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Renal and Male GU

What are some drugs associated with hematuria? Warfarin, Heparin, Cyclophosphamide (also risk for TCC)
Which type of azotemia would present with BUN/Cr < 15? Why? Renal azotemia due to damage of tubular epithelium (Prolonged obstruction presents similarly)
Describe casts. Where are they formed? protein matrix that entrap cells, debris, or protein leaking through glomeruli; formed in tubular lumens
What determines protein filtration at the GBM? size and charge; heparan sulfate is (-) thus only permeable to LMW cationic proteins
In Nephritic syndrome, what mediates glomerular injury? IC deposition, Complement activated, C5a recruits neutrophils
What are some clinical features of nephritic syndrome? HTN (Na), Periorbital puffiness, Oligura, Hematuria,
In nephrotic syndrome, what mediates glomerular injury? T cell production of cytokines that cause GBM to lose (-) charge and may cause podocytes to fuse
What are some clinical features of nephrotic syndrome? Proteinuria, Edema, Fatty casts with maltese crosses and oval fat bodies, Hypercoaguable state (loss of ATIII)
IgA glomerulopathy Berger's disease, nephritic mesangial IC deposits w/ granular IF, eposodic bouts of hematuria following URI
Post-streptococcal GN Follows Group A Strep infection; Subepithelial IC depositis with granular "lumpy bumpy" IF; diffuse proliferative pattern with neutrophils;Hematuria, periorbital edema, incr anti-DNase B titers
Nephropathy in SLE (II) increase in mesangial cells and matrix, proteinuria (IV) Diffuse proliferative GN; subendothelial IC deposits w/ granular IF = wire-looping of capilaries; endothelial cell and GBM proliferation
RPGN (crescentic) crescent = proliferation of parietal cells and deposition of fibrin in Bowmans space; Goodpastures, Wegener's (c-ANCA), Microscopic polyarteritis (p-ANCA)
Minimal change disease most common nephrotic syndrome in children; EM shows podocyte fusion; often preceded by URI or immunization; responds well to steroids
Focal segmental glomerulosclerosis similar to MCD but it adults; secondary cause due to HIV
Diffuse membranous glomerulopathy most common nephrotic syndrome in adults; subepithelial IC deposits show "spike and dome" pattern on silver stain; due to drugs, infections, malignancy, SLE
Type I MPGN subendothelial ICs activate complement and cause reduplication of GBM due to mesangial expansion resulting in tram track appearance
Type II MPGN Dense Deposit Disease; C3 nephritic factor is an autoAb to C3 convertase which causes sustained activity and low serum C3 levels
What is one of the earliest changes in diabetic nephropathy? GBM thickening due to deposition of type IV collagen
What changes occur to the arterioles in diabetic nephropathy? Nonenzymatic glycosylation produces hylaine arteriolosclerosis, incr GFR which damages the mesangial cells (proteins); KW nodular masses develop due to incr type IV collagen and trapped proteins
Alport's syndrome X-linked mutation in alpha5 type IV collagen; irregular GBM thickening and splitting of lamina densa; isolated hematuria and nerve deafness
Thin Basement Membrane Disease Benign familial hematuria; mutations in alpha3 and 4 collagen type IV
What is the pathogenesis of tubular cell injury in ATN? depletion of ATP, redistribution of membrane proteins, loss of polarity (Na causes vasoconstriction), cells detach from BM and obstruct lumen
What are some drugs commonly associated with ATIN? penicillin, rifampin, sulfonamides, thiazide diuretics, NSAIDs
What are some clinical signs of ATIN? 2 wks after exposure: fever, oliguria, rash, eosinophlia; kidney: intersitial edema w/ inflamm cell infiltrate
What is the most common cause of acute pyelonephritis? vesicoureteral reflux with ascending infection
What are the microscopic findings of chronic pyelonephritis? U-shaped cortical scar; interstitial fibrosis, some tubules contain hyaline casts that resemble thyroid tissue (thyroidization)
Analgesic nephropathy combination of ASA and acetaminophen; leads to renal papillary necrosis w/ heamaturia, proteinuria, and colicky flank pain
Amyloidosis causes nephrotic syndrome; mesangial expansion w/ GMB irregularly thickened (fringe on a rug) with PAS and silver stains
Benign nephrosclerosis finely granular cortical surface; hyaline arteriolosclerosis, reduplication of int. elastic membrane; interstitial fibrosis, tubular atrophy, glomerular sclerosis
Malignant nephrosclerosis surface has pinpoint flea-bitten hemorrhages; concentrially arranged myofibroblasts w/ collagen = hyperplastic arteriolitis ("onion sknning"); fibrinoid necrosis and thrombosus of arterioles and glomeruli
What is a Goldblatt kidney? blood vessels of ischemic kidney are protected from HTN in renal artery stenosis
In what location is Renal Cell Carcinoma most common? Where does it invade? upper poles, invades renal vein
Where is Renal Cell (clear) carcinoma derived from? What is contained in the clear cells? tubular epithlium; glycogen and lipids
What is the most common renal tumor in children? From where is it derived? Wilm's tumor; mesonephric mesoderm
What is the term for bladder muscosa exposed to the anterior body surface? What other abnormality is it associated with? exstrophy of the bladder; associated with epispadias
What is the most common cause of bladder adenocarcinoma? urachal cyst remnant drainage of urine from umbilicus
What is the most common risk factor for TCC? location? smoking increases risk 5-7 fold; lateral and posterior wall of the bladder
What are some risk factors for testicular seminoma? cryptorhid testicle, testicular feminization, Klinefelter's syndrome
What tumor are Schiller-Duval bodies associated with? What do they resemble? Yolk sac (endodermal sinus) tumor; resemble glomeruli
In BPH, where does hyperplasia of glandular and stromal cells develop? glandular - transitional zone; stromal - periurethral zone
Does SHBG have a higher affinity for testosterone or estrogen? testosterone
How do androgens/estrogens affect synthesis of SHBG? estrogens increase the synthesis while androgens decrease the synthesis
What are some causes of leydig cell and seminiferous tubule dysfunction? chronic alcoholic liver disease (inhibits binding of LH to cells), chronic renal failure (toxins), irradiation, orchitis, trauma
What is the most common cause of impotence in men > 50? vascular insufficiency (Leriche syndrome); aortoiliac atherosclerosis, calf claudication, diminished femoral pulse
What is Peyronie's disease? fibromatosis with painful contractures of the penis causing lateral curvature; may cause infertility
What metabolic abnormality is a serious risk in ATN? When does it occur? In the initial oliguric phase, hyperkalemia can cause a fatal arrhythmia
What is Fanconi syndrome? dysfunction of PT (hereditary or acquired) causing impaired resorption of glucose, AA, phosphate, and bicarbonate
What is the most common cause of diffuse cortical necrosis? obstetric catastrophes (placental abruption or eclampsia); end-organ vasospasm and DIC
What are the characteristics of uremia? azotemia, acidosis (sulfates, phosphates, organic acids), hyperkalemia, abnormal volume control, hypocaclemia, anemia, HTN
Define WAGR complex? Wilm's tumor, Aniridia, GU abnormalities, Mental/Motor retardation; deletions on chromosome 11
In urethritis, what infection should be suspected when bacteria are NOT demonstrated in a purulent urethral discharge? Chlamydia
What diuretic causes a gouty attack? thiazide diruetics
Created by: ash0403



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