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Renal
Acute Tubular Necrosis
ETIOLOGY
Ischemic Injury
Nephrotoxic Injury
HISTOLOGY
Granular Muddy Brown Casts
Signs & Symptoms
Intrinsic Renal Failure
Oliguric Phase
Metabolic Acidosis
Hyperkalemia
Increase in BUN and Creatinine
Polyuria Phase
Decrease in BUN and Creatinine
Hypokalemia
Treatment
Supportive Care
3 mins
Amyloidosis
Etiologies
Primary
Multiple Myeloma
Secondary
Tuberculosis (TB)
Rheumatoid Arthritis
Pathology
Congo Red Stain
Apple Green Birefringence
Complications
Nephrotic Syndrome
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
1 min
Diabetic Glomerulonephropathy
Pathophysiology
Nonenzymatic Glycosylation of Glomerular Basement Membrane
Nonenzymatic Glycosylation of Arterioles
Hyperfiltration
Increased GFR
Histological Findings
Hyaline Arteriolosclerosis
Mesangial Expansion
Type IV Collagen Deposition
Kimmelstiel Wilson Lesions
Presentation
Nephrotic
2 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
2 mins
Distal Tubule
Characteristics
Hormonally Regulated
Aldosterone Causes Na+ Reabsorption
Na+ Reabsorbed Via Active Transport
Water follows Na+
Early Distal Tubule is Impermeable to Water
Parathyroid Hormone Causes Ca2+ Reabsorption
Leads to Collecting Duct
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
1 min
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
2 mins
Hartnup Disease
Pathophysiology
Autosomal Recessive
Neutral amino acids
Defective Transporter
Renal and Intestinal cells
Signs and Symptoms
Causes tryptophan excretion in urine
Leads to Pellagra
Diarrhea
Dermatitis
Dementia
2 mins
Loop of Henle
Characteristics
Descending Limb
Water Follows Na+
Medullary Hypertonicity
Increased Water Reabsorption
Vasa Recta
Na+ Reabsorbed Via Active Transport
Ascending Limb
Reabsorbs Na+, K+, Cl-
Decreased Concentration of Filtrate
Impermeable to Water
Distal Tubule
2 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
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
3 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
2 mins
Nephritic Syndrome
Inflammatory
Hematuria
RBC casts
Increased Nitrogen in blood
Oliguria
Hypertension
Proteinuria < 3.5 grams per day
2 mins
Nephrotic Syndrome
Signs and Symptoms
Massive Proteinuria > 3.5g per Day
Edema
Increased risk of infection
Thromboembolism
Hyperlipidemia
Fatty casts
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
2 mins
Proximal Tubule
Characteristics
Na+ Reabsorbed Via Active Transport
Water Follows Na+
Most Of Glucose Reabsorbed
Most Of Amino Acids Reabsorbed
Bicarbonate Exchanged For H+
Drugs and Toxins Excreted
Filtrate Osmolarity Same As Plasma
Leads To Loop Of Henle
2 mins
Pyelonephritis Assessment
Cause/Mechanism
Ascending Urethral Bacteria
Assessment
Dysuria
Fever
Fatigue
Flank Pain
Costovertebral Tenderness
Nausea and Vomiting
1 min
Pyelonephritis Interventions
Urinalysis
NSAIDs
Antibiotics
Increase Fluid Intake
Avoid Catheterization
Consideration
Urosepsis
1 min
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
3 mins
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