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Flashcards in Renal Deck (77):
1

stimuli that induce renin release

B-adrenergic stimulation (sympathetic tone)
low Na in DCT (macula densa)
low pressure in afferent arteriole

2

body water

60% body weight
1/3 extracellular, 1/4 of that is plasma

3

glomerular filtration barrier

fenestrated capillary epithelium
BM with heparan sulfate (- charge)
podocyte foot processes

4

Renal formulas

CL=UV/P
GFR=UV/P (inulin or creatinine)
RPF=UP/V (PAH)
Filtration fraction=GFR/RPF
Filtered load=GFR*Px
Excretion rate=V*Ux
Reabsorption=filtered-excreted
Secretion=excreted-filtered

5

effect of NSAIDS on kidney

inhibit PG (normally dilate afferent arterioles)
so constrict afferent arteriole:
decreases RBF and GFR, so FF stays the same

6

site of excretion of organic anions and cations

PCT

7

site of isotonic fluid reabsorption

PCT

8

gout+intellectual disability+lip-biting

Lesch-Nyhan syndrome

9

Psammoma bodies

Papillary adenocarcinoma of thyroid
serous cystadenocarcinoma of ovary
meningioma
mesothelioma

10

function of distal tubule

Principal cells: reabsorb H2O and Na
secrete K
Intercalated: secrete H or HCO
reabsorb K

11

two types of intercalated cells

alpha (a cells): secrete H ions
beta (B cells): secrete HCO3

12

effect of aldosterone on collecting duct

principal cells: increase reabsorption of Na and secretion of K
intercalated: increases secretion of H

13

acute pulmonary edema

loop diuretic

14

idiopathic hypercalciuria (calcium stones)

thiazide
avoid loop (increase Ca excretion)

15

glaucoma

mannitol or acetazolamide

16

mild to moderate CHF with expanded ECV

loop

17

conjunction with loop or thiazide to spare K

K sparing

18

edema associated with nephrotic syndrome

loop

19

increased intracranial pressure

mannitol

20

mild to moderate HTN

thiazide

21

hypercalcemia

loop

22

hyperaldosteronism

spironolactone or eplerenone (ald antagonists)

23

heart failure pt with sulfa allergy

ethacrynic acid

24

peaked t waves

hyperkalemia

25

tetany

hypocalcemia, hypomagnesia

26

arrythmias

hypo/hyper K, hypomagnesia

27

decreased deep tendon reflexes

hypermagnesia

28

flattened T waves, U waves on EKG

hypokalemia

29

diagnostic features of DI

polyuria
decreased SG and osmolarity of urine
water deprivation test: no increase in urine osmolarity
desmopressin:
central if urine osmolarity increases
nephrogenic if urine osmolarity stays the same

30

factors cause hyperkalemia

Digitalis
B antagonists
acidoses
decreased insulin
hyperosmolariy
cell lysis
ACE inhibitors and K sparing

31

factors cause hypokalemia

increased insulin
B agonists
alkalosis
hyposmolarity
cell proliferation
loop

32

emergency treatment of hyperkalemia

B agonist
IV dextrose then IV insulin
IV bicarb

33

treatment for central DI

desmopressin

34

treatment for nephrogenic DI

HCTZ, indomethacin, amiloride

35

treatment for lithium-induced nephrogenic DI

amiloride

36

high anion gap metabolic acidosis

MUDPILES
methanol
uremia
diabetic ketoacidosis
propylene glycol
iron tablets or INH
lactic acidosis
ethylene glycol
salicylates (late)

37

Renal tubular acidosis

type 1 (distal): decreased H excretion, pH>5.5 and increased Ca stones, hypokalemia
type 2 (proximal): decreased HCOs reabsorption, pH5.5, decreased aldo response

38

determining acid base problems

bicarb follows pH in metabolic causes
pCO2 is opposite pH in respiratory causes

39

CSF changes in Guillain-Barre

albumino-cytologic dissociation
increased protein with normal cell counts

40

rash on palms and soles

secondary syphilis
rocky mountain spotted fever
coxsackie A virus
kawasaki disease

41

features of nephrotic syndrome

proteinuria > 3.5 g/day
hypoalbuminemia
peripheral edema

42

glomerular histology reveals multiple mesangial nodules

diabetic nephropathy

43

linear patterns of IgG deposition on IF

Goodpasture syndrome

44

lumpy-bumpy deposits of IgG, IgM, and C3 in the mesangium

poststreptococcal glomerulonephritis

45

deposits of IgA in the mesangium

IgA nephropathy (Berger's)

46

anti-GBM antibodies, hematuria, hemoptysis

Goodpasture syndrome

47

nephritis, deafness, cataracts

Alport syndrome

48

crescent formation in glomeuli

rapidly progressive glomerulonephritis

49

wire-loop appearance on EM

lupus nephritis

50

most common nephrotic syndrome in children

minimal change disease

51

most common nephrotic syndrome in adults

focal segmental glomerulosclerosis (FSGS)

52

Kimmelstiel-Wilson lesions (nodular glomerulosclerosis)

diabetic nephropathy

53

EM: effacement of epithelial foot processes

minimal change disease

54

nephrotic syndrome associated with hepatitis B

membrano-proliferative glomerulonephritis (MPGN)

55

nephrotic syndrome associated with HIV

FSGS

56

EM: subendothelial humps and tram-track appearance

membrano-proliferative glomerulonephritis (MPGN)

57

LM: segmental sclerosis and hyalinosis

FSGS

58

purpura on back of arms and legs, abdominal pain, IgA nephropathy

Henoch-Schonlein purpura

59

apple-green birefringence with Congo-red stain

Amyloidosis

60

EM: spiking of the GBM due to electron dense subepithelial deposits

membranous nephropathy

61

nodular hyaline deposits in the glomeruli

Kimmelstiel-Wilson nodules (diabetic nephropathy)

62

glomerulonephritis plus pulmonary vasculitis

granulomatosis with polyangitis (Wegener's)
or Goodpasture Syndrome

63

WAGR complex

Wilm's tumor
aniridia (no iris)
genitourinary malformation
mental/motor retardation

64

risk factors for transitional cell carcinoma

smoking, aniline dyes, cyclophosphamide

65

classic features of drug-induced acute interstitial nephritis

fever, rash, hematuria, CVA tenderness
eosinophilia
azotemia

66

what changes will be seen in a BMP in a pt with renal failure

hyperkalemia
hypocalcemia
increased BUN and Cr

67

most common tumor of the urinary tract

transitional cell carcinoma

68

most common renal malignancy of early childhood

Wilm's tumor

69

fever, rash, hematuria and eosinophilia

acute interstitial nephritis

70

red cell casts

acute glomerulonephritis

71

waxy casts

chronic renal failure

72

thyroid-like appearance of kidney

chronic pyelonephritis

73

most common renal tumor

renal cell carcinoma

74

most common type of renal stone

calcium

75

type of renal stone associated with Proteus vulgaris (also Klebsiella)

struvite stones (staghorn calculi)

76

drugs that cause acute tubular necrosis

aminoglycosides, cephalosporins, polymyxins

77

BUN/Cr >20 with decreased RBF

prerenal azotemia