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