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Flashcards in Nephrology Deck (100):
1

Site of erythropoietin (EPO) production

Interstitial cells of the peritubular capillaries

2

Active form of Vitamin D

1,25-dihydroxycholecalciferol (calcitriol)

3

Contains vasa recta and has longer loops of Henle

Juxtamedullary nephrons (less common than cortical nephrons)

4

Components of the juxtaglomerular apparatus

Macula densa (walls of the dital tubule; detects changes in BP)

5

Physiologic function of renin

None (merely converts angiotensinogen from the liver to angiotensin I)

6

Physiologic function of angiotensin I

None (merely converted to angiotensin II due to ACE in the lungs)

7

Physiologic functions of angiotensin II

Vasoconstricts afferent and efferent arteriole (efferent > afferent)

8

Site of aldosterone production

Zona glomerulosa of the adrenal cortex

9

Aldosterone actions

Increases Na+ reabsorption, K+ secretion, H+ secretion

10

ADH actions

Insertion of aquaporins (AQP-2) in the collecting ducts

11

Triggers for ADH secretion

Increased plasma osmolarity

12

Increases GFR

Afferent arteriolar vasodilation

13

Decreases GFR

Afferent arteriolar vasoconstriction

14

Principal cells

Absorb Na+ and H20 and secrete K+

15

Intercalated cells

Absorb K+ and secrete H+

16

Tubuloglomerular feedback

Macula densa feedback

17

Glomerulotubular balanca

"Percentage of solute reabsorbed is held constant"

18

Substances with no transport maximum and renal threshold

Sodium and all passively transported solutes

19

Ascending limb of the Loop of Henle is permeable to

Solutes (Mnemonic: asin-ding limb is permeable to solutes)

20

Descending limb of the Loop of Henle is permeable to

Water

21

Normal pH in various fluid sites

Arterial blood: 7.4

22

Acid-base abnormalities caused by diuretics

Metabolic acidosis: acetazolamide (Mnemonic: acid-azolamide)

23

Intact Nephron Hypothesis by Neil Bricker

Decreases in the number of functioning nephrons causes remaining nephrons to carry a larger burden of transport, synthetic function and regulatory function

24

Bricker's Trade-Off Hypothesis

Some physiologic adaptations to nephron loss also produce unintended clinical consequences

25

Hyperfiltration Hypothesis by Barry Brenner

Some adaptations accelerate the deterioration of residual nephrons

26

Standard test for measurement of albuminuria

Accurate 24-hour urine collection

27

Most useful renal imaging study

Renal ultrasound

28

The only test to establish etiology in early-stage CKD in the absence of a clinical diagnosis

Renal biopsy

29

Most sensitive test for renal vein thrombosis (RVT)

CT angiography

30

Imaging test for diagnosis of nephrolithiasis

Helical computed tomography (CT) scanning without radiocontrast enhancement

31

Most common form of renal replacement therapy for AKI

Hemodialysis

32

Clear indications for initiation of renal replacement therapy in patients with CKD

1. Uremic pericarditis

33

Best potential for complete renal rehabilitation

Kidney transplantation

34

Educational programs should be commenced

No later than stage 4 CKD

35

Most common therapeutic modality for end-stage renal disease (ESRD)

Hemodialysis

36

Leading cause of ESRD

Diabetes mellitus

37

Dialysis access with highest long-term patency rate

Fistula

38

Most important complication of arteriovenous grafts

Thrombosis of the graft and graft failure

39

Most common acute complication of hemodialysis, particularly among DM patients

Hypotension

40

Preferred buffer in peritoneal dialysis solutions

Lactate

41

Most common additives to peritoneal dialysis solutions

Heparin

42

Most common organisms in peritoneal dialysis-related peritonitis

Gram-positive cocci including Staphylococcus (reflecting the origin from the skin)

43

Absolute indication for the urgent initiation of or intensification of dialysis prescription

Uremic pericarditis

44

Definition of AKI (Acute Kidney Injury)

A rise of at least 0.3 mg/dL within 48h or 50% higher than baseline within 1 week; or reduction in urine output to <0.5 mL/kg/h for >6 hours

45

Definition of oliguria

<400 mL/24h

46

Associated with multiple myeloma

Renal amyloidosis

47

Most common cause of Acute Renal Failure (ARF)

Acute Tubular Necrosis (ATN)

48

Most common form of AKI

Prerenal Azotemia (from Harrison's IM)

49

Patchy necrosis, PCT & LH affected, relatively short lengths of tubules affected

Ischemic-type ATN (e.g. in hypovolemia)

50

Extensive necrosis, PCT and DT affected, relatively longer lengths of tubules

Toxic-type ATN (e.g. in use of aminoglycosides, radiocontrast dyes)

51

Three broad categories of AKI

Prerenal Azotemia

52

Most common clinical conditions associated with prerenal azotemia

Hypovolemia

53

Most common causes of intrinsic AKI

Sepsis, ischemia, and nephrotoxins

54

Most common clinical course of contrast nephropathy

A rise in SCr beginning 24-48 hours following exposure

55

Most common protein in urine and produced in the thick ascending limb of the loop of Henle

Uromodulin/ Tamm-Horsfall Protein

56

Hallmark of AKI

Buildup of nitrogenous waste products, manifested as an elevated BUN concentration

57

Causes of large kidneys observed in CKD

Diabetic nephropathy

58

Can provide definitive diagnostic and prognostic information about CKD

Kidney biopsy

59

Definitive treatment of the hepatorenal syndrome

Liver transplantation

60

Cerebral edema

Severe hemodynamic instability

61

Continuous Renal Replacement Therapy is often preferred in patients with

Significant volume overload

62

Chronic renal failure typically corresponds to

Stage 3-5 CKD

63

ESRD refers to

Stage 5 CKD (<15% GFR)

64

Screening test for early detection of renal disease

Microalbuminuria (especially in DM)

65

Major side effect of calcium-based phosphate binders

Total-body calcium accumulation and hypercalcemia

66

Leading cause of morbidity and mortality in patients at every stage of CKD

Cardiovascular disease (CVD)

67

Major risk factor for ischemic CVD

Presence of any stage of CKD

68

Among the strongest risk factors for cardiovascular morbidity and mortality in CKD

Left ventricular hypertrophy and dilated cardiomyopathy

69

Absence of hypertension in CKD may signify

Salt-wasting form of renal disease

70

Stage of CKD where normocytic, normochromic anemia appears

As early as Stage 3 CKD

71

Primary cause of anemia

Insufficient production of EPO by the diseased kidneys

72

Target hemoglobin concentration in CKD

100-115 g/L

73

Stage of CKD where peripheral neuropathy usually becomes clinically evident

Stage 4 CKD

74

Stage of CKD where assessment for protein-energy malnutrition should begin

Stage 3 CKD

75

Indication for therapy with ACE inhibitors for ARBs

Protein excretion >300 mg

76

Derives from the breakdown of urea to ammonia in saliva and is often associated with an unpleasant metallic taste (dysgeusia)

Uremic fetor

77

Most important initial diagnostic step in the evaluation of a patient presenting with elevated serum creatinine

To distinguish newly diagnosed CKD from acute or subacute renal failure

78

Classic lesion of secondary hyperparathyroidism; high bone turnover with increased PTH levels

Osteitis fibrosa cystica

79

Low bone turnover with low or normal PTH levels

Adynamic bone disease and Osteomalacia

80

Devastating condition seen almost exclusively in patients with advanced CKD

Calciphylaxis (Calcific uremic arteriolopathy)

81

Seen in patients with CKD who have been exposed to gadolinium

Nephrogenic fibrosing dermopathy

82

"Thyroidization" (appearance similar to thyroid follicles) of the kidney

Chronic glomerulonephritis (GN)

83

RBC casts or dysmorphic RBCs seen in the sediment

GN

84

Most common causes of glomerulonephritis throughout the world (save for subacute bacterial endocarditis in the Western hemisphere)

Malaria and schistosomiasis (closely followed by: HIV, chronic hepatitis B and C)

85

Prototypical for acute endocapillary proliferative GN

Poststreptococcal GN (PSGN)

86

Streptococcal strains associated with impetigo

M types 47, 49, 55, 2, 60, and 57

87

Streptococcal strains associated with pharyngitis

M types 1, 2, 4, 3, 25, 49, and 12

88

Kidneys have subcapsular hemorrhages with a "flea-bitten" appearance

Endocarditis-associated GN

89

Primary treatment for endocarditis-associated GN

Eradication of the infection with 4-6 weeks of antibiotics

90

May produce nephrotic or nephritic signs and symptoms

Membranoproliferative GN (MPGN)

91

Type I MPGN characteristics

Presence of subendothelial deposits; low C3

92

Type II MPGN characteristics

Intramembranous deposits, ribbon-like pattern, IgG autoantibody; low C3

93

Most proliferative of the three types of MPGN

Type I MPGN

94

Pathologic changes of FSGS are most prominent in

Glomeruli located at the corticomedullary junction (if the renal biopsy specimen is from superficial tissue, the lesions can be missed, leading to a misdiagnosis of MCD)

95

Has the highest reported incidences of renal vein thrombosis, pulmonary embolism, and deep vein thrombosis

Membranous Nephropathy (MGN)

96

Sensitive indicator for the presence of diabetes but correlates poorly with the presence or absence of clinically significant nephropathy

Thickening of the GBM

97

Earliest manifestation in ~40% of patients with diabetes who develop diabetic nephropathy

Increase in albuminuria detected by sensitive radioimmunoassay

98

Potent risk factor for cardiovascular events and death in patients with type 2 diabetes

Microalbuminuria

99

Most renal amyloidosis is the result of

Fibrillar deposits of immunoglobulin light chains

100

Lesion in HIV-associated nephropathy

FSGS