Flashcards in Renal & Electrolytes UWorld Deck (96)
Why are patients on thiazides more likely to become hyponatremic compared to those taking loop diuretics?
The loop diuretics prevent reabsorption of salt in the ascending loop of Henle and disrupt the normal corticomedullary gradient. This results in significant water and salt loss. Thiazides do not affect the corticomedullary gradient and patients respond more to increased vasopressin levels, retain more water and are at higher risk of hyponatremia.
Light microscopy, electron microscopy and immunofluorescence in patients with post-strep glomerulonephritis?
LM = hypercellularity
EM = sub-epithelial humps
IF = lumpy-bumpy IgG, IgM and C3 deposits
Layers of the anterior abdominal wall
A) Substances that are freely filtered by the glomerulus without absorption or secretion?
B) Substances with net reabsorption?
C) Substances with net secretion?
A) Manitol and inulin
B) Glucose, Na and BUN
C) PAH and creatinine
Where is BUN reabsorbed and secreted in the nephron?
Reabsorbed: PCT & medullary collecting duct
Secreted: thin loop of Henle
What is used to calculate renal plasma flow?
PAH. It is freely filtered, more is secreted than is filtered and not reabsorbed.
Congenital abnormalities that can result from failure of the urachus to obliterate?
Patent urachus = attachment of bladder to umbilical cord
Vesicourachal diverticulum = asymptomatic out pouching at the apex of the bladder
Urachal sinus = failure to close the distal urachus resulting in recurrent infections
Urachal cyst = fluid filled cyst between the two obliterated ends of the urachus between the navel and bladder
Baby with meconium coming from his belly button
Persistent vitelline duct (yolk sac). Partially obliterated vitelline duct results in a Meckel diverticulum.
Most common viral cause of acute hemorrhagic cystitis in children
2nd most common cause of UTI in sexually active women
Hyper acute, acute and chronic kidney transplant characteristics
Hyperacute: preformed antibodies, within minutes to hours
Acute: C4b deposition, PMNs, lymphs and vasculitis less than 6 months after transplant
Chronic: vascular wall thickening, fibrosis and atrophy months to years after transplant
Drugs for renal transplant patients that can cause renal arterial hyalinization, tubular vacuolization and reduced renal blood flow.
Calcineurin inhibitors: tacrolimus and cyclosporine
Embryonic kidney development
Pronephros: forms and completely regresses by 5 weeks
Mesonephros: gives rise to the vas deferens, epididymus and Gartner's ducts in women.
Metanephric diverticulum: ureteric bud sprouts off mesonephros. It penetrates into the sacral intermediate mesoderm and induces surrounding tissue to differentiate into the metanephric mesoderm (blastema). The metanephric blastema then causes the ureteric bud to differentiate into the collecting system.
Metanephric blastema: gives rise to the glomerulus, PCT and DCT.
Content inside granules of eosinophils
Major basic protein
Causes of metabolic alkalosis that are saline responsive?
What types are not saline responsive?
Saline-responsive: vomiting/NG (low urine Cl) and prior diuretic use (high urine Cl) deplete the body of Cl-. This prevents HCO3- excretion and promotes H+ excretion.
Saline-non-responsive: Bartter, Gitleman and excess mineralocorticoid receptor stimuli
What enzyme is critical for DNA synthesis in bacteria and is involved in the incorporation of uracil into DNA?
Primase. It synthesizes the RNA primers at the replication fork that are necessary before DNA polymerase III can continue replication away from the replication fork.
Enzyme that repairs single-stranded breaks in DNA
Enzyme that is primarily responsible for synthesis of the daughter strands in DNA replication
DNA polymerase III
Enzyme that is responsible for replacement of RNA primers with DNA bases
DNA polymerase I has 5'->3' exonuclease activity that allows it to remove the RNA bases and replace them with DNA bases
What allows DNA polymerase I and III to repair mismatched bases in newly formed daughter strands?
3'->5' exonuclease proofreading function
Enzymes involved in unwinding DNA during replication
Helicase unwinds it at the replication fork, topoisomerase II relieves the downstream tension secondary to unwinding the double helix
Why must you be cautious when prescribing ACE-I to patients with renal artery stenosis?
ATII is necessary to maintain renal perfusion pressure. When ATII is blocked, renal perfusion pressure can drop and the patient can develop acute kidney injury.
Mechanism of Henoch-Schoelin purpura
Post-infectious IgA immune complexes result in leukocytoclastic vasculitis and deposit in vessel walls (palpable purpura), GI tract (hematochezia), kidneys (IgA nephropathy) and joints (arthralgia).
Taking what class of drugs would decrease the response of your patient to loop diuretics?
NSAIDs. Loops also increase prostaglandin release, dilating blood vessels and increasing drug delivery to the target site. NSAIDs inhibit prostaglandin synthesis and limit this effect.
How does the tonicity of tubular fluid change as you progress through the nephron?
PCT: isotonic because water is passively reabsorbed
Descending loop of Henle: hypertonic due to its impermeability to Na+, but permeability to H2O and hypertonicity of medulla
Ascending loop of Henle: becomes hypotonic due to impermeability to H2O, but transport of Na, K and Cl out of tubule.
DCT: lower water permeability generally means hypotonic fluid, however, this region is dependent on vasopressin
CD: hypertonic in presence of ADH due to increased H2O permeability, hypotonic in absence of ADH due to decreased H2O permeability
Substances that can be used to calculate GFR and renal plasma flow (RPF)?
GFR = inulin and creatinine
RPF = PAH
Clearance = [urine] x (flow rate/[plasma])
How to calculate filtration fraction. Normal value?
GFR/RPF. Normal value ~ 20%.
How does diabetic nephropathy occur?
1st morphologic changes = GBM thickening and mesangial matrix deposition
1st clinical changes = upregulation of heparinase, degradation of heparin sulfate in GBM, proteinuria and increased GFR
In later stages Kimmelstein-Wilson nodules form, GFR drops dramatically and patients develop nephrotic syndrome
Triggers of minimal change disease and characteristic EM findings?
Immunization, bee stings and allergies can cause. EM shows podocyte foot process effacement.