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Flashcards in GU/Nephrology 6% Deck (75):
1

Proximal convoluted tubules (resorb/secrete) ____

What medication work here?

Resorb
All organic nutrients (glucose, AA)
Bicarb
Na, Cl
75-90% of H2O

Acetazolamide
Mannitol

2

Thin Descending Limb of Loop of Henle (resorbs/secretes) ___

Resorbs
H20 passively

Impermeable to Na and solutes

3

Thick Ascending Limb of Loop of Henle (resorbs/secretes) ___

What medication work here?

Resorbs
Actively Na+, K+, Cl-
Indirectly resorbs Mg+ and Ca+

Loop diuretics --> inhibit water, Na, K, Cl cotransport

4

Early distal convoluted tubule (resorbs/secretes) ____

Other functions?

What medication work here?

SECRETES
Organic acids, toxins, drugs
K+, H+

Dilutes urine by actively resorbing Na+ and Cl-

Thiazide diuretics --> impairs urinary dilution

5

____ determine final osmolarity of urine via ____

What medication work here?

Distal collecting tubules
Via Aldosterone, ADH

K-sparing diuretics: inhibit aldosterone mediated Na/H2O absorption --> hyperkalemia, metabolic acidosis

6

Nephrotic syndrome is characterized by ___ (4)

Proteinuria
Hypoalbuminemia
Hyperlipidemia
Edema

7

80% of nephrotic syndrome in children =

Microscopy findings:

Tx:

Minimal change disease

Loss of foot processes of podocytes
Loss of negative charge of glomerular basement membrane

Tx: Prednisone

8

Sclerosis(fibrosis) within glomerulus

Seen in ___

Tx:

Focal segmental glomerulosclerosis

Seen in HTN in blacks

Tx: steroids

9

Thickened glomerular basement membrane

Caused by:

Membranous Nephropathy

Caused by SLE, viral hepatitis, malaria, drugs (Pencillamine)
D/t immune complex deposition

10

MC cause of nephrotic syndrome in adults

Diabetes mellitus

11

Gold standard of dx of nephrotic syndrome

Urinalysis shows:

24 hrs urine protein collection > 3.5 g/d

Oval fat bodies "maltese cross shaped"

12

Acute glomerulonephritis is characterized by (4)

HTN
Hematuria (RBC casts)
Dependent edema (proteinuria)
Azotemia (build up of nitrogen waste in blood)

13

All of the following are causes of Acute glomerulonephritis EXCEPT:
A. IgA Nephropathy (Berger's dz)
B. Goodpasture's syndrome
C. Post infectious
D. Membranousproliferative GN
E. Vasculitis

TRICK QUESTION. All are causes of AGN.

14

IgA Nephropathy (a.k.a. ____)

T/F: MC cause of AGN in children worldwide

When does it usually occur? Why?

Dx?

Tx?

Berger's dz

False. MC cause of AGN in ADULTS worldwide

Young men within days after URI or GI infection d/t IgA overproduction

Dx: IgA depositis in mesangium w/ immunostaining

Tx: ACE-I + Corticosteroids

15

Post infectious AGN occurs MC after ____

Presentation:

Dx:

Tx:

Group A Beta-hemolytic Strep (can occur after any infection)

Skin/pharyngeal infection
2-14 y/o boys w/ puffy eyelids, facial edema, cola colored/dark urine

Dx: Increased antistreptolysin (ASO) titers
Low serum complement (C3)

Tx: supportive, abx

16

Rapidly progressive glomerulonephritis (RPGN) is (good/bad) prognosis

Bx findings?

Tx?

bad prognosis --> rapid progression to ESRD

Cresent formation d/t fibrin and plasma protein deposition

Tx: steroids + cyclophosphamide

17

+ Anti-GBM antibodies seen in ____

Results in ___

Often occurs ____

Dx:

Tx:

Goodpasture's syndrome

Kidney failure and HEMOPTYSIS (d/t ab against type 4 collagen of GBM in kidney and lung alveoli)

Often occurs after URI

Dx: Linear IgG deposits

Tx: High dose steroid immunosuppression + Cyclophosphamide + plasmapharesis

18

Vasculitis AGN is characterized by ___

2 types:

lack of immune deposits, + ANCA ab

Microscopic polyangiitis = vasculitis of small renal vessels --> + P-ANCA
Granulomatosis w/ polyangiitis (Wegener's) = necrotizing vasculitis --> + C-ANCA

19

Gold standard dx of AGN

renal bx

Urinalysis: RBC casts, high specific gravity > 1.020osm

20

WBC casts are pathognomonic for ___

Other clinical features?

acute tubulointerstitial nephritis (AIN)

EOSINOPHILIA
fever
maculopapular rash
arthralgia

21

4 causes of intrinsic AKI
MC type?

Acute Tubular Necrosis (ATN) = MC type of intrinsic AKI
Acute tubulointerstitial nephritis (AIN)
Glomerular (AGN)
Vascular

22

Medication that may cause Acute Tubular Necrosis

Aminoglycosides

23

Inflammatory or allergic response in interstitium, sparing glomeruli and blood vessels =

Commonly caused by ____

Acute tubulointerstitial nephritis (AIN)

PCN, NSAIDs, Sulfa drugs

24

All of the following are features of ATN EXCEPT:
A. Epithelial cell casts and muddy brown casts
B. High specific gravity
C. Hypokalemia
D. High phosphate

B, C
LOW specific gravity
HYPERkalemia

25

Narrow waxy casts seen in ___

Broad waxy casts seen in ___

Chronic ATN/Glomerlonephritis

End stage renal disease

26

ATN or Prerenal?
Low specific gravity
Creatinine rapidly improves w/ IVF
BUN:Cr > 20:1
UNA > 40 , FeNa > 2%
Cr increases at 0.3-0.5 mg/dL/day

Low specific gravity: ATN

Creatinine rapidly improves w/ IVF: Prerenal
Creatinine does NOT improve w/ IVF = ATN

BUN:Cr > 20:1 = Prerenal
BUN:Cr 10-15:1 = ATN

UNA > 40 , FeNa > 2% = ATN

Cr increases at 0.3-0.5 mg/dL/day = ATN
Cr increases slower than 0.3 mg/dL/day = prerenal

27

Causes of HYPERphosphatemia
Associated Ca, Phosphate and PTH levels of each?

Renal failure (MC) : dec. Ca, inc. phosphate, inc. PTH

Primary hypoparathyroidism: dec. Ca, inc. phosphate, dec. PTH

Vit D intoxication: inc. Ca, inc. phosphate, dec. PTH

28

Causes of HYPOphosphatemia

Primary HYPERparathyroidism
Excessive IV glucose, Tx for DKA
Refeeding syndrome in ETOHics
Respiratory alkalosis
Vit D deficiency (dec Ca and dec phosphate)

29

Polycystic Kidney Dz = autosomal (dominant/recessive) d/o d/t mutation of ____ gene(s).

Characterized by ___

Extrarenal manifestations:

AD
PKD1, PKD2

formation and enlargement of kidney cysts in other organs (LIVER, spleen, pancreas)
Vasopressin stimulates cystogenesis --> ESRD

Cerebral "berry" aneurysms**
Mitral valve prolapse **

30

Chronic kidney disease staging

Normal GFR =

0 = at risk; normal GFR and urine
1 = kidney damage w/ normal GFR (>90)
2 = GFR 89-60
3 = GFR 59-30
4 = GFR 29-15
5 = GRF < 15

Normal GFR = 120-130

31

Best predictor of disease progression in CKD

Proteinuria

32

Hematologic complications of CKD

Anemia of chronic disease = normochromic, normocytic anemia
Inc. ferritin, dec. serum Fe, dec. TIBC

Tx: Oral FeSO4
Erythropoietin or Darbepoetin-alpha

33

"salt and pepper" appearance of skull on x ray

Labs:

Osteitis Fibrosis Cystica d/t CKD

Increased osteoclast activity

Increased PO4, HYPOcalcemia (d/t decreased vit D production from kidney) --> Inc PTH --> 2ndary hyperparathyroidism

34

SIADH causes (iso/hypo/hyper)volemic (hyper/hypo)tonic (hyper/hypo)natremia

Become clinically symptomatic w/ (increased/decreased) oral free H2O intake

(increase/decrease) serum osm
(increase/decrease) NA
(hyper/hypo)uricemia
(increase/decrease) BUN
(increase/decrease) urine osm
(increase/decrease) UNa

SIADH causes ISOvolemic HYPOtonic HYPOnatremia
--> increase free water retention + impaired water excretion

Become clinically symptomatic w/ INCREASED oral free H2O intake

DECREASED serum osm <280
DECREASED Na<135
HYPOuricemia
DECREASED BUN
INCREASED urine osm >300
INCREASED UNa > 20

35

Central DI =
Nephrogenic DI =

Become clinically symptomatic w/ (increased/decreased) oral free H2O intake

What happens?

Central DI = ADH (Vasopressin) deficiency
Nephrogenic DI = ADH insensitivity

Become clinically symptomatic w/ DECREASED oral free H2O intake

Both end with production of LARGE amount of DILUTE urine

36

Lithium causes (central/nephrogenic) DI

Nephrogenic DI

37

Dx of Diabetes Insipidus

Fluid deprivation test: continued production of dilute urine

Desmopressin Stimulation test: differentiates nephrogenic vs central DI
Central: reduction of urine output, increase Uosm --> response to ADH
Nephrogenic: continued production of dilute urine

38

Tx of
Central DI:
Nephrogenic DI:

Central DI: Desmopressin/DDAVP, Carbamazepine

Nephrogenic DI: Na/protein restriction -->HCTZ, indomethacin

39

Alpha-1 activation causes afferent arteriole (dilation/constriction) which (increases/decreases) GFR. This causes (more/less) water to be excreted, thus H2O (conservation/depletion).

Alpha-1 activation causes afferent arteriole CONSTRICTION which DECREASES GFR. This causes LESS water to be excreted, thus H2O CONSERVATION.

40

Water homeostasis is determined by ___. Stimuli include ___(2)

Na homeostasis is determined by ___. Stimuli include ___(2)

Water: ADH; hypovolemia, hyperosmolarity*

Na: Aldosterone; hypovolemia, hyperkalemia

41

Tx of:
Isovolemic hypotonic hyponatremia
Hypervolemic hypotonic hyponatremia
Hypovolemic hypotonic hyponatremia

Hypertonic hyponatremia
Severe Iso/hypervolemic hyponatremia

Isovolemic hypotonic hyponatremia: H2O restriction
Hypervolemic hypotonic hyponatremia: H20 + Na restriction
Hypovolemic hypotonic hyponatremia: Normal saline

Hypertonic hyponatremia: Normal saline until hemodynamically stable --> 1/2 normal saline
Severe Iso/hypervolemic hyponatremia: Hypertonic saline w/ Furosemide

42

Hypomagnesemia causes (increased/decreased) DTR, (hypo/hyper)calcemia

HYPOmagnesemia causes INCREASED DTR, HYPOcalcemia --> Trousseau's, Chvostek's sign

43

Tx of hypermagnesemia

Mild-moderate: IV fluids, Furosemide

Severe: calcium gluconate --> antagnoizes toxic effects of magnesium, stabilizes cardiac membrane

44

PPI, amphotericin B, cisplatin, cyclosporine, aminoglycosides can cause ____

HYPOmagnesemia

45

Metabolic acidosis may cause (hypo/hyper)kalemia

HYPERkalemia
Metabolic alkalosis causes HYPOkalemia

46

Tx of hyperkalemia

IV calcium gluconate
Insulin w/ glucose: shift K+ intracellularly
Beta2 agonists (4-8x dose for asthma)
Kayexalate: enhances GI potassium excretion

47

MC cause of epididymitis/orchitis in children and men >35

Tx:

Enteric organisms: E. coli, Klebsiella

Fluoroquinolones
Cephalexin, amoxicillin in children

48

Acute orchitis MC caused by

Mumps**

49

Dx of testicular torsion
Best initial:
Gold standard:

Best initial: Testicular doppler US
Gold standard: Radionuclide scan

50

Sudden onset of left-sided varicocele in older men may possibly suggest ____

Right sided varicocele in children <10 y/o may possibly suggest ___

Renal cell carcinoma

Retroperitoneal malignancy

51

Orchiopexy recommended for cryptorchidism in ____

6 month old, before 1 year old

52

MC type of testicular cancer

Seminoma (germinal cell tumors)

53

T/F: Seminomas are radiosensitive and show elevated alpha-fetoprotein and beta-HCG

False: seminomas are radiosensitive BUT lack tumor markers

"Seminomas are Simple & Sensitive"

Nonseminomatous Germ Cell Tumors are RADIORESISTENT and have ELEVATED alpha-fetoprotein and beta-HCG

54

Tx of complicated cystitis in pregnancy

Amoxicillin, nitrofurantoin x 7-14 days

55

T/F: Phimosis is a urologic emergency

False. Paraphimosis is a urologic emergency

56

Tx of acute prostatitis

Fluoroquinolones, Bactrim
Ampicillin w/ gentamicin
x 1 month

57

Tx for BPH that has positive effect on clinical course of BPH

5-alpha reductase inhibitors (Finasteride)

Vs. alpha-1 blockers (Tamsulosin) provides rapid sx relief but NO effect on BPH clinical course

58

90% of bladder cancers are ___

transitional cell

59

MC abdominal malignancy in children

Wilm's tumor (Nephroblastoma)

MC in children w/i 1st 5 years of life

60

Dx of Renovascular HTN

Renogram (best noninvasive)
Captopril test: increase plasma renin activity 1 hr p administration

Renal angiography = gold standard

61

Tx of Renovascular HTN

Sx: angioplasty w/ stent = definitive

ACE-I/ARB
BUT CI in pts w/ bilateral stenosis or solitary kidney b/c ACEI markedly reduces renal blood flow + GFR

62

Tx of priapism

Terbutaline* = beta-adrenergic agonist
Phenylephrine = selective α1-adrenergic receptor

63

Infant that develops urethritis, neonatal pneumonia and neonatal conjunctivitis 2-5 days after birth, think ___ pathogen.

5-7 days after birth, think ___

2-5 days: Gonococcal

5-7 days: Chlamydia

64

Tx of
Stress incontinence:

Urge incontinence:

Overflow incontinence:

Stress incontinence: Alpha agonists (Midodrine, Pseudoephedrine) --> increase urethral sphincter tone/urethral urine flow resistance

Urge incontinence:
--Antichoinergic (Oxybutynin, Tolterodine, Propantheline) --> block cholinergic receptors in bladder --> decrease involuntary contraction strength (overactive detrusor mm)
--TCAs: central and peripheral anticholinergic effect + alpha adrenergic agonist
--Mirabegron (beta-3 agonist) --> bladder relaxant

Overflow incontinence: Cholinergics (Bethanacol) --> increase detrusor mm activity

65

Bence Jones protein in urine is seen in ____.

Multiple Myeloma

66

Glucose is excreted into urine when blood glucose exceeds ____

180-200 mg/dL

67

Unilateral small kidney on US describes ___

renal artery stenosis

68

Bactrim can cause (hyper/hypo)kalemia, (increase/decrease) serum creatinine, cause ___ kidney injury, thus a poor choice in CKD 4 patients.

HYPERkalemia
DECREASED Cr
Acute interstitial nephritis (AIN)

69

Phototherapy treats ____ by _____.
SE include (4)

Physiologic jaundice in newborns
converts bilirubin to lumirubin

SE: fever, rash, diarrhea, dehydration

70

Type of kidney stone that is radiolucent

Uric acid

71

Best dx of diverticulosis

Barium edema
MORE specific than colonoscopy

72

Nitrites on UA indicates presence of ___

Enterobacteriaceae: E. coli, Klebsiella, Proteus, Serratia, Salmonella

73

Tx of enterobiasis (a.k.a ___)

Pinworms

Mebendazole, albendazole

74

Uncomplicated pyelonephritis tx

fluoroquinolone
(Cipro x 14 days)

75

Chronic renal disease is characterized by (hyper/hypo)kalemia, (hyper/hypo)calcemia, (hyper/hypo)phosphatemia, metabolic (acidosis/alkalosis).

HYPERkalemia
HYPOcalcemia
HYPERphosphatemia
Metabolic ACIDOSIS