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Pathophysiology > Exam 3 Renal > Flashcards

Exam 3 Renal Flashcards

1
Q

What is azotemia indicative of?

A

High BUN or urea level

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2
Q

What is uremia indicative of?

A

Azotemia + symptoms

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3
Q

Bowman’s capsule is also known as?

A

urinary space

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4
Q

What can cross the glomerular filtration barrier?

a. RBCs
b. Albumin
c. Creatinine
d. WBCs

A

C creatinine

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5
Q

How is the glomerular BM charged?

a. positive
b. negative
c. neutral (uncharged)

A

B negative

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6
Q

What is oliguric acute kidney injury characteristic of?

a. normal urine output
b. decraesd urine output
c. increased urine output
d. NO urine output

A

Decreased urine output

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7
Q

What is hte problem in pre-renal ARF?

A

not perfusing the kidney enough

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8
Q

What is the BUN:creatinine ratio in pre-renal ARF?

A

20:1

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9
Q

In intrinsic ARF, what is the BUN: creatnint ratio?

A

much closer to 1:1 because both increase the same

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10
Q

If a pre-renal ARF patient, would you excrete MORE or LESS sodium?

A

LESS! less than 0.5% because you are volume depleted!

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11
Q

In an intrinsic kidney ARF patient, what will percentage of sodium excretion be?

A

Increased, to 2%

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12
Q

Patient with sterile pyuria most likely has?

a. Acute glomerulonephritis
b. Acute interstitial nephritis
c. Acute tubular necrosis
d. Lupus Nephritis
e. Minimal change disease

A

B

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13
Q

What is the most common cause of acute renal failure in hospitalized patients?

a. Acute glomerulonephritis
b. Acute interstitial nephritis
c. Acute tubular necrosis
d. Lupus Nephritis
e. Minimal change disease

A

C

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14
Q

Which of the following are seen with NEPHROTIC syndrome?

a. hyperalbuminemia
b. hypolipidemia
c. proteinuria
d. hematuria
e. None of the above

A 
C!
Nephrotic Syndrome is characterized by:
edema
proteinuria
hypOalbuminemia
HyPERlipidemia
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15
Q

T/F Most patients wtih chronic kidney disease secondary to diabetes will progress to end stage renal disease first rather than die

A

False, death occurs first

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16
Q

With what disease do you commonly see Kimmelsteil WIlson nodules?

a. Acute glomerulonephritis
b. Acute interstitial nephritis
c. Acute tubular necrosis
d. Lupus Nephritis
e. Diabetic Kidney Disease

A

E

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17
Q

In someone with hematuria, what is MOST likely true?

a. sediment is red, supernatant is red
b. sediment is red, supernatant is clear
c. sediment is clear, supernatant is clear
d. sediment is clear, supernatant is red

A

B

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18
Q

Positive blood on a dipstick but NO RBCs suggests?

A

rhabdomyolsis

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19
Q

Patient has a specific gravity of urine of 1.03. Their urine most likely?

a. is normal
b. is concentrated
c. is dilute
d. has RBCs in it
e. has WBCs in it

A

VERY concentrated (B)

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20
Q 
Your patient has a very concentrated urine, with a high specific gravity and a high osmolarity. What is the most probably cause of their kidney dysfunction?
A. pre-renal azotemia
B. acute tubular necrosis
C. acute interstitial nephritis
D. acute glomerulonephritis
E. lupus nephritis
A

A. because this is the only one that is PRE-renal which meanst hat they are not perfusing their kidneys so the kidneys are holding onto salt + water. all other options were intrinsic

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21
Q

UTIs caused by proteus or klebsiella commonly presents wtih :

a. acidic urine
b. alkaline urine
c. neutral urine

A

B alkaline

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22
Q

An alkaline urine would more likely present with:

a. uric acid stones
b. calcium phosphate stones
c. sodium potassium stones
d. nitrogen stones

A

B. alkaline

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23
Q

T/F Normally, you should not see bilirubin in the urine, but you should see urobilinogen

A

True

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24
Q

Someone with a common bile duct obstruction will have:

a. bilirubin in the urine
b. no urobilinogen in the urine
c. urobilinogen in the urine
d. no bilirubin in the urine
e. A and B

A

E

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25
Q

What is the biggest thing we look for in diagnosig UTIs?

A

leukocyte esterases which tells you there are white blood cells (possible infection or interstitial nephritis)

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26
Q

Seeing this marker in the urine is most likely indicative of DM

A

glucose

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27
Q

When quantifying the albumin: creatinine ratio, a patient with macroalbuminuria would most likely have

a. 30:1 ratio
b. 100:1 ratio
c. 200:1 ratio
d. 500:1 ratio

A

D.

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28
Q

In regards to the cells in the urinalysis, what is normal?

a. 1-2 renal tubular cells
b. a few squamous epithelial cells
c. isomorphic RBCs
d. hyaline casts
e. B and D are both normal

A

E

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29
Q

T/F If you see dysmorphic RBCs in the urine, you should be concerned about glomerulonephritis

A

True

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30
Q

What is the MOST likely diagnosis of a patient who has muddy brown granular casts in their urine?

a. Acute glomerulonephritis
b. Acute interstitial nephritis
c. Acute tubular necrosis
d. Lupus Nephritis
e. Diabetic Kidney Disease

A

C. ATN

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31
Q

Maltese cross is commonly associated with?

A

Fatty casts + oval fat bodies + nehprotic syndrome

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32
Q

Patients urinalysis comes back positive calcium oxalate crystals. What is the most likely diagnosis?

A

ethylene glycol ingestion!!!!!!!!!! antifreeze.

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33
Q

These often have a coffin-lid shape to them.

a. calcium oxalate crystals
b. magnesium ammonium phosphate crystals
c. uric acid crystals
d. crystine crystals
e. pharmaceutical crystals

A

magnesium ammonium phosphate crystals (AKA STRUVITE)

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34
Q

These are rhombus shaped and are seen in someone with tumor lysis syndrome (after chemotherapy)

a. calcium oxalate crystals
b. magnesium ammonium phosphate crystals
c. uric acid crystals
d. crystine crystals
e. pharmaceutical crystals

A

C

35
Q

These are hexagonal shaped seen in patients with cystinuria

a. calcium oxalate crystals
b. magnesium ammonium phosphate crystals
c. uric acid crystals
d. crystine crystals
e. pharmaceutical crystals

A

D

36
Q

These are dumb-bell shaped and make up 75% of kidney stones we see

a. calcium oxalate crystals
b. magnesium ammonium phosphate crystals
c. uric acid crystals
d. crystine crystals
e. pharmaceutical crystals

A

A

37
Q

These are sulfonamide and indinavir and may cause ARF in paitenst who are dehydrated

a. calcium oxalate crystals
b. magnesium ammonium phosphate crystals
c. uric acid crystals
d. crystine crystals
e. pharmaceutical crystals

A

E

38
Q

T/F When the concentration of free protons goes up, the pH goes up

A

False, it goes down because a lower pH indicates more free protons = acidemia

39
Q

When a pt is in metabolic acidosis, what organ compensates?

a. brain
b. kidney
c. lungs
d. liver
e. spleen

A

C lungs

40
Q

When a pt is in respiratory acidosis, what organ compensates?

a. brain
b. kidney
c. lungs
d. liver
e. spleen

A

B kidney

41
Q

T/F When the proximal tubule secretes a proton to neutralize carbonic acid, it is not excreted from the body

A

True

42
Q

How do we buffer our urine?

a. NH3
b. NH4
c. NH4+
d. NH2

A

A ammonia!

43
Q

What causes respiratory acidosis?

a. hypoventilation
b. hyperventilation
c. hyperkalemia
d. hypokalemia

A

A hypoventilation

44
Q

All of the following are possible causes of respiratory alkalosis EXCEPT?

a. anxiety attack
b. asthma attack
c. anesthesia
d. hyperventilation
e. hypoxia

A

C. anesthesia

45
Q

A pt of yours has a LOW pH and a normal PCO2. what does he most likely have?

a. metabolic alkalosis
b. respiratory alkalosis
c. metabolic acidosis
d. respiratory acidosis

A

C because not respiratory bc CO2 is normal

46
Q

What is the normal anion gap in a healthy person?

a. 5
b. 8
c. 12
d. 20
e. 30

A

C 12

47
Q

Difference between Type A and Type B lactic acidosis?

A

A: tissue hypoxia => septic, hypotensive, in shock, not perfusing tissue
B: due to liver failure

48
Q

What does MUDPILES stand for?

A 
M: methanol
U: uremia
D: diabetic ketoacidosis
P: Paraldehyde
I: Infection, iron, ionazid
L: lactic acidosis
E: ethylene glycol
S: Salicylic acid
49
Q

What is Winter’s Formula a calculation of? What is it?

A

PaCO2 given normal respiratory compensation in the setting of a gapped metabolic acidosis
(1.5 (HCO3-) + 8 (+/-2))

50
Q

If your patients PaCO2 is lower than expected according to Winter’s formula, what do they most likely have?

a. primary respiratory alkalosis
b. secondary respiratory alkalosis
c. primary respiratory acidosis
d. secondary respiratory acidosis

A

B

51
Q

What are the two causes of non-gapped metabolic acidosis?

A

diarrhea + renal tubular acidosis

52
Q

This type of RTA is characterized by a problem in the proximal tubule, where teh kidney cannot claim filtered bicarb or glucose, resulting in loss of both in the urine

a. type I
b. type II
c. type III
d. type IV

A

B type II

53
Q

This type of RTA is a problem in the collecting duct in which the kidney is unable to secrete or excrete protons, thus these pts are at risk for kidney stones

a. type I
b. type II
c. type III
d. type IV

A

A type I

54
Q

This type of RTA is characterizd by the lack of aldosterone to drive protein secretion

a. type I
b. type II
c. type III
d. type IV

A

D

55
Q

What is the treatment for a patient with ethylene glycol ingestion?

a. dialysis
b. disulfiram
c. alcohol dehydrogenase
d. A and B

A

D - key here is to remove the toxic metabolites from the body by either removing htem w dialysis or blocking hte enzyme that metabolizes them

56
Q

T/F You use bicarb to treat lactic acidosis and diabetic ketoacidosis

A

FALSE

57
Q

T/F you give bicarb to treat metabolic acidosis + salicylate ingestion

A

True

58
Q

Which of the following is NOT a cause of LOW VOLUME hypotonic hyponatremia?

a. GI losses
b. diuretics
c. adrenal insufficiency
d. Cirrhosis

A

D

59
Q

How do you treat low volume hypotonic hyponatremia?

a. saline
b. free water restriction
c. diuresis
d. all of the above

A

A

60
Q

What is the tx for chronic hypotonic hyponatremic patients?

a. hypertonic saline
b. free water restriction
c. demeclocycline
d. B and C

A

D

61
Q

Hypernatremia almost always occurs in the setting of:

a. hypovolemia
b. hypervolemia
c. euvolemic
d. all of the above

A

A

62
Q

What is the tx of HYPERnatremia?

A

Lasix

63
Q

this is usually due to malnutrition and “refeeding syndrome”

a. hypomagnesaemia
b. hypermagnesaemia
c. hypercalcemia
d. hypophosphatemia
e. hyperphosphatemia

A

D

64
Q

Hypokalemia is a side effect of which of the diuretics?

a. CAIs
b. Loops
c. Thiazides
d. Potassium Sparing

A

B loop

65
Q

Hyponatremia & SIADH is a side effect of which of the diuretics?

a. CAIs
b. Loops
c. Thiazides
d. Potassium Sparing

A

thiazides

66
Q

Which two parts of the nephron are important for acid-base balance?

a. proximal + distal tubule
b. proximal + loop of henle
c. proximal + collecting duct
d. loop of Henle + distal tubule
e. loop of Henle + collecting duct

A

C

67
Q

What is oliguria?

A

a. excretion of less than400 ml of urine per day

68
Q

T/F Unlike creatinine, BUN is reabsorbed across tubular epithelial cells after it is filtered

A

True

69
Q

If your patient has a fractional excretion of sodium that is less than 1%, what is it MOST indicative of?

a. prerenal ARF
b. intrinsic ARF
c. postrenal ARF

A

A

70
Q

If your patient presents w blood cells, protein and cellular casts in their urine, what is the most likely diagnosis?

a. prerenal ARF
b. intrinsic ARF
c. postrenal ARF

A

B intrinsic

71
Q

AIN is most commonly caused by

A

NSAIDs

72
Q

What is (isosthenuria?

A

When kidneys cannot concentrate urine

73
Q

T/F A urinalysis with leukocyte esterase + nitrities in the urine is indicative of a UTI

A

True

74
Q

T/F Very concentrated urine would most likely yield a false positive on a reagent test strip

A

True

75
Q

What are Tamm-Horsfall proteins and where are they found?

A

They are secreted by the thick ascending limb of hte loop of henle and can form a cast matrix that precipitates cells in urinary space

76
Q

A non-glomerular bleeding source is most likely indicative of?

A

Isomorphic RBCs

77
Q

T/F HCO3- is directly related to pH and pCO2 is indirectly related to pH

A

True

78
Q

What is the anion gap equation? What does it normally equal?

A

sodium - chlorine + bicarb

12

79
Q

Methanol can cause what?

a. diarrhea
b. blindness
c. deafness
d. muscle tremors
e. dehydration

A

B blindess

classic patient presents with a gapped metabolic acidosis + blindness

80
Q

salicylates can cause what kind of mixed disorder?

a. gapped metabolic acidosis + secondary respiratory alkalosis
b. gapped metabolic acidosis + secondary resp acidosis
c. non-gapped met acid + secondary respiratory acidosis
d. non-gapped met acid + secondary respiratory acidosis

A

A

81
Q

If your patients PaCO2 is HIGHER than expected according to Winter’s formula, what do they most likely have?

a. primary respiratory alkalosis
b. secondary respiratory alkalosis
c. primary respiratory acidosis
d. secondary respiratory acidosis

A

D

82
Q

A urinary anion gap that is positive is indicative of?

A

acidosis of renal cause

83
Q

A urinary anion gap that is negative is indicative of?

A

acidosis of GI cause

Pathophysiology (6 decks)

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