Janani Shared "Z Renal" - 43 Picmonics

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Z Renal

Oligohydramnios
Decreased Amniotic Fluid
Etiologies
Renal Agenesis (Fetal Urinary Tract Abnormalities)
Uteroplacental Insufficiency
Premature Rupture of Membranes (PROM)
Diagnosis
Ultrasound
Amniotic Fluid Index (AFI) < 5 cm
Complications
Spontaneous Abortion
Pulmonary Hypoplasia
Musculoskeletal Abnormalities
Intrauterine Growth Restriction (IUGR)
Treatment
Treat Underlying Cause
Delivery (When Viable)
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2 mins
Polyhydramnios
Pathophysiology
Increased Amniotic Fluid
Causes
Duodenal Atresia (or Gastrointestinal Atresias)
Maternal Diabetes
Multiple Gestations
Anencephaly
Hydrops Fetalis
Diagnosis
Ultrasound
Amniotic Fluid Index (AFI) > 25 cm
Treatment
Weekly Nonstress Test (NST) and Biophysical Profile (BPP)
Amnioreduction
Indomethacin
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3 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
Bartter Syndrome
Autosomal Recessive
Defective Na+/K+/2Cl- Co-transporter
Thick Ascending Limb Of Loop Of Henle
Secondary Hyperaldosteronism
Symptoms
Polyuria
Polydipsia
Hypokalemia
Metabolic Alkalosis
Hypercalciuria
Treatment
NSAIDS
Potassium Sparing Diuretics
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Gitelman Syndrome
Metabolic alkalosis
Gitelman syndrome causes a hypokalemic metabolic alkalosis
Hypomagnesemia
Genetic mutation
Loss-of-function mutation of the thiazide-sensitive sodium chloride symporter
Signs & Symptoms
Hypocalciuria
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21 secs
Liddle Syndrome (Pseudoaldosteronism)
Autosomal Dominant
Constitutively Active ENaC
Hypertension
Hypokalemia
Metabolic Alkalosis
Low Aldosterone (vs. Hyperaldosteronism)
Tx. = Amiloride and Triamterene
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Syndrome of Apparent Mineralocorticoid Excess
Hereditary deficiency of 11Beta-hydroxysteroid dehydrogenase
Excess cortisol
Hypertension
Hypokalemia
Metabolic Alkalosis
Low serum aldosterone
Can acquire disorder from glycyrrhetinic acid
Corticosteroids
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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
Winter's Formula
Evaluates Respiratory Compensation
Used in Metabolic Acidosis
Equation
(HCO3 x 1.5 ) + 8 plus-minus 2 = PCO2
Steps
Bicarbonate (HCO3) x 1.5
+ 8
± 2
= Expected Value for PCO2
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1 min
Renal Tubular Acidosis
Hyperchloremia
Type 1 RTA
Type 1 RTA
Urine pH >5.5
Kidney stones
Defect in hydrogen secretion
Bicarbonate treatment for Type 1
Type 2 RTA
Type 2 RTA (Fanconi Syndrome)
urine pH <5.5
Thiazide treatment for Type 2
Type 4 RTA
Type 4 RTA
Urine pH
Aldosterone resistance
Hyperkalemia
Treatment
Fludricortisone treatment for Type 4 RTA
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Congenital Cystic Kidney Pathology
Multicystic Dysplastic Kidney (MCDK)
Ureteric Bud failure to induce Metanephros
Dysplasia: Inc. Collagen, Connective Tissue
Proximal Ureter Atresia
If B/L --> Oligohydramnios --> POTTER
Medullary Sponge Kidney (MSK)
Cysts: Alpha-intercalated Cells in Collecting Duct
Recurrent Kidney Stones
Medullary Cystic Kidney Disease (MCKD)
MCKD1: MUC1 mutation | MCKD2: UMOD mutation
Autosomal Dominant
presents in Adulthood
Tubulointerstitial Fibrosis + Corticomedullary Cysts --> Glomerular Sclerosis --> ESRD
Hyperuricemia, Polyuria, Salt Wasting
Nephronophthisis
presents in Childhood
Autosomal Recessive
NPHP1: Ciliary dysfunction --> Tubular atrophy, Hepatic fibrosis, Situs Inversus
presents like MCKD
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Autosomal Dominant Polycystic Kidney Disease (ADPKD)
Begins at 20-25
Tubular epithelium
Most common symptom is flank pain
PKD1
Chromosome 16
More severe disease
80-85% of disease
Renal Failure at 55
PKD2
Chromosome 4
Renal failure at 75+
Ca2+ Receptors
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Acute Interstitial Nephritis
penicillin
TMP-SMX
cephalosporins
NSAIDS
clinical signs
Maculopapular rash
fever
eosinophils/ WBCs in urine
Diuretics
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Renal Papillary Necrosis Causes
POSTCARDS
Pyelonephritis
Obstruction of Urogenital Tract
Sickle Cell Disease
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Hypertension & kidneys
Hypertensive nephrosclerosis
Uncontrolled essential HTN (benign)
cobblestone, shrunken kidneys
Malignant hypertension
flea bitten kidney
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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
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
Focal Segmental Glomerulosclerosis
Most Common Cause of Nephrotic Syndrome in Hispanics 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

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