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Ryan's shit list - Step 1 > RSL - Renal > Flashcards

RSL - Renal Flashcards

(61 cards)

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1
Q

Extracellular compartments:

A

70kg

  • 60% water (42L)
    • 1/3 extracellular fluid (14L)
      • 75% interstitial fluid (10.5L)
      • 25% plasma (3.5L)
    • 2/3 intracellular fluid (28L)
      • 10% RBC volume (2.8L)
  • 40% non-water mass (28kg)
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2
Q

Fanconi Syndrome

(and causes)

A

Causes: PCT

  • Hereditary defects:
    • Wilson’s disease,
    • tyrosinemia,
    • glycogen storage disease,
  • Ischemia
  • Multiple myeloma
  • Nephrotoxins: Expired tetracyclines, tenofovir,
  • Lead poisoning
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3
Q

Bartter

A

Thick ascending loop of henle: Na/K/2Cl

  • Hypokalemia
  • metabolic acidosis
  • Hypercalciuria
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4
Q

Gitelman syndrome

A

DCT

  • Hypokalemia
  • Hypomagnesemia
  • Metabolic alkalosis
  • Hypocalciuria
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5
Q

Liddle syndrome

A

Collecting duct: gain of function (ENaC)

  • Hypokalemia
  • metabolic alkalosis
  • decreased aldosterone

Treat: amiloride

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6
Q

Syndrome of apparent mineralocorticoid excess

A

Collecting duct: (11 B-hydroxysteroid dehydrogenase)

  • Hypokalemia,
  • hypertension
  • metabolic alkalosis

Can be acquired from glycyrrhetic acid

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7
Q

Na+ Low/High serum conc.

A

Low:Nausea, malaise, stupor, coma, seizures

High: Irritability, stupor, coma

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8
Q

K+ low/high []

A
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9
Q

[Ca++] low/high

A

Low Ca++: tetany, seizures, GT prolongation

High Ca++: Kidney stones, Bone pain, diahrea, increased urinary freq, psychiatric changes

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10
Q

[Mg++] low/high

A

Low: Tetany, torsades de pointes, hypokalemia

High: Decreased DTRs, Lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia

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11
Q

[PO4—]

A

Low: Bone loss, osteomalacia, rickets

High: Renal stones, metastatic calcifications, hypocalcemia

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12
Q

Distal (type 1), urine pH >5.5

A

Defect in alpha intercalated cells

  • –> no H+ secretion
    • –> no HCO3- regeneration –> Acidosis
      • –> Kidney stones
    • –> no H+/K+ exchange –> hyperkalemia

Causes:

  • Amphotericin B, analgesic nephropathy, congenital anomalies of urinary tract
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13
Q

Proximal (type 2), Urine pH <5.5

A

PCT HCO3- reabsorption:

  • increased HCO3- excretion –> metabolic acidosis
  • Na+ not reabsorbed –> increased Acid/K+ loss
    • Hypokalemia, low pH

Causes: fanconi syndrome, CA inhibitors

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14
Q

Hyperkalemic (type 4), urine pH <5.5

A

Hypoaldosteronism

  • hyperkalemia –> decreased NH3 synthesis in PCT –> decreased NH4+ excretion

Causes:

  • Low aldosterone (diabetic hyporeninism, ACE inhibitors, ARBs, NSAIDS, heparin, cyclosporine, adrenal insufficiency
  • Aldosterone resistance (K+ sparing diuretics, nephropathy due to obstruction, TMP/SMX)
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15
Q

Post streptococcal Glomerulonephritis

(LM/IF/EM)

A

LM: Hypercellular glomeruli that is enlarged

IF: Starry sky granular appearance. Lumpy bumpy due to IgG, IgM, C3 deposition in GBM and mesangium

EM: Subepithelial imunne complex humps

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16
Q

Rapidly progressive Glomerulonephritis

(LM/IF)

A

LM/IF: Crescent moon shape consisting of fibrina and plasma proteins with glomerular parietal cells, monocytes, macrophages

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17
Q

Good pasture syndrome

A

Type II hypersensitivity –> ab to GBM and Alveolar basement membrane –> hematuria/hemoptysis

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18
Q

Granulomatosis with polyangitis (wegener)

A

PR3-ANCA / c-ANCA

(sinusitis; not seen in good pastures)

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19
Q

Microscopic polyangitis

A

MPO-ANCA / p-ANCA

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20
Q

Diffuse proliferative glomerulonephritis

(LM/IF/EM)

(DT/)

A

LM: wire looping of capillaries

IF: granular

EM: subendothelial and sumetimes intramembranous IgG based IC often with C3 deposition

Often nephrotic / nephritic concurrently

Dt/ SLE or membranoproliferative glomerulonephritis

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21
Q

IgA nephropathy (Berger disease)

(LM/IF/EM)

(disease)

A

LM: Mesangial proliferation

IF: IgA based IC deposits in mesangium

EM: mesangial IC deposits

DT/ Henoch-Schönlein purpura

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22
Q

Alport syndrome

(mutation)

(symptoms)

(EM)

A

Type IV collagen mutation –> thinning and splitting of GBM

Symp: Eyes, glomerulonephritis, sensorineural deafness

EM: Basket weave appearance

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23
Q

Membranoproliferative glomerulonephritis

Type 1: (EM/IF/PAS)(association)

Type 2: (EM)

A

1: hep B / C

  • EM: Subendothelial immune complex deposits
  • IF: granular
  • PAS (LM): tram track appearance

2: C3 nephritic factor (stabolizes C3 convertase)
* EM: intramembranous IC deposits; dense deposits

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24
Q

Focal segmental glomerulosclerosis

(LM/IF/EM)

(Associations)

Treat:

A

LM: Segmental sclerosis and hyalinosis

IF: Non-specific deposits of IgM, C3, C1

EM: Effacement of foot processes similar to minimal change disease

Associations: African american, Hispanic, HIV, Sickle cell, Obesity, Heroin use, IFN treatment,

Treat: inconsistent response to steroids

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25
Minimal change disease | (LM/IF/EM)
LM: normal IF: negative EM: **podocyte effacement** Secondary to: immunization, recent infection Treat: responds well to steroids
26
Membranous nephropathy (LM/IF/EM) (associations)
**LM: diffuse capillary and GBM thickening** IF: Granular EM: **Spike and dome** appearance with subepithelial deposits Association: * ab to PLA2R, * ab to drugs (NSAIDS, penicillin), * infections (HBV,HCV), * SLE, * solid tumors
27
Amyloidosis: | (Deposits?)
Subepi, subendo, GBM, Mesangium
28
Diabetic glomerulonephropathy | (LM)
LM: mesangial expansion, GBM thickening, eosinophilic nodular glomerulosclerosis (**kimmelstiel-wilson nodules**)
29
Renal Cell carcinoma (histology)
PCT --\> Polygonal Clear cells filled with lipid and carbohydrates
30
Renal Oncytoma | (origin, histology)
Epithelial cells --\> Collecting duct Large eosinophillic cells abundant with mitochondria and no perinuclear clearing
31
Wilms tumor (nephroblastoma) | (ages, presentation, genes)
2-4, unilateral flank mass + HTN (DT/renin secretion, WT1/WT2 on ch 11
32
Beckwith-Wiedman syndrome
* Wilms tumor * Macroglossia * organomegally * Neonatal decreased glucose * Muscular hemihypertrophy
33
WAGR syndrome
* Wilm's tumor * Aniridia * Genitourinary malformation * Mental retardation
34
Transition cell carcinoma risk factors | (urothelial CA)
Phenacetin Smoking (napthylamine) Analine dyes (azo dyes) Cyclophosphamide
35
Chronic pyelonephritis: histology
36
Acute pyelonephritis: Imaging
CT
37
Drug induced interstitial nephritis | (Tubulointerstitial nephritis)
38
Acute interstitial nephritis Drugs
39
Acute tubular necrosis: Stage 1
Oliguria; decreased GFR * High: BUN, creatinine, Kalemia, acid, urea
40
Acute Tubular necrosis: Stage 3
Recovery: polyuric * Low BUN, Creatinine, k+, Mg++, Ca++, PO4--, Na+
41
ATN: nephrotoxins
aminoglycosides, radiocontrast agents, lead, cisplatin Crush injury (myoglobinuria) Hemoglobinuria
42
Calcium stones (**precipitation**, X-Ray, Appearance, cause, treat)
**Precipitation:** * **CaPO4: high pH** * **CaOxalate: low pH** X-Ray: Radiopaque Appearance: Envelope (octahedron; square with X in middle) Cause: hypercalciuria Treat: Hydration, Thiazides, Citrate
43
Ammonium magnesium phosphate (**precipitaiton**, X-Ray, Appearance, cause, treatment)
**high pH** Radiopaque Coffin lid \*AKA struvite; caused by urease positive bugs (Urea --\> ammonia) - often causes staghorn Treat: infection, surgical removal of stone
44
Uric acid (**precipitaiton**, X-Ray, Appearance, cause, treatment)
**low pH** radiolucent Rhomboid or rosettes low urine volue, arid climates, hyperuricemia, increased cell turnover Treat: alkalinization of urine, allopurinol
45
Cysteine (**precipitaiton**, X-Ray, Appearance, cause, Test, treatment)
**low pH** radiopaque Hexagonal Hereditary PCT transporter loss (can form staghorn calliculi) Sodium cyanide nitroprusside test Treat: alkalinization of urine
46
Calcium stones (precipitation, **X-Ray**, Appearance, cause, treat)
Precipitation: * CaPO4: high pH * CaOxalate: low pH **X-Ray: Radiopaque** Appearance: Envelope (octahedron; square with X in middle) Cause: hypercalciuria Treat: Hydration, Thiazides, Citrate
47
Ammonium magnesium phosphate (precipitaiton, **X-Ray,** Appearance, cause, treatment)
high pH **Radiopaque** Coffin lid \*AKA struvite; caused by urease positive bugs (Urea --\> ammonia) - often causes staghorn Treat: infection, surgical removal of stone
48
Uric acid (precipitaiton, **X-Ray,** Appearance, cause, treatment)
low pH **radiolucent** Rhomboid or rosettes low urine volue, arid climates, hyperuricemia, increased cell turnover Treat: alkalinization of urine, allopurinol
49
Cysteine (precipitaiton, **X-Ray**, Appearance, cause, Test, treatment)
low pH **radiopaque** Hexagonal Hereditary PCT transporter loss (can form staghorn calliculi) Sodium cyanide nitroprusside test Treat: alkalinization of urine
50
Calcium stones (precipitation, X-Ray, **Appearance**, cause, treat)
Precipitation: * CaPO4: high pH * CaOxalate: low pH X-Ray: Radiopaque **Appearance: Envelope (octahedron; square with X in middle)** Cause: hypercalciuria Treat: Hydration, Thiazides, Citrate
51
Ammonium magnesium phosphate (precipitaiton, X-Ray, **Appearance**, cause, treatment)
high pH Radiopaque **Coffin lid** \*AKA struvite; caused by urease positive bugs (Urea --\> ammonia) - often causes staghorn Treat: infection, surgical removal of stone
52
Uric acid (precipitaiton, X-Ray, **Appearance**, cause, treatment)
low pH radiolucent **Rhomboid or rosettes** low urine volue, arid climates, hyperuricemia, increased cell turnover Treat: alkalinization of urine, allopurinol
53
Cysteine (precipitaiton, X-Ray, **Appearance**, cause, Test, treatment)
low pH radiopaque **Hexagonal** Hereditary PCT transporter loss (can form staghorn calliculi) Sodium cyanide nitroprusside test Treat: alkalinization of urine
54
Calcium stones (precipitation, X-Ray, Appearance, **cause**, treat)
Precipitation: * CaPO4: high pH * CaOxalate: low pH X-Ray: Radiopaque Appearance: Envelope (octahedron; square with X in middle) **Cause: hypercalciuria** Treat: Hydration, Thiazides, Citrate
55
Ammonium magnesium phosphate (precipitaiton, X-Ray, Appearance, **cause**, treatment)
high pH Radiopaque Coffin lid **\*AKA struvite; caused by urease positive bugs (Urea --\> ammonia)** - often causes staghorn Treat: infection, surgical removal of stone
56
Uric acid (precipitaiton, X-Ray, Appearance, **cause**, treatment)
low pH radiolucent Rhomboid or rosettes **low urine volue, arid climates, hyperuricemia, increased cell turnover** Treat: alkalinization of urine, allopurinol
57
Cysteine (precipitaiton, X-Ray, Appearance, **cause**, Test, treatment)
low pH radiopaque Hexagonal **Hereditary PCT transporter loss** (can form staghorn calliculi) Sodium cyanide nitroprusside test Treat: alkalinization of urine
58
Calcium stones (precipitation, X-Ray, Appearance, cause, **treat**)
Precipitation: * CaPO4: high pH * CaOxalate: low pH X-Ray: Radiopaque Appearance: Envelope (octahedron; square with X in middle) Cause: hypercalciuria **Treat: Hydration, Thiazides, Citrate**
59
Ammonium magnesium phosphate (precipitaiton, X-Ray, Appearance, cause, **treatment**)
high pH Radiopaque Coffin lid \*AKA struvite; caused by urease positive bugs (Urea --\> ammonia) - often causes staghorn **Treat: infection, surgical removal of stone**
60
Uric acid (precipitaiton, X-Ray, Appearance, cause, **treatment**)
low pH radiolucent Rhomboid or rosettes low urine volue, arid climates, hyperuricemia, increased cell turnover **Treat: alkalinization of urine, allopurinol**
61
Cysteine (precipitaiton, X-Ray, Appearance, cause, Test, **treatment**)
low pH radiopaque Hexagonal Hereditary PCT transporter loss (can form staghorn calliculi) Sodium cyanide nitroprusside test **Treat: alkalinization of urine**

Ryan's shit list - Step 1 (27 decks)

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