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Flashcards in GU 1 (Step up son) Deck (39):
1

What happens in proximal convoluted tubule?

Glucose, amino acids, metabolites, and sodium (2/3) are reabsorbed
Cl- and H2O go along gradient
HCO3- is reabsorbed via carbonic anhydrase

Organic acids (uric acid) and bases are SECRETED

2

What happens in the descending loop of Henle?

Permeable to water...deeper increases osmotic gradient --> reabsorption of water/concentration of urine

3

What happens in the ascending loop of Henle?

Active reabsorption via Na+/K+/2Cl- cotransporter
Reabsorption of Mg2+, Ca2+, and K+ via paracellular diffusion

4

What happens in the distal convoluted tubule?

Impermeable to water
Na+ and Cl- are reabsorbed via Na+/Cl- transporter
Ca2+ reabsorbed via PTH activity

5

What happens in the collecting tubule and duct?

Aldosterone causes principal cells to reabsorb Na+ and secrete K+
Intercalated cells secrete H+ and reabsorb K+
ADH drives H2O reabsorption

6

Why do loop diuretics help with treating pulmonary edema caused by volume overload?

Beyond getting rid of fluid, the also have a direct pulmonary vasodilatory effect

7

Where do loop diuretics work? What are the side effects?

Loops inhibit Na/K/2Cl cotransporter in the ascending limb

Ototoxicity
Hyperuricemia
Hypokalemia
Hypocalcemia

8

Where do thiazides work? What are the side effects?

Thiazides inhibit Na/Cl cotransporter in the distal convoluted tubule

Hypokalemia
HyperGLUC...Glucose, Lipids, Uric acid, Calcium

9

What causes pyelonephritis?

E. coli (most common)
Staph sapro, Klebsiella, and proteus also can
Candida in immunocompromised

10

How is pyelonephritis treated?

Fluoroquinolones
Aminoglycosides (gentamicin)
3rd gen cephalosporins

11

What can happen if a pregnant woman gets pyelo?

preterm labor and low birth weight

12

What kind of kidney stones will not show up on AXR?

Uric acid stone

13

What is a pathologic difference between calcium oxalate stones and calcium phosphate stones?

Calcium oxalate: idiopathic
Calcium phosphate: Hyperparathyroidism

14

What causes persistent hematuria in patients less than 20?

Glomerular disease

15

What causes persistent hematuria in patients between 20 and 50?

Adult PCKD
Neoplasm (bladder, kidney, prostate)
Glomerular disease

16

What causes persistent hematuria in patients Older than 50?

Adult PCKD
BPH
Neoplasm (bladder, kidney, prostate)
Glomerular disease

17

What is a possible complication of PCKD?

Subarachnoid hemorrhage (15% of PCKD patients)
MVP

18

What is elevated with renal cell carcinoma? What other malignancies cause this?

Erythropoietin

Hepatocellular carcinoma
Pheochromocytoma
Hemangioblastoma

19

Watch out for Acute Interstitial Nephritis (AIN) after starting a new drug (it's a long list)...

...look for signs of ARF, N/V, malaise, rash, fever; also eosinophilia

20

A kid comes in concerned about brown pee and swelling. On review, he had a fever, sore throat, and tender lumps on his neck a couple of weeks ago. What is a possible diagnosis? What would be seen on labs? How should he be treated?

Likely poststreptococcal glomerulonephritis

UA: hematuria and proteinuria
Antistreptolysin O titer (ASO): high
Electron microscopy (EM) of GBM: bumpy deposits* of IgG and C3

Self-limited...supportive if necessary (edema, HTN)

21

What is seen with EM of IgA nephropathy (Berger disease)? How should it be treated?

Mesangial cell proliferation

Occasionally self-limited
ACEI and statin for prolonged proteinuria
Corticosteroids if becomes nephrotic (proteinuria > 3.5g/day)

22

REVIEW: How is Goodpasture syndrome treated?

Plasmapheresis
Corticosteroids and immunosuppressive agents can help

23

Mom brings young infant in because of hematuria. Also says that the baby doesn't react to whistling and other high-pitched sounds and the baby's eyes are cloudy. What is a likely diagnosis? What would be seen on EM? What can be done?

This is likely Alport Syndrome (defect in collagen IV in basement membrane)

EM shows a split basement membrane*

ACEI helps w/ proteinuria
Transplant can be complicated by Alport induced Goodpastures

24

What causes the crescents with rapidly progressive glomerulonephritis (RPGN)? What is it called if ANCA+? How is it managed?

Basement membrane wrinkling with inflammatory cells and fibrous material in Bowman capsule

Pauci-Immune RPGN

Steroids, plasmapheresis, and immunosuppressive agents kinda help...but transplant is usually required

25

What happens with Lupus nephritis? How is it treated?

Proliferation of endothelial and mesangial cells

Corticosteroids
ACEI
Statin

26

REVIEW: Granulomatosis with polyangiitis (Wegener's) has what lab elevation?

c-ANCA

27

SUMMARY: How are nephritic syndromes treated?

Corticosteroids
ACEI and Statins to reduce proteinuria

28

What is the most common nephrotic syndrome in kids? what is seen on EM? how is it treated?

Minimal Change Disease

Effacement of foot processes

Steroids

29

What is the most common nephrotic syndrome in adults? How is it treated?

Focal Segmental Glomerular Sclerosis (FSGS)

Steroids, cytotoxic agents, ACEI, statins
Rarely transplant...usually recurs anyway

30

What type of nephrotic syndrome presents with *spike and dome BM thickening*? What abnormal treatment is required?

Membranous globerulonephritis

Requires anticoagulation...renal vain thrombosis

31

A patient with either a systemic infection or autoimmune condition comes in for progressively frothy urine that may be getting a little darker. What is a concern? What would be seen on EM if that were the case?

Membanoproliferative glomerulonephritis

*Train tracks*

32

A patient comes in w/ hx of uncontrolled DM now having frothy urine. What is the pathology of the disease? What might be seen on EM? How is it managed?

Diabetic nephropathy (diffuse or nodular) results from basement membrane and mesangial thickening

BM thickening for sure
Round nodules (Kimmelstiel-Wilson nodules) w/ nodular type

DM treatment
Dietary protein restriction
ACEI

33

What is the most common cause of acute renal failure?

Drugs --> ATN --> ARF

34

What is indicated by hematuria and red cell casts on UA?

Glomerular or vasculitic disease

35

What is indicated by epithelial casts?

ATN

36

What is indicated by pyuria with waxy casts?

Interstitial disease or obstruction

37

What is indicated by pyuria alone?

Infection

38

How is FENa calculated? what does it indicate?

FENa = (urine Na/serum Na)/(urine cr/serum cr)

Less than 1% --> prerenal
Greater than 2% --> ATN

39

How should ARF be managed?

Prevent fluid overload
Stop drugs causing ATN
Low protein diet
Steroids
Dialysis