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Renal Flashcards

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1
Q

Hydronephrosis in fetus

A

failure of utereopelvic junction to canalize

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2
Q

Potter’s syndrome

A

oligohydramnios
compression of fetus
pulmonary hypoplasia
death

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3
Q

Horseshoe kidney

A

ascension blocked by IMA

assc with Turner syndrome

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4
Q

What can cross ureters and cause urine backup?

A

accessory renal artery

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5
Q

Characteristics of Glc renal clearance

A

threshold-past where you see Glc in urine (160mg/dL)
splay-gradual appearance of Glc in urine
full saturation of Glc transporters at 250mg/dL

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6
Q

Pellegra sx

Not B3 deficiency

A

Hartnup’s disease
deficiency of neutral AA transport
Tryptophan important loss

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7
Q

Impact of fluid by adrenal insufficiency

A 
increased ICF (pulls ECF out)
decreased ECF
decreased osmolarity (lose salt)
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8
Q

Impact of fluid by SIADH

A

increased ICF
increased ECF
decreased osmolarity

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9
Q

Impact of fluid by diabetes insipidus

A 
decreased ICF/ECF
increased osmolarity (loss of water)
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10
Q

Impact of fluid by primary aldosteronism

A

decreased ICF (pulled out by salt)
increased ECF
increased osmolarity

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11
Q

PTH on proximal tubule

A

inhibits Na+/phosphate cotransport

decreased phosphate resorption

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12
Q

AT II on proximal tubule

A

increased Na+/H+ exchange

increased Na+/HCO3- resorption

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13
Q

PTH on distal convoluted tubule

A

increased Ca2+/Na+ exchange

increased Ca2+ resorption

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14
Q

Aldosterone on collecting tubule

A

increased Na+ channels on luminal side

increased Na+ resorption

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15
Q

Renal BP control

A 
myogenic response (stretch constricts-Ca2+ mediated)
tubuloglomerular feedback (macula densa)
PGE/NO (vasodilate)
epi/NE/endothelin (vasoconstrict)
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16
Q

Beta1 receptors on kidney action

A

increase renin secretion by juxtaglomerular cells

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17
Q

Alpha1 receptors on kidney action

A

increase Na+/K+ pump in proximal tubule

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18
Q

Central Diabetes insipidus

A

lack of ADH secretion
responds to desmopressin
chromosome 20 defect

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19
Q

Nephrogenic diabetes insipidus

A

genetic loss of V2R/AQP-2 or lithium toxicity

no desmopressin response

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20
Q

EPO production

A

made by peritubular capillary bed
in response to hypoxia
increases RBC production

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21
Q

VIt D and kidneys

A

converts 25-OH Vit D to 1,25-(OH)2 Vit D (active form)

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22
Q

NSAIDs impact on kidneys

A

decrease PGE which dilate arterioles

can cause acute renal failure

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23
Q

Insulins impact on K+

A

shifts K+ into cells

causing hypokalemia

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24
Q

Hyperkalemia impact on heart

A

wide QRS complex

peaked T waves

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25
ABG for metabolic acidosis
decreased bicarb decreased PCO2 decreased pH
26
ABG for respiratory acidosis
increased bicarb increased PCO2 decreased pH
27
Type 1 renal tubular acidosis
defect in H+ excretion | increased risk for Ca2+/phosphate stones
28
Type 2 renal tubular acidosis
defect in tubule bicarb resorption
29
Sign of azotemia
increased BUN and creatinine | decreased GFR
30
Fatty casts in urine
nephrotic syndrome
31
granular casts in urine
acute tubular necrosis
32
waxy casts in urine
chronic renal failure
33
Focal segmental glomerulosclerosis
collapse of glomeruli (HIV/blacks/heroin assc) hyalinosis effacement of foot processes IgM and C3
34
Membranous nephropathy
adult caucasian males GBM thickening spike and dome (immune complex deposits) granular immunofluorescence
35
Minimal change disease
2-6 y/o post infection and Hodgkin lymphoma assc foot process effacement selective loss of albumin responds to corticosteriods
36
Amyloidosis
congo red stain apple green birefringence assc with multiple myeloma
37
Membranoproliferative GN
type 1:tram track due to GBM splitting C3/C4/IgG type 2:ribbon like, only C3 assc with HBV/HCV
38
Diabetic glomerulonephropathy
nonenzymatic glycosylation nodular glomerulosclerosis Kimmelstiel-Wilson lesion hyaline arteriosclerosis
39
Acute poststrep GN
lumpy bumpy appearance (immune complex deposition) child post URT infection periorbital edema IgG/IgM/C3
40
Rapidly progressive GN
crescent moon shape seen in Goodpasture's (linear IF)/Wegeners's (c-ANCA)/microscopic polyangiitis (p-ANCA) petechial hemorrhage on cortical surfaces
41
Diffuse proliferative GN
SLE or PMGN wire looping of capillaries IgG and C3 deposition granular on IF
42
Berger's disease
related to Henoch-Schoenlein purpura mesangial proliferation IgA in mesangium aka IgA nephropathy
43
Alport syndrome
mutation of type IV collagen, X linked split basement membrane deafness/eye problems
44
Ca2+ kidney stones
acid-oxalate/basic-phosphate can result from ethylene glycol/Vit C hypercalciuria/normocalcemia
45
Struvite kidney stones
Mg2+/NH4+/phosphate caused by infection (urease (+)) acidify urine to tx
46
Uric acid kidney stones
radiolucent assc with hyperuricemia seen in diseases with increased cell turnover (leukemia)
47
Cystine kidney stones
hexagonal crystals | congenital defect in cysteine resorption
48
Renal cell carcinoma
yellow color/upper pole of kidney assc with Von Hippel-Lindau (chromosome 3 deletion) and tuberous sclerosis mets to lung/bone
49
Wilm's tumor
2-4 y/o deletion of suppressor gene WT1 chromosome 11 embryonic glomerular structures Anirida/GI malformation/MR (Beckwith Wiedemann syndrome)
50
Transitional cell carcinoma
painless hematuria | assc with aniline dyes/cyclophosphamide
51
Acute pyelonephritis
WBC casts neutrophils affects cortex (not glomeruli) tubular necrosis
52
Chronic pyelonephritis
Eosinophilic casts vesicoureteral reflux corticomedullary scarring thyroidization of kidney
53
Drug induced interstitial nephritis
eosinophils/azotemia 1-2 wks after drug use (but months with NSAIDs) hypersensitivity rxn
54
Acute tubular necrosis
HgCl/CCl4/ethylene glycol all cause metabolic acidosis and oliguria granular casts assc with renal ischemia
55
Renal papillary neccrosis
sloughing off of renal papillae hematuria/proteinuria DM/sickle cell/acute pyelonephritis/chronic phenacetin use
56
Prerenal azotemia labs
increased BUN/creatinine ratio | decreased GFR
57
Intrinsic renal azotemia labs
due to acute tubular necrosis decreased BUN/creatinine ratio fluid backflow
58
Postrenal azotemia labs
normal BUN/creatinine ratio | outflow obstruction
59
Renal osteodystrophy
failure of Vit D hydroxylation increased PTH (secondary to increased phosphate) subperiosteal thinning of bone
60
Chromophobe renal carcinoma
(+) Hale's colloidal iron stain halo around nucleus tan-brown color
61
ADPKD
multiple lg bilateral cysts mutation of PKD1/PKD2 assc with berrry aneurysms destroys kidney parenchyma
62
ARPKD
infantile PKD sponge like appearance of medulla/cortex hepatic fibrosis assc with Potter's syndrome (oligohydramnios)
63
Medullary sponge kidney
assc with Marfan's/Ehler's Danlos dilations of collecting ducts adult onset
64
Acetazolamide use
glaucoma altitude sickness pseudotumor cerebri (increased ICP)
65
Furosemide adverse effects
loop diuretic ototoxicity/gout sulfa allergy
66
Use of ethacrynic acid
for pts with sulfa allergy who cannot use furosemide
67
HCT adverse effect
hyperlipidemia sulfa allergy hyperglycemia
68
Spironolactone adverse effects
gynecomastia | hyperkalemia
69
ACE-I's contraindication
bilateral renal artery stenosis

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