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Nephrology > Week 3 > Flashcards

Week 3 Flashcards

1
Q

What does hypochloremia lead to?

A

more HCO3- reabsorption to balance the loss of serum chloride

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2
Q

Why is it hard to correct prox. renal tubular acidosis with bicarb?

A

you won’t reabsorb much of the bicarb given

most of it will spill out into the urine

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3
Q

How is ammonia formed?

A

ammonia is formed by breaking down glutamine

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4
Q

What are 2 products of glutamine breakdown?

A

ammonia (secreted into lumen)

a-ketoglutamate

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5
Q

What does break down of a-ketoglutamate create as byproducts?

A

Breakdown requires 2 H+ so this leads to 2 HCO3- being produced

2 HCO3- can be absorbed into blood

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6
Q

What does a low pH do to amminogenesis ?

A

increases

we want more buffer since we have an acidic intracellular environment

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7
Q

Hypokalemia and amminogenesis

A

more K+ is being reabsorbed into blood and more H+ being pulled into cell

more H+ intracellularly leads to increased amminogenesis

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8
Q

What scenario should you use urine anion gap?

A

normal AG acidosis

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9
Q

Urine anion gap formula

A

UNa + Uk - UCl

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10
Q

What does a negative urine anion gap tell you?

A

the kidneys are working normally

excreting H+ as ammonium which is combining with Cl

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11
Q

What does a positive urine anion gap tell you?

A

the kidneys are not working normally

ammonium is not present and you probably have a RTA

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12
Q

Where is carbonic anhydrase found? (2)

A

proximal tubule

collecting duct

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13
Q

What type of urine pH is associated with distal RTA?

A

there is a problem secreted H+

this leads to a high urine pH (alkaline)

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14
Q

What potassium balance is associated with distal RTA?

A

hypokalemia

more K+ is secreted into lumen in attempt to replace the absent H+

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15
Q

What type of RTA can hypoaldosteronism cause?

A

little secretion of K+

this leads to hyperkalemia RTA (type 4)

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16
Q

How do catecholamines and insulin increase intracellular K+?

A

increase Na/K ATPase

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17
Q

What effects do carbonic anhydrase inhibitors have on potassium balance?

A

less reabsorption of bicarb leads to more bicarb at collecting duct

secrete more K+ to try to balance

this leads to hypokalemia

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18
Q

What hormone increases the concentration gradient of urea?

A

ADH

this leads to more water retention

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19
Q

How do ANA + dopamine work?

A

both counteract RAAS when there is increased volume

they decrease Na/K ATPase

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20
Q

What drives Ca and Mg reabsorption in the thick ascending limb?

A

this reabsorption is driven by K+ backflow

this K+ backflow into lumen causes increased lumen positivity

lumen positivity pushes Ca, Na and Mg into cell

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21
Q

What is normal GFR?

A

above 60

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22
Q

What defines CKD?

A

GFR < 60 for longer than 3 months

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23
Q

Is CKD reversible?

A

no

the damage to nephrons is irreversible

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24
Q

When do you define someone with ESRD?

A

GFR < 15

(also look for high phosphate and low bicarb)

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25
Q

How does CKD lead to osteoporosis?

A

hyperphosphemia sucks up the free Ca2+ which leads to hypocalecmia

PTH then recruits calcium from bones to try to raise serum calcium levels

this results in osteoporosis

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26
Q

How does renal failure cause hyperphosphatemia ?

A

decreased renal excretion of phosphate

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27
Q

Do you treat a UTI if there are no symptoms?

A

No!

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28
Q

What do granular casts indicate?

A

tubular injury

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29
Q

How do you treat RPGN?

A

IV glucocorticoid

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30
Q

What 3 supplements need to be given with IV glucocorticoids? Why?

A

Calcium / vitamin D (can cause osteoporosis)

Proton pump inhibitor (can cause acidosis in stomach)

Bactrim (can cause fungal infection, Candida)

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31
Q

What 2 factors determine progression of CKD?

A

decreased eGFR

increased albuminuria

32
Q

What 2 adaptations do nephrons make in response to CKD? What do these changes lead to?

A

1) hyperfiltration

2) hypertrophy (more glomerular / tubular growth)

*can lead to fibrosis and sclerosis

33
Q

FGF23

A

tries to counteract hyperphosphatemia by secreting more phosphate

34
Q

What stimulates PTH in renal disease?

A

hypocalcemia secondary to hyperphosphatemia

35
Q

When does hyperkalemia develop in CKD?

A

develops in late CKD

36
Q

What are the 2 medications we given to manage CKD?

A

ACE/ARB and SGLT2i

*give these when a patient is stable so you can determine % GFR drop from drugs vs. from disease

37
Q

What does CKD do to water handling?

A

reduced GFR limits ability to clear water

this leads to hyponatremia

(or you could have polyuria due to functional defects in ADH / aquaporin channels)

38
Q

What type of acid base disturbance occurs due to CKD?

A

metabolic acidosis

not excreting NH3 as buffer and therefore more H+ is retained

39
Q

Uremia

A

Due to retained products of metabolism and loss of metabolic/endocrine functions performed by the kidney

40
Q

Is there a correlation between serum levels of BUN/Cr and development of symptoms in CKD?

A

no

41
Q

What is one weird sign of uremia?

A

patient’s breath smells like urine since they are retaining ammonia

42
Q

Difference between PKD1 and PKD2 gene

A

PKD1 is more severe and more prevalanet

PKD2 is more mild

43
Q

What are the indications for dialysis?

A

A - acidosis
E - severe electrolyte imbalance
I - substance intoxication
O - volume overload
U - uremia

44
Q

What is the screening test for PKD?

A

ultrasound

45
Q

What is the prognostic test for PKD?

A

determine total kidney volume by CT

this can give you prognosis

46
Q

What are some symptoms of PKD?

A

HTN, kidney stones, diluted urine

47
Q

How does PKD lead to HTN?

A

cysts cause decreased RPF which leads to increased secretion of RAAS

RAAS leads to HTN

48
Q

What is a potential side effect of ACE/ARB?

A

hyperkalemia

49
Q

What is are extra-renal findings in autosomal dominant PKD?

A

berry aneurysm

MVP

colonic diverticulosis

hepatic cysts

50
Q

What causes hypotension in hemodialysis patients?

A

dialysis directly effects the intravascular volume

decrease in intravascular volume = hypotension

*will self-correct in 2-12 hours

51
Q

What can occlude the PD catheter?

A

fibrin

52
Q

Is PD or hemodialysis more likely to have excess urea removal?

A

hemodialysis

hemodialysis is more effective at small molecule clearance compared to PD

53
Q

What is a reason for increases in living donor renal donation?

A

the option for laparoscopic nephrectomy

54
Q

What are the #1 and #2 leading causes of death in post-transplant patients?

A

1) cardiovascular disease

2) infection

55
Q

In what 3 populations do you treat an asymptomatic UTI?

A

pregnant

patients undergoing a urologic intervention

patients who have a kidney transplant

56
Q

What is a second reason that hypocalcemia develops in patients besides hyperphosphate?

A

kidneys cannot activate vitamin D (calcitriol)

lack of vitamin D leads to decreased GI reabsorption of calcium

57
Q

Genetic mutations in which proteins lead to ADPK?

A

polycystin 1 and 2

58
Q

Genetic mutations in which proteins lead to ADRK?

A

fibrocytstin

59
Q

What are hemangioblastomas associated with ?

A

VHL disease

60
Q

What gene causes tuberous sclerosis?

A

mTOR

61
Q

What are signs of tuberous sclerosis? (4)

A

cystic kidneys

seizures

ash-leaf spots

angiomyolipomas

62
Q

How does multi-cystic dysplastic kidney disease arise?

A

error in embryonic development (uteric bud and mesenchyme)

NOT genetic

63
Q

Which cystic kidney diseases have small kidneys? (3)

A

multi-cystic kidney disease

acquired cystic disease

medullary cystic kidney disease

64
Q

What is usually the first symptom in ADPKD patients?

A

hypertension due to activation of RAAS

65
Q

Why do cysts only form in homozygous ADPK mutation cells?

A

the disease is inherited through one mutation

BUT when you knock out both mutations this is when you get the cysts forming

(this is similar to tumor suppressor genes)

66
Q

What two conditions do you see a WBC cast in urine?

A

pyelonephritis and interstitial nephritis

67
Q

What is the prognosis of clear cell RCC vs. chromophobe carcinoma?

A

Chromophobe carcinoma has a better prognosis

68
Q

Where does clear cell RCC arise from?

A

proximal tubule

69
Q

Where does chromophobe carcinoma arise from?

A

the collecting duct

70
Q

The PKD1 and PKD2 genes are associated with which form of the disease …

A

the autosomal dominant form

71
Q

The PKHD1 gene is associated with which form of the disease …

A

the autosomal recessive form

72
Q

What are the severe forms of uremia that indicate a patient needs dialysis?

A

uremic pericarditis and uremic encephalopathy

73
Q

What is the incidence of UTIs in men and women over the age of 50?

A

similar

74
Q

is genitourinary TB considered a complicated UTI?

A

yes

(uncomplicated is normally caused by E. Coli)

75
Q

How do you treat genitourinary TB?

A

isoniazid and antibiotics

76
Q

What is the most common site of extraplumonary TB?

A

genitourinary TB

77
Q
A

Nephrology (6 decks)

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