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UWorld > Renal > Flashcards

Renal Flashcards

1
Q

What is the proximal tubular fluid/plasma ultrafiltrate ratio?

A

Concentration of a substance in the proximal tubule/ initial concentration of the substance in Bowman’s Space.

Positive ratio: freely filtered, poorly resorbed
- PAH, Cr, inulin > urea

Net zero: Na, K (same as water)

Negative ratio: resorbed
- Glucose, amino acids > bicarb

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2
Q

What species causes urinary schistosomiasis?

A

S. hematobium

  • North Africa
  • Sub-Saharan Africa
  • Middle East

vs. S. mansoni and S. japonicum, which cause intestinal and hepatic schistosomiasis

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3
Q

What are the symptoms of S. hematobium?

A

Causes urinary schistosomiasis

  • Terminal hematuria
  • Frequent urination
  • Hydronephrosis
  • Pyelonephritis
  • SCC of bladder
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4
Q

What enzyme converts pyruvate to acetyl coA?

A

Pyruvate dehydrogenase

Because this is an aerobic process (start of Kreb’s Cycle), deficiency causes:

  • Metabolic acidosis
  • High anion gap
  • High plasma lactate
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5
Q

What chronic condition are Kimmelstiel-Wilson nodules associated with?

A

Diabetes

KW Nodules are:

  • In the peripheral mesangium
  • Ovoid or spherical
  • Lamellated in appearance
  • Eosinophilic on H&E
  • PAS +
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6
Q

What is Henoch-Schonlein Disease?

A
  1. Skin: purpura
  2. GI: abdominal pain, vomit, intestinal bleeding, intussusspetion
  3. Renal: IgA Nephropathy
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7
Q

What does Calcinuerin do?

A

Essential for activation of IL-2, which promotes growth/diff of T cells.

Immunosuppressants like cyclopsorine and tacrolimus work by inhibiting calcineurin.

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8
Q

What is the role of eosinophils in parasitic defense?

A
  1. Parasite entering mucosa or bloodstream is coated by IgE and IgG.
  2. These Abs bind the Fc receptors on eosinophil cell surface.
  3. Triggers eosinophil degranulation and release of cytotoxic proteins (ex. major basic protein)

Antibody Dependent Cell Mediated Cytotoxicity (ADCC)
- Alsomacros, neutros, NK cells

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9
Q

What are the findings of Conn’s Syndrome?

A

Aldo secreting tumor

  • HTN from increased Na
  • Met alkalsosis from lost H, K
  • Decreased plasma renin
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10
Q

What is the Rx for Conn’s Syndrome?

A

Spironolactone or eplerenone, aldo antagonists

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11
Q

What is stress incontinence?

A

Lose urethral support

Intrabdominal pressure > urethral sphincter pressure

Sx: leaking with coughing, sneezing, laughing, lifting

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12
Q

What is urge incontinence?

A

Detrusor overactivity

Sx: sudden overwhelming or frequent need to empty bladder

ex. MS

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13
Q

What is overflow incontinence?

A

Impaired Detrusor contractility, bladder outlet obstruction

Sx: constant involuntary dribbling of urine, incomplete emptying

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14
Q

In what part of the nephron does ADH work?

A

MEDULLARY portion of the collecting duct

  • Increases water and urea reabsoprtion
  • Creates maximally concentrated urine
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15
Q

What is the treatment for recurrent Ca stones?

A

Saturation with citrate

Citrate binds free (ionized) calcium, preventing precipitation and facilitating excretion.

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16
Q

What pathological process differentiates lower UTIs from pyelonephritis?

A

Anatomical or functional vesicoureteral reflux.

Urine flows back into the kidney

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17
Q

What area of the nephron is impermeable to water regardless of serum ADH levels?

A

The ascending loop of Henle.

Reabsorption of electrolytes by the NA/K/2Cl transporter occurs in the TAL and contributes to the corticomedullary gradient.

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18
Q

What type of kidney stone cannot be seen on xray?

A

Uric acid stones
- Radiolucent

Found in patients with:

  • Gout
  • Myeloproliferative disorders
  • High protein diets
  • Low fluid intake
  • Lesch-Nyhan
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19
Q

How does spironolactone affect H secretion?

A

Spironolactone is an aldo receptor inhibitor

  • Aldo increases Na absorption, and thus H secretion from a-intercalated cells in the CD
  • No aldo = no Na absorption, no H (or K) secretion
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20
Q

Where in the kidney is the concentration of PAH the lowest?

A

Bowman’s Space

PAH is freely filtered an not reabsorbed, so the concentration will be lowest at the start (Bowman’s) and highest at the end of the nephron.

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21
Q

How does losartan affect levels of:

  • Renin
  • ATI
  • ATII
  • Aldo
  • Braydkinin
A

Losartan is an ARB.

  • Renin: increase
  • ATI: increase
  • ATII: increase
  • Aldo: decrease
  • Bradykinin: no change
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22
Q

How do you avoid acyclovir nephrotoxicity?

A

When acyclovir conc. in CD exceeds solubility, get crystallization, crystalluria, renal tubular damage.

Avoid with:

  • Aggressive IV hydration
  • Lower dosage
  • Slow rate of IV infusion
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23
Q

How does efferent arteriolar constriction affect GFR and FF?

A

GFR: increases

  • Efferent constriction increases Ph glomerulus
  • This increases GFR
  • GFR depends on difference between hdyrostatic and oncotic pressures between glomerular capillaries and Bowman’s space

FF: increases

  • FF = GFR/RPF
  • Renal Plasma Flow is reduced by efferent constriction
  • More GFR and less RPF = greater FF
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24
Q

What is the most likely source of obstruction in fetal hydronephros?

A

Ureteropelvic Jx.

The ureteropelvic jx is the jx between the kidney and ureter.

  • Last segment of the fetal ureter to canalize
  • Most common site of obstruction
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25
Q

Calculate FF, given:

  • RBF = 1
  • GFR = .1
  • Hct = .5
A

FF = GFR/RPF

RPF = RBF * (1-Hct)
RPF = (1)* (1-.5) = .5

FF = .1/.5 = .2

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26
Q

A diuretic causes increased serum Ca. What kind of drug is it and where does it work?

A

Thiazide diuretic.

  • Distal Convoluted Tubule
  • Works to block the Na/Cl symporter (apical)
  • Less Na in means apically means more in basolaterally via Na/Ca exchanger
  • More Ca back into serum
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27
Q

Baby is born with bilateral renal agenesis. What is the most likely cause of death?

A

Lung immaturity.

Swallowed amniotic fluid contributes to lung maturity in fetus.

Renal agenesis results in Potter’s:

  • Renal aplasia
  • Oligohydramnios
  • Characteristic facies
  • Lung hypoplasia
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28
Q

How much K is reabsorbed at each part of the nephron?

A

Bowman’s: freely filtered (100% remains)
PT: 65% reabsorbed (35% remains)
TAL: 25-30% reabsorbed (10% remains)
CD: 100+% secreted by principal cells (110%)

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29
Q

What is first dose hypotension?

A

Adverse effect when initiating ACE inhibitors. Risk factors:

  • Hypovolemia secondary to diuretics
  • Hyponatremia
  • High renin or aldo
  • Renal impairment
  • Heart failure
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30
Q

Biopsy shows narrowed renal arterioles with arteriolar walls homogenously thickened and stained pink with H&E.

What is the underlying chronic condition?

A

This is hyaline arteriosclerosis from:

  • Diabetes, or,
  • NON malignant HTN
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31
Q

What kind of arteriosclerosis does malignant HTN produce?

A

Hyperplastic arteriosclerosis

- Onion skin concentric thickening

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32
Q

Where in the nephron does most water reabsorption occur?

A

Proximal tubule

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33
Q

Calculate RBF given:

  • Hct 50%
  • Urine flow 1 ml/min
  • PAH = 100 in urine, .2 in serum
A

RBF = PAH clearance/ (1-Hct)

PAH clearance = (urine PAH x urine flow rate)/ plasma PAH

= [(100 x 1)/.2} = 500

PAH = 500/ (1-.5) = 1000 ml/min

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34
Q

What is the most common cause of kidney stones?

A

Idiopathic hypercalicuria.

Other causes:

  • Hyperoxaluria
  • Hyperuricosuria
  • Low urine vol
  • Hypocitraturia
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35
Q

What type of immune response mediates hyperacute (minutes to hours) transplant rejection?

A

Preformed antibodies against graft in recipient’s circulation

  • Gross mottling and cyanosis
  • Arterial fibrinoid necrosis & capillary thrombotic occlusion
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36
Q

What type of immune response mediates acute organ rejection?

A

Humoral response: Cd4 deposition, neutrophilic infiltrate, necrotizing vasculitis

Cellular: activation of naive immune cells

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37
Q

What type of immune response mediates chronic (months to years) organ rejection after transplant?

A

Chronic, low grade immune response refractory to immunosuppressants

  • Vascular wall thickening and luminal narrowing
  • Interstitial fibrosis
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38
Q

What type of glomerulonephritis is associated with antibodies against the PLA2R (phospholipase A2 receptor) found on podocytes?

A

Idiopathic membranous nephropathy

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39
Q

What type of immune response is associated with each stage of organ rejection?

A

Hyperacute
- Preformed host antibodies attack organ

Acute
- T cell sensitization against donor MHC (HLA) antigens

Chronic
- Long term, low grade immun response

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40
Q

How does the liver respond to proteinuria in minimal change disease?

A

Makes more lipoproteins because of the loss in albumin.

Increase in serum lipoproteins is followed by lipiduria.

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41
Q

The exchange of inductive signals between the ureteric bud and the metanephric blastema drives the diffierentiation of structures that form the mature kidney.

What does the ureteric bud give rise to?

A
  • Collecting tubules & ducts
  • Major & minor calyces
  • Renal pelvis
  • Ureters
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42
Q

The exchange of inductive signals between the ureteric bud and the metanephric blastema drives the diffierentiation of structures that form the mature kidney.

What does the metanephric blastema give rise to?

A
  • Glomeruli
  • Bowman’s space
  • Proximal tubules
  • Loop of Henle
  • Distal convoluted tubules
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43
Q

Which diuretic (part of a multi-drug treatment regimen) has been shown to improve overall survival in CHF?

A

Spironolactone, through inhibition of the neurohormonal effects of aldo, particularly on the heart.

It’s possible the diuretic effects contributed little to the overall benefit.

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44
Q

How does Lithium cause nephrotox?

A

Antagonizes ADH in principal cells of the CD.

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45
Q

What is the pathogenesis of overflow incontinence?

A

Impaired detrusor contractility or bladder obstruction.

Diabetics with autonomic neuropathy affecting the detrusor muscle innervation >

Incomplete emptying (cannot sense full bladder) >

Overflow

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46
Q

Unintentional ureteral ligation is a risk of surgery to remove cervical cancer due to manipulation of the uterine artery.

What is a possible adverse result?

A

Hydronephrosis

  • Kidney makes urine but it doesn’t drain to the bladder
  • Presents as palpable mass (kidney) on deep abdominal palpation
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47
Q

What are causes of hyperosmotic volume contraction?

A

DI or profuse sweating

increased Osm, decreased ICF, decreased ECF

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48
Q

Lipophilic drugs are eliminated (renally or hepatically)…

A

Hepatically

  • Cross renal tubular membrane and re-enter tissue
  • Enter hepatocytes and excreted through bile
49
Q

No tubular reabsorption or secretion

Filtered amount = excreted amount

A

Inulin and Mannitol

50
Q

Net tubular reabsorption

Filtered amount&raquo_space; excreted amount

A

Glucose, Na, Urea

51
Q

Net tubular secretion

Filtered amount

A

PAH and Creatinine

52
Q

Used to measure GFR

A

Inulin

53
Q

Used to measure RPF

A

PAH

54
Q

Horseshoe kidneys get trapped under what vessel?

A

IMA

55
Q

NSAIDs cause injury to what parts of the kidney?

A

Papillary or Interstitial Necrosis (not glomerular or vascular)

56
Q

Type of urinary incontinence:

Loss of urethral support
Leaking w laugh, cough, sneeze, lift

A

Stress incontinence

57
Q

Type of urinary incontinence:

Detrusor overactivity
Sudden urge to empty bladder

A

Urge incontinence

58
Q

Type of urinary incontinence:

Impaired detrusor contractility
Bladder outlet obstruction
Involuntary dribbling, incomplete emptying

A

Overflow incontinence

59
Q

How does efferent constriction change:

  • GFR
  • RPF
  • FF
A

Increases GFR
Decreases RPF
Increases FF (= GFR/RPF)

60
Q

The Urachus is a remnant of what fetal structure?

A

Allantois, which connects bladder to yolk sac

61
Q

Urine discharge from umbilicus in neonate indicates:

A

Persistent allantois (urachus)

62
Q

Meconium discharge from umbilicus in neonate indicates:

A

Persistent yolk sac

63
Q

Which rib is over the kidney?

A

12

64
Q

Ethylene glycol produces what kind of crystals?

A

Oxalate crystals int he renal tubules + damage

Anion gap acidosis, increased osmolar gap, crystals in urine

65
Q

1st result of salicylate tox

A

Resp alk

66
Q

2nd result of salicylate tox

A

Metab acid

67
Q

Symptoms of salicylate tox:

A

Fever, tinnitus, tachypnea

68
Q

Membranous Glomerulonephropathy is associated with what systemic diseases?

A

Diabetes
Lupus
Solid tumors

69
Q

Membranous Glomerulonephropathy is associated with what drugs?

A

Gold

Penicillamine

70
Q

Membranous Glomerulopnephropathy is associated wtih what infetions?

A

Hep B, C
Malaria
Syph

71
Q

What does Membranous Glomerulonephropathy look like on LM?

A

Uniform thickening of capillary wall of glomerulus

Without increase in cellularity

72
Q

What does Membranous Glomerulonephropathy look like on EM?

A

Spike and dome: IgG + C3

73
Q

Kimmelstiel Wilson nodules indicate:

A

Diabetic Nephropathy

74
Q

What is the MOA of sildelafil and tadalafil?

A

Phosphodiesterase inhibitors that promote erection by relaxing venous smooth muscle in corpora cavernosa

75
Q

What is the most important prognostic factor in PSGN?

A

Age! Kids recover, but adults may progress to RPGN

76
Q

How does ureteral constriction affect FF?

A

Decreased FF

Increased P in Bowman’s Space >
Decreased GFR >
FF = GFR/RPF

77
Q

What is the differential for metabolic alkalosis? (What is the Cl- in each?)

A
  1. Vomiting/nasogastric suction (low Cl-)
  2. Thiazide/loop diuretic (high Cl- while using, low after)
  3. Hyperaldo (high Cl-)
78
Q

What test do you order to differentiate types of metabolic alkalosis?

A

Urine Cl-

79
Q

What are side effects of ACE-I?

A

Increased Ck
Hyperkalemia
COUGH
Rare: angioedema

80
Q

What are the two embryological origins of the kidney?

A

Metanephric Mesoderm

Ureteric Bud

81
Q

What structures derive from the Ureteric Bud?

A

Collecting ducts
Minor/major calyces
Renal pelvis
Ureters

82
Q

What structures derive from the Metanephric Mesoderm?

A 
Glomeruli
Bowman's space
PT
Loop of Henle
DCT
83
Q

Necrotizing vasculitis of upper and lower respiratory tract
Nasal ulcers, sinusitis, hemoptysis, RPGN
cANCA (MPO)

A

Wegner’s

84
Q

What is osteitis fibrosa cystica?

A

Result of end stage renal disease, in which you have secondary hyperparathyroidism that results in increased bone turnover and osteodystrophy

85
Q

How does vasopressin affect urea?

A

Vasopressin increases permeability to water AND UREA at the luminal membrane of the CD
- Increased reabsorption, decreased clearance from plasma

86
Q

Palpable purpura preceded by URT infection

A

Henoch Schonlein Purpura

87
Q

Henoch Schonlein Purpura is associated with what immunoglobulin?

A

IgA

88
Q

What systems does Henoch Schonlein Purpura affect?

A

GI: intermittent severe ab pain, bloody stool, diarrhea
Kidney: IgA nephropathy + mesangial proliferation
Joints: migratory arthralgia, arthritis in large joints

89
Q

What is the formula for RBF?

A

RBF = PAH clearance/(1-Hct)

PAH clearance = (urine flow rate x urine [PAH]/) plasma [PAH]

90
Q

What renal syndrome can present a few day after a URI?

A

IgA nephropathy

91
Q

What renal syndrome can present a few weeks after a URI?

A

PSGN

92
Q

What lysosomal storage disease can result in renal failure?

A

Fabry

93
Q

What enzyme is deficient in Fabry’s?

A

a-galactosidase A, leading to buildup of ceramide trihexoside

94
Q

Lab values in DKA: (increase/decrease)

  • Ketones
  • Glucose
  • Na
  • K
A

Hyperketonemia
Hyperglycemia
HYPOnatremia
HYPERkalemia

95
Q

Collapsing glomerulonephropathy is associated with what nephrotic syndrome?

A

FSGS

Affected segments show BM collapse, hyalinosis, increased matrix

96
Q

Renal failure + toe gangrene + livedo reticularis after invasive vascular procedure indicates what kidney pathology?

A

Atherothrombolic renal disease

97
Q

What is found in the kidney in atheroembolic kidney disease?

A

Cholesterol emboli obstructing renal arterioles (not intrinsic to kidney)

98
Q

What adverse effect can occur on the first dose of ACE-I?

A

Hypotension

- Renal impairment is a risk factor

99
Q

What are 3 types of RPGN?

A
  1. Goodpasture’s
  2. PSGN
  3. Pauci-immune (ANCA)

All are crescentric!

100
Q

Fever + maculopapular rash + eosinophilia + renal failure 1-3 weeks post rx with b-lactams indicates:

A

Acute Interstitial Nephrosis

101
Q

Type of nephropathy associated wtih IgG4 Abs to PLA2 receptor

A

Idiopathic Membranous Nephropathy

102
Q

Lab findings with Thiazides:

A

HYPER

  • Calcemia
  • Uricemia
  • Glycemia
  • Lipidemia

HYPO

  • kalemia
  • tension
103
Q

Dehydration and:

  • GFR
  • RPF
  • FF
A

GFR decreases a little (Because RAAS maintains some)
RPF decreases a lot
FF increases

104
Q

What type of crystal composes a staghorn calculus?

A

Ammonium Magnesium Phosphate (struvite)

105
Q

What bugs cause staghorn calculi?

A

Protease (+)

Proteus
Klebsiella
Staph aureus

106
Q

Congenital renal anomaly that causes dilation of renal pelvis and minimal functionality

A

Congenital Ureteral Obstruction

  • Increased risk of UTI
107
Q

How does BPH cause renal failure?

A

Pressure backup into Bowman’s space decreases GFR

108
Q

Name that vasculitis:

Necrotizing granulomas
Sinusitis +/- perforated nasal septum
Hemoptysis, cough
Hematuria, RBCs
cANCA
A

Wegner’s

109
Q

Name that vasculitis:

Necrotizing granulomas
Sinusitis with eos
Asthma
Hematuria, RBCs
Peripheral neuropathy
pANCA
A

Churg-Strauss (EGPA)

110
Q

Hemoptysis, cough
Hematuria, RBCs
pANCA

A

MPA

111
Q

From where in the kidney does RCC originate?

A

PT

- Clear cells

112
Q

From where in the kidney does renal oncocytoma originate?

A

CD

- Large, well diff cell with mitoses

113
Q

From where in the kidney does a papillary tumor originate?

A

Renal pelvis

- Urothelium + thin fibrotic stalk

114
Q

Gross hematuria + acute colicky flank pain + passage of tissue fragments in urine:

A

Papillary Necrosis

115
Q

How does mannitol cause pulmonary edema?

A

Osmotic diuresis >
Increased hydrostatic P in vasculature >
3rd spacing of fluid

116
Q

In what condition is mannitol contraindicated?

A

CHF or previously established pulmonary edema

117
Q

Densely immunostaining, protein containing cells adjacent to the glomerulus

A

J-G Apparatus

- Renin synth, storage, secretion

118
Q

What is IVC syndrome?

A

Compression of the IVC that may be acute or gradual (Ex. renal tumor)

Colateral compensation by abdominal wall vessels
Edema

119
Q

Classic triad of flank pain, flank mass, and hematuria indicates:

A

Renal Cell Carcinoma

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