis. - Significant oliguric renal failure in utero can lead to Potter sequence. - Concerns ...
- Autosomal dominant tubulointerstitial kidney disease ... Also known as medullary cystic kidney disease.Inherited disease causing tubulointerstitial fibrosis and progressive renal insufficiency with inability to concentrate urine. - Medullary cysts usually not ...
- Mannitol Osmotic diuretic, ↑ tubular fluid osmolarity, producing ↑ urine flow, ↓ intracranial/intraocular pressure Clinical use: - Drug overdose- Elevated intracranial/intraocular pressure Toxicity: ...
- Casts in urine Presence of casts indicates that hematuria/pyuria is of glomerular or renal tubular origin.- Bladder cancer, kidney stones → hematuria, no casts.- Acute cystitis → pyuria, no casts. RBC casts: Glomerulonephritis, ...
- RBC cast Glomerulonephritis, malignant hypertension
- WBC cast Tubulointerstitial inflammatoin, acute pyelonephritis, transplant rejection
- Fatty casts ("oval fat bodies") Nephrotic syndrome Associated with "Maltese cross" sign
- Granular ("muddy brown") casts Acute tubular necrosis
- Waxy cast End-stage renal disease/chronic renal failure
- Intoxication Acidification of urine:- treatment with ammonium chloride- increases renal clearance of weak base --> increased ionization- eg, amphetamine intoxication Alkalinization of urine:- treatment with bicarbonate- ...