Renal 1 Flashcards Preview

ID/LC Step Review > Renal 1 > Flashcards

Flashcards in Renal 1 Deck (43):
1

Sporadic renal cell carcinoma gene deletion

Deletion of VHL gene on chromosome 3p

Associated w/ von Hippel Lindau disease

2

Von Hippel-Lindau

AD

Deletion/mutation of VHL on 3p

- Cerebellar hemangioblastomas
- Clear cell renal carcinomas
- Pheochromocytomas

3

Location of lowest pH in the nephron

Distal tubules

Collecting ducts

4

Tumor lysis syndrome

- Occurs when tumors w/ high cell turnover are treated w/ chemo
- Lysed tumor cells release intracellular ions (K, PO4, uric acid) into serum

5

Complications associated w/ tumor lysis syndrome

Uric acid crystallization => obstructive uropathy & acute renal failure

Why??
Because uric acid has pKa of 5.4 and precipitates in low pHs

6

Prevention of tumor lysis syndrome

- Urine alkalinization
- Hydration
- High urine flow
- High pH

Prevents crystallization and precipitation of uric acid

7

Indwelling catheter UTI

(-) lactose, g(-) rod, (+) oxidase

Pseudomonas aeruginosa

8

Anti-glomerular basement membrane Abs react w/ what?

Type IV collagen

Leads to RPGN, also pulm hemorrhage (hematuria and hemoptysis)

THINK CRESCENTS on LM

9

Post-strep GN leads to what on EM?

Subepithelial immune complex deposition!

Composed of IgG, IgM, and C3

THINK HUMPS

10

Which area of the nephron is ALWAYS impermeable to water? Regardless of vasopressin levels

Ascending loop of henle

Where Na/K/2Cl transport occurs

11

Cancers of people who smoked or with occupation exposure to rubber, plastics, aromatic amine-containing dyes, textiles, leather

Transitional cell carcinoma of the bladder

12

Which structure obstructs ascent of a horseshoe kidney?

Inferior mesenteric artery

Kidney is fused at the poles

13

Chronic transplant rejection cause

Chronic, low grade immune response refractory to immunosuppressants

14

Chronic transplant rejection morphology

- Vascular wall thickening & luminal narrowing
- Interstitial fibrosis & parenchyma atrophy

Presents w/ worsening HTN, progressive ^ serum Cr

15

Renal failure + pulm/upper resp sx...?

Think Wegener's vasculitis

p-ANCA

16

Pauci-immune RPGN, ANCA, (-) Ig/complement deposition, crescent formation

Microscopic polyangiitis or Granulomatosis w/ polyangiitis (Wegener's)

17

Left 12th rib overlies which internal organs

Medially:
Parietal pleura

Laterally:
Kidney

18

Antiphospholipid antibody syndrome

- Presence of APA
- Can be secondary to SLE (APA is not present in all pts w/ SLE)
- Elevated aPTT in coag studies
- Leads to venous/arterial thromboembolism => recurrent pregnancy loss
- False (+) for RPR/VDRL

19

What is the filtration fraction?

- Portion of renal plasma flow filtered from the glomerular caps
- GFR:RPF ratio

20

Acute ureteral constriction or obstruction does what to the GFR and FF?

Both are decreased

21

Once you determine a pt has a metabolic alkalosis, what should you look at next?

Urine Chloride

22

Metabolic alkalose w/ low urine Cl is due to...?

- Vomiting/nasogastric aspiration
- Prior diuretic use

Saline responsive

23

Metabolic alkalosis w/ high urine Cl and hypo/euvolemia

- Current diuretic use (saline responsive)
- Bartter & Gitelman syndrome (non-saline)

24

Metabolic alkalosis w/ high urine Cl and hypervolemia?

Excess mineralocorticoid activity
- 1ar hyperaldosteronism
- Cushing
- Ectopic ACTH production

Non-saline responsive

25

Ureter relation to ovarian/gonadal vessels?

Posterior

Before true pelvis

26

Ureter relation to common/external iliac a.

Anterior

Before true pelvis

27

Ureter relation to internal iliac

Anterior

w/in true pelvis

28

Ureter relation to ovarian vessels

Medial

w/in true pelvis

29

GO REVIEW RESORPTION/EXCRETION ON A NEPHRON

NOW

30

Where is most of K filtered by glomeruli resorbed back into serum?

Proximal tubule

LOH

31

Frequent UTIs and pyelonephritis?

Think Vesicoureteral reflux

Pyelo wouldn't occur w/o this

32

How do you determine RPF from RBF?

RPF = RBF * (1-Hct)

33

A good rule of thumb for comparing GFR and serum Cr?

Everytime GFR halves => Cr doubles

34

Where is angiotensin I converted into angiotensin II?

Pulm vasculature

35

Function of Angiotensin II?

Potent vasoconstrictor
- in systemic circulation => ^ BP
- in efferent arterioles => maintains GFR

Also - stimulates adrenal gland => release of aldosterone => Na retention => ^ afterload

36

Foscarnet

-Pyrophosphate analog
- Used for ganciclovir-resistant CMV
- Chelates calcium => hypomagnesemia & v PTH release => hypocalcemia

Seizures!

37

Most common cause of unilateral fetal hydronephrosis

Uteropelvic junction (connection site between kidney and ureter)
- Due to inadequate canalization

Detected in 2nd trimester

38

Significant renal hypoperfusion causes what?

Activation of RAAS system

Chronic hypoperfusion => hypertrophy & hyperplasia of afferent arteriole

39

What is located in the afferent arteriole in the kidney?

Modified SM cells (juxtaglomerular cells) => synthesize renin

40

Loop diuretics do what?

- Blocks Na/Cl transport => ^ed Na, Cl, and fluid excretion
- Stimulates prostaglandin release => vasodilatory effects => ^ RBF => ^ GFR and drug delivery

NSAIDs fuck up that shit b/c of decreased prostaglandins

41

Bethanechol

Muscarinic agonist

42

How does anesthesia affect urinary system?

Post-op urinary retention
- Incomplete bladder emptying
- decreased micturition reflex
- Decreased contractility of bladder detrusos
- +/- increased vesical sphincter tone

43

Aldosterone excess leads to what?

- HTN
- Hypokalemia
- Metabolic alkalosis
- Depressed renin

Conn syndrome