Renal Flashcards

Question

What are the two forms of PKD (polycystic kidney dz)

Answer 1

* AR and AD

Answer 2

* infants * CP: worsening renal failure and HTN * newborns may present with Potter sequence * associated w/: * congenital heptaic fibrosis * leads to portal HTN * --and-- hepatic cysts

Answer 3

* young adults * CP: * HTN d/t increased RENIN * hematuria * worsening renal failure * PP: mut in APKD1 or APKD2 gene * cysts develop over time * assoc w/: * hepatic cysts * mitral valve prolapse (MVP) * berry aneurysm-COD

Answer 4

* AD defects leads to cysts in the medullary collecting ducts * parenchymal fibrosis results in shrunken kidneys and worsening renal failure

Answer 5

* acidosis stimulates renal ammoniogenesis which is a process by which: * renal tubular epithelial cells metabolize **glutamine to glutamate** * generate **ammonium** that is excreted in the urine * generate **bicarb** that is absorbed into the blood and **buffers acids** * renal ammoniagenesis is a process that is responsible for MAJORITY of renal acid excretion in chronic acidotic states

Answer 6

* half of acid secreted in the urine is in the form of ammonium * other half is excreted as titratable acids (espec inorganic phosphate)

Answer 7

IN ammonium production

Answer 8

* Ab are bound to a parasitic organism * stimulated eos will destroy parasite vie Ab-dependent cell-mediated cytotoxicity

using enzymes from their cytoplasmic granules

* eos also regulate type 1 HSR

Answer 9

* eosinophils * macrophages * neutrophils * NK cells

Answer 10

* easy fatigability (due to anemia) * constipation (due to hypercalcemia) * back pain (bone lysis d/t production of osteoclast-activating factor y myeloma cells) * elevated serum protein (monoclonal proteins) * azotemia/renal failure * epi: elderly pt *

Answer 11

large (glassy) eos casts composed of Bence-Jones (free light chains) proteins are seen in the tubular lumen in myeloma cast nephropathy

Answer 12

* XR * alpha-galactosidase A deficiency results in acumulation of globo-tria-osyl-ceramide

Answer 13

* neuropathic pain * angiokeratomas * telangiectasias * glomerular dz (eg proteinuria) * cerebrovascular dz (eg TIA, stroke) * cardiac dz (eg LVH)

Answer 14

* lipid storage d/o * alpha galactosidase A is a lysosomal enzyme that breaks down Gb3-/ceramide trihexoside a sphingolipid

Answer 15

* Gb3 accumulation in: * vascular smooth muscle cells * glomerular/distal tubule cells * cardiac myocytes * dorsal root and autonomic ganglia

Answer 16

* neuropathic pain and hypohidrosis (DEC sweating) present during adolescence. * late adolescence: angiokeratomas (dark red, non-blanching macule and papules, butt groin umbilicus) and telangiectasias develop on the skin * exercise, stress, fatigue=exacerbating factors

Answer 17

* cerebrovascular and cardiac dz=mc cod * also: Gb3 buildup in the glomerulus and distal tubules results in protein

Answer 18

* **diabetic autonomic neuropathy** is common in type 1 diabetics * it can cause overflow incontinence d/t inability to sense a full bladder and incomplete emptying * PVR (postvoid residual) testing with US or catherization can confirm inadequate bladder emptying

Answer 19

* loss of sensation in the perineal area * can indicate cauda equina syndrome--commonly d/t epidural cord compression from a malignancy * pts usually develop urinary retention late in the course of the disease-usually assocuated with fecal incontinence

Answer 20

* when tumors with a high cell turnover are treated with chemotherapy * lysis of tumor cells causes intracellular ions to be released into serum * prevent with: urine alkalinization and hydration * high urine flow and high pH along the nephron rpevents crystallization an dprecipitation of uric acid

Answer 21

* uric acid=metabolite of tumor nucleic acid * uric acid is soluble at physiologic pH * UA can precipitate in the normally acidic environment of distal tubules and collecting ducts

Answer 22

* can cause renal hypoperfusion and activation of RAA * modified smooth muscle (juxtaglomerular) cells of the afferent glomerular arterioles synthesize RENIN * leads to a cascade of effects that include systemic vasoconstriction (angiotensin 2) nd Na and water retention (aldosterone and angiotensin 2) * chronic renal hypoperfusion will cause hypertrophy and hyperplasia of the juxtaglomerular cells

Answer 23

* consists of macula densa and JG cells * MD-in distal tubule, monitor salt content and tubular flow rate * transmits info to nearby JG cells (**modified smooth muscle cells** with renin-containing zymogen granules) located mostly in wall of afferent arteriole

Answer 24

it auses the JG cells of the affected kidneys to undergo hypertrophy and hyperplasia

Answer 25

* even if contralat kidney fxn, secretion of renin by stenotic kid wil cause INC angiotensin 2 and aldosterone leading to systemic vasoCONSTRICTION and retention of salt and water by **BOTH KIDNEYS**

Answer 26

* bilat RAS: CKD * unilat RAS-will NOT have CKD, nml kideny can still efficiently filter and excrete waste products

Answer 27

* IgA nephropathy (Berger dz) * older kids and young adults * CP: painless hematuria within 5-7 days of an URTI * hematuria returns every few months, or with another URTI

Answer 28

* Ab against streptococcal antigens cross-react with GBM

Answer 29

* IF: C3 granular staining along GBM * EM: **SUB-EPITHELIAL HUMPS**

Answer 30

* Light microscopy: glomerular crescents * IF: **LINEAR STAINING (IgG)** along GBM

Answer 31

Ab vs. type 4 collagen in GBM

Answer 32

* SEVERE immunolgic injury (eg anti-GBM Ab, immune complex deposition)

Answer 33

* LM: glomerular **CRESCENTS** * IF: fibrinogen in crescent

Answer 34

* deposition of IgA-containing complexes

Answer 35

* LM: mesangial hypercellularity * **IF: IgA in mesangium**

Answer 36

* defective type IV collagen in GBM * EM: lamellated appearance of GBM

Answer 37

* signs of embolism: * blue toe, livedo reticularis (bilek legs) with nml peripheral pulses) * following an **invasive vascular procedure**: * angiography, angioplasty, aortic sx

Answer 38

PP: cholesterol-containing debris gets dislodged form larger arteries (the aorta during cardiac catheterization) and dislodges in smaller vessels=ischemia

Answer 39

* acute kidney injury (oliguria, azotemia) * frequently seen in elderly pts with pre-existing renal atherosclerosis * cholesterol is disolved during tissue prep for microscopic evaluation leaving needle-shaped clefts that partially or completely obstruct the arcuate or intrlobular renal arteries

Answer 40

* collecting system of the kidney: * collecting tubules and ducts * major and minor calyces * renal pelvis * ureters

Answer 41

* glomeruli * Bowman's space * proximal tubules * the loop of Henle * distal convoluted tubules

Answer 42

* common clinical and pathologic features * result in platelet activation and diffuse microthombosis in arterioles and capillaries * CP: hemolytic anemia with: * microangiopathic hemolytic anemia with schistocytes * thrombocytopenia * organ injury (brain, kidneys, heart)

Answer 43

* humoral components: IgE * cellular components: basophils and mast cells * examples: anaphylaxis and allergies

Answer 44

* humoral components: * IgG and IgM auto-Ab * complement activation * cellular components: * NK cells * eos * neutrophils * macrophages * examples: * auto-immune hemolytic anemia * Goodpasture syndrome

Answer 45

* humoral components: * deposition of antibody-antigen complexes * complement activation * cellular components: neutrophils * examples: * serum sickness * PSGN * lupus nephritis

Answer 46

* humoral components: NONE * cellular components: T-cells AND macrophages * examples: contact dermatitis and tuberculin skin test

Answer 47

M=Methanol U=Uremia D=Diabetic ketoacidosis P=Propylene glycol I=Iron tables, Isoniazid L=Lactic acidosi E=Ethylene glycol S=Salicylates(late)

Answer 48

H=hyperalimentation A=Addisons disease R=Renal Tubular Acidosis D=Diarrhoea A=Acetazolamide S=Spiranolactone S=Saline Infusion

Answer 49

* S: suprarenal (adrenal) gland * A: aorta/IVC * D: duodenum (second and third part) * P: pancreas (except tail) * U: ureters * C: colon (ascending and descending) * K: kidneys * E: (o)esophagus * R: rectum

Answer 50

* in placement of a suprapubic cystostomy, trocar and cannula will pierce the layers of the abdominal wall * will NOT enter the peritoneum

Answer 51

* Para-amino-hippuric acid is freely filtered from the blood in the glomerular capillaries to the tubular fluid in Bowmans space * some is also freely filtered by the glomerulus * PAH is NOT reabsorbed by any portion of the nephron * it is also secreted from the blood into the tubular fluid by the cells of the proximal tubule by a carrier protei-mediated process * PAH secretion can be saturated at high blood concentrations

Answer 52

* kids: mostly recover completely * adults: poor prognosis and higher r/o chronic HTN and renal insufficiency

Answer 53

* can be asymptomatic * if symptomatic (onset 1-3 wks after group A strep pharyngitis or skin infection): * gross hematuria (tea-/cola-colored urine) * edema (peri-orbital, generalized) * HTN

Answer 54

* UA: +protein, +blood, +/- RBC casts * serum: * DEC C3 and possible DEC C4 * INC: * serum Cr * anti-DNase B and AH-ase * ASO and anti-NAD (from preceding pharyngitis)

Answer 55

* the left kidney! * left 12th rib overlies the parietal pleura medially and the idney laterally

Answer 56

* 1-7=true ribs * costal cartilage attaches directly to the sternum * 8-12=false ribs * costal cartilage does NOT attach directly to the sternum * cartilage of ribs 8-10 attaches to the costal cartilage of the upper ribs * 11&12 are floating ribs=NOT bound to the anterior rib cage by cartilage

Answer 57

* antiphospholipid Ab syndrome is characterized by presence of ANTI-phospholipid Ab in the setting of venous or arterial thromboembolism AND/OR recurrant pregnancy loss * may be a primary d/o or occur secondary to other a.i dz such as SLE * antiphospholipid Ab are present in 10-30% of pts with SLE

Answer 58

* prolonged activated partial thromboplastin time (**aPTT**)--in vitro * false-positive results of nontreponemal serologic syphilis tests by reacting with **cardio-lipin** :

rapid plasma reagin (RPR)
VDRL

* in vivo--produce hypercoaguable state d/t activation of phospholipid-dependent coagulation pathways

Answer 59

* venous or arterial thromboembolic disease * DVT * PE * ischemic stroke/TIA * adverse pregnancy outcomes * unexplained embryonic or fetal loss * premature birth d/t placental insuficiency or pre-eclampsia

Answer 60

* **lupus anticoagulant** effect: paradoxical **aPTT prolongation** * not reverse on plasma mixing studies * presence of specific antiphospholipid antibodies * **ANTI-cardiolipin Ab** * **ANTI-beta2-glycoprotein-I Ab**

Answer 61

* albumin loss with minimal loss of the more buky proteins (such as IgG and macroglobulin)

Answer 62

* barrier: glomerular capillary wall * 3 components: * fenestrated endothelium * GBM (glomerular basement membrane) * epithelial cells * selective to **size and charge**

Answer 63

* size selectivity is a features of the dimensions of the pores * endothelial cells: fenestrations with 40nm raidus * GBM pores: 4nm radius * also: slit diaphragms

Answer 64

* provided by negtively charged anions on endothelial cells and the GBM * repel negatively charged molecules (such as albumin) * albummin is small enough to fit through GBM pores

Answer 65

* assoc w/ presence of LMW proteins: * beta 2-miroglobulin * immunoglobulin LC * AA * retinol-binding protein * they are normally filtered by the glomerulus and almost completely reabsorbed in the proximal tubule * appear in urine when proximal tubular fxn is disrupted (ex: tubulointerstitial nephritis)

Answer 66

* decreased serum pH and HCO3- * compensatory decrease in pCO2 * kidneys try to correct metabolic acidosis via 3 major mechs: * INC HCO3 reabsorption * INC H+ secretion * INC acid buffer excretion

Answer 67

* UTI causes by typical and opportunistic organisms * typical: * E coli * Klebsiella * S. saprophyticus * Proteus mirabilis * opportunistic: * Pseudonomas

Answer 68

* ADH acts on the medularry segment of the CD to INC urea and water rebsorption, allowing for the production of maximally concentrated urine

Answer 69

* ADH/V is the primary physiologic INHIBITOR or free water EXCRETION (stay here, mufuh) * V1R stimulation: vasoconstriction and INC PG release * V2R stimulation: anti-diuretic response * ADH is secreted in resp to plasma HYPER-osmolarity and (to a lesser extent) depletion of the ECV

Answer 70

* medullary interstitium of the collecting duct * here, ADH increases the number of passive urea transporters=highly concentrated urea diffuses down its concentration gradient

Answer 71

* binds to the immunophilin FK-506 binding protein (FKBP) in the cytoplasm * forms a complex that binds and inhibits mTOR * inhibition of mTOR signaling blocks IL-2 signal transduction and prevents cell cycle progression and lymphocyte proliferation

Answer 72

* sodium retention (direct effect) * aldosterone production * vasoconstriction

Answer 73

* elderly d/t atherosclerotic changes in the arterial intima * women of childbearing age d/t fibromuscular dysplasia * HT and abdominal bruit are often present

Answer 74

* most concentrated at the jxn between the descending and ascending limbs of the loop of Henle * most dilute in the collecting ducts

Answer 75

* stress, urge, overflow

Answer 76

* most common form, typically after 45 * 2x as common in women b/c EUS trauma or pudendal nerve (innervated EUS) injury is common d/r vaginal child birth * etiology: * loss of urethral support and intra-abdo pressure\>urethral sphincter pressure * symptoms: * leaking with coughing, sneezing, laughing and lifting (all INC abdo pressure)

Answer 77

* etiology: detrusor over-activity * symptoms: overwhelming, or frequent need to empty bladder

Answer 78

* etiology: impaired detrusor contractility and bladder outlet obstruction * symptoms: constant involuntary dribbling of urine and incomplete emptying

Answer 79

* internal: mainly smooth muscle, controlled by autonomic nervous system * sym=contraction, PS=relaxation * external: mostly pelvic floor skeletal muscl under voluntary control

Answer 80

* bladder emptying-mainly d/t detrusor muscle contraction * continence-maintained by urethral (mainly external) sphincters * d/r bladder filling: sympathetic activation closes the internal sphincter and **inhibits detrusor contraction**

Answer 81

* higher glomerular hydrostatic pressure

Answer 82

* INC bowmans capsule hydrostatic pressure * --or-- * higher glomerular capillary oncotic pressure

Answer 83

* GFR:RPF ratio; the portion of the RPF that is filtered form the glomerular capilaries into bowman's space * acute ureteral constriction or obstruction decreases the GFR and FF

Answer 84

1. S. haema-tobium 2. S. man-soni 3. S. japon-icum

Answer 85

* location: * N. Africa, SSA, ME * symptoms: **Urinary schisto** * terminal hematuria, dysuria, frequent urination * hydronephrosis, pyelonephritis, squamous cell carinoma of the bladder

Answer 86

* location: SSA, ME, SA, Caribb * **Intestinal Schisto** * Symptoms: * diarrhea and abdo pain * intestinal ulceration--\>iron deficiency anemia

Answer 87

* location: Asia (\*China, also: Phillipines, Japan) * **hepatic schisto** * symptoms: * hepato-spleno-megaly * peiportal fibrosis and subsequent portal HTN

Answer 88

dog tapeworm *Echino-coccus granulosus*

Answer 89

* urinary tract anomaly * anuria/oliguria in utero (classic finding: bilat renal agenesis) * oligohydramnios (severely reduced amniotic fluid) * pulmonary hypoplasia (d/t lack of nml alveolar distension by aspirated amniotic fluid), flat facies, limb deformities (club feet)

Answer 90

* mc c/o ESRD in the US * moderately INC albuminuria (\<300mg/day) is the earliest manifestation of diabetic nephropathy

Answer 91

* tobacco smoke * obesity

Answer 92

* dietary nitrates * alcohol and tobacco use * H. pylori

Answer 93

* Hep B and C * liver cirrhosis (any cause) * hemochromatosis * aflatoxin

Answer 94

* hereditary CRC syndromes * IBD * obesity * charred or fried foods

Answer 95

* tobacco smoke * obesity * HTN

Answer 96

* tobacco smoke * occupational exposures * rubber * aromatic amine-containing dyes * textiles * leather

Answer 97

* early menarche * late menopause * nulliparity * BRCA mutations

Answer 98

* INC age * negussss

Answer 99

WBC casts only form in the renal tubules and are pathognomonic for acute pyelonephritis when accompanied by s/s of acute UTI

Answer 100

* constriction of EFFERENT will IMPEDE blood flow through the kidney * will DEC RPF * INC glomerular capillary hydrostatic pressure as the fluid "backs up" in the glomerulus * increased glomerular hydrostatic pressure will cause an INC in the FF

Answer 101

* volume of plasma that is delivered to the kidney per unit time * provided by the renal blood flow-delivers BOTH erythrocytes and plasma to the kidney * clinically calculated by PAH clearance

Answer 102

* can cause **regional or generalized interstitial edema** b/c the DEC in *serum albumin* and total protein concentrations *lowers* the plasma oncotic pressure and INC net plasma filtration in capillary beds

Answer 103

* vomiting/nasogastric suctioning * thiazide/loopdiuretic use * --they cause volume and Cl- depletion

Answer 104

* excess mineralcorticoid activity: * primary hyperaldosteronism * Cushing dz * ectopic ACTH production

Answer 105

* proximal tubule passively with the reabsorption of solutes

Answer 106

THICK and thin ascending limbs of Henle's loop

Answer 107

Bowman's space

Answer 108

* remnant of the allantois that connects the bladder with the yolk sac d/r fetal development * failure of urachus to obliterate at birth=patent urachus * patent urachus can facilitate discharge of urine form the umbilicus!! * excerbated by crying, straining, or prone position * local skin irritation can cause erythema

Answer 109

PRIMASE-DNA dependent RNA polymerase

Answer 110

DNA ligase

Answer 111

* when GFR is nml, relatively large decreases in GFR result in only small increases in serum Cr * when GFR is significantly DEC, small decrements in GFR produce relatively large changes in serum creatine (an L shape ona graph: GFR x-axis, SCr y-axis) * \*\*every time **GFR halves**, **SCr doubles**

Answer 112

hyperacute, acute, chronic

Answer 113

* onset time: minutes to hours * etiology: **preformed** Ab vs. graft in recipient's *circulation* * morphology: * gross mottling and cyanosis * **arterial** fibrinoid _necrosis_ *and* **capillary** thrombotic _occlusion_

Answer 114

* onset time: usually \<6 months * Etiology: exposure to donor Ag induces humoral/cellular activation of naive immune cells * Morphology * ***Humoral***: * **C4d** deposition * **neutrophilic** infiltrate * necrotizing vasculitis * ***Cellular***: * **lymphocytic** interstitial infiltrate * endotheliitis

Answer 115

* onset time: months to years * etiology: *chronic low-grade* immune response refractory to immunosuppressants * morphology: * vascular **wall thickening** + **luminal narrowing** *(ying and yang)* * interstitial **fibrosis** + parenchyma **atrophy**

Answer 116

* pts with MS often develop a spastic bladder a few wks after developing an acute lesion of the SC * CP: INC urinary frequency and urge incontinence * urodynamic studies: bladder hypertonia

Answer 117

* typically occurs in the setting of LMN lesions (cauda equina syndrome) * pt w/ flaccid bladder will have a large residual volume of urine after attempted emtying and will typically experience urinary incontinece at the end of the day * pressure from a full bladder becomes greater than urinary sphincter pressure

Answer 118

frequent episodes of urinary incontinence throughout the day d/t urgency

Answer 119

* common organisms: N. gonorrhoeae and C. trachomatis * symptoms: * pain or buring sensation d/r urination * --or-- frequent urination * Lab: UA +WBC

Answer 120

* Common organisms: * E. coli * S. saprophyticus * P. mirabilis * Klebsiella * Enterococci * symptoms: * may by asymptomatic or symptomatic * suprapubic pain and tenderness * frequent urination * UA&Micro: * +Leukocyte esterase * +Nitrites * +bacteria * +WBC * +RBC (occasionally)

Answer 121

* common organisms (same as cystitis): * E. coli * S. saprophyticus * P. mirabilis * Klebsiella * Enterococci * symptoms: * flank pain * costovertebral angle tenderness * fever * chills * hematuria with casts * UA&Micro: * same findings as in cystitis [+Leukocyte esterase, +Nitrites, +bacteria, +WBC, +RBC (occasionally)] * may also see WBC casts indicating renal-based pyuria * CBC: elevated WBC

Answer 122

* AUG codon initiates * UAA, UAG, UGA codon halts protein synthesis

Answer 123

* PP: caused by retrograde urine flow into the ureter * hydrostatic pressure of refluxing urine along with infections d/t ascending bacteria causes inflammation * compound papillae in the upper and lower poles of the kidney are most susceptible to reflux-induced damage * gross: dilated calyces and overlying renal cortical scarring

Answer 124

* h/o recurrent fever * abdominal pain * imaging findings with renal scarring

Answer 125

* nml: ureters travel through bladder wall at an oblique angle * when bladder fills intramural ureter becomes compressed * flap-valve mechanism prevents retrograde flow of urine * with VUR (vesico-ureteral reflux), FV mech is fucked because the ureter enters the bladder at a more perpendicular angle

Answer 126

* higher risk for chronic pyelonephritis * if uncorrected, can lead to loss of nephrons and secondary HTN

Answer 127

FF=GFR/RPF RPF=RBF\*(1-HCt)

Answer 128

* DEC arterial pressure * DEC RPF (DEC glomerular hydrostatic pressure) * DEC GFR (DEC NaCl reaching macula densa) * afferent arteriolar dilation AND (via RAS activation) efferent arteriolar constriction * restoration of GFR and INC FF

Answer 129

* microangiopathic hemolytic anemia (MAHA) * with schistocytes * thrombocytopenia * acute kidney injury

Answer 130

* major cause of acute renal failure in young kids * most cases d/t: intestinal infection by Shiga toxin (verotoxin)-producing organisms

Answer 131

* shiga toxin (vero-toxin)-producing organisms * toxins injure the endothelium of preglomerular arterioles and glomerular capillaries * leads to platelet activation and aggregation and the formation of microthrombi

Answer 132

* Bowmans capsule: 100% * proximal tubule: 35% * THICK ascending loop: 10% * collecting duct: 110%

Answer 133

* High extracellular K levels * INC aldosterone * alkalosis * volume expansion, high sodium intake, or diuretic use (thiazide and loop diuretics)=INC fluid flow through the distal tubule, quickly flush away secreted K

Answer 134

* inadequate canalization of the URETERO-pelvic jxn, the connection site between the kidney and the ureter * undiagnosed NBN CP: palpable abdominal mass reflecting an enlarged kidney

Answer 135

* produced by helper T cells * stimulates the growth of CD4+ and CD8+ T cells and B cells * activates NK cells and monocytes * INC activity of T cells and NK cells gives IL-2 its ANTI-cancer effect on metastatic melanoma and RCC

Answer 136

* AR * lack of homogentisic acid dioxygenase blocks the metabolism of tyrosine * leads to an accumulation of homogentisic acid * CP: * black urine color when exposed to air * blue-black pigmentation on the face * ochronotic arthropathy

Answer 137

* aldosterone antagonist (along with sprinolactone--S and E of SEAT) * can be used as medical therapy for Conns syndrome

Answer 138

* CP: * HTN * hypokalemia * metabolic alkalosis * DEC plasma renin activity * aldosterone causes: * resorption of sodium and water + wasting of K and H ions at distal nephron=hypokalemia and alkalossis * will also suppress renin activity as pt of a feedback inhibition loop

Answer 139

* AcoD * affects lung and liver * alpha-1 anti-trypsin=serum protein (produced mostly in liver) * inhibits neutrophil elastase (and other proteolytic enzymes), so reduces tissue damage caused by inflammation * Histo: reddish-pink, PAS positive granules of unsecreted, polymerized AAT in the periortal hepatocytes

Answer 140

* stimulation of sympathetic nervous system an the RAA system * a1 to a2 by endothelial-bound ACE in lungs * a2: * systemic vasoconstriction to INC bp * efferent arteriolar vasoconstriction to maintain GFR

Answer 141

* massive proteinuria (\>3.5g/day adults, \>40mg/m2/hr in kids) * hypO-albuminemia (\<2.5g/dL) * generalized edema * hyperlipidemia * lipiduria

Answer 142

1. INC permeability of the clomerular capillary wall to plasma proteins leas to massive urine protein loss (mostly albumin, sometime globulins) 2. drop in colloid osmotic pressure in blood, fluid moves into interstitial tissue=EDEMA 3. fluid shift=depeltion of intravascular volume=DEC renal perfusion pressure--\>triggers RAA=aldo syn and Na retention (and water)=exacerbates edema 4. liver increases protein syn (incuding lipoproteins) 5. lipiduria

Answer 143

* CP: * fever * maculopapular rash * symptoms of ARF * 1-3wks after beginning tx with: beta-lactam B or other * Clinical clues: peripheral eosinophilia and eosinophiluria * symptoms resolve completely after cessation of the offending medication * glomeruli are usually spared

Answer 144

commonly damaged in hypertensive or diabetic nephropathy

Answer 145

in conditions such as SLE and HSP; can cause a proliferative glomerulonephritis characterized by INC glomerular cellularity

Answer 146

* AD d/o * results in GOF mut inthe FGFR gene * most infected indivs are heterozygous and have 50% chance of transmitting mut to their offspring (Punnett squarezzz)

Answer 147

* tx: IV nml saline and insulin * they INC bicarb and Na and DEC serum glucose, osmolality, and K

Answer 148

ATN (acute tubular necrosis)

Answer 149

* TF with a critical role in the immune response to infection * (upregulates transcription of G-CSF and TNF-alpha) * normally present in the cytoplasm in a latent, inactive state bound to its inhibitor protein IKB * extracellular substances such as LPS can initiate a signal cascade that results in the destruction of IKB and translocation of free NFKB to the nucleus

Answer 150

* TK involved in the signalling PW for myeloproliferation * constituent activation is assoc w: * polycythemia vera * essential thrombocytosis * myelofibrosis * does not play a major role in the immune resp to infection

Answer 151

* common electrolyte disturbances d/t INC in distal tubular membrane permeability: * hypO-kalemia * hypO-Mg

Answer 152

* Ampho B and its nephrotoxicity * d/t DEC in GFR and direct toxic effects on the tubular epithelium * tox can lead to anemia (DEC EPO production) and electrolyte abnormalities

Answer 153

thich and thin ASCENDING LoH

Answer 154

descending limb of the LoH

Answer 155

* mc cause: defect in cystathionine synthase * inability to form cysteine from HOMO-cysteine * cysteine becomes essential in affected pts * HOMO-cysteine buildup leads to elevated methionine * HOMO-cysteine is PRO-thrombic...results in premature thromboembolic events : * atherosclerosis * acute coronary syndrome

Answer 156

relieve intraocular pressure in open-angle and angle-closure glaucoma

Answer 157

* peripheral vasculature * lung * bladder * eyes * GI * skin

Answer 158

* Furosemide, Torsemide, Bumatenide, Ethacrynic acid * MOA: inhibit Na-K-2Cl cotransporter in THICK ascending LoH

Answer 159

* electrolyte abnormalities: * hypO-kalemia * metabolic ALK-alosis * hypO-calcemia * Ci: volume-overloaded states (CHF)

Answer 160

* **Hydrochlorothiazide** (*HOT*), Chlorthalidone, Indapamide, Metolazone * inhibits the Na-Cl cotransporter in the *early DCT*

Answer 161

* electrolytes: * hypO-natremia * **hypO-kalemia** * metabolic alkalosis (HYPER-uricemia) * **HYPER-calcemia** * Ci: * HTN * Ca nephrolithiasis prophylaxis

Answer 162

inhibit CA enzyme in the proximal tubule (ALL)

Answer 163

* refractory metabolic ALK-alosis * intracranial HTN

Answer 164

* sodium channel blockers and mineralcorticoid receptor antagonists * ci: often used in synergy with loop and thiazide diuretics to limit potassium loss

Answer 165

* Amiloride and Triamterene (AT of SEAT) * MOA: inhibit the apical ENac channel in the cortical CD

Answer 166

* Spironolactone and Eplerenone (SE of SEAT) * used in synergy with loop and thiazide diuretics to limit K loss

Answer 167

* reduce A2=cause EFFERENT arteriole dilation=DEC glomerular pressure and filtration rate * can precipitate acute renal failure in pts with reduced intrarenal perfusion pressure (...eg..: * renal artery stenosis (RAS) * CHF * hypO-volemia * chronic renal dz

Answer 168

* can cause an acute rise in sCr by blocking angiotensin mediated efferent arteriole vasoconstriction * leads to a reduction in renal FF * in pts dependent on EFFERENT arteriole constriction to maintain renal perfusion (those with RAS), ACEi can be detrimental by precipitating ARF

Answer 169

* loop diuretics stimulate renal PG release * this INC RBF, leading to INC GFR and enhanced drug delivery * concurrent use of NSAIDS with loop diuretics can result in a decreased DIURETIC response

Answer 170

* important mediator in the bodys inflamm response * peptide that stimulate pain, vasodilation, and INC vascular permeability

Answer 171

Spironolactone

Answer 172

* requires collab of multiple disciplines: * physician * nurse * social worker * SW can be instrumental in assessing whether the pt has adequte family or caregiver support at home

Answer 173

* it is neither secreted NOR reabsorbed by the renal tubules * filtered amount=excreted amount

Answer 174

* renal calculi occur when there is an ambalance of the factors that facilitate and prevent stone formation * INC concentrations of the following promote salt crystallization: * calcium, phosphate, oxalate, UA * **INC citrate and high fluid intake** help prevent calculi formation

Answer 175

* HIGH urine citrate binds to free (ionized) calcium, thus preventing its precipitation and facilitating its excretion * K citrate is often prescribed to prevent recurrent calcium stones in adults when dietary modifications are unsuccessful

Answer 176

* proximal tubular cell ballooning an vacuolar degeneration in a pt with acute RF=ATN * oxalata crystals in the tubular lumen is suggestive of ethylene glycol poisoning * EG found in antifreeze (and fireball, yummm) * EG rapidly absorbed from GI tract, metabolized to glycolic acid which is toxic to renal tubules and oxalic acid which precipitate as ca-oxalate crystals

Answer 177

* symptoms of ethanol intoxication * signs of acute renal failure 24-72 hr after ingestion: * oliguria * anorexia * flank pain * high AG metabolic acidosis and osmolar gap are typically seen * UA: tubular casts and oxalate crystals * LM: morphologically nml glomeruli with proximal tubular necrosis

Answer 178

avoid the use of unsafe abbreviations and trailing zeros in medication orders

Answer 179

* proximal ureter-branches of renal artery * distal ureter-superior vesical artery * in between-anastomic, highly variable, possible afferent branches from gonadal, common and internal iliac, aorta, uterine arteries

Answer 180

* native kidney are left in place, donor is placed retroperitoneally in the right iliac fossa * establish blood supply by anastomosing donor renal artery with the recipients external iliac artery * most distal pt of the ureter may be susceptible to ischemia d/t lack of anastomotic connections * leakage of urine 5-10 days following transplant

Answer 181

* malformation characterized by a spectrum of fetal anomalies d/t incomplete division of the forebrain (or proencephalon) * [malformation=primary, intrinsic defect in the cells or tissues that form a structure leading to a chain of downstream anomalies]

Answer 182

* fetal structural anomalies that occur d/t extrinsic mechanical forces * m/c: pressure applied by the uterus

Answer 183

* secondary breakdown of a previously nml tissue or structure * Ex: rupture of the amnon d/r fetal development may produce amniotic bands which can compress or amputate fetal limbs

Answer 184

* occurs when a number of abnormalities result from a single primary defect * ex: oligohydramnios causing Potter sequence etc

Answer 185

* presbyopia and skin wrinkles * presbyopia: d/t denaturation of structural proteins within the lens * leads to loss of lens elasticity * skin (rhytides) wrinkles: d/t DEC synthesis (DEC fibroblasts) and INC breakdown of collagen and elastin * with age, skin becomes atrophic, fragile, LESS elastiity, LESS subdermal fat * dermal and epidermal thinning * flatteing of dermoepithelial jxn

Answer 186

* vasopressin (ADH) and desmopressin (DDVAP-synthetic ADH analogue) cause a V2 receptor-mediated INC in water and urea permeability at the INNER medullary COLLECTING DUCT * resulting rise in urea reabsorption (**DECreased urea clearance**) enhances medullay osmotic gradient--\>allows production of **maximally concentrated urine**

Answer 187

* majority of filtered calcium is passively absorbed in the proximal tubule and ascending LoF * further ca reabsorption by the distal and collecting ducts is stimulated by parathyroid hormone

Answer 188

* aka clear cell carcinoma * mostly originate from epithelial cells of the proximal renal tubules * mc type of kidney tumor * HIGH lipid content * gross: golden ylw mass * LM: large, rounded, polygonal cells with abundant clear cytoplasm and eccentric nuclei * detected incidentally at an advanced stage * mc site for mets: LUNGS

Answer 189

* responsible for 90% of the tumors involving the renal pelvis * arises from renal pelvis lining * tends to multifocal in nature * often forms papillary tumors composed of urothelium supported by a thin fibrovascular stalk

Answer 190

* v. rare tumors * originate from CD cells * oncocytes=lage, well-differentiated neoplastic cells * contain numerous mitochondria

Answer 191

* AR d/o * PP: defective transportation of cystine, ornithine, arginine, and lysine across the intestinal and renal tubular epithelium (COLA shares a common transporter in the intestinal lumen and kidneys) * clinical manifestation: recurrent nephrolithiasis * UA: pathognomonic hexagonal cystine crystals

Answer 192

* frequency: 70-80% * ca oxalate-micro: octahedron (square with an X in the ctr) * ca phosphate-micro: * elongated, wedge-shaped * forms rosettes * pH\>7 * both: HIGH radiograph opacity

Answer 193

* Magnesium ammonium phosphate (struvite or triple phosphate) * freq: 15% * high radiography opacity * pH\>7 * micro: rectangular prism (coffin lids)

Answer 194

* freq: 5% * pH\<7 * micro: ylw or red-brown diamond or rhombus

Answer 195

* freq: 1% * pH\<7 * micro: flat, ylw HEX-agonal

Answer 196

* Chlor-Thalidone..but also has more associated metabolic abnormalities * significant hypO-kalemia can cause muscle weakness, cramps, and possible rhabdomyolysis

Answer 197

* white ppl live in MN * idiopathic MN is assoc w/ circulating IgG4 Ab to the phospholipase A2 receptor * may play a role in the development of the dz * The M-type PLA2R is a transmembrane R found in high concentrations in glomerular podocytes

Answer 198

* CP: HYPEr-phosphatemia, secondary HYPER-parathyroidism, and DEC calcitriol levels * pts can be asymptomatic or develop weakness, bone pain, and fractures

Answer 199

* HSP-Henoch-Schonlein purpura * affects boys 2-10yo * often preceded by viral or streptococcal URTI * symptoms develop a few wks after the associated illness resolves * PP: Ag from the infection stimulates production of IgA Ab and IgA-containing immune complexes then deposit in vessel walls, induce inflamm rxn * --IgA-mediated leukocytoclastic (hypersensitivity) vasculitis

Answer 200

* **GI tract**-intermittent severe abdo pain, uppper and lower GI bleed, INC r/o intussusception * **Kidneys**-similar to IgA nephropathy in Berger dz...mesangial proliferation and crescent formation * **Skin**-palpable purpura on butt and lower extrmeities, d/t leukocytoclasis of cutaneous vessels * **Joints**-self-limited migratory arthralgias and arthritis; m/c seen in large jts of lower extremities (ankles, knees)

Answer 201

* a. swollen LN and red eyes * b. other s/s: high fevers, strawberry tongue, perioral erythema and fissuring, periungual desquamation

Answer 202

* canbe asymptomatic * if symptomatic: * gross hematuria (tea-/cola-colored urine) * edema (periorbital, generalized) * HTN

Answer 203

* most common cause: idiopathic HYPER-calciuria! * characterized by: * **nml sCa with HYPERcalcuria** * other RF: * HYPER-oxaluria * HYPER-uricosuria * low urine volume * HYPO-citraturia

Answer 204

* Net tubular SECRETION * excreted amt\>\>filtered amt..more gets added to the shit that has already been filtered

Answer 205

* net tubular reabsorption * excreted amt\<

Answer 206

* PP: anti-GBM Ab that react with a component of the alpha3-chain of collagen type IV * \*\*GBM is composed of TYPE FOUR * CP: rapidly progressive glomerulonephritis resulting in acute RF and hemoptysis d/t pulmonary hemorrhage * LM: crescent formation * anti-GBM Ab cross-react with other basement membranes, especially those in the lung alveoli=pulmonary hemorrhage (hemoptysis)

Answer 207

* straining on urination in an elderly male suggests BOO (bladder outflow obstruction) * BOO usually d/t prostate enlargement * m/c cause: BPH * as bladder outlet obstruction worsens, pts experience a sensation of incomplete bladder emptying * usually signifies urinary retention * overflow incontinence=next clinical stage

Answer 208

* combo of epithelial and stromal hyperplasia * predom in peri-urethral and transition zones * on palpation: rubbery consistency (vs. prostate ca nodular and firm) * leads to intermittent BOO and overflow incontinence * urinary rtention results in INC pressure in urinary tract and resultant reflux nephropathy * ultimately: hydronephrosis and renal interstitial atrophy and scarring * prolonged obstruction: permanent damage and chronic renal failure

Answer 209

* ototoxicity occurs with higer dosages * usually reversible * other ototoxic agents: aminoglycosides, salicylates, cisplatin

Answer 210

* **Anti-GBM** RPGN * liner GBM deposits of IgG and C3 found on IF * some pts: anti-GBM Ab cross-react with pulmonary alveolar BM=pulmonary hemorrhages (Goodpasture syndrome) * **IC** RPGN * "lumpy bumpy" granular pattern of staining for Ab (IgG & IgA) and complement on IF microscopy * can be a complication of post-strep GN, SLE, IgA nephropathy, or HSP * **pauci-immune** RPGN * no BM deposits * ANCA in serum * assoc w/: granulomatosis w/ polyangitis or microscopic polyangitis

Answer 211

* LOOP DIURETICS * MOA: inhib Na-K-2Cl cotransporter in the medullary and cortical thick ascending limb of LoH--\>INC Na, Cl, and H20 excretion * Ci: used as first-line for rapid relief of symptoms in pts with acute decompensatd HF

Answer 212

* beta-adrenergic blocking dx INHIBIT renin release by blocking Beta-1 receptor-mediated regulation of the RAAS * =reduced plasma renin activity * =reduction in A1, A2, and aldosterone levels * (RAA is all: omg lets INC bp...beta blockers are all: simmer tf down)

Answer 213

* macula densa (distal tubule sodium sensor) * intrrenal baroreceptors * beta-adrenergic receptors * mediated through sympathetic stimulation of beta-1 receptors on JG cells * have no affect on ACE activity=do NOT affect bradykinin levels

Answer 214

* medication-related falls are a common problem in elderly nursing home pts * optimal management should include careful me review AND discontinuation of agents assoc w/ INC fall risk

Answer 215

* begins with ligand-receptor binding and Gq-protein activation * **exchange of GDP for GTP** on the alpha-subunit of Gq * Gq alpha subunit conformation change leads to activation of **phospho-lipase C (PLC)** * PLC hydrolyzes phos-phatidyl inositol bisphosphate **(PIP2)** and forms diacylglycerol **(DAG)** and inositol triphosphate **(IP3)** * finally: IP3 activates Protein kinase (PKC) via an INCREASE in intracellular Ca2+

Answer 216

* alpha-1 adrenergic * M1 and M3 cholinergic * V1 (vasopressin) * H1 (histamine) * oxytocin * Angiotensin 2 * TRH * GnRH

Answer 217

* prevent conversion of A1 to A2 * leads to DEC levels of A2 and aldosterone * INC plasma renin and A1 d/t inhibition of negative feedback (inhib the inhibitors) * INC level of bradykinin (ACE is a kininase, degrades bradykinin) * responsible for coughing seen in treted pts

Answer 218

* block the action of A2 on AT1 receptors * leads to INC levels of renin and A1&A2 * no effect on bradykinin levels

Answer 219

* appropriate glycemic and bp control * ACEi and A2RB are the preferred anti-hypertensive agents d/t their bp-INDEPENDENT antiii-proteinuric effects

Answer 220

* pts with CKD may develop renal osteodystrophy (abnormal bone path) from secondary hyperparathyroidism (caused by hyper-phosphatemia and hypo-calcemia)

Answer 221

* result of Lithium's antagonizing effect on the action of vasopressin on *principial cells* within the *collecting duct system* * s/s: * psych hx+polydipsia, polyuria, inappropriately low urine specific gravity after 8hr of water restriction * Li reduces the ability of the kidneys to concentrate urine by antagonizing the action of vasopressin (ADH) in collecting duct and tubules * can be permanent if yrs of chronic use

Answer 222

* Down syndrome * meiotic NON-disjxn * assoc w/: * DEC maternal alpha-fetoprotein * INC nuchal translucency (via US) * mc gi complication: duodenal atresia * CP: first few days w/ bilious emesis and DOUBLE-BUBBLE sign

Answer 223

* epicanthic folds (eyes) * upslanting palpebral features * low-set small ears * flat facial profile * short neck with excess skin * furrowed tongue * sandal-toe deformity * hypoplastic incurved 5th finger * single transverse palmar crease * brushfield spots

Answer 224

* pts with evidence of diffuse atherosclerosis may have bilat RAS * GFR is therefore dependent on A2-mediated efferent arteriolar vasoCONSTRICTION * ACEi or A@RBs cause efferent arteriolar vasoDILATION that causes the GFR to fall and may lead to the development of acute renal failure

Answer 225

* primry HYPER-parathyroidism (--\>hyper-**calciuria**) * Crohn dz (--\>hyper**oxaluria**) * distal RTA (--\> hypo**citraturia**) * gout (--\>hyper**uricosuria**)

Answer 226

* low fluid (dehydration) * low calcium * high oxalate (spinach, rhubarb) * high protein * high sodium * high fructose

Answer 227

* initiation * maintenance (oliguric) * recovery: re-epithelization of tubules

Renal Flashcards

(253 cards)