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STEP1 2014 > Renal > Flashcards

Flashcards in Renal Deck (31):
1

Normal arterial blood gas ranges

pH= 7.35-7.45
pCO2= 35-45
pO2>90
HCO3= 22-28

2

RTA1: distal, pH>5.5

Defective alpha-intercalated cells unable to secrete acid; new bicarb is not generated
this pump normally takes in protons and secretes potassium

metabolic acidosis
hypokalemia
high urine pH

increased risk for calcium phosphate kidney stones due to increased urine pH and increased bone turnover

Causes:
amphotericin B
analgesic nephropathy
multiple myeloma light chains
congenital anomalies of the urinary tract

3

RTA2: distal, pH<5.5

Defect in proximal tubule, bicarb is not reabsorbed, resulting in increased excretion of bicarb in the urine with subsequent metabolic acidosis. Urine is acidified by alpha- intercalated cells in the collecting tubules.

hypokalemia
hypophosphatemia
low urine pH

hypophosphatemia- increased risk for hypophosphatemic rickets

Causes:
Fanconi syndrome (eg Wilson disease)
chemicals toxic to the proximal tubule (lead, aminoglycosides)
carbonic anhydrase inhibitors

4

RTA4, hyperkalemic pH<5.5

hypoaldosteronism, aldosterone resistance, or K+ sparing diuretics
-hyperkalemia impairs ammoniagenesis in the proximal tubule
-decreased buffering capacity and decreased proton excretion into the urine

5

MUDPILES anion gap acidosis

anion gap acidosis
Methanol
Uremia
Diabetic ketoacidosis
Propylene glycol
Iron tablets of INH
Lactic acidosis
Ethylene glycol (oxalic acid)
Salicylates (late)

6

HARDASS normal anion gap acidosis

normal anion gap acidosis
hyperalimentation
addison disease
renal tubular acidosis
diarrhea
acetazolamide
spironolactone
saline infusion

7

Respiratory alkalosis

psychogenic
hypoxemia (altitude)
salicylates cause hyperventilation early on
tumor
pulmonary embolism (acute hypoxemia)

8

metabolic alkalosis with respiratory compensation (pCO2> 40):

loop diuretics
vomiting
antacid use
hyperaldosteronism (hypokalemia, hypertension, metabolic alkalosis)

9

pCO2>40

respiratory alkalosis

10

Respiratory acidosis

hypoventilation:
airway obstruction
acute lung disease
chronic lung disease
opioids, sedatives
weak respiratory muscles

11

Linear pattern of IgG deposition on immunofluorescence

Goodpasture anti-glomerular basement membrane antibodies

12

Lumpy bumpy deposits of IgG, IgM, C3 in the mesangium

PSGN

13

Deposits of IgA in the mesangium

IgA nephropathy (Berger)

14

Anti-GBM antibodies, hematuria, hemoptysis

Goodpasture

15

nephritis, deafness, cataracts

Alport

16

Crescent formation in the glomeruli

rapidly progressive crescentic glomerulonephritis

17

wire-loop appearance on light microscopy

lupus diffuse proliferative glomerulonephritis

18

most common nephritic syndrome in children

minimal change disease

19

most common nephrotic syndrome in adults

focal segmental glomerulonephrosis, most common in AA, hispanics, HIV infected. Also associated with SCD, heroine abuse, massive obesity, interferon treatment, chronid kidney disease

20

Kimmelstiel- Wilson lesions (nodular glomerulosclerosis)

diabetic glomerulonephropathy

21

electron microscopy: effacement of epithelial foot processes

minimal change glomerulonephropathy

22

Nephrotic syndrome associated with hep B

membranous, membranoproliferative

23

electron microscopy: subendothelial humps and train tracks

membranoproliferative glomerulonephritis

24

light microscopy: segmental sclerosis and hyalinosis

focal segmental glomerulonephrosis

25

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

Henoch Scholein purpura

26

Apple- green birefringence with Congo- red stain under polarized light

Amyloidosis

27

Electron microscopy: spiking of the GBM due to electron- dense subepithelial deposits, "spike and dome"

membranous nephropathy

28

most common in caucasian adults

membranous, which is idiopathic or associated with SLE, solid tumors, antibody to phospholipase A2 receptor

29

Nephrotic syndrome

3 criteria for diagnosis include >3.5g/day protein in urine
hypoalbuminemia
edema

you may also see hyperlipidemia as the liver's response to decreased oncotic pressure (for reasons unknown) is to generate lipoprotein particles. At the same time, TG metabolism is impaired.

increased risk of thrombosis, infection

30

Nodular hyaline deposits in the mesangia of glomeruli, eosinophilic and acellular, dramatically expanded mesangium, capillaries that have lost their prominence

Kimmelstiel- Wilson

31

Glomerulonephritis plus pulmonary vasculitis

GPA and Goodpasture both have lung and kidney involvement. GPA has upper respiratory involvement (sinuses, soft palate)