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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
How does CKD lead to osteoporosis?
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
26
How does renal failure cause hyperphosphatemia ?
decreased renal excretion of phosphate
27
Do you treat a UTI if there are no symptoms?
No!
28
What do granular casts indicate?
tubular injury
29
How do you treat RPGN?
IV glucocorticoid
30
What 3 supplements need to be given with IV glucocorticoids? Why?
Calcium / vitamin D (can cause osteoporosis) Proton pump inhibitor (can cause acidosis in stomach) Bactrim (can cause fungal infection, Candida)
31
What 2 factors determine progression of CKD?
decreased eGFR increased albuminuria
32
What 2 adaptations do nephrons make in response to CKD? What do these changes lead to?
1) hyperfiltration 2) hypertrophy (more glomerular / tubular growth) *can lead to fibrosis and sclerosis
33
FGF23
tries to counteract hyperphosphatemia by secreting more phosphate
34
What stimulates PTH in renal disease?
hypocalcemia secondary to hyperphosphatemia
35
When does hyperkalemia develop in CKD?
develops in late CKD
36
What are the 2 medications we given to manage CKD?
ACE/ARB and SGLT2i *give these when a patient is stable so you can determine % GFR drop from drugs vs. from disease
37
What does CKD do to water handling?
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
What type of acid base disturbance occurs due to CKD?
metabolic acidosis not excreting NH3 as buffer and therefore more H+ is retained
39
Uremia
Due to retained products of metabolism and loss of metabolic/endocrine functions performed by the kidney
40
Is there a correlation between serum levels of BUN/Cr and development of symptoms in CKD?
no
41
What is one weird sign of uremia?
patient's breath smells like urine since they are retaining ammonia
42
Difference between PKD1 and PKD2 gene
PKD1 is more severe and more prevalanet PKD2 is more mild
43
What are the indications for dialysis?
A - acidosis E - severe electrolyte imbalance I - substance intoxication O - volume overload U - uremia
44
What is the screening test for PKD?
ultrasound
45
What is the prognostic test for PKD?
determine total kidney volume by CT this can give you prognosis
46
What are some symptoms of PKD?
HTN, kidney stones, diluted urine
47
How does PKD lead to HTN?
cysts cause decreased RPF which leads to increased secretion of RAAS RAAS leads to HTN
48
What is a potential side effect of ACE/ARB?
hyperkalemia
49
What is are extra-renal findings in autosomal dominant PKD?
berry aneurysm MVP colonic diverticulosis hepatic cysts
50
What causes hypotension in hemodialysis patients?
dialysis directly effects the intravascular volume decrease in intravascular volume = hypotension *will self-correct in 2-12 hours
51
What can occlude the PD catheter?
fibrin
52
Is PD or hemodialysis more likely to have excess urea removal?
hemodialysis hemodialysis is more effective at small molecule clearance compared to PD
53
What is a reason for increases in living donor renal donation?
the option for laparoscopic nephrectomy
54
What are the #1 and #2 leading causes of death in post-transplant patients?
1) cardiovascular disease 2) infection
55
In what 3 populations do you treat an asymptomatic UTI?
pregnant patients undergoing a urologic intervention patients who have a kidney transplant
56
What is a second reason that hypocalcemia develops in patients besides hyperphosphate?
kidneys cannot activate vitamin D (calcitriol) lack of vitamin D leads to decreased GI reabsorption of calcium
57
Genetic mutations in which proteins lead to ADPK?
polycystin 1 and 2
58
Genetic mutations in which proteins lead to ADRK?
fibrocytstin
59
What are hemangioblastomas associated with ?
VHL disease
60
What gene causes tuberous sclerosis?
mTOR
61
What are signs of tuberous sclerosis? (4)
cystic kidneys seizures ash-leaf spots angiomyolipomas
62
How does multi-cystic dysplastic kidney disease arise?
error in embryonic development (uteric bud and mesenchyme) NOT genetic
63
Which cystic kidney diseases have small kidneys? (3)
multi-cystic kidney disease acquired cystic disease medullary cystic kidney disease
64
What is usually the first symptom in ADPKD patients?
hypertension due to activation of RAAS
65
Why do cysts only form in homozygous ADPK mutation cells?
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
What two conditions do you see a WBC cast in urine?
pyelonephritis and interstitial nephritis
67
What is the prognosis of clear cell RCC vs. chromophobe carcinoma?
Chromophobe carcinoma has a better prognosis
68
Where does clear cell RCC arise from?
proximal tubule
69
Where does chromophobe carcinoma arise from?
the collecting duct
70
The PKD1 and PKD2 genes are associated with which form of the disease ...
the autosomal dominant form
71
The PKHD1 gene is associated with which form of the disease ...
the autosomal recessive form
72
What are the severe forms of uremia that indicate a patient needs dialysis?
uremic pericarditis and uremic encephalopathy
73
What is the incidence of UTIs in men and women over the age of 50?
similar
74
is genitourinary TB considered a complicated UTI?
yes (uncomplicated is normally caused by E. Coli)
75
How do you treat genitourinary TB?
isoniazid and antibiotics
76
What is the most common site of extraplumonary TB?
genitourinary TB
77

Nephrology (6 decks)

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