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Renal

FA review Round 1 2020

QuestionAnswer
What cancer is associated with Paraneoplastic syndrome of Inappropriate ADH production? Small Cell carcinoma
Which paraneoplastic condition is associated with Small Cell carcinoma? SIADH
On which receptors does ADH act upon? V1 and V2-receptors of the renal collecting tubules
What is the action of ADH on V1-receptors? Stimulation of vascular smooth muscle to cause contraction
What is the action of ADH on V2-receptors? In DCT and Collecting duct cells to increase water reabsorption via increased luminal aquaporin density
Which receptor, V1 or V2, cause vascular smooth muscle contraction upon actions ADH? V1-receptors
Which receptor, V1 or V2, increase water reaborosion in the DCT and collecting duct cells by increasing aquaporin density? V2-receptors
What is the cause of BPH? Hyperplasia of prostate transitional zone tissue
Which zone of the prostate is enlarged in BPH? Transitional zone
What factor is associated with development of BPH? Increasing age
What enzyme is activated the Vasopressin and V2-receptor binding? Adenylyl cyclase
What is the ultimate result of the activation of Adenylyl cyclase by vasopressin binding to V2-receptors? Increased reabsorption of water
What is the definition of Filtration fraction (FF)? Fraction of renal plasma flow that is filtered across the glomerular capillaries into the Bowman
FF = GFR ----------------------------- RBF (1-hematocrit)
GFR ------ RPF FF
What is the result of increased PTH in CKD patients? Reduction in phosphate excretion
What are the effects of HR, TPR, Renin, and Vasopressin due to hypovolemia? Increase in all those RAAS aspects
What is the most common Carbonic anhydrase inhibitor? Acetazolamide
Acetazolamide induced metabolic acidosis or metabolic alkalosis? Metabolic acidosis
What is the immediate compensation to metabolic acidosis? Increased respiratory drive
Which diuretic is known to treat Acute Mountain Sickness? Acetazolamide
What conditions are known to be treated with Acetazolamide? 1. Acute Mountain sickness 2. Altitude sickness 3. Metabolic alkalosis 4. Glaucoma 5. Idiopathic intracranial hypertension
What type of diuretics is used to treat and prevent Calcium kidney stones? Thiazides
What is the typical lab measure or condition, that immediately should raise suspicion of a calcium renal calculi? Idiopathic hypercalciuria
What are the urine and serum C2+ levels in Idiopathic hypercalciuria? 1. Elevated urine calcium 2. Normal serum calcium
What is the normal range of Urine Calcium levels? 100-300 mg/day
Which renal function measure is measured with Inulin clearance? GFR
Why is inulin clearance a good estimate for GFR? It is freely filtered (inulin)
Overestimation of GFR is due to : Compound used to measure GFR is secreted in the PCT
If a compound used to measure GFR gives an underestimation, means that: It is not Freely filtered
What type diuretic is Furosemide? Loop diuretic
What is Furosemide clinical use? 1. Symptoms of CHF 2. Acute pulmonary edema
Furosemide is contraindicated in: Patients with HYPOCALCEMIA
Furosemide is CI in patients with Hypo- or Hypercalcemia? Hypocalcemia
What is the effect of Prostaglandins in glomerular filtration? Dilate Afferent arteriole
Which arteriole is prefered by Prostaglandins, afferent or efferent? Afferent
What medications cause inhibition of prostaglandin action in the Afferent arteriole? NSAIDs
NSAID use causes what in the renal arterioles? It causes CONSTRICTION in the Afferent arteriole
Which arteriole is preferred by NSAIDs, afferent or efferent? Afferent
Which article is preferred by AT II, afferent or efferent? Efferent
Which arteriole is preferred by ACE inhibitors, afferent or efferent? Efferent
What is the effect on glomerular arterioles by ATII? Constric Efferent arteriole
Which medications inhibit the actions of AT II on the Glomerular efferent arteriole? ACE inhibitors
What are some common NSAIDS? Ibuprofen, Naproxen, Indomethacin, and Ketorolac
What enzyme is directly affected by the use beta-blockers in the RAA system? Renin
A decrease in Renin production will cause what effect to the following enzymes and products of the RAAS? All will decrease
What is SIADH? Excess ADH secreted by the pituitary, malignancies, or pulmonary cells in respiratory illness
What is the main electrolyte imbalance seen with SIADH? Hyponatremia
Why does SIADH develop hyponatremia? Due to renal water retention
What is the only treatment hyponatremia in SIADH? Water restriction, in order to gradually increase plasma Na+ concentration
Which 3 conditions are the ones that can bypass parental consent? 1. "Sex" --> contraceptives, STIs, and pregnancy 2. "Drugs" --> substance abuse 3. "Rock and Roll" --> Emergency or Trauma
What is the IF of MPGN type 1? Subendothelial deposites of C3 and IgG
Which nephrotic/nephritic condition is seen with IF depicting subendothelial deposits of C3 and IgG? MPGN type 1
What is the cause of MPGN type 2? Caused by C3 nephritic factor, which stabilizes C3 convertase, leading to a dense deposit disease
Which type of MPGN, 1 or 2, is caused by C3 nephritic factor? MPGN type 2
What is the properties description of S. epidermidis? Gram (+) coagulase (-) staphylococci
What conditions are associated by S. epidermidis infection? Indwelling prosthetic devices or catheters
Which bacteria is part of normal skin flora, but is associated by development of peritonitis in a person with a central line catherer? S. epidermidis
What is the most common cause of Dialysis-associated peritonitis? S. epidermidis
A CKD patient is on dialysis, which is a possible skin infection that may develop? S. epidermidis
Location of RTA type 1? DCT
Location of RTA type II? PCT
What are the location for RTA type IV? Adrenal or Collecting tubule
Which RTA types have urine pH > 5.5? Type 1 and Type 2
Which RTA type(s) have a urine pH < 5.5? Type IV
Which RTA type is seen with a high K+ level? Type IV
What electrolyte level separates Type IV RTA from Type I and type II RTA? Hyperkalemia
Urine pH < 5.5, Hyperkalemia Hypoaldosteronism Dx? RTA type IV
Low or high, K+ level of RTA type I? Low
Hypokalemia or hyperkalemia in RTA type II? Hypokalemia
What is the main defect in RTA I? No H+ secretion
Which RTA is due to "No HCO3- reabsorption"? RTA type II
What is the cause for RTA type IV? Hypoaldosteronism
Low levels of aldosterone are the cause of which RTA? RTA type IV
Which conditions are often associated with Hep A infection? 1. Areas of poor sanitation (third world countries) 2. Eating contaminated raw fish
What are the clinical sgs associated of a Hep A infection? N/V, malaise, abdominal pain, jaundice and bilirrubinuria
What causes the dark urine seen in Hep A infected patients? Bilirubinuria
What is uremia? Complication of CKD that leads to significantly elevated level so urea in blood
What type of metabolic acidosis is caused by Uremia? High anion gap metabolic acidosis
What condition can cause High anion gap metabolic acidosis? Methanol ( formic acid) Uremia DKA Polythene glycol Iron and Isoniazid Lactic acidosis Ethylene glycol (oxalic acid) Salicylate (late aspirin) toxicity
"MUDPILES" Mnemonic used to summarize causes of high anion gap metabolic acidosis
What does the U in "MUDPILES" stand for? Uremia
What does the D in "MUDPILES" stand for? Diabetic ketoacidosis (DKA)
Iron overdose will cause high or normal anion gap metabolic acidosis? High anion gap
What mnemonic is used to summarize causes of normal anion gap metabolic acidosis? HARDASS
What conditions ar summarized in HARDASS? Hyperalimentation Addison disease RTA Diarrhea Acetazolamide Spironolactone Saline solution
What does the D in HARDASS stand for? Diarrhea
RTA causes high- or normal anion gap metabolic acidosis? Normal anion gap
What happens to FF in cases of decrease RPF and increase GRF? Increase
Which enzyme can cause an increase in FF, by decreasing RPF and increasing GFR? AT II
What is the most common nephritic syndrome in children? PSGN
In PSGN, is there low or high levels of C3? Low
Why is PSGN seen with low levels of C3? PSGN activates complement which leads to consumption of C3, which cause its low levels
What is an electrolyte imbalance due to rapid water ingestion? Hyponatremia
What causes hyponatremia due to rapid water ingestion? Kidney to increase the excretion of water and urea in urine
What is an important risk of rapid loss in serum osmolality? Cerebral edema
List of clinical signs/symptoms of PSGN: 1. Acute-onset hypertension 2. Dark, "tea-colored" urine 3. Edema (Periorbital, Peripheral, and/or Pulmonary) 4. Fatigue
What nephritic syndrome is common in children after 2 weeks form a throat or skin strep infection? PSGN
What is the common treatment for PSGN? Supportive care
PSGN treatment: Supportive care
What are the renal function effects of NSAIDS in renal patients or cirrhotic patients? - Decreased prostaglandin synthesis leads to: 1. Increased Preglomerular resistance, 2. Increased renal blood flow (RBF) 3. Reduced GFR
How is NSAID-induced renal ischemia clinically manifested? Interstitial nephritis or Nephrotic syndrome
MOA of Indinavir Protease inhibitor
What renal adverse effect is associated with Indinavir? Crystal-induced nephropathy
What is the clinical presentation of Crystal-induced nephropathy? Malaise, weakness, nausea, flank pain, dark urine, and rarely oliguria
What HIV medication is associated with Crystal-induced nephropathy? Indinavir
What is the 1st choice for UTI treatment in pregnant women? Nitrofurantoin
WHat is the 2nd choice treatment for UTI in pregnant women? Penicillin or 1st generation Cephalosporin
MOA of Nitrofurantoin Converted (nitrofurantoin) by bacterial enzyme into toxic intermediates that interfere with bacterial ribosomes
What is the most common renally associated species of Enterococcus that causes infection? Enterococcus faecalis
What patients are often seen with E. faecalis renal infection? 1. Prolonged catheterization, 2. Invasive urinary tract procedures (cystoscopy)
What conditions are often due renal E. faecalis infection? Pyelonephritis, bacteremia, and Endocarditis
What is the MCC of community-acquired and hospital-acquired UTI? E. coli
E. coli UTI is (+) for ________________. Nitrates
When does Tumor Lysis syndrome present? After chemotherapy for leukemia
What are the acute kidney injury signs of Tumor Lysis syndrome? Hypocalcemia, hyperphosphatemia, hyperuricemia, and hyperkalemia
What medications/actions are used to prevent Tumor Lysis syndrome? Hydration, Rasburicase, and Allopurinol
Which electrolyte or serum levels are seen at higher levels in Tumor lysis syndrome? Phosphate, uric acid, and potassium
Hypocalcemia or Hypercalcemia in Tumor Lysis syndrome? Hypocalcemia
What condition is treated with Probenecid? Gout
What is the MOA of Probenecid? Increases uric acid excretion in the urine
Which part of the renal artery is affected by Fibromuscular dysplasia? Distal 2/3 of the renal artery or segmental bronchioles
Which population is most likely to develop RAS due to fibromuscular dysplasia? Young or middle-age women
What are the common symptoms or clinical presentation of RAS? - Subacture and/or refractory HTN with no family Hx - Asymmetric renal size - Epigastric/Flank bruits - Hypokalemia
Which condition is often described with abdominal (bilateral or unilateral) bruits? Renal Artery Stenosis (RAS)
What are the 2 main causes of Renal Artery Stenosis (RAS)? 1. Atherosclerotic plaques 2. Fibromuscular dysplasia
Population most likely to develop RAS due to atherosclerotic plaques? Older males and smokers
Which part of the renal artery is affected in RAS due to atherosclerotic plaques? Proximal 1/3 of renal artery
A patient with RAS, shows the problem in the proximal third of the renal artery, what is the most common cause? Atheroslcerotic plaques
Key: Epigastric or Flank bruits. Dx? Renal Artery Stenosis (RAS)
What happens to electrolytes and fluid volume in a person vomiting? Leads to loss of HCl and extracellular volume
What are the consequences of HCL and ECV loss due to vomiting? Decreased ECF and Contraction Metabolic Alkalosis
Which type of metabolic disorder, acidosis or alkalosis, is produced by chronic vomiting? Contraction Metabolic Alkalosis
What is the MCC of BIlateral Fetal hydronephrosis? Posterior Urethral valves
How is bilateral fetal hydronephrosis caused? Due to embryonic defect that lead to persisten obstructing urogenital membrane of the junction of the bladder and urethra
What junction is obstructed in Bilateral Fetal Hydronephrosis? Urogenital membrane of the junction of the bladder and urethra
Posterior Urethral valves are the most common cause of: Bilateral Fetal hydronephrosis
How is Ureteropelvic junction obstruction clinically presented? Unilateral Hydronephrosis
Which is is the obstructed junction in most cases of Unilateral hydronephrosis? Ureteropelvic junction (UPJ)
Which type of genitourinary junction obstruction is seen with possible bladder and urethra distension? Junction of the bladder and urethra junction due to Posterior urethral valves persistence
Are the fetal bladder and urethra distended in Ureteropelvic junction obstruction? No, the dilation is only seen proximal to the obstruction
What is a serous and common complication of DM type 1? DKA
What are lab features (levels) seen in DKA? 1. Hyperglycemia (very elevated glucose levels) 2. Hyperkalemic 2. High anion gap metabolic acidosis
What are the serum replacements given in the treatment of DKA? Insulin and Potassium
Which condition, despite of presenting with Hyperkalemia, is still treated with K+ replacement? DKA
What occurs in the kidneys due to bilateral RAS? Kidneys become dependent on high levels of Angiotensin II to maintain renal perfusion and function
Why are bilateral RAS patients so dependent of high levels of ATII? Maintains renal perfusion and function
Which type of medication should be used very cautiously in bilateral RAS patients? ACE inhibitors
What is the common type of drug used to treat Renal Cell carcinoma? Recombinant IL-2
Why are Recombinant IL-2 drugs used to treat RCC? T-lymphocyte growth factor; used to promote immune-mediated antitumor effects
What is the most common Recombinant IL-2 drug? Aldesleukin
What type of malignancy is treated with Aldesleukin? Renal cell carcinoma
What substance is freely filtered at the glomerulus, and at normal plasma levels? Glucose
In which part of the nephron is glucose completely reabsorbed? PCT
What substance is completely reabsorbed in the PCT? Glucose
At what serum glucose range, is glucose start been present in urine? 200-375 mg/dL
What does it mean when glucose levels exceed 375 mg/dL? Transport proteins are completely saturated
Bartter syndrome has mutations in : Na+/K+/2Cl- transporters in the Thick Ascending loop of Henle
Bartter syndrome imitates what condition? Chronic use of Loop diuretics
What are important or classic serum/urine abnormalities seen with Bartter syndrome? Metabolic alkalosis, hypokalemia, and Hypercalciuria
What is the MCC of Nephrogenic Diabetes insipidus? Adverse effect of Lithium therapy
What "sugar" condition is associated with Lithium administration? Nephrogenic Diabetes insipidus
Minimal to no change in urine osmolality after water deprivation test. Dx? Nephrogenic Diabetes insipidus
How are ADH level in nephrogenic DI? Elevated or normal
If the levels of ADH are decreased, which DI is present? Central Diabetes insipidus
Bipolar patient presents with extremely elevated glucose levels, and shows improvement in urine osmolality after water deprivation test. Dx? Central Diabetes insipidus
Which arterial gas value is fist to be checked to determine the proper imbalance? pH
What is the second value in ABG to be checked in order to determine the proper diagnosis? PaCO2
If pH and PaCO2 change in the "same" direction, meaning both go up or down, it is said to be metabolic or respiratory? Metabolic
ABG: pH goes up PaCO2 goes up Metabolic alkalosis
ABG: pH goes down PaCO2 goes up Respiratory acidosis
A simple way to define proper compensation to acid-base disturbances is to think "For ACIDOSIS" Things go Faster
What is the compensation for Metabolic Acidosis? Hyperventilation
What is the compensation for Respiratory Acidosis? Increased renal HCO3 reabsorption
What would be the proper compensatory mechanism for metabolic alkalosis? Hypoventilation
What type of Acid-Base disorder is compensated by a decrease renal bicarbonate reabsorption? Respiratory alkalosis
Common causes of Metabolic alkalosis: 1. Loop diuretics 2. Vomiting 3. Antacid use 4. Hyperaldosteronism
A patient with an OD on Furosemide is likely to develop which acid-base disturbance? Metabolic alkalosis
What type of acid-base disorder is due to vomiting? Metabolic alkalosis
Patient with a adrenal gland tumor, that produces excessive amounts of aldosterone, will develop what acid-base disorder? Metabolic alkalosis
List of common causes of Respiratory acidosis: 1. Airway obstruction 2. Acute/Chronic lung disease 3. Opioids and sedatives 4. Weakening of Respiratory muscles
A problem that diminishes or interferes the person's ability to produce normal respiration, will likely develop which type of acid-base disorder? Respiratory acidosis
A person OD with heroin, arrives to ER. What type of acid-base condition would likely show the ABGs of the patient? Respiratory acidosis
List of conditions that lead to Respiratory alkalosis: 1. Anxiety/Panic attack 2. Hypoxemia (high altitude) 3. Salicylates (early) 4. Tumor 5. Pulmonary embolism
A person with a pulmonary embolism will likely to develop which acid-base condition? Respiratory alkalosis
What is the acid-base disturbance of early aspirin toxicity? Respiratory alkalosis
Late aspirin toxicity is seen with metabolic _________________. Acidosis
Respiratory alkalosis ----> Metabolic acidosis. This is a classical change in ABG disturbance seen with: Aspirin overdose
A person in a Mountain camp base, will likely develop which Acid-Base disturbance? Respiratory alkalosis
What is the cause of Liddle syndrome? Genetic disorder that involves the constitutive activation of the epithelial sodium channel in the collecting tubules of the kidney
Which collecting tube channel are affected in Liddle syndrome? Epithelial sodium channels
What is the treatment options for Liddle syndrome? Triamterene and/or Amiloride
What type of drugs are Treambere and Amiloride? Diuretics that inhibit the epithelial Na+ channels (ENaC) of the collecting tubules of the kidney
What are the common signs of Liddle syndrome? Early HTN characterized by: - Low levels of Renin and Angiotensin - Excess reabsorption of Na+ - Loss reabsorption of K+
What are structural abnormalities associated with Turner syndrome? Horseshoe kidney, Collecting-system malformations, and Positional abnormalities
What renal structural abnormalities are the reason for increased risk of UTIs in Turner syndrome? Positional abnormalities and Collecting-system malformations
Which hepatitis infections seen with symptoms of cirrhosis? Hep C infection
What is the structural description of Hep C virus? Linear, (+) ss-RNA virus with icosahedral capsid, part of Flavivirus family
Which hepatitis virus a a Flavivirus? Hepatitis C
Created by: rakomi
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