Goljan Renal
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| First sign tubule cell dysfunction | inability to concentrate urine
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| Fixed specific gravity | chronic renal failure; cannot concentrate or dilute urine
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| Negative urine bilirubin + trace urobilinogen | normal urine
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| Positive urine bilirubin, absent urobilinogen | obstructive jaundice
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| Positive urine bilirubin + increased urobilinogen | hepatitis
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| Negative urine bilirubin + increased urobilinogen | extravascular hemolytic anemia
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| Positive urine nitrite + positive urine leukocyte esterase | urinary tract infection
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| Sterile pyuria | positive urine leukocyte esterase but negative standard culture; TB, C. trachomatis
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| Prerenal azotemia | ↑ BUN and creatinine; ↓ renal blood flow (e.g. heart failure, hypovolemia)
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| Renal azotemia | ↑ BUN and creatinine due to intrinsic renal disease (acute tubular necrosis)
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| Postrenal azotemia | ↑ BUN and creatinine due to obstruction to urine flow
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| Serum BUN:creatinine ratio | <15:1 (renal failure); >15:1 (prerenal or postrenal azotemia)
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| BUN 80 mg/dL:creatinine 8 mg/dL | ratio 10/1 - renal failure
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| BUN 80 mg/dL:creatinine 2 mg/dL | ratio 40/1 - prerenal azotemia or postrenal azotemia
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| Creatinine clearance | measures GFR
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| Proteinuria | important sign of renal dysfunction
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| RBC casts | nephritic type of glomerulonephritis
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| WBC casts | acute pyelonephritis, acute tubulointerstitial nephritis
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| Fatty casts with Maltese crosses | nephrotic syndrome
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| Hyaline casts | normal unless associated with proteinuria
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| Renal tubular cell casts | acute tubular necrosis
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| Waxy or broad casts | chronic renal failure
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| Cystinuria | hexagonal crystals
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| Horseshoe kidney | Turner’s syndrome; lower poles fused
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| Renal dysplasia | MC childhood cystic disease; abnormal development; flank mass
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| Maternal oligohydramnios | fetal juvenile polycystic kidney disease; Potter’s facies in newborn
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| Adult polycystic kidney disease | AD; hypertension MC sign; cerebral berry aneurysms
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| Visceral epithelial cells | synthesize basement membrane
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| Glomerular BM | negative charge due to heparan sulfate
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| Nephritic syndrome | oliguria; RBC casts; hypertension; mild to moderate proteinuria
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| Nephrotic syndrome | proteinuria >3.5 g/day; ascites and pitting edema; fatty casts; fusion of podocytes
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| Immunofluorescence | linear (anti-glomerular BM antibodies); granular (IC deposition)
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| IgA GN | MC GN; usually nephritic; episodic hematuria; mesangial IC (lgA-anti-IgA) deposits
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| Post-streptococcal GN | nephritic; subepithelial deposits; skin/pharyngeal infections; anti-DNAase B
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| SLE type IV GN | nephritic; subendothelial deposits; anti-DNA antibodies
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| Crescentic GN | crescents from parietal cell proliferation; worst GN; Goodpasture’s, Wegener’s
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| Goodpasture’s | nephritic; anti-BM antibodies (glomerular + pulmonary capillary); crescentic GN
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| S/S | young male with hemoptysis progressing to renal failure
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| Minimal change disease (lipoid nephrosis) | MCC childhood nephrotic syndrome
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| Lipoid nephrosis | podocyte fusion; loss of negative charge in glomerular BM
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| Focal segmental glomerulosclerosis | nephrotic syndrome; AIDS and IV heroin abuse
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| Membranous GN | MCC adult nephrotic syndrome; subepithelial deposits; epimembranous spikes
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| Causes membranous GN | HBV, ACE inhibitors, cancer
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| Type I MPGN | nephrotic; subepithelial deposits; HCV association; tram tracks
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| Type II MPGN | nephrotic; C3 nephritic factor; intramembranous ICs (dense deposit disease)
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| DM nodular glomerulosclerosis | microalbuminuria first sign
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| DM glomerulosclerosis | nodules with collagen in mesangium; hyaline arteriolosclerosis of arterioles
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| ACE inhibitors | inhibit angiotensin II vasoconstriction of efferent arterioles
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| Alport’s syndrome | XD hereditary nephritis with sensorineural hearing loss
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| Ischemic ATN | prerenal azotemia MCC; renal tubular cell casts; BUN:creatinine ratio <15:1
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| Ischemic ATN | disruption of BM in proximal tubule and thick ascending limb
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| Nephrotoxic ATN | aminoglycosides, IVP dye, Pb/mercury poisoning
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| Nephrotoxic ATN | proximal tubule dysfunction; intact BM
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| Oliguria | prerenal azotemia, ATN, glomerulonephritis, postrenal azotemia
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| Acute pyelonephritis | vesicoureteral reflux with ascending infection; WBC casts, fever, flank pain
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| Chronic pyelonephritis | U-shaped scars overlying blunt calyces
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| Drug-induced tubulointerstitial nephritis | type I/IV reaction; e.g., penicillin
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| S/S | ARF, fever, rash, eosinophilia, eosinophiluria, WBC casts
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| Analgesic nephropathy | aspirin plus acetaminophen; renal papillary necrosis; IVP with ring defect
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| Myeloma kidney | BJ protein produces foreign body reaction in tubules
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| Urate nephropathy | prevent by giving allopurinol prior to chemotherapy
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| CRF | fixed specific gravity; BUN:creatinine <15:1; waxy and broad casts
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| Renal osteodystrophy CRF | hypovitaminosis D (no 1-α-hydroxylase); produces osteomalacia
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| Renal osteodystrophy CRF | osteoporosis from metabolic acidosis
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| Renal osteodystrophy CRF | secondary HPTH with increased osteoclastic activity
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| S/S CRF | pericarditis, prolonged bleeding time, normocytic anemia, pathologic fractures
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| Benign nephrosclerosis | kidney of hypertension; shrunken kidneys due to hyaline arteriolosclerosis
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| Malignant hypertension | renal failure; encephalopathy; BP >210/120 mm Hg; IV nitroprusside
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| Renal findings | necrotizing arteriolitis; “flea bitten” kidney; hyperplastic arteriolosclerosis
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| Renal infarction | pale infarcts; hematuria; common in polyarteritis nodosa
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| Hydronephrosis | renal stone MCC; atrophy of cortex/medulla; postrenal azotemia
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| Renal stones | most contain calcium (calcium oxalate/phosphate); hypercalciuria MC risk factor
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| S/S | colicky pain radiating into groin, hematuria; x-ray usually shows stone
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| Staghorn calculus | due to urease producing organisms (Proteus); alkaline urine pH; ammonia smell
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| Angiomyolipoma | hamartoma; associated with tuberous sclerosis
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| Renal cell carcinoma | smoking MCC; invasion renal vein/vena cava; lung, bone mets; yellow colored
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| S/S | flank mass, hematuria; ectopic hormones (EPO, PTH related peptide), left-sided varicocele
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| Renal pelvis transitional cell carcinoma | smoking MCC, phenacetin, aniline dyes, cyclophosphamide
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| Wilm’s tumor | hypertension, unilateral abdominal mass in child; aniridia/hemihypertrophy in AD types
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| Urine draining from umbilicus | persistent urachus
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| Retroperitoneal fibrosis | produces hydronephrosis
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| Bladder extrophy | abdominal wall defect + epispadias
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| Bladder diverticula | most commonly due to prostatic hyperplasia with urethral obstruction
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| Acute cystitis | E. coli; females > males; no fever, flank pain, or WBC casts
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| Bladder transitional cell carcinoma | smoking MCC, aniline dyes, cyclophosphamide; papillary
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| S/S | hematuria; hydronephrosis
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| Bladder adenocarcinoma | risk factors persistent urachus, extrophy
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| Bladder squamous cell carcinoma | Schistosoma hematobium infection
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