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1st Aid Memorize > Renal > Flashcards

Flashcards in Renal Deck (80):
1

What cells release erythropoietin?

Interstitial cells in the peritubular capillary bed

2

What cells activate 25-OH-vitamin D?

Proximal tubule cells

3

What enzyme is used to convert 25-OH-vitamin D to active form?

1-alpha-hydroxylase

4

What cells release renin?

JG cells (afferent arteriole)

5

What is the action of prostaglandins in the glomerulus?

vasodilate afferent arteriole to increase RBF

6

What is the action of ang II at the glomerulus?

vasoconstrict efferent arteriole to increase GFR and FF (and to reabsorb Na from the proximal and distal nephron)

7

What is the role of ANP at the glomerulus?

Increase GFR and increase Na filtration with NO compensatory Na reabsorption (volume loss and Na loss)

8

What is the overall effect of aldosterone on the glomerulus?

Increases Na reabsorption
Increases K secretion
Increases H secretion

9

What things lead to K+ shift OUT of cells?

Digitalis
hyperOsmolarity
Lysis of cells
Acidosis
Beta-blockers
Insulin deficiency

(DO LAB for insulin deficiency)

10

What things cause K+ shift IN to cells?

hypoosmolarity
Insulin (increase Na/K ATPase)
Alkalosis
Beta-agonists (increase Na/K ATPase)

11

Electrolyte deficiency: nausea, malaise, stupor, coma

Na

12

Electrolyte deficiency: tetany, torsades de pointes

Mg

13

Electrolyte deficiency: bone loss, osteomalacia

PO4

14

Electrolyte deficiency: U waves on ECG, flattened T waves, arrhythmias, muscle weakness

K

15

Electrolyte deficiency: Tetany, seizures, QT prolongation

Ca

16

Electrolyte surplus: low DTRs, lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia

Mg

17

Electrolyte surplus: Renal stones, metastatic calcifications, hypocalcemia

PO4

18

Electrolyte surplus: irritability, stupor, coma

Na

19

Electrolyte surplus: kidney stones, bone pains, abdominal pain, anxiety, alteredmential status

Ca

20

Electrolyte surplus: Wide QRS, peaked T waves on ECG, arrhythmias, muscle weakness

K

21

Causes of Respiratory Acidosis (Pco2 > 40)

Hypoventilation (airway obstruction, acute lung disease, chronic lung disease, opioids, weak respiratory muscles)

22

Causes of metabolic acidosis (high anion gap > 8-12)

MUDPILES:
Methanol
Uremia
DKA
Propylene glycol
Iron tablets; INH
Lactic acidosis
Ethylene glycol (oxalic acid)
Salicylates (late)

23

Cuases of non-anion gap metabolic acidosis (8-12)

HARD-ASS
Hyperalimentation
Addison disease
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion

24

Causes of Respiratory Alkalosis (Pco2 < 40)

Hyperventilation (hysteria, hypoxemia, salicylates (early), tumor, pulmonary embolism)

25

Causes of metabolic alkalosis

Loop diuretics
Vomiting
Antacid use
Hyperaldosteronism

26

Type of renal tubular acidosis with:
-pH>5.5
-Hypokalemia
-High urine pH

Type 1

27

Type of renal tubular acidosis with:
-pH <5.5
-Hyperkalemia
-High urine pH

Type 4

28

Type of renal tubular acidosis with:
-pH <5.5
-Hypokalemia
-Low/normal urine pH

Type 2

29

Problem in type 1 RTA

DISTAL defect in alpha intercalated cells to secrete H+ (no HCO3- is generated)

30

Problem in type 2 RTA

Defect in PROXIMAL tubule HCO3- reabsorption results in increase excretion of HCO3- in urine

31

Problem in type 3 RTA

Hyperkalemia from hypoaldosteronism or K+ sparing diuretics impairs ammoniagenesis in the PT which decreases buffering capacity and decreases H+ secretion into urine

32

Causes of type 1 RTA

Ampho B toxicity
Analgesic nephropathy
Congenital anomalies (obstruction) or urinary tract

33

Causes of type 2 RTA

Fanconi syndrome (ex. Wilson disease)
Lead/aminoglycoside toxicity
Carbonic anhydrase inhibitors
Multiple myeloma (light chains)

34

Hyaline casts

can be normal finding (concentrated urine)

35

Waxy casts

Advanced (chronic) renal disease

36

Granular casts (muddy brown)

Acute tubular necrosis

37

Fatty casts (oval fat bodies)

Nephrotic syndrome

38

WBC casts

Tubulointerstitial inflammation
Acute pyelonephritis
Transplant rejection

39

RBC casts

glomerulonephritis
ischemia
malignant HTN

40

Pyuria no casts

Acute cystitis

41

Hematuria no casts

Bladder cancer
Kidney stone

42

Nephritic or nephrotic: Acute PSGN

Nephritic

43

Nephritic or nephrotic: FSGS

Nephrotic

44

Nephritic or nephrotic: amyloidosis

Nephrotic

45

Nephritic or nephrotic: MPGN

both

46

Nephritic or nephrotic: Alport syndrome

Nephritic

47

Nephritic or nephrotic: Diffuse Proliferative GN

both

48

Nephritic or nephrotic: RPGN

nephritic

49

Nephritic or nephrotic: minimal change disease

Nephrotic

50

Nephritic or nephrotic: IgA glomerulonephropathy

Nephritic

51

Nephritic or nephrotic: Membranous nephropathy

Nephrotic

52

Nephritic or nephrotic: Diabetic glomerulonephropathy

Nephrotic

53

Proteniuria level in nephrotic syndrome

> 3.5 g/day

54

Most common kidney stone presentation

patient with normocalcemia and hypercalciuria (calcium oxalate stone)

55

Which kidney stone is radiolucent?

uric acid

56

Enveloped shaped crystals

Calcium stones

57

Coffin lid crystals

Ammonium magnesium phosphate stone

58

Hexagonal crystals

Cystine stone

59

Rhomboid or rosette crystals

uric acid

60

Stones that precipitate at high pH

Calcium PHOSPHATE
Ammonium magnesium phosphate

61

Stones that precipitate at low pH

Calcium OXALATE
Uric acid
Cystine

62

Cause of ammonium magnesium phosphate (struvite) stones

Urease positive bug infection (proteus, staphylococcus, klebsiella, etc)

63

Treatment for calcium stones

thiazides
citrate

64

Treatment for struvite stones

eradicate infection
remove stone

65

Treatment for uric acid stone

alkalinizaiton of urine

66

Treatment of cystine stones

alkalinizaiton of urine
hydration

67

Causes of uric acid stones

leukemia
hyperuricemia (gout)

68

Causes of cystine stones

Cystinuria

69

Test for cystine stones

sodium nitroprusside test positive

70

Cystitis with ammonia smelling urine

Proteus mirabilis

71

Viral cause of acute infectious cystitis

Adenovirus (hemorrhagic cystitis)

72

What is positive in labs for acute infectious cystitis?

leukocyte esterase

73

Thyroidization of kidney

chronic pyelonephritis

74

What parts of glomerulus are most sensitive to ischemia?

proximal tubule
thick ascending limb

75

Type of ARF with:
Urine osmolality >500
Urine Na 20

Prerenal azotemia

76

Type of ARF with:
Urine osmolality 40
FENa >2%
Serum BUN/Cr <15

Intrinsic renal failure

77

Type of ARF with:
Urine osmolality 40
FENa >1% (mild) or >2% (severe)
Serum BUN/Cr >15 (varies)

Postrenal azotemia

78

Causes of prerenal azotemia

Low RBF (hypotension) so urea is retained by kidney to conserve volume

79

Causes of postrenal azotemia

Outflow obstruction (bilateral due to stones, BPH, neoplasia, etc)

80

Causes of Intrinsic renal failure

ATN or ischemia/toxins (patchy necrosis leads to debris obstructing tubule and fluid backflow across necrotic tubule which impairs BUN reabsorption)