Renal 2 Flashcards Preview

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Flashcards in Renal 2 Deck (36):
1

Concentrations of which substances increase as you move along the proximal tubule?

- PAH
- Cr
- Inulin
- Urea

2

Concentrations of which substances decrease as you move along the proximal tubule?

- Bicarb
- Glucose
- AAs

3

Grapefruit is a what?

P450 inhibitor

Increases nephrotoxicity by raising circulating drug levels

Slows breakdown of drugs metabolized by this pathway

4

Cyclosporine and ^ed levels of serum Cr?

Calcineurin inhibitor nephrotoxicity

via P450 pathway

5

Beta-blockers function

- Decrease renin production
- Decrease sympathetic stimulation

6

Indication of diabetic nephropathy?

Increased albumin excretin

7

Appropriate tx for diabetic pt w/ diabetic nephropathy

- Anti-glycemic drugs
- ACEIs (have anti-proteinuric effects)

8

Athroembolic renal disease

- Occur post-invasive vascular procedures
- Needle-shaped cholesterol clefts within the atheromatous thrombus
- Emboli found in kidneys (most common), GI tract, CNS, skin

9

DKA emergent tx

IV NS and insulin

Increase serum bicarb, Na

Decrease glucose, osmolality, and K

10

Urinalysis of PSGN

RBC cast, mild proteinuria, ^ serum Cr

11

PSGN clinical presentation

- Commonly in kids
- Hematuria
- HTN
- Periorbital edem

12

Genetics of ARPKD

AR duh

Mutation in PKHD1 gene

Codes for fibrocystin (present in kidney and liver)

13

Clinical findings of ARPKD

- Renal insufficiency
- Nephromegaly
- HTN

Dx: bilateral enlarged, echogenic kidneys on US

Associated w/ Potter sequence

14

Potter sequence

- Flattened facies
- Limb deformities
- Pulm hypoplasia
- Oligohydramnios

HIGH mortality

15

Pyelonephritis histo characteristics

- Massive interstitial infiltration
- PMNs in interstitium and tubular lamina
- Fever, hematuria

16

Adverse rxn associated w/ Beta-lactam antibiotics?

- Fever
- Rash
- ARF

Drug-induced acute interstitial nephritis

Also - NSAIDs, sulfonamides, rifampin, diuretics

17

Acute interstitial nephritis

- Peripheral eosinophilia and eosinophiluria
- Hypersensitivity

18

Ramipril

ACEI

19

Primase

DNA-dependent RNA poly

Incorporates short RNA primers into replicating DNA

20

Frothy/foamy urine?

Caused by proteinuria => nephrotic syndrome

21

Pts w/ MS and urinary issues

- Spastic bladder after developing acute lesion on spinal cord
- Increased urinary freq and urge incontinence
- Bladder hypertonia (UMN!!!)

22

Where does majority of water reabsorption occur?

Proximal tubule

Passively w/ reabsorption of solutes

23

Crescents in RPGN consist of which materials?

- Glomerular parietal cells
- Monocytes
- Macros
- ABUNDANT fibrin

Eventually become sclerotic, disrupting glomerular function => irreversible renal injury

24

In acute transplant rejection, what is the humoral response?

- C4d deposition
- PMN infiltrate
- Necrotizing vasculitis

25

In acute transplant rejection, what is the cellular response?

- Lymphocytic interstitial infiltrate
- Endotheliitis

26

Acute hemolytic transfusion reaction

- Fever & chills
- Hypotension
- Dyspnea
- Chest/back pain
- Hemoglobinuria (red- to brown-colored urine)

Occur w/in minutes/hours of starting a blood transfusion --- ABO incompatibility

Ab-mediated (Type III) hypersensitivity reaction

27

Type III hypersensivity

- IgM bind to Ag => complement activation
- C3a and C5a cause vasodilation and sx of shock
- Complement mediated cell lysis

28

Urachus

- Yolk sac forms the allantois => extends into urogenital sinus => becomes bladder (5th-7th week)
- Allantois becomes urachus after bladder formation => now duct between bladder and yolk sac

29

Patent urachus

- Aka persistent allantois remnant
- Connects umbilicus and bladder
- Pts present w/ urine discharge from umbilicus
- Exacerbated w/ crying, straining, voiding, prone position

30

Vesicourachal diverticulum

- Failure to close part of urachus
- commonly asymptomatic
- Outpouching of bladder apex

31

Urachial sinus

- Failure to close distal part of urachus
- Presents w/ periumbilical tenderness and purulent discharge from persistent/recurrent infections
- Adjacent to umbilicus

32

Urachal cyst

- Failure of central portion of urachus to obliterate
- Fluid filled structure located between the two obliterated ends of urachus

33

Vitelline duct

- Persistent yolk stalk
- Connects small intestine w/ skin
- Presents w/ meconium discharge from umbilicus
- Incomplete obliteration => meckel diverticulum

34

Proximal ureter blood supply

Renal artery

35

Distal ureter blood supply

Superior vesical artery

36

Urinary incontinence in pts w/ MS

- Develop urge incontinence due to loss of CNS inhibition of detrusor contraction in the bladder
- Bladder can become atonic, dilated => overflow incontinence