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14. Renal Flashcards

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1
Q

What artery prevents a horseshoe kidney from ascending in the abdomen?

A

IMA

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2
Q

What fundamental problem creates Potter sequence?

A

oligohydramnios

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3
Q

What cell type releases renin?

A

juxtaglomerular cells

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4
Q

What are the 3 stimuli that induce renin release?

A
  • beta-adrenergic stimulation
  • low renal arterial BP (sensed by JG cells)
  • decreased Na+ in distal convoluted tubule (sensed by macula densa)
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5
Q

What effect will a renal stone that obstructs the ureter have on GFR and FF?

A
  • decreased GFR
  • no change in RPF
  • thus, decreased FF
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6
Q

What is the maximal serum glucose concentration at which glucose can be absorbed in the tubules?

A

350 mg/dL

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7
Q

What vitamin deficiency results from Hartnup disease?

A

niacin (B3) –> pellagra

note: Hartnup disease is when there is deficiency of neutral amino acid transporters in proximal renal tubular cells (ex. tryptophan)
- thus, decreased tryptophan for conversion to niacin

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8
Q

What is the equation for the renal clearance of any substance?

A

Renal clearance = UV/P

  • U = urine concentration of particular substrate (mg/mL)
  • V = urine flow rate (mL/min)
  • P = plasma concentration of substrate (mg/dL)
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9
Q

What segment of the renal tubule matches each of the following statements?
- reabsorbs 67% of the fluid and electrolytes filtered by the glomerulus

A

prox tubule

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10
Q

What segment of the renal tubule matches each of the following statements?
- site of secretion of organic anions and cations

A

prox tubule

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11
Q

What segment of the renal tubule matches each of the following statements?
- always impermeable to water

A

thick ascending limb

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12
Q

What segment of the renal tubule matches each of the following statements?
- permeable to water only in the presence of ADH

A

late distal tubule, collecting duct

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13
Q

What segment of the renal tubule matches each of the following statements?
- site of Na/2Cl/K co-transporter

A

thick ascending limb

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14
Q

What segment of the renal tubule matches each of the following statements?
- site of isotonic fluid reabsorption

A

prox tubule

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15
Q

What segment of the renal tubule matches each of the following statements?
- site responsible for diluting urine

A

thick ascending limb

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16
Q

What segment of the renal tubule matches each of the following statements?
- only site where glucose and amino acids are reabsorbed

A

prox tubule

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17
Q

What segment of the renal tubule matches each of the following statements?
- water reabsorption in the loop of Henle

A

thin descending limb

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18
Q

What are the 2 main cell types of the collecting duct?

A
  • principal cell

- intercalated cell

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19
Q

What type of diuretic is each of the following drugs?

- triamterene

A

K+ sparing

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20
Q

What type of diuretic is each of the following drugs?

- acetazolamide

A

carbonic anhydrase inhibitor

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21
Q

What type of diuretic is each of the following drugs?

- hydrochlorothiazide

A

thiazide

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22
Q

What type of diuretic is each of the following drugs?

- bumetanide

A

loop

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23
Q

What type of diuretic is each of the following drugs?

- spironolactone

A

K+ sparing (aldo-antagonist)

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24
Q

What type of diuretic is each of the following drugs?

- ethacrynic acid

A

loop (non-sulfa)

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25
What type of diuretic is each of the following drugs? | - mannitol
osmotic diuretic
26
What type of diuretic is each of the following drugs? | - metolazone
thiazide
27
What type of diuretic is each of the following drugs? | - chlorthalidone
thiazide
28
What type of diuretic is each of the following drugs? | - furosemide
loop
29
What type of diuretic is each of the following drugs? | - amiloride
K+ sparing
30
What type of diuretic is each of the following drugs? | - torsemide
loop
31
``` What diuretic or class of diuretic would be most useful in each of the following situations? - acute pulmonary edema ```
loop
32
``` What diuretic or class of diuretic would be most useful in each of the following situations? - idiopathic hypercalciuria (--> calcium stones) ```
thiazide
33
``` What diuretic or class of diuretic would be most useful in each of the following situations? - glaucoma (2) ```
acetazolamide, mannitol
34
``` What diuretic or class of diuretic would be most useful in each of the following situations? - mild to moderate CHF with expanded ECV ```
loop
35
``` What diuretic or class of diuretic would be most useful in each of the following situations? - in conjunction with loop or thiazide diuretics to retain K+ ```
K+ sparing
36
``` What diuretic or class of diuretic would be most useful in each of the following situations? - edema associated with nephrotic syndrome ```
loop
37
``` What diuretic or class of diuretic would be most useful in each of the following situations? - increased intracranial pressure ```
mannitol
38
``` What diuretic or class of diuretic would be most useful in each of the following situations? - mild to moderate hypertension ```
thiazide
39
``` What diuretic or class of diuretic would be most useful in each of the following situations? - hypercalcemia ```
loop
40
``` What diuretic or class of diuretic would be most useful in each of the following situations? - altitude sickness ```
acetazolamide
41
``` What diuretic or class of diuretic would be most useful in each of the following situations? - hyperaldosteronism ```
spironolactone, eplerenone
42
What is the site of action of the thiazides?
distal convoluted tubule
43
A patient with heart failure exacerbation needs medical diuresis but has a sulfa allergy. What diuretic can be used?
Ethacrynic acid (loop)
44
Which electrolyte disturbance fits each of the following presentations? - correcting too rapidly may result in central pontine myelinolysis
hypo Na+
45
Which electrolyte disturbance fits each of the following presentations? - peaked T waves
hyper K+
46
Which electrolyte disturbance fits each of the following presentations? - tetany
hypo Ca2+, hypoMg2+
47
Which electrolyte disturbance fits each of the following presentations? - arrhythmias
hyper K+, hypo K+, hypo Mg2+
48
Which electrolyte disturbance fits each of the following presentations? - decreased deep tendon reflexes
hyper Mg2+
49
Which electrolyte disturbance fits each of the following presentations? - flattened T waves, U waves on EKG
hypo K+
50
What factors/substances cause hyperkalemia? (8)
- acidosis - low insulin - beta-blocker - digitalis - cell lysis (rhabdo, crush injury) - hyperosmolarity - K+ sparing diuretics - ACE inhibitors (b/c of decrease in aldosterone)
51
What factors/substances cause hypokalemia? (5)
- insulin - beta agonist - alkalosis - loops - thiazides
52
What are the causes of acidosis with elevated anion gap?
MUD PILES - methanol - uremia - diabetic ketoacidosis - propylene glycol - iron tablets/isoniazid - lactic acidosis - ethylene glycol - salicylates (late)
53
A patient is found to have both glomerulonephritis and pulmonary vasculitis. What two diagnoses should be considered?
- Goodpasture | - GPA (Wegener)
54
An 8 yo girl presents with abdominal pain, hip and knee pain, and purpura on the backs of the arms and legs. U/A shows microscopic hematuria and mild proteinuria. What is the most likely diagnosis?
IgA nephropathy (HSP)
55
Which glomerular disease would you suspect most in a patient with the following findings? - linear pattern of IgG deposition on IF
Goodpasture
56
Which glomerular disease would you suspect most in a patient with the following findings? - lumpy-bumpy deposits of IgG, IgM, and C3 in the mesangium
PSGN
57
Which glomerular disease would you suspect most in a patient with the following findings? - Deposits of IgA in the mesangium
IgA nephropathy
58
Which glomerular disease would you suspect most in a patient with the following findings? - anti-GBM antibodies, hematuria, hemoptysis
Goodpasture
59
Which glomerular disease would you suspect most in a patient with the following findings? - crescent formation in the glomeruli
RPGN (crescentic)
60
Which glomerular disease would you suspect most in a patient with the following findings? - wire-looping appearance on LM
lupus-nephritis
61
What are the defining features of nephrotic syndrome? (3)
- proteinuria > 3.5 g/day - hypoalbuminemia - peripheral edema
62
Glomerular histology reveals multiple mesangial nodules. This lesion is indicative of what disease?
Diabetic glomerulonephropathy | - Kimmelstiel-Wilson lesions
63
Which glomerular disease would you suspect most? | - most common nephrotic syndrome in adults
FSGS
64
Which glomerular disease would you suspect most? | - EM: effacement of epithelial foot processes
minimal change
65
Which glomerular disease would you suspect most? | - nephrotic syndrome associated with hep B
membranoproliferative glomerulonephritis (MPGN)
66
Which glomerular disease would you suspect most? | - nephrotic syndrome associated with HIV
FSGS
67
Which glomerular disease would you suspect most? | - EM: subendothelial humps and tram-track appearance
MPGN
68
Which glomerular disease would you suspect most? | - LM: segmental sclerosis and hyalinosis
FSGS
69
Which glomerular disease would you suspect most? | - purpura on back of arms and legs, abdominal pain, IgA nephropathy
Henoch-Schonlein purpura (HSP)
70
Which glomerular disease would you suspect most? | - EM: spiking of the GBM due to electron-dense subepithelial deposits
membranous nephropathy
71
What is the WAGR complex?
Wilm's tumor Aniridia GU malformation Retardation (mental)
72
What are the risk factors for transitional cell carcinoma? (3)
- smoking - aniline dyes - cyclophosphamide
73
What GU pathology fits each of the following descriptions? | - most common tumor of the urinary tract
TCC
74
What GU pathology fits each of the following descriptions? | - most common renal malignancy of early childhood (age 2-4)
Wilm's
75
What GU pathology fits each of the following descriptions? | - most common type of renal stone
calcium
76
What GU pathology fits each of the following descriptions? | - type of renal stone associated with Proteus vulgaris
struvite stones
77
What GU pathology fits each of the following descriptions? | - red cell casts
acute glomerulonephritis
78
What GU pathology fits each of the following descriptions? | - waxy casts
chronic renal failure (long standing kidney disease)
79
What are the classic features of drug-induced acute interstitial nephritis? (4)
fever, rash, eosinophilia, azotemia
80
What changes will be seen in a BMP in a pt with renal failure? (3)
- high K+ - low Ca2+ - high BUN and Cr

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