Kaplan guy - renal Flashcards by Lauren Sophiea

complement helps form pore to allow RBCs out causing nephritic syndrome - this can crack the vessel causing fibrinous exudate in Bowman’s capsule resulting in what?

How can this be treated?

rapidly progressive glomerular nephritis

will respond to steroids

How well did you know this?

Not at all

Perfectly

tubulointerstitial disease causes kidney damage by deposition of what?

Calcium, uric acid, and toxic drugs

How well did you know this?

Not at all

Perfectly

If the BUN:Cr is greater than 20:1, what am I thinking?

What is another tell tale sign of this?

pre-renal failure is occurring

this could be dehydration, or CHF - ultimately there isn’t enough blood reaching the kidneys

small urine production

How well did you know this?

Not at all

Perfectly

first line tx for HTN is…

MOA? where?

AE?

thiazide diuretic

acts in distal convoluted tubule, blocking Na/Cl- channels, creating a negative Na gradient

increased amount of Ca2+ to be reabsorbed via Na/Ca Antiporter causing hypercalcemia

How well did you know this?

Not at all

Perfectly

What are three examples of thiazide diuretics?

chlorthalidone

chlorothiazide

hydrochlorothiazide

How well did you know this?

Not at all

Perfectly

What is post-renal failure and examples? What might be the BUN:Cr ratio?

obstruction - kidney stone, enlarged prostate - urine can’t be excreted

15:1

How well did you know this?

Not at all

Perfectly

DM and HTN cause damage to the small vessels of the kidney causing…

hyaline arteriolosclerosis - narrowing of the small vessels

How well did you know this?

Not at all

Perfectly

What are three small vessel vasculitities that damage the small vessels of the kidney?

henoch schonlein purpura

granulomatosis with polyangitis (wegner)

churg strauss

How well did you know this?

Not at all

Perfectly

What is churg-strauss syndrome?

eosinophilic granulomatosis with polyangitis (allergic granulomatosis)

autoimmune dz of small and medium vessels

prodromal stage of airway inflammation (asthma or allergic rhinitis)
hypereosinophilia causing tissue damage to lungs and digestive tract
third stage is vasculitis leading to cell death

How well did you know this?

Not at all

Perfectly

How do you treat Churg-straus syndrome?

suppress immune system
- glucocorticoids
- cyclophosphamide or azathioprine

How well did you know this?

Not at all

Perfectly

fibrinous exudate leaking out of the glomerular basement membrane causing fibrous scarring leads to…

crescenteric glomerular nephritis

How well did you know this?

Not at all

Perfectly

In tubulointerstitial disease casts are formed by…

endothelial cells of the proximal tubule

How well did you know this?

Not at all

Perfectly

Who benefits the most from thiazide diuretics?

elderly and AA

How well did you know this?

Not at all

Perfectly

What are risk factors for essential HTN?

BMI, race, sodium intake, age, sedentary lifestyle

How well did you know this?

Not at all

Perfectly

How does the neurological system sense HTN?

distention of baroreceptors in the carotid sinus and aortic arch sending signals to the solitary nucleus of the medulla

How well did you know this?

Not at all

Perfectly

activation of parasympathetic M2 receptors will..

decrease HR

How well did you know this?

Not at all

Perfectly

inhibition of Beta-1 receptors will…

decrease HR

How well did you know this?

Not at all

Perfectly

activation of alpha-1 receptors will

increase peripheral resistance

How well did you know this?

Not at all

Perfectly

What is the biggest concern about concentric hypertrophy due to HTN v hypertrophy d/t exercise?

subendocardial ischemia - with exercise you produce VEGF to increase number of vessels; concentric hypertrophy doesn’t create VEGF and so there are few vessels in the subendothelial wall that penetrate the full depth to supply O2

How well did you know this?

Not at all

Perfectly

How much Na should be in the urine? If it is greater than this, what does that mean?

should be minimal (<1%)

if greater, then think inter-renal failure, indicator for tubular function

How well did you know this?

Not at all

Perfectly

What is the formula for clearance through the urine?

([U] x V)/ [P]

concentration in the urine x flow rate of urine divided by the concentration in the plasma

How well did you know this?

Not at all

Perfectly

What is the formula for renal blood flow (RBF)?

= RPF/ (1-Hct)

How well did you know this?

Not at all

Perfectly

What is the formula for Renal plasma flow (RPF)?

= RBF x (1-Hct)

How well did you know this?

Not at all

Perfectly

What = RPF?

PAH clearance

How well did you know this?

Not at all

Perfectly

What is the formula for GFR?

creatinine or inulin clearance

What is FF formula?

= GFR/RPF

What is filtered load?

GFR x plasma concentration

filtered load - excretion rate is called

reabsorption rate

excretion rate is

urine concentration x urine flow rate

constriction of either the afferent arteriole or the efferent arteriole will cause...

decreased flow to the kidney, decreases RPF

dilation of either the afferent or efferent arteriole will cause..

increase flow to the kidney, increasing RPF

Constriction of the efferent arteriole would cause what to GFR?

increased pressure, increasing GFR

What does constriction of the afferent arteriole do to GFR?

decrease pressure, decrease GFR

enalapril will act by dilating..

efferent arteriole

pre diabetes is what Hgb A1c?

5.7 - 6.5

Diabetes has a Hgb A1c of

\>6.5

glucose should be reabsorbed in the kidney up to what point? What will happen if this is exceeded?

blood glucose of about 280 after that point it will be excreted in the urine (so glucose in the urine means BG \>280)

PAH can be secreted and excreted to a certain point...

until all transporter maxiumums are met and then it will remain constant

What is the formula for determining serum osmolality?

2 (Na) + (glucose/18) + (BUN/2.8)

My pt has hyponatremia. How do I know if this is accurate?

look at serum osmolality if serum osmolality is low, it is true hyponatremia if serum osmolality is normal, it is pseudohyponatremia

What might cause pseudohyponatremia and what can it be a/w?

increased water intake diluting the serum or from taking a diuretic might also be seeing hyperglycemia, hyperproteinemia, or hyperlipidemia

How do you figure true sodium level if pt is diabetic?

for every 100 mg/dL of glucose above normal, sodium should be dropped by 1.6

In a euvolemic pt with true hyponatremia, what could be causes?

SIADH (causing less urea to be cleared, elevated BUN) hypothyroidism

How is serum urea (BUN roughly) related to urine output?

decreased urine production means increased serum urea (increased BUN)

Diabetes inspidus will cause what kind of Na abnormality?

hypernatremia - because the system is pushing out all the water

What can happen if you correct hyponatremia too quickly?

osmotic demyelination syndrome/central pontine myelinolysis

What happens if you correct hypernatremia too quickly?

cerebral edema

What are 6 common causes of hypokalemia?

1. insluin - shifts K into cells 2. diuretic - urine K loss 3. B2 agonists- shifts K into cells 4. bicarb - shifts K into cells 5. laxative abuse - loss in stool 6. vomiting - loss in emesis

genetic mutation of the thiazide-sensitive Na-Cl symporter located in distal convoluted tubule of the kidney ssx?

Gitelman syndrome decreased chloride, potassium, magnesium increased pH muscle cramps, weakness, numbness, thirst, waking up to urinate

congenital lack of Na/K/Cl transporter how does this work/what happens?

Bartter's syndrome lack positive charge in urine, so Ca2+ and Mg2+ get lost rather than reabsorbed - similar to furosemide diuretic

NSAIDs will inhibit prostaglandins and cause constriction of...

afferent arteriole, decreasing GFR and can throw pt into AKF

What is the first line tx for osteoarthritis, why?

acetaminophen - fewer AEs on kidney and GI PGs protect the mucosa of teh stomach, releasing bicarb, increases blood supply to mucosa cells

nephrotic syndrome with normal glomerulus with oval fat body with maltese cross dx? Who?

minimal change disease MC in kids, except for adults with Hodgkins

subepithelial deposits forming spike and dome appearance dx?

membranous nephropathy

segmental damage to glomerulus dx?

focal segmental glomerulosclerosis

subepithelial hump formation (singular)

post-streptococcal glomerulonephritis

effacement of foot processes of podocytes dx?

minimal change disease

thickening of glomerular basement membrane with a double contour/tram tracking dx?

membranoproliferative glomerular nephritis

accumulation of immune complexes along the subepithelial side of the basement membrane?

membranous nephropathy

crescent formation in most of the glomerulus with fibrin strands between cell layers

crescenteric glomerulonephropathy rapidly progressive glomerulonephropathy

anitbodies to glomerular basement membrane

goodpastures syndrome

non-enzymatic glycosylation of GBM and arterioles

diabetic nephropathy

* fusion of podocytes with damage * caused by immunizations, URI, Hodgkins * normotensive * no CKD dx? tx?

minimal change disease steroids

* kidney disease in pt with heroin use and HIV, SCA * AA and hispanics esp. * MCC of nephrotic syndrome in adults * hematuria and HTN dx? tx?

focal segmental glomerulosclerosis steroids

leukocyte in mesangium of basement membrane dx?

membranoproliferative glomerulonephritis

* subendothelial deposits * deficient in C1, C4, C3, and C2 * HBV and HCV

Type 1 membranoproliferative GN

* intraglomerular basement membrane dense deposit * deficient in C3 * normal C1 and C4 dx?

Membranoproliferative GN type 2

* 1-4 weeks sp pharyngitis * immune complex mediated * GAS strains that are nephritigenic * glomerulus enlarged and hypercellular * subepithelial hump

post-streptococcal GN

* abs v collagen type IV * hemoptysis and hematuria * linear pattern of immunoflurescence dx? tx?

goodpasture syndrome plasmapheresis or immunosuppressive agents and steroids

How do I differentiate Wegners from Goodpastures?

Wegners will have URT involvement like ulcers in nose or pharynx

What is the normal pH of urine?

5.5

What is the MC stone seen in alkaline urine?

calcium stone/calcium oxalate

What type of stone is more common in women with UTIs? What is in this?

struvite stone Magnesium ammonium phosphate

What type of stones are more common in men with gout, or chemotherapy?

uric acid stones

WBC casts in urine make you think...

pyelonephritis or interstitial nephritis

fatty casts/ oval fat bodies with maltese cross

nephrotic syndrome

brownish granular casts

acute tubular necrosis

eosinophils in urine

acute interstitial nephritis

dysmorphic erythrocytes

glomerular bleeding

periorbital edema in pt, what is first thing I look at?

kidneys being the source

What are the cells of origin for renal cell carcinoma? how do I dx?

proximal rental tubular cells nephrectomy and then biopsy - do not biospy for risk of spreading in vivo

hematuria, abdominal mass, flank pain

triad of renal cell carcinoma

L sided varicocele... thought process to malignancy?

L spermatic vein ends in L renal vein, with renal cell carcinoma, this might be blocked causing the varicocele

What things should you not biopsy for dx for fear of risk of spreading?

renal cell carcinoma hepatic carcinoma choriocarcinoma medullary thyroid carcinoma

HTN, hypercholesterolemia, edema

nephrotic syndrome

nodular appearance in glomerulus

Kimmesteil Wilson

rupture of GBM with fibrosis

rapidly progressive/crescenteric

kimmesteil wilson

diabetic nephropathy

non-enzymatic glycosylation of GBM

diabetic nephropathy or kimmesteil wilson

cysts with cartilage and immature collecting ducts

muticystic renal dysplasia

injury from leukocytes on GBM

nephritic syndrome

hematuria with URI

IgA nephropathy

MC pathogen causing pyelo?

E. coli

radiopaque stones

calcium oxalate

stone in pt \<20 yo

cysteine stones, ppt bc doesnt get reabsorbed, can prevent with cysteine chelator

MCC of renal cancer in children?

wilms tumor

IgA deposits in mesangial region

IgA nephropathy

deafness, cataracts, and GN?

Alport syndrome

small kidneys with mononuclear infiltrate

chronic glomerulonephritis

large kidneys with chronic renal failure

diabetes and polycystic kidney disease

MC stone in acidic urine

uric acid stone

tumor with vessels, muscles, and lipids

angiomyolipoma

decreased concentration of urine and hematuria

sickle cell nephropathy

Kaplan guy - renal Flashcards

(103 cards)