Renal 2

Question 1

Concentrations of which substances increase as you move along the proximal tubule?

Answer 1

• PAH
• Cr
• Inulin
• Urea

Question 2

Concentrations of which substances decrease as you move along the proximal tubule?

Answer 2

• Bicarb
• Glucose
• AAs

Question 3

Grapefruit is a what?

Answer 3

P450 inhibitor

Increases nephrotoxicity by raising circulating drug levels

Slows breakdown of drugs metabolized by this pathway

Question 4

Cyclosporine and ^ed levels of serum Cr?

Answer 4

Calcineurin inhibitor nephrotoxicity

via P450 pathway

Question 5

Beta-blockers function

Answer 5

• Decrease renin production

- Decrease sympathetic stimulation

Question 6

Indication of diabetic nephropathy?

Answer 6

Increased albumin excretin

Question 7

Appropriate tx for diabetic pt w/ diabetic nephropathy

Answer 7

• Anti-glycemic drugs

- ACEIs (have anti-proteinuric effects)

Question 8

Athroembolic renal disease

Answer 8

• Occur post-invasive vascular procedures
• Needle-shaped cholesterol clefts within the atheromatous thrombus
• Emboli found in kidneys (most common), GI tract, CNS, skin

Question 9

DKA emergent tx

Answer 9

IV NS and insulin

Increase serum bicarb, Na

Decrease glucose, osmolality, and K

Question 10

Urinalysis of PSGN

Answer 10

RBC cast, mild proteinuria, ^ serum Cr

Question 11

PSGN clinical presentation

Answer 11

• Commonly in kids
• Hematuria
• HTN
• Periorbital edem

Question 12

Genetics of ARPKD

Answer 12

AR duh

Mutation in PKHD1 gene

Codes for fibrocystin (present in kidney and liver)

Question 13

Clinical findings of ARPKD

Answer 13

• Renal insufficiency
• Nephromegaly
• HTN

Dx: bilateral enlarged, echogenic kidneys on US

Associated w/ Potter sequence

Question 14

Potter sequence

Answer 14

• Flattened facies
• Limb deformities
• Pulm hypoplasia
• Oligohydramnios

HIGH mortality

Question 15

Pyelonephritis histo characteristics

Answer 15

• Massive interstitial infiltration
• PMNs in interstitium and tubular lamina
• Fever, hematuria

Question 16

Adverse rxn associated w/ Beta-lactam antibiotics?

Answer 16

• Fever
• Rash
• ARF

Drug-induced acute interstitial nephritis

Also - NSAIDs, sulfonamides, rifampin, diuretics

Question 17

Acute interstitial nephritis

Answer 17

• Peripheral eosinophilia and eosinophiluria

- Hypersensitivity

Question 18

Ramipril

Answer 18

ACEI

Question 19

Primase

Answer 19

DNA-dependent RNA poly

Incorporates short RNA primers into replicating DNA

Question 20

Frothy/foamy urine?

Answer 20

Caused by proteinuria => nephrotic syndrome

Question 21

Pts w/ MS and urinary issues

Answer 21

• Spastic bladder after developing acute lesion on spinal cord
• Increased urinary freq and urge incontinence
• Bladder hypertonia (UMN!!!)

Question 22

Where does majority of water reabsorption occur?

Answer 22

Proximal tubule

Passively w/ reabsorption of solutes

Question 23

Crescents in RPGN consist of which materials?

Answer 23

• Glomerular parietal cells
• Monocytes
• Macros
• ABUNDANT fibrin

Eventually become sclerotic, disrupting glomerular function => irreversible renal injury

Question 24

In acute transplant rejection, what is the humoral response?

Answer 24

• C4d deposition
• PMN infiltrate
• Necrotizing vasculitis

Question 25

In acute transplant rejection, what is the cellular response?

Answer 25

- Lymphocytic interstitial infiltrate | - Endotheliitis

Question 26

Acute hemolytic transfusion reaction

Answer 26

- Fever & chills - Hypotension - Dyspnea - Chest/back pain - Hemoglobinuria (red- to brown-colored urine) Occur w/in minutes/hours of starting a blood transfusion --- ABO incompatibility Ab-mediated (Type III) hypersensitivity reaction

Question 27

Type III hypersensivity

Answer 27

- IgM bind to Ag => complement activation - C3a and C5a cause vasodilation and sx of shock - Complement mediated cell lysis

Question 28

Urachus

Answer 28

- Yolk sac forms the allantois => extends into urogenital sinus => becomes bladder (5th-7th week) - Allantois becomes urachus after bladder formation => now duct between bladder and yolk sac

Question 29

Patent urachus

Answer 29

- Aka persistent allantois remnant - Connects umbilicus and bladder - Pts present w/ urine discharge from umbilicus - Exacerbated w/ crying, straining, voiding, prone position

Question 30

Vesicourachal diverticulum

Answer 30

- Failure to close part of urachus - commonly asymptomatic - Outpouching of bladder apex

Question 31

Urachial sinus

Answer 31

- Failure to close distal part of urachus - Presents w/ periumbilical tenderness and purulent discharge from persistent/recurrent infections - Adjacent to umbilicus

Question 32

Urachal cyst

Answer 32

- Failure of central portion of urachus to obliterate | - Fluid filled structure located between the two obliterated ends of urachus

Question 33

Vitelline duct

Answer 33

- Persistent yolk stalk - Connects small intestine w/ skin - Presents w/ meconium discharge from umbilicus - Incomplete obliteration => meckel diverticulum

Question 34

Proximal ureter blood supply

Answer 34

Renal artery

Question 35

Distal ureter blood supply

Answer 35

Superior vesical artery

Question 36

Urinary incontinence in pts w/ MS

Answer 36

- Develop urge incontinence due to loss of CNS inhibition of detrusor contraction in the bladder - Bladder can become atonic, dilated => overflow incontinence