Pathology: Renal
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What is the likely origin of the glomerular disorder when the following are seen with Immunofluorescence stain: 1. linear pattern 2. granular pattern | 1. antibodies formed against basement membrane (i.e. Goodpastures)
2. immunocomplex deposition in glomerulus (type III hypersensitivity)
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What is the cause of edema in: 1. Nephritic syndrome 2. Nephrotic syndrome | 1. Na+ retention
2. hypoalbuminemia
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How much protein loss distinguishes nephrotic from nephritic? | nephrotic is > 3.5g/day
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What is the underlying cause of glomerular injury: 1. Nephritic syndrome 2. Nephrotic syndrome | 1. neutrophils
2. cytokines
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Diagnosis? 1. WBC cast on U/A 2. RBC cast on U/A 3. Granular "muddy brown" cast on U/A | 1. acute pyelonephritis
2. glomerulonephritis
3. Acute tubular necrosis
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Most common cause of Acute Tubular Necrosis | prerenal azotemia due to hypovolemia
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How does chronic aspirin use lead to tubulointerstitial nephritis? | aspirin inhibits PGE2, the vasodilator of the afferent arteriole.
Afferent arteries constrict and ATII unopposed to constrict the efferent arteriole. Lose blood supply to renal medulla → necrosis
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1. Which finding on electron microscopy indicates nephrotic syndrome? 2. Which cells make the glomerular basement membrane? 3. What molecule gives the basement membrane a negative charge? | 1. fusion of podocytes
2. visceral podocytes
3. heparan sulfate
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1. Most common glomerulonephritis? 2. When does it occur? | 1. IgA glomerulonephritis (Berger's disease)
2. a few days after a GI, upper respiratory or urinary infection in children
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Most common cause of nephrotic syndrome: 1. in children 2. in adults | 1. minimal change disease
2. focal segmental glomerulonephritis
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Renal adenocarinoma is known to ectopically secrete: | 1. EPO leads to polycythemia
2. PTH like peptide leads to hypercalcemia
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Huge, palpable flank mass and hematuria in a child | Wilm's tumor
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1. initial laboratory finding of diabetic glomerulopathy? 2. Which tests allows this detection? | 1. microalbuminuria
2. microalbuminuria dipstick
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What is edema due to in: 1. Nephritic syndrome 2. Nephrotic syndrome | 1. Na+ retention
2. hypoalbuminemia
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Most common subtype of glomerular disease in systemic lupus erythematosus | Diffuse proliferative glomerulonephritis
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1. Glomerular disease associated with "tram track" appearance 2. Glomerular disease associated with C3 nephritic factor | 1. Type I MPGN
2. Type II MPGN
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How do you determine if respiratory adequate compensation has occurred in response to metabolic acidosis? | Winter's formula
Pco2 = 1.5(HCO3-) + 8 +/- 2
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1. How does acidosis effect K+ concentration? 2. How does hyperkalemia effect H+ concentration? | 1. Acidosis → K+ release from cells (hyperkalemia)
2. Hyperkalemia → H+ release from cells (acidosis)
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What acid/base abnormalities do the following cause: 1. hyperaldosteronism 2. diuretics 3. uremia 4. methanol 5. diarrhea 5. renal tubule acidosis | 1. metabolic alkalosis
2. metabolic alkalosis
3. ↑ anion gap metabolic acidosis
4. ↑ anion gap metabolic acidosis
5. normal anion gap metabolic acidosis
6. normal anion gap metabolic acidosis
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1. Congo red stain with apple-green birefringence 2. common cause of ammonium magnesium phosphate kidney stones 3. how does hyperaldosteronism contribute to acid/base pathology? | 1. amyloidosis
2. infection with urease positive bugs
3. aldosterone → ↑K+ & H+ secretion → metabolic alkalosis
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What is the inheritance pattern of polycystic kidney disease in: 1. adults 2. children | 1. autosomal dominant
2. autosomal recessive
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Cause of Renal osteodystrophy | 1. osteoporosis: chronic metabolic acidosis → loss of bone mass to buffer acids
2. osteomalacia: hypovitaminosis D → ↓mineralization of bone
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1. child with aniridia, abdominal mass. 2. What is hypertension due to in polycystic kidney disease | 1. Wilm's tumor
2. ↑ renin production
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1. Subepithelial immunocomplex deposits with granular IF staining. 2. Mesangial immunocomplex deposits with granular IF staining 3. Subendothlial immunocomplex deposits with granular IF staining and "wire looping" of capillaries. | 1. Post-streptococcal GN
2. IgA glomerulopathy
3. Diffuse proliferative GN; caused by SLE
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1. Hepatitis B virus, silver stains show "spike and dome" pattern. 2. Most common causes (2) of acute tubular necrosis? | 1. Diffuse membranous glomerulopathy
2. ischemic injury and toxic injury
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1. Fibrinoid necrosis. 2. Nodular glomerulosclerosis. 3. Hyperplastic arteriosclerosis. 4. Hyaline arteriosclerosis. | 1. Malignant hypertension
2. Diabetes
3. Malignant hypertension
4. Benign, long-standing hypertension
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Treatment for: 1. Goodpastures syndrome? 2. Diffuse proliferative GN 3. Minimal change disease 4. IgA glomerulonephropathy | 1. plasmaphoresis
2. corticosteroids + cyclophosphamide
3. corticosteroids
4. corticosteroids
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1. Unilateral enlarged, cystic kidney. 2. Hemoptysis, hematuria, sinusitis | 1. Renal dysplasia
2. Wegener's (affects both upper & lower respiratory tract; Goodpastures only effects lower)
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Where in the kidney tubule do cysts appear in: 1. Autosomal dominant Polycystic Kidney Disease 2. Autosomal recessive Polycystic Kidney Disease | 1. proximal convoluted tubule
2. collecting duct
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ADPKD is associated with a defect on chromosome __. | chromosoome 16
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1. Male with bilateral hydronephrosis. DDx? 2. With which disorder is it common to see eosinophils in the urine? | 1. BPH
2. interstitial nephritis (usually drug induced)
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1. Associated with squamous cell bladder cancer in the Middle East 2. Only two glomerulonephritis disorders associated with subendothelial deposits | 1. Schistosomiasis
2. MPGN, Diffuse proliferative
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What is the defect in Alport syndrome? | type IV collagen (basement membrane) defect
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Rapidly progressive glomerulonephritis with: 1. p-ANCA 2. c-ANCA | 1. Microscopic polyangiitis
2. Wegener's granulomatosis
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Most common nephrotic syndrome in HIV patient | Focal segmental glomerulosclerosis
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What is the plasma calcium level of most individuals with kidney stones? | normocalcemia; kidney stones are usually idiopathic
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Staghorn calculi in adult | Ammonium magnesium phosphate from urease-positive bug (proteus, Klebsiella)
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Which kidney stone is radiolucent (not seen on X-ray)? | Uric acid
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Which renal pathology are the following associated with: 1. penicillin 2. aminoglycosides 3. acetaminophen 4. sulfonamides 5. shock 6. sickle cell disease | 1. interstitial nephritis (drug acts as hapten)
2. acute tubular necrosis
3. renal papillary necrosis
4. interstitial nephritis
5. acute tubular necrosis
6. renal papillary necrosis
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