Shit - Renal UWorld Flashcards Preview

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Flashcards in Shit - Renal UWorld Deck (27):
1

Kidney transplant prevention: drug names and MOA

Cyclosporin and tacrolimus

 

Block calcineurin → prevent dephosphorylation of NFAT → NFAT cant go to nucleus to increase IL-2 TC → T-cells dont proliferate and differnentiate, preventing graft attack

 

Cyclosporin: binds cyclophillin, which blocks calcineurin

Tacrolimus: binds FKBP, which blocks calcineurin

 

2

Where is most H2O resorbed?

PCT

 

*no matter what condition*

3

Estimates of:

GFR

RPF

GFR = creatinine/inulin

RPF = PAH

CLEARANCE!

4

HCP: 4 s/s

Palpable purpura (buttocks and legs)

Arthralgias (large joints)

IgA neohropathy

GIT pain/bleeding (risk of intussiception)

5

HSV Rx renal problems:

Acyclovir/Famicyclovir/valacylovir

Ganciclovir

Foscarnet

Cidofovir

Acyclovir/Famicyclovir/valacylovir: obstructive crystalline nephropathy (prevent with hydration) and ARF (allergy)

Ganciclovir: some renal toxicity (crystalline)

Foscarnet: Low Mg causing PTH inhibition causing hypocalcemia and hyperphosphatemia; can cause seizures

Cidofovir: nephrotoxic, decrease with probenecid and IV saline

6

1st dose effect of ACE-I and risk factors

1st dose hypotension

 

Low Na or BV (other diuretics), low BP, renal impairments,  heart failure, high renin or aldosterone levels

7

Hemmorhagic cytitis: causes and s/s

Caused by isophosphamide/cyclophosphamide, via metabolism to acrolein

 

s/s = hematuria, dysuria, frequency and urgency

8

Renal sign of Multiple Myelomas

Eosinophilic casts (NOT cells):

 

BJP overwhelm absorptive capacity --> ppt out with Tamm-Horsefall protein --> directly toxic to epi cells (atrophy) and block the lumen.

9

ARF with ACE-I:

Bilateral renal artery stenosis

Decompensated HF

Chronic kidney disease

Volume depletion 

10

Diuretic causing ototoxicity

Loops (furosemide, bumetanide, torsemide)

11

Ototoxic drugs:

Loops. sialicylates, aminoglycosides, vancomycin, cisplatin

12

Hypercellularity of PSGN via:

 

PSGN buzzwords:

Leukocyte invation (PMN and macro) + endothelial proliferation + messangial proliferation

 

Buzzwords: IF = starry sky + lumpy bumpy

EM = humps

13

Digoxin-renal link

Old age decreases renal clearance, which can cause digoxin toxicity (decreased muscle mass may prevent concomitant increase in creatinine)

 

Toxicity:

- Cholinergic (with blurry yellow vision)

- arrythmyas and AV block

- hyperkalemia

14

Stress Incontience: cause, s/s, etiology

Decreased sphincter control

 

leak with increased intra-abd pressure

 

weak sphincter (EUS), woman, old

15

Urge incontinents: cause, s/s, etiology

overactive detrussor

 

sudden overwhelming urge (and dont make it sometimes), frequency

 

frontal lobe probelm (cant control micturiction reflex)

16

overflow incontience: cause, s/s, etiology

cause: decreased detrussor contractility, outlet obstruction, loss of sensory

 

s/s full bladder that cant empty fully, constant dribbling

 

etiology: diabetic autonomic neuropathy

17

anti-PLA2-R IgG4 Abs

Idiopathic membranous nephropathy

18

Necessary condition for ascending pyelonephrisits

VUR!

 

Can be congenital, or from increased urinary retention or recurrent UTIs

19

Important urine buffers

NH3 → NH3+

HPO42- → H2PO4-

20

Kidney stone @ high pH

Ammonuim magnesium phosphate (struvite)

21

Ethylene glycol effect on kidneys

Metabolized to glycolic acid and oxalic acid

Glycolic acid is directly toxic to renal tubules

Oxalic acid binds Ca forming Ca-oxalate stones

22

Earliest manifestation if diabetic nephropathy

microalbuminuria 

(via loss of negatively charged heparin sulfate via upregulation of heparinases)

23

Activators of RAS

Macula densa

Internal baro-R

B1 adrenergic (on JG)

24

Mechanism to test cause of metabolic alkalosis

Urine Cl-

 

Vomiting or NG suction = loss of HCl, so fix with saline and Cl-

Thiazide/Loop = loss of Na and Cl, so fix with saline and Cl-

Mineralocorticoid excess; CANNOT fix with saline because of constant mienralocorticoid activity

25

RPF, GFR, and FF in severe hypovolemia

Decreased RPF, which causes a decreased GFR

 

BUT compensation from RAS causes ang-II efferent vasocontriction to try to maintain GFR

 

So decrease in RPF > decrease in GFR; so FF increases

[low num/very low denom = higher number]

 

[eff constiction without hypovolemia also causes increased FF, but GFR is increased while RPF is only slightly decreased]

26

Areas of nephron most succeptible to:

1) ischemic injury

2) nephrotoxic

ischemia = PCT and thick ascending limb

nephrotoxic = PCT

27

GMB collagen type

IV

 

Abs to a3 chain of IV = goodpastures 

Mutated col IV = alports