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Flashcards in cram.firstaid.renal Deck (233)
1

ureters pass under ___ or ___

uterine a.
vas deferens

2

___ of total bodyweight is water

60%

3

2 compartments of total body water

ICF
ECF

4

ICF is ___ of total body water

3-Feb

5

2 parts of ECF

interstitial fluid
plasma

6

interstitial fluid is ___ of ECF

4-Mar

7

plasma volume is measured via ___ (2)

radiolabeled albumin
evans blue

8

ECF is measured via ___ (2)

inulin
mannitol

9

negative charge of glomerular BM is from ___
this is lost in ___

heparan sulfate
nephrotic syndrome

10

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

11

if C_x < GFR, then ___

x is reabsorbed

12

if C_x > GFR, then ___

x is secreted

13

because ____, ____ (2) can estimate GFR

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

14

starling forces equation for GFR

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

15

renal plasma flow may be estimated by ___
this is because ___

CL_PAH
it is primarily secreted and only slightly filtered

16

RPF in terms of RBF

RPF = RBF(1-HCT)

17

estimated RPF (from PAH) over/underestimates RPF

underestimates

18

definition of filtration fraction (FF)
normal value of FF

FF = GFR/RPF
20%

19

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

efferent
constriction
ACEI or ARB

20

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

afferent
dilation
NSAIDs

21

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

lowers
lowers
no change

22

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

lowers
raises
raises

23

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

no change
lowers
lowers

24

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

no change
lowers
lowers

25

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)

26

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

0

27

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

filtered load = (GFR)(P_x)

28

2 related measures of urinary transit of substance x

filtered load
excretion rate

29

filtered load is product of ___ (2)

GFR
P_x

30

excretion rate is product of ___ (2)

V
U_x

31

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

x is neither reabsorbed nor filtered

32

glucosuria occurs at plasma glucose levels above ___ mg%

160

33

___ happens above plasma glucose of 350mg%

saturation of Glc transporters

34

2 disease resulting from deficient PT AA transporters

Hartnup
cystinuria

35

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

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

36

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

37

4 substances with reabsorption > secretion

Glc
AAs
HCO3-
P_i

38

2 parts of juxtaglomerular apparatus

JG cells
macula densa

39

JG cells are ___ cells in ___

smooth muscle
afferent arteriole

40

macula densa cells are ___ cells in ___

epithelial
early DCT

41

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

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

42

renin acts via ___

converting angiotensinogen -> Ang I

43

EPO is made by ___ cells of ___

endothelial
peritubular capillaries

44

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

proximal tubule
1alpha hydroxylase
PTH

45

3 physiologic states which cause K+ shift OUT of cell

acidosis
severe exercise
hyperosmolarity

46

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

beta blocker
digoxin
Na+/K+ ATPase inhibition

47

acidosis causes hyperkalemia because ___

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

48

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

insulin
beta agonists
Na+/K+ ATPase activation

49

2 kinds of acidosis

respiratory
metabolic

50

2 defining lab values for respiratory acidosis

pH40 mmHg

51

2 defining lab values for metabolic acidosis

pH<40 mmHg

52

2 kinds of metabolic acidosis

anion gap high
anion gap normal

53

anion gap definition

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

54

anion gap is comprised of ___ (4)

anionic protein
P_i
citrate
sulfate

55

elevated anion gap metabolic acidisis means ___ (2)

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

56

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

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

57

4 causes of non-anion gap metabolic acidosis

diarrhea
glue sniffing
RTA
hyperchloremia

58

normal anion gap

8-12 mEq/L

59

2 kinds of alkalosis

metabolic
respiratory

60

2 lab values for metabolic alkalosis

pH>7.4
PCO2>40 mmHg

61

2 required lab values for respiratory alkalosis

pH>7.4
PCO2<40 mmHg

62

4 causes of metabolic alkalosis

diuretics
vomiting
antacids
hyperaldosteronism

63

2 causes of respiratory alkalosis

hyperventilation
aspirin intoxication (early)

64

3 types of RTA

1
2
4

65

type 1 RTA is caused by ___ in ___

deficient H+ excretion
collecting tubule

66

type 1 RTA is associated with ___ (2)

hypokalemia
Ca2+ stones

67

type 2 RTA is caused by ___ in ___

deficient HCO3- reabsorption
proximal tubule

68

type 2 RTA is associated with ___ (2)

hypokalemia
hypophasphatemic rickets

69

type 4 RTA is caused by ___ (2)

hypoaldosteronism
aldosterone insensitivity

70

type 4 RTA is associated with ___

hyperkalemia

71

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

reduced NH3 excretion
aciduria

72

dd of RBC casts (3)

GN
ischemia
malignant HTN

73

dd of WBC casts (3)

tubulointerstitial inflammation
acute pyelonephritis
transplant rejection

74

cause of granular casts

ATN

75

cause of waxy casts

RF (main chronic)

76

presence of casts means urinary complaint is ___

of renal origin

77

3 kinds of causes of RPGN

anti-GBM disease
immune complex vasculitis
pauci-immune vasculitis

78

___ causes anti-GBM RPGN

Goodpasture's disease

79

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

essential cryoglobulinemic
HSP
cutaneous leukocytoclastic
SLE
PAN
HSP
SLE

80

GN causes ___ (2) in urine

hematuria
RBC casts

81

GN causes ___ (4) derangements of renal function

azotemia
oliguria
HTN
proteinuria

82

proteinuria in GN is ___

<3.5g/day

83

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

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

84

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

kids
spontaneous resolution
S. pyogenes

85

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

IgG
IgM
C3

86

2 lab values for post-strep GN

high ASO
low C3

87

4 components of RPGN cresents

glomerular parietal epitheilum
fibrin
plasma protein
MQs

88

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

urinary (Bowman's) space

89

2 causes of diffuse proliferative GN

SLE
MPGN

90

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

subendothelial deposits
lumpy-bumpy pattern

91

diffuse proliferative GN represents WHO class ___ SLE renal disease

4

92

class I SLE renal disease

no changes

93

class II SLE renal disease

mesangial GN

94

class III SLE renal disease

focal proliferative GN

95

class V SLE renal disease

diffuse membranous GN

96

most common form of SLE renal disease

class IV

97

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

capillary wall thickening
wire looping
subendothelial deposits
lumpy bumpy pattern

98

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

mesangial IC deposits
URI
gastroeneteritis

99

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

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

100

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

capillary wall thickening
GBM thickening
subepithelial deposits

101

DMGN subepithelial deposits have ___ appearance

spike and dome

102

___ is MCC of nephrotic syndrome in kids

minimal change disease (MCD)

103

on LM, MCD has ___
on EM it has ___

minimal change
foot process effacement

104

MCD patients lose ___ but not ___

albumin
globulins

105

MCD tx

CS

106

most common glomerular disease in HIV patients

FSGS

107

T/F: FSGS is usually secondary to systemic disease

false: usually idiopathic

108

idiopathic FSGS is more common in ___ (2 ethnicities)

hispanic
black

109

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

50

110

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

IgM
C3
ICs

111

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

foot-process effacement

112

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

filtration slit
nephrin
podocin
alpha-actinin

113

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

114

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

immune complex MPGN
dense deposit disease
immune complex MPGN

115

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

116

deposits in IC MPGN are ___ (4)

IgG
C3
C4
C1

117

deposits in dense deposit disease are ___ (2)

C3
properdin

118

in MPGN serum C3 is high/low

low

119

amyloidosis deposits accumulate in ___ (2)

mesangium
subendothelium

120

3 GBM changes in DM

thickening
more collagen IV
less proteoglycans

121

___ is a useful early test in DM

microalbuminuria

122

2 DM risk factors for DM nephropathy

uncontrolled DM
HTN

123

___ are essential drugs for arresting DM nephropathy

ACEIs

124

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

diffuse GBM thickening
non-enzymatic glycation
diffuse GS
nodular GS

125

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

PAS + nodules
dilated capillaries
Kimmelstiel-Wilson disease

126

microalbuminuria is ____/day
macroproteinuria is ___/day

>30mg
>300mg

127

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

hyaline arteriolosclerosis
pyelonephritis

128

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

volatile hydrocarbons
gasoline workers

129

3 problems in Alport's syndrome

nephritis
deafness
ophthalmic disorders

130

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

XLR
AR
XLR

131

Alport's is caused by mutations in ___.

collagen IV

132

Alport's appears as ___ on EM

lamellation of GBM

133

in nephrotic syndrome ANP is high/low

low

134

2 complications of nephrotic syndrome

infection
thrombosis

135

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

loss of Igs
loss of anticoagulants

136

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

Berger's disease
IgA
C3
mesangium
alternate complement pathway

137

IgA nephropathy may appear via LM as ___ (3)

normal
focal GN
mesangial cell proliferation

138

IgA nephropathy is associated with ___ (2).

celiac
liver disease

139

IgA nephropathy is a mild/severe disease.

mild

140

T/F: in MCD renal function is normal.

TRUE

141

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

nephrin deficiency
HLy
NSAIDs
atopy

142

3 systemic diseases causing nephrotic syndrome

SLE
amyloidosis
DM

143

2 complications of kidney stones

hydronephrosis
pyelonephritis

144

___ is most common kind of kidney stone

Ca2+

145

2 kinds of Ca2+ kidney stone

Ca2+ oxalate
Ca2+ phosphate

146

Ca2+ stones are radio-___

opaque

147

Ca2+ stone crystal shape

rectangular with X

148

4 causes of Ca2+ stones

hyper-PTH
hypervitaminosis D
cancer
milk-alkali syndrome

149

2 causes of Ca2+ oxalate crystals

ethylene glycol poisoning (antifreeze)
vitamin C abuse

150

2nd most common kidney stone

struvite (15%)

151

struvite is either ___ or ___

NH4MgSO4
NH4Mg(PO3)3

152

struvite stones can cause ___

staghorn calculi

153

staghorn calculi can cause ___

UTI

154

struvite stones are radio-___

opaque

155

struvite stones are caused by ___

urease + bacteria

156

5 urease + bugs

Proteus vulgaris
Klebsiella
HP
Ureaplasma
Staph

157

struvite crystal shape

rectangular

158

3rd most common kidney stone

urate (5%)

159

urate crystals are associated with ___ (2)

leukemia
MPD
(high cell turnorver rate)

160

urate crystals are radio-___

lucent

161

4th most common kidney stone

cystine (1%)

162

main cause of cystine stones

cystinuria

163

cystine crystals shape

hexagonal

164

cystine crystals can cause ___

staghorn calculi

165

cystine crystals are radio-___

opaque (faintly)

166

4 ectopic hormones associated with RCC

EPO
ACTH
PTHrP
PRL

167

RCC is associated with ___

VHL

168

___ is most common renal malignancy in kids

Wilms'

169

Wilms' tumor contains ___

embryonic glomeruli

170

growth disorder associated with Wilms' tumor

hemihypertrophy

171

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

WT1
11
tumor-suppressor

172

complex including Wilms' tumor

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

173

symptom suggestive of transitional cell ca

painless hematuria

174

TCC is associated with ___ (4)

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

175

pyelonephritis primarily affects ___ of kidney

cortex

176

pyelonephritis has ___ casts in ___
this is called ___

eosinophilic
tubules
thyroidization

177

2 causes of diffuse cortical necrosis

obstetric catastrophe
septic shock

178

2 mechanisms of diffuse cortical necrosis

DIC
vasospasm

179

___ is reversible but requires ___ to prevent death

ATN
supportive dialysis

180

ATN is associated with ___ (3)

shock
crush injury (myoglobinuria)
toxins

181

ATN has ___ phase followed by ___ occurring at ___

oliguric
recovery
2--3 weeks

182

death from ATN occurs in ___ phase

oliguric

183

prerenal azotemia is caused by ___

reduced RBF

184

postrenal azotemia is caused by ___

BILATERAL outflow obstruction

185

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

high (>500)
low (20

186

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

low (20)
>2%
<15

187

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

low (40)
>4%
>15

188

electrolyte disorder in RF

hyperkalemia

189

acid-base disorder in RF

metabolic acidosis

190

uremia syndrome includes ___ (5)

nausea
pericaditis
encephalopathy
platelet dysfunction
asterixis

191

skeletal disorder in RF
cause is ___

renal osteodystrophy
deficient 1,25-OHD

192

metabolic disorder in RF

dyslipidemia (hyper-TAG)

193

Fanconi's syndrome is deficient ___ in ___

metabolite transport
PT

194

4 metabolites lost in Fanconi's syndrome

Glc
AAs
phosphate
uric acid

195

2 kinds of Fanconi's syndrome

congenital
acquired

196

3 kinds of causes of Fanconi's

Wilson's
glycogen storage disease
drugs

197

2 drugs causing Fanconi's

cisplatin
expired tetracycline

198

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

cortex
benign

199

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

concentrating defect
small kidney on US
bad

200

4 sx of hyponatremia

disorientation
stupor
coma
seizure

201

3 sx of hypernatremia

irritability
delirium
coma

202

hypochloremia is associated with ___ (4)

metabolic alkalosis
hyperaldosteronism
hypokalemia
hypovolemia

203

hyperchloremia is associated wtih ___

non-anion gap metabolic acidosis

204

2 sx of hypokalemia

paralysis
arrhythmia

205

2 EKG signs of hypokalemia

U wave
flattened T wave

206

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

small deflection after T wave
T wave
septal repolarization

207

T/F: u wave is pathological

false: present in 50% of normal EKG

208

sx of hyperkalemia

arrhythmia

209

2 EKG signs of hyperkalemia

peaked T wave
wide QRS

210

2 sx of hypocalcemia

tetany
neuromuscular irritability

211

T/F: hypercalcemia can occur without hypercalciuria

TRUE

212

2 sx of hypomagnesemia

neuromuscular irritability
arrhythmia

213

3 sx of hypermagnesemia

delirium
decreased DTRs
cardiopulmonary arrest

214

2 sx of hypophosphatemia

bone loss
osteomalacia

215

2 sx of hyperphosphatemia

kidney stones
metastatic calcification

216

4 indications for mannitol

high ICP
high intraocular pressure
drug OD
shock

217

2 mannitol SEs

pulmonary edema
dehydration

218

mannitol is contraindicated in ___ (2)

CHF
anuria

219

acetazolamide mechanism

CA inhibition

220

CA does ___

H2O + CO2 H2CO3

221

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

HCO3-
H+
H2CO3

222

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

HCO3- reabsorption
HCO3- excretion
metabolic acidosis

223

6 indications for acetazolamide

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

224

furosemide causes increased ___ excretion

Ca2+

225

6 furosemide SEs

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

226

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

ethacrynic acid
gout

227

4 indications for thiazide

HTN
CHF
idiopathic hypercalciuria
nephrogenic DI

228

7 thiazide SEs

hypokalemic metabolic alkalosis
hyponatremia
hyperGlycemia
hyperLipidemia
hyperUricemia
hyperCalcemia
sulfa allergy

229

triamterene acts at same channel as ___

amiloride

230

___ diuretics cause acidemia
___ (2) cause alkalemia

acetazolamide
loop diuretics
thiazide

231

___ diuretics cause hypercalciuria
___ cause hypocalciuria

loop diuretics
thiazide

232

10 ACEI SEs

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

233

ACEIs are contraindicated in ___
because ___

bilateral renal artery stenosis
they lower GFR