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Flashcards in Renal Deck (80):
1

Plasma volume measured by?

Albumin

2

Extracellular volume measured by?

Inulin

3

Negative charge on glomerular bm?

Heparan sulfate (lost in nephrotic syndrome)

4

Sodium correction for glucose?

(glucose-100)/100) *1.6= +sodium

5

Filtration fraction?

GFR/RPF

6

Normal FF?

20%

7

Renal plasma flow is best estimated using?

PAH (measures renal plasma flow)

8

Deficiency in neutral amino acid (tryptophan) transporter?

Hartnup's disease-- results in pellagra

Should never see amino acids in urine-- amino acids are absorbed by sodium dependent transporters in proximal tubule

9

Causes of pellagra?

Dec niacin or tryptophan-- why tryptophan? because the body converts tryptophan into niacin

10

Sodium is absorbed with.......in the early PCT? and ...... in the late PCT?

Bicarb
Cl-

11

Describe AII and contraction alkalosis?

AII acts on the PCT to absorb Na-- which in turn secretes H+-- Bicarb is absorbed when H+ is secreted-->metabolic alkalosis (i.e. contraction alkalosis)

12

Part of nephron that is impermeable to water?

Thick ascending limb-- absorbs 10-20%

13

Difference between thiazide and loop diuretics with regard to calcium?

Thiazides increase calcium
Loops decrease calcium

14

Tetany and arrhythmia caused by which electrolyte imbalance?

Low serum Magnesium

15

opioids? alk or acid?

Respiratory acidosis

16

Spironolactone-- acidemia or alkalosis?

Metabolic acidosis

17

Salicylates-- alk or acid?

Respiratory alkalosis

18

Loop diuretics-- alk or acid?

Metabolic alkalosis

19

Hyperaldosteronism-- alk or acid?

Metabolic alkalosis

20

RBC cast ddx?

Glomerulonephritis; ischemia or malignant htn

21

WBC casts?

Tubulointerstitial inflammation; acute pyelonpehritis; transplant rejection

i.e. infection or inflammation

22

RBC casts may have which protein?

Tamm horsefall protein

23

Fatty casts (oval fat bodies)

Nephrotic syndrome

24

Granular/muddy brown casts?

Acute tubular necrosis

25

Waxy casts?

Advanced renal disease/chronic renal failure

26

Hyaline casts?

Nonspecific-- can be normal finding

27

Common to see what type of cells in urine?

Epithelial cells

28

Pt. presents with proteinuria, fatty casts and edema-- what would you expect on blood labs?

Hypoaggamablobulinemia and hyperlipidemia and hypoalbuminemia

Increased risk of infection due to hypoagammaglobulinemia

29

MCC of nephrotic syndrome in adults?

Focal segmental glomerulosclerosis-- no immune complexes

30

EM shows effacement of foot processes; poor response to steroids?

Focal segmental glomerulosclerosis

31

Spike and dome appearance with subepithelial deposits of IgG and C3? causes?

Membranous nephropathy (nephrotic)
Granular on IF
Drugs, infection, sle, idiopathic

32

Foot process effacement; loss of albumin but not globulins?

Minimal change disease-- usually follows infection. Responds well to corticosteroids
Dec IgG and inc IgM

33

DDX of amyloidosis?

Multiple myeloma; TB; RA

34

Subendothelial IC deposits with granular IF; tramtrack appearance due to splitting of mesangial ingrowth? What is this associated with?

Membranoproliferative glomerulonephritis type 1-- associated with HBV and HCV

35

Intramembranous IC deposits; dense deposits; dec C3?

Membranoproliferative glomerulonephritis type 2

36

Resorptive defect in PCT assoc with increased excretion of all amino acids?

Fanconi-- metabolic acidosis

37

Resorptive defect in TAL?

Barterr syndrome--hypokalemia; met alkalosis and hypercalceuria

38

Subepithelial humps?

Acute poststrep-- neutrophils in humps

39

Granular appearance ddx?

Acute strep; diffuse proliferative; membranous

40

LM wire looping of capillaries?

Diffuse proliferative

41

Staghorn caliculi?

Ammonium magnesium phosphate aka struvite crystals

42

Radiolucent crystals on xray?

Uric acid-- lemon drop shape

43

Lemon drop shape crystals?

Uric acid-- seen with diseases of high cell turnover

44

Hexagonal crystals?

Cystine

45

Painless hematuria with no casts for male?

suggests bladder cancer

46

Transitional cell carcinoma assoc with?

Pee SAC
Phenacetin; smoking; aniline dyes; and cyclophosphamide

47

Subendothelial humps?

Lupus nephritis (diffuse progressive)( and membranoproliferative

48

Where are IgA deposits in kidney?

Mesangium

49

Brown granular casts-- dead epithelial cells?

Acute tubular necrosis

50

Rash, fever, kidney disease?

Acute interstitial nephritis-- inflammatory infiltrate-- eosinophils in urine, may lead to papillary necrosis

51

Fatty casts?

Nephrotic syndrome

52

FSGS-- IF?

Nothing-- NO immune complexes

53

Spike and dome?

Membranous-- thick glomerular BM dt immune complexes

54

Granular IF?

Immune complexes eg Membranous, membranoproliferative; Post streptococcul; diffuse proliferative

55

Tram tracks?

Membranoproliferative

56

What do you see in nephritic syndrome (glomerulus?)

Hypercellular inflamed glomerulus

57

Difference between Wegeners and Good pastures?

Nasopharynx involvement in Wegeners and no IF because no immune complexes

58

Pathology of chronic pyelonephritis?

Cortical scarring and blunted calyces

59

Pyuria with negative urine cultures?

urithritis dt chlamydia and neisseria

60

Contraction alkalosis

ATII stimulates Na/H exchange-->inc Na and HCO3

61

PTH acts proximally and distally-- what does it do in each instance?

Proximally it inhibits Na/phosphate
Distally it enhances Ca/Na exchange-->Ca reabsorption

62

Distal tubule is impermeable to urea

FREEBIE

63

principal cells

enhances Na/K pump--- i.e. secretes K and H

64

erythropoietin released by

interstitial cells in peritugbular capillary bed in response to hypoxia

65

Low K?

WEAKNESS

66

High K?

wide QRS and peaked T waves

67

stones bones groans and psychiatric overtones

HYPERCALCEMIA

68

Electrolye that will cause Decreased DTR in excess?

Magnesium

69

Renal tubular acidosis are associated with

Hypokalemia except 4 which causes hyperkalemia dt decreased aldosterone or lack of response to aldosterone

Remember: type 2 has decreased urine despite being a tubular acidosis

70

Eosinophilic nodular glomerulosclerosis

kimmelstiel wilson lesions

71

Upper respiratory tract infection; IgA deposition; gastroenteritis

henoch schonlein or bergers disease

72

treatment for calcium stones

HCTZ and CITRATES

73

RCC spread to?

lung and bone

74

common bugs of pyelonephritis?

Enterobacter faecalis; kleb; ecoli

75

eosinophilic casts (thyroidization of kidney)

chronic pyelonephritis

76

3 stages of ATN

1) inciting event
2) Maintenance phase-- oliguric 1-3 weeks; risk of hyperkalemia
3) Recovery phase-- polyuric, bun and creatinine fall; risk of hypokalemia

77

Used to treat pseudotumor cerebri

acetazolamide

78

Furosemide effect on afferent arteriole?

stimulates PGE release

79

toxicity of furosemide

OH DANG
ototoxic; hypokalemic; dehydration; allergy; nephritis; GOUT

80

Side effects of Ace inhibitors

CATCHH
cough, angioedema, Teratogen, Creatinine increase; HYPERkalemia; hypotension