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Goljan Renal

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