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Flashcards in Renal Endo GU Deck (157):
1

Oligohydramnios

Potter's Sequence: Lung hypoplasia, flat face/ears, limb defects.

2

Pre-renal azotemia Labs

Increased Serum BUN:CR > 15. FeNA<1%, normal Urine Anion gap, high urine osmality (kidneys are working)

3

Post-Renal Azotemia Labs

Initially you get absorption of BUN (cuz tubules are working thus BUN:CR 15. FeNA>2%, (cuz kidneys have broken)

4

Intrarenal injury labs

Elevated BUN and Cr (decreased GFR) thus Serum BUN:CR < 15. FeNA>2%, (cuz kidneys have broken) and no urine anion gap

5

Ischemic ATN location?

Proximal tubule and Medullar segment of ascending limb

6

Nephotoxic ATN location and causes?

-Proximal Tubule -Aminoglycosides, heavy metals, myoglobin (crush injury), ethylene glycol, radiocontrast

7

Eosiniphils in urine?

Acute interstial nephritis leading to Acute renal failure. Drug induced: PCN, NSAIDS and diuretics

8

Gross Hematuria and Flank pain?

Renal Papillary Necrosis. dt progression of acute interstial neprhitis. From Long term analgensic use, DM, Sickle cell trait, severe acute pylenephritis

9

Nephrotic Syndrome Presentation

Edema, infeciton, coagulation, poor lipid profiles from: Hypoalbunimemia, hypogammaglobulinemia, hypercoagulable state (loss of ATIII), hyperlipidemia and hypercholesterolemia ("liver trying to compensate for thin blood")

10

First and second most common renal issue in SLE?

1) Diffuse proliferative glomeruloneprhitis 2) Membranous nephropahty

11

Renal diseases with granular immunoflourecence?

Immune complex deposition: (look for word membranous) MGN, MPGN

12

Puffy face in kid?

Minimal Change disease (losing albumin but no IgG due to cytokine induced effacement of podocytes)

13

Focal Segmental Glomerulosclerosis is associated with which populations? Positve or negative immunoflourescence?

AA, Hispanics, HIV, Herion, sickle cell disease. Negative immunoflor.

14

Spike and dome appearance? Where? Condition associated with?

1) Membranous nephropathy. Subepithelial side of BM. Immunocomplex dep. 2) Hep B/C, solid tumors, SLE, drugs.

15

Tram Track appearance? Location?

1) MPGN Type 1 > Type 2 (2 associated with C3 nephritic factor stabilizing C3 converatse = compliment acitvation). 2) Type 1 (Subendo); Type 2 (BM)

16

Diabetic Mechanism of Renal Damage

Non-enzymatic Glycosolation of BM allowing for hylanie arteriolosclerosis. Preferentially of efferent arteriole leading to hyperfiltration injury.

17

Round lesions in glomeruli? Associated with which condition? Other findings?

Kimmelstein Wilson nodules (christmas ball sclerosis) in DM. Increased PAS+ staining eosinophilic material.

18

Mechanism for general nephritic syndromes?

Immune complex deposition activating C5-->C5a which attrachs neutrophils causing hypercellular inflamed glomerulus

19

Child who was recently sick with throat infection, has risk for what renal disease? Virulence factor? Histology?

Post-strep glomerulnephritis. Group A beta hemolytic strep (pyogenes) with M protein factor (M causing N-ephritic). Supepiethelial humps

20

Cresents on histology indicative of? Made of what?

Rapidly progressive glomeulonephritis. Made up of inflammatory debris (macros and fibrin).

21

Family with hearing, vision, and hematuria

Alport syndrome, X linked, defect in Type 4 collagen. "Can't see, can't hear, can't pee)

22

Bugs in cystitis

E coli. Staph Saprophyticus (in young sexually active females, novobiocin resistant)

23

Fever, flank pain, wbc casts, leukocytosis

Pyleonephritis. Ecoli, kleb, enterococcus faecalis

24

Cortical scarring with blunted calyces.

Chronic Pyelonephritis. Can also show thyroidization of kidney from eosinpholic proteinaceous material with waxy casts in urine

25

Calcium oxalate/phosphate stones: causes and tx?

Idiopathic hypercalcuria, hypercalcemia, crohns. Tx with HCTZ (calcium sparing diruetic; but increased risk of gout with HCTZ).

26

Ammonia Pyrophosphate Crystals (AMP stones)

PPPS: proteus, high pH, pyrophophates, staghorn coliculi (nitus for UTIs). Kelbseilla too cuz its also urease positive.

27

Uric Acid Crystals

Radiolucent, "U CAN'T SEE U-RIC Cystals". Gout. Tx: alkalinize urine and allopuirnal + hydration

28

Where is EPO made?

Renal peritubule epithelial Cells

29

Hematuria, palpable mass, flank pain

Renal cell carcinoma.

Presents with Left sided varicoceal, Paraneoplastic (EPO, PTHrP, ACTH). Loss of VHL or gene deletion (BOTH ON CHROMO 3) 

Obesity/smoking is risk factor.

Mets to retroperitoneal lymph nodes, but "prefers" IVC hematogenous spread

30

Hemangioblastoma of Cerebellum and Renal Cell carinoma.  Chromosome? Associated with?

vHL.  Chromo 3.

 Panc NETs, Pheos

31

Wilms tumor, neonatal hypoglycmie,a muscular hemihypetophy, oragnomegaly (tongue)

Beckwith wiedemann syndrome

32

RCC and HCC will can be associated with?

EPO production leading to 2dary PV or ANEMIA OF CHRONIC DISEASE (iron def anemia=microcytic)

33

HPV Subtypes: High risk? low risk? Vaccine Covers? High risk virulence factors?

Low Risk: 6, 11 forming condylomas. High Risk 16 18 31 33: squamous cell cancer particularly of transformation zone of cervix (also causes Adenomas) Vaccine: 6, 11, 16, 18. (therefore still need PAPs for other subtypes). E6--l p53; E7--l Rb--l E2f-->G1 to S phase transition

34

DD for Extramamillary Paget's disease? Markers for each?

Carcinoma (Keratin +, PAS +) Melanoma (S100+; comes from neural crests) However usually there is no underlying cancer as opposed with Paget's Disease of Breast

35

Focal Persistence of columnar cells in upper vagina? Exposure? Risk for? Embryologic Derivatives?

Adenosis (different than Adenomyosis). Embyologically the lower 1/3 (from urogenital) sinus starting as squamous cells. These during maturation normally overtake the upper 2/3 columnar cells (from mullerian duct). DES exposure in utero causes persistence of columnar cells putting pnt at risk for CLEAR CELL ADENOMA.

36

Bleeding Grape like mass on genitals of <5yo? Dx tests? Histological Features?

Embryonal Rhadomyosarcoma. Desmin +, Myogenin +. Cytoplasmic Cross Striations present.

37

Post-coital bleeding in a middle aged woman?

Cervical Carcinoma (increased risk w/ smoking; invades locally=likely to cause hydronephrosis leading to ARF).

38

Amennorehia in woman who recently had a choriocarcinoma

Asherman's Sydnrome of uterine adhesions causing secondary ammenorhia from overagressive Dilatation and Cuerrtetage causing a loss of uterine basalis (no stem cells to regen endometrium)

39

Abnormal uterine bleeding of woman on tamoxifen

Uterine polyp, side effect from tamoxifen stimulating endometrial ER (antagonist in breast, agonist in bone=osteoprotective)

40

Severe cyclic pain in female cycle? Features?

Endometriosis (glands and stroma outside of endometrial lining). Chocolate cysts (walled off cyst without outlet for blood to escape), gunpowder lesions (endometrium in soft tissue)

41

Endometrial glands and stroma in the muscular layer of uterus

Adenomyosis (different than adenosis)

42

Anovulatory Cycles put pnt at risk for?

Endometrial hyperplasia progressing to dysplasia (from unopposed estrogen=growth; no progesterone=no cycling)

43

Endometrial Carcinoma. Pathways? Age group? Mutations?

1) Endometrioid (Type1): hyperplasia from unopposed estrogen leading to dysplasia. 50yo, PTEN mutation, obese women. 2) Sporadic (Type2): Papillary Serous (psammoma bodies), Elderly/frail, p53 mutation

44

Mutiple white whorled masses on endometrial biopsy

Leiomyoma (fibroids), bening no risk to progression. Minor risk for infertility. Presents in young female

45

Single mass on endometrial biopsy

Leiomyosarcoma. Usually postmenopausal, irregular, necrotic, arrising de novo****

46

Obese young woman with infertility oligomenorrhea, and hisutism

PCOS: increase LH>FSH ratio (2+; meaning increased androgens which cause male fat distrubution, hair, and ammenorhea=aromatization in hypothal to E2 which shuts down HPgondal axis)

47

Ovarian Tumor in: 1) 15-30yo 2) 35-40yo 3) 60-70yo

1) Germ Cell Tumor 2) Benign surface epithelial tumor 3) Malignant surface epithelial tumor

48

Single Ovarian Cyst

Benign Cystadenoma (30-40yo), smooth lining

49

Multiple Ovarian Cysts

Malignant, Shagy lining, postmenopausal women

50

BRCA1 carrier at risk for?

Breast, Endometrial, Fallopian and Ovarian (serous). Why angelina jolie went for hysterectomy with bilateral salphingooorphorectomy.

51

Ovarian tumor with urothelium

Brenner Tumor (B for bladder-like=urothelium)

52

Where do ovarian tumors spread?

Seeding of peritoneal cavity, Omental caking

53

Tumor marker for ovarian cancer?

CA-125 (used to monitor response to therapy/recurrence; NOT SCREENING)

54

High AFP and betaHCG (female)

Embryonal Carcinoma (germ cell tumor). "malignant teraatoma"

55

AFP (female)

Endodermal Sinus Tumor (yolk sac tumor): "YAFP", yolk is yellow like urine=schiller duval bodies (renal glomeruloid bodies in tumor)

56

LDH, Alk phosph and Large cell with clear cytoplasm (female)

Dysgerminoma, malignant

57

High BetaHCG (female)

Choriocarcioma

58

Small eosinophilled fluided between granulosa cells.

Call-Exner bodies indicative of granulosa/theca cell tumors. Pnt will have estrogen excess=precocious puberty or abnormal cycles or postmenopausal bleeding.

59

Pleural Effusion and ascites associated with tumor? (female)

Meigs Syndrome: triad of fibromas, ascites, and hydrothrorax.

Women will note pulling sensation in groin

60

Pink Crystals found in tumor (female)?

Reinke Crystals, Sertoli/Leydig cell tumor: Excess andros producing hirtuism/virilization

61

Bilateral ovarian tumors with nuclei pushed to side in cells

Krukenberg Tumor (GI met), mucus producing signet cells.

62

Female presents with mucinous distension of stomach

Pseudomyxoma Peritonei (jelly belly); udt mucinous adenocarcinoma of appendix

63

Woman comes in with abdominal pain what test?

PREGGERs TEST ALWAYS

64

Woman with history of DVTs and spontaneous abortions

Antiphospholid Antibodies/Lups anticoagulant (antibodies to ATIII)

65

Placenta seen on preg cervical examination

Placental Previa; risk to cut blood supply during labor therefore C section indicated

66

Severe Bleeding during 3rd trimester

Placental Abruption, risk of DIC (amnoitic fluid is high in thromboplastin), and Amniotic fluid Pulm Embolism.

67

Placenta implanted in the wrong tissue?

Placenta Accrete (A for adhesion) into the myometrium (rather than the functionalis layer). "Increta" for insertion (little worse) "Pecreta" for penetration (much worse)

68

Fibrinoid necrosis of placental vessels?

Preeclampsia. HTN, proteinuria, edema in 3rd*** trimester. Risk to progress to eclampsia = seizures.

69

Preggers with anemia, and abnomral LFTs

HELLP: Hemolysis, Elevated liver enzymes and Low platelets.

70

High BhCG with larger than normal uterus at gestational landmarks

Hyatidiform mole; risk of Choriocarcimona; passing of grape like masses, snowstorm appearance on Ultrasound. Monitor BhCG levels to rule out choriocarcinoma.

71

Types of Choriocarinoma?

Complete: 46 chromos, all from dad, highest BhCG, higher risk of choriocarcinoma (will respond to chemo better than sporadic chorios). Partial 69 chromo (46 from dad), Less risk for choriocarcinoma.

72

ACEI's SEs?

CATCHH: Cough, angioedema, teratogen, creatinine increase, hyperkalemia, hypotension

73

von Hippel Lindau

Autodominant, Capillary hemangioblastomas in Cerebellum and Retina, congential cysts, neoplasms of the liver, kidney (bilateral RCC), pancreas

74

Osler Weber Rendu

Hereditary Hemohorrage Teleangectasias: autodominant, epistaxis, GI bleeding or hematuria

75

Sturge-Weber Syndrome

Encephalotrigemnal Angiomatosis: Neurocutaneous disorder: facial and leptomeningeal angiomas. Skull radiagraphs can show tram track appearance.

76

Which ligament does a surgeon ligate during an oorphectomy?

Suspensatory Ligament (infundibulopelvic ligament)

77

Breast Milk Deficient in?

Vit D and K (both fat sol...dunno why tho). DK

78

What measures are reflexctive of the following

Urea

Creatinine

PAH

 

Urea: reflective of water absorption of kidney.  When a person is dehydrated urea increases from holding onto water. (increased BUN:CR in dehydration=prerenal azotemia)

Creatinine: Freely filters and additonal 10% secreted by prox tubule.  Increases in only creatinine signify renal failure as there is less filtration and this extra 10% Cr stays in blood (not secreted).

PAH: tells you renal plasma/blood flow as it is has almost a 100% clearance (both freely filtered AND secreted)

79

DD between Leydig Cell hyperplasia and Congential adrenal hyperplasia?

Both show early virulization:

Leydig cell WONT show increase in 17-hydroxyprogesterone levels

21 alpha hydroxylase def will show increase 17 hydroyprogesterone (and both show inc testoterone).  Can show salt wasting (severe form) but doesn't have to (moderate form)

80

Difference between IgA nepropathy and PSGN?

IgA Nepropahty presents several days after the infection. Compliment levels are normal.  Mesangial Deposition will be seen on EM.

PSGN takes a FEW WEEKS to devo.  C3 is low**

81

Two things that relax uterine tone?

Increase?

B2 agonists and P4

Oxytocin, and PGs

82

Cirrhosis/Liver Failure's Effect on male?

Decreased break down of estrogens causing hyperestrogenemia==Gynecomastia/spider angiomatas

(not verified but) this causes increased sex hormone binding protein production (questionable cuz of liver failure) which further decreases testosterone causing erectile dysfunction.

83

Where does the fructose come from in seminal fluid?

Seminal Vessicles

84

Renal Failure's Effect on Bleeding?  Why?

Hyperuremia causes platelet qualitative dysfunction of platelets.

Normal PT/PTT and normal platelet levels

85

IgG4 Antibodies to phospholipase A2 (PLA2R)= transmembrane protein on podocytes results in what form of kidney disease?

Membranous Nepropathy

86

PSNS and SNS control of insulin secretion?

Smell/sight of food=PSNS driven insulin secretion

SNS: Alpha's inhibit insulin secretion, Beta stims insulin secretion

87

What does Thyroid Peroxidase do?

Iodinate Thyroglobulin

88

Severally dehydrated patient, where is majority of water resorbed?

Proximal Tubules (60% of water) NOT proximal and distal collecting ducts (this aids via ADH but majority still in Prox tubules)

89

What hormones share the same alpha subunit?

TSH, LH, FSH, betaHCG

90

Cancers that cause ectopic:

ACTH

PTHrp

EPO

ADH

1) Small Cell carcinoma

2) Squamous cell carinoma of lung, breast, renal cell carcinoma

3) RCC, HCC, hemangioblastoma, Pheos

4) Small cell carcinoma

91

Insulin Receptor?

Tyrosine Kinase inducing glucose uptake via increased production and expression of Glut transporters.

Also turns on Na/K atpases

92

Insulin dependent and independent Gluts?  And where are they found?

GLUT 4: Dependent; Adipose and skeletal muscle

GLUT1: Independent; RBCs, brain cornea

GLUT5 (fructose): indepent spermatocytes, GI tract

GLUT2 (bidirectional) indpendent: b islet, liver, kidney, small intesine.

93

Hormone cause of insulin resistance? 

GH

Increased FFA in serum---mechanism unknown

94

Insulin release in Beta islet cells?

Glucose enters GLUT2

Glycolysis generating inc ATP:ADP

ATP closes ATP-senstiive K channels

Cell depolarizes bringing in Ca

Ca causes granular release of prepackaged vessicles of insulin

95

Most specific sign for hypercortisolism? and mechanism?

Vilaceous Striae.

Cortisol inhibits fibroblast activity

96

Wolff Chaikoff effect?

Excess Iodine temporarily inhibits thyroid peroxidase causing decreased iodine organification lowering T3/4 production

97

How does T3/T4 get into cell?

T3/T4 are lipophilic but still use ATP membrane dpeendent transport

98

Child presents with abdominal distension and a firm irregular mass CROSSING midline.  Dx?

Other associations?

If it didn't cross midline?

Neuroblastoma (can be anywhere along sympathetic chain), most common extracranial childhood cancer of neurotissue

Neural Crest origin.  HVA in urine.  Bombesin +, N-myc oncogene.

Opsoclonus-myoclonus syndrome: non-rhythmic conjugate eyemovement (WONT SEE THIS IN MEDULLOBLASTOMA)

Homer-right rossettes can be associated (radial arrangments of tmr cells surounding fibrils)

(Wilms tumor if it didn't cross midline)

99

Child with large abdomen, puffy face, and large tongue, with some signs of mental slowness

Cretinism (congential Hypothyroidism)

6P's Pot biellied, pale, puffy faced, protruding umbilicus, protuberant tongue, poor brain devo

100

Increased ESR, jaw pain, Tender thyroid

De Quervain subacute thyroditis

usuually following a flu, self limited

De querVAIN's has PAIN

Granulomatous inflammation

101

Thyroid replaced by fibrous tissue

Riedel thyroidits

Hard rock like painless thyroid("hard thyroid like riddell helmets")

Need to DD this with anaplastic carncoma

 

102

Cuase of toxic multinodular goiter?

Mutation in TSH receptor causing hyperfunctioning follicules.  "HOT NODULES" rarely malignant

103

MHC associated with Hashimotos?

HLA DR5

"Thive-roid"

104

Thyroid Storm Tx?

3 P's

Propanolol (Bblockers), Propylthiouracil, Prednisolone (corticosteroids)

Beta blockers are used because T3 upregulates beta receptors (particularly in heart) leading to SNS type sxs commonly seen in hyperthyroidism

NB: Steroids are the only thing that will decrease proptosis rapidly...Propylthio/meth won't

105

Thyroid cancer associated with:

Psammoma bodies

RET mutation (2)

MEN2a/2b

Older Patients

Childhood irradiation (eg eastern european)

Hashimoto's

Empty appearing nuclei

Amyloid stroma with sheets of cells

Psammoma bodies: Papillary

RET mutation (2): Papillary (also associated w/ BRAF), Medullary

MEN2a/2b: Medullary

Older Patients: Anaplastic

Childhood irradiation (eg eastern european): Papillary

Hashimoto's: Lymphoma (nonhodgkins)

Empty appearing nuclei: Papillary (annie orphan nuclei)

Amyloid stroma with sheets of cells: Calcitonin secreting cells=Medullary 

106

Increased cAMP in urine?

Hyperparathryoidism (usually primary)

107

How to Dx acromegaly

Increased Serum IGF-1

or Failure to suppress GH following oral glucose tolerance test (normally: Glucose--l GH)

Pituitary mass on MRI

108

Dx ZE syndrome?

Secretin injection
nonZE: Secretin---lGastrin

ZE: secretin--->Gastrin (wont inhibit it)

109

POMC cleaved into?

ACTH, MSH, and Beta endorphin (opiate type molecule)

110

Rubber Factory Worker with hematuria?  Other risk factors for this condition?

Transitional Epithelial cancer of the bladder

Cyclophosphamide, smoking, aniline dyes, phenacetin,

NB: Schistosoma is associated with SQUAMOUS CELL CARCINOMA

111

Where does the following estrogens come from?

E2

E3

E1 

E2: Ovaries

E3: Placenta

E1: Adipose Tissue

112

Hypothyroidism can result in what two endocrine related outcomes?

Lactation and Amenorrhia

Extra TRH stimulates PL release which can inhibit GnRH.

113

Addisons Disease

Cushings Disease

A-ddisons is primary A-drenal Insufficiency

Cushings is pituitary ACTH overproduction 

114

Drug to give if aldosterone deficient?

Flucortisone

115

HCTZ SEs?

"hyperGLUC"

Hyper:

GLYCEMIA, LIPIDEMIA, Uricemia, Calcemia, 

Hypo:

Kalemia, Tension

116

Patient being medically treated successfully for hyperthyroidism, now comes to your office with fever and throat pain.  What do you do?

Get a WBC count and differential as both Propthiourical and methimazole have AGRANULOCYTOSIS as a SEs.

PTU also block 5' deiodinase peripherally

Methimazole is teratogenic

117

Branchial Cleft cyst vs Thyroglossal duct cyst

Thyroglossal Cleft cyst moves with swallowing and is medial (remove cuz of risk of infection)

Branchial Cleft cyst is lateral and doesn't move with swallowing

118

What AA precursor does thyroglobulin come from?

Tyrosine. MIT=MonoiodoTyrosine

119

Most common lab values of someone with hyperthyroidism?

Low TSH high T3/4

Graves disease

120

C peptide levels reflect?

Endogenous insulin.

High insulin without C peptide=means exogenous delivery

121

Leptin stims and inhibits?

Leptin Inhibits Lateral Hypothalm

Stims Ventromedial Hypothal

Thus it is a satiety signal

122

Metabolic Syndrome Criteria

3 of 5:

Low HDL

High BP

High Fasting blood glucose

High TAGs

Abdominal Obesity

123

DIffernce between Renal osteodystrophy and other secondary hyperPTH?

Renal osteodystrophy will present with HIGHER PO4 from nephron loss being able to respond to PTH's signal to dump PO4.

While most other secondary etiologies will show lower PO4

124

One potential cause of maternal diabetes.  Hormones effect?

hPL: human placental lactogen from syncytotrophblasts.

Has both Prolactin and Growth Hormone (insulin resistance) function

Placenta also contribues with GH, Estro, Progestro and glucocorticoid production

 

125

Blocks sodium iodide symporter on basolateral membrane of thyroid follicular cells?

Potassium Perchlorate.

Can be used in patients who are refractory to PTU/Meth.  This will inhibit iodine uptake and lower the amount of iodinated thyroglobulin availible to be released.

126

What do following cells do/location:

JG Cells

Macula Densa

JGApparatus

 

JGCells: SYSTEMIC BP control.  On afferent arteriole and monitor Bp thus affecting afferent vasoconstriction which maintains adequate total BP to kidney.  If bp is decreased they secrete renin increase body bp.

Macula Densa: of Distal convuluted tubule.  Monitor resorption of kidney via [Na].  High [Na] means high flow (less time to resorb Na).  Thus low [Na] means low flow (more resorb time) which means low BP causing RENIN secretion

127

Fanconi Syndrome? Location? Sxs?

Resorption defect in prox convuluted tubule. (severe RTA type 2)

Heridtary defects (Wilson disease), ischemia, nephrotxins/drugs

128

Renal tubular defects?

"FABulous Glittering Liquid"

FAnconi Anemia: Prox tubule, RTA2

B-artter syndrome: thick ascending loop, hypok + meta alk + hyperCa (think HCTZ, despit dif location of action)

Gitelman-poor resorb of NaCl in DCT (hypoK, met alkalosis, NO hyperCa)

Liddle Syndrome: Distal collecting duct (increased Na resorb): HTN, Met alk, dec aldo

129

NSAIDs effect on kidney?

Inhibits PG's (loss of afferent vasodilation) causing:

Decreased GFR and Risk for ischemia causing acute renal failure

130

Easy way to remember renal pathologies with Type III HSR?

They will have "itis" in their name.

PSGN, Diffuse proliferative glomulonephritis, Membranoproliferative glomerulonephritis, Membranous glomerulonephritis

131

Dysuria and hematuria in several boys at day care?

Adenovirus causing hemorrhagic cystitis.

132

SEs of Glitazones?

What patient don't you use metformin in?

What patient don't you use sulfonyureas?

Hepatoxicity, Heart Failure, Weight gain.

Renal failure cuz of risk for met acidosis

DM1 cuz you need some functioning Beta cells to have an effect

133

Treatment for Esophageal Varices?  What else does this drug treat?

Octreotide (somatostatin analog).

Acromegaly, carcionid, gastrinoma, glucagonoma

134

Furosemides Mech of Action (2)? Where?

SEs?

1) Inhbits NaKCC2

2) Stimulates PGE** release-->vasodilation of afferent arteriole increasing diruresis.

**NSAIDS inhibit this---thus NSAIDs inhibit Furosemide's efficacy

3) Thick ascending limp of Loop

4) "DANG furOHsemide": Dehydration, allergies (sulfa), Nephritis (interstitial), Gout***, Ototox, HypoK (and hypoCa)

135

Fluid in body proportions?

"60 40 20"

60% Total body water

40% of Total body weight=Intracellular fluid (High K)

20% of Total body weight=Extracellular fluid (high Na): of this 1/4 (5% total fluid) is plasma volume and 3/4 (15% is interstitial fluid)

Plasma is about 5% of total body weight**

136

Where does PTH cause Ca absorption in nephron?

Early Distal convuluted tubule.

137

2 things that turn on Na/K atpase?

SNS tone (B receptors) and insulin

both lowering K levels/causing hypokalemia

138

Electrolyte disturbance giving decreased deep tendon reflexes?

Hypermagnesemia

139

Nephrogenic DI tx?

Tx for lithium induced DI?

1) HCTZ--diruretic is forcing tubules to hang onto water

2) Amiloride for lithium induced DI; NB HCTZ will cause lithium TOXICITY (decreased excretion)

140

Waxy casts in urine?

Fatty Casts?

End stage (advanced) chronic renal disease

Nephrotic Syndrome

141

Fever Rash eosinophilia, azotemia?

Drug Induced acute interstitial nephritis

tx w / steroids

142

Chronic Acetaminophne use causes what renal issue?

Other risk factors?

Renal papillary necrosis.

DM, Acute pyelnephritis, sickel cell anemia AND TRAIT (renal papilla have very low O2 tension thus increased risk of sickling causing vasocculsive crisis)

143

Dehydration with NSAIDs puts patient at risk for?

Acute Renal Failure from decreased renal perfusion

NSAIDs stop afferent arteriole PG mediated vasodilation.

144

Why do you see pseudohyperaldosterism in cushings?

Cortisol has weak mineralcorticoid activity and is normally inactivated by local 11betaHSD2.  But in cushings this enzyme is overwhelmed and so you get mineralcorticoid activation.

145

Levels of ACTH in Primary Hyperaldosterism?  Why?

Aldosterone Levels in secondary/teritary hypoadrenalism?

1) Normal.  Aldosterone feedback is at the level of kidneys (knocking down renin) and isn't part of the HPA axis

2) Secondary/tertiary means bad pit/hypothal thus no on signal to adrenals.  Will have normal levels of aldo because renals are intact so they can stimulate Glomerulus of adrenal cortex

 

146

When do you have hyperpigmentation in hypoadrenalism?

ONLY PRIMARY (addison's disease).  Extra ACTH means extra POMC=extra MSH.

secondary/tertiary hypoadrenalism you don't see pigmentation.

147

What type of (hypo/hyper/normo) volemia and natremia does SIADH present with and why?

Euvolemic Hyponatremia.

RAAS system senses fluid overload state and turns off therefore you get dilutional hyponatremia but normal extravascular fluid status (can have very minor hypervoluemia intially, but normalizes rapidly)

148

Histological Features of the following thyroditsises:

Hypothyroidism dt hashimotos

Papillary Thyroid Cancer

Subacute DeQuervains Thyroiditis

Riedel's

1) Hashimotos: Mononuclear parenchymal infiltration with well developed germinal centers

2) Papillary: Branching papillary structures with interspersed calcified bodies (+ follicular hyperplasia with tall interfollicular papillary projections)

3) DeQuevarins: Mixed cellular infiltration with occasional multinucleated giant cells.

4) Reidels: Extensive stromal fibrosis that extends beyond the thyroid capsule

149

Male with foamy urine, comes in with a new left varicocele why?

Patient has nephrotic syndrome and is loosing ATIII thus making blood post glomerulus hypercoagulable.  Get a clot in the renal vein which causes back pressure in the spermatic vein

150

Bilateral Renal Tumors DD?

von Hippel Lindau if they are Renal Cell Carcinoma

TSC if they are angiomyolipomas

151

First dose HOTN seen with what drug? Particularly if added to which other drug?

ACEI; especially with HCTZ

152

What type of glomerulus will PSGN show on LM?

Hypercellular Glomerulus

153

Steroids SEs?

Hypocalcemia, hypokalemia, fluid retention, hyperglycemia, hypernatremia

154

Renal Cell carcinoma triad?

Hematuria, Abdominal Mass, Flank pain

155

Pheo's Effect on BP?

Increased BP but particularly of DIASTOLIC BP (NE/Epi cause Alpha 1 activation leading to increased TPR)

156

Metyrosine

Inhibits Tyrosine hydroxylase thus inhibits catecholamine synth

157

Propanolols effects in thyrotoxicosis?

1) Decreased sympathetic outflow to organs

2) Decreased peripheral conversion from T4 to T3***