GU 1 (Step up son)

Question 1

What happens in proximal convoluted tubule?

Answer 1

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

Question 2

What happens in the descending loop of Henle?

Answer 2

Permeable to water…deeper increases osmotic gradient –> reabsorption of water/concentration of urine

Question 3

What happens in the ascending loop of Henle?

Answer 3

Active reabsorption via Na+/K+/2Cl- cotransporter

Reabsorption of Mg2+, Ca2+, and K+ via paracellular diffusion

Question 4

What happens in the distal convoluted tubule?

Answer 4

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

Question 5

What happens in the collecting tubule and duct?

Answer 5

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

Question 6

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

Answer 6

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

Question 7

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

Answer 7

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

Ototoxicity
Hyperuricemia
Hypokalemia
Hypocalcemia

Question 8

Where do thiazides work? What are the side effects?

Answer 8

Thiazides inhibit Na/Cl cotransporter in the distal convoluted tubule

Hypokalemia
HyperGLUC…Glucose, Lipids, Uric acid, Calcium

Question 9

What causes pyelonephritis?

Answer 9

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

Question 10

How is pyelonephritis treated?

Answer 10

Fluoroquinolones
Aminoglycosides (gentamicin)
3rd gen cephalosporins

Question 11

What can happen if a pregnant woman gets pyelo?

Answer 11

preterm labor and low birth weight

Question 12

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

Answer 12

Uric acid stone

Question 13

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

Answer 13

Calcium oxalate: idiopathic

Calcium phosphate: Hyperparathyroidism

Question 14

What causes persistent hematuria in patients less than 20?

Answer 14

Glomerular disease

Question 15

What causes persistent hematuria in patients between 20 and 50?

Answer 15

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

Question 16

What causes persistent hematuria in patients Older than 50?

Answer 16

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

Question 17

What is a possible complication of PCKD?

Answer 17

Subarachnoid hemorrhage (15% of PCKD patients)
MVP

Question 18

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

Answer 18

Erythropoietin

Hepatocellular carcinoma
Pheochromocytoma
Hemangioblastoma

Question 19

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

Answer 19

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

Question 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?

Answer 20

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)

Question 21

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

Answer 21

Mesangial cell proliferation

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

Question 22

REVIEW: How is Goodpasture syndrome treated?

Answer 22

Plasmapheresis

Corticosteroids and immunosuppressive agents can help

Question 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?

Answer 23

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

Question 24

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

Answer 24

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

Question 25

What happens with Lupus nephritis? How is it treated?

Answer 25

Proliferation of endothelial and mesangial cells Corticosteroids ACEI Statin

Question 26

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

Answer 26

c-ANCA

Question 27

SUMMARY: How are nephritic syndromes treated?

Answer 27

Corticosteroids | ACEI and Statins to reduce proteinuria

Question 28

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

Answer 28

Minimal Change Disease Effacement of foot processes Steroids

Question 29

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

Answer 29

Focal Segmental Glomerular Sclerosis (FSGS) Steroids, cytotoxic agents, ACEI, statins Rarely transplant...usually recurs anyway

Question 30

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

Answer 30

Membranous globerulonephritis Requires anticoagulation...renal vain thrombosis

Question 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?

Answer 31

Membanoproliferative glomerulonephritis *Train tracks*

Question 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?

Answer 32

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

Question 33

What is the most common cause of acute renal failure?

Answer 33

Drugs --> ATN --> ARF

Question 34

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

Answer 34

Glomerular or vasculitic disease

Question 35

What is indicated by epithelial casts?

Answer 35

ATN

Question 36

What is indicated by pyuria with waxy casts?

Answer 36

Interstitial disease or obstruction

Question 37

What is indicated by pyuria alone?

Answer 37

Infection

Question 38

How is FENa calculated? what does it indicate?

Answer 38

FENa = (urine Na/serum Na)/(urine cr/serum cr) Less than 1% --> prerenal Greater than 2% --> ATN

Question 39

How should ARF be managed?

Answer 39

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