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Renal_Kaplan

QuestionAnswer
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