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Renal 10 Acute/sub R

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Created by: bcriss

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Question	Answer
Nephrotic Syndrome	Non-inflammatory Damage to the basement membrane Increased permeability Proteinuria >3.5 g/d
Increased premeability leads to...	↓ albumin ↓ oncotic pressure ↓ effective circulating volume Loss of Antithrombin III
Nephritic Syndrome	Inflammatory Immune-mediated damage Infiltrates of neutrophils and phagocytes -Crescentic lesions -Rupture of GBM
Clinical and lab findings with nephritic syndrome	Hematuria Oliguria HTN RBC casts Proteinuria <3.5g/d
Glomerular diseases: Symptoms	Edema Weight gain Malaise Oliguria Hematuria Worsening HTN
Glomerular diseases: Past Medical Hx	HTN DM Hep B/C HIV Hyperlipidemia DVT/PE
Glomerular diseases: Family Hx	Kidney disease DM Autoimmune Dz
Glomerular diseases: Physical exam	Edema, JVD, crackles HTN Conjunctival pallor Signs of autoimmune dz Xanthomas
General labs/workup	Rule out pre/post-renal Urine protein/Cr ratio UA specifically for casts Cholesterol panel Albumin
What tests are used to help rule out pre/post-renal ARF?	Bladder scan UA Specific gravity FeNa Uosm
Nephrotic syndrome findings	Proteinuria >3.5 Serum albumin <3.5 Cholesterol >300 mg/dL Oval fat bodies on UA
Nephrotic syndrome findings (cont.)	↓Ca due to ↓albumin Anemia due to loss of transferrin and erythropoietin Hypercoaguability due to loss of Antithrombin III
Nephrotic Syndrome Tx	Statins ACEI/ARBs Fluid and salt retention
Nephrotic Syndrome BUZZWORDS	Proteinuria Hypoabluminemia Edema Hyperlipidemia
Nephrotic syndromes	Minimal change disease Focal segmental GS Membranous GN Diabetic GS Amyloid
Minimal Change Disease	Most common type in kids 90% of nephrotic cases <10 Sudden onset Usually idiopathic
Minimal Change Disease: Association and Damage	A: Medications Lymphomas D: effacement of podocytes
Why do you get the nephrotic proteinuria with MCD?	Uniform thinning of GBM Subepithelial accumulation of immune complexes Disrupted filtration slits
Minimal Change Disease Clinical and Dx	Edema Proteinuria (up to 9g/d) Dx: biopsy shows effacement of podocytes
Minimal Change Disease Tx and prognosis	Tx: High dose steroids for 8 weeks Prognosis: Very good, few progress to ESRD
Focal Segmental Glomerulosclerosis (FSGS)	#1 cause of nephrotic syndrome in African Americans ~30% of adult nephrotic
FSGS Mechanism	HTN causes hyperfiltration Accumulation of ECM Leads to scarring and tamponade Epithelial cells damaged
FSGS Associations	*HIV* IV heroin Urethral reflux Massive obstruction Chronic pyelonephritis Interstitial kidney dz
FSGS Clinical	Usually asymptomatic Microscopic hematuria initially
FSGS Tx and prognosis	Tx High dose steroids Treat underlying cause Prognosis 50% → ESRD in 5 yrs
Membranous Glomerulonephropathy	From antibody/antigen deposition Up to 1/3 adult nephrotic 2:1 M:F Typical age 30-50
Membranous Glomerulonephropathy Mechanism	Damage to mesangial matrix Immune cells can't cross GBM so it's non-inflammatory
Membranous Glomerulonephropathy Causes	Usually idiopathic Malignancies -Breast, colon, stomach, kidney, lung Hepatitis B/C Syphilis, DM, SLE
Membranous Glomerulonephropathy Workup and Tx	Exclude SLE, RA Hepatitis serologies age appropriate cancer screenings Tx: Steroids and cytotoxic agents
Diabetic Glomerulosclerosis Developes within...	5-10yrs in DM II 10-20yrs in DM I ~50% diabetics
Diabetic Glomerulosclerosis Increased prevalence in...	Smokers Non-whites Pts with poor glycemic and BP control
Diabetic Glomerulosclerosis Dx	Urine microslbumin test -microalb/Cr >30 Nodular sclerosis on biopsy Kimmelstiel-Wilson nodules
Diabetic Glomerulosclerosis Tx	Glycemic control BP control with ACEI/ARBs Intensive cholesterol control (LDL<100)
Nephritic disease	Inflammatory responce Immune mediated damage Crescentric lesions Plug up Bowman's Capsule Necrosis/thinning of GBM Rupture of GBM
Nephritic disease Clinical	*********** Hematuria Oliguria * HTN * ***********
Nephritic disease Labs	UA: Hematuria RBC casts Protein <3.5g/d
Nephritic Diseases	IgA Nephropathy Henoch Schonlein Purpura Post-infectious GN Membranoproliferative GN Anti-GBM/Goodpasture's Syndrome
What immunoglobulin plays a critical role in mucosal immunity?	IgA
IgA Nephropathy	#1 cause of GN worldwide 2-3 days post infection
Causes of IgA nephropathy	URT and GI infxn Causes defective mucosal immunity Overproduction and increased serum IgA
How does a pt with IgA nephropathy present?	1. Macroscopic or gross hematuria 2. Microscopic hematuria 3. High BP or kidney failure
IgA nephropathy Clinical findings, Dx and Tx	Macroscopic hematuria 40% have asymptomatic microscopic hematuria Normal complement (C3&4) Tx ACEI/ARBs, steroids
Henoch-Schonlein Purpura	Disease of kids Follows URI IgA in: -skin, GI tract, kidney, joints
Henoch-Schonlein Purpura Clinical findings and Tx	Lower extremity bruising Bloody diarrhea Hematuria/HTN Arthalgias Tx: supportive
Post-Infectious GN	Subendothelial antigen deposition 2-3 weeks post infxn Low C3 and C4
How is streptococcal pharyngitis diagnosed?	Rapid strep test ASO titer
Post-Infectious GN Dx and Tx	Dx: Hx, ASO titer, anti-DNAase B Tx: none, self-resolving
Membranoproliferative GN	Idiopathic cases uncommon Usually secondary to other dz
Membranoproliferative GN Associated with	Sjogren's Syndrome SLE Hep B/C WITH cryoglobulinemia Infective endocarditis
Membranoproliferative GN Labs and Tx	UA with dysmorphic RBCs, RBC casts, low C3 and normal C4 Treat underlying cause, steroids, antiplatelets
Anti-GB/Goodpasture's Syndrome	10-20% of cases of rapidly progressive GN Can be ANCA+ Antibodies to type IV collagen
Anti-GB/Goodpasture's Syndrome Clinical	Rapid onset of HTN Oliguria Fatal if not treated promptly
Anti-GB/Goodpasture's Syndrome Kidney and lung involvement	Kidney only More common in older women (Anti-GBM) Kidney/lung More common in young men (Goodpasture's syndrome)
Goodpasture's Syndrome	70% will have alveolar hemorrhage (hemoptosis)
Anti-GB/Goodpasture's Syndrome Dx and Tx	Dx Anti-GBM antibodies, biopsy Tx Cyclophosphamide+steroids Plasmapheresis if pulmonary hemorrhage
Anti-GB/Goodpasture's Syndrome Prognosis depends on...	Promptness of Dx and Tx Degree of kidney involvement
Small Vessel Vasculitis	Wegener's Granulomatosis -Lung, kidney, sinus Microscopic Polyangiitis
Small Vessel Vasculitis Clinical	Decreased appetite Weight loss Hematuria/proteinuria Polymyalgia
Small Vessel Vasculitis Dx and Tx	c-ANCA+ anti-PR3- Wegener's anti-MPO- Microscopic Cyclophosphamide+steroids Plasmapheresis for Wegener's
Nephrotic/Nephritic Lupus Nephritis	WHO classifications III focal nephritis IV diffuse nephritis V Membrane formation VI >90% of glomeruli sclerotic
Nephrotic/Nephritic Lupus Nephritis Clinical and Dx	Acute onset of hematuria Proteinuria Edema Pancytopenia Dx: anti-Sm, anti-Ds DNA
Nephrotic/Nephritic Lupus Nephritis Tx and prognosis	>Class III Cyclophosphamide+/-steroids Prognosis depends on Kidney fxn Histologic type Crescents