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Most common cause of acute renal failure
Acute Kidney Injury
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4 Causes of Acute Kidney Injury
- Ischemia
- Direct toxic injury to tubules
- Acute tubulointerstitial nephritis
- Urinary obstrucion
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AKI: Clinical recovery
Hypokalemia, increased urine output, increased vulnerability to infxn
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Increased urine volumes often seen w/ nephrotoxins
Non-oliguric acute kidney injury
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3 causes of Acute Pyelonephritis
- Acute suppurative inflammation (normally bacterial)
- Hematogenous induced by septicemia
- Ascending Infxn
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3 Complications of Acute Pyelonephritis
- Papillary Necrosis
- Pyonephrosis
- Perinephric abscess
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Vesicoureteral reflux: Acute or chronic pyelonephritis
Acute
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Pain at CVA
Pyuria (neutrophils in urine)
WBC casts in urine (confirm renal involvement)
Acute Pyelonephritis
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Acute Pyelonephritis produces
- Fibrosis
- Cortical scarring
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Chronic Pyelonephritis: Scarring in
calyces, renal pelvis
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2 Major forms of Chronic Pyelonephritis
- Reflux nephropathy
- Chronic Obstructive Pyelonephritis
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Do tubulointerstitial diseases involve the pelvocalyceal system?
No
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Most common form of pyelonephritic scarring
Reflux Nephropathy
*Typically begins in childhood due to UTI and coexisting vesicoureteral reflux (unilateral OR bilateral)
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Leads to recurrent infxns an parenchymal atrophy
Chronic Obstruct Pyelonephritis
*Can be bilateral as w/ posterior urethral valves
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Dilated calyces most prominent at Upper and lower poles
- Chronic pylonephritis
- Reflux nephropathy
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Renal Papillary Necrosis associated w/
- Analgesic abuse (phenacetin)
- DM
- Sickle cell anemia
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Renal papillary necrosis is due to relative ischemia of the
Renal Medulla
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Complications of Renal Papillary Necrosis
- Ureteral obstruction
- Transitional Cell Carcinoma
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Obstructive uropathy that predisposes to stones
Bilateral, partial
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Urolithiasis: Most common
Calcium oxalate and phosphate
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Urolithiasis: Associated w/ urea-splitting bacteria like Proteus
Struvite
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Symptoms of ADPKD
- Bilateral enlargment of kidneys
- Innumerable cysts
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ADPKD associated w/
- cerebral berry aneurysms
- mitral valve prolapse
- Cysts in liver, spleen, pancreas, or lungs
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ARPKD: Children who survive infancy usually have
- Hepatic cysts associated w/ bile duct proliferation
- Progressive fibrosis (congenital hepatic fibrosis)
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Symptoms of ARPKD
- Symmetrically enlarged kidneys w/ smooth surfaces
- Numerous slit-like cysts replace the cortex and medulla
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ARPKD mutation
PKHD1 gene
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Incidental finding in adults
Small cysts (< 5 cm) found in collecting ducts of the renal papillae
Medullary sponge kidney
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Medullary Sponge Kidney has a normal
renal cortex
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Cysts of Medullary Sponge Kidney may
contribute to the development of kidney stones or pyelonephritis
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Cysts in the medulla (usually at the corticomedullary junction)
- Nephronopthisis
- Adult-Onset Medullary Cystic Disease
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Cause of renal insufficiency in N and AOMCD
Cortical tubulointerstitial damage
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3 types of Nephronophthisis
- Sporadic, non-familial
- Familial juvenile nephronophthisis (most common)
- Renal-retinal dysplasia
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Inheritance:
Familal Nephronopthisis?
AOMCKD?
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Sporadic disorder characterized by presence in the kidney of abnormal structures
Multicystic Renal Dysplasia
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Prolonged dialysis presents with cortical and medullary cysts (0.5- 2 cm)
Acquired (Dialysis-Associated) Cystic Disease
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Cysts of Acquired Cystic Disease
Clear fluid often containing calcium oxalate crystals
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Acquired Cystic Disease results in an increased risk for
- Renal Cortical Adenomas
- Renal Cell Carcinoma
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Sporadic findings in renal cortex of asymptomatic individuals
Single or multiple, bulge from surface
1-5 cm in diameter
Simple renal cysts
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Less than 0.5 cm in diameter
Tan-grey, well-circumscribed cortical nodule
Renal Papillary Adenoma
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Prognostic factor of renal papillary adneoma
Size
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Variegated yellow mass w/ areas of hemorrhage and cystic degeneration
Renal Cell Carcinoma
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Renal Cell Carcinoma grading is based on
Nuclear Atypia
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Renal Cell Carcinoma mutation
Von Hippel-Lindau (VHL)
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3 Classic Diagnostic features of RCC
- CVA pain
- Palpable mass
- Hematuria
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RCC is associated w/
paraneoplastic syndromes
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RCC metastasizes before or after it causes symptoms?
before
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Most common type of Renal Cell Carcinoma
Clear Cell Type
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Inheritance of RCC: Clear Cell Type
Sporadic, associated with loss of sequences on short arm of chromosome 3 (involves the VHL gene area)
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Chromophil RCC
RCC: Papillary RCC
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Foam cells in the papillary cores (papillary growth pattern)
RCC: Papillary RCC
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Trisomies associated w/ Papillary RCC
Trisomies 7, 16, 17; loss of Y in male pts.
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Gene for familial form mapped to a locus on chromosome 7 for the MET proto-oncogene.
Papillary RCC
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Prominent cell membranes, pale eosinophilic cytoplasm, peri-nuclear halo
RCC: Chromophobe RCC
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Bellini duct
Collecting duct cells in the medulla
Hobnail pattern
RCC: Collecting Duct Carcinoma
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Epithelial Tumor composed of large eosinophilic cells w/ small nuclei containing nucleoli
Oncocytoma
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Oncocytoma gross appearance
Tan to mahogany brown, centra scar
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Cells contain abundant mitochondria
Oncocytoma
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Benign tumor consisting of vessels, smooth muscle, and fat
Angiomyolipoma
*Prone to spontaneous hemorrhage
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Chronic Kidney Disease stages
- I: GFR < 90
- II: GFR 89-60
- III: GFR: 59-30
- IV: GFR 29-15
- V: GFR < 15
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Blood presure is stable for long periods of time
Benign HTN
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Alterations associated w/ benign HTN - hyalinzes arterioles, intimal hyperplasia, sclerotic glomeruli
Benign nephrosclerosis
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Diastolic >120
Malignant HTN
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Malignant Nephrosclerosis
Onion skinning of arteries and fibrinoid necrosis of arterioles and glomeruli
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Renin Levels:
Benign HTN?
Malignant HTN?
- B- low or normal plasma renin levels
- M- high renin
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Flea bitten kidney
Malignant HTN
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High renovascular levels cause HTN by
- Vasoconstriction
- Aldosterone-mediated salt retention
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Renovascular HTN
- Elevated plasma renin levels
- Renal artery narrowing
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Most common cause of renovascular HTN
Atherosclerosis (disease of aging)
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Fibrous or fibromuscular thickening that occurs primarily in the media of the artery; common in women; bilateral
Fibromuscular Dysplasia
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