Review Flashcards
(115 cards)
1
Q
Where is renin secreted by?
A
kidneys
2
Q
What causes renin to be secreted?
A
decrease in renal pressure/flow
3
Q
What does renin bind and cleave too?
A
angiotensinogen
4
Q
Where is angiotensinogen made?
A
liver
5
Q
What does angiotensinogen form?
A
angiotensin I (inactive)
6
Q
Where does angiotensin I get converted to angiotensin II?
A
lungs by ACE
7
Q
What is the role of angiotensin II?
A
vasoconstriction
8
Q
Where does angiotensin II bind?
A
receptor cells in the zone glomerulus of the adrenal gland which decreases aldosterone
9
Q
Where does aldosterone bind?
A
principle cells in the collecting duct
10
Q
What does aldosterone cause?
A
water and Na+ to be retained
11
Q
Organs of the upper urinary tract
A
kidneys and ureters
12
Q
Organs of the lower urinary tract
A
bladder and urethra
13
Q
Pathway from blood to urine
A
kidneys - afferent arterial - glomerulus (podocytes) - bowman’s capsule - proximal collecting duct - descending loop of henle - Loop of henle - ascending loop of henle - distal convoluted tubule - collecting duct - renal pelvis - ureter - bladder - urethra
14
Q
Proximal tubule - Reabsorption
A
Na, K, Cl, H2O, HCO3, Glucose, Amino Acids
15
Q
Proximal tubule - secretion
A
creatine, antibiotics, diuretics, uric acid
16
Q
Descending limb of LOH - reabsorption
A
H2O
17
Q
Ascending limb of LOH - reabsorption
A
Na, K, Mg, Ca, Cl
18
Q
Distal convoluted tubule - reabsorption
A
Na, Cl, Ca, H2O
19
Q
Distal convoluted tubule - secretion
A
K, H, Urea
20
Q
Collecting duct - reabsorption
A
H2O
21
Q
Proximal tubule - diuretics
A
carbonic anhydrase inhibitors, osmotic diuretics
22
Q
descending LOH - diuretics
A
osmotic diuretics
23
Q
ascending LOH - diuretics
A
loop diuretics
24
Q
distal convoluted tubule - diuretics
A
thiazide/thiazide like, osmotic
25
collecting duct - diuretics
potassium sparing, osmotic
26
Stop taking potassium supplement when you switch to
potassium sparing diuretic
27
ACE - where is it?
lungs
28
ACE - what does it do?
converts angiotensin I to angiotensin II
29
Chronic glomerulonephritis - labs
UA - decrease SG,
| PTH (elevated)
30
Chronic glomerulonephritis - presentation
Anemia
Pericarditis 2nd to uremia
taste change
foamy bubbly urine
31
Goodpasture's Syndrome
hemoptysis: coughing up blood
Drop in Hgb
glomeruli and alveoli rapidly move into renal failure
32
Diabetic nephropathy
leading cause of end stage renal disease
| persistent albuminuria, decreased GFR, HTN
33
IgA nephropathy
follows URI, can develop within 4 days of URI
| RBC casts
34
Renal vein thrombosis
CTA 100% sensitive
| responsible for a hyper coagulability state do to hypoalbuminemia
35
Renal artery stenosis - MCC
secondary hypertension
36
Renal artery stenosis - gold standard
renal arteriogram
| -abdominal bruit
37
Types of tubulointersital nephritis
pyelonephritis
acute tubular necrosis
drug induced
38
Chronic pyelonephritis
inflammation leading to WBC breakdown causing chronic scarring/atrophy
- blunted/deformed calyces
- urinary tract obstruction
39
Chronic pyelonephritis - UA
WBC
40
Acute tubular necrosis - MCC
intrinsic acute renal failure
41
Acute tubular necrosis - cause
acute ischemic or toxic event (NSAID use)
42
Acute tubular necrosis - recent history
hypovolemia, sepsis, vascular compromise
43
Drug induced interstitial nephritis - what kind of drugs
pcn, NSAIDs, IV contrast
44
Drug induced interstitial nephritis - presentation
Classic triad
- low grade fever
- skin rash
- arthralgias
45
Polycystic kidney disease
autosomal dominant
| berry aneurysm
46
Hypertensive nephrosclerosis
hardening of nephrons
47
hypertensive nephrosclerosis - risk factors
Age 45-65 yo
African American
Smoking
Hypercholesteremia
48
Hypertensive nephroslcerosis - treatment
neep BP <130/80 give diuretic, ACE, or ARB
49
Diabetes incipits
hypernatremia: diluted urine concentration
50
Membranous nephropathy - MC
caucasians
| 30-50 years
51
Membranous nephropathy
associated with malignancy
edema: abdomen, face,
Renal vein thrombosis, DVT
52
Varicocele
due to renal cell carcinoma
53
Renal cell carcinoma - presentation
Classic triad
- flank pain
- palpable mass
- hematuria
54
Renal cell carcinoma
-smoking, familial form
Hereditary: von hippel Lindau disease
Anemia - sign of advance disease
hypercalcemia - indicative of tumors
55
Renal cell carcinoma - treatment
UA, CT, surgery
56
Nephritic
RBC Cast
57
Nephrotic
heavy proteinuria > 3.5 over 24 hours, edema, hypoalbuminia
58
Pre renal AKI
blood not getting to kidneys
| -hypovolemic
59
Intrinsic AKI
within the kidneys
| -nephrotoxic drugs: NSAIDs, IV contrast, Bactrim, pcn
60
Post renal AKI
urinary tract
| -tumor/stone
61
Torsades
hypocalcemia
hypomagnesemia (MC)
hyperkalemia
62
Tall tented T waves
hyperkalemia
63
U wave
hypokalmeia
64
prolonged PR and QT, widening QRS, Flattened "T" wave, prominent "U" wave
hypomagnesemia
65
decreased amniotic fluid with neonatal respiratory distress
chronic kidney disease
66
Willms tumor
unilateral mass
18 yr old in homeless clinic scar below Left ribs, flank to right upper abdomen cancer removed at age 3, chemo therapy, iris are irregular
67
CKD in kids- younger child
congenital abnormalities of kidneys and urinary tract
68
CKD in kids - >10 year old
glomerular disease
69
CKD in kids
progression varies by age during rapid growth
70
CKD in kids - complications
failure to thrive and broken bones
71
Post streptococcal glomerulonephritis
hypertension
dark brown urine
preorbital edema - swelling around face
can develop several weeks after strep infection
72
Post streptococcal glomerulonephritis - MC
acute immune mediate glomerulonephritis
73
Minimal change disease - MC
children - spontaneous resolution
74
Minimal change disease - MCC
nephrotic syndrome
75
Minimal change disease - presentation
facial edema, hypertension, respiratory infection
76
Minimal change disease - UA
increases SG and Hbg/Hct
77
Minimal change disease - treatment
steroids
78
Proteinuria orthostatic
sports physical: pee in cup, 13 years old female
get test first thing in am -negative
if in late morning or afternoon - positive
79
Kids: decrease renal perfusion
dehydration
80
Management/complications with diuretics
| furosemide: peeing all night
take in AM
81
drugs to reduce peripheral edema
furosemide (loop diuretic) and give potassium
82
NSAIDs and kidneys
inhibit prostaglandins and dilation of afferent arterial
83
Electrolyte out of range
potassium - monitor with ACE
84
Management meds in dialysis patients
renal clearance contributes to plasma clearance by 30%, dialysis is considered to be clinically important
cut in half
in ESRD dialysis, may remove a therapeutic drug from the body, may require redoing during or after - immediately
85
SIADH management - inpatient only
conivaptan (short term IV)
86
Sulfa allergy
ethacrynic acid
87
Calcium and phosphate are messed do to kidney disease
Calcitriol: Vitamin D becomes active
-reduced path
calcium acetate and calcium carbon containing phosphate binders
88
What electrolyte problem with ACEI
hyperkalemia
89
spironolactone
hyperkalemia
90
common causes of hematuria
bladder cancer
91
FSGS
MC: African Americans
Also seen in sickle cell disease
IVDA, HTN, DM
associated with high frequency renal failure
92
FSGS - treatment
steroids cyclosporine A cyclophosomide
93
Inertcalculated cells and principle cells location
collecting duct
94
elevated BUN/Creatine means
hypoatremia
95
EKG U wave, decreased deep tendon reflex, diarrhea
hypokalemia
96
RBC Cast
pathological
97
Nephrotic
proteinuria
hypercholestrolemia
hyperalbumin
swelling in the legs
98
Family history, polycystic kidney disease, berry aneurysm - testing
PKD 2 testing
99
100% sensitive renal vein thrombosis testing
CT
100
Hypernatremia
Skin flushing
agitation
low grade fever
thirst
101
hypovolemic hypoatremia - low ECF
increase ADH leading to hypothermia in free H2O intake
102
Hypovolemic hypoatremia - treatment
isotonic saline - monitor volume status
103
Hypervolemia hyponatremia - high ECF
CHF
Cirrhosis
nephrotic syndrome
104
Hypervolemia hyponatremia - treatment
diuretic or dialysis in severe pts
105
Isovolumic/euvolemic hyponatremia
Na is going too high but it is really low due to high fluid
| glucocorticoid def, SIDAH renal dysfuction
106
RCC - test
CT scan
107
best treatment for long term cure for RCC
nephrectomy - get kid of tumor
108
AKI vs. Chronic
```
stage 3 and up send to nephrology
reversible vs irreversible
stage 3 - can't go bad
Chronic >3 months
pre, post, intrinsic AKI
Intrinsic: UA
```
109
Renal dosing of meds
dont take NSAIDs
hydrate
BP and DM control
110
what level of GFR to determine dose of NSAIDS
NSAIDS <30
| NSAIDS <60 in AKI stop
111
End stage renal
hemoglobin = 8 (low)
now in failure
how to increase hemoglobin - erthryopoietin
112
depression causes what?
SIADH
113
Pre AKI
```
blood/fluid loss
hypovolemic
bleeding out
HTN meds
MI
liver failure
severe burns
severe dehydration
Drugs: ASA, ibuprofen
Allergic reaction
```
114
Intrinsic AKI
-blood cut that is preventing blood from getting inside
backs up through the glomeruli's, congestion in arterials inside
cholesterol deposits
glomerular nephritis
Meds: antibiotics
alcohol
115
Post
Obstruction
Tumor
Stones
