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Renal Disorders

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Genitourinary / Renal System | Nurse Practitioner (NP) School Study Aid

Renal Disorders
41 Picmonics to Learn | 1 hr 35 mins
Nephritic Syndrome
Inflammatory
Hematuria
RBC casts
Increased Nitrogen in blood
Oliguria
Hypertension
Proteinuria < 3.5 grams per day
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2 mins
Nephrotic Syndrome
Signs and Symptoms
Massive Proteinuria > 3.5g per Day
Edema
Increased risk of infection
Thromboembolism
Hyperlipidemia
Fatty casts
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1 min
Post Streptococcal Glomerulonephritis
Pathophysiology
Nephritic
Children
Signs and Symptoms
Edema
Cola Colored Urine
Follows Group A Streptococcal pharyngitis or Skin Infection
Diagnosis
Neutrophils
Immunofluorescence (IF) Granular
Lumpy Bumpy Appearance on Immunofluorescence (IF)
Subepithelial Immune Complex Humps
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2 mins
Membranous Glomerulonephritis
Characteristics
Nephrotic
Diagnosis
LM Thickening of Capillary and Glomerular Basement Membrane (GBM)
EM Spike and Dome Appearance with Subepithelial Deposits
IF Granular
Primary
Phospholipase A2 Receptor Autoantibodies
Secondary
NSAIDS
Gold
Solid Tumors
Hepatitis B Virus (HBV)
Lupus
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3 mins
Membranoproliferative Glomerulonephritis
Nephritic-Nephrotic Syndrome
Type I
Subendothelial Immune Complexes
Hepatitis C Virus
Granular IF
Tram Tracks Caused by Splitting of the GBM
Ingrowth of Mesangium
Type II
Dense Deposit Disease
C3 Nephritic Factor
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2 mins
Rapidly Progressive Glomerulonephritis
Pathogenesis
Nephritic Syndrome
Crescent Shape
Crescents Consist of Fibrin and C3b
With Parietal Cells, Monocytes, and Macrophages
IMMUNOFLUORESCENCE
Linear Immunofluorescence
Negative Immunofluorescence
Granular Immunofluorescence
Etiology
Goodpasture Syndrome
Granulomatosis with Polyangiitis (Formerly Wegener's)
Microscopic Polyangiitis
Prognosis
Poor Prognosis
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3 mins
Focal Segmental Glomerulosclerosis
Most Common Cause of Nephrotic Syndrome in Hispanic People and African Americans
Associated with Sickle Cell Disease and HIV
Associated Interferon Therapy and Heroin Abuse
Histopathology
LM Segmental Sclerosis and Hyalinosis
EM Focal Damage of Visceral Epithelial Cells
IF Negative
Signs & Symptoms
Microscopic Hematuria
Nonselective Proteinuria
Considerations
Poor Prognosis
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2 mins
Pyelonephritis Assessment
Cause/Mechanism
Ascending Urethral Bacteria
Assessment
Dysuria
Fever
Fatigue
Flank Pain
Costovertebral Tenderness
Nausea and Vomiting
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1 min
Pyelonephritis Interventions
Urinalysis
NSAIDs
Antibiotics
Increase Fluid Intake
Avoid Catheterization
Consideration
Urosepsis
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1 min
Kidney Transplant
Indications
End Stage Renal Disease (ESRD)
Considerations
Selective Candidacy
Close Compatibility
Immunosuppressants
Monitor for Rejection
Monitor for Infection
Monitor Urine Output
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2 mins
Wilms' Tumor (Nephroblastoma)
Cause
Malignant Renal Tumor
Assessment
Abdominal Mass
Hematuria
Fever
Hypertension
Interventions
Nephrectomy
Chemotherapy
Radiation
Considerations
Do Not Palpate Abdomen
Children Under 5 Years Old
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2 mins
Indications for Urgent Dialysis (AEIOU)
Signs and Symptoms
AEIOU Mnemonic
Acidosis
pH < 7.1
Electrolyte Imbalances
Symptomatic Hyperkalemia
> 6.5 mEq/L
Ingestion
Overload (Volume)
Uremia
Encephalitis
Pericarditis
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2 mins
Casts in Urine (Differential Diagnosis)
Characteristics
RBC Casts
Glomerular Disease
WBC Casts
Acute Interstitial Nephritis
Acute Pyelonephritis
Fatty Casts
Maltese Cross Sign
Nephrotic Syndrome
Granular Muddy Brown Casts
Acute Tubular Necrosis (ATN)
Waxy Casts
End Stage Renal Disease (ESRD) (Chronic Renal Failure)
Hyaline Casts
Non-Specific
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2 mins
Fanconi Syndrome Characteristics
Pathophysiology
Resorption Defect in Proximal Tubule
Signs and Symptoms
Hypophosphatemia
Rickets
Osteomalacia
Hypokalemia
Metabolic Acidosis
Type 2 Renal Tubular Acidosis
Treatment
Treat Underlying Disorder
Bicarbonate
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1 min
Fanconi Syndrome Causes
Hereditary Causes
Cystinosis
Dent's Disease
Wilson's Disease
Oculocerebrorenal (Lowe) Syndrome
Galactosemia
Hereditary Fructose Intolerance
Glycogen Storage Diseases
Tyrosinemia
Acquired and Medication Causes
Tenofovir
Heavy Metals
Expired Tetracyclines
Cisplatin
Gentamycin (Aminoglycosides)
Valproate Sodium
Multiple Myeloma
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2 mins
Minimal Change Disease
Pathophysiology
Nephrotic
Most Common in Children
May be Triggered by Recent Infection or Immune Stimulus
Diagnosis
On Electron Microscopy (EM) See Foot Process (Podocyte) Effacement
On Light Microscopy (LM) See Normal Glomeruli
Loss of Negative Charge
Selective Loss of Albumin
Treatment
Responds to Corticosteroids
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2 mins
Berger's Disease (IgA Nephropathy)
Nephritic
IgA Nephropathy
Immune Complex Deposit in Mesangium
Increased Synthesis of IgA
Most Common Cause of Nephritic Syndrome
Overlapping Features with Henoch–Schönlein Purpura
Presents with Pharyngitis, URI or Acute Gastroenteritis
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1 min
Alport Syndrome
Pathophysiology
Nephritic
X-linked
Mutation in Type IV Collagen
Diagnosis
Split Basement Membrane
Basket Weave Appearance
Signs and Symptoms
Ocular Disorders
Deafness
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2 mins
Amyloidosis
Etiologies
Primary
Multiple Myeloma
Secondary
Tuberculosis (TB)
Rheumatoid Arthritis
Pathology
Congo Red Stain
Apple Green Birefringence
Complications
Nephrotic Syndrome
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2 mins
Respiratory Acidosis
Hypoventilation
Increased PaCO2 > 45
Barbiturates Depress Central Respiratory Center of Brain
Opioids Depress Central Respiratory Center of the Brain
Airway Obstruction
Respiratory Muscle Weakness/Paralysis
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3 mins
Respiratory Alkalosis
Hyperventilation
High Altitude
Aspirin
Restrictive Lung Disease
Pulmonary Embolism
Pregnancy
Progesterone
Rib Fracture
Anxiety
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2 mins
Normal Gap Metabolic Acidosis
HARD-ASS
Hyperalimentation
Addison's Disease
Renal Tubular Acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline Infusion
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2 mins
Anion Gap Metabolic Acidosis
Pathophysiology
Increased Anion Gap
MUDPILES
Methanol
Uremia
Diabetic Ketoacidosis (DKA)
Propylene Glycol
Isoniazid or Iron
Lactic Acid
Ethylene Glycol
Salicylates
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1 min
Metabolic Alkalosis
Diuretic use
Vomiting
Antacid
Hyperaldosteronism
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26 secs
Transitional Cell Carcinoma
Most Common Cause Of Lower Urinary Tract Cancer
Risk factors
Cyclophosphamide
P-SAC
Cigarette Smoke
Azo Dyes, Alcohol, Anilines (Dyes, Rubber)
Older Adult
Signs and Symptoms
Painless Hematuria
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3 mins
Distal Renal Tubular Acidosis (Type I)
Pathophysiology
Distal Tube
Defect in H+ Secretion
Labs
Increased Urinary pH
Urinary pH >5.5
Hypokalemia
Causes
Amphotericin B Toxicity
Autoimmune Disease
Lithium
Obstruction Of The Urinary Tract
Complication
Kidney Stones
Treatment
Bicarbonate
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3 mins
Syndrome Of Apparent Mineralocorticoid Excess (SAME)
Pathophysiology
11 Beta-Hydroxysteroid Dehydrogenase Deficiency
Elevated Cortisol
Low Renin
Low Aldosterone
Causes
Autosomal-Recessive
Licorice (glycyrrhetinic acid) Ingestion
Signs & Symptoms
Hypertension
Hypokalemia
Metabolic Alkalosis
Treatment
Potassium-Sparing Diuretics
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4 mins
Gitelman Syndrome
Pathophysiology
Autosomal Recessive
Defective Sodium-Chloride Cotransporter in Distal Tubule
Mechanism Mimics Thiazide Diuretics
Clinical Presentation
Cramping and Tetany
Severe Fatigue
Polyuria
Diagnosis
Hypokalemia
Metabolic Alkalosis
High Urine Chloride
Treatment
Electrolyte Supplements
Spironolactone
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4 mins
Type 2 Renal Tubular Acidosis
Proximal Tubule
Pathophysiology
Inability To Reabsorb Bicarbonate
ETIOLOGY
Fanconi Syndrome
Sporadic Type
Familial Types
Autosomal Recessive
Acetazolamide
Characteristics
Decreased Urinary pH
Hypokalemia
Treatments
Treat Underlying Disorder
Alkali Therapy
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4 mins
Renal Tubular Acidosis Type 4
Characteristics
Aldosterone Resistance
Decreased Aldosterone Production
Causes Of Hypoaldosteronism
Addison’s Disease (Primary Adrenal Insufficiency)
Hyporeninism
Causes Of Aldosterone Resistance
Trimethoprim-Sulfamethoxazole
Potassium Sparing Diuretics
Labs
Hyperkalemia
Low Urine pH
Diminished Ammonium (NH4) Urinary Excretion
Treatment
Furosemide
Fludrocortisone
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5 mins
Diffuse Proliferative Glomerulonephritis (DPGN)
Nephritic and Nephrotic Syndrome
Associations
Systemic Lupus Erythematosus (SLE)
IgA Nephropathy
Characteristics
Wire Looping
IF Granular
Subendothelial Immune Complexes
Subepithelial Immune Complexes
C3 Deposition
Treatment
Treat Underlying Disorder
Steroids
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2 mins
Squamous Cell Carcinoma of the Bladder Clinical Features
Risk Factors
Smoking
Chronic Cystitis
Schistosoma
Chronic Nephrolithiasis
Clinical Findings
Painless Hematuria
Urinary Frequency and Urgency
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1 min
Potter Sequence
PATHOGENESIS
Oligohydramnios
clinical findings
Limb Deformities
Facial Anomalies
Pulmonary Hypoplasia (Most Common Cause of Death)
Etiologies
Autosomal Recessive Polycystic Kidney Disease (ARPKD)
Posterior Urethral Valves
Chronic Placental Insufficiency
Bilateral Renal Agenesis
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3 mins
Liddle Syndrome
Pathophysiology
Autosomal Dominant
Collecting Duct
Gain of Function Mutation in Epithelial Sodium Channel (ENaC)
Excess Na+ and H2O Reabsorption
Clinical Features
Decreased Renin
Decreased Aldosterone
Hypertension with Hypokalemia
Metabolic Alkalosis
Pseudohyperaldosteronism
Treatment
Amiloride and Triamterene
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3 mins
Squamous Cell Carcinoma of the Bladder Diagnosis and Management
Diagnosis
Urinalysis
CT Urography
Cystoscopy with Biopsy
Management
Surgery
Radiation
Chemotherapy
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2 mins
Bartter Syndrome
Pathophysiology
Autosomal Recessive
Thick Ascending Limb of Loop of Henle
Defective NKCC Cotransporter
Decreased Na+ Reabsorption
Decreased Ca2+ Reabsorption
Increased Aldosterone
Clinical Features
Hypovolemia
Polyuria and Polydipsia
Metabolic Alkalosis
Mimics Loop Diuretics
Nephrolithiasis
Treatment
Spironolactone (Aldactone)
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4 mins
Autosomal Dominant Polycystic Kidney Disease
Characteristics
Autosomal Dominant
Mutations in PKD1/2
Cystic Enlargement of Renal Tubules
Clinical Features
Chronic Kidney Disease
Hypertension
Mitral Valve Prolapse
Hepatic Cysts
Berry (Saccular) Aneurysms
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3 mins
Renal Oncocytoma
Characteristics
Benign Epithelial Tumor
Central Radial Scar
Excessive Mitochondria
Renal Cortex
Clinical Features
Hematuria
Flank Pain
Abdominal Mass
Considerations
Malignant Transformation
Surgical Resection
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2 mins
Nephrolithiasis Diagnosis and Management
Diagnosis
Urinalysis with Culture
Noncontrast CT
Ultrasound
Management
< 10 mm
Supportive Care
10-20 mm
Extracorporeal Shock Wave Lithotripsy
Ureteroscopy
> 20 mm
Surgery
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2 mins
Nephrolithiasis Stone Types (Part 1/2)
Calcium Oxalate
Calcium Oxalate
Inflammatory Bowel Disease
Ethylene Glycol
Vitamin C
"Dumbbell", Bipyramidal, or Octahedral-shaped
Radiopaque
Uric Acid
Uric Acid
Gout
Tumor Lysis Syndrome
Rhomboidal, Rosette, or Needle-shaped
Radiolucent
Decreased Urine pH
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2 mins
Nephrolithiasis Stone Types (Part 2/2)
Struvite
Struvite (Ammonium Magnesium Phosphate)
Urinary Tract Infections
"Coffin Lid" Appearance
Radiopaque
Increased Urine pH
Calcium Phosphate
Calcium Phosphate
Hypercalcemia
Wedge-shaped Prisms
Radiopaque
Increased Urine pH
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2 mins

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