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DU PA Glomerular DZs

Duke PA Glomerular disease and other Intrinsic Renal Disease

the initial manifestation of glomerular disease includes hematuria, proteinuria, new onset hypertension, edema, malaise
less than __mg of protein excreted in the urine per day 50
nephrotic range proteinuria (>__/day) represents diffuse glomerular injury 3.5g
characterized by the abrupt onset of hematuria with RBC casts and or dysmorphic RBCs, proteinuria (usually non-nephrotic range), and impaired renal function Acute Nephritis syndrome
Acute nephritic syndrome is most commonly caused by proliferative glomerulonephritis (PSGN)
Occurs as a postinfectious complication of nephritogenic strains of group A beta-hemolytic streptococcal infection proliferative glomerulonephritis (PSGN)
is typically seen in children 3-12 although it can occur in adults proliferative glomerulonephritis (PSGN)
complete recovery occurs in 90-95% of all patients with proliferative glomerulonephritis (PSGN)
characterized by glomerular hematuria (RBC casts or dysmorphic RBCs) and renal failure developing over weeks to months associated with diffuse glomerular epithelial cell proliferation in Bowman's space leading to cresent formation evident on renal biopsy rapidly progressive glomerulonephritis (RPGN)
characterized by the presence of proteinuria, hypoalbuminemia, edema, hyperlipiduria, and hyperlipidemia nephrotic syndrome
the finding of proteinuria of 3.5g/24hr/1.73m(3) is sufficient for the designation of nephrotic syndrome
nephrotic syndromes are subdivided into active and ___ bland
bland nephrotic syndrome pure nephrotic
active nephrotic syndrome mixed nephrotic/nephritic
the cut off mean GFR when we start to define chronic kidney disease is ___ ml/min per 1.73m(2) 60
oliguria is a decrease in urine production to less than ____cc per day 500
sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness prerenal cause of ARF
direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply intrarenal cause of ARF
sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury postrenal cause of ARF
____ is a decrease in urine production to less than 500 cc per day oliguria
means nonpassage of urine. But, is practically defined as passage of less than 50 milliliter of urine in a day anuria
intermittant inability to maintain extremity posture against gravity. frequency 1-2 hz. pathognomonic for uremia, hepatic failure, and hypercapnea asterixis
how is volume overload measured JVP
You can either measure JVP, or just say that the patient has JVD
Profound dyspnea, Orthnopnea, Decreased arterial oxygenation, Respiratory failure Pulmonary edema
Chest pain, Friction rub, Tamponade physiology uremic pericarditis
BP of 100/60 and HR 120 lying down, BP of 80/40 and HR 140 sitting up orthostasis
low renal perfusion leads to renal failure
hypotension leads to low reanl perfusion
GFR is directly related to renal perfusion
increased creatinine can be caused by decreased GFR
aldosterone leads to reabsorption of Na+ and water
aldosterone leads to secretion of K+
aldosterone leads to increased blood volume
Infusion of isotonic saline in hypotensive and volume contracted patient. Treatment of underlying illness. Discontinuation of antihypertensives. Discontinuation of diuretics. Octreotide in patients with cirrhosis Pre-renal Azotemia Therapy
anything that can cause dramatic decrease in blood pressure can lead to ATN
muddy brown (dark densely granulated) casts are a tell tell sign for acute tubular necrosis (ATN)
treatment for acute tubular necrosis Conservative: medical management of volume overload, acidosis, hyperkalemia, uremia. Or Renal replacement therapy:HemodialysisIntermittant hemodialysis, Continuos veno-venous hemodialysis (CVVHD
Dialysate: lacks ___ urea and creatinine
dialysis does not cure the underlying problem
the 4 catagories of intrinsic renal failure vascular, tubular, glomerular, interstitial
Renal infarct, Renal artery stenosis, Renal vein thrombosis Intrinsic Renal Failure - Vascular
___% of the cardiac output goes to the kidneys 33
___L of GFR is produced every 24 hours 180
systolic hypertension >180mmHg, associated with retinal hemorrhage, acute nephrosclerosis malignant hypertension
treatment for malignant hypertension Nitroprusside, Fenoldopam, Phentolamine, Methyldopa
gradual thickening of the skin, internal organs are affected, hypertension triggers progressive renal failure scleroderma renal crisis
treatment for scleroderma renal crisis ACE inhibition, 5 year survival 65%
Cholesterol emboli cause organ damage, Most common after arterial instrumentation in aorta (cardiac cath), Irreversible, Slow progression of ARF (0.1-0.2 mg/dL/day), Diognosis: ARF and typical skin findings (livedo reticularis) Arthero-Embolic Disease
Nephrotoxic substance is damaging proximal tubular cells. Leak of nitrogenous waste into blood leading to decrease in glomerular filtration. Inability to excrete BUN, Cr, potassium, hydrogen ion. Caused by drugs, contrast, cellular breakdown products Intrinsic Renal Failure - Tubular Nephrotoxic Insult
aminoglycosides, ACEIs, NSAIDs, radiocontrast media most common tubular selected nephrotoxins
normal plt 150,000 to 400,000/mm3
normal Hct Male: 40.7-50.3%, Female: 36.1-44.3%
is a renal injury associated with a) an abrupt deterioration in renal function, b) inflammation and edema of the renal interstitium Acute interstitial nephritis (AIN)
Diseases or drugs cause immunologic response in renal interstitium causing ___ often associated with a systemic immunologic response (e.g. rash). Acute interstitial nephritis (AIN)
azotemia secondary to the inability of urine to flow freely. Obstruction due to extra-renal or intra-tubular barrier. Extra-renal examples: prostate, kidney stones, retroperitoneal fibrosis, GYN cancers post-renal failure
three broad categories of intrarenal disease glomerular, tubulo-interstitial, cystic
active sediment-indicating active inflammation in the kidney, casts will usually contain byproducts of inflammation nephritic sediment
very large quantities of protein in the urine and a lack of tell tale signs of inflammation nephrotic sediment
a biopsy is like a controlled stabbing
nil disease (lipoid nephrosis) is a disease of the kidney which causes nephrotic syndrome and usually affects children (peak incidence at 2-3 years of age) minimal change disease
Taking lots of NSAIDs can lead to minimal change disease
Group A β-hemolytic Streptococcus after impetigo or pharyngitis, MRSA, S.pneumonia, meningococcal infection. Time to onset 1-3 weeks. Clinical presentation:edema, hypertension, gross hematuria, renal failure Post-Infectious Glomerulonephritis
post-infectious glomerulonephritis-elevated IgA levels in MRSA infection
Subepithelial humps, almost pathognomonic for Post streptococcal GN
Epidemiology: most common glomerulonephritis, uncommon in blacks, more common in Asians and Australians. Secondary: Cirrhosis, Celiac Disease, HIV, CMV. Mechanism: Abnormal IgA deposition in glomerulus IGA nephropathy
most important intervention for keeping kidneys alive in IgA nephropathy perfect blood pressure control (ACEI/ARBs)
Male:female ratio 6:1, 10% develop RPGNHighest frequency in 2nd to 3rd decade, Associated with influenza A, hydrocarbon solvent exposure, HLA DR2 and B7 Antigen, Development of anti-Basement Membrane Ab, aka pulmonary and renal syndrome Goodpasture Syndrome
a rare autoimmune disorder characterized by pulmonary hemorrhage, rapidly progressing glomerulonephritis, and antiglomerular basement membrane (GBM) antibody formation. The syndrome typically strikes young men, is rapidly progressive, and can be fatal. Goodpasture Syndrome
pathologic product of many different diseases. Proteinuria, Focal glomerular scarring and consolidation leading to ESRD. 25% of adult nephropathies.vBlacks > Whites. Men > Women. Part of the kidney is diseased and only a segment of the glomerulus. Focal Segmental Glomerulosclerosis (FSGS)
about 1/3 of patients with FSGS who undergo kidney transplantation will have a recurrance
most common nephrotic syndrome. Usually presents in the 5th-6th decade of life. 1/3 will develop ESRD. Membranous GN
1/3 of these patients will have spontaneous remission, 1/3 will respond to treatment Membranous GN
Acute commonly associated with toxins and ischemia. Chronic can be associated with: Kidney size small and contracted. Decreased urinary concentrating ability. Hyperchloremic metabolic acidosis. HyperkalemiaReduced GFR. Tubulointerstitial Diseases
Chronic Tubulointerstitial disease is most commonly associated with obstructive uropathy, and vesicoureteral reflux
most common genetic disorder affecting the kidneys polycystic kidney disease
rarely symptomatic, until later in life cystic kidney disease
patients with poycystic kidney disease can also develop polycystic liver
patients with poycystic kidney disease can also develop cancer
Created by: bwyche