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Buzz Words- Renal
Buzz words and hallmark presentations (path, thomas, zel, ryan- tubulo ds)
| question | Answer |
|---|---|
| complement levels in IgA nephropathy? | NORMAL C3 and C4 key to DDx from Post-infectious GN in which complement levels are LOW (also IgA occurs <b>days<b/> post infection; Post Infectious GN occurs weeks later) |
| oval fat bodies may be sign of? associated with what type of syndrome? | hyperlipidemia; nephrotic syndrome |
| classic presentation: proteinuria (foamy urine), hypoalbuminemia, edema, hyperlipidemia | nephrotic syndrome |
| likely to present in children with acute onset; associated with lymphomas*; caused by effacement of podocytes | minimal change disease |
| most common cause of nephrotic syndrome in african americans? | FSGS |
| nephrotic syndrome most commonly associated with HIV/AIDS | FSGS |
| which nephrotic syndrome is an exception in that it is due to an antibody/antigen complex? | membranous glomerulonephropathy |
| which syndrome is it crucial to perform age appropriate cancer screening? | membranous GN |
| kimmel steil- wilson nodules | diabetic glomerulosclerosis or as Bri says... Jimmy Kimmel has diabetes (but he doesn't?) |
| classic presentation: hematuria, oliguria, HTN (+ RBC casts and low protein) | nephritic syndrome |
| crescentic lesions (general) | nephritic syndrome |
| #1 cause of GN worldwide | IgA nephropathy |
| associated with Henoch Schonlein Purpura | IgA nephropathy |
| IgA nephropathy is associated to occur after which two broad kind of infections? | URI and GI infections |
| Post-infectious is associated to occur after what kind of infection usually? | Strep Pharyngitis |
| which nephritic syndrome presents with low C3 and low C4? | Post infectious GN |
| which nephritic syndrome presents with low C3 and normal C4? | Membranoproliferative GN |
| which nephritic syndrome presents with normal C3 and normal C4? | IgA nephropathy |
| dry mouth, dry eyes; positive anti-ro and anti-la antibodies | Sjogrens disease (commonly associated with membranoproliferative GN) |
| Anti-GBM only kidney involvement- more likely in? | older women |
| Anti-GBM- goodpasture (with kidney and lung involvement)-- more likely in? | young men with history of smoking (may present with hemoptysis |
| nephritic syndrome with lung, kidney AND SINUS involvement | Wegener's granulomatosis (a type of small vessel vasculitis); sinus involvement may include- epistaxis or recurrent sinusitis must Ddx from Goodpastures (kidney and lung only) |
| c-ANCA (+) AND anti-PR3 | Wegener's |
| hansel stain (eosinophilia) | acute interstitial nephritis |
| sterile pyuria and HTN | chronic interstitial nephritis |
| brown muddy casts | acute tubular necrosis |
| tubulointerstitial disease associated with fanconi's syndrome | renal tubular acidosis (type II) |
| acquired fanconi's syndrome | multiple myeloma |
| tamm-horsfall mucoprotein | cast nephropathy assoc. with multiple myeloma |
| congo red stain with beta pleats | amyloid assoc. with multiple myeloma |
| Benz-jones proteins | multiple myeloma |
| onion skin lesions (hyperplastic arteriolitis) | malignant HTN |
| fibrotic intimal thickening (luminal narrowing) | HTN nephrosclerosis (benign) |
| high levels of renin in elevated renal vein | renal artery stenosis |
| string of beads on angiogram | fibromuscular dysplasia |
| schistocyes in peripheral blood smear | microangiopathic thrombotic disease (also seen in pentad of symptoms with TTP) |
| classic presentation: pentad-- fever, neurologic symptoms, microangio hem. anemia, thrombocytopenia, ARF | TTP |
| ADAMTS13 and vWF | TTP |
| WAGR syndrome + WT1/WT2 mutations | nephroblastoma (wilm's) |
| most common renal tumor of infancy | congential mesoblastic nephroma |
| most common renal tubular epithelium neoplasm | renal papillary adenoma |
| mahogany brown; stellate central scar | renal oncocytomas |
| LM: mix of adipose, smooth muscle, blood vessels | angiomyolipoma (duh look at the word.. angio-- vessel, myo-- muscle, lipo--fat) |
| VHL gene mutation leading to high levels of VEGF | RCC (more specfically in clear cell) mutation occurs in over 90%!!! |
| triad of sym: flank pain, palpable mass, hematuria | RCC |
| most common RCC | clear cell- conventional |
| C-met gene | Papillary RCC (also assoc. with RF/ "dialysis kidney") |
| renal tumor assoc. with sickle cell (african am and mediterranean) | renal medullary carcinoma very rare, very aggressive |
| urothelial invasion of the bladder | collecting duct carcinoma (worst prognosis of typical RCC subtypes) |
| known to invade the renal vein and IVC | RCC |
| dilation of renal pelvis and calyces & atrophy | obstructive uropathy |
| neoplasm associated with urachal cysts | adenocarcinoma |
| soft tan broad mucosal plaques | malacoplakia |
| foamy macrophage, multinucleated cells with granular PAS positive | malacoplakia (note: amyloid is PAS negative) |
| michaelis gutmann bodies | malacoplakia |
| developmental anomoly associated with Trisomy 18 | horseshoe kidney |
| oligohydraminos and Potter's sequence (fatal condition) | bilateral renal agenesis **TOL said to know** (potters- flat nose, low set ears, recessed chin) |
| cobblestone gross appearance kidney | ADPKD |
| development path associated with berry aneurysms | ADPKD |
| develpment path associated with hepatic fibrosis | ARPKD |
| clinical triad: abnormal abdominal musculature, UT anomalies, bilateral cryptorchidism | prune belly syndrome |
| cobra head appearance on IVU | ureterocele |
| hallmark of costovertebral angle tenderness | ureteral calcuil |
| WBC casts in UA | pyelonephritis |
| Balanitis is commonly associated with? | Phimosis |
| hallmark of perineal discomfort and fever | bacterial prostatitis |
| bladder pain relieved by voiding | interstitial cystitis |
| glomerulations-- submucosal hemorrhage | interstitial cystitis |
| christmass tree bladder | bladder diverticuli (neurogenic) |
| tender, enlarged epididymis AND assoc with arthritis | epididymitis |
| clinical triad: mass, hematuria, pain | RCC (kidney) |
| requires Lasix for Dx | UPJ obstruction |
| one exception of nephrotic diseases in which renal biopsy is NOT indicated | MCD in children |
| No finding on LM and IF; podocyte effacement on EM | Minimal change disease note: FSGS may also show similar findings if focal segment is missed on biopsy (IF will also show collapse of capillaries and increase in ECM) |
| the only nephrotic with immune complex deposits | membranous glomerulopathy (this is a repeat but was mentioned with both thomas and leonard) |
| LM: thick capillary walls with silver stain spikes IF: granular stainging EM: subepithelial immune deposits* | membranous glomerulopathy (remember only nephrotic with immune complexes) |
| FSGS must be DDx with? | MCD |
| leading cause of ESRD; often presents with small vessel disease and microalbumin | Diabetic GS |
| LM: thickening of BM region AND proliferation/expansion of mesangium | Diabetic GS (DDx with FSGS- this occurs only in the glomerular capillary) |
| hallmark of back pain with lytic lesions on xray | multiple myeloma (associated with Amyloid nephropathy) |
| congo red stain and apple green bifringement with polarized light | amyloid nephropathy (remember it is PAS negative! unlike Diabetic GS) |
| LM: proliferative GN IF: "lumpy-bumpy" deposits EM: subepithelial "humps" | Acute post infectious GN |
| EM: immune complex deposits subendothelium and mesangial hypercellularity | Type I MPGN |
| "tram tracking" of GBM on silverstain | Type I MPGN |
| deposit of complement and ribbon like increase in GBM density | Type II MPGN |
| associated with C3 nephritic factor (IgG autoAb) | Type II MPGN |
| common presentation in female african americans with SLE | Lupus nephritis (think malar rash with nephritic symptoms) |
| Morphologic: thick capillary loops--"wire loops" | Lupus nephritis |
| ANA (+) with anti-dsDNA antibodies | Lupus nephritis Dx |
| associated with autoantibody against IV collagen | anti-GBM GN |
| IF: smooth diffuse "linear" IgG staining | Anti-GBM GN (as opposed to "lumpy" with acute post infectious and "granular" with membranous glomerulopathy) |
| prominent hyaline sclerosis in renal arterioles | diabetic GS (FSGS also shows sclerotic changes but only in the GC not the arterioles) |
| most common cause of nephrotic syndrome in kiddos | minimal change disease |
| most common cause of nephrotic syndrome in US caucasian/asian adults? african american? | membranous glomerulopathy; FSGS |
| glomerular disease with favorable prognosis with corticosteroid Tx | Minimal change disease |
| classic triphasic histopath of nephroblasomta | blastema (primitive tubules), epthielium (abortive tubules), stroma (spindle cells) |
| three syndromes assoc with nephroblasomta | beckwith-Wiedeman, *WAGR syndrome*, denys drash WAGR- genital anomaly retardation |
| tumor characterized by spindled cells resembling immature tissue; metastases rare | congential mesoblastic nephroma (Ddx: wilms tumor-- commonly metastases to lung) |
| most common renal tubular epithelium neoplasm | renal papillary adenoma |
| renal papillary adenoma commonly associated with what? | acquired cystic renal disease |
| rank in order of worst prognosis to best clear cell RCC, Papillary RCC, Chomophobe RCC, collecting duct RCC | collecting duct (worst)-->clear cell--> papillary-->Chomophobe (Best) |
| carcinoma associated with "carcinogenic field effect" and presence of mulifocal neoplasms | renal urothelial carcinomas |
| commonly associated with hepatic fibrosis and portal hypertension | ARPKD |
| primary genetic abnormality PKD1 or PKD2; what do these encode? | ADPKD; encode polycystin |
| primary genetic abnormality PKHD1; what does this encode? | ARPKD; encodes fibrocystin (think ARPKD-- hepatic FIBROSIS (hard liver=H in PK*H*D1) |
| acquired condition which may be hemorrhagic and confused with cystic RCC** | simple renal cyst*** must do microscopic evaluation to Dx -- will see thin walled uniloculated in simple renal cysts |
| degenerative kidney, bumpy shrunken gross appearance leading to ESRD and dialysis | acquired renal cystic disease |
| Abx induced acute interstitial nephritis clinical triad: | fever, rash, eosinophilia |
| high urine glucose and normal serum glucose | chronic interstitial nephritis |
| characterized by clinical presentation of acidosis and hyperkalemia from prolonged hypotension (septic shock) | acute tubular necrosis (think brown muddy casts) |
| renal tubular acidosis with hyperkalemia, hyperchloremic met. acidosis | type 4 - high serum K (distal) |
| renal tubular acidosis with hypokalemia and acidosis | type 1- low serum k often presents in kids as failure to thrive and renal stones |
| low back pain, male age>50, african american hepatosplenomegaly, cardiomyopathy | multiple myeloma |
| most common cause of Multiple myeloma | cast nephropathy (*tamm-horsfall mucoprotein) |
| DDX between RTA and Multiple myeloma | Anion gap RTA (normal AG) Multiple myeloma (low AG) |
| which disease is assoc with acquired fanconis ? which is caused by fancois synd? | acquired-- multiple myeloma caused by fanconis syndrome-- type II renal tubular acidosis (also pharm plug-- tetracyclines that have expired are linked with acquired fanconis) |
| potassium disorder; hypertensive, low renin, low aldosterone | Liddles-- hypokalemic |
| K disorder; normotensive, HIGH urine Ca | Bartters-- hypokalmeic |
| K disorder; normotensive, NORMAL urine Ca and low serum Mg | Gitelmans-- hypokalemic |
| K disorder; HTN, low renin activity hyperK withOUT renal failure | Gordans (pseduohyopaldosteronism) aldosterone resistant-- impaired renal excretion |
| EKG: ST depression, decreased amplitude, U WAVE* | hypokalemia |
| EKG: Tinted T waves, no P wave, wide QRS | hyperkalemia |
| if urine Osm > serum Osm Dx likely? | SIADH |
| what is the lethal dose of ASA? | 500 mg/dl |
| toxic dose of ASA? | 150 mg/kg or >40 mg/dL |
| 3 Tx options of ASA OD | charcoal, sodium bicarb, hemodiaylsis (if neurologic symptoms) |
| acid base disturbances seen with ASA OD | resp alkalosis and metabolic acidosis (SEPERATE and INDEPENDENT) |
| SSRIs (sertraline, fluoxitine, citalopram) lead to what common disorder in older people? | hyponatremia |
| most common cause of staghorn calculi | UPJ obstruction |
Created by:
caldwekl
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