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USMLE
Goljan Renal Path 1
| Question | Answer |
|---|---|
| What are podocytes? | visceral epithelial cells |
| What are the spaces between the podocytes called? | split pores |
| Which cells synthesize the glomerular BM? | visceral epithelial cells (podocytes) |
| What keeps albumin out of urine? | strong negative charge of Glomerular BM |
| What is responsible for charge of GBM? | Heparan Sulfate (strong negative charge) |
| damage to visceral epithelial cell results in what? | damage to BM and leaking of albumin into urine --> nephrotic syndrome |
| linear pattern outlining BM on Immunofluorescence | goodpasture syndrome |
| subendothelial immune complex deposits in glomeruli on EM (granular) | lupus |
| subepithelial immune complex deposits in glomeruli EM (granular) | post-strep glomerulonephritis |
| only glomerulonephritis one can diagnose with IF | IgA glomerulonephritis |
| granular pattern on IF. what does it mean? | immunocomplex type III disease (membranous glomerulonephritis = immune complexes) |
| anti BM antibodies is what type of immune complex disease? | Type II |
| RBC casts in urine is unique to what class of diseases | nephritic syndromes |
| serum ANA shows rim pattern. what does that mean? | anti-DNA --> lupus |
| crescentic glomerulonephritis is most commonly seen in what syndrome? | goodpasture's syndrome |
| cholesterol casts in urine that when polarized look like maltese crosses. what is the diagnosis? | nephrotic syndrome |
| why does lipoid nephrosis occur (Minimal change disease)? | loss of negative charge of GBM |
| Nephrotic syndrome associated with HIV | FSGS |
| glomerular problem in HBV | diffuse membraneous glomerulonephritis |
| glomerular problem in HCV | Membranoproliferative glomerulonephritis |
| vasculitis associated with HBV | polyarteritis nodosa |
| large golf-ball appearing glomeruli on H&E | diabetic nephropathy |
| what happens to the GFR and creatinine clearance in early diabetic nephropathy? | hyalinization of efferent arterioles, so Cr clearance and GFR increase. Also nonenzymatic glycosylation of BM cause microalbuminuria |
| ACE inhibitors do what to glomerular arterioles? | less angiotensin II dilates efferent arteriole |
| mesangial cells split BM on EM. C3 deposited adjacent to but not within dense deposits. serum C3 is very low. what is the diagnosis? | Type II membranoproliferative glomerulonephritis |
| properties of BUN | blood urea nitrogen - secreted and reabsorbed in PCT |
| properties of Creatinine | end-product of creatine - only filtered in kidney, neither reabsorbed nor secreted in kidney (can be in other places in very high levels) |
| normal BUN and Cr levels | BUN: 9-10 Cr: 1 mg/dl |
| normal BUN/Cr | 10 |
| pre-renal azotemia | normal kidneys, but reduced Cardiac Output (e.g. CHF), ergo, GFR decreases. BUN/Cr >20 |
| most common cause of acute renal failure | ischemic acute tubular necrosis |
| Cardiac output decreases and oliguria, what do you worry about most? | ischemic acute tubular necrosis |
| Acute tubular necrosis associated with? | renal ischemia (eg shock), crush injury (myoglobinuria), toxins |
| Acute renal failure values: BUN/Cr | Prerenal: >20 Renal: <15 Postrenal: >15 |
| Acute renal failure values: Urine Osmolality | Prerenal: >500 Renal: <350 Postrenal: <350 |
| Acute renal failure values: Urine Na | Prerenal: <10 Renal: >20 Postrenal: >40 |
Created by:
Asclepius
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