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Renal 2
UWORLD + FA Renal Review
| Question | Answer |
|---|---|
| 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
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