Lectures

Question 1

what is the most common tumor stage for prostate cancer? why?

Answer 1

• 1c, it’s not palpable but patients come in because of elevated psa

Question 2

what is dilution anemia

what condition can you see it with?

Answer 2

• increased rbcs, but there is so much increased blood volume that it seems like you have anemia
• pregnancy

Question 3

what is the different between hypersthenuria, hyposthenuria, and isosthenuria?

Answer 3

hyper- urine has specific gravity >1.010

hypo- urine has specific gravity <1.010

iso- urine has specific gravity=1

Question 4

for type 1 (distal) renal tubular acidosis:

what can cause it?

at steady state, what is the urine pH, serum K level?

if you administer HCO3, what happens to urine pH and serum K level

Answer 4

• decreased secretion of H into urine at distal tubule –> defect H-ATPase, defective CL-HCO3 exchanger
• urine pH >5.5, K value can be anything
• urine pH >5.5, k value can be anything

URINE PH ALWAYS >5.5

Question 5

what electrolyte imbalances/lab values can be observed in rhabdomyolysis?

Answer 5

• hypocalcemia
• SUPER HIGH CPK >20000
• hyperphosphatemia
• hyperkalemia
• high creatinine
• high uric acid

CCCUPP

Question 6

if a patient has hypovolemic hyponatremia, when should you give normal saline vs hypertonic saline

Answer 6

• normal saline usually

- hypertonic saline if patient is symptomatic or has Na<120

Question 7

what is the normal concentration of HCO3 in plasma? what is the pK of HCO3; what is normal PCO2 of blood? What is the normal concentration of H2CO3?

Answer 7

• 24 mM
• 6.1
• 40 mmHg
• [H2CO3]= [CO2] = 40*.03= 1.2

Question 8

what enzyme converts testosterone to dht?

what drug can block this?

Answer 8

Type II 5 alpha reductase

finasteride

Question 9

what type of retinopathy finding in hypertension is optic disc bulging due increased intracranial pressure

is it a hypertensive emergency

Answer 9

papilledema

YES

Question 10

what demographic is usually affected in renal carcinoma?

Answer 10

• elderly men who smoke

Question 11

what kind of acid base disorder is chronic renal failure?

Answer 11

metabolic acidosis (loss of nephron means less H excreted)

Question 12

name causes of hypomagnesemia

how does it present?

how do you treat?

Answer 12

• cisplatinum,aminoglycosides,ppi, diuretics, starvation, etoh, refeeding syndrome, laxatives, malabsorption, hypercalcemia, barter’s syndrome
• like hypokalemia and hypocalcemia (tetany, muscle spasms, hyperreflexia), prolonged qt interval, arrhythmias, ataxia, vertigo, anorexia, nausea, paralytic ileus
• oral and iv repletion, stop medication

Question 13

what is the formula for net reabsorption or secretion?

Answer 13

filtered load- excretion rate

if f>e, means net reabsorption
if f

Question 14

what type of receptor is abundant in the bladder neck and prostate? what specific subtype is dominant in the prostate

Answer 14

alpha adrenergic

alpha 1a

Question 15

how does grapefruit juice affect drug levels

Answer 15

• inhibits cyp3a4 which is responsible for drug metabolism in the liver and absorption in the gi tract
• this can cause decreased absorption in the gi tract, and increased levels of drug in blood

Question 16

which zone of the prostate does bph affect?

what about prostate cancer?

Answer 16

• transitional zone (also called adenoma)

- peripheral zone (also called capsule) (can also affect transitional and central)

Question 17

what condition do alpha blockers treat?

alpha blockers mnemonic

Answer 17

• bph

A TaD underSTAFFed
Alfusozin
Terazosin
Doxazosin
Tamsulosin
silodosin

AFF= alpha blocker

Question 18

what are two effects of the sympathetic nervous system in response to decrease Na content, decrease EABV, and decrease Pa

what hpappens what there is increased na content, eabv, and Pa

Answer 18

• constriction of afferent arterioles and increase of Na reabsorption in the proximal tubules
• reverse happens, sympathetics is inhibited

Question 19

what is an example of hyposmotic volume expansion?

what is gained?

Answer 19

• increased water intake or SIADH

H20

Question 20

how does increased urine flow rate affect K secretion?

what medication can cause this?

Answer 20

• increased flow rate dilutes K in the tubule –> increased driving force for secretion
• loop and thiazide diuretics

Question 21

what are two scenarios in which you shouldn’t use alpha blockers?

Answer 21

congestive heart failure and PDE5 inhibitor use

Question 22

if you have asymptomatic bacteruria during pregnancy, what should you treat it with and for how long?

Answer 22

• sulfonamides, nitrofurantoin, or fosfomycin for 3 days

Question 23

what is the difference between osmolarity and osmolality

Answer 23

• both measure total solute concentration

osmolarity = mOsmoles/L
osmolality= mOsmoles/kg of H2O

Question 24

what condition is associated with a tram tracks appearance

Answer 24

membranoproliferative glomerulonephritis

Question 25

what is a side effect of nonselective alpha blockers? name three examples of nonselective alpha blockers

Answer 25

- orthostatic hypotension, so dizziness, fatigue terazosin, doxazosin, alfuzosin

Question 26

if a patient is significantly hyponatremic and you need to give hypertonic saline, what rate should you administer it at?

Answer 26

rate of sodium rise should be no more than 1 mEq/L/hr

Question 27

what stimulates angiotension II secretion what inhibits it?

Answer 27

- increased renin | - ace inhibitors

Question 28

when does autosomal dominant polycystic kidney disease present vs autosomal recessive?

Answer 28

- adulthood vs. present at birth

Question 29

where is the only place in the nephron that phosphate is reabsorbed? What can prevent its reabsorption? how much is left in the urine?

Answer 29

- proximal tubule (early 70% and late 15%) - PTH - 15%

Question 30

describe the three places where K secretion/reabsorption happens in the nephron; state whether it is secreted or reabsorbed.

Answer 30

- proximal convoluted tubule- reabsorbed (follows Na+) - thick ascending limb of loop of henle- reabsorption via Na-K-2Cl pump (a little K leaks back) - distal convoluted tubule/collecting duct- intercalated cells reabsorb sometimes) and principal cells (variable secretion)

Question 31

what are the three criteria for orthostatic hypotension

Answer 31

decrease in systolic by 15 OR decrease in diastolic by 10 OR increased in Hr by 15

Question 32

strong acids have ____ (high or low) equilibrium constants and _____ pK

Answer 32

- high equilibrium constant, low pK

Question 33

for wilms tumor: what gene is most commonly affected describe the pathophysiology what demographic is commonly affected what three conditions is it associated with?

Answer 33

- WT1 on chromosome 11 - Wt1 is a tumor supressor gene, that is necessary for renal development, mutation causes abnormal primitive neprhogenic rests to form - children - WAGR syndrome (wilms, aniridia, genital abnormalities, mental retardation), denys- drash (gonadal dysgenesis, wilms, progressive renal disease, beckwith widemann syndrome (organomegaly, hemi hypertorphy, macroglossia, wilms tumor)

Question 34

body ____ content is the major determinant of ECF volume. body ____ content is the major determinant of body fluid oxmolarity

Answer 34

- Na+ | - water

Question 35

if a urinalysis has a positive dipstick for blood, but no rbcs are present, what condition is most likely present? what is causing the positive dipstick? what is a classic presentation? how do you treat?

Answer 35

- rhabdomyolysis - myoglobin - someone on statins or someone that hella exercised - hydrate until euvolemic

Question 36

what are the front line anti-hypertensive drugs? (mnemonic)

Answer 36

``` CAATs are HYPER Calcium channel blockers ACE inhibitors ARBs Thiazide diuretics ```

Question 37

for type 2 (proximal) renal tubular acidosis: what can cause it? at steady state, what is the urine pH, serum K level? if you administer HCO3, what happens to urine pH and serum K level

Answer 37

- defect in reabsorption of HCO3 in proximal tubule --> acetozolomide, topiramate, hereditary defect in carbonic anhydrase, fanconi syndrome - steady stage: urine ph <5.5, hypokalemic - urine ph>5.5, hypokalemia worsens

Question 38

in responsee to _____, ANP is released by the ____ and BNP is released by the _____

Answer 38

- stretch (atrial pressure)/increased blood (ECF) volume - atria - ventricles

Question 39

what does a sieving coefficient of 1 mean? what has a sieving coefficient of 1?

Answer 39

- it is freely filtered across the glomerular capillary border inulin

Question 40

what is a unique side effect spironolactone that is different than other k sparing diuretics and other diuretics how does spironolactone differ from other k sparing diuretics?

Answer 40

gynecomastia - spironolactone blocks mineralocorticoid receptor, whereas k sparing diuretics block Na channel in principal cells

Question 41

which would have elevated renin levels: primary hyperaldosteronism or renal artery stenosis?

Answer 41

renal artery stenosis

Question 42

in the steady state, Na+ input is matched by

Answer 42

Na+ excretion by the kidneys + extrarenal sources (GI, sweat, usually negligible)

Question 43

how do you treat hyperphosphatemia

Answer 43

- phosphate binders - saline decrease intake dialysis if renal failure

Question 44

where is fgf23 made? by what? what is its main functions? how does it accomplish them

Answer 44

- made in bone by osteocytes - prevent supersaturation of phos and Ca in the blood and prevent loss of Ca and phos from bone increase phosphaturia inhibit 1 alpha hydroxylase --> decrease calcitriol inhibit pth synthesis --> decrease pth

Question 45

what causes type b lactic acidosis?

Answer 45

- ethanol, diabetes, lymphoma/malignancy, salicylates

Question 46

myelomas and uric acid can accumulate where in the kidney?

Answer 46

tubules! (can form casts)

Question 47

does prostate size increase or decrease with age? does incidence of bph increase or decrease with age?

Answer 47

both increase with age

Question 48

what stage does prostate cancer become palpable?

Answer 48

T2

Question 49

the RAA system detects changes in blood volume on the ____ (arterial/venous) side stretch receptors detects changes in blood volume on the ____ (arterial/venous) side

Answer 49

- arterial | - venous

Question 50

what are intradialytic complications (name at least 5)? which one is most common? name side effects of dialysis?

Answer 50

- HYPOTENSION (MOST COMMON) - hypertension - bleeding - air embolism - electrolyte imbalances - muscle cramps - anaphylactoid reactions - dialysis dysequilibrium (brain makes osmoles during uremia, if you remove solute from plasma will cause fluid to rush into the cells --> swelling) - insomnia, fatigue - anorexia - restless leg syndrome - cramps

Question 51

prerenal azotemia, if undetected, can progress to _____

Answer 51

acute tubular necrosis

Question 52

why can you get itching in chronic kidney disease?

Answer 52

- due to hyperparathyroidism of chronic kidney disease, calcium phosphate complexes deposit in the skin and cause itching

Question 53

what is the risk for end stage renal disease for kidney donors? who is at highest risk? what other side effects can you get

Answer 53

less than 1% black men (still less than 1%) - urinary protein, increase in bp, gestational htn or pre-eclampsia

Question 54

which two acid base disorder types would have increased HCO3 and increased CO2?

Answer 54

- metabolic alkalosis | - respiratory acidosis

Question 55

can you get edema with acute kidney injury?

Answer 55

ABSOLUTELY (fluid retention because your kidney isn't working)

Question 56

Is the fractional excretion of Na increased or decreased in prerenal azotemia? what about renal disease?

Answer 56

- very decreased (<1%) | - increased (>2%)

Question 57

are wbc casts diagnostic of acute pyelonephritis?

Answer 57

yes

Question 58

name 5 functions of calcitriol

Answer 58

``` increase CA absorption in GI increase Ca reabsorption in the kidney increase phosphate absorption in GI downregulate PTH increase bone mineralization ```

Question 59

for incipient diabetic nephropathy, what are the main pathologic features? what would a glomerulus look like on h and e stain?

Answer 59

- microalbuminuria (30-300 mg), htn, normal gfr - thickened glomerular and tubular basement membrane, mesangial proliferation, thickened mesangium, arteriolar hyalinosis

Question 60

what are the four edema states that can lead to signs of volume overload?

Answer 60

- CHF, cirrhosis and nephrotic syndrome | renal failure

Question 61

name at least 5 scenarios of complicated urinary tract infection

Answer 61

- kidney transplant - recurrent infections - resistant infections - anatomical defect - kidney stones - hospital acquired infection - diabetes - pregnancy - immunocompromised - fungal infection

Question 62

criteria for nephritic syndrome

Answer 62

``` Hematuria (RBC casts are diagnostic) Proteinuria (<3.5 gm/day) -Salt & water retention -----Hypertension ------Weight gain Edema (late finding) Decreased GFR (frequent finding) ```

Question 63

what chromosome mutation is involved in invasive urothelial carcinoma

Answer 63

17p

Question 64

what new pathologic condition can thiazide diuretics cause as a side effect?

Answer 64

- increased glucose --> diabetes

Question 65

what is the hormonal influence of the prostate? what are other minor hormonal influences

Answer 65

dihydrotestosterone (DHT) Androstendione Prolactin Estrogens

Question 66

what is the general cause of post renal obstruction? what specific things can cause it? what symptoms will they usually present with?

Answer 66

- urinary tract obstruction (can be anywhere along it) - bph, tumors, kidney stones, endometriosis severe oliguria, anuria, dribble, subrapubic tenderness

Question 67

name at least 3 risk factors that increase your chance of getting diabetic nephropathy (6 total)

Answer 67

- type 1 dm (get diagnosed at a younger age) - smoking - oral contraceptives - poor blood pressure control - poor blood sugar control - low birth weight (activates catch up genes that promote weight gain --> obesity --> predisposed to diabetes)

Question 68

what are two urine values that are distorted in an edema state (excluding renal failure) explain why each value is distorted

Answer 68

- urine Na is low- due to decreased renal perfusion prssure --> increased renin --> increased angiotension II --> aldosterone --> increase na reabsorption --> decreased urine na - increased urine osmolality- due to either increased na reabsorption or decreased bp --> adh stimulation --> increased water reabsorption --> increased urine osmolality

Question 69

What percent (range and average) of of weight is total body water? what two demographics tend to have the highest total body water

Answer 69

50- 70 (60) males and infants (75%)

Question 70

# define isolated systolic hypertension are you at greater risk for cvd?

Answer 70

htn >140/<90 hell yeah!

Question 71

what is the formula for volume of a marker substance?

Answer 71

- volume= amount given- amount lost (excretion)/ concentration

Question 72

thiazide diuretics _____ (increase/decrease) Na excretion and ______ (increase/decrease) Ca excretion

Answer 72

- increase Na excretion (block reabsorption) | - decrease Ca excretion (increase reabsorption)

Question 73

what is the formula for the henderson hasselbach equation

Answer 73

pH= pK' + log ( [A-]/[HA]) AHA! (a is on top of ha)

Question 74

if someone has chronic hypernatremia and is hypotensive, at what rate would you want administer normal saline? why?

Answer 74

- .5mEq/L/hour in chronic hypernatremia, the brain shrinks and creates its own osmoles that take a while to clear, if you give saline too quickly, brain will swell and herniate

Question 75

# define oliguria; what is the common etiology define polyuria; what are the common etiologies?

Answer 75

<400 mL excreted/day --> renail failure >2000 mL excreted/day --> glycosuria, diabetes insidipidus, brain tumor, aneurysm, granuloma, psychogenic polydipsia

Question 76

Where is prorenin converted to renin? what does renin do?

Answer 76

juxtoglomerular cells converts angiotensinogen to angiotensin I

Question 77

when calculating the anion gap for a metabolic disorder, if your HCO3 is higher than expected, then what type of acid base disorder do you have in addition to a metabolic acidosis? what about if your HCO3 is lower than expected?

Answer 77

- metabolic alkalosis | - additional normal anion gap metabolic acidosis

Question 78

if a patient has frequent daytime urination, what do they have? if a patient has excessive nighttime urination, what do they have?

Answer 78

pollakiuria nocturia

Question 79

when there is no activated ADH, papillary and medullary interstitium osmolarity is significantly decreased. Give two reasons

Answer 79

- decreased adh --> decreased Urea recycled into interstitium --> decreased osmolarity - decreased adh --> decreased reabsorption at Na-K-2Cl pump in the thick ascending limb --> decreased osmolarity (counter current multiplication is decreased)

Question 80

what type of hypertension is normal when in the doctor's office but high when at home?

Answer 80

masked hypertension

Question 81

name 3 causes of hypokalemia and 5 causes of hyperkalemia what is a pump present in all cells that plays a role in hypo and hyperkalemia?

Answer 81

- hypokalemia: insulin, beta agonist, alkalosis - hyperkalemia: lack of insulin, beta antagonist, acidosis, exercise, cell lysis H- K pump

Question 82

what part of the nephron is affected in toxic acute tubular necrosis? what about ischemic acute tubular necrosis?

Answer 82

- proximal tubule | - patchy, segmental areas along the tubules

Question 83

in familial hypocalcuric hypercalcemia, what is defective? what happens as a result

Answer 83

- calcium sensing receptor | as a result, the body thinks it is hypocalcemic, and does not inhibit the Na-K-2Cl receptor

Question 84

does renal artery stenosis cause prerenal or intrarenal azotemia? why?

Answer 84

- prerenal azotemia | - kidney perceives decreased perfusion due to narrowed lumen

Question 85

is diabetic nephropathy a macrovascular or microvascular complication of diabetes? what progressive urine finding is common? can it be detected on a urine dipstick? which demographics are at increased risk?

Answer 85

microvascular micro or macro albuminuria micro cannot, but macro can african americans, hispanics, and native americans

Question 86

what are some advantages to using creatinine as a marker of gfr? what are some disadvantages?

Answer 86

- cheap, endogenous, increases as gfr decreases - only increases after significant gfr decrease (can't detect mild impairment), increased with use of cimetidine and trimethoprim, decreased in liver disease

Question 87

decreased levels of citrate in the urine increase risk for what?

Answer 87

calcium stones

Question 88

what is an example of hyperosmotic volume expansion? what is gained?

Answer 88

- increased NaCl intake | - NaCl

Question 89

if a patient has hypertension and edema, what condition should you think of?

Answer 89

- hyperaldosteronism

Question 90

phenobarbital and aspirin are ____ (bases or acids), addition of bicarb would ____ (increase or decrease) renal clearance

Answer 90

acids increase

Question 91

give two example of weak bases and weak acids in urine?

Answer 91

- weak base: morphine and quinine weak acid- PAh and salicyclic acid

Question 92

what is a staghorn stone?

Answer 92

a kidney stone that involves the renal pelvis and at least two caluces

Question 93

does lupus more commonly cause nephritic or nephrotic syndrome?

Answer 93

nephritic (rapidly progressive glomerulonephritis)

Question 94

what is free water clearance (CH20) what is the formula?

Answer 94

- the amount of free water that must be added to or substracted from urine to make urine isoosmotic with plasma - V- Cosm ``` V= urine flow rate Cosm= UosmV/Posm ```

Question 95

name an example of an mtor inhibitor; what does it do? side effects?

Answer 95

- sirolimus: inhibits mtor, which is important for the cell cycle - nephrotoxicity (atn, proteinuria, tubulotoxicity) - impaired wound healing, dyslipidemia - pneumonitis - anemias and cytopenias

Question 96

where is a common place/direction that renal cell carcinoma likes to spread to?

Answer 96

renal vein/ivc

Question 97

describe the two main effects of ANP and BNP

Answer 97

- dilation of afferent arterioles and constriction of efferent arterioles --> increased GFR --> increased Na excretion - inhibition of Na reabsorption at distal tubules and collecting ducts --> increased Na excretion --> decreased ECF volume and BP

Question 98

what drug is in 80% of transplant protocols? how does it function?

Answer 98

- corticosteroids! | - suppresses cytokines (esp IL2), inhibits dendritic cells, inhibits translocation to nucleus of nk-kfb

Question 99

what is a scenario in which you can have physiologic hydronephrosis? explain why which kidney is more dilated? why?

Answer 99

- pregnancy - progesterone, prostacycline, and relaxin dilating smooth muscle of ureters right kidney because uterus is dextrorotated

Question 100

what type of acid base disorder is diarrhea?

Answer 100

metabolic acidosis

Question 101

what is tertiary hyperparathyroidism in the context of chronic kidney disease what is the treatment what serious complication can occur as a result of treating this?how can you fix it

Answer 101

- parathyroids are so stimulates that hyperplasia increases so much that autonomous adenoma occurs - parathyroidectomy - hungry bone syndrome: after pth stimulus is removed, ca and phos flood back into the bone, which can cause profound hypocalcemia and hypophosphatemia - give vit d and calcium

Question 102

what are the two main things that cause adh release? what are three other causes what can inhibit adh?

Answer 102

1% increase in plasma osmolarity, 10% decrease in blood volume (stronger effect) - pain, nausea, adh - alcohol

Question 103

what risk factors could cause papillary ischemic necrosis?

Answer 103

nsaids, sickle cell disease, diabetes, pyelonephritis

Question 104

where does prostate cancer metastasize to? who should get ct screening for mets?

Answer 104

- bone and obturator and para-aortic lymph nodes | - people with psa >20 - gleason score 8-10 - tumore stage T2C (palpable and bilateral think 20/10=2)

Question 105

what are signs/symptoms of uremia?

Answer 105

- uremic frost - asterixis (tremoring of hand while wrist is extended) - nausea - vomiting - small mental status changes - loss of appetite

Question 106

name at least 5 causes of respiratory alkalosis. describe whether each of the following should be increased or decrease: pH, CO2, HCO3 describe the acute and chronic compensation what is the treatment

Answer 106

- anxiety - sepsis - fever - liver disease - pregnancy - pulmonary edema - heart failure - mitral valve disease - interstitial lung disease - mild pneumonia - mechanical ventilation - aspirin toxicity - altitude pH= increased, CO2= decreased, HCO3= decreased - acute: mass action --> for every 1 decrease in PCO2, .2 decrease in HCO3 - chronic: kidneys decrease reabsorption --> for every 1 decrease in PCO2, .4 decrease in HCO3 - breathe into a paper bag, treat the underlying disorder

Question 107

what are the mutations for autosomal dominant and autosomal recessive polycystic kidney disease? which chromosomes are affected

Answer 107

autosomal dominent- polycystin 1 (chromosome 16) and 2 (ca channel complex) (chromosome 4) autosomal recessive- fibrocystin (function unknown) (chromosome 6)

Question 108

what can cause pseudohyerkalemia?

Answer 108

issues with drawing blood - ischemic blood draw - too many platelets or wbc's in sample - cell lysis

Question 109

what are three places in the glomerulus where immune complexes can be deposited?

Answer 109

- subepithelial (between podocytes or under them) - mesangial - subendothelial (under the basement membrane)

Question 110

invasive urothelial carcinoma is associated with what (name 3 things)

Answer 110

smoking arylamines (dyes) SCHISTOSOMA

Question 111

what happens to ECF volume and arterial pressure in volume contraction? what about volume expansion? what extra symptom can you get in volume expansion

Answer 111

- decrease ECF volume, decrease Pa | - increase ECF volume, increase OR decrease Pa, edema!

Question 112

what is the formula for renal plasma flow (true and effective)

Answer 112

true rpf= V * [U] pah/ ([RA]pah - [RV]pah) effective rpf = V* [U]pah/Ppah ``` RA= renal artery RV= renal vein ```

Question 113

dsecribe Tm and threshold in terms of glucose reabsorption

Answer 113

Tm is the point in which reabsorption is saturated and the rate stays constant threshold is the point at which glucose first appears in the urine

Question 114

what is the preferred imaging for kidney stones?

Answer 114

spiral CT

Question 115

usually, effective arterial blood volume determines _____ and parallels _____ What is one situation in which it doesn't parallel?

Answer 115

- tissue perfusion - ECF volume - heart failure, ECF is increased, but EABV is not because the increase ECF volume is in the interstitium not the circulation (which leads to increases Na+ retention and edema)

Question 116

what can plasma osmolarity be approximated by

Answer 116

2 * [Na+]

Question 117

name 2 scenarios where Fractional excretion of Na (FeNa) is not reliable

Answer 117

chronic renal failure and diuretics both are high

Question 118

Name two things renin is stimulated by? name one thing renin is inhibited by?

Answer 118

- increased sympathetic stimulation and decreased perfusion pressure - ANP

Question 119

for cystinuria: what is the genetic inheritance? what is the defect what population can this commonly be seen in what shaped crystals would you see? are they correlated with stones? does it precipitate in alkaline or acidic urine?

Answer 119

- autosomal recessive - defect in amino acid transport in renal tubule of cysteine, ornithine, lysine, arginine (COLA) - children - hexagonal, yes - acidic

Question 120

what does aliskiren do?

Answer 120

block renin

Question 121

what is the mechanism of action for minoxidil what is something very important you must do when you prescribe minoxidil

Answer 121

- binds to vascular smooth K channels --> decreased bp - minoxidil causes activation of sympathetic nervous system and RAAS so you MUST prescribe diuretic and beta blocker with it

Question 122

in what part of the nephron does Ca2+ and Mg2+ both get reabsorbed and what can prevent this? where is another location where ca is reabsorbed? what can stimulate it?

Answer 122

- thicc ascending limb of loop of henle loop diuretics early distal tubule, thiazide diuretics and pth

Question 123

what is an angiomyolipoma made of? is it benign or malignant? - what demographic is it associated with - what condition is it associated with

Answer 123

- blood vessels, smooth muscle, fat - benign (can be life threatening if it hemorrhages) - female - tuberus sclerosis

Question 124

where is ADH stored

Answer 124

posterior pituitary

Question 125

name the four stages of diabetic nephropathy

Answer 125

- pre/latent --> incipient --> overt --> renal failure

Question 126

name 3 alpha antagonists what is the mechanism of action what are side effects?

Answer 126

- doxazosin, serzosin, etc (can treat bph) - phenoxybenzamine (can treat pheochromocytoma) - phentolamine (nonselective) - decreases vasoconstriction - postural hypotension, reflex tachycardia

Question 127

what are two things that make a good buffer?

Answer 127

- need to have a large concentration of it | - should have a pK that is + or - 1 of pH

Question 128

what are the two major determinants of whether a substance can cross the glomerular capillary border

Answer 128

molecular weight (anything under 5500 daltons can cross) - charge (barrier lined with negative charges, negatively charged molecules can't get through)

Question 129

Androgen receptors with ____ (longer or shorter) repeats of _____ codon have increased androgen sensitivity which demographic have shorter codons? which demographic have longer codons?

Answer 129

- shorter repeats - CAG (glutamine) codon - black - asian

Question 130

if a patient has edema, 99% of the time it is due to what/

Answer 130

- increased na (whether ingestion or retention)

Question 131

what kind of acid base disorder does diabetic ketoacidosis cause?

Answer 131

- metabolic acidosis (due to overproduction of fixed keto acids)

Question 132

do loop diuretics increase or decrease Ca excretion? explain why? what is another ion that operates exactly like Ca in response to loop diuretics?

Answer 132

increased excretion - loop diuretics block the Na-K-2Cl pump in the TALH, which decreases the positive luminal difference necessary for Ca to be reabsorption, so it is excreted - magnesium!!

Question 133

what is the most common genetic kidney disease ?

Answer 133

autosomal dominant polycystic kidney disease

Question 134

mnemonic for chromosome abnormalities in clear cell and papillary renal carcinoma

Answer 134

C3P- fo - c= clear 3- chromosome 3 p= papillary fo= four chromosomes (1,trisomy 7,16,17)

Question 135

when doing a crossmatch for kidney transplant, what is used?

Answer 135

- recipient serum and donor's lymphocytes + complement | - if preformed antibodies are present in the serum and bind to lymphocytes and cause >20% cell lysis, not a match

Question 136

where does titration of H+ by HPO42- happen in the nephron

Answer 136

late distal tubule/collecting ducts in the alpha intercalated cells

Question 137

what prostaglandins does cox 1/2 make? what are they responsible for ? what happens to them if you take nsaids

Answer 137

- PGE2: decreases reabsorption of Na at TALH (nsaid would allow for increased reabsorption and less diuretic efficacy) - PGI2: vasodilator and releases renin (nsaids can cause hyporenin hypoaldosteronism aka type 4 renal tubular acidosis)

Question 138

what is a normal BUN:Cr ratio name two scenarios where you can have an increased ratio

Answer 138

10-15:1 pre renal azotemia and high catabolic states (gi hemorrhage, infection)

Question 139

describe the driving force behind glomerulotublar balance? what 2 scenarios can override it?

Answer 139

- increase in oncotic pressure in peritubular capillary from water being filtered out of afferent arteriole drives water and Na into capillary, keeps Na reabsorption in proximal tubule at 67% - ecf volume expansion, more water in peritubular capillary, less oncotic pressure, less water and na reabsorbed --> more water and na reabsorbed - ecg volume contraction, less water in peritubular capillary, higher oncotic pressure, more water and na reabsorbed --> less water and na excreted

Question 140

Does aldosterone cause an increase or decrease in K secretion? Give two reasons why?

Answer 140

- increase - it increase ENaC, which increases the driving force for the Na-K pump to bring more K in --> increased intracellular K --> increased driving force for K secretion - it also increases the number of K channels for secretion

Question 141

what cystic kidney disease is commonly associated with nephrolithiasis?

Answer 141

medullary sponge kidney

Question 142

the _____ (lower/higher) the urine pH, the more H+ is secreted as NH4+ why?

Answer 142

- lower - acidic pH provides an even larger gradient for NH3 to diffuse from the interstitium to the lumen of the tubule (use henderson hasselbach formula)

Question 143

what is a side effect that all antihypertensive drugs cause

Answer 143

impotence

Question 144

parathyroid hormone blocks reabsorption of what in which part of the nephron?

Answer 144

- phosphate in the early proximal tubule

Question 145

when determining what the source of hypokalemia is, what measurement can be used?

Answer 145

- urine K/g creatinine if greater than 22, due to renal loss

Question 146

what are the four main effects of adh

Answer 146

* acts on V2 receptor on principle cells in the collecting duct --> increased Gs and cAMP --> increased aquaporin 2 channels --> increased water reabsorption * acts on V1 receptor on blood vessels to increase tpr and Pa - works on Na K 2 Cl channel in thick ascending limb - increases urea reabsorbing in the inner medullary collecting ducts

Question 147

what is the threshold for starting drug therapy for hypertension? what are the two exceptions? what is the goal bp?

Answer 147

>130/80, UNLESS primary stroke (cvd risk <10%) or cvd risk <10%, then >140/90 <130/80

Question 148

if a patient has afib and hypertension what would be a good drug to consider to treat both?

Answer 148

ARBs

Question 149

mnemonic for causes of toxic acute tubular necrosis

Answer 149

CRAMming is so TOXIC for ME Cisplatinum Radiographic contrast Aminoglycosides Mannitol Myoglobin (from rhabdomyolysis) Ethylene glycol

Question 150

What condition is the gleason grading system used to describe? describe the grading system

Answer 150

- prostate carcinoma - you characterize the dominant histologic pattern 0-5 (0 well diff 5 poorly diff) and then do the same thing for the second dominant pattern and add them together, the higher the score the worse the prognosis (6 is decent, 10 v bad)

Question 151

for multicystic dysplastic kidney: what is the cause? what does the kidney look like grossly? what is the prognosis?

Answer 151

- error in embryonic differentiation (no genetic mutation) - shrunken, doesn't resemble kidney shape, doesn't have kidney structures - if unilateral, great prognosis because other kidney can compensate

Question 152

what specific part of a protein provides the most buffer capacity?

Answer 152

imidazole group of histidine (pK 6 but argued to be 6.4-7)

Question 153

rbc casts in urine is 100% specific for what?? what color is hematuria?

Answer 153

- glomerulonephritis | - cola/tea colored (mickey mouse ears microscopically)

Question 154

what are the two types of invasive urothelial carcinoma precursors? - do they tend to be low grade or high grade - are they malignant? - what chromosome is affected

Answer 154

- non invasive papilary carcinoma [in situ] (has papillary) - non invasive flat urothelial carcinoma [in situ] (hard to detect cuz flat) - can be either - no, but can become malignant if breaks through basement membrane (low grade less likely to become malignant) - chromosome 9

Question 155

what arteriole in the kidney can nsaids affect in prerenal azotemia?

Answer 155

afferent arteriole (inhibit prostaglandins, which inhibits arteriole's ability to vasodilate)

Question 156

what is adynamic bone disease? in what group of people is this common?

Answer 156

- aggressive treatment of hyperparathyroidism with calcium and vitamin d can lead to normalization of pth values and hypercalcemia --> bone turnover decreases --> increases fractures, calciphylaxis, ca complex deposition in soft tissue and skin - dialysis patients

Question 157

for rapidly progressive glomerulonephritis: what is the clinical presentation? what would you see on histology? what are the three types what is the treatment?

Answer 157

- RENAL FAILURE (elevated Cr), oliguria, hematuria, proteinuria - CRESCENTS (proliferation of partietal layer of bowman's capsule) - anti gbm (goodpastures), immune-complex mediated, and pauci-immune (vasculitis!) - aggressive immunosuppression (cyclophosphamide) and steroids

Question 158

what buffer is responsible for excreting 60% of H+ in the urine

Answer 158

NH3/NH4+

Question 159

what is desmopressin used for in chronic kidney disease?

Answer 159

- if a patient has uremia, that can cause platelet dysfunction; desmopressin increases von willebrand factor release from endothelial cells and improves platelet aggregation

Question 160

name physiologic pulmonary changes during pregnancy

Answer 160

- increased tidal volume - increased minute ventilation - respiratory alkalosis - diaphragm pushed upward

Question 161

what is the main volatile acid in the body? Name at least 3 non-volatile/fixed

Answer 161

- CO2 sulfuric acid (methionine, cysteine) phosphoric acid (phospholipids) salicylic acid (aspirin) beta hydroxybutyric acid and acetoacetic acid (ketoacids) lactic acid formic acid (methanol) glycolic and oxalic acid (ethylene glycol)

Question 162

what causes av knicking

Answer 162

- artierolar thickening which compresses on the vein, making it look paler

Question 163

match the following urine casts with the most representative condition: - muddy brown casts, wbc casts, rbc casts, fatty casts - acute interstitial nephritis, nephrotic syndrome, acute tubular necrosis, nephritic syndrome

Answer 163

acute tubular necrosis- muddy brown casts acute interstitial nephritis- wbc casts nephrotic syndrome- fatty casts nephritic syndrome- rbc casts

Question 164

what is the cockroft gault formula for gfr/creatinine clearance?

Answer 164

Ccr= (140-age) X (Lean Weight in Kg)/(Scr X 72) [ *.85 if female]

Question 165

for goodpasture syndrome, what other organ can be involved besides the kidney? What happens? what would immunofluorescence reveal what would you see on EM?

Answer 165

- lung - pulmonary hemorrhage (igg on basement membrane of alveolar capillary) - linear fluorescence of capillary loops - no deposits

Question 166

what is the urine anion gap charge for type 1 and type 4 RTA? what is urine anion gap charge for type 2 RTA?

Answer 166

- less negative than usual | - negative

Question 167

what is the formula for renal blood flow

Answer 167

renal blood flow= renal plasma flow/ (1-Hct) hct= hematocrit (fraction of blood volume occupied by rbcs)

Question 168

if the measured serum osmolality and calculated serum osmolality do not = each other, what could be the cause

Answer 168

- toxin ingestion of methanol or ethylene glycol --> increasing measured osmolarity

Question 169

What separates a simple cyst from a complex cyst?

Answer 169

complex cysts tend to have septations, calcifications, thickened walls, soft tissue components, enhanced contrast on ct, etc and a higher risk for malignancy

Question 170

which part of the nephron do loop diuretics work on? which channel? give an example

Answer 170

- thick ascending limb of loop of henle - Na K 2 Cl - furosemide

Question 171

in what scenario can you get a kidney transplant? do you need to have done dialysis to quality for transplant? what are some contraindications? name 3 conditions that are no longer contraindicated?

Answer 171

- chronic kidney disease with gfr <20 - nope! - liver cirrhosis, heart failure, dementia, drug use, etoh use - HIV, Hep C, Hep B

Question 172

kussmaul respirations are associated with what acid base disorder?

Answer 172

metabolic acidosis | slow, deep gasping breaths

Question 173

minimal change disease mnemonic

Answer 173

He SAID he would CHANGE his AWFUL T SHIRT after injecting STEROIDS into his FOOT ``` Said= nsaids Change- minimal change disease Awful- nephrOtic Tshirt- t cell damage Steroids- steroids treatment Foot- reversible podocyte injury ```

Question 174

mnemonic for renal carcinoma paraneoplastic syndromes

Answer 174

HHHH ``` hyper calcuria (pthrp) hypertension (renin) high rbcs (polycythemia from epo) hepatic dysfunciton (stauffer's syndrome) ```

Question 175

acute onset of flank pain, dysuria, fever, and opaque urine could be a sign of what?

Answer 175

acute pyelonephritis

Question 176

what is the formula for fraction of filtered water that is reabsorbed

Answer 176

1- 1/ (TF/P)inulin ``` TF= tubular fluid concentration of inulin P= plasma concentration of inulin ```

Question 177

for overt diabetic nephropathy, what are the main pathologic features? what would a glomerulus look like on h and e stain?

Answer 177

- decreased gfr (cr might start to increase), macroalbuminuria/proteinuria, edema - kimmelstiel wilson nodules, glomerular/tubular sclerosis, interstitial fibrosis, hyalinized vessels (arteriosclerosis)

Question 178

name 2 antihypertensive drugs that block adrenergic neurons how do they do it what are the side effects for each

Answer 178

- guanethedine: prevents NE release from adrenergic neurons (guane= gone, adrenergic neurons are GONE) - reserpine: prevents NE uptake into storage vesicles (reser= reserves, destroying NE reserves) - guanethedine: diarrhea, fluid retention - reserpine- sedation, depression, gastric acid secretion

Question 179

how does spironolactone affect K secretion?

Answer 179

- it's an aldosterone receptor antagonist, so it decreases K secretion

Question 180

when is your blood pressure usually the lowest?

Answer 180

at night (nocturnal dip)

Question 181

for autosomal recessive polycystic kidney disease where are the cysts located? are they large or small? how does it present?

Answer 181

- located at a 90 degree angle to the cortical surface, v small (kidney has spongelike appearance) - usually presents at birth with serious complications; improper renal function in utero can lead to oligohydramnios--> potter sequence (flattened face, low set ears, pulmonary hypoplasia; can also have hepatic fibrosis and cysts and biliary proliferation

Question 182

name causes of hypermagnesemia what are symptoms how would you treat it?

Answer 182

iatrogenic- laxatives, enema, maalox, milk of magnesia, infusion for preeclampsia cerebral edema or severe asthma, - decreased reflexes, heart block , respiratory depression, paralysis, coma, hypocalcemia, hypotension bradycardia - calcium gluconate to stabilize membranes, saline to encourage excretion, ,dialysis if severe

Question 183

the kidneys recognize changes in Na+ by deteching changes in what?

Answer 183

ECF volume (Na determines it)

Question 184

what is the steady state body fluid osmolarity

Answer 184

290 mOsm/L

Question 185

for contrast induced nephropathy: what causes it? what happens as a result? what should you avoid when treating?

Answer 185

- contrast from ct imaging usually (mri contrasts are safe) - renal vasoconstriction --> medullary ischemia --> acute tubular injury - nsaids, volume depletion, and repeat studies (don't repeat them to the same contrast!)

Question 186

where in the nephron do k sparing diuretics work? name 3 k sparing diuretics how does it work? what is it indicated for? side effects?

Answer 186

- late distal convoluted tubule and collecting ducts (both principal and alpha intercalated cells) - spironolactone, triamterene, amiloride (the k STAys) - triamterene and amiloride inhibit na channels in principal cells, spironolactone competitively binds to aldosterone receptor and prevents translocation to nucleus - used with loop or thiazide diuretics to prevent K wasting, refractory edema - hyperkalemia, type IV RTA (metabolic acidosis), gynecomastia (spironolactone)

Question 187

which layer of a blood vessel does Ca lay down and calcify after being resorbed in chronic kidney disease

Answer 187

media

Question 188

what is an example of isoosmotic volume contraction? what is lost?

Answer 188

diarrhea NaCl and water

Question 189

if you have a catheter related or post- instrumentation bacteruria, what medication should you give and for how long?

Answer 189

- fluoroquinolones for 7-10 days

Question 190

for type 4 renal tubular acidosis: what can cause it? at steady state, what is the urine pH, serum K level?

Answer 190

- hyporenin- hypoaldosteronism --> decreases ammonia production - urine ph always <5.5, always hyperkalemic

Question 191

what are surgical complications during kidney transplant (specifically in regards to attaching the kidney)

Answer 191

- artery thrombosis and stenosis - veinous thrombosis and stenosis - ureter leak and stenosis - lymphocele

Question 192

what are three things that affect effective arterial blood volume?

Answer 192

- cardiac output, tpr, and intravascular volume (if any of these decrease, eabv decreases)

Question 193

what are the two soluble receptors released in preeclampsia and which factor do they correspond with

Answer 193

- sFlt --> antagonist for VEGF | - sEng- soluble coreceptor for tgfb

Question 194

what is the lowest ph that can be tolerated in the urine?

Answer 194

4.4

Question 195

name causes of hypophosphatemia

Answer 195

- decreased intake (starvation, etoh, malabsorption, vit d deficiency, phosphate binders) - redistribution (hungry bone syndrome, refeeding, uptake during blood sample) - renal wasting (fanconi syndrome, tenofovir, aminoglycosides, amphotericin b, cyclosporine, cisplatinum, diuretics, hypophosphatemic rickets) - Gi wasting aka DIARRHEA

Question 196

for membranous glomerulonephropathy: what is the histology? what can cause it? what demographic is it common in what is the treatment?

Answer 196

- thick basement membrane with spikes between subepithelial immune complex deposition - granular deposits on immunofluorescence - primary: PLA2R antigen on podocytes secondary: SLE, RA, solid tumor, HEpatitis b, syphillis, penacillamine - white people! - steroids AND immunosuppressants

Question 197

weak acid diuretics are inhibited by what give an example of these diuretics (3)

Answer 197

- probenecid | - acetazolamide, loop diuretics, thiazide diuretics

Question 198

mnemonic for causes of Allergic/Acute Interstitial Nephritis

Answer 198

- allergic interstitial nephritis = AINs ``` A= antibiotics/amoxicillin I= infection N= nsaids s= sjogrens/SLE ```

Question 199

what is the normal pH of blood? what range is it tightly regulated within? what range is compatible with life

Answer 199

- 7.4 - 7.35-7.40 - 6.8-8

Question 200

what is an example of hyperosmotic volume contraction? what is lost?

Answer 200

diabetes insipidus or water deprivation (FEVER) just water

Question 201

what are causes of hypokalemia what is the treatment? what other ion imbalance must you consider before treating?

Answer 201

- vomit, diarrhea, alcohol, hyperaldosteronism, drug toxicity, hypokalemic periodic paralysis, diuretics, excess catecholamines, 10 mEq/hr for ever .1 decrease - must check for hypomagnesemia, can cause hypokalemia

Question 202

what are the 5 most likely bacterial causes of urinary tract infection, and are they gram + or -

Answer 202

KEEPS - klebsiella (-) - Enterococcus (+) - E. Coli (-) - Proteus mirabilis (-) - staph saprophyticus (+)

Question 203

what is a good medication to use if you have bph and erectile dysfunction

Answer 203

pde 5 inhibitor

Question 204

what genetic mutation significantly increases your risk for prostate cancer

Answer 204

- BRCA 2

Question 205

symptoms of hypokalemia

Answer 205

muscle weakness/rhabdomyolysis nausea vomitingg respiratory failure (weak diaphragm) - increased NH3/4 in urine and increased HCO3 in blood

Question 206

what is the formula plasma osmolarity

Answer 206

2 [Na+] + glucose/18 + BUN/2.8

Question 207

name at least 6 causes of metabolic alkalosis (saline responsive and saline resistant. what is the underlying problem with all types of metabolic alkalosis? describe whether each of the following should be increased or decrease: pH, CO2, HCO3 describe the compensation what is the treatment

Answer 207

- saline responsive: vomit, Cl diarrhea, ng tube, villous adenoma, diuretics - saline resistant: primary hyperaldosteronism, adrenal adenoma, bilateral adrenal hyperplasia, cushings, licorice, post hypercapnic, renal artery stenosis - aldosterone secretion - pH= increased, CO2= increased, HCO3= increased - for every 1 increase in HCO3, CO2 increases by .6 - saline if volume depleted, acetozolomide, aldosterone inhibition

Question 208

what are treatments for prostate cancer?

Answer 208

- radiation therapy - cryoablation - da vinci prostatectomy - hormonal therapy - surgical castration (orchiectomy), medical castration (leuprolide, degarelix), antiandrogens (bicalutamide)

Question 209

name the 4 steps towards diagnosing primary hyperaldosteronism. describe the purpose of each step. what is the treatment?

Answer 209

1) aldosterone: renin ratio- screening test (20-30 is positive) 2) salt loading- biochemical diagnostic test 3) abdominal ct- to check for adrenal carcinoma 4) adrenal venous sampling- to distinguish between adrenal adenoma and bilateral adrenal hyperplasia - surgical resection of adenoma if possible, mineralocorticoid receptor antagonist

Question 210

for dialysis associated cystic disease: what is the cause where are the cysts? what serious complication can occur?

Answer 210

- kidneys are not being used due to dialysis, eventually form cysts and calcify and fibrose also - medullary and cortical cysts - some of these cysts can come renal cell carcinoma

Question 211

does drowning cause hypernatremia or hyponatremia? is it euvolemic, hypervolemic, or hypovolemic? how would you treat it

Answer 211

- hypervolemic hypernatremia D5W and diuretics

Question 212

increase in what two things in diet can increase calcium excretion

Answer 212

- sodium and animal protein

Question 213

name at least 5 risk factors for acute kidney injury

Answer 213

- age >75 - chronic kidney disease - diabetes - myeloma - proteinuria - heart failure - cirrhosis - peripheral vascular disease - volume depletion

Question 214

for post-infectious glomerulonephritis: what is the histology? what is the pathophysiology what is the classic presentation what would urinalysis reveal? any high serum titers? what is the treatment?

Answer 214

- granular lumpy bumpy pattern along capillary loops, can resemble lobar simplification like in mpgn (cauliflower), very cellular due to exudate and mesangial+endothelial proliferation - antigen from infection (most likely strep) has similarity to basement membrane and deposits subepithelial( VLARGE DEPOSIT); complement activation - hematuria (cola urine), proteinuria, edema, azotemia (increased cr) oliguria 1-4 weeks after strep A infection (also staph, pneumococcal, measles, chickenpox, hep b) - rbc and wbc cast - high aso titers - supportive treatment, antihypertensives, diuretics

Question 215

name four scenarios in which you should suspect primary hyperaldosteronism?

Answer 215

- htn and an adrenal adenoma - htn resistant to three medications - htn and hypokalemia - early onset htn, esp with stroke

Question 216

what should the hepcidin, hemoglobin, TIBC (transferrin), serum iron level, % saturation, and ferritin values be in anemia of chronic kidney

Answer 216

``` hepcidin- high (increased production and decreased clerance) hgb- low TIBC- low Serum iron- low %saturation- low ferritin- high ```

Question 217

where does the prostate arise from embryologically? at which week gestation?

Answer 217

urogenital sinus 10 weeks

Question 218

high K diet results in ______ (increased or decreased) K secretion in the principal cells? low K diet results in ______ (increased or decreased) K secretion in the principal cells?

Answer 218

- increased | - decreased

Question 219

where in the nephron do loop diuretics work? name 3 loop diuretics how does it work? what is it indicated for? contraindications? side effects?

Answer 219

- thicc ascending loop of henle - furosemide, bumetanide, ethacrynic acid - anion form competitively binds to Cl site and prevents reabsorption (most powerful diuretic) of Na, K, Cl, Mg, and Ca, also increases uric acid reabsorption in PCT by causing ECF contraction - edema and severe hypercalcemia - sulfonamide allergy (bumetanide and furosemide) - hypokalemia, hypomagnesemia, ototoxicity, hyperuricemia, metabolic (contraction) alkalosis, hypernatremia, hyponatremia (OHH DAANG)

Question 220

what type of acid base disorder does acetazolamide cause what about loop diuretics? thiazide diuretics? K sparing diuretics?

Answer 220

- Type II renal tubular acidosis (metabolic acidosis) - metabolic (contraction) alkalosis - metabolic (contraction) alkalosis - type IV renal tubular acidosis (metabolic acidosis)

Question 221

a widened mediastinum is indicative of what

Answer 221

aortic dissection

Question 222

if a medication is easily cleared renally, should you give the medication before or after dialysis? can ace inhibitors be removed by dialysis?

Answer 222

after! YES

Question 223

would increasing calcium intake make kidney stones worse or better?

Answer 223

better! calcium will bind oxalate in the gut and prevent absorption

Question 224

do loop diuretics cause hypernatremia or hyponatremia? is it euvolemic, hypervolemic, or hypovolemic? how would you treat it?

Answer 224

hypovolemic hypernatremia normal saline if hypotensive oral water to replace volume loss

Question 225

name a scenario in which renal compensation for metabolic alkalosis will NOT happen?

Answer 225

- if you have metabolic alkalosis due to ECF volume contraction (have to treat volume contraction first before treating alkalosis)

Question 226

in what cells of the prostate is 5alpha reductase located mostly? is bph more due to cells living longer or more cells forming

Answer 226

stromal cells cells living longer

Question 227

does decreased renin cause hypo or hyperkalemia? name three things that can decrease renin and subsequently affected potassium levels?

Answer 227

hyperkalemia - cyclosporine, nsaids, and diabetic nephropathy

Question 228

name treatment methods of secondary parathyroidism in chronic kidney disease

Answer 228

- phosphate binders (calcium carbonate, sevelemer) - vitamind d analogs - cinacalcet (binds to calcium sensing receptor)

Question 229

what gfr values correspond to the 5 stages of kidney disease?

Answer 229

1: >90 2: 60-89 3: 30-59 4: 15-29 5: <15

Question 230

what is a kidney stone that involves the renal pelvis and at least two caluces

Answer 230

staghorn stone

Question 231

what ions/molecuels are reabsorbed in the kidney which ones are secreted?

Answer 231

I NAGginly HAC the CPU - Na, glucose, HCO3, amino acids, ca2+, Cl, phosphate, urea - PAHK My Hair - pah, K+, Morphine, H+

Question 232

what two glomerular diseases would have negative immunofluorescence?

Answer 232

minimal change disease and focal segmental glomerulosclerosis (no immune complex deposition)

Question 233

where does NH4+ that is used to buffer H+ originally come from?

Answer 233

via glutamine in the proximal tubule glutamine gets converted to NH4 via glutaminase

Question 234

for squamous cell carcinoma of the penis what two situations is it associated with? where does it metastasize to?

Answer 234

- uncircumsized people and hpv 16 and 18 regional lymph nodes

Question 235

what does positive Ch20 (positive free water clearance) mean what does negative Ch20 mean?

Answer 235

- urine osmolarity is less than plasma, meaning more water was excreted, water diuresis - urine osmolarity is more than plasma osmolarity, meaning less water was excreted (more water reabsorbed), water antidiuresis

Question 236

which part of the nephron do thiazide diuretics work on? which channel? give an example

Answer 236

- early distal tubule Na Cl channel hydrochlorothiazide, chlorothiazide

Question 237

what are common causes of secondary hypertension

Answer 237

``` - DRROP drugs or alcohol renal parenchymal disease renovascular disease obstructive sleep apnea primary aldosteronism ```

Question 238

which cystic kidney disease can you get berry aneurysms, mitral valve prolapse or liver cysts?

Answer 238

autosomal dominant polycystic kidney diseasee

Question 239

Where in the body does angiotensin converting enzyme work? What does it convert?

Answer 239

- lungs | - angiotensin I to angiotensin II

Question 240

what can cause normal anion gap metabolic acidosis?

Answer 240

- diarrhea, all types of renal tubular acidosis

Question 241

name the places in which urea is impermeable in the nephron name the places in which water is impermeable

Answer 241

- from thick ascending limb to outer medullary collecting duct - from thick ascending limb to early distal tubule

Question 242

what is used to estimate renal plasma flow/renal blood flow why

Answer 242

para aminohippuric acid (PAH, an organic acid) - it has high clearance, aka is filtered and secrete

Question 243

what is the most common bacterial cause of pyelonephritis? where does it originate from? what are two uncommon causes and where do they originate from?

Answer 243

- ecoli, ascending from perinum and vesicouteral reflux - staph aureus, hematogenous spread - mycobacterium tuberculosis, from lung

Question 244

demeclocycline is used to treat what? what is a side effect

Answer 244

SIADH nephrogenic diabetes

Question 245

What fraction of TBW is ECF? ICF? what separates ECF and ICF

Answer 245

ECF --> 1/3 ICF -->2/3 cell membrane

Question 246

what is the formula for filtered load?

Answer 246

GFR * [P]x (*% of x unbound in plasma) ``` GFR= clearance of inulin or creatinine Px= plasma concentration of x ```

Question 247

what cardiac changes occur during pregnancy

Answer 247

- decreased svr due to progesterone, prostacyclin and relaxin relaxing the muscle - increased cardiac output - dilution anemia - increased blood volume from RAAs and adh but also desensitive AII

Question 248

all diuretics are filtered AND secreted in the ________ tubule

Answer 248

late proximal

Question 249

name 6 changes in renal physiology during pregnancy

Answer 249

- increased gfr and rbf - increased adh - increased RAAS - hyponatremia and edema - increased Na retention - glycosuria

Question 250

hypophosphatemic rickets is due an activating mutation in ____ or ____

Answer 250

fgf23 or vitamind d receptor

Question 251

what acid base disorder is primary hyperaldosteronism associated with? if a person with primary hyperaldosteronism has muscle cramps, what could be the reason?

Answer 251

metabolic alkalosis hypokalemia

Question 252

how much does the glomerulus filter initially vs how much urine is the final product after reabsorption and secretion

Answer 252

180L/day vs 1-1.5 L/day

Question 253

for chronic glomerulonephritis: what causes it? what does histology look like what would the kidney grossly look like? what is the treatment?

Answer 253

- essentially any nephrotic or nephritic syndrome besides minimal change can cause it (esp rapidly progressive glomerulonephritis), BUT it is so far progressed that you can't find the original etiology - global glomerular sclerosis and interstitial fibrosis - it would be smol! (<9.5 cm) - dialysis and kidney transplant

Question 254

name and describe the three components of the juxtaglomerular apparatus what arre the two main functions of the juxtaglomerular apparatus

Answer 254

mesangial cells (line afferent, efferent arterioles and glomerulus) juxtaglomerular cells (surround afferent arterioles and release renin) macula densa (part of early distal convoluted tubule and comes very close to its own glomerulus) - secrete renin and tubuloglomerular feedback

Question 255

what signs of a kidney stone suggest urgent intervention is necessary?

Answer 255

fever high wbc uncontrolled pain renal failure

Question 256

for IgA nephropathy: what is the histology? what is the pathophysiology? what is the classic presentation? what is a vasculitis that is associated with it?

Answer 256

- mesanial hyperplasia matrix expansion in response to IgA complex deposition; "prune bush" pattern on IF - abnormally increased IgA possibly due to upper respiratory or mucosal infection that deposits in the mesangium; complement activation subsequently - hematuria coinciding with upper respiratory infection ( can also have proteinuria, htn, edema etc) - henoch- schoenlein purpura (purpura, arthralgias and flank pain triad)

Question 257

if a medication has a high volume of distribution, then it is _____ (easy, hard) to clear it renally/via dialysis give an example

Answer 257

hard digoxin!

Question 258

for hypergycemic, hyperosmotic non-ketotic diabetic coma: what demographic is most often affected? what is the cause what often precipitates it? what is the blood sodium concentration what is the treatment?

Answer 258

- elderly with type 2 diabetes - hyperglycemia --> glycosuria --> loss of water with glucose in urine - stress, infection, steroids - can be high, low or normal - .9% saline to replace volume loss, almost always insulin, and water

Question 259

what is the classic triad seen with renal cell carcinoma? which is most common?

Answer 259

hematuria (most common), palpable mass, flank pain

Question 260

what three vitamins can increase the absorption of Ca

Answer 260

C A D

Question 261

what ekg abnormalities can be present due to hyperkalemia?

Answer 261

peaked t waves

Question 262

do invasive urothelial carcinomas recur if removed?

Answer 262

yes, esp if high grade

Question 263

mnemonic for medications that can cause htn

Answer 263

The DON'TS of hypertension ``` D- decongestants O- oral contraceptives N- NSAIDS T- Tricyclic Antidepressants S- steroids ```

Question 264

what are complications of using a tunnel catheter for dialysis?

Answer 264

- endocarditis - bacteremia to the spine - thrombus - infection - extruded cuff

Question 265

what gender, age group, and ethnicity/race is more likely to get hypertension?

Answer 265

- older african american men

Question 266

when is urine sodium >20 and urine osmolality high in volume depleted states?

Answer 266

RENAL LOSSES OF FLUID - diuretics - glycosuria

Question 267

what three hormones relax smooth muscle during pregnancy

Answer 267

relaxin, progesterone, prostacyclin

Question 268

what are normal values for gfr for young and elderly men and women

Answer 268

Males: Age 20-30 approximately 110ml/min Age 70-80 approximately 65 ml/min Females:Age 20- 30 approximately 100 ml/min Age 70-80 approximately 50 ml/min

Question 269

does diabetes insipidus cause hypernatremia or hyponatremia? is it euvolemic, hypervolemic, or hypovolemic? how would you treat it

Answer 269

- euvolemic hypernatremia D5w

Question 270

for (Type II) Immne complex mediated rapidly progressive glomerulonephritis, what is the cause? what is the fluorescence pattern? what is the treatment?

Answer 270

- any cause of immune complex glomerulonephritis ex: SLE, iga nephropathy, postinfectious GN granular deposits treat the underlying cause!

Question 271

for (type III) pauci-immune rapidly progressive glomerulonephritis: what causes it (3 things) what does IF show? what does H & E stain show what titers will be elevated

Answer 271

- vasculitides: wegners, microscopic polyangitis, churg strauss syndrome - doesn't show anything! no antibodies or immune complexes - crescent (proliferation of partial layer of bowman's capsule) - C-ANCA for wegners, P-ANCA for microscopic polyangitis and churg strauss

Question 272

what is diffusion trapping?

Answer 272

- the concept that once NH3 diffuses from the interstitium of the medulla to the lumen and combines with H+ to form NH4+, it is now charges and cannot diffuse back to the interstitium and gets excreted

Question 273

can you get hyperkalemia from high K food intake?

Answer 273

NAH, only can happen if you have end stage renal disease

Question 274

what two demographics of renal cell carcinoma are hereditary?

Answer 274

- hereditary papillary carcinoma (multiple bilateral nodules, mutation in met oncogene) - Von Hippel Landau Syndrome (autosomal dominant, inactivating mutation of VHL tumor suppressor gene)

Question 275

how should prerenal azotemia be treated?

Answer 275

- if true volume depletion, normal saline | - treat underlying cause

Question 276

what is the most common genetic cause of end stage renal disease in people less than 30 years old? what is it characterized by?

Answer 276

- medullary cystic disease hella cysts in the cortico-medullary junction

Question 277

what are the two antimetabolite drugs used for kidney transplant/how do they work? side effects?

Answer 277

- azathioprine- incorporated into rna and stops cell cycle - mycophenylate- inhibits inosine monophosphate dehydrogenase--> inhibits cell cycle - azathioprine- bone marrow suppression, hepatitis, don't use with allopurinol - mycophenylate- nausea vomiting diarrhea

Question 278

for autosomal dominant polycystic kidney disease: what is the pathogenesis? what are the symptoms? what are three major systemic manifestations? what is the treatment?

Answer 278

- have dominant mutation that will cause asymptomatic cysts or no cysts until a second hit causes rapid proliferation of cysts, causes significant cystic dilation of nephrons - hematuria, proteinuria, polyuria, hypertension, back pain - polycystic liver disease, berry aneurysm, mitral valve prolapse - transplant (curative), dialysis, caffeine avoidance, tolvaptan, anti-hypertensives

Question 279

what are the two major processes responsible for establishing the corticopapillary gradient?

Answer 279

- countercurrent multiplication | - urea recycling

Question 280

speed of flow through the vasa recta MUST be ____ (slow or fast). explain why

Answer 280

slow other wise vasa recta will wash away solute and dissipate corticopapillary gradient

Question 281

what is the pK of Hb-O2? what about Hb

Answer 281

HbO2 6.7 | Hb 7.9

Question 282

what are treatment options for renal cell carcinoma

Answer 282

- IL2, only curative option, but toxic af and not always effective - tyrosin kinase inhibitor, temsirolimus - radical nephrectomy - partial nephrectomy - checkpoint inhibitors (nivolumab and ipilimummab)

Question 283

what is specific gravity what specific gravity value indicates that there is intact kidney function?

Answer 283

- ratio of weight of urine to equal volume of distilled water (helps you figure out if kidneys are capable of concentrating urine - >1.018

Question 284

what is the difference between essential hypertension and secondary hypertension

Answer 284

- essential has an unknown cause but secondary this is a definite/known cause

Question 285

which condition does rule of thirds refer to? what is the rule of thirds?

Answer 285

membranous glomerulonephropathy - third will go into remission third will have partial remission and slow progression third will get esrd

Question 286

for membranoproliferative glomerulonephritis: what is the histology? what is the cause? who is affected? is it a nephrotic or nephritic syndrome?

Answer 286

- subendothelial immune complexes +complement lead to second basement membrane (tram tracks); igg and complement granular fluorescence; lobular simplification (cauliflower), mesangial interposition primary idiopathic secondary: SLE, hep c, endocarditis, lymphoma primary: young adults and children secondary: adults - mix of both nephrotic and nephritic syndrome

Question 287

what are the four effects of angiotensin II in response to decrease Pa

Answer 287

- increases thirst --> increased H20 intake - increases aldosterone synthesis --> increased aldosterone --> increase Na channels in distal tubules and collecting ducts --> increase Na reabsorption - increases TPR - stimulates Na+ H exchange in proximal tubule, increasing Na reabsorption

Question 288

for pheochromocytoma: what is it? what are symptoms how do you diagnose it how do you treat it

Answer 288

- catecholamine secreting tumor (can be in adrenals or elsewhere= paragangliomas) - htn, pallor, palpitations, headaches, diaphoresis, orthostatic hypotension (due to intravascular volume loss) - screen by checking metanephrine levels in serum or 24 hr urine, then abdominal ct - alpha blocker then surgery, DON'T USE BETA BLOCKERS

Question 289

what is the 60-40-20 rule?

Answer 289

60% of weight is total body water 40% of weight is ICF 20% of weight is ECF

Question 290

what is the definition of proteinuria? what is a common tell tale visible sign of proteinuria?

Answer 290

>150 mg protein in 24 hr urine specimen or >150 mg/g creatinine in random sample foamy urine

Question 291

How can you differentiate prostate intraepithelial neoplasia and prostate carcinoma?

Answer 291

stain the basement membrane - prostate carcinoma invades the basement membrane whereas pin does not

Question 292

describe three reasons why you can get glucosuria

Answer 292

- diabetes, increased plasma glucose concentration --> increased filtered load (fl= GFR * Px) - pregnancy, increased gfr --> increased filtered load (fl= GFR* Px) - renal glucosuria, decreased affinity or amount of na-glucose transporters --> decreased Tm --> increased excretion

Question 293

in saline resistant metabolic alkalosis, what would the urine chloride be and why? what about saline sensitive metabolic alkalosis? Will the urine sodium match urine chloride in the urine?

Answer 293

- would be higher >15, not in volume depleted state, don't need to reabsorb as much Na Cl - would be low because body is trying to retain as much Na Cl as possible in volume depleted state - nope, because after Cl is reabsorbed, remaining Na is obligated to pass through urine with HCO3

Question 294

mnemonic for marker substances

Answer 294

- I HAD MARC jacobs' pRIMER MARC= MARKERS H TO A ntipyrene D 2O R adioactive sulfate I nulin M annitol E van's blue dye R adioiodinated serum albumin

Question 295

what antihypertensive drugs are safe for pregnancy? which ones are not safe?

Answer 295

- methyldopa, labetalol, hydralazine, calcium channel blockers - ace inhibitors, arb's spironolactone

Question 296

what are poor predictors of membranous glomerulonephropathy ?

Answer 296

``` tubulointerstitial fibrosis elevated creatinine at diagnosis male sex hypertension older age heavy proteinuria ```

Question 297

what condition do lower urinary tract symptoms refer to? name some

Answer 297

- benign prostate hyperplasia | - nocturia, urgency, frequency, hesitancy, post void dribble, slow stream

Question 298

what is urodilatin? where does it act?

Answer 298

- similar in structure to ANP, causes local prevention of Na reabsorption--> increased Na excretion - distal nephron

Question 299

does alkalemia result in increased or decreased K secretion? what about acidemia? what channel facilitates this?

Answer 299

- increased secretion - decreased secretion - H- K pump

Question 300

name four common ways you lose K?

Answer 300

- the four D's - diarrhea - diuretics - drinking water - alDosterone

Question 301

what type of acid-base disorder does aspirin overdose cause?

Answer 301

- TRICK QUESTION IT CAUSES TWO TYPES (mixed disorder) ``` metabolic acidosis (ingestion of Fixed H) respiratory alkalosis (has direct effect on medulla ```

Question 302

does acute cystitis present with fever? does acute pyelonephritis present with fever?

Answer 302

- no (not systemic infection) | - yes

Question 303

what increases aldosterone secretion? what decreases aldosterone secretion?

Answer 303

- increase angiotensin II, hyperkalemia (& decreased pressure) - decreased angiotensin II, hypokalemia (increased pressure)

Question 304

how can you treat aspirin poisoning by excreting more aspiring?

Answer 304

- by alkalinizing the urine --> favor A- form of aspirin over HA --> A- is water soluble and can't diffuse back into blood -> more aspirin is excreted

Question 305

all diuretics are filtered AND ____ in the late proximal tubule

Answer 305

secreted

Question 306

name 5 target-organ damage due to hypertension?

Answer 306

- retinopathy - stroke, hemorrhage, dementia - peripheral vascular disease - renal failure - LVH, HF, CHD

Question 307

antihistamines and amphertamines are ____ (bases or acids), addition of bicarb would ____ (increase or decrease) renal clearance

Answer 307

bases | decrease

Question 308

what causes of metabolic acidosis can cause a normal anion gap

Answer 308

diarrhea and all types of renal tubular acidosis

Question 309

name 5 functions of PTH name three things that regulate the parathyroid glands

Answer 309

``` increase Ca reabsorption in the kidney increase Ca resorption in bone increase calcitriol production increase bone turnover decrease phosphate reabsorption ``` - vitamin d (via vitamin d receptor) - calcium (via calcium sending receptor) - phosphate

Question 310

what are the three criteria of benign prostatic hyperplasia?

Answer 310

- prostatic volume (enlarged prostate) - histology- hyperplasia of epithelial and smooth muscle cells - lower urinary tract symptoms- nocturia, urgency, frequency, hesitancy, post void dribble, slow stream

Question 311

for Liddle syndrome: what is the cause what are the aldosterone and renin levels

Answer 311

- autosomal dominant disorder in which na channels on principal cells are over activated - low aldosterone, low renin

Question 312

what type of retinopathy finding in hypertension is due to swollen/damaged axons?

Answer 312

cotton wool spots

Question 313

when you should consider doing ct or sonogram for a patient with acute pyelo nephritis?

Answer 313

- if symptoms don't decrease after 3 days - has more than 2 episodes of pyelonephritis in a year - complicated nephritis - urine culture reveals yeast - symptoms returns less than 2 weeks after treatment

Question 314

name three erythropoiesis stimulating agents what do they do name side effects what should you give with esa's

Answer 314

- erythropoietin, darbepoietin, mircera - stimulate erythropoiesis - iron deficiency, worsening htn

Question 315

what are treatment options for bladder cancer (5)

Answer 315

- radical cystoprostatectomy - partial cystectomy (difficult because usually multifocal) - neoadjuvant chemo + cystectomy - turbt - bladder preservation protocol

Question 316

what are the two hereditary causes of nephrogenic diabetes insipidus? what is their inheritance? what are two non-inheritable causes of nephrogenic diabetes?

Answer 316

- V2 receptor mutation- x linked recessive - aquaporin defect- autosomal recessive - lithium (used to treat bipolar) and demeclocycline (treats siadh)

Question 317

does hypoaldosteronism cause hyper or hypokalemia?

Answer 317

- hyperkalemia

Question 318

give an example of positive Na+ balance describe how the body compensates

Answer 318

- increased ingestion of Na+ (and water) - Na and subsequently water will fill the ECF, both values increase, and body weight increases, then a few days later the kidneys sense the increase in ECF volume, which causes them to excrete more Na+ than what is being ingested, bringing the ECF and Na content back to normal

Question 319

which two acid base disorder types would have decreased HCO3 and decreased CO2?

Answer 319

- metabolic acidosis | - respiratory alkalosis

Question 320

for glucocorticoid remediable aldosteronism: what is the cause what are the aldosterone and renin levels what is the treatment?

Answer 320

- autosomal dominant inherited chrimer gene that causes acth, not raas, to be the main stimulator of aldosterone synthase - high aldosterone, low renin - steroids!

Question 321

what is an example of hyposmotic volume contraction? what is lost?

Answer 321

- adrenal insufficiency | - NaCl

Question 322

name three scenarios in which you would have no ADH turned on

Answer 322

- drink hella water - central diabetes insipidus - nephrogenic diabetes insipidus

Question 323

what is the difference between chronic hypertension, gestational hypertension, and preeclampsia during pregnancy?

Answer 323

- chronic- hypertension before 20 weeks - gestational - htn after 20 weeks - preeclampsia- htn after 20 weeks WITH at least one severe feature (ex: 160/110, proteinuria, HELLP syndrome, visual disturbances, seizures, thrombocytopenia, acute kidney injury, pulmonary edema)

Question 324

what dietary intake should you increase if you have hypertension

Answer 324

potassium

Question 325

for apparent mineralocrticoid excess: what is the cause what are the aldosterone and renin levels

Answer 325

- either too much cortisol (cushing) that 11 B hydroxysteroid dehydrogenase is overwhelmed OR glycyrrhizinic acid (licorice, tobacco) inhibits 11BHSD --> cortisol is not all converted to coritsone and can activate mineralocorticoid receptor - low aldosterone, low renin

Question 326

what is the treatment for low and high grade superficial bladder cancer (and carcinoma in situ)?

Answer 326

- transurethral resection of bladder tumor (TURBT) + intravesicle mitomycin - intravesicle BCG for 6 weeks

Question 327

what can cause tumor lysis syndrome? what causes it? how should you treat it?

Answer 327

- initiation of chemo for hematologic cancer - increased tumor cell turnover --> increased uric acid - hydration with isotonic fluid and allopurinol

Question 328

what stain is used to differentiate diabetic nephropathy from amyloidosis? what would you see on the stain?

Answer 328

congo red stain apple green birefringence to light

Question 329

Concentration of what urinary molecule would reflect PTH action?

Answer 329

urinary cyclic AMP! (from when PTH binds to cells in the proximal convoluted tubule to inhibit phosphate reabsorption)

Question 330

what are three different type of uric acid nephropathies that can occur

Answer 330

- uric acid stone - acute urate nephropathy: when you start treating malignancy, increased cell turnover leads to increased uric acid in the tubules, --> acute tubular necrosis - chronic urate nephropathy: in people with gout, you can get depositions of uric acid (similarly to how it deposits in joints)

Question 331

the half half point of a weak acid/weak base is when?

Answer 331

pH= pK | half is A- and half is HA

Question 332

what are the first two signs of recovery in acute tubular necrosis? should you give saline?

Answer 332

- first urine output increases - second cr decreases - ONLY IF HYPOVOLEMIC, if they're not making urine, it doesn't mean you should give saline

Question 333

name in increasing order which populations are affected by prostate cancer black asian white

Answer 333

asians, white, black

Question 334

what is an example of isoosmotic volume expansion? what is gained?

Answer 334

- isoosmotic saline infusion | - water and NaCl

Question 335

what is the treatment for acute pyelonephritis? for how long? what if you need parental abx?

Answer 335

trimethoprim/sulfamethoxazole for 14 days (can also use fluoroquinolones) - ceftriaxone with aminoglycoside, if enteroccous, ampicillin and aminoglycoside

Question 336

for medullary sponge kidney: what is the cause? what is the presentation? what are they at more increased risk of getting? what is the treatment?

Answer 336

- some developmental abnormality causes dilation of the medullary collecting ducts, which can pinch off and form cysts - can be asymptomatic, can also have flank pain, hematuria, kidney stones, UTIs, nephrocalcinosis - kidney stones (nephrolithiasis) - none! benign

Question 337

what are three ways to increase blood pressure?

Answer 337

``` BP= CO* TPR CO= SV*HR ``` increase the rate (HR) increase the amount the heart pumps (SV) increase the resistance (TPR)

Question 338

what two things can increase calcium reabsorption in the distal tubule?

Answer 338

pth and thiazide diuretics

Question 339

mnemonic for indications for dialysis

Answer 339

``` AEIOU A- acidosis E- electrolytes (severe hyperkalemia) I- ingestions/intoxications O- (volume) overload U- Uremia (pericarditis, encephalopathy) ```

Question 340

what is the pc1-pc2 complex? what is it important for? what do mutations in this cause?

Answer 340

- Ca2+ channel complex in the primary cilia, lets the cell know when it's bent - it releases the centrosome during mitosis which provides the cell with correct polarity and makes sure it divides in the correct direction/orientation - mutations in this (or in the centrosome) result in loss of polarity and direction of mitosis (loss of architecture) and formation of cysts (in addition to increase in ion and h20 channels)

Question 341

which part of the nephron does aldosterone work on? which channels?

Answer 341

- late distal tubule and collecting ducts - Na reabsorption channel and K secreting channel of principle cells and H ATPase secretion channel of intercalated cells

Question 342

what is the formula for excretion rate

Answer 342

V* [U]x ``` Ux= urinary concentration of x V= urinary flow rate ```

Question 343

reabsorption of HCO3- in the proximal tubule involves the net secretion of how many H+?

Answer 343

- ZERO! (H is recycled)

Question 344

what is more of a medical emergency, hyperkalemia or hypokalemia? what should you do to treat it?

Answer 344

HYPERKALEMIA V BIG EMERGENCY - buy time initially by giving calcium gluconate to stabilize membrane and b agonist (inhaled abuterol) and insulin - then you MUST remove the K from the body by either diuresis, dialysis, polystyrene resin

Question 345

which condition can cause hypocalcemia, hypogammaglobulinemia, and hypercoagulability? why?

Answer 345

- nephrotic syndrome, due to loss of proteins (vit d binding protein, protein c and s, globulins)

Question 346

name three clinical presentations of acute tubular necrosis?

Answer 346

OAF! Oliguria azotemia FeNa>2% (means tubules are damaged and can't reabsorb Na)

Question 347

name at least 5 medications medications/substances that are nephrotoxic?

Answer 347

``` cyclosporine amphotericin radiocontrast tacrolimus heavy metals aminoglycosides acyclovir sulfathiazole ```

Question 348

for latent diabetic nephropathy, what is the main pathologic feature? what would a glomerulus look like on h and e stain?

Answer 348

- increased GFR | - nothing really, MAYBE slight increased in size

Question 349

name the intracellular and extracellular buffer proteins and which ones are most important

Answer 349

mnemonic: ahh! it's a bop! ecf: albumin, HCO3/H2CO3/CO2 (most important), HPO4/H2PO4 icf: "bone", organic phosphates (adp, atp, etc), proteins (Hemoglobin, most important)

Question 350

what is splay? name two reasons why it occurs?

Answer 350

- when the Tm for reabsorption of a substance is reached after the threshold for excretion - nephron heterogeneity (individual nephrons have different Tm - low affinity high capacity Na- Glucose transporter in the early proximal tubule

Question 351

mnemonic for focal segmental glomerulosclerosis

Answer 351

The SMALL AFRICAN HISSING COCKROACH FOCUSED on HER FOOD-hunting SKILL from her HIVE. Small= small kidney for size (low birth weight, morbid obesity) African- aa most affected Hissing- Hispanic ``` Cockroach- cmv Focused- focal segmental glomerulosclerosis HER- heroin FOOD- FOOT process Skill- sclerosis Hive= hiv ```

Question 352

if ct urogram is negative for renal or bladder cancer what is the next step? why?

Answer 352

cytoscopy, carcinoma in situ or very small tumors won't show up on ct

Question 353

what condition can look like a cystic kidney disease but actually is not?

Answer 353

hydronephrosis

Question 354

what is the formula for anion gap? what is a normal range? what is it used to distinguish?

Answer 354

[Na] - ( [Cl]+ [HCO3]) 8- 16 mEq/L different types of metabolic acidosis; if it's due to overproduction or ingestion, the anion gap will be larger than normal; if it's due to diarrhea/RTAs, it will be normal because Cl will increase

Question 355

which part of the nephron do K+ sparing diuretics work on? which channel? give an example

Answer 355

- late distal tubule and collecting ducts - Na channel - spironolactone, amiloride

Question 356

what is the standard work up imaging done for suspected kidney stones/urolithiasis what are treatment options?

Answer 356

- renal colic CT | - let it pass on own, pain meds, hydration, alpha receptor antagonist, uteroscopy + LASER lithotripsy, SMASH IT, stent

Question 357

what medication is retrograde ejaculation a side effect for?

Answer 357

alpha blockers

Question 358

what are the 2 criteria for nephrotic syndrome? what are 3 symptoms

Answer 358

proteinuria >3.5/day hypoalbuminemia <3.5 g/dl edema (due to intense sodium retention or decreased oncotic pressure), hyperlipidemia, and lipiduria (liver is inhibited from making albumin, so it makes lipoproteins instead)

Question 359

where in the nephron do thiazide diuretics work? name 3 thiazide diuretics how does it work? what is it indicated for? side effects?

Answer 359

- early distal convoluted tubule - hydrochlorothiazide, chlorithalidone, metolazone - blocks Na Cl transporter, increases Ca reabsorption, decreases GFR - htn, edema, hypercalculria, nephrogenic DI (increases salt excretion and increases h2o reabsorption) - hypokalemia, metabolic alkalosis, hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia (hyperGLUC)

Question 360

what is calciphylaxis in the context of chronic kidney disease

Answer 360

- significant calcifications in micro blood vessels of skin and adipose tissue that cause ischemic painful lesions

Question 361

what are the symptoms/ pathologies of chronic kidney disease (mnemonic)

Answer 361

MAD HUNGER Metabolic Acidosis Dyslipidemia Hyperkalemia Uremia (encephalopathy, pericarditis, asterixis, platelet dysfunction, anorexia, nausea) Na/H2O retention (HTN, CHF, pulm edema) Growth retardation and developmental delay Erythropoietin failure (anemia of chronic disease) Renal osteodystrophy

Question 362

what is diagnostic of acute pyelonephritis?

Answer 362

wbc casts

Question 363

what is considered the gold standard treatment for UTI how many days should you take it which medications are not effective, why?

Answer 363

- trimethoprim/sulfamethoxazole (nitrofurantoin good for ecoli, fluoroquinolones good but expensive, should be used if resistant to bactrim) - 3 days - ampicillin and sulfonamides, 50% of ecoli is resistant

Question 364

where in the nephron does mannitol work? how does it work? what is it indicated for? what is it contraindicated for?

Answer 364

- proximal tubule - increases osmolarity of proximal tubule lumen; in order to maintain isoosmolarity, Na gets reabsorbed and then goes back down it's concentration gradient into the lumen --> increases Na and H2O excretion - increased intracranial or intraocular pressure - edema (will make it worse)

Question 365

what causes type A lactic acidosis?

Answer 365

- overall due to ischemia | - hypotension, cardiac failure, hypoperfusion, seizures, sepsis

Question 366

a specific gravity of 1.010 tells you what?

Answer 366

a person's kidney are not capable of concentrating urine (it's <1.018) and they probably have some degree of kidney injury

Question 367

what drug class are tacrolimus and cyclosporine? what do they do? what are they used for? are there drug drug interactions? side effects?

Answer 367

- calcineurin inhibitors - block calcineurin --> prevent NFAT from activating t cell response - yee calcium channel blocks and azoles (increase serum level), anticonvulsants (decrease serum level) - htn, tremors, hirsutism, neurotox

Question 368

is respiratory alkalosis or respiratory acidosis common in pregnancy? why

Answer 368

respiratory alkalosis because you are breathing more heavily and blowing off CO2 due to increased CO2 sensitivity

Question 369

lesions on ct that increase by 15-20 houndsfield units are considered suspicious for ____________

Answer 369

- renal cancer

Question 370

name 6 causes of hyperphosphatemia

Answer 370

- increases intake (junk food, milk) - vitamin d therapoy - rhabdomyolysis - tumor lysis syndrome - hypoparathyroidism - renal failure - familiak tumoral calcinosis

Question 371

what is chlorpropamide? what is the mechanism of action what are side effects?

Answer 371

- hypoglycemic agent used to increase water reabsorption and enhance adh - increase Na reabsorption in TALH and increase permeability of H2O in collecting ducts - hypoglycemia (give thiazide) and hyponatremia

Question 372

What is ECF further divided into? | How much of ECF is each part and what separates them?

Answer 372

- plasma (1/4) and interstitial fluid (3/4) capillary wall

Question 373

which of the following are weak acids and which are weak bases: thiazide diuretics, amiloride, loop diuretics, triamterene, acetazolamide

Answer 373

- weak acids: acetazolamide, loop diuretics, thiazide diuretics - weak bases: amiloride, triamterene

Question 374

what part of the kidney does clear cell carcinoma usually arise? what about papillary carcinoma? chromophobe renal cell carcinoma? collectin duct carcinoma?

Answer 374

- proximal convoluted tubule - distal convoluted tubule - collecting duct - medullary collecting duct

Question 375

what are some advantages to using BUN as a marker of gfr? what are some disadvantages?

Answer 375

- cheap and widely accepted - has variable tubular reabsorption and it's production is variable (can change with diet, infection, GI hemorrhage, protein catabolism)

Question 376

In an alkalemic state, albumin minds more ____ (Ca or H) than _____ (Ca or H). what happens as a result?

Answer 376

Ca than H - decreased ionized Ca --> tetany, tingling, numbness, cramping

Question 377

what is a medication class that can cause acute kidney injury but also treat kidney disease longterm?

Answer 377

- ace inhibitors/ arbs

Question 378

for renal artery stenosis: name two causes? what lab/physical findings point towards renal artery stenosis what are the screening tests what is the gold standard diagnostic test treatment?

Answer 378

- fibromuscular dysplasia (yong women and atherosclerosis (people >50) - elevated renin (differentiates from primary hyperaldo) , abdominal bruit, metabolic alkalosis, hypokalemia - MRA, CT, duplex ultrasound - intraarterial arteriography - angioplasty, stent

Question 379

vomiting is what kind of acid base disorder?

Answer 379

- metabolic alkalosis

Question 380

what cause familial tumoral calcinosis

Answer 380

- deficiency or resistance to fgf 23 --> hyperphosphatemia --> ca and phos deposition in tissues

Question 381

If a patient presents with a rash, eosinophiluria, fever pyuria, and wbc casts, what condition do they most likely have

Answer 381

allergic/acute interstitial nephritis | eosinophiluria + rash are v unique features to remember

Question 382

aside from acting on the distal convoluted tubule, name two other actions of thiazide diuretics?

Answer 382

- increases reabsorption of na in proximal tubule | - increases thirst

Question 383

what is pre-renal azotemia? what causes pre-renal azotemia? what is one lab value that would signify this?

Answer 383

- increased in nitrogenous substances in the blood - due to decreased renal perfusion (regardless of etiology, think chf, cirrhosis, nenphrotic syndrome) --> increased reabsorption of Na, H20 and urea in the process - increased BUN: Cr ratio

Question 384

name at least 5 causes of respiratory acidosis. describe whether each of the following should be increased or decrease: pH, CO2, HCO3 describe the acute and chronic compensation what is the treatment

Answer 384

- COPD, apnea, etoh, benzos, narcotics, brain stem injury, severe pneumonia or pulmonary embolism, guillan barre, myasthena gravis, polio, diaphragmatic paralysis, severe hypokalemia, severe hypophosphatemia, - ph- decreases, CO2- increased, HCO3, increased - acute: mass action= for every 1 increase in PCO2, HCO3 increases by .1 - chronic: kidney increase HCO3 reabsorption= for every 1 increase in PCO2, HCO3 increases by .3 - mechanical ventilation if not able to breathe on their own, treat underlying condition

Question 385

is polyuria indicative of bph? why or why not? what about nocturnal polyuria?

Answer 385

- no, peeing greater than 3 L means that you are drinking too much - no, if 1/3 of peeing is at night it's usually do to a non urologic cause

Question 386

what is the most common cause of chronic kidney transplant failure

Answer 386

accumulation of comorbidities esp cardiovascular disease

Question 387

what are the two ways in which the kidney autoregulates blood pressure

Answer 387

- myogenic (Q=P/R, vessel contracts to increases resistance when pressure is high and vice versa) - tubuloglomerular feedback (macula densa senses transient increase in Na and Cl, releases adenosine and causes contraction of afferent arteriole)

Question 388

where in the nephron does acetazolamide work? how does it work? what is it indicated for? what is it contraindicated for? side effects?

Answer 388

- early proximal tubule - inhibits luminal carbonic anhydrase - glaucoma (aqueous humor cells have hella HCO3 and carbonic anhydrase), alkalinizing urine (cystine and uric acid stones, acid overdoses), altitude sickness - hepatic cirrhosis - metabolic acidosis (ACETazolamide causes ACIDosis), hypokalemia (increased flow rate)

Question 389

what stones precipitate more in alkaline ph what stones precipiate more in acidic ph

Answer 389

- calcium phosphate and ammonium magnesium phosphate (struvite) - uric acid and cystine

Question 390

the higher the urinary flow rate, the ____ (less or more) urea is excreted. explain why

Answer 390

- more - the higher the flow rate, the less water that is reabsorbed, which means the less urea concentration gradient that is made , which leads to less reabsorption

Question 391

define resistance hypertension?

Answer 391

- htn >130/80 on 3 meds OR bp <130/80 on 4 meds

Question 392

what can cause respiratory alkalosis

Answer 392

hysteria brain stem tumor aspirin poisoning hypoxemia

Question 393

mnemonic for elevated anion gap metabolic acidosis?

Answer 393

MUDPILES ``` M- methanol U- uremia D- DKA (acetoacid acid and bhydroxybutyric acid) P- Propylene Glycol (in icu sedtives) I- Isoniazid L- lactic acidosis E- ethylene glycol/ETOH S- salicylates ```

Question 394

what happens in hepatorenal syndrome? what liver conditions is it associated with can you treat it?

Answer 394

renal vasoconstriction and systemic vasodilation in response to increase volume and bp (unknown mechanism) - associated with cirrhosis and ascites vasopressin analogues, octreotide (splanchnic vasoconstrictor), midodrine, transplant

Question 395

what are three things that can cause hypertonic hyponatremia

Answer 395

- glucose, glycerol, mannitol would have high plasma osmolality but low plasma sodium concentration

Question 396

give an example of negative Na+ balance describe how the body compensates

Answer 396

diarrhea (loss of Na+ and fluid) - Na and subsequently fluid leaves the ECF, after a few days kidney senses the decrease of ECF volume and decreases excretion of Na, making Na ingestion greater than excretion until Na and ECF volume return to normal

Question 397

what is the net ultrafiltration pressure

Answer 397

the sum of hydrostatic pressure of the glomerular capillaries, hydrostatic pressure of bowman's space, and the oncotic pressure of the glomerular capillaries

Question 398

in hyponatremia, how low does the sodium value need to decrease before you experience symptoms below what sodium value would you experience seizures and coma?

Answer 398

- under 125 mEq/L | - under 115 mEq/L

Question 399

what ions/molecules make up the ECF (3) vs. the ICF (4)

Answer 399

- ECF: Na+, Cl-, HCO3- | - ICF: organophosphates (ADP, ATP, 23DPG), K+, Mg2+, proteins

Question 400

is your chance of death higher if you have high systolic blood pressure or high diastolic blood pressure?

Answer 400

systolic

Question 401

what is BCG used to treat? What is its mechanism of action

Answer 401

- high grade superfical bladder cancer and carcinoma in situ (drug of choice for CIS) - helps increase TH1 response and il2 and ifn g

Question 402

what histologic renal changes occur in preeclampsia

Answer 402

swelling of endothelial cells (endothelial dysfunction) which can lead to closing of some capillary loops

Question 403

what is the nephrotic range for proteinuria what is the subnephrotic range?

Answer 403

>3.5 g/day <3.5 g/day

Question 404

what is the single most factor that limits progression of diabetic nephropathy to chronic kidney disease/renal failure? what is the #1 thing you would use to achieve this?

Answer 404

BLOOD PRESSURE CONTROL!! ACE inhibitors and ARBs

Question 405

what is the space between foot processes called? what two things is it made of?

Answer 405

filtration slit podocin and nephrin proteins

Question 406

what is the formula for renal clearance rate for a substance x

Answer 406

Cx= [Ux] * V/[Px] Cx= clearance of substance x (volume of plasma removed of substance x per unit time ``` [Ux] = urine concentration of x V= urinary flow rate [Px]= plasma concentration of x ```

Question 407

describe how systolic and diastolic blood pressure change as your age?

Answer 407

- systolic continues to increase as you age | - diastolic increases to a point and then decreases

Question 408

if the kidney doesn't recover from acute tubuler necrosis, what secondary acute condition can result?

Answer 408

acute cortical necrosis

Question 409

when should you give Na HCO3 in a person with metabolic acidosis? what should you be careful of?

Answer 409

if the pH is less than 7.2 make sure not to give too much, can cause metabolic alkalosis

Question 410

when on a loop diuretic, do you lose the ability to concentrate urine or dilute urine? what about thiazide diuretics?

Answer 410

both! (lose diluting segment and lose cp gradient) dilute urine(can't still concentrate because cp gradient is maintained)

Question 411

substances with high clearance rates are filtered and _____ substances with low clearance rates are filtered and ______

Answer 411

- secreted | - reabsorbed

Question 412

name 2 alpha 2 agonists that can be used for hypertension what is the mechanism of action what is one special scenario in which one of these drugs may be used side effects

Answer 412

- methyldopa and clonidine - enter brain and bind to presynaptic a2 receptors which causes negative feedback and prevents NE from being released --> CNS mediated decrease in sympathetic tone - methyldopa is v safe to use in pregnancy - drowsiness, dry mouth, rebound hypertension

Question 413

what is a risk factor for renal and bladder cancer?

Answer 413

smoking

Question 414

what ekg abnormalities can be present due to hypokalemia

Answer 414

u waves, torsades de pointes

Question 415

describe the process of how diabetic nephropathy affects the kidney

Answer 415

- increased glucose in the glomerulus --> increased advanced glycation end products --> release of TGF b, IGF-1, renin-angiotensin --> afferent arteriole dilation and increased gfr --> efferent arteriole constriction (increased glomerular capillary pressure)

Question 416

what happens grossly to the kidney as a result of chronic pyelonephritis? what kind of stone can occur due to chronic pyelonephritis?

Answer 416

- dimpling of the kidney due to scarring, shrinking of the overall kidney struvite (magnesium ammonium phosphate) staghorn stone

Question 417

what is the formula for filtration fraction

Answer 417

GFR/RPF (aka clearance of inulin/clearance of PAH)

Question 418

what drug can be synergistically added with alpha blockers to improve symptoms and address the cause of bph?

Answer 418

5 alpha reductase inhibitor aka finasteride

Question 419

is prostate specific antigen (PSA) organ specific? what about cancer specific?

Answer 419

organ specific but not cancer specific (can be elevated in benign conditions like bph)