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Renal_Kaplan
| Question | Answer |
|---|---|
| Where is phosphate reabsorbed? | 85% reabsorbed at proximal tubule |
| How is phosphate reabsorbed? | by Na+/phosphate cotransport |
| What inhibits phosphate reabsorption? | PTH |
| How is phosphate inhibited? | PTH inhibits Na+/phosphate cotransport |
| Where is tubular osmolarity the lowest? | early DCT (<150 mOsm/L) |
| What does PTH do at the early DCT? | increases Ca2+ reabsorption by increasing Ca2+/Na+ exchange |
| What condition has no response to ADH? | nephrogenic diabetes insipidus |
| What are the labs like for nephrogenic diabetes insipidus? | high Na and high ADH levels |
| Which diuretics increase K+ secretion? | thiazides and loops |
| Which diuretics decrease K+ secretion? | K+ sparing diurectics (spironolactone, triamterene, amiloride) |
| What part of the nephron does K+ secretion take place and through which cells? | Late distal tubule and collecting duct. Principal cells |
| Which cells reabsorb K+? | a-intercalated cells |
| Which diuretics treat edema w/ CrCl as low as 10mL/min? | loops |
| Which diuretics treat edema w/ CrCl as low as 40mL/min? | thiazides and K+ sparing |
| Which nephritic syndrome has a "lumpy-bumpy" appearance on LM? | Acute poststreptococcal glomerulonephritis |
| Subepithelial immune complex humps on EM describes which nephritic syndrome? | acute PSGN |
| Crescent-moon shape on LM and IF describes which nephritic syndrome? | RPGN (Goodpasture's, Wegener's, Microscopic polyarteritis) |
| Subendothelial DNA-anti-DNA ICs describes what? | Diffuse proliferative GN (due to SLE) |
| Wire looping describes what? | Diffuse proliferative GN (due to SLE) |
| What is the MCC of death in SLE? | Diffuse proliferative GN (due to SLE) |
| ICs deposit in mesangium describes what? | Berger's disease (IgA glomerulopathy) |
| Mutation in type 4 collagen --> split basement membrane describes what? | Alport's syndrome |
| "Spike and dome" appearance on EM describes what? | membranous glomerulonephritis (diffuse membranous glomerulopathy) |
| Foot process effacement on EM describes what? | Minimal change disease (lipoid nephrosis) |
| MCC of adult nephrotic syndrome? | membranous glomerulonephritis (diffuse membranous glomerulopathy) |
| What stain reveals the "spike and dome" pattern seen on EM? | Methenamine silver stain |
| What drugs cause membranous glomerulonephritis (diffuse membranous glomerulopathy)? | penicillamine, captopril, mercury, gold |
| Which nephrotic syndrome is associated with multiple myeloma, chronic conditions, TB, and RA? | Amyloidosis |
| What measurement does CrCl correlate with? | GFR |
| What is CrCl useful in detecting? | Renal dysfunction |
| What is the normal adult CrCl? | 97-137 mL/min |
| Is there collateral circulation in renal vessels? | no - they are end arteries |
| Which arterioles contain the JG apparatus? | afferent arterioles |
| Linear pattern is a characteristic finding in which disease? Example? | anti-GBM disease. Goodpasture's syndrome |
| What does a granular ("lumpy-bumpy") pattern usually indicate? | immunocomplex (IC) deposition in the glomerulus |
| What stain identifies the patterns and type of protein deposition (i.e. linear pattern and granular pattern)? | immunofluorescence (IF) stain |
| Segmental sclerosis and hyalinosis describes which nephrotic syndrome? | focal segmental glomerulosclerosis |
| What is the MC glomerular disease in HIV patients? | focal segmental glomerulosclerosis |
| Which nephrotic syndrome is associated with HBV>HCV? | membranoproliferative glomerulonephritis |
| "Tram-track" appearance on EM due to GBM splitting describes which nephrotic syndrome? | membranoproliferative glomerulonephritis |
| Subendothelial ICs with granular IF describes which nephrotic syndrome? | membranoproliferative glomerulonephritis |
| What are the 4 major types of kidney stones? | calcium, ammonium magnesium phosphate (struvite), uric acid, cystine |
| Which kidney stones are hexagonal in shape? | cystine |
| Which kidney stones are radiolucent? | Uric acid |
| Which kidney stones can result from ethylene glycol? | oxalate crystals |
| Which kidney stones can result from vitamin C abuse? | oxalate crystals |
| What is the MC type of kidney stones? | calcium |
| What is the MC renal malignancy? | renal cell CA |
| What age group and sex does renal cell CA affect? | men ages 50-70 |
| What factors increase the incidence of renal cell CA? | smoking and obesity |
| Where does renal cell CA originate? | renal tubule cells |
| What is seen in the renal tubule cells in renal cell CA? | polygonal clear cells - glycogen and lipid accumulate |
| How does renal cell CA manifest? | with hematuria, 2-polycythemia, and plethora of skin |
| What is associated with renal cell CA? | paraneoplastic syndromes - ectopic EPO, ACTH, PTHrP, and prolactin |
| What is the MC site of metastasis for renal cell CA? | lung |
| What is the MCC of prerenal azotemia? | ischemic ATN |
| White cell casts in urine are pathognomonic of which disease? | acute pyelonephritis |
| Granular ("muddy brown") casts describes what? | ATN |
| What is the MCC of nephrotoxic ATN? | aminoglycosides and IVP dyes |
| Where does nephrotoxic ATN affect? | proximal tubule only |
| What are 4 causes of renal papillary necrosis? | (DACS) DM, acute pyelonephritis, chronic acetaminophen use, sickle cell anemia |
| Minimum urine required to excrete solutes is known as what? | obligatory urine volume |
| What is the formula for obligatory urine volume? | amt solute excreted per day/ max urine osmolarity |
| What is the function of potassium? | maintains intracellular tonicity, transmit nerve impulses, muscle contraction, and maintenance of renal function |
| What is the MOA of spironolactone? | competitive antagonist of aldosterone receptor in cortical collectiing tubule |
| What is the MOA of Triamterene and Amiloride? | blocks Na+ channels |
| What do thiazides inhibit? | NaCl reabsorption |
| What do thiazides enhance? | reabsorption of Ca2+ by stimulating Na/Ca2+ exchange |
| With thiazides, where does Na/Ca2+ exchange occur? | basolateral membrane |
| What is the problem with giving thiazides to patients with hyperparathyroidism? | can cause increased Ca2+ levels |
| What is the adverse effect of cyclosporine? | nephrotoxicity |
| What happens with the extracellular volume during water deprivation? | volume contraction |
| What happens to the plama osmolarity during extracellular volume contraction? | increased plasma osmolarity |
| What does hyperosmolarity stimulate? | increased rate of ADH secretion |
| What is the formula for mean arterial pressure? | MAP = (CO x SVR) + CVP |
| How do you maintain a constant renal plasma flow if mean arterial pressure is increased? | increase renal vascular resistance |
| What happens to the afferent arteriole with increased pressure at the macula densa? | afferent arteriole constricts by direct response to increased pressure at macula densa |
| What happens to the efferent arteriole with increased pressure at the macula densa? | efferent arteriole dilates due to decreased renin secretion and decreased angiotensin II production |
| What is the MOA of drugs that increase urine flow rate? | blocks ADH receptor |
| What is the function of ADH receptor blockers? | increase free water clearance w/o affecting Na+ or K+ excretion |
| What does ADH do? | inserts additional H2O channels into apical membrane of principal cells |
| Where does ADH work | renal collecting ducts |
| What drug is given for urinary incontinence? | Antimuscarinics = Oxybutynine and Tolterodine (neurogenic bladder) |
| What is the acid-base blanace that occurs with cardiopulmonary arrest? | mixed acidosis: low pH, high CO2, and low HCO3 |
| What will blocking the ADH receptor do acutely? | dec urine osmolarity without major change in electrolyte excretion |
| What is the MOA of Acetazolamide? | blocks carbonic anhydrase in proximal tubule |
| What effect does Acetazolamide have on the kidney? | osmotic diuresis increases NaCl delivery to MD |
| What is the feedback of Acetazolamide? | causes afferent arteriole constriction which will increase resistance |
| Where is most water and Na+ reabsorption even in the presence of increased ADH? | proximal convoluted tubule |
| What is the formula for determining the volume of a compartment? | qty of indicator given/concentration of indicator in the compartment |
| How much is the saturation of glucose carriers? | >200 mg/dL |
| Which drugs have a decrease in BA when antacids are taken? | Ofloxacin (Fluoroquinolones) |
| Plasma osmolality equation? | = (total body osmoles - urine osmoles)/ (TBW - urine volume) |
| Equation for TBW? | = weight x body weight H2O (60%) |
| Equation for Total body osmoles? | initial plasma osmolality x TBW |
| What is freely filtered and secreted in the proximal tubule? | creatinine |
| What is the action of carbonic anhydrase? | hydrates CO2 to form H2CO3 resulting in H+ and HCO3- |
| With carbonic anhydrase, what happens to H+ and HCO3-? | H+ is secreted to lumen and HCO3- is reabsorbed to circulation |
| If carbonic anhydrase in inhibited by Acetazolamide, what happens to H+ secretion? | H+ secretion decreased |
| What happens to GFR and RPF when the efferent arteriole is constricted? | inc GFR by inc glomerular capillary pressure which inc renal vascular resistance which dec RPF |
| What is reabsorbed in the PCT? | isoosmotic reabsorption of AA, glucose, cations (including Na+) and HCO3- reabsorption |
| Where are amino acid active transporters located? | apical surface |
| What happens with the BUN and crea levels in burn patients? | increase in BUN and crea b/c significant urea synthesis and inc protein catabolism |
| Patient has ARF, fever, maculopapular rash and eosinophilia. What is the cause? | NSAIDs - Acute interstitial nephritis |
| What happens to renal clearance when plasma concentration increases? | decreases and comes close to that of inulin after saturation of secretory mechanism |
| What happens to GFR with ACEI? | decreases b/c prevents efferent arteriolar constriction |
| What will happen to serum creatinine with ACEI? | increase leading to ARF |
| What does creatinine clearance measure? | GFR |
| Where is the lowest osmolarity? | cortical thick ascending LoH and early distal tubule (macula densa) |
| What is the equation for filtered load? | FL = GFR x plasma concentration |
| What is the effect of inhibiting ACE? | reduces angiotensin II levels |
| What is the result of reducing angiotensin II levels? | renin release is increased due to loss of FB inhibition |
| What happens to the Na+ and K+ levels with ACEI? | Na+ decreases and K+ levels increase |
| Linear deposits of IgG to the BM and pulmonary alveoli indicates which renal disease? | Goodpasture's - RPGN |
| Embryonic glomerular and tubular structures surrounded by mesenchymal spindle cells. Dx? | Wilm's tumor |
| What kind of stones are common in patients requiring chronic bladder catheterization? | Staghorn calculi (Proteus = urea splitting bacteria) composed of magnesium ammonium phosphate |
| What are the 2 causes of patients with glomerular crescents (RPGN)? | anti GBM ds and primary systemic vasculitis |
| What area is affected in acute pyelonephritis? | renal parenchyma and renal pelvis |
| How do you treat acute pyelonephritis? | IV ampicillin and gentamicin for E. coli |
| What is the diagnosis of albumin in highest concentration and fusion of podocyte foot processes on EM? | minimal change ds |
| What is the MCC of nephrotic syndrome? | FSGS = segmental solidification and fibrosis of glomerular tuft |
| What is the risk for patients with PCKD? | subarachnoid hemorrhage from malignant HTN |
| HTN can present as hyaline arteriosclerosis and patchy ischemic atrophy, but what is the presentation in the kidneys? | fibroelastic hyperplasia |
| In aortic dissection, what is the effect on kidneys? | involvement of renal arteries causes bilateral renal infarction with flank pain and hematuria |
| What are some risks of UTIs? | cause stones b/c urease raises pH of urine and causes formation of renal calculi |
| What can TB cause? | chronic antigenic stimulation |
| What does chronic antigenic stimulation with TB do? | leads to deposition of AA type of amyloid |
| What can regenerate the epidermis following a deep abrasion that removes full thickness of epidermis? | Epithelial stem cells from deep within the dermis located along hair follicles and sweat glands |
| What is the defect in Potter's syndrome? | ureteric bud malfoms causing bilateral renal agenesis |
| Which bacteria is an oxidase-positive, gram-negative rod which is non-lactose fermenting? | Pseudomonas |
| What does the exotoxin of Pseudomonas do? | exotoxin A ADP ribosylates EF-2 |
| What causes decreased serum creatinine? | dilate afferent arteriole - inc GFR - inc glomerular capillary pressure |
| What causes increased serum creatinine? | reduced GFR (creatinine clearance asseses GFR) |
| What bacteria causes GN after sore throat? | strep pyogenes (catalase neg) |
| What favors sickling of erythrocytes in vasa recta in sickle cell patients? | high osmolarity of renal medulla |
| What does obliterating the urachus do? | forms median umbilical ligament |
| What does the median umbilical ligament connect? | upper end of bladder to umbilicus |
| What is a renal failure diet? | dec protein, dec phosphate, inc cars, moderate fat, limit H2O and Na+ intake b/c dec GFR |
| What is the only site where epithelial cells have a "brush border"? | PCT |
| What boxcar-shaped, gram (+) rod is aerobic and spore-forming? | bacillus anthracis |
| How do you treat bacillus anthracis? | ciprofloxacin or doxycycline |
| How does a dec in GFR stimulate renin release? | dec NaCl delivery to MD |
| What does angiotensin II do to efferent arterioles? | stimulates contraction to increase resistance |
| What happens when efferent arteriole resistance is increased? | inc glomerular hydrostatic pressure to increase GFR to normal |
| Glucose at a normal plasma level is completely reabsorbed where? | proximal tubule |
| Where does secondar active transport occur? | proximal tubule |
| How do NSAIDs cause acute renal failure? | by inhibiting the renal production of prostaglandins |
| What do PGs do? | keep the afferent arterioles vasodilated to maintain GFR |
| What are 4 causes of normal anion gap (8-12 mEq/L)? | diarrhea, glue sniffing, RTA, hyperchloremia |
| Carbonic anhydrase inhibitors would decrease which excretion? | H+ secretion would decrease thereby decreasing NH4+ excretion |
| What does an increase in cAMP do to the afferent arteriole of the kidney? | dilation |
| What does cAMP do in the cardiac muscle? | increases force |
| What does cAMP do in the smooth muscle? | decreases force |
| Inhibition of calcium reabsorption occurs where in the renal tubules? | distal tubules |
Created by:
eandres1
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