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PEARLS book Flashcards

(101 cards)

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1
Q

the bladder, controlled by a sphincter, contracts to expel urine via the urethra with _______ stimulation

A

parasympathetic (Ach)

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2
Q

network of capillaries involved in the 1st step of urine formation by filtering the blood

A

Glomerulus

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3
Q

Receives blood from afferent arteriole and leaves via efferent arteriole

A

Glomerulus

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4
Q

Crescent shaped structure that receives ultra filtrate from the glomerulus and is the beginning of the neprhon

A

Bowman’s Capsule

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5
Q

Bowmans capsule + glomerulus =

A

renal corpuscle

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6
Q

GFR depends on..

A

age
sex
body size
race

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7
Q

Most active secretion happens in the _____ convoluted tubule

*ie..uric acid, K+, H+, drugs, foreign substances, creatinine, bile salts

A

DISTAL

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8
Q

removal of substances from blood to be excreted into urine

A

Secretion

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9
Q

Most reabsorption occurs at the _____ tubule

A

PROXIMAL

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10
Q

Saturation and Rate of Flow affect…

A

Reabsorption

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11
Q

Tubular reabsorption of vital substances
Isotonic reabsorption of all organic nutrients (i.e. glucose, AAs), most bicarb, Na, Cl and 75-90% of H20

occurs….?

A

PROXIMAL convoluted tubule

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12
Q

Passively absorbs H20 but impermeable to sodium and solutes at the _____ DESCENDING Loop of Henle

A

THIN

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13
Q

Impermeable to H20 but actively reabsorbs Na, K, Cl via Na/K/2Cl co-transporter happens at the ______ ASCENDING Loop of Henle

*loop diuretics work here

A

THICK

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14
Q

Loop diuretics work on which part of the Loop of Henle?

A

Thick Ascending

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15
Q

Main job of Distal Convoluted Tubule…

*Thiazisde diuretics work here

A

Tubular secretion!

*most active secretion occurs here (i.e. acids, toxins, drugs)

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16
Q

Thiazide diuretics work at the…

A

Distal Convoluted Tubule

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17
Q

Distal tubule determines the final _____ of urine (via Aldosterone and ADH)

A

OSMOLARITY

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18
Q

Aldosterone causes an increased Sodium…..

A

reabsorption

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19
Q

ADH does what to the concentration of urine

A

Increases!

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20
Q

This hormone helps regulate BP by controlling aldosterone secretion

A

Renin

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21
Q

Controls real blood flow and GFR as well as controls renin release

A

Juxtaglomerular Apparatus

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22
Q

Juxtaglomerular (JG) cells are specialized smooth cells of _____ arteriole. These cells release renin if low BP

A

AFFERENT

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23
Q

NaCl sensor found in the distal convoluted tubule

A

Macula densa

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24
Q

Decreased BP detected by JG cells
Decreased Cl delivery to Macula dense
Increased Beta1 activation

stimulate….

A

Renin secretion

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25
Kidney disease characterized by: - Proteinuria - HYPOalbuminemia - HYPERlipidemia - Edema
nephrOtic syndrome
26
Gold standard dx of NephrOtic Syndrom
24 hour urine protein collection
27
Urinalysis shows: Proteinuria, Oval fat bodies "maltese cross shaped"* Also...HYPOalbuminemia, HYPERlipidemia
NephrOtic syndrome
28
Minimal change dz Focal segmental glomerulosclerosis Membranous nephropathy All can cause primary (idiopathic)..
NephrOtic syndrome
29
Diabetes**** SLE Erythematosus Amyloidosis All can secondary...
NephrOtic syndrome
30
Immunologic inflammation of glomeruli causing PROTEIN and RBC leakage into urine**
Acute glomerulonephritis
31
HTN, hematuria (RBC casts), dependent edema (proteinuria) and azotemia are HALLMARK! for...
Acute glomerulonephritis
32
Most common cause of Acute glomerulonephritis
IgA nephropathy (Berger Dz)
33
MC cause of acute glomerulonephritis *often affects young males within days (24-48H) after URI or GI infection - diagnosed with IgA deposits - Tx= ACEi plus corticosteroids
IgA nephropathy (Berger Dz)
34
- IgA nephropathy (Berger dz) - Post infectious (i.e. after GABHS) - Membranoproliferative/ Mesangiocapillary can all cause...
Acute glomerulonephritis
35
Rapidly progressive acute glomerulonephritis is associated with what kind of prognosis? (Goodpasture's syndrome, Vasculitis)
POOR
36
Clinical manifestations: - Hematuria** (hallmark!) - Edema - HTN* - Fevers, abdominal/flank pain - AKI (oliguria**)
Acute glomerulonephritis
37
Urinalysis shows Hematuria (RBC casts)**, dysmorphic RBCs, proteinuria, high specific gravity Increased BUN and Cr
Acute glomerulonephritis
38
GOLD STANDARD FOR DX OF ACUTE GLOMERULONEPHRITIS?
RENAL BIOPSY***
39
Most of the time glomerulonephritis is...
self limiting!
40
Glomerulonephritis..aka
Nephritic syndrome
41
Pathophysiology= immune mediated glomerular inflammation leading to glomerular damage and PROTEINURIA AND RBC LOSS**
Nephritis syndrome
42
Predominant feature of nephrOtic syndrome
Edema
43
``` Edema** Increased BUN/Cr transudative pleural effusion** DVTs Frothy urine ``` Nephrotic or Nephritic?
Nephrotic!
44
Hematuria, HTN* Azotemia (increase BUN/Cr) Oliguria (under 400 ml a day) Fever, abd, flank pain Nephrotic or Nephritic?
Nephritic
45
Hypocellular biopsy..
Nephrotic | HYPERcellular biopsy would be nephritic
46
Acute tubular necrosis Acute tubulointerstitial nephritis Acute glomerulonephritis Vascular All causes of what kind of kidney failure?
intrinsic
47
If not corrected, pre renal failure can lead to....
intrinsic renal failure
48
Reduced renal perfusion (nephrons structurally in tact!)
Pre renal
49
autosomal dominant disorder due to mutations in either genes PKD1 or PKD2 *pts usually in 20s-40s (autosomal recessie type seen in children)
Polycystic kidney dz
50
Multisystemic progressive disorder characterized by formation and enlargement of kidney cysts in other organs (liver*, spleen, pancreas) Vasopressin stimulates cystogenesis, leading to end stage renal dz over time
Polycystic kidney dz
51
- Adbominal/flank pain - Palpable flank mass - HTN, hematuria, micro albuminuria - Extra renal: cerebral "berry" aneurysms**, hepatic cysts, mitral valve prolapse*, colonic diverticula
Polycystic kidney dz
52
most widely used diagnostic test in Polycystic kidney dz?
Renal ultrasound!** | genetic testing should also be done
53
Are CTs/MRI more sensitive than ultrasound for polycystic kidney dz?
yes
54
Treatment for... Simple cyst: observation, period reevaluation Multiple cyst: supportive, INCREASE FLUID INTAKE, control HTN, possibly dialysis or renal transplant
Polycystic kidney dz
55
CKD must be chronic kidney damage for longer than....
3 months
56
- Proteinuria - Abnormal urine sediment - Abnormal urine/serum chemistries - Abnormal imaging studies - Inability to buffer pH - Inability to make urine - Inability to excrete nitrogenous waste - Decreased synthesis of Vitamin D/ Erythropoietin
CKD
57
At risk pts: DM, HTN, chronic NSAID use, ethnic minority, over 60 yo, SLE, post transplanted kidney, am hx kidney dz *Normal GFR, normal urine Stage?
Stage 0
58
Kidney damage with normal GFR (or above 90) Kidney damage= proteinuria, abnormal UA, serum, imaging Stage?
Stage 1
59
GFR 89-60 Stage?
Stage 2
60
GFR 59-30 Stage?
Stage 3
61
GFR 29-15 Stage?
Stage 4
62
GFR under 15 *End stage renal dz (uremia requiring dialysis or transplant) Stage?
Stage 5
63
- Diabetes (MC cause!)..due to diabetic nephropathy - HTN (2nd MC cause) - Glomerulonephritis Causes of..
CKD
64
Single best predictor of CKD progression?
Proteinuria
65
Renal ultrasound will show what in CKD?
Small kidneys
66
- HTN control (under 130/80) - Diabetes control (A1C under 6.5) - Proteinuria control (ACEI or ARB) control these for...
CKD management
67
- Hematologic complications (anemia, coagulopathy) | - Renal osteodystrophy (bone dz)
CKD complications
68
Periostal erosions, bony cysts on X ray, "salt and pepper" appearance of the skull on X ray *increased PO4 *HYPOcalcemia *decreased vitamin D (PTH increases)
Renal osteodystrophy
69
non-physiologic excess of increased ADH from pituitary or ectopic source..leads to free water retention and impaired water excretion * HypoNa * Kidneys unable to dilute urine
SIADH | MC of euvolemic HypoNa
70
Causes include: CNS: stroke, head trauma, meningitis, CNS tumor Pulm: small cell lung ca Meds: narcotics, NSAIDs, anticonvulsants, SSRIs
SIADH | MC cause of euvolemic HypoNa
71
Pts usually only become symptomatic with increased oral free H2O intake * symptoms of HypoNa * urine has increased osm (concentrated!)
SIADH
72
Tx for SIADH
fluid restriction | IV hypertonic saline w furosemide
73
1. hyperosmolarity (increase concen of Na), decreased water 2. decreased effective arterial volume (hypovolemia) stimulate....
ADH
74
Does hypovolemia always take precedence over hypoosmolarity?
YES
75
The kidney regulates Na via...
Aldosterone | Aldosterone causes Na retention
76
Twice the Na concentration roughly equals serum...
Osmolality
77
90% of bladder cancer is...
Transitional cell *most present early and respond well to tx
78
``` Risk factors... Smokin**** occupational exposure: dyes, rubber, leather age over 40 white males ```
Bladder cancer
79
Painless micrscopic or gross hematuria**** biggest sign for...
bladder cancer
80
Cytoscopy with biopsy**** gold standard for dx...
bladder cancer
81
Transurethral resection used for what kind of bladder cancer
localized or superficial
82
Cystectomy used for what kind of bladder cancer
Invasive (advanced or involving muscular layer)
83
BCG immune therapy can be used for...
recurrent bladder cancer
84
95% of tumor originating in the kidney are.... * tumor of proximal convoluted renal tubule cells * lack of warning signs, variable presentations, resistant to chemo/XRT
renal cell carcinoma
85
``` Smoking** dialysis HTN obesity men ``` risk factors for...
Renal cell carcinoma (RCC)
86
Classic triad: 1. hematuria 2. flank/abdominal pain 3. palpable mass (also..L sided varicocele, HTN, HyperCa)
RCC
87
Diagnosis of RCC made with....
CT scan
88
If RCC is localized, tx=?
Radical nephrectomy
89
Nephroblastoma MC children under 5yo | *palpable, painless abdominal mass*, hematuria, HTN, anemia
Wilm's tumor
90
Wilms tumor tx
Nephrectomy followed by chemo
91
1. calcium (increase protein and salt intake) 2. uric acid (high protein food) 3. struvite (Proteus, klebsiella, pseudomonas) 4. cystine (genetic)
stones of nephrolithiasis
92
Mg ammonium phosphate stones that may form staghorn calculi in renal pelvis
Struvite stones
93
- Renal colic - Costovertebral angle tenderness - Groin pain
Nephrolithiasis
94
UA= microscopic hematuria, pH under 5 (uric acid or cystine) or pH above 7.2 (struvite)
Nephrolithiasis
95
MC 1st diagnostic test in nephrolithiasis
noncontrast CT abdomen/pelvis
96
80% chance of spontaneous passage tx with opiates and NSAIDs if stone is less than ___mm
5 mm
97
Shock wave lithotripsy, uretoscopy, percutaneous nephrolithotomy may be needed if stone is greater than ___mm
7 mm
98
``` E.coli****** Staph saprophyticus (in sexually active women) ``` most common causes of...
UTIs
99
greater than 100,000 in clean catch specimen *urine culture=definitive dx!
UTI
100
Fluoroquinolones** (Cipro) Trimethoprim-Sulfamethaxazole Nitrofurantoin
UTI tx
101
Hypocalcemia is often associated with..
Hypomagnesemia | Bc magnesium is needed to make PTH

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