Balance Wk 1 bootcamp LG4

What is a primary renal disease?

Answer: A disease that originates from renal tissue.

Extra Information:

• Primary means the disease process begins within the kidney itself.

What are examples of primary renal diseases?

Answer: Minimal change disease, focal segmental glomerulosclerosis, and IgA nephropathy.

Extra Information:

• These diseases originate from renal tissue.

What is a secondary renal disease?

Answer: Kidney damage originating from a systemic process.

Extra Information:

• The kidney is affected secondary to a disease process originating elsewhere in the body.

What are examples of secondary renal diseases?

Answer: Diabetic nephropathy, lupus nephritis, and amyloidosis.

Extra Information:

• These represent kidney damage caused by systemic processes.

What does focal glomerular involvement mean?

Answer: Less than 50% of the glomeruli are involved.

Extra Information:

• Focal segmental glomerulosclerosis is an example.

What disease is an example of focal glomerular involvement?

Answer: Focal segmental glomerulosclerosis.

Extra Information:

• Focal means less than 50% of glomeruli are involved.

What does diffuse glomerular involvement mean?

Answer: Greater than 50% of the glomeruli are involved.

Extra Information:

• Diffuse proliferative glomerulonephritis is an example.

What disease is an example of diffuse glomerular involvement?

Answer: Diffuse proliferative glomerulonephritis.

Extra Information:

• Diffuse means greater than 50% of glomeruli are involved.

What does membranous mean when describing glomerular disease?

Answer: Thickening of the glomerular basement membrane without significant inflammation.

Extra Information:

• Idiopathic membranous nephropathy is an example.

What secondary causes are associated with membranous disease?

Answer: Malignancy, hepatitis B, hepatitis C, and lupus.

Extra Information:

• These are the secondary associations listed on the slide.

What does proliferative mean when describing glomerular disease?

Answer: An increase in the number of glomerular cells.

Extra Information:

• This describes increased cellularity within the glomerulus.

What diseases are examples of a proliferative glomerular pattern?

Answer: Post-streptococcal glomerulonephritis and diffuse proliferative glomerulonephritis.

Extra Information:

• Proliferative means there is an increased number of glomerular cells.

What does necrotizing mean when describing glomerular disease?

Answer: Destruction of the glomerulus with fibrinoid necrosis.

Extra Information:

• This describes a destructive pattern of glomerular injury.

What diseases are examples of a necrotizing glomerular pattern?

Answer: ANCA-associated vasculitis and granulomatosis with polyangiitis.

Extra Information:

• These are the examples listed for necrotizing glomerular disease.

What does crescentic mean when describing glomerular disease?

Answer: The presence of crescents within Bowman space.

Extra Information:

• Rapidly progressive glomerulonephritis is an example.

What disease is associated with a crescentic glomerular pattern?

Answer: Rapidly progressive glomerulonephritis.

Extra Information:

• Crescentic refers to crescents within Bowman space.

What does sclerosing mean when describing renal pathology?

Answer: Obliteration and scarring of tissue.

Extra Information:

• Sclerosis refers to a scarring pattern.

What disease is an example of a sclerosing pattern?

Answer: Focal segmental glomerulosclerosis.

Extra Information:

• Sclerosing means obliteration and scarring of tissue.

What urine color is considered normal on gross examination?

Answer: Clear/yellow.

Extra Information:

• Changes in urine color can suggest different underlying substances or conditions.

What can red, pink, or dark urine indicate?

Answer: Hematuria, myoglobinuria, or beets.

Extra Information:

• These are the causes associated with red, pink, or dark urine on the slide.

What can dark brown urine indicate?

Answer: Liver disease or bilirubinuria.

Extra Information:

• Dark brown urine is distinguished from red/pink urine and black urine on gross examination.

What condition is associated with black urine?

Answer: Alkaptonuria.

Extra Information:

• This is the specific association for black urine on the slide.

What does cloudy urine suggest?

Answer: Possible infection or pyuria.

Extra Information:

• Clear urine is considered normal on gross examination.

What conditions are associated with a “sweet” urine odor?

Answer: Maple syrup urine disease and ketoacidosis.

Extra Information:

• Urine odor can provide clues to underlying metabolic abnormalities.

What condition is associated with a “musty” urine odor?

Answer: Phenylketonuria.

Extra Information:

• Phenylketonuria is abbreviated PKU.

How does a urine dipstick detect substances in urine?

Answer: A chemical reagent is dipped into urine, and a color change represents the presence of various substances.

Extra Information:

• Different dipstick components test different chemical properties of urine.

What is the normal urine pH range?

Answer: 4.5–8.0.

Extra Information:

• Urine pH is one of the measurements obtained from a urine dipstick.

What is the normal urine specific gravity range?

Answer: 1.003–1.030.

Extra Information:

• Specific gravity reflects urine concentration.

What does urine specific gravity reflect?

Answer: Urine concentration.

Extra Information:

• The normal range on the slide is 1.003–1.030.

What conditions are associated with increased urine specific gravity?

Answer: Dehydration and syndrome of inappropriate antidiuretic hormone secretion.

Extra Information:

• Increased specific gravity reflects more concentrated urine.

What conditions are associated with decreased urine specific gravity?

Answer: Diabetes insipidus and renal failure.

Extra Information:

• Decreased specific gravity reflects less concentrated urine.

When does glucose become positive on urine dipstick according to the slide?

Answer: When serum glucose exceeds approximately 180 mg/dL.

Extra Information:

• Urine glucose is normally negative.

• Diabetes mellitus is an example associated with a positive result.

What does the protein portion of a urine dipstick primarily detect?

Answer: Albumin.

Extra Information:

• Urine protein is normally negative or minimal.

• Protein is graded on a scale from +1 to +4.

What is the normal urine ketone result, and when can ketones become positive?

Answer: Ketones are normally negative but can become positive in states such as diabetic ketoacidosis.

Extra Information:

• Ketones are measured using the urine dipstick.

What does the blood portion of a urine dipstick detect?

Answer: Hemoglobin and myoglobin.

Extra Information:

• It can be positive with hematuria, hemoglobinuria, or myoglobinuria.

What does a positive leukocyte esterase indicate?

Answer: Pyuria, which suggests infection.

Extra Information:

• A urinary tract infection is an example given on the slide.

What does a positive urine nitrite test indicate?

Answer: Nitrate-reducing bacteria.

Extra Information:

• These are typically gram-negative rods.

• Examples on the slide include E. coli, Klebsiella, and Proteus.

What can cause a positive urine heme test?

Answer: Red blood cells, hemoglobin, or myoglobin.

Extra Information:

• A positive heme result should be confirmed with microscopic examination.

Why is microscopic examination performed after a positive urine heme result?

Answer: To determine whether red blood cells are actually present.

Extra Information:

• Dipstick heme can be positive from red blood cells, free hemoglobin, or myoglobin.

• Microscopy helps distinguish these possibilities by identifying red blood cells.

What is the normal urine urobilinogen range, and what do increased versus decreased levels suggest?

Answer: Normal is 0.2–1.0 mg/dL. Increased urobilinogen suggests hemolytic anemia or liver disease, while decreased urobilinogen suggests biliary obstruction.

Extra Information:

• Urobilinogen is measured as part of urine dipstick testing.

What is urine sediment analysis, and what can it evaluate?

Answer: It is microscopic analysis of centrifuged urine that evaluates cells, casts, and urinary crystals.

Extra Information:

• Cells include uniform or dysmorphic red blood cells, white blood cells, and epithelial cells.

• Casts include fatty, granular, epithelial, red blood cell, white blood cell, and hyaline casts.

• Crystals include uric acid, calcium, struvite, and cystine crystals.

What is the clinical purpose of urine sediment analysis?

Answer: It helps localize urinary pathology.

Extra Information:

• The slide lists infectious, glomerular, tubular, and interstitial pathology as examples.

• Microscopy evaluates findings such as cells, casts, and crystals.

What are fatty casts composed of?

Answer: Lipid-laden renal tubular epithelial cells.

Extra Information:

• Fatty casts are associated with heavy proteinuria and lipiduria.

What characteristic appearance is associated with fatty casts under polarized light?

Answer: A “Maltese cross” appearance.

Extra Information:

• This finding is associated with lipid-containing fatty casts.

Which conditions are associated with fatty casts?

Answer: Nephrotic syndromes such as minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy.

Extra Information:

• Fatty casts indicate heavy proteinuria and lipiduria.

What are granular casts?

Answer: Degenerated cellular casts, often derived from epithelial cells.

Extra Information:

• They indicate tubular cell injury and necrosis.

What is the significance of “muddy brown” granular casts?

Answer: They are specific for acute tubular necrosis.

Extra Information:

• Granular casts reflect tubular cell injury and necrosis.

What are hyaline casts composed of?

Answer: Tamm-Horsfall protein secreted by tubular epithelial cells.

Extra Information:

• Hyaline casts are nonspecific.

When can hyaline casts be seen?

Answer: They can occur in healthy individuals, such as with dehydration, and may also occur in kidney disease.

Extra Information:

• Their presence may indicate concentrated urine.

• They are nonspecific.

Which urinary cast is nonspecific and may indicate concentrated urine?

Answer: Hyaline casts.

Extra Information:

• They may be seen with dehydration.

• They are composed of Tamm-Horsfall protein.

What are red blood cell casts composed of?

Answer: Red blood cells and mucoproteins.

Extra Information:

• Their presence indicates bleeding originating from the glomerulus.

Which conditions are associated with red blood cell casts?

Answer: Glomerulonephritis and hypertensive emergency.

Extra Information:

• Examples of glomerulonephritis on the slide include post-streptococcal glomerulonephritis and lupus nephritis.

What do red blood cell casts indicate about the location and mechanism of kidney injury?

Answer: Glomerular bleeding with disruption of the glomerular basement membrane.

Extra Information:

• Red blood cell casts therefore point toward glomerular pathology.

What are white blood cell casts composed of?

Answer: White blood cells and Tamm-Horsfall protein.

Extra Information:

• They indicate inflammation or infection within the renal interstitium or tubules.

Which conditions are associated with white blood cell casts?

Answer: Acute pyelonephritis, acute interstitial nephritis, and transplant rejection.

Extra Information:

• These conditions involve inflammation or infection within the renal interstitium or tubules.

What do white blood cell casts indicate?

Answer: Inflammation or infection within the renal interstitium or tubules.

Extra Information:

• Acute pyelonephritis and acute interstitial nephritis are important associations.

What are waxy casts?

Answer: Degenerative granular casts.

Extra Information:

• They are associated with advanced or chronic kidney disease on the slide.

Which conditions are associated with waxy casts?

Answer: Chronic kidney disease and end-stage renal disease.

Extra Information:

• Waxy casts can indicate kidney damage and renal stasis.

What is the clinical significance of waxy casts?

Answer: They can indicate kidney damage and renal stasis from low urine flow.

Extra Information:

• Waxy casts may also be nonspecific.

• They are associated with chronic kidney disease and end-stage renal disease.

Match the major urinary cast types with their key associations.

Answer: Fatty → nephrotic syndromes. Muddy brown granular → acute tubular necrosis. Hyaline → dehydration or concentrated urine. Red blood cell → glomerulonephritis. White blood cell → pyelonephritis or interstitial nephritis. Waxy → chronic kidney disease or end-stage renal disease.

Extra Information:

• This card integrates the major cast-to-disease relationships from the slide.

• Use the individual cards to recall each cast’s composition and clinical significance.

What are the two terms used on this slide for an acute decline in kidney function?

Answer: Acute kidney injury and acute renal failure.

Extra Information:

• Acute kidney injury is abbreviated AKI.

• Acute renal failure is abbreviated ARF.

What are the three major categories of acute kidney injury?

Answer: Prerenal, intrarenal, and postrenal.

Extra Information:

• These categories are used to classify acute kidney injury.

How does the reversibility of acute kidney injury generally compare with chronic kidney disease?

Answer: Acute kidney injury is typically reversible, while chronic kidney disease is typically irreversible.

Extra Information:

• The slide also refers to chronic kidney disease as chronic renal failure.

Can acute kidney injury be asymptomatic?

Answer: Yes, acute kidney injury can be asymptomatic.

Extra Information:

• When symptoms occur, the presentation can vary.

What gastrointestinal symptoms can occur with acute kidney injury?

Answer: Nausea, vomiting, and anorexia.

Extra Information:

• These are listed among the possible presentations of acute kidney injury.

What changes in urine output can occur with acute kidney injury?

Answer: Patients can be oliguric or anuric.

Extra Information:

• These terms describe reduced or absent urine output.

What findings can result from fluid overload in acute kidney injury?

Answer: Peripheral edema or pulmonary edema.

Extra Information:

• Fluid overload is one possible presentation of acute kidney injury.

Which type of acute kidney injury can present with volume depletion?

Answer: Prerenal acute kidney injury.

Extra Information:

• Volume depletion is given as an example associated with prerenal acute kidney injury.

What neurologic findings can occur with increased urea in acute kidney injury?

Answer: Asterixis and encephalopathy.

Extra Information:

• These are listed as signs associated with increased urea.

What cardiac finding can occur with increased urea in acute kidney injury?

Answer: Pericarditis.

Extra Information:

• Pericarditis is one of the signs associated with increased urea on the slide.

How can increased urea affect platelet function?

Answer: It can cause platelet dysfunction with increased bleeding time.

Extra Information:

• Platelet dysfunction is one of the signs associated with increased urea.

What laboratory values increase in acute kidney injury because less is filtered?

Answer: Creatinine and blood urea nitrogen.

Extra Information:

• Both increase as kidney filtration decreases.

What rise in creatinine over 48 hours meets the diagnostic criterion for acute kidney injury on this slide?

Answer: An increase in creatinine of at least 0.3 mg/dL over 48 hours.

Extra Information:

• This is one of the two creatinine-based diagnostic criteria listed on the slide.

What change in creatinine within 7 days meets the diagnostic criterion for acute kidney injury on this slide?

Answer: An increase in creatinine to at least 1.5 times baseline within 7 days.

Extra Information:

• This is the second creatinine-based diagnostic criterion listed on the slide.

What is the basic pathophysiology of prerenal acute kidney injury?

Answer: Decreased cardiac output and/or decreased effective circulating volume → decreased renal blood flow and glomerular filtration rate → renin-angiotensin-aldosterone system activation → decreased urinary sodium and water → increased urine osmolality.

Extra Information:

• The kidney responds to decreased perfusion by conserving sodium and water.

What happens to renal blood flow and glomerular filtration rate in prerenal acute kidney injury?

Answer: Both renal blood flow and glomerular filtration rate decrease.

Extra Information:

• This occurs because of decreased cardiac output and/or decreased effective circulating volume.

Why is the renin-angiotensin-aldosterone system activated in prerenal acute kidney injury?

Answer: Decreased renal perfusion from decreased cardiac output and/or decreased effective circulating volume activates the renin-angiotensin-aldosterone system.

Extra Information:

• Activation leads to decreased urinary sodium and water.

How does prerenal acute kidney injury affect urinary sodium, urinary water, and urine osmolality?

Answer: Urinary sodium and water decrease, while urine osmolality increases.

Extra Information:

• These changes occur as the kidney attempts to conserve sodium and water.

What hypotensive conditions can cause prerenal acute kidney injury according to the slide?

Answer: Heart failure and cirrhosis.

Extra Information:

• Hypotension is one cause of decreased renal perfusion.

What hypovolemic conditions can cause prerenal acute kidney injury?

Answer: Sweating, diarrhea, hemorrhage, and vomiting.

Extra Information:

• Hypovolemia decreases effective circulating volume and renal perfusion.

What vascular condition can cause prerenal acute kidney injury?

Answer: Renal artery stenosis.

Extra Information:

• Renal artery stenosis is listed as an etiology of prerenal acute kidney injury.

Which medications can contribute to prerenal acute kidney injury?

Answer: Diuretics, nonsteroidal anti-inflammatory drugs, and angiotensin-converting enzyme inhibitors.

Extra Information:

• Contributing medications may need to be discontinued during management.

What urine osmolality is expected in prerenal acute kidney injury?

Answer: Greater than 500 mOsm/kg.

Extra Information:

• The urine is relatively concentrated in prerenal acute kidney injury.

What urine sodium concentration is expected in prerenal acute kidney injury?

Answer: Less than 20 mEq/L.

Extra Information:

• The kidney conserves sodium in response to decreased renal perfusion.

What fractional excretion of sodium is expected in prerenal acute kidney injury?

Answer: Less than 1%.

Extra Information:

• Fractional excretion of sodium is abbreviated FeNa.

What serum blood urea nitrogen-to-creatinine ratio is expected in prerenal acute kidney injury?

Answer: Greater than 20.

Extra Information:

• This is one of the diagnostic findings listed on the slide.

What happens to serum creatinine and urine output in prerenal acute kidney injury?

Answer: Serum creatinine increases and urine output decreases.

Extra Information:

• The slide gives an approximately 50% increase in serum creatinine from baseline as an example.

What urine sediment is expected in prerenal acute kidney injury?

Answer: Bland urine sediment.

Extra Information:

• There is no protein or cells.
• Hyaline casts may rarely be present.

What is the main management goal in prerenal acute kidney injury?

Answer: Restore renal perfusion.

Extra Information:

• The slide gives intravenous fluids and blood as examples.

Which contributing medications should be discontinued in prerenal acute kidney injury according to the slide?

Answer: Nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers.

Extra Information:

• Discontinuing contributing medications is part of management.

Which special prerenal acute kidney injury syndromes do not respond to fluid administration?

Answer: Hepatorenal syndrome and cardiorenal syndrome.

Extra Information:

• These are identified as special scenarios on the slide.

What is the classic diagnostic pattern for prerenal acute kidney injury?

Answer: Urine osmolality greater than 500 mOsm/kg, urine sodium less than 20 mEq/L, fractional excretion of sodium less than 1%, serum blood urea nitrogen-to-creatinine ratio greater than 20, increased serum creatinine, decreased urine output, and bland urine sediment.

Extra Information:

• Think of the overall pattern as the kidney conserving sodium and water in response to decreased renal perfusion.

What is the basic pathophysiology of intrarenal acute kidney injury?

Answer: Renal tubular damage → decreased reabsorption capacity → increased urinary sodium and water → decreased urine osmolality.

Extra Information:

• Damaged renal tubules cannot reabsorb sodium and water as effectively.

How does intrarenal acute kidney injury affect urinary sodium, urinary water, and urine osmolality?

Answer: Urinary sodium and water increase, while urine osmolality decreases.

Extra Information:

• This results from decreased tubular reabsorption capacity.

What are the four major categories of causes of intrarenal acute kidney injury on the slide?

Answer: Acute tubular necrosis, acute interstitial nephritis, glomerulonephritis, and vascular disease.

Extra Information:

• Each represents injury occurring within the kidney itself.

What can cause acute tubular necrosis?

Answer: Ischemia, nephrotoxic medications, and toxins.

Extra Information:

• Acute tubular necrosis is one cause of intrarenal acute kidney injury.

Which nephrotoxic medications are associated with acute tubular necrosis on the slide?

Answer: Aminoglycosides and contrast.

Extra Information:

• These are examples of nephrotoxic causes of acute tubular necrosis.

Which toxins are associated with acute tubular necrosis on the slide?

Answer: Hemoglobin, myoglobin, and Bence-Jones proteins.

Extra Information:

• These are listed as toxin-related causes of acute tubular necrosis.

What are the major causes of acute interstitial nephritis on the slide?

Answer: Medications, infections, and infiltrative diseases.

Extra Information:

• Acute interstitial nephritis is one cause of intrarenal acute kidney injury.

Which medications can cause acute interstitial nephritis according to the slide?

Answer: Diuretics, nonsteroidal anti-inflammatory drugs, antibiotics, proton pump inhibitors, rifampin, and sulfa drugs.

Extra Information:

• These are the medication examples specifically listed on the slide.