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Renal
FA review Round 1 2020
| Question | Answer |
|---|---|
| What cancer is associated with Paraneoplastic syndrome of Inappropriate ADH production? | Small Cell carcinoma |
| Which paraneoplastic condition is associated with Small Cell carcinoma? | SIADH |
| On which receptors does ADH act upon? | V1 and V2-receptors of the renal collecting tubules |
| What is the action of ADH on V1-receptors? | Stimulation of vascular smooth muscle to cause contraction |
| What is the action of ADH on V2-receptors? | In DCT and Collecting duct cells to increase water reabsorption via increased luminal aquaporin density |
| Which receptor, V1 or V2, cause vascular smooth muscle contraction upon actions ADH? | V1-receptors |
| Which receptor, V1 or V2, increase water reaborosion in the DCT and collecting duct cells by increasing aquaporin density? | V2-receptors |
| What is the cause of BPH? | Hyperplasia of prostate transitional zone tissue |
| Which zone of the prostate is enlarged in BPH? | Transitional zone |
| What factor is associated with development of BPH? | Increasing age |
| What enzyme is activated the Vasopressin and V2-receptor binding? | Adenylyl cyclase |
| What is the ultimate result of the activation of Adenylyl cyclase by vasopressin binding to V2-receptors? | Increased reabsorption of water |
| What is the definition of Filtration fraction (FF)? | Fraction of renal plasma flow that is filtered across the glomerular capillaries into the Bowman |
| FF = | GFR ----------------------------- RBF (1-hematocrit) |
| GFR ------ RPF | FF |
| What is the result of increased PTH in CKD patients? | Reduction in phosphate excretion |
| What are the effects of HR, TPR, Renin, and Vasopressin due to hypovolemia? | Increase in all those RAAS aspects |
| What is the most common Carbonic anhydrase inhibitor? | Acetazolamide |
| Acetazolamide induced metabolic acidosis or metabolic alkalosis? | Metabolic acidosis |
| What is the immediate compensation to metabolic acidosis? | Increased respiratory drive |
| Which diuretic is known to treat Acute Mountain Sickness? | Acetazolamide |
| What conditions are known to be treated with Acetazolamide? | 1. Acute Mountain sickness 2. Altitude sickness 3. Metabolic alkalosis 4. Glaucoma 5. Idiopathic intracranial hypertension |
| What type of diuretics is used to treat and prevent Calcium kidney stones? | Thiazides |
| What is the typical lab measure or condition, that immediately should raise suspicion of a calcium renal calculi? | Idiopathic hypercalciuria |
| What are the urine and serum C2+ levels in Idiopathic hypercalciuria? | 1. Elevated urine calcium 2. Normal serum calcium |
| What is the normal range of Urine Calcium levels? | 100-300 mg/day |
| Which renal function measure is measured with Inulin clearance? | GFR |
| Why is inulin clearance a good estimate for GFR? | It is freely filtered (inulin) |
| Overestimation of GFR is due to : | Compound used to measure GFR is secreted in the PCT |
| If a compound used to measure GFR gives an underestimation, means that: | It is not Freely filtered |
| What type diuretic is Furosemide? | Loop diuretic |
| What is Furosemide clinical use? | 1. Symptoms of CHF 2. Acute pulmonary edema |
| Furosemide is contraindicated in: | Patients with HYPOCALCEMIA |
| Furosemide is CI in patients with Hypo- or Hypercalcemia? | Hypocalcemia |
| What is the effect of Prostaglandins in glomerular filtration? | Dilate Afferent arteriole |
| Which arteriole is prefered by Prostaglandins, afferent or efferent? | Afferent |
| What medications cause inhibition of prostaglandin action in the Afferent arteriole? | NSAIDs |
| NSAID use causes what in the renal arterioles? | It causes CONSTRICTION in the Afferent arteriole |
| Which arteriole is preferred by NSAIDs, afferent or efferent? | Afferent |
| Which article is preferred by AT II, afferent or efferent? | Efferent |
| Which arteriole is preferred by ACE inhibitors, afferent or efferent? | Efferent |
| What is the effect on glomerular arterioles by ATII? | Constric Efferent arteriole |
| Which medications inhibit the actions of AT II on the Glomerular efferent arteriole? | ACE inhibitors |
| What are some common NSAIDS? | Ibuprofen, Naproxen, Indomethacin, and Ketorolac |
| What enzyme is directly affected by the use beta-blockers in the RAA system? | Renin |
| A decrease in Renin production will cause what effect to the following enzymes and products of the RAAS? | All will decrease |
| What is SIADH? | Excess ADH secreted by the pituitary, malignancies, or pulmonary cells in respiratory illness |
| What is the main electrolyte imbalance seen with SIADH? | Hyponatremia |
| Why does SIADH develop hyponatremia? | Due to renal water retention |
| What is the only treatment hyponatremia in SIADH? | Water restriction, in order to gradually increase plasma Na+ concentration |
| Which 3 conditions are the ones that can bypass parental consent? | 1. "Sex" --> contraceptives, STIs, and pregnancy 2. "Drugs" --> substance abuse 3. "Rock and Roll" --> Emergency or Trauma |
| What is the IF of MPGN type 1? | Subendothelial deposites of C3 and IgG |
| Which nephrotic/nephritic condition is seen with IF depicting subendothelial deposits of C3 and IgG? | MPGN type 1 |
| What is the cause of MPGN type 2? | Caused by C3 nephritic factor, which stabilizes C3 convertase, leading to a dense deposit disease |
| Which type of MPGN, 1 or 2, is caused by C3 nephritic factor? | MPGN type 2 |
| What is the properties description of S. epidermidis? | Gram (+) coagulase (-) staphylococci |
| What conditions are associated by S. epidermidis infection? | Indwelling prosthetic devices or catheters |
| Which bacteria is part of normal skin flora, but is associated by development of peritonitis in a person with a central line catherer? | S. epidermidis |
| What is the most common cause of Dialysis-associated peritonitis? | S. epidermidis |
| A CKD patient is on dialysis, which is a possible skin infection that may develop? | S. epidermidis |
| Location of RTA type 1? | DCT |
| Location of RTA type II? | PCT |
| What are the location for RTA type IV? | Adrenal or Collecting tubule |
| Which RTA types have urine pH > 5.5? | Type 1 and Type 2 |
| Which RTA type(s) have a urine pH < 5.5? | Type IV |
| Which RTA type is seen with a high K+ level? | Type IV |
| What electrolyte level separates Type IV RTA from Type I and type II RTA? | Hyperkalemia |
| Urine pH < 5.5, Hyperkalemia Hypoaldosteronism Dx? | RTA type IV |
| Low or high, K+ level of RTA type I? | Low |
| Hypokalemia or hyperkalemia in RTA type II? | Hypokalemia |
| What is the main defect in RTA I? | No H+ secretion |
| Which RTA is due to "No HCO3- reabsorption"? | RTA type II |
| What is the cause for RTA type IV? | Hypoaldosteronism |
| Low levels of aldosterone are the cause of which RTA? | RTA type IV |
| Which conditions are often associated with Hep A infection? | 1. Areas of poor sanitation (third world countries) 2. Eating contaminated raw fish |
| What are the clinical sgs associated of a Hep A infection? | N/V, malaise, abdominal pain, jaundice and bilirrubinuria |
| What causes the dark urine seen in Hep A infected patients? | Bilirubinuria |
| What is uremia? | Complication of CKD that leads to significantly elevated level so urea in blood |
| What type of metabolic acidosis is caused by Uremia? | High anion gap metabolic acidosis |
| What condition can cause High anion gap metabolic acidosis? | Methanol ( formic acid) Uremia DKA Polythene glycol Iron and Isoniazid Lactic acidosis Ethylene glycol (oxalic acid) Salicylate (late aspirin) toxicity |
| "MUDPILES" | Mnemonic used to summarize causes of high anion gap metabolic acidosis |
| What does the U in "MUDPILES" stand for? | Uremia |
| What does the D in "MUDPILES" stand for? | Diabetic ketoacidosis (DKA) |
| Iron overdose will cause high or normal anion gap metabolic acidosis? | High anion gap |
| What mnemonic is used to summarize causes of normal anion gap metabolic acidosis? | HARDASS |
| What conditions ar summarized in HARDASS? | Hyperalimentation Addison disease RTA Diarrhea Acetazolamide Spironolactone Saline solution |
| What does the D in HARDASS stand for? | Diarrhea |
| RTA causes high- or normal anion gap metabolic acidosis? | Normal anion gap |
| What happens to FF in cases of decrease RPF and increase GRF? | Increase |
| Which enzyme can cause an increase in FF, by decreasing RPF and increasing GFR? | AT II |
| What is the most common nephritic syndrome in children? | PSGN |
| In PSGN, is there low or high levels of C3? | Low |
| Why is PSGN seen with low levels of C3? | PSGN activates complement which leads to consumption of C3, which cause its low levels |
| What is an electrolyte imbalance due to rapid water ingestion? | Hyponatremia |
| What causes hyponatremia due to rapid water ingestion? | Kidney to increase the excretion of water and urea in urine |
| What is an important risk of rapid loss in serum osmolality? | Cerebral edema |
| List of clinical signs/symptoms of PSGN: | 1. Acute-onset hypertension 2. Dark, "tea-colored" urine 3. Edema (Periorbital, Peripheral, and/or Pulmonary) 4. Fatigue |
| What nephritic syndrome is common in children after 2 weeks form a throat or skin strep infection? | PSGN |
| What is the common treatment for PSGN? | Supportive care |
| PSGN treatment: | Supportive care |
| What are the renal function effects of NSAIDS in renal patients or cirrhotic patients? | - Decreased prostaglandin synthesis leads to: 1. Increased Preglomerular resistance, 2. Increased renal blood flow (RBF) 3. Reduced GFR |
| How is NSAID-induced renal ischemia clinically manifested? | Interstitial nephritis or Nephrotic syndrome |
| MOA of Indinavir | Protease inhibitor |
| What renal adverse effect is associated with Indinavir? | Crystal-induced nephropathy |
| What is the clinical presentation of Crystal-induced nephropathy? | Malaise, weakness, nausea, flank pain, dark urine, and rarely oliguria |
| What HIV medication is associated with Crystal-induced nephropathy? | Indinavir |
| What is the 1st choice for UTI treatment in pregnant women? | Nitrofurantoin |
| WHat is the 2nd choice treatment for UTI in pregnant women? | Penicillin or 1st generation Cephalosporin |
| MOA of Nitrofurantoin | Converted (nitrofurantoin) by bacterial enzyme into toxic intermediates that interfere with bacterial ribosomes |
| What is the most common renally associated species of Enterococcus that causes infection? | Enterococcus faecalis |
| What patients are often seen with E. faecalis renal infection? | 1. Prolonged catheterization, 2. Invasive urinary tract procedures (cystoscopy) |
| What conditions are often due renal E. faecalis infection? | Pyelonephritis, bacteremia, and Endocarditis |
| What is the MCC of community-acquired and hospital-acquired UTI? | E. coli |
| E. coli UTI is (+) for ________________. | Nitrates |
| When does Tumor Lysis syndrome present? | After chemotherapy for leukemia |
| What are the acute kidney injury signs of Tumor Lysis syndrome? | Hypocalcemia, hyperphosphatemia, hyperuricemia, and hyperkalemia |
| What medications/actions are used to prevent Tumor Lysis syndrome? | Hydration, Rasburicase, and Allopurinol |
| Which electrolyte or serum levels are seen at higher levels in Tumor lysis syndrome? | Phosphate, uric acid, and potassium |
| Hypocalcemia or Hypercalcemia in Tumor Lysis syndrome? | Hypocalcemia |
| What condition is treated with Probenecid? | Gout |
| What is the MOA of Probenecid? | Increases uric acid excretion in the urine |
| Which part of the renal artery is affected by Fibromuscular dysplasia? | Distal 2/3 of the renal artery or segmental bronchioles |
| Which population is most likely to develop RAS due to fibromuscular dysplasia? | Young or middle-age women |
| What are the common symptoms or clinical presentation of RAS? | - Subacture and/or refractory HTN with no family Hx - Asymmetric renal size - Epigastric/Flank bruits - Hypokalemia |
| Which condition is often described with abdominal (bilateral or unilateral) bruits? | Renal Artery Stenosis (RAS) |
| What are the 2 main causes of Renal Artery Stenosis (RAS)? | 1. Atherosclerotic plaques 2. Fibromuscular dysplasia |
| Population most likely to develop RAS due to atherosclerotic plaques? | Older males and smokers |
| Which part of the renal artery is affected in RAS due to atherosclerotic plaques? | Proximal 1/3 of renal artery |
| A patient with RAS, shows the problem in the proximal third of the renal artery, what is the most common cause? | Atheroslcerotic plaques |
| Key: Epigastric or Flank bruits. Dx? | Renal Artery Stenosis (RAS) |
| What happens to electrolytes and fluid volume in a person vomiting? | Leads to loss of HCl and extracellular volume |
| What are the consequences of HCL and ECV loss due to vomiting? | Decreased ECF and Contraction Metabolic Alkalosis |
| Which type of metabolic disorder, acidosis or alkalosis, is produced by chronic vomiting? | Contraction Metabolic Alkalosis |
| What is the MCC of BIlateral Fetal hydronephrosis? | Posterior Urethral valves |
| How is bilateral fetal hydronephrosis caused? | Due to embryonic defect that lead to persisten obstructing urogenital membrane of the junction of the bladder and urethra |
| What junction is obstructed in Bilateral Fetal Hydronephrosis? | Urogenital membrane of the junction of the bladder and urethra |
| Posterior Urethral valves are the most common cause of: | Bilateral Fetal hydronephrosis |
| How is Ureteropelvic junction obstruction clinically presented? | Unilateral Hydronephrosis |
| Which is is the obstructed junction in most cases of Unilateral hydronephrosis? | Ureteropelvic junction (UPJ) |
| Which type of genitourinary junction obstruction is seen with possible bladder and urethra distension? | Junction of the bladder and urethra junction due to Posterior urethral valves persistence |
| Are the fetal bladder and urethra distended in Ureteropelvic junction obstruction? | No, the dilation is only seen proximal to the obstruction |
| What is a serous and common complication of DM type 1? | DKA |
| What are lab features (levels) seen in DKA? | 1. Hyperglycemia (very elevated glucose levels) 2. Hyperkalemic 2. High anion gap metabolic acidosis |
| What are the serum replacements given in the treatment of DKA? | Insulin and Potassium |
| Which condition, despite of presenting with Hyperkalemia, is still treated with K+ replacement? | DKA |
| What occurs in the kidneys due to bilateral RAS? | Kidneys become dependent on high levels of Angiotensin II to maintain renal perfusion and function |
| Why are bilateral RAS patients so dependent of high levels of ATII? | Maintains renal perfusion and function |
| Which type of medication should be used very cautiously in bilateral RAS patients? | ACE inhibitors |
| What is the common type of drug used to treat Renal Cell carcinoma? | Recombinant IL-2 |
| Why are Recombinant IL-2 drugs used to treat RCC? | T-lymphocyte growth factor; used to promote immune-mediated antitumor effects |
| What is the most common Recombinant IL-2 drug? | Aldesleukin |
| What type of malignancy is treated with Aldesleukin? | Renal cell carcinoma |
| What substance is freely filtered at the glomerulus, and at normal plasma levels? | Glucose |
| In which part of the nephron is glucose completely reabsorbed? | PCT |
| What substance is completely reabsorbed in the PCT? | Glucose |
| At what serum glucose range, is glucose start been present in urine? | 200-375 mg/dL |
| What does it mean when glucose levels exceed 375 mg/dL? | Transport proteins are completely saturated |
| Bartter syndrome has mutations in : | Na+/K+/2Cl- transporters in the Thick Ascending loop of Henle |
| Bartter syndrome imitates what condition? | Chronic use of Loop diuretics |
| What are important or classic serum/urine abnormalities seen with Bartter syndrome? | Metabolic alkalosis, hypokalemia, and Hypercalciuria |
| What is the MCC of Nephrogenic Diabetes insipidus? | Adverse effect of Lithium therapy |
| What "sugar" condition is associated with Lithium administration? | Nephrogenic Diabetes insipidus |
| Minimal to no change in urine osmolality after water deprivation test. Dx? | Nephrogenic Diabetes insipidus |
| How are ADH level in nephrogenic DI? | Elevated or normal |
| If the levels of ADH are decreased, which DI is present? | Central Diabetes insipidus |
| Bipolar patient presents with extremely elevated glucose levels, and shows improvement in urine osmolality after water deprivation test. Dx? | Central Diabetes insipidus |
| Which arterial gas value is fist to be checked to determine the proper imbalance? | pH |
| What is the second value in ABG to be checked in order to determine the proper diagnosis? | PaCO2 |
| If pH and PaCO2 change in the "same" direction, meaning both go up or down, it is said to be metabolic or respiratory? | Metabolic |
| ABG: pH goes up PaCO2 goes up | Metabolic alkalosis |
| ABG: pH goes down PaCO2 goes up | Respiratory acidosis |
| A simple way to define proper compensation to acid-base disturbances is to think "For ACIDOSIS" | Things go Faster |
| What is the compensation for Metabolic Acidosis? | Hyperventilation |
| What is the compensation for Respiratory Acidosis? | Increased renal HCO3 reabsorption |
| What would be the proper compensatory mechanism for metabolic alkalosis? | Hypoventilation |
| What type of Acid-Base disorder is compensated by a decrease renal bicarbonate reabsorption? | Respiratory alkalosis |
| Common causes of Metabolic alkalosis: | 1. Loop diuretics 2. Vomiting 3. Antacid use 4. Hyperaldosteronism |
| A patient with an OD on Furosemide is likely to develop which acid-base disturbance? | Metabolic alkalosis |
| What type of acid-base disorder is due to vomiting? | Metabolic alkalosis |
| Patient with a adrenal gland tumor, that produces excessive amounts of aldosterone, will develop what acid-base disorder? | Metabolic alkalosis |
| List of common causes of Respiratory acidosis: | 1. Airway obstruction 2. Acute/Chronic lung disease 3. Opioids and sedatives 4. Weakening of Respiratory muscles |
| A problem that diminishes or interferes the person's ability to produce normal respiration, will likely develop which type of acid-base disorder? | Respiratory acidosis |
| A person OD with heroin, arrives to ER. What type of acid-base condition would likely show the ABGs of the patient? | Respiratory acidosis |
| List of conditions that lead to Respiratory alkalosis: | 1. Anxiety/Panic attack 2. Hypoxemia (high altitude) 3. Salicylates (early) 4. Tumor 5. Pulmonary embolism |
| A person with a pulmonary embolism will likely to develop which acid-base condition? | Respiratory alkalosis |
| What is the acid-base disturbance of early aspirin toxicity? | Respiratory alkalosis |
| Late aspirin toxicity is seen with metabolic _________________. | Acidosis |
| Respiratory alkalosis ----> Metabolic acidosis. This is a classical change in ABG disturbance seen with: | Aspirin overdose |
| A person in a Mountain camp base, will likely develop which Acid-Base disturbance? | Respiratory alkalosis |
| What is the cause of Liddle syndrome? | Genetic disorder that involves the constitutive activation of the epithelial sodium channel in the collecting tubules of the kidney |
| Which collecting tube channel are affected in Liddle syndrome? | Epithelial sodium channels |
| What is the treatment options for Liddle syndrome? | Triamterene and/or Amiloride |
| What type of drugs are Treambere and Amiloride? | Diuretics that inhibit the epithelial Na+ channels (ENaC) of the collecting tubules of the kidney |
| What are the common signs of Liddle syndrome? | Early HTN characterized by: - Low levels of Renin and Angiotensin - Excess reabsorption of Na+ - Loss reabsorption of K+ |
| What are structural abnormalities associated with Turner syndrome? | Horseshoe kidney, Collecting-system malformations, and Positional abnormalities |
| What renal structural abnormalities are the reason for increased risk of UTIs in Turner syndrome? | Positional abnormalities and Collecting-system malformations |
| Which hepatitis infections seen with symptoms of cirrhosis? | Hep C infection |
| What is the structural description of Hep C virus? | Linear, (+) ss-RNA virus with icosahedral capsid, part of Flavivirus family |
| Which hepatitis virus a a Flavivirus? | Hepatitis C |
Created by:
rakomi
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