cram.firstaid.renal Flashcards by d k

ureters pass under ___ or ___

uterine a.

vas deferens

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___ of total bodyweight is water

60%

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2 compartments of total body water

ICF

ECF

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ICF is ___ of total body water

3-Feb

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2 parts of ECF

interstitial fluid

plasma

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interstitial fluid is ___ of ECF

4-Mar

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plasma volume is measured via ___ (2)

radiolabeled albumin

evans blue

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ECF is measured via ___ (2)

inulin

mannitol

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negative charge of glomerular BM is from ___

this is lost in ___

heparan sulfate

nephrotic syndrome

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formula for clearance of substance X

C_x = U_xV/P_x
where C_x = clearance of x, 
U_x = urinary concentration of x, 
V = urine flow rate,
P_x = plasma concentration of x

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if C_x < GFR, then ___

x is reabsorbed

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if C_x > GFR, then ___

x is secreted

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because ____, ____ (2) can estimate GFR

they are neither reabsorbed nor secreted
inulin clearance
creatinine clearance (slightly secreted though)

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starling forces equation for GFR

GFR = K_f[(P_GC - P_BS) - (Pi_GC - Pi_BS)]

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renal plasma flow may be estimated by ___

this is because ___

CL_PAH

it is primarily secreted and only slightly filtered

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RPF in terms of RBF

RPF = RBF(1-HCT)

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estimated RPF (from PAH) over/underestimates RPF

underestimates

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definition of filtration fraction (FF)

normal value of FF

FF = GFR/RPF

20%

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Ang II works on ___ arteriole
effect is ___
effect is blocked by ___

efferent
constriction
ACEI or ARB

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PGs work on ___ arteriole
effect is ___
effect is blocked by ___

afferent
dilation
NSAIDs

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afferent arteriole constriction does
___ to RPF
___ to GFR
___ to FF

lowers
lowers
no change

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efferent arteriole constriction does
___ to RPF
___ to GFR
___ to FF

lowers
raises
raises

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plasma protein concentration increase does
___ to RPF
___ to GFR
___ to FF

no change
lowers
lowers

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ureter constriction does
___ to RPF
___ to GFR
___ to FF

no change
lowers
lowers

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definition of free water clearance

C_H2O = V - C_osm where V = urine flow rate, C_osm = clearance of osmoles = U_osmV/P_osm i.e. C_H2O = V(1 - U_osm/P_osm)

when ADH is present, C_H2O is ___ | otherwise, it's ___

quantity of x excreted in terms of GFR (filtered load)

filtered load = (GFR)(P_x)

2 related measures of urinary transit of substance x

filtered load | excretion rate

filtered load is product of ___ (2)

GFR | P_x

excretion rate is product of ___ (2)

V | U_x

(excretion rate)_x = (filtered load)_x if ___

x is neither reabsorbed nor filtered

glucosuria occurs at plasma glucose levels above ___ mg%

160

___ happens above plasma glucose of 350mg%

saturation of Glc transporters

2 disease resulting from deficient PT AA transporters

Hartnup | cystinuria

descending limb of LOH is ___ for water | ascending limb is ___

permeable (water efflux from urine) | impermeable (electrolyte efflux)

5 substances with secretion > reabsorption | on plot of [TF]/[P] vs. distance along PT, this is represented as ___

``` PAH inulin creatinine urea Cl- slope > 1 ```

4 substances with reabsorption > secretion

Glc AAs HCO3- P_i

2 parts of juxtaglomerular apparatus

JG cells | macula densa

JG cells are ___ cells in ___

smooth muscle | afferent arteriole

macula densa cells are ___ cells in ___

epithelial | early DCT

renin is secreted by ___ | in response to ___ (3)

JG cells hypoTN reduced Na+ at macula densa NE (beta_1 R)

renin acts via ___

converting angiotensinogen -> Ang I

EPO is made by ___ cells of ___

endothelial | peritubular capillaries

2nd hydroxylation of D3 is done by ___ cells enzyme is ___ it is induced by ___

proximal tubule 1alpha hydroxylase PTH

3 physiologic states which cause K+ shift OUT of cell

acidosis severe exercise hyperosmolarity

2 drugs which cause K+ shift OUT of cell | mechanism of both is ___

beta blocker digoxin Na+/K+ ATPase inhibition

acidosis causes hyperkalemia because ___

H+/K+ exchanger swaps extracellular H+ for intracellular K+

2 drugs which cause K+ shift INTO cell | mechanism is ___

insulin beta agonists Na+/K+ ATPase activation

2 kinds of acidosis

respiratory | metabolic

2 defining lab values for respiratory acidosis

pH40 mmHg

2 defining lab values for metabolic acidosis

pH<40 mmHg

2 kinds of metabolic acidosis

anion gap high | anion gap normal

anion gap definition

AG = Na+ - (Cl- + HCO3-)

anion gap is comprised of ___ (4)

anionic protein P_i citrate sulfate

elevated anion gap metabolic acidisis means ___ (2)

HCO3- was lost | the unmeasured anions have increased to take its place

non-elevated anion gap metabolic acidosis means ___ (2)

HCO3- was lost | Cl- has increased to take its place

4 causes of non-anion gap metabolic acidosis

diarrhea glue sniffing RTA hyperchloremia

normal anion gap

8-12 mEq/L

2 kinds of alkalosis

metabolic | respiratory

2 lab values for metabolic alkalosis

pH>7.4 | PCO2>40 mmHg

2 required lab values for respiratory alkalosis

pH>7.4 | PCO2<40 mmHg

4 causes of metabolic alkalosis

diuretics vomiting antacids hyperaldosteronism

2 causes of respiratory alkalosis

``` hyperventilation aspirin intoxication (early) ```

3 types of RTA

1 2 4

type 1 RTA is caused by ___ in ___

deficient H+ excretion | collecting tubule

type 1 RTA is associated with ___ (2)

hypokalemia | Ca2+ stones

type 2 RTA is caused by ___ in ___

deficient HCO3- reabsorption | proximal tubule

type 2 RTA is associated with ___ (2)

hypokalemia | hypophasphatemic rickets

type 4 RTA is caused by ___ (2)

hypoaldosteronism | aldosterone insensitivity

type 4 RTA is associated with ___

hyperkalemia

hyperkalemia in type 4 RTA causes ___ in PT | this causes ___

reduced NH3 excretion | aciduria

dd of RBC casts (3)

GN ischemia malignant HTN

dd of WBC casts (3)

tubulointerstitial inflammation acute pyelonephritis transplant rejection

cause of granular casts

ATN

cause of waxy casts

RF (main chronic)

presence of casts means urinary complaint is ___

of renal origin

3 kinds of causes of RPGN

anti-GBM disease immune complex vasculitis pauci-immune vasculitis

___ causes anti-GBM RPGN

Goodpasture's disease

5 immune complex causes of RPGN | of these ___ (2) also cause plain GN

``` essential cryoglobulinemic HSP cutaneous leukocytoclastic SLE PAN HSP SLE ```

GN causes ___ (2) in urine

hematuria | RBC casts

GN causes ___ (4) derangements of renal function

azotemia oliguria HTN proteinuria

proteinuria in GN is ___

<3.5g/day

post-strep GN has ___ (2) on LM, ___ on EM, and ___ on IF

hypercellular glomeruli (proliferative) neutrophilic infiltrate subepithelial deposits lumpy-bumpy pattern

post-strep GN happens mostly in ___ end-point is ___ causative strep species is ___

kids spontaneous resolution S. pyogenes

immune complexes in post-strep GN consist of ___ (3)

IgG IgM C3

2 lab values for post-strep GN

high ASO | low C3

4 components of RPGN cresents

glomerular parietal epitheilum fibrin plasma protein MQs

fibrin, plasma protein and MQs of RPGN crescents are located in ___

urinary (Bowman's) space

2 causes of diffuse proliferative GN

SLE | MPGN

diffuse proliferative GN has ___ on EM, and | ___ on IF

subendothelial deposits | lumpy-bumpy pattern

diffuse proliferative GN represents WHO class ___ SLE renal disease

class I SLE renal disease

no changes

class II SLE renal disease

mesangial GN

class III SLE renal disease

focal proliferative GN

class V SLE renal disease

diffuse membranous GN

most common form of SLE renal disease

class IV

on LM, DPGN has ___ aka ___ on EM it has ___ on IF it has ___

capillary wall thickening wire looping subendothelial deposits lumpy bumpy pattern

IgA nephropathy GN has ___ on LM | it commonly occurs after ___ (2)

mesangial IC deposits URI gastroeneteritis

___ is the MCC of nephrotic syndrome in adults | it is caused by ___ (4)

``` diffuse membranous GN (DMGN) SLE (class V) drugs infections solid tumors ```

on LM, DMGN has ___ (2) | on EM it has ___

capillary wall thickening GBM thickening subepithelial deposits

DMGN subepithelial deposits have ___ appearance

spike and dome

___ is MCC of nephrotic syndrome in kids

minimal change disease (MCD)

on LM, MCD has ___ | on EM it has ___

minimal change | foot process effacement

MCD patients lose ___ but not ___

albumin | globulins

MCD tx

most common glomerular disease in HIV patients

FSGS

T/F: FSGS is usually secondary to systemic disease

false: usually idiopathic

idiopathic FSGS is more common in ___ (2 ethnicities)

hispanic | black

___% of FSGS reach end-stage disease within 10 years

in FSGS, IF identifies ___ (2) deposits. these are not ___s.

IgM C3 ICs

in FSGS, ____ is visible on EM in non-sclerotic areas

foot-process effacement

idiopathic FSGS is caused by defect in ___. for example, ____ (3 proteins).

filtration slit nephrin podocin alpha-actinin

in membranous nephropathy complement causes capillary damage directly via ___ and indirectly via ____ from ____ (2)

MAC MAC-triggered ROS and protease release epithelial cells mesangial cells

2 kinds of MPGN are ___. ___ is much more common than the other.

immune complex MPGN dense deposit disease immune complex MPGN

in both kinds of MPGN, ____ cells try to phagocytose ____, after which they ___. in response ____ cells secrete more ____, which causes loss of ____.

``` mesangial subendothelial deposits proliferate endothelial GBM capillary lumen ```

deposits in IC MPGN are ___ (4)

IgG C3 C4 C1

deposits in dense deposit disease are ___ (2)

C3 | properdin

in MPGN serum C3 is high/low

low

amyloidosis deposits accumulate in ___ (2)

mesangium | subendothelium

3 GBM changes in DM

thickening more collagen IV less proteoglycans

___ is a useful early test in DM

microalbuminuria

2 DM risk factors for DM nephropathy

uncontrolled DM | HTN

___ are essential drugs for arresting DM nephropathy

ACEIs

all DM has ___. this is caused by ___. | some patients progress to ___ and others to ___.

diffuse GBM thickening non-enzymatic glycation diffuse GS nodular GS

nodular GS has ____ surrounded by ___. nodular GS is aka ___

PAS + nodules dilated capillaries Kimmelstiel-Wilson disease

microalbuminuria is ____/day | macroproteinuria is ___/day

>30mg | >300mg

in addition to GS, ____ (2) are DM associated nephropathies

hyaline arteriolosclerosis | pyelonephritis

exposure to ___ such as in ___ (occupation) is a risk factor for Goodpasture

volatile hydrocarbons | gasoline workers

3 problems in Alport's syndrome

nephritis deafness ophthalmic disorders

2 inheritance patterns for Alport's. the more common is ___.

XLR AR XLR

Alport's is caused by mutations in ___.

collagen IV

Alport's appears as ___ on EM

lamellation of GBM

in nephrotic syndrome ANP is high/low

low

2 complications of nephrotic syndrome

infection | thrombosis

infection in nephrotic syndrome is because of ___ | thrombosis in nephrotic syndrome is because of ___

loss of Igs | loss of anticoagulants

IgA nephropathy is aka ___. it is caused by accumulation of ___ (2) in ___. this activates ___.

``` Berger's disease IgA C3 mesangium alternate complement pathway ```

IgA nephropathy may appear via LM as ___ (3)

normal focal GN mesangial cell proliferation

IgA nephropathy is associated with ___ (2).

celiac | liver disease

IgA nephropathy is a mild/severe disease.

mild

T/F: in MCD renal function is normal.

TRUE

MCD is occasionally associated with ___ and rarely with ___ (3)

nephrin deficiency HLy NSAIDs atopy

3 systemic diseases causing nephrotic syndrome

SLE amyloidosis DM

2 complications of kidney stones

hydronephrosis | pyelonephritis

___ is most common kind of kidney stone

Ca2+

2 kinds of Ca2+ kidney stone

Ca2+ oxalate | Ca2+ phosphate

Ca2+ stones are radio-___

opaque

Ca2+ stone crystal shape

rectangular with X

4 causes of Ca2+ stones

hyper-PTH hypervitaminosis D cancer milk-alkali syndrome

2 causes of Ca2+ oxalate crystals

ethylene glycol poisoning (antifreeze) | vitamin C abuse

2nd most common kidney stone

struvite (15%)

struvite is either ___ or ___

NH4MgSO4 | NH4Mg(PO3)3

struvite stones can cause ___

staghorn calculi

staghorn calculi can cause ___

UTI

struvite stones are radio-___

opaque

struvite stones are caused by ___

urease + bacteria

5 urease + bugs

``` Proteus vulgaris Klebsiella HP Ureaplasma Staph ```

struvite crystal shape

rectangular

3rd most common kidney stone

urate (5%)

urate crystals are associated with ___ (2)

leukemia MPD (high cell turnorver rate)

urate crystals are radio-___

lucent

4th most common kidney stone

cystine (1%)

main cause of cystine stones

cystinuria

cystine crystals shape

hexagonal

cystine crystals can cause ___

staghorn calculi

cystine crystals are radio-___

opaque (faintly)

4 ectopic hormones associated with RCC

EPO ACTH PTHrP PRL

RCC is associated with ___

VHL

___ is most common renal malignancy in kids

Wilms'

Wilms' tumor contains ___

embryonic glomeruli

growth disorder associated with Wilms' tumor

hemihypertrophy

___ on chromosome ___ is a gene linked to Wilms' tumor | it is a ___ gene

WT1 11 tumor-suppressor

complex including Wilms' tumor

``` Wilms' tumor Aniridia Genitourinary malformation mental-motor Retardation (WAGR) ```

symptom suggestive of transitional cell ca

painless hematuria

TCC is associated with ___ (4)

``` Phenacetin (analgesic) Smoking Aniline dyes CTX (Pee SAC) ```

pyelonephritis primarily affects ___ of kidney

cortex

pyelonephritis has ___ casts in ___ | this is called ___

eosinophilic tubules thyroidization

2 causes of diffuse cortical necrosis

obstetric catastrophe | septic shock

2 mechanisms of diffuse cortical necrosis

DIC | vasospasm

___ is reversible but requires ___ to prevent death

ATN | supportive dialysis

ATN is associated with ___ (3)

shock crush injury (myoglobinuria) toxins

ATN has ___ phase followed by ___ occurring at ___

oliguric recovery 2--3 weeks

death from ATN occurs in ___ phase

oliguric

prerenal azotemia is caused by ___

reduced RBF

postrenal azotemia is caused by ___

BILATERAL outflow obstruction

``` prerenal ARF has ___ urine osmolality ___ urine Na+ ___ FENa and ___ BUN/Cr ratio ```

high (>500) | low (20

``` renal ARF has ___ urine osmolality ___ urine Na+ ___ FENa and ___ BUN/Cr ratio ```

low (20) >2% <15

``` postrenal ARF has ___ urine osmolality ___ urine Na+ ___ FeNa and ___ BUN/Cr ratio ```

low (40) >4% >15

electrolyte disorder in RF

hyperkalemia

acid-base disorder in RF

metabolic acidosis

uremia syndrome includes ___ (5)

``` nausea pericaditis encephalopathy platelet dysfunction asterixis ```

skeletal disorder in RF | cause is ___

renal osteodystrophy | deficient 1,25-OHD

metabolic disorder in RF

dyslipidemia (hyper-TAG)

Fanconi's syndrome is deficient ___ in ___

metabolite transport | PT

4 metabolites lost in Fanconi's syndrome

Glc AAs phosphate uric acid

2 kinds of Fanconi's syndrome

congenital | acquired

3 kinds of causes of Fanconi's

Wilson's glycogen storage disease drugs

2 drugs causing Fanconi's

cisplatin | expired tetracycline

simple renal cysts are located in ___ | they are benign/symptomatic

cortex | benign

medullary renal cysts pw ___ (2) | prognosis is good/bad

concentrating defect small kidney on US bad

4 sx of hyponatremia

disorientation stupor coma seizure

3 sx of hypernatremia

irritability delirium coma

hypochloremia is associated with ___ (4)

metabolic alkalosis hyperaldosteronism hypokalemia hypovolemia

hyperchloremia is associated wtih ___

non-anion gap metabolic acidosis

2 sx of hypokalemia

paralysis | arrhythmia

2 EKG signs of hypokalemia

U wave | flattened T wave

U wave is ___ it has same polarity as ___ it is caused by ___

small deflection after T wave T wave septal repolarization

T/F: u wave is pathological

false: present in 50% of normal EKG

sx of hyperkalemia

arrhythmia

2 EKG signs of hyperkalemia

peaked T wave | wide QRS

2 sx of hypocalcemia

tetany | neuromuscular irritability

T/F: hypercalcemia can occur without hypercalciuria

TRUE

2 sx of hypomagnesemia

neuromuscular irritability | arrhythmia

3 sx of hypermagnesemia

delirium decreased DTRs cardiopulmonary arrest

2 sx of hypophosphatemia

bone loss | osteomalacia

2 sx of hyperphosphatemia

kidney stones | metastatic calcification

4 indications for mannitol

high ICP high intraocular pressure drug OD shock

2 mannitol SEs

pulmonary edema | dehydration

mannitol is contraindicated in ___ (2)

CHF | anuria

acetazolamide mechanism

CA inhibition

CA does ___

H2O + CO2 H2CO3

in PT, filtered ___ combines with secreted ___ to make ___

HCO3- H+ H2CO3

normally, CA facilitates ___ therefore, inhibition causes ___ this causes ___

HCO3- reabsorption HCO3- excretion metabolic acidosis

6 indications for acetazolamide

``` open angle glaucoma pseudotumor cerebri cystinuria altitude sickness metabolic alkalosis dural ectasia ```

furosemide causes increased ___ excretion

Ca2+

6 furosemide SEs

``` Ototoxicity Hypokalemia Dehydration Allergy (sulfa) Nephritis (interstitial) Gout ```

___ is a non-sulfonamide loop diuretic | it can be used in the presence of ___

ethacrynic acid | gout

4 indications for thiazide

HTN CHF idiopathic hypercalciuria nephrogenic DI

7 thiazide SEs

``` hypokalemic metabolic alkalosis hyponatremia hyperGlycemia hyperLipidemia hyperUricemia hyperCalcemia sulfa allergy ```

triamterene acts at same channel as ___

amiloride

___ diuretics cause acidemia | ___ (2) cause alkalemia

acetazolamide loop diuretics thiazide

___ diuretics cause hypercalciuria | ___ cause hypocalciuria

loop diuretics | thiazide

10 ACEI SEs

``` Cough Angioedema Proteinuria Taste changes hypOtension Pregnancy problems Rash Increased renin Lower Ang II hyperkalemia ```

ACEIs are contraindicated in ___ | because ___

bilateral renal artery stenosis | they lower GFR

cram.firstaid.renal Flashcards

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