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high yield Flashcards

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1
Q

major function of ADH

A

insert water channels into collecting duct luminal surface to increase water reabsorption (w/o ADH collecting duct is impermeable to water)
released from supraoptic nuclei in hypothalamus

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2
Q

sodium reabsorption proximal tubule

A

50-55% reabsorbed;
NH exchanger
Na–glu, aa, phos, organic solute cotransporter

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3
Q

sodium reabsorption loop of henle

A

35-45%

NKCC transporter

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4
Q

sodium reabsorption distal tubule

A

5-8%

NC cotransporter

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5
Q

sodium reabsorption collecting tubule

A

2-3%

ENAC

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6
Q

if ADH is absent, urine osmolality=?

A

<100

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7
Q

DDX of urine osmolality<100

A
  • Psychogenic Polydipsia
  • Beer Potomania (aka Tea + Toast, aka Low Osmolar Load hyponatremia)
  • Reset Osmostat (if pt’s serum Osm is below their set-point)
  • “You Fixed It” Hyponatremia (Pt with prior UOsm > 100, but cause went away)
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8
Q

hyponatremic, hypervolemic

A

CHF
cirrhosis
nephrosis

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9
Q

hyponatremic, hypovolemic

A 
GI loss
Sweating excessively
Thiazides
Cerebral Na wasting
Aldosterone deficiency
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10
Q

Hyponatremic euvolemic

A

SIADH
Glucocorticoid deficiency
hypothyroidism
reset osmostat

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11
Q

clinical symptoms of hyperkalemia

A

Cardiac: arrhythmias
o Neuromuscular: paralysis
o Renal: hyperchloremic acidosis (interferes w/ renal ammonium excretion, thereby limiting acid excretion)

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12
Q

causes of yellow/orange urine

A

concentrated urine
bile
meds (rifampin, coumadin, flaglyl)
urate

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13
Q

causes of red/brown/black urine

A

blood (RBC or Hgb)
myoglobin
meds (phenothiazines, dilantin)
Food (beets, blackberries, red dye)

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14
Q

causes of blue/green urine

A

meds (amitriptyline, methylene blue, indomethican)

pseudomonas infection

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15
Q

normal glomerulus by LM in a child with heavy proteinuria

A

minimal change disease

confirm by noting FPP (?) by EM

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16
Q

subepithelial electron dense deposits on EM

A

membranous glomerulonephritis in adults

post-strep glomerulonephritis in kids

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17
Q

subendothelial depsits

A

membranoproliferative glomerulonephritis (but check for clinical description SLE!)

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18
Q

hematuria

A

IgA neprhopathy, esp in conjunction with URI

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19
Q

history of deafness or alterations in glomerular basement membrane

A

hereditary nephritis–Alport syndrome

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20
Q

IF pattern is coarsely granular

A

post-strep glomerulonephritis

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21
Q

thickened basement membranes by EM

A

diabetetes; confirm with PAS positive material on LM

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22
Q

fibrils on EM

A

amyloidosis

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23
Q

IF pattern is linear

A

Goodpastures syndrome (anti-basement membrane disease)

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24
Q

pt has signs and symptoms of systemic disease

Study These Flashcards
A

overall diagnosis–SLE, systemic vasculitis, diabetes then find secondary renal involvement

25
Euvolemic hypernatremia causes
Renal: central or nephrogenic DI Extrarenal: respiratory loss, dermal loss
26
Hypovolemic hypernatremia
Renal: osmotic diuretic, loop diuretic, post-obstruction, intrinsic renal disease Extrarenal: GI loss, burns
27
Hypervolemic hypernatremia causes
too much salt water in system (ingestion, IV etc)
28
in hyponatremia, if sodium is correct too quickly what is the risk?
osmotic demyelination - signs/sx: dysarthria, weakness, seizures,lethargy, *irreversible - occurs 2-6days after treatment - risk factors: over-correction (>12meq/24h or >0.5meq/h), females, alcoholism, malnutrtion, liver dysfx, hypokalemia
29
causes of high anion gap metabolic acidosis (5)
1. increased acid production (lactic acidosis, ketoacidosis) 2. ingestion toxins (salicylate, methanol, ethylene glycol) 3. Advanced renal failure (GFR<20) 4. massive rhabdomyolysis 5. septic shock * all others are normal anion gap
30
unilateral renal agenesis
: asymptomatic, solitary kidney undergoes compensatory hypertrophy and performs function of missing kidney
31
bilateral renal agenesis
* Assoc. w/ potter’s syndrome: pulmonary hypoplasia, facial and limb abnormalities * Incompatible with life * Oligohydraminos (responsible for lung, face, limb abnormalities)
32
malrotation and ectopic kidneys
* Proper rotation of kidney is with hilum facing medially * Ectopic kidneys from failure to ascend→located in pelvis * These kidneys have inc. incidence of extra or malplaced ureters or blood vessels
33
horseshoe kidney
* Assoc. w/ Turners Syndrome * Fusion of lower renal poles during development; IMA limits ascent of fused kidney * Asymptomatic or present with urinary obstruction, abdominal mass, or hematuria from pelvic trauma or infection
34
dyplastic kidney
Renal parenchyma comprised of cysts, immature glomeruli and tubules, undifferentiated mesenchyme and connective tissue • May present with varying degrees of renal obstruction or insufficiency • Non-inherited!
35
polycystic kidney disease
``` • Inherited! • Bilateral enlargement • Cysts in renal cortex AND medulla Autosomal recessive PKD: • Infants • Present with renal failure, HTN • Potters sequence • Congential hepatic fibrosis and cysts (portal HTN) Autosomal dominant PKD: • Young adults • Present with HTN, hematuria, worsening renal failure • APKD1/2 mutations • Berry aneurysms, hepatic cysts, mitral valve prolapse ```
36
medullary cystic kidney disease
* Cysts in medulla (vs PKD has cysts in cortex and medulla) * Shrunken kidneys (vs PKD has enlarged kidneys) * Present with renal failure
37
ectopic ureter and ureteral obstruction
* Extra/ectopic/duplicated ureters can drain to anomalous locations in bladder, urethra, vagina, or ductus deferens * Assoc. w/ VUR
38
VUR
retrograde movement of urine from bladder towards renal pelvis • From anatomic and functional abnormalities of ureteres and bladder • High risk for pyelonephritis and scarring and hypertension • Grading: 1-5 • w/ chronic VUR, there is dilation of urters and kidneys
39
physiologic differences neonate vs adult kideny
neonate has... - dec GFR - dec Na handling capacity (higher FENa) - dec concentrating ability (tubules relatively insensitive to ADH, and lack of medullary hypertonicity) - dec. ability to reabsorb bicarb
40
obtaining pediatric urine sample for urinalysis
o Clean catch: ideal for continent patients o Bag specimen: useful for infants when urine does not need to be sterile o Catheterization: for any age incontinent patient where sterile urine specimen is needed o Suprapubic aspiration: infants where genital anatomy makes cath difficult
41
ESR
normal is 15-20mm/hr increased in inflammatory d/o affected by age, race, gender
42
CRP
- Produced in response to inflammatory cytokines (IL-1, IL-6, TNFalpha) - CRP activates the classic complement pathway - affected by gender, race - moderate elevation (1-10mg/dL) assoc. w/ rheumatoid diseases
43
complement
o Measure levels of C3, C4, and CH50 | o Useful in initial diagnosis of lupus (decreased complement in lupus)
44
definition of rheumatoid factor
o Rheumatoid Factor (RF): IgM or IgG antibody against Fc portion of IgG.
45
definition of Anti-CCP antibodies
• Recognize post-translational modification or arginine to citrulline (by peptidyl arginine deiminiase) • Citrullinated vimentin, fibrin, collagen type II, filaggrin -higher specificity than RF for diagnosis of RA
46
ANA antibodies
* Antibodies that bind nuclear factors (ds DNA, histones, RNA/Protein nuclear complexes) * Tested by IF (patterns include: homogenous, perinuclear, speckled, nucleolar) * Use serial dilution to estimate titer * High titer (must dilute pt’s serum a lot)—suggests high concentration or high affinity of autoantibody * Titer does not correlate with disease activity or prognosis
47
anti-smith
(binds non-coding RNA complex) very specific for SLE, but only detected in 30% SLE pts
48
anti-RNP
(binds non-coding RNA complex) found in pts with SLE, mixed connective tissue disorders
49
anti-SSA
40% of patients with SLE, but also in primary or secondary sjogrens • **placental transmission can cause neonatal lupus!
50
anti-SSB
40% of patients with SLE and 15% patients with primary sjogrens
51
anti-dsDNA
70% specific for SLE, titers used to assess SLE activity, correlate with development of SLE nephritis
52
anti-centromere
limited scleroderma (CREST)
53
Anti-Scl-70
very specific but not sensitive for systemic sclerosis/scleroderma
54
anti-histone
drug induced lupus
55
antiphospholipid antibodies
* Anti-cardiolipin (IgG, IgM, IgA) and anti-B2 glycoprotein detected by ELISA * Lupus anti-coagulant: tests to detect inhibitor of phospholipid dependent clotting * Antibodies target cell membranes * Anti-phospholipid antibody syndrome: Pts present with coagulopathy, thrombocytopenia, recurrent fetal loss
56
anti-Jo1
interstitial lung disease, raynaud’s, mechanic’s hands, polymyositis or dermatomyositis with moderate response to treatment
57
anti-Mi2
dermatomyositis and good prognosis
58
anti-SRP
: cardiac disease and severe weakness; good prognosis

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