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Renal 1.1

UWORLD Renal Review

QuestionAnswer
Hyperphosphatemia in chronic kidney disease CKD leads to decreased GFR, which causes a decreased 1, 25 -Vit D , leading to decreased serum Calcium, and to Phosphate retention, elevating serum phosphate levels
Low serum Ca and High serum phosphorus causes --> Secondary Hyperparathyroidism
What type of Hyperparathyroidism is seen in CKD? Secondary Hyperparathyroidism
Elevated levels of PTH and Calcium in blood, are seen in: Primary Hyperparathyroidism
Vitamin D Toxicity exhibits: High blood calcium with low PTH in blood levels
Vitamin D deficiency has _________ of serum Calcium and _______ serum PTH. Low Calcium and Low PTH
What is the serum difference in PTH/Calcium profile between kidney failure and Primary Hyperparathyroidism? Kidney Failure has High levels of PTH and low Calcium, while 1-Hyperparathyroidism has high levels of Calcium and PTH.
The levels of PTH and Calcium in CKD, resemble the closest to those seen in: Secondary Hyperparathyroidism
What is the relation in serum levels between PTH and Ca2+ seen in Primary Hypoparathyroidism? Low levels of Calcium and PTH
Patient with a PTH-derived malignancy, produces ____________ of PTH and _________ of Calcium in blood serum. Low PTH; High Calcium
Vitamin D deficiency share similar levels of Calcium and PTH as: Primary Hypoparathyroidism
Which category of people are most seen with Renal Artery Stenosis with unilateral kidney atrophy? Elderly and women of childbearing age.
Pathogenesis of Renal Artery stenosis seen in the elderly? Atherosclerosis changes in the arterial intima
Fibromuscular dysplasia in women of childbearing age, predisposes them to increase risk of developing what renal-related condition? Renal Artery Stenosis with unilateral kidney atrophy
What are associations and clinical manifestations of Renal Artery Stenosis? Associated with hypertension and an ABDOMINAL BRUIT.
What is the effect of compensation seen in Renal artery stenosis? Enlargement of the healthy kidney
Immunosuppressant, SIROLIMUS, binds to which protein ? FK506 in the cytoplasm
The binding of Sirolimus and FK506 Inhibits the mTOR
What are the effects of mTOR inhibition? Blockade of IL-2 signal Transduction preventing cell cycle progression
Calcineurin inhibits: 1. Cyclosporine 2. Tacrolimus
What drugs inhibit the de Novo Purine nucleotide synthesis? Mycophenolate and Leflunomide
Which substances have same filtration and excretion rate/content? Inulin and Mannitol
Glucose, Na+ and Urea have gratear ____________________, than _______________. FILTERED >>>> excretion
EXCRETION >>>>> filtered PAH and Creatine
Inulin clearance is equal to __________ GFR
100% of _____________ is excreted and 0% of _________ is reabsorbed. Inulin; Inulin
A GFR equal to 100 mL/min, equals to ____________ of inulin clearance. 100 mL/min of Inulin clearance
PAH clearance estimates ___________________ Renal Plasma Flow (RPF)
Inulin clearance estimates _________________ GFR
RPF = C-PAH (clearance of PAH)
RPF = C-PAH = (Urinary-PAH x Volume) / Plasma -PAH
What is the the essential difference between calculating Inulin clearance and PAH clearance? The use of ether Urinary PAH or Inulin and/or Plasma PAH or Inulin.
Loss of Pelvic floor support and Incompetence or urethral Sphincter, describes the pathogenesis of? Stress Incontinence
Patient complains of involuntary loss of urine, while coughing or sneezing Stress incontinence
The increase in ___________________ in patients with stress incontinence leads to the _________________ loss of urine. Abdominal pressure; Involuntary
What are the causes of Stress incontinence: 1. decreased urethral tone 2. Urethral hypermobility
Leakage with cough, lifting and sneezing Stress incontinence
Detrusor hyperactivity, leads to development of: Urge incontinence
Sudden, overwhelming urge to urinate Urge incontinence
What are the 2 main causes of OVERFLOW incontinence? 1. Impaired detrusor contractility 2. Bladder outlet obstruction
The impaired function of the detrusor muscle is associated with development of __________________ incontinence, while its overactivity develop ___________ incontinence. Overflow; Urge
Patient complains of not voiding completely, and indicates often involuntary urine dribbling. Overflow incontinence
MCC of nephrotic syndrome in children Minimal Change Disease (MCD)
Massive proteinuria (selective for Albumin), reduced plasma oncotic pressure, hypoalbuminemia, edema, and increased risk of thrombotic event in child? Minimal Change Disease (MCD)
What are basic characteristics of Nephrotic Syndrome? 1. Increased glomerular permeability 2. MASSIVE proteinuria 3. Hypoalbuminemia 4. Increased liver protein synthesis leading to HYPERLIPIDEMIA (increased thrombotic events) 5. Increased aldosterone and ADH secretion --> Edema --> Increased oncotic pressure
RBC casts are seen in Nephritic syndrome
Features of Nephritic Syndrome RBC casts/Hematuria, HTN, Oliguria, decreased GFR, minimal proteinuria
Features of Nephrotic Syndrome Massive proteinuria, hypoalbuminemia, Edema, hyperlipidemia, and lipiduria
Which conditions are considered PURELY Nephrotic syndromes? 1. Focal Segmental Glomerulosclerosis 2. Membranous Nephropathy 3. Minimal Change Disease 4. Amyloidosis 5. Diabetic Glomerulonephropathy
1. PSGN 2. RPGN 3. Berger Disease (IgA nephropathy) 4. Alport Syndrome Nephritic Syndromes (only)
Which 2 conditions are considered Nephritic and Nephrotic simultaneously? 1. Diffuse Proliferative GN 2. Membranoproliferative GN
What is the most common cause of asymptomatic primary glomerulonephritis? IgA nephropathy (Berger Disease)
Berger disease is a _______________, and Buerger disease is a _______________________. IgA nephropathy (Nephritic syndrome); Small/Medium artery vasculitis seen in smokers
IgG4 antibodies to the phospholipase A2 Membranous Nephropathy
What 2 different antibodies are seen in Membranous Nephropathy? 1. IgG4 antibodies against Phospholipase A2 2. PLA2R antibodies
What are the clinical manifestations of Aspirin toxicity? Tinnitus, fever and tachypnea. Initially seen with Respiratory Alkalosis, followed by mixed Respiratory Alkalosis and anion-gap Metabolic Acidosis.
What are the acidotic-alkalotic balances seen in Aspirin toxicity? First RESPIRATORY ALKALOSIS followed by METABOLIC ACIDOSIS (anion-gap)
IgA immune complexes deposited in glomerular membrane Berger Disease
Presents with recurrent, self-limited, painless hematuria, seen 5 days after Upper Respiratory infection. Berger Disease
How is the time between Berger Disease and PSGN infection differs? Berger Disease precipitating is 5 days after URI, and PSGN preceding URI is seen 2-3 weeks after.
Streptococcal pharyngitis PSGN
Antibodies against Streptococcal antigens that deposit on GMB PSGN
Electron microscopy views Subepithelial humps PSGN
What is seen on IF in PSGN? C3 granular staining along GMB
Antibodies against Type 4 Collagen develops what disease? RPGN (Goodpasture Disease)
IF: Linear staining (IgG) along GMB RPGN (Goodpasture Disease)
RPNG LM seen in Glomerular crescents; IF -> Fibrinogen crescents
LM: hypercellular hypercellularity Berger Disease
Defective Type 4 collagen in GMB Alport Syndrome
EM: lamellated appearance of GMB Alport Syndrome
AT II works on the ___________________ arteriole and it causes __________________. Efferent arteriole; Vasoconstriction
What type of drug works on the efferent arteriole? what does it cause? ACE inhibitors and ARBs and cause Vasodilation, leading to a fall in GFR.
The afferent arteriole vasodilation is caused by? Vasoconstriction? Vasodilate with Prostaglandins and ANP Vasoconstric by the use of NSAIDS
Which arteriole forms the glomerulus? Afferent arteriole
What is the glomerulus? A knot formed by the afferent arteriole inside the Bowman's capsule
Which arteriole carries grater amount of water? Afferent arteriole
The renal arteries branching forms the _____________ arteriole. Afferent
Which vascular structure "brings in" O2 rich blood into kidney? Afferent arteriole
Which lumen is narrower, the afferent or efferent arteriole lumen? Efferent is twice as narrow
The EFFERENT arteriole divides to form the __________________ which envelopes the renal ________________. Vasa recta; tubule
High resistance outflow pathway is seen in the ______________ arteriole. Efferent
Fraction of plasma flowing through the glomeruli that is filtered across the glomerular capillaries to the Bowman's space Filtration Fraction (FF)
Glomerular Filtration rate divided by Renal Plasma Flow Filtration Fraction (FF)
RBF (renal blood flow) x (1-hematocrit) RPF
RBF is equal to ________________. Clearance of PAH
Volume that is occupied by RBC, and it is UNABLE to cross the glomerular capillaries. Renal Blood Flow (RBF)
So if GFR is the same as ___________________, and RPF is the same as __________________, then the filtration fraction may be defined as? Inulin clearance; PAH clearance; Ratio of Inulin clearance to PAH clearance
What is a normal FF? 20% or approximately 180 L/day
What is a role of FF? at which part of the nephron most importantly? Estimation of Tubular Reabsorptive Efficiency, at the proximal tubule.
As FF increases, the plasma protein concentration increases
RPF is defined as: Volume of plasma that is ABLE to pass through the glomerular capillaries.
What is the primary substance controlling the GFR? Angiotensin II
What conditions cause increased AT II? Condition of volume depletion (dehydration, hemorrhage)
Angiotensin II has a preference to Vasoconstric the __________ arteriole. Efferent
Constriction of Ureter causes: No change in RPF but decrease in GFR and FF
Constriction of the ________________ arteriole causes a increase in FF, as it ____________ GFR and ____________ RPF. Efferent; Increase; Decrease
Constriction of the afferent arterioles, causes what changes in FF? It produces a reduction in GFR and RPF, thus no change in FF.
Common causes of Metabolic Alkalosis? 1. Loop diuretics 2. Vomiting 3. Antacid use 4. Hyperaldosteronism
Histeria, hypoxemia, salicylates (early), tumor, and pulmonary embolism, are? Common causes of Respiratory Alkalosis
Respiratory acidosis is most commonly caused by: 1. Airway obstruction, 2. Acute and Chronic lung disease 3. Opioids, sedatives, 4. Weakening respiratory muscles
Patient with rapidly progressive ascending paresthesias after consuming contaminated food followed by severe periods of bloody diarrhea. Overtime, patient will develop what acid-base imbalance? Respiratory Acidosis caused by advancing Guillain Barre syndrome.
What is the pH range in arterial blood? 7.35 - 7.45
HCO3 levels range between _________-_________ mEq/L. 20-28 mEq/L
The PCO2 levels are marked normal between __________ and _______ mm Hg. 36 and 44 mmHg
The imbalance is considered Respiratory alkalosis if? PCO2 levels fall below 36 mm Hg and pH is greater than 7.45
What is the normal range of the anion-gap? 8-12 mEq/L
What is the formula to obtain the anion gap? = Na - (Cl+HCO3)
What causes metabolic acidosis with anion gap of 14? MUDPILES: Methanol, Uremia, DKA, Prolyethenly glycol, Iron and INH, Lactic acidosis, Ethylene glycol, Salicylates (late)
HARDASS: Mnemonic for non-anion gap causes of metabolic acidosis
What some causes of Non-anion gap metabolic acidosis: Hyperalimentation, Addison's disease, Renal tubular acidosis (RTA), Diarrhea, Acetazolamide, Spironolactone, Saline solution
Male patient in chronic treatment for edema and low potassium level, develops enlarged breast tissue. This patient is may also develop what kind of Acid-Base imbalance? Non-anion gap Metabolic Acidosis
Example of patient that is more likely to develop metabolic acidosis with a normal anion gap? Patient stabilized blood pressure with saline fluids over a 5 day hospitalization stay after sustaining severe hemorrhage following a car accident.
Patient in HYPERVENTILATION will most likely develop: Respiratory Alkalosis
Why do Hyperventilation develop Respiratory Acidosis? Increase or rapid loss of CO2
What is the pathogenesis of Thrombotic Microangiopathy? Platelet activation and diffuse microthrombosis in arterioles and capillaries.
Common clinical presentation of Thrombotic Microangiopathy? Hemolytic anemia with schistocytes, thrombocytopenia, and organ injury.
Where does Aldosterone acts most specifically? On Intercalated cell of the renal collection tubules
What is the actions stimulated by Aldosterone? Reabsorption of Sodium and water, along with the loss ot K+ and Hydrogen ions.
What are some Aldosterone antagonists? Spironolactone and Eplerenone.
Ureteropelvic Junction obstruction leads to: Unilateral Fetal Hydronephrosis.
Vesicoureteral junction obstruction is a common cause of? Vesicoureteral reflux
Efferent vasoconstriction is accomplished by administration of _____________ and ___________, leading to the maintenance of ________. ACE inhibitors; ARBs; GFR
What other electrolyte is important to check in a patient with Metabolic Alkalosis to further investigate the Dx? Urine Chloride
Decreased Urine Cl- in a patient with Metabolic acidosis, may indicate? Vomiting, nasogastric aspiration, or past use of diuretics.
Batter Syndrome and Glitterman Syndrome are seen in a patient with __________________ and __________ urine _______, but a state of ___________________. Metabolic Alkalosis; Low urine Cl; Hypovolemia
High urine Cl-, elevated pH, and HCO3 > 24, are seen in a patient with hypervolemia. Possible causes? Excess mineralocorticoid therapy, Primary Hyperaldosteronism, Cushing disease, or Ectopic ACTH
What organism causes Hemolytic Uremic Syndrome (HUS)? Shiga-like toxin, by E. coli and Shigella.
HUS' symptom triad 1. Microangiopathic hemolytic anemia 2. Thrombocytopenia 3. Acute kidney injury
How is kidney injury seen in HUS seen? Elevated Creatinine (Cr)
Diuretics that effectively increase Ca2+ reabsorption for the nephron. Thiazide diuretics
Thiazide diuretics is seen with the development of _______________ secondary to _____________________, and thus highly contraindicated in patients with some type of __________________. Nephrolithiasis; Hypercalciuria; Hypercalcemia
MoA of Thiazide diuretics Keep Calcium in the Tubular lumen by DEACTIVATING the Na/Ca2+ co-transport.
Goodpasture syndrome is a type of _______________________, seen with ___________ deposits of IgG and C3 deposition. Hypersensitivity 2; Linear
+ ANCA RNPG Pauci-immune RPGN
Treatment of CN intoxication: Sodium NITRATE
Treatment options of CN toxicity: 1. Sodium NITRATE 2. Sodium THIOSULFATE 3. HYDROXYCOBALAMIN
Elevated level in blood of _________, __________, and _____________ promote crystallization , thus calculi promotion. Calcium, Oxalate, adn Uric acid
Elevated levels of _______________________ prevents kidney stone formation. Citrate
Biopsy demonstrates hyaline arteriosclerosis and nodular glomerulosclerosis Diabetic Nephropathy
What are the EM findings in Diabetic Nephropathy named or called? Kimmelstiel-Wilson nodules.
The ____________________ are seen with glomerular basement membrane (GBM) ___________________ and increased ______________ matrix deposition. Kimmelstiel-Wilson nodules; Thickening; Mesangial
What cells are involved in Type 1 Hypersensitivity? Basophils and Mast cells
PSGN, SLE and serum sickness are: Type 3 Hypersensitivity reactions
What renal Nephritic syndrome is considered a Type 2 Hypersensitivity reaction? Goodpasture Syndrome
What is the humoral activity seen in Type 2 Hypersensitivity reactions? Increased IgG and IgM production levels and Complement activation.
Which cells are seen involved in Cytotoxic Hypersensitivity? NK cell, Eosinophils, Neutrophils, and Macrophages
Onset of Transplant rejection reactions: Hyperacute, Acute, and Chronic? Hyperacute ---> Minutes to Hours Acute --> Less than 6 months Chronic ---> More than 6 months to years
What is the Etiology of Hyperacute organ transplant rejection? PREFORMED antibodies against graft in recipient blood. SIMPLY: Antibodies of the recipient attack the tissue antigens of the donated tissue.
Hyperacute graft rejection presents commonly still during __________, by appearance of _______________________ of graft vessels. It is considered a type ______ hypersensitivity. Surgery; Thrombosis and Occlusion; Type 2 Hypersensitivity
Hyperacute, Acute and Chronic organ rejection are known also as _____________________. "Host vs Graft"
In the writing sequence of organ rejection, the one written first is the one _________________. Attaking. Ex. "Graft vs Host Disease" ; the GRAFT is attacking the Host's tissue. In "Host vs Graft" the Host (recipient) attacks the donated tissue.
What is etiology (pathogenesis) of Acute organ rejection? The HOST creates a T-cell immune response against the foreign (donor) MHC.
How is Acute organ rejection vessel histology presented? Leukocyte (macrophages and lymphocyte) infiltration of graft vessels (donor vessels)
Intimal thickening and fibrosis of graft vessels as well as graft atrophy, in patient with a organ transplant over a year ago. Dx? Chronic organ rejection
Which is the most common type of "Host vs Graft Disease"? Acute organ rejection
Acute organ rejection is a Type _____ Hypersensitivity reaction. Type 4
Chronic organ rejection is considered a Type _____ and _____ Hypersensitivity reaction. Type 3 and Type 4
What is the mechanism of pathology seen in "Graft vs Host Disease" (GVHD)? DONOR T cells proliferate and attack recipient's tissue.
What type of transplant yields the highest chance of developing GVHD? Bone Marrow
What is the clinical presentation of GVHD? Diarrhea, Rash and Jaundice
GVHD is considered which type of Hypersensitivity reaction? Type 4 Hypersensitivity reaction
Smooth muscle proliferation and vessel occlusion is seen in? Chronic Organ rejection
Endotheliitis is seen in Acute Organ rejection
What is the humoral response presentation of Acute organ rejection? C4d deposition, neutrophilic infiltrate, and Necrotizing vasculitis
Lymphocytic interstitial infiltrate and endotheliitis, is seen as the? Cellular response of Acute Organ/Graft rejection
Extraperitoneal organ Bladder
During a suprapubic cystostomy, the cannula will pierce the ____________, but NOT enter the ___________________. Abdominal wall; Peritoneum
Causes of secondary Hyperaldosteronism? Renovascular disease, Malignant HTN, and Renin-secreting tumors.
Increased levels of serum Aldosterone and Renin, point to: Secondary Hyperaldosteronism
Patient with renin-secreting tumor-induced Hyperaldosteronism, presents with: Hypertension, Hypokalemia, and muscle weakness.
What 2 syndromes may cause Secondary Hyperaldosteronism? How is blood pressure different in such causes? Secondary Hyperaldosteronism is usually presented with HTN, unless is caused by: 1. Batter's Syndrome 2. Gitelman's syndrome This cause NORMOTENSIVE Secondary Hyperaldosteronism
Renin, this enzyme, stimulates the release of __________________, thus causing an increase in ___________________. Aldosterone; Blood Pressure
Ureter anatomical position with respect to the Internal iliac and Uterine arteries. Ureter passes ANTERIORLY to Internal Iliac artery Ureter passes POSTERIORLY to the Uterine artery.
What urinary system structure passes anterior to the Internal Iliac artery? URETER
Urinary conductive tube-like structure that passes POSTERIOR to the Uterine arteries, bilaterally? URETER
MC area of nephron affected by Acute Tubular Necrosis (ATN) Straight Proximal Tubules and the Thick Ascending limb of the Loop of Henle located at the Outer medulla.
Muddy Brown casts. Dx? Acute Tubular Necrosis (ATN)
Pathognomic cast seen in ATN? Muddy Brown Cast
ATN shows an increased _________ and ________ but a _______________ _____:_______ ratio. Cr and BUN levels; NORMAL BUN:Cr ratio.
What are the MCC of ATN? Decreased Renal Perfusion due to severe: 1. Hypoxemia, 2. Shock, 3. Surgery
What characteristic is shared by the areas MC affected by ATN? High ATP-consuming activity
The three phases of ATN: 1. Inciting event 2. Maintenance phase 3. Recovery phase
Which ATN phase is considered oliguric, and increases the risk of? Maintenance phase; lasts 1-3 weeks and increases the risk of developing Hyperkalemia, Metabolic acidosis, and uremia
Which is the polyuric phase in ATN? Recovery phase
The recovery phase in ATN is seen with: Fall of BUN and Cr levels, and increase risk of developing hypokalemia, and increased risk of mineral and electrolyte wasting
What are the main to kinds of causes of ATN? 1. Ischemic (due to decreased renal blood flow) 2. Nephrotoxic (mostly due to drugs/toxic substances)
Which areas of nephron anatomy are particularly at higher risk of been affected by Ischemic ATN? PCT and Ascending Limp of Loop of Henle
What area is particularly affected by Nephrotoxic ATN? Proximal tubule
Substances often causing Nephrotoxic ATN? Aminoglycosides, Radiocontrast agents, lead, cisplatin, ethylene glycol.
Myoglobinuria and Hematuria are often causes of: Nephrotoxic ATN
ATN causes which type of Acute Kidney injury? Intrinsic Renal Failure
Urine osmolarity < 350 and Serum BUN:Cr < 15 Intrinsic Renal Failure
BUN:Cr ration in blood > 20 Prerenal azotemia
What is the common level of Urine osmolarity seen in Prerenal Azotemia? Greater than 500
Which level is the only one consistently observed without variation in Postrenal azotemia? Urine osmolarity < 350
Order of Tubular fluid/ plasma infiltrate along the distance of Proximal Tubule (Greatest --> lowest concentration) PAH > Cr> Inulin >>>HCO3 > > Glucose
If the [Tubular Fluid]/[Plasma] is equal to 1? <1?>1? = 1 --> solute and water are REABSORBED at same time. =>1 (greater than 1) --> represents solute secretion and/or solute is reabsorbed less quickly than water =<1 (less than 1) --> solute is reabsorbed quicker than water
ARPKD is seen in ______________, while ADPKD is mostly seen in __________________. Children; Adults
What is the clinical presentation of ARPKD? Findings in ultrasound? Renal insufficiency (oligohydramnios), Nephromegaly, and HTN. The U/S depicts bilateral, enlarged echogenic kidneys.
ARPKD patients are often associated with what other condition? Potter Sequence (flattened face, limb deformities, and Pulmonary hypoplasia)
Patient presents with facial features resembling a crushed, flat face, femur, ulnar and radial deformities, and Hx of steroid use as premature baby. Dx? Potter sequence. (steroids probably given to develop the lungs)
Why is ADPKD seen in adults and not in children? The cysts produced by the Autosomal Dominant version of the disease, are very small, and thus not seen until later in life as they become symptomatic.
How do ADPKD cysts become symptomatic? Compress the renal parenchyma.
What chromosomes have the gene involved in ADPKD? Chromosomes 4 and 16 (PKD-1, and PKD-2, respectively)
Which part of the Ureter is irrigated by the Renal Artery? Proximal part (top area)
Variable anastomotic blood supply, provides irrigation to most of the ________ portion of the ureter. Middle
Which artery provides blood supply to the Distal ureter? Superior Vesical Artery
Ureter blood supply: Renal artery (proximal/top part), Anastomotic (middle section), and Superior Vesical Artery (DIstal/lower/bottom area).
Another (larger) artery that supplies the distal section of the ureter, besides the Superior Vesical artery? Internal Iliac artery
Tumor Lysis Syndrome Occurs in HIGH cell turnover tumor is treated with chemotherapy
In Tumor Lysis syndrome, the destruction of cells leads to: 1. Release of intracellular K+, phosphorus and uric acid.
The increased level of uric acid seen in conditions such as Tumor Lysis syndrome, it leads to: Acidic environment at the Distal Tubules and the collecting tubules, which may be prevented with Allopurinol.
What drug is commonly used to ALKALINIZE urine, in conditions such as Tumor Lysis Syndrome? Allopurinol
Tumor Lysis Syndrome is most commonly seen in: Lymphomas and Leukemias
What is the reason of acute kidney injury in Tumor lysis syndrome? Increase breakdown of nucleic acids, leads to an state of Hyperuricemia, which cause the kidney injury.
What are the important blood levels in Tumor lysis syndrome? Hyperkalemia, Hyperphosphatemia, and HYPOcalcemia
What drugs are used to prevent and treat the hyperuricemia seen in Tumor lysis syndrome? 1. ALLOPURINOL 2. Rubicase 3. Aggressive hydration
What factors regulate FF, GFR and RPF? The AFFERENT or EFFERENT vasoconstriction or vasodilation.
What two changes constitute a decrease in GFR? 1. Constriction of Afferent arteriole and, 2. Dilation of Efferent arteriole
Constriction of Efferent arteriole and Dilation of Afferent arteriole cause Increased GFR, and overall increase in FF.
What are the main effects of Theophylline intoxication? 1. SEIZURES which are treated with Benzodiazepines and Barbiturates 2. Tachyarrhthmias treated with B-blockers
Why are benzodiazepines used in a patient that is suffering a Theophylline intoxication? Theophylline OD provokes SEIZURES which are treated with benzodiazepines such as Clonazepam.
Classification of Theophylline Phosphodiesterase inhibitor
Theophylline action in treatment of lung disease/asthma Causes bronchodilation by increasing cAMP levels
Theophylline is similar to ___________________, as it interacts with CYP450 with ___________________ and ______________, in the same way. Warfarin; Inducers and Inhibitors
Theophylline blocks the actions of ____________________. Adenosine
Adenosine actions are blocked or inhibited by ______________, Phosphodiesterase inhibitor, Theophylline.
Possible drug to treat Theophylline-induced arrhythmias? Propranolol
Which sex is more susceptible to developing Pyelonephritis? Why? Women; Urethra is closer to the rectum, and the urethra is also shorter than male's.
What lifestyle choices increase the risk of developing urethritis and cystitis? Sexual activity
Clinical features of Urethritis or cystitis? Dysuria, frequency, PYURIA, and bacteriuria.
What key feature distinguishes cystitis? Suprapubic tenderness.
A person with cystitis may develop Pyelonephritis due to: The pathogens ascend up to the ureters to penetrate the kidney.
What is the clinical presentation of Pyelonephritis? Flank/abdominal pain, and COSTOVERTEBRAL angle tenderness.
WBC casts PYELONEPHRITIS
Precipitate found in the nephron tubules, that precipitate with Tamm-Horsfall protein? WBC casts (seen in Pyelonephritis)
Interstitial nephritis, Papillary necrosis of the medullary vasa recta. These are seen in what condition? Analgesic Nephropathy
Common Osmotic diuretic Mannitol
Mechanism of action of mannitol Increased osmolality. It leads to extraction of water from the interstitial space into vascular space, leading to diuresis
Mannitol common uses? 1. Treat ICP
What is Mannitol most severe side effect? Pulmonary edema
In what patients does Renal osteodystrophy commonly presents? CKD secondary to Hyperparathyroidism, leadinto to Hyperphosphatemia and Hypocalcemia
In which conditions is Mannitol contraindicated? Patients with anuria or HF
Mannitol may be used to reduce ICP and _______________________ Intraocular pressure
Mannitol may cause, as side effect, hypo- and/or hyper______________. Natremia. (Na+ levels)
Failure of Vitamin _____ _______________________ is seen in patients with renal osteodystrophy. Vitamin D Hydroxylation
What condition is seen with subperiosteal thinning of the bones? Renal Osteodystrophy
The increased glomerular membrane permeability seen in MCD, causes __________________________, seen in EM. Effacement of the PODOCYTES
Which properties of the GMB are lost as cause of effacement podocytes in MCD? Anionic properties
What is the ultimate result of Podocyte effacement in MCD? GMB losses anion properties, leading to the loss of SELECTIVE Albumin
Which is the only nephrotic syndrome that is selective of protein loss> Minimal Change Disease (MCD)
With MCH as the exception, all Nephrotic syndromes are ________________________, in respect of protein loss. Non-Selective
12 yo male complains of swollen legs, red-brown urine, and nearly 21 ago he was treated for Strep infection with penicillin. Dx? Post-Strep GN (PSGN)
BPH is a common cause of which type of urinary involuntary loss? Overflow incontinence
Why are BPH patients often found with higher rates of UTIs? The higher resistance to urine outflow,lead to residual urine, serving as medium for bacterial growth.
Yellow-brown, diamond shape crystals, that are radiolucent on plain X-ray. Uric acid kidney stones
Which conditions favor the precipitation of uric acid kidney stones? Low urinary pH, Low urine volume, and high uric acid concentration, in the setting of chronic diarrhea
Hexagonal kidney stone Cysteine
Mg-NH3-PO3 nephrolithiasis Enveloped-shaped crystal
Which kidney stones required acidic environment? Calcium-oxalate stones, Uric Acid stone, and Cysteine Stones
What is the general clinical manifestation of kidney stones on a patient? 1. Unilateral flank tenderness 2. Colicky pain radiating to groin 3. Hematuria
Which kidney stones require an alkalotic environment to precipitate? Calcium-Phosphate stones and Ammonium-Nitrate-Phosphate stones.
All kidney stones are _________________________, except for ______ which is _____________________, in X-ray view. RadioPAQUE; Cysteine is RadioLUCENT in x-ray view.
Which kidneys stones are wedge-shaped prism? Calcium-Phosphate
Coffin-like shaped kidney stone? Mg-NH3-PO3 stone
Ethylene glycol (antifreeze) ingestion, Vitamin C abuse, hypocitraturia, Crohn's disease Common disorder that present Calcium-Phosphate kidney stones
What is the treatment of Calcium kidney stones? Thiazides, citrate, and low sodium diet
The organisms involved in Mg-NH3-PO3 stone formation, cause the __________________ of urine. ALKALIZATION
Hydrolyze urea to ammonia Action seen in Urease positive organisms causing the Alkalization of urine in Struvite formation
What 3 common urease + organisms cause Mg-NH3-PO3 kidney stones? Proteus mirabilis, Staph saprophyticus, and Klebsiella.
What conditions predispose uric acid kidney stone formation? Strongly associated to hyperuricemia (Gout) and to leukemias with high cell turnover
Treatment of Uric acid nephrolithiasis Alkalization of urine and ALLOPURINOL
Defective Cysteine-transporter in PCT cells leads to ______________, leading to greater chances of developing ______________ kidney stones. Cystinuria; Cysteine
Sodium cyanide nitroprusside + test Cysteine kidney stones
The hereditary condition leading to cysteine kidney stones, due to defective Cysteine-transporter in PCT , also lead to poor absorption of which amino acids? COLA (Cysteine, Ornithine, Lysine, Arginine)
Which is the most common type of renal cell cancer? Clear cell carcinoma
Where is the most common site to find clear cell carcinoma? Epithelial cells of the Proximal renal tubules.
Clear cell carcinoma is derived from _________________ cells. Epithelial cells of the Proximal renal tubules.
Gross-examination of affected tissue shows a sphere-like mass made of GOLDEN-YELLOW cells, with high-lipid content, and areas of necrosis and hemorrhage. Clear Cell renal carcinoma
MC sites of metastasis of renal cell carcinoma Lungs and Bone due to hematogenous spread
Renal cell carcinoma is associated with which AD condition? von Hippel Lindau Syndrome, due to chromosome 3 mutation
Which gene and on what chromosome is mutated n VHL? VHL gene on chromosome 3
Which paraneoplastic syndromes are associated with RCC? PEAR : PTHrP, Ectopic EPO, and ACTH, and Renin
PEAR Mnemonic of paraneoplastic syndromes associated with RCC
PTHrP, Ectopic EPO, ACTH, and Renin paraneoplastic syndromes PEAR; associated with RCC
What is the most common Primary renal malignancy? Renal cell carcinoma (RCC)
Resistant to chemotherapy and radiation Renal cell carcinoma (RCC)
Malignancy commonly seen with flank pain, painless hematuria, SECONDARY POLYCYTHEMIA, and palpable abdominal mass? Renal cell carcinoma (RCC)
Filtration rate equation Filtration rate of Sub X = (Inulin clearance * (Plasma [X])
Filtration rate of X minus Tubular reabsorption of Sub X Net Excretion of Sub X
What renal condition is associated with the use of antibiotics such as B-lactams, sulfonamides, adn rifampin, and others such as PPIs, NSAIDS, and diuretics? Acute Interstitial Nephritis
Patient recently started with a 3rd generation cephalosporin, visits doctor's office due to new rash and fever. Dx? Acute Interstitial Nephritis
Another name or denomination for Acute Interstitial nephritis? Tubulointerstitial Nephritis
What is a common sign of Tubulointerstitial nephritis? PYURIA with administration of new drug
WBC casts + Pyuria + Hematuria + New Drug Acute Interstitial Nephritis
What is likely to be found in urine examination of a patient with acute Interstitial nephritis? Eosinophilia and urinary eosinophils
Osmotic diuretic Mannitol
Acetazolamide Carbonic anhydrase inhibitor
Alkalinizes urine (diuretic) Acetazolamide
Treatment of Altitude sickness Acetazolamide
Furosemide, Butamide and Torsemide Sulfonamide Loop diuretics
Non-sulfonamide Loop diuretic? Ethacrynic acid
Side effects of Loop diuretics Ototoxicity, Hypokalemia, Hypomagnesemia, Dehydration, Allergy (sulfa), metabolic Alkalosis, Nephritis (interstitial), Gout
Which type of Loop diuretic is more ototoxic? Non-sulfonamide Loop diuretic
Loop diuretics increase the loss of what ion? Calcium
Which are the most common Thiazide diuretics? Hydrochlorothiazide, chlorthalidone, and metolazone
Side effects seen in HCTZ? HypoKalemic Metabolic Alkalosis, Hyponatremia + Hyper: Glycemia, Lipidemia, Uricemia, Calcemia
HyperGLUC? Mnemonic used to indicate the elevated levels of glycine, Lipids, Uric acid, and Calcium seen in Thiazide diuretics side effects
Which labs are decreased in Thiazide side effects? Hypokalemia and Hyponatremia
The Thiazides ___________________ calcium ______________. Decreased Ca excretion
Gout like effects are often seen in which type of diuretics? Thiazides and Loop diuretics
Which K-sparing diuretics are competitive antagonists of Aldosterone? Spironolactone and Eplerenone
Which K-sparing diuretics block the Na+ channels? Triamterene and amiloride
Spironolactone is an ________________________________________. Competitive Aldosterone Antagonist
K+-sparing diuretics work more at the _______________________ ___________________ tubule. CORTICAL COLLECTING tubule
Hyperaldosteronism, HF, K-depletion, hepatic ascites, and antiandrogenic Clinical uses of K+ sparing diuretics
Which Potassium sparing diuretic is specifically used in management of Nephrogenic DI? Amiloride
NaCl in urine increases with? In the use of diuretics
Which type of diuretics increase Urinary K+ the most? Loop and Thiazide
Which diuretics cause Acidemia? Carbonic anhydrase inhibitors and K-Sparing diuretics
Which pair of diuretics cause Alkalemia? Loop and Thiazide
Created by: rakomi