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Renal 2

UWORLD + FA Renal Review

QuestionAnswer
What population is at higher risk of developing Multiple Myeloma (MM)? Elderly
What are the lab and physical finding in Multiple Myeloma? HYPERCALCEMIA, normocytic anemia, bone pain, elevated gamma gap, and renal failure.
Light-chain nephropathy is seen in __________________ patients. Multiple Myeloma (MM)
What kind of urinary casts are seen in Multiple Myeloma? Large, waxy, eosinophilic casts, composed of Bence Jones proteins in the tubular lumen.
Waxy casts in MM Numerous, large, glassy eosinophilic casts
Plasma cell neoplasm produces MONOCLONAL immunoglobulin Multiple Myeloma (MM)
Osteolytic lesions/osteopenia, M-spike, and B-cell neoplasm Multiple Myeloma (MM)
WBC casts are seen in: Acute pyelonephritis and Interstitial nephritis
ATN has ____________________ casts. Granular (muddy brown)
What conditions exhibit Hyaline casts? Chronic interstitial nephritis or acute papillary necrosis
What are the two types of calcium stones? Oxalate and Phosphate
What is the most common risk factor of Calcium kidney stone formation? Hypercalciuria
If a healthy patient develops a calcium kidney stones, the patient usually exhibits a serum __________________, and urinary _______________. Normocalcemia; Hypercalciuria
What are levels of parathyroidism and calcium in primary hyperparathyroidism? Elevated PTH and Calcium
What is the MCC of Nephritic syndrome in children? Post-Streptococcal GN
PSGN is a __________________, which is ___________________. Type III Hypersensitivity; Immune-complex mediated
What are common Type III Hypersensitivity diseases? 1. Serum Sickness 2. PSGN 3. Lupus nephritis
Type II hypersensitivity are IgG or IgM autoantibodies deposition.
What are two common Type II Hypersensitivity pathologies? Goodpasture syndrome and Autoimmune Hemolytic Anemia
Diabetic autonomic neuropathy is commonly exhibited in ________________. Diabetes Mellitus type 1
What kind of urinary incontince is seen in a DM1 patient? Overflow incontinence
Overflow incontinence due to inability to sense a full bladder and incomplete emptying, is commonly seen in ____________ patients. Diabetic Type 1
What test is used to diagnose overflow incontinence? Post Void Residual (PVR) test
What kind of urinary incontinence are seen or provoked by and enlarged prostate? 1. Urge incontinence --> due to prostate causing irritation to the bladder 2. Overflow incontinence --> due to obstruction by prostate
What kind of pathology or condition may lead to an increase in Tubular Hydrostatic Pressure? Urinary Tract obstruction leading to urinary reflux into renal tubules
A calculi in the proximal ureters is seen with a _____________ Tubular hydrostatic pressure, which lead to an ____________ gradiente in the glomeruli and Bowman's space, leading to a __________________. Increase; Decreased; Decreased GFR
What are some common side effects of ACE inhibitors? 1. Decreased GFR 2. Hyperkalemia 3. Cough and Angioedema (rarely)
Why can Lisinopril cause a reduction in GFR? ACE inhibitors stop the conversion of ATI into AT II, thus, the efferent arteriole is not constricted more than the afferent leading to a decrease in glomerular pressure --> decreased GFR
What kind of drug prevents AT I --------> AT II? ACE Inhibitors
What are the main three factors or conditions leading up to Uric acid stone formation? 1. Increased Uric Acid excretion 2. Increased Urine concentration 3. Low urine pH
What diseases are associated ith and increased Uric acid excretion? Gout and Myeloproliferative disorders
What can cause a low urine pH? Chronic diarrhea ( due to GI bicarbonate loss), Metabolic Syndrome and Diabetes Mellitus
What cells produce EPO? Peritubular fibroblast cells in the Renal Cortex
What underlying condition leads to EPO-synthesizing cells to increase their activity? Decreased renal oxygen delivery
CKD patients often have damage to the EPO-synthesising cells leading to: Normocytic anemia due to insufficient EPO
What is osmolarity? Concentration of a solution expressed as the total of solute particles per liter.
Highest Osmolarity = Highest concentration
What combination of solutes and solution, would yield the greatest increase in osmolarity? Increase in solute (protein) and a decrease/loss of solutio (water)
The ______________ of the _________________ has the highest osmolarity. Bottom (curved) part; Loop of Henle
What is the approximate osmolarity of the lowest part of the Loop of Henle? 1200 Osm/L
What are the approximate Osmolarities of ? PCT --> Descending Loop of Henle --> Bottom (curved) Loop of Henle --> Thick (Ascending) Loop of Henle --> DCT --> -- 300 -- 350--450 -- 1,200 -- 400-100 -- 100
Surgeries such as Hysterectomy and Pelvic Lymphadenectomy may cause ____________________ after a week from the surgery. Uretic Obstruction
A decrease in GFT subsequently lead also to a decrease in ________, unless compensated by modifying the RPF. Filtration fraction
What is the equation for Net Filtration Pressure? (Pc - Pi) - (Nc - Ni)
Pc- Pi is? Hydrostatic Pressure gradient
Pc stands for? Hydrostatic capillary pressure
Hydrostatic interstitial pressure? Pi
Oncotic pressure gradient? Nc - Ni
Oncotic interstitial pressure Ni
Nc stands for? Oncotic Capillary pressure
A negative Net filtration pressure means? Fluid is traveling from the INTERSTITIUM into the CAPILLARIES.
Fluid from CAPILLARIES ------> INTERSTITIUM Positive Net filtration pressure
Acute urinary retention presents characteristically with? Anuria and bladder distension
What is the MCC of a distended bladder? BPH due to urethral compression
What are the 3 types of cells that make up the Juxtaglomerular apparatus? 1. Macula Densa cells 2. Juxtaglomerular cells 3. Extraglomerular Mesangial cells
Tall, narrow cells, located at the distal tubule, and responsible for sensing salt content and tubular flow rate. Macula Densa cells
Abnormal flow rate of urine in the renal tubules is sensed by the _____________ cells, which send such information to the ____________, in order to respond. Macula Densa cells; Juxtaglomerular cells.
Modified smooth muscle cells that release renin? JG cells
Renal hypoperfusion is sensed by ________ cells, which respond with compensatory release of __________, which increases the levels of ________ and _____________. JG cells; RENIN: AT II and Aldosterone
Stress incontinence is due to: 1. Decreased urethral SPHINCTER tone 2. Urethral HYPERMOBILITY
Detrusor hyperactivity is the pathogenesis of? Urge incontinence
What are the causes or reasons for Overflow incontinence? 1. Impaired Detrusor contractility 2. Bladder Outlet Obstruction
Decreased urethral sphincter tone, will cause _______ incontinence, especially in women after birth while sneezing. Stress
Fatty casts are seen in ___________________, and are composed of _____________. Nephrotic Syndrome; Lipid droplets
What urinary casts are made up of Tamm-Horsfall protein? Hyaline casts
A degenerated hyaline casts is know as _______________ cast, and is associated with _______________. Waxy cast; Chronic Kidney disease
Sloughed tubular epithelial cells with pigmented granules Granular (Muddy brown) casts
Muddy-Brown casts are associated with __________________. Acute Tubular necrosis (ATN)
What diseases are seen with WBC casts? 1. Pyelonephritis 2. Intestitial Nephritis
Glomerulonephritis is seen with ____________ casts. RBC
Weak pelvic floor is seen in __________ incontinence. Stress
Impaired Bicarbonate reabsorption in the PCT. Dx? Type 2 Proximal RTA
What is Renal Tubular Acidosis (RTA)? Condition that affects the renal tubules and results in a HYPOCHLOREMIC metabolic acidosis with a normal serum anion gap.
What is the serum Potassium (K+) level of Type 1 Proximal RTA and Type 2 Distal RTA? Hypokalemia (Low K+)
Type 4 RTA is seen with _____________________, contrary to Type 1 and Type 2 RTA. Hyperkalemia
Type 4 RTA is mainly located at the endo to the ______________. Collecting Tubules
Hyperkalemic RTA is also known as? Type 4 RTA
What is the main issue in Type 1 RTA? Impaired H+ secretion
What are common findings in Type 1 RTA? Renal stones, Hypokalemia, and pH > 5.5
Decreased ALDOSTERONE secretion or ALDOSTERONE resistance, is the pathogenesis for? Type 4 RTA
What parts of the nephron are the ones with lowest pH? DCT and Collecting ducts
What kind of kidneys stones are precipitated with Tumor Lysis syndrome? Uric acid
Why is uric acid stones present in Tumor Lysis patients? The lysis of tumor cells release K+, phosphorus, and Uric acid.
What factors aid in the precipitation of Uric acid stones? The low pH of the DCT and Collecting tubes, and the low flow rate through the nephron.
Alkalinization of urine and proper hydration are used to prevent the formation of ____________________ seen in Tumor Lysis syndrome. Uric acid stones
What artery supplies the proximal part of the ureter? Renal artery
The ureter donor's __________________ anastomoses with the recipients' _________________, in order to provide proper blood flow the transplanted ureter. Renal artery; External Iliac artery
What artery provides blood irrigation to the distal ureter? Superior Vesical artery
What part of the nephron accounts for the MOST REABSORPTION of water ? PCT
What area is ADH-independent, the most permeable to water? PCT
The collecting ducts can be water ______________, if the ADH level is ______________, or ___________________, if the ADH level is _________. CT --- Permeable if ADH is high CT --- Impermeable if ADH is low
Time required to have an acute organ rejection. Weeks to months
Acute organ rejection has both, ___________ and __________ - sensitization. Host B Cell and Host T-cell sensitization
Mononuclear (lymphocytic) infiltrate on histopathology, is commonly seen in: Acute Cellular (T-cell) rejection
How is the acute Humoral rejection presented? Causes NECROTIZING vasculitis with an neutrophilic infiltrate
Acute allograft rejection has (2): 1. Antibody - mediated process 2. Cell-mediated process
What is the cell-mediated process seen in acute cellular rejection? Diffuse lymphocytic infiltration of the renal vasculature (endotheliitis), tubules, and interstitium.
What is a common and early sign of acute cell mediated rejection? Elevated serum creatinine
What two measures can be used to measure GFR? 1. Inulin clearance 2. Creatinine clearance
Inulin and Creatinine: substances that are FREELY FILTERED at the glomerulus, and have relative insignificant tubular reabsorption or secretion.
The Inulin and/or Creatinine clearance rates are used to measure or approximate the _________________. GFR
What is the formula for Clearance of X (Cx)? = ([Urine concentration of X] x [Urine flow rate])/ (Plasma concentration of X)
The clearance of PAH approximates _______________. RPF (Renal plasma flow)
Clearance of Inulin/ Clearance of PAH = FF
What is the most practical equation for Renal Blood Flow (RBF)? = (PAH clearance) / (1-hematocrit)
RPF divided by (1-hematocrit) RBF
What is the immediate effect of renal artery stenosis? Renal hypoperfusion
How is renal hypoperfusion, due to bilateral RAS, compensated? Vasoconstriction of AT II on efferent arteriole, to maintain GFR
What is the effect of ARBs or ACE inhibitors on the glomeruli? They cause vasodilation on the Efferent arteriole.
What are some changes seen in renal glomeruli forces in a patient with low renal perfusion and started on Lisinopril? The GFR is diminished, due to the decreased intraglomerular force, caused by the constriction of the efferent arteriole.
What kind of drugs affect the actions of AT II on the Efferent arteriole? ARBs (Losartan) and ACE inhibitors (Captopril)
What features are shared by all Primary Thrombotic Microangiopathy (TMA) syndromes? 1. Hemolytic anemia with Schistocytes 2. Thrombocytopenia 3. Organ injury (Brain, Kidneys, Heart)
What are two common TMA syndromes? TTP-HUS and DIC
IN Primary TMA syndromes, the platelet activation and microthrombosis in arterioles and capillaries, accounts for the common symptom of _________________. Organ injury to brain, kidneys, and heart
WBC casts are pathognomonic of? Pyelonephitits
Bacteriuria and Pyuria are shared characteristics of Upper and Lower UTIs
If the resistance is decreased (vasodilated) in the afferent arteriole, it causes what changes in GFR and RBF? RBF and GFR increase
If the resistance is augmented (Vasoconstricted) in the afferent arterioles, it causes? Decrease in RBF and GFR
A constriction or dilation only to the AFFERENT arterioles, cause a ____________ direction change in ____________ and _________. Equal/Same/Parallel; GFR and RBF. (both increase or both decrease together)
Opposing changes of RBF and GFR, indicated either vasoconstriction or vasodilation of the _________________. Efferent arteriole
Increased RBF and decreased GFR, is caused by __________________. Decrease resistance (Vasodilation) of the efferent arteriole
Where would you need to place a clip in order to produced an increase in GFR with a Decrease in RPF? In the efferent arteriole in order to produce a vasoconstriction of the efferent.
Definition of GFR. Volume of fluid filtered from the renal glomerular capillaries into the Bowman space per unit time
RPF is defined as: Volume of plasma delivered to the kidney per unit time
RPF is reduced by anything that________________________ causes less plasma to reach the kidney
What are some common causes of a reduced RPF? 1. Loss of fluid: Vomit, diarrhea, hemorrhage 2. Systemic arteriolar Vasoconstriction
Constriction of the ______________ arteriole causes a more drastic decrease in RPF. Efferent
Explain the relation of arterial hypertension, and GFR, RPF, and FF. Systemic arterial HTN causes a state of renal hypoperfusion, which leads to a decreased GFR. A decreased GFR causes less NaCl to reach the DCT and Macula densa, which causes an Increase in AT II and Renin production
What does an increase in AT II contitute? Vasoconstriction of the Efferent arteriole, which allow for a minimal increase or not such a dramatic decrease in GFR.
A decrease in __________ produces a direct decrease in ________ and ____________________________. RPF; GFR and Glomerular Hydrostatic Pressure
Decrease GFR ----> Decrease NaCl reaching the Macula Densa at the DCT
Decreased FF is due to a ______________________________. Decrease in Glomerular Hydrostatic Pressure
What are the compensatory effects of the afferent and efferent arterioles to a decreased GFR due to arterial hypotension? Afferent arteriolar DILATION Efferent arteriolar CONSTRICTION
Non-absorbable anion-exchange resin Sevelamer
What is the mode of action of Sevelamer? It is a non-absorbable anion-exchange resin that binds to intestinal PHOSPHATE to reduce absorption.
What is the common clinical (electrolyte imbalance) use for Sevelamer? Treatment of Hyperphosphatemia in CKD patients
Sevelamer promotes the _____________________ of _______________. Excretion of phosphorus
Acute Hemolytic Transfusion reaction is a _______________________. Type 2 Hypersensitivity
Pre-existing anti-ABO antibodies that bind antigens on transfused donor erythrocytes. Acute Hemolytic Transfusion reaction
WHat are the common findings in of Acute Hemolytic Transfusion reaction? Patient present with signs of shock, chest and back pain, and hemoglobinuria
Multiple myeloma is seen with _______________, due to tumor-related cytokines, which leads to a decreased ________________. The low levels of ___________ lead to ________________________. Hypercalcemia; PTH synthesis; Low PTH --> decreased renal reabsorption (Hypercalciuria)
Why is MM associated with low Vitamin D levels? MM is presents with CKD, thus, low levels of 1,25-(OH)2 Vit D synthesis.
Acute Hemolytic Transfusion reaction can be Intravascular or Extravascular, how are they distinguished from each other? Intra--> ABO blood group incompatibility; hemoglobinuria Extra --> Host antibody reaction against foreign antigen on donor's RBCs; Jaundice
How low is Acute Hemolytic Transfusion reaction first presented? Withing 1 hour
What are some of the MC NSAIDs? Ibuprofen, Aspirin, Naproxen
NSAIDs block _______________, causing a decrease production of ________________. COX 1/2 enzymes; Prostacyclins
Prostacyclins __________________ the afferent arteriole, and NSAIDs cause __________________________. Prostacyclins ---- Vasodilation ---- Afferent NSAIDs ---- Vasoconstriction --- Afferent
The ________________ __________________ caused by NSAIDs, can lead to a _______________, which would be classified as _________________, in whihc there is a BUN:Cr ratio of __________. Afferent arteriole vasoconstriction; Decrease in GFR; PRERENAL azotemia; BUN:Cr >20:1.
What is the MCC of Analgesic Nephropathy? Prolonged use of NSAIDs
What does the chronic use of analgesics, such as Naproxen and Ibuprofen, cause? Analgesic Nephropathy
How is Analgesic Nephropathy presented with? Papillary Necrosis and chronic Interstitial Nephritis
Receptor used by Vasopressin and Desmopressin? V-2 receptor in the Collecting tubules
What are the effects of Vasopressin? Increase water and urea permeability of the Inner Medullary Collecting duct, by stimulation of the V2 receptors.
Vasopressin increases the retention of ______________ and _________. Water and Urea
The increased permeability to Water and Urea by Vasopressin or Desmopressin, means? More water gets "out" of Collecting Tube lumen and goes into interstitium or blood vessel, in order to preserve intracellular water, and decrease its secretion, thus, causing a more concentrated urine.
High altitude is due to: Low levels of PiO2, which lead to Hypoxemia with compensated Hyperventilation and Respiratory alkalosis.
Patient presents with a 2d-day Hx of Hypoxemia, rapid breathing rate,and a blood pH of 7.50. Dx? High Altitude (Altitude sickness)
What two imbalances give the symptoms of Altitude Sickness? Hypoxemia and Alkalemia
Altitude sickness is compensated by the kidneys by: Producing a Metabolic Acidosis and by Increasing EPO secretion.
How does the compensatory metabolic acidosis is achieved ? 1. Decrease HCO3- reabsorption (less base in body) 2. Decrease H+ secretion (more acid)
Why is there increased EPO production in Altitude Sickness? To alleviate the Hypoxemia
What is the effect seek by athletes that do off season training in the mountains? The compensatory increase of EPO synthesis by the kidneys, allowing a higher oxygenation of the muscle tissue once in competition.
At normal levels of glucose in blood, the renal tubules____________ Reabsorb the ENTIRE filtered load of glucose
What is the TmG of glucose? 375 mg/min
What happens if the TmG of glucose is > 375 mg/min? Glucose begins to be excreted
At what point there are the first signs of glucose in urine? At threshold of 200 mg/dL
What is the threshold of glucose? 200 mg/dL
The _______________ line in a Excretion Vs Filtration graph, is 1:1 (perfectly positively linear) Inulin
If the slope in a Excretion vs Filtration graph of Inulin is 1:1, then the one for Urea is? 1:3
PAH lowest concentration is at the _____________________. Bowman capsule
PAH is not Absorbed by any part of the of the nephron, and is secreted into the nephron entirely by the proximal tubule.
The Tubular fluid concentration of __________, _________, and ________ follows the same pattern of concentration. Creatine, Inulin, and Mannitol
What part of the Nephron has the lowest NaCl plasma concentration? Distal Loop of Henle and early DCT
Glucose tubular concentration disappears early in the__________ Proximal Tubule
TF/P greater than 1 means: More water is reabsorbed than solute
Common examples of substances that have a TF/P >1? PAH, Inulin, Creatine, Urea
What are some examples of substances that have TF/P < 1? Bicarbonate >glucose= amino acids
A TF/P = 0.20 means? More solute is reabsorbed than water
What common vein is most often invaded by RCC? Renal Vein
In case that RCC starts to spread it will invade the ___________ and eventually spread to the ________________. Renal vein; IVC
IVC obstruction by RCC is presented with: Lower extremity edema, and with prominent development of venous collaterals in the abdominal wall.
What is the single most common risk factor associated with RCC development? Smoking
RCC is often presented clinically with: Flank pain, palpable mass, and Hematuria
What are some common risk factors for Rhabdomyolysis? Crush injury (car), prolonged muscle activity ( seizures, marathon training), and drug/medications use (statins, amphetamines, heroin)
Rhabdomyolysis is defined by: 1. Myocyte necrosis, release of intracellular contents (Myoglobin) 2. Kidney injury: Heme pigment-induced acute tubular necrosis
What labs are associated with Rhabdomyolysis? 1. Elevated Creatine Kinase 2. Myoglobinuria (positive for blood, but with NO RBCs) 3. Acute kidney injury and electrolyte abnormalities (Increased K+ and P+, and low Calcium)
Created by: rakomi