痛風腎の検査所見腹部超音波検査で腎髄質部に尿酸塩沈着（皮質よりも高いレベルで描出）がみられる．また腎病理像では尿酸塩結晶による尿細管間質性腎炎がみられる renal国試 Feb 3, 2021, 11:47 PM HirotoShishido
Management of chronic kidney disease• diet
■ preventing HTN and volume overload
■ ☆low-protein diet
• Na+ restriction
■ preventing electrolyte imbalances
■ target of <2 g/d (5 g/d of salt)
• K+ restriction (40-60 mmol/d)
• PO43– restriction (1 g/d)
• avoid extra-dietary Mg2+ (e.g. antacids)
■ preventing uremia and potentially delaying decline in GFR
• protein restriction with adequate caloric intake (☆25-35kcal/kg day) in order to limit endogenous protein catabolism renal国試過去3年 Oct 18, 2020, 2:16 AM HirotoShishido
definition of chronic kidney disease①尿異常，画像診断，血液，病理で腎障害の存在が明らか．特に蛋白尿の存在が重要．
②糸球体濾過量（GFR：glomerular filtration rate）＜60mL/分/1.73m2
①，②のいずれか，または両方が3ヵ月以上持続する．
→ GFRが正常でも，☆血尿・尿潜血が3ヵ月以上続けばCKDと定義される．
GFRが正常でも☆顕性蛋白尿(>=0.5g/日) が3ヵ月続けばCKDである． renal国試過去3回国試直前 Oct 12, 2020, 2:22 AM HirotoShishido
management of nocturnal enuresisEnuresis alarms are the most effective long-term intervention but can take 3-4 months to be effective.
Pharmacotherapy with ★desmopressin is also considered first-line therapy for those who desire immediate improvement. pediatricsrenalUWorld step2CK Sep 20, 2020, 5:26 AM HirotoShishido
causes of hypokalemia・decreased intake
・intracellular translocation
insulin, β-adrenargic activity(dobutamine, ☆stress-induced(eg. alcohol withdrawal, acute MI)), alkalosis
・GI loss
diarrhea, vomiting, hyperaldosteroeism
・urinary loss
hyperaldosteroeism, diuretics, RTA (type Ⅰ, Ⅱ)
・sweat loss renalendocrinologyUWorld Jul 9, 2020, 2:16 AM HirotoShishido
diagnosis/ causes of rhabdomyolysis☆Positive blood on urine dipstick (a reaction that detects the heme pigment in both hemoglobin and myoglobin) in the absence of red blood cells on microscopic urinalysis suggests myoglobinuria.
contrast agent nephropathyDirect cytotoxicity of intravenous contrast on tubular cells
→ diffuse necrosis of the ☆proximal tubular cells visible on histologic specimens and muddy brown casts on urinalysis
Renal vasoconstriction
→ Renal vasoconstriction causing medullary ischemia and a prerenal injury pattern (ie, fractional excretion of sodium <1%), even in the absence of clinical volume depletion renalUWorld Jul 8, 2020, 6:50 AM HirotoShishido
EM for glomerular diseasesubepithelial IC hump → PSGN
epithelial deposits → MN ("spike and dome" appearance)
intramembranous deposits(dense deposits) → type Ⅱ MPGN
subendothelial IC deposits → type Ⅰ MPGN (HBV, HCV)
megangial IC deposits → IgA nephropathy renal Jul 8, 2020, 4:52 AM HirotoShishido
metanephric mesenchyme, ureteric budMetanephric mesenchyme (ie, metanephric blastema)
→ glomerulus through to distal convoluted tubule (DCT)
Ureteric bud (metanephric diverticulum)
derived from caudal end of mesonephric duct → gives rise to ureter, pelvises, calyces, collecting ducts; renalembryologyUWorld Jul 8, 2020, 3:01 AM HirotoShishido
primary membranous nephropathyantibodies to ☆phospholipase A2 receptor
(highly specific for MN)
titers correlate with disease activity, and serial mesurments can be used to determine the efficacy of immunosuppressive therapy renalUWorld Jul 5, 2020, 11:04 PM HirotoShishido
hyaline renal arteriosclerosisdeposition of eosinophilic hyaline material (☆homogenous, glassy material that stains pink with PAS stain) in the latima and media of small arteries and arterioles, which is characteristic ☆diabetes mellitus or poorly controlled hypertension renalendocrinologyUWorld Jul 5, 2020, 2:10 AM HirotoShishido
kidney transplantThe native kidneys are typically left in place, and the donor kidney is placed retroperitoneally in the right iliac fossa.
Blood supply is established by anastomosing the donor renal artery with the recipient's ☆external iliac artery.
Although the transplanted ureter will continue to receive blood ☆through the donor's renal artery, the most distal portion may be susceptible to ischemia due to lack of anastomotic connections. renalanatomyUWorld Jun 28, 2020, 12:26 AM HirotoShishido
the difference between IgA nephropathy and poststreptococcal glomerulonephritis (PSGN)IgA→ concurrent with or 5-7 days after upper respiratory infection (synpharyngitic)
hematuria ☆returns every few months
complement normal
renal biopsy→ ☆mesangial hypercellularity with mesangial IgA deposits
PSGN→ ☆1-3 weeks after streptoccal pharyngitis
☆recurrence is rare
biopsy→ granular IgG and C3 deposits along the glomerular basement membrane renalUWorld Jun 26, 2020, 2:12 AM HirotoShishido
Picturenephrotic syndrome- amyloidosis
LM-Congo red stain shows ☆apple-green birefringence under polarized light due to amyloid deposition in the mesangium renalUWorld Jun 26, 2020, 2:00 AM HirotoShishido
histologic changes of hypertensive (malignant) nephrosclerosisLeakage of fibrinogen and coagulation factors through the damaged endothelium causes fibrin deposition in vessel walls, which appear as circumferential, acellular eosinophilic deposits (fibrinoid necrosis).
Over time, release of growth factors by damaged tissue stimulates the formation of concentric layers of collagen and proliferating smooth muscle cells, resulting in an☆ "onion skin" appearance (hyperplastic arteriosclerosis) of the arteriole.
