FA pg 536- 540 Renal Flashcards
what Causes eferent arteriole constriction
ang 2
List the causes of hyperkalemia in cells
digitalis HyperOsmolarity Lysis of cells (e.g., crush injury, rhabdomyolysis, cancer) Acidosis β-blocker High blood Sugar (insulin de ciency) Patient with hyperkalemia? DO LAβS.
list the causes of hypokalemia
Hypo-osmolarity
Alkalosis
β-adrenergic agonist ( Na+/K+ ATPase) Insulin ( Na+/K+ ATPase)
Insulin shifts K+ into cells
Signs of Low Na
Nausea and malaise, stupor, coma, seizures
signs of High Na
Irritability, stupor, coma
low K+ signs
U waves on ECG, flattened T waves, arrhythmias, muscle spasm
high K+ signs
Wide QRS and peaked T waves on ECG, arrhythmias, muscle weakness
Low Ca signs
Tetany, seizures, QT prolongation
low Mg
Tetany, torsades de pointes, hypokalemia
high Mg
DTRs, lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia
low phosphate causes
Bone loss, osteomalacia (adults), rickets (children)
high Phosphate cause
Renal stones, metastatic calci cations, hypocalcemia
causes of Resp Acidosis
Hypoventilation –Airway obstruction –Acute lung disease –Chronic lung disease –Opioids, sedative
weakness of resp muscles
what is the formula of anion gap
Na - (cl +Hco3)
Inc Anion Gap
MUDDLES anion gap
MUDPILES:
Methanol (formic acid) Uremia
Diabetic ketoacidosis Propylene glycol
Iron tablets or Isoniazid Lactic acidosis
Ethylene glycol (oxalic acid) Salicylates (late)
normal anion gap btw 8-12 meq/l
HARDASSHARD-ASS:
Hyperalimentation
Addison disease
Renal tubular acidosis Diarrhea Acetazolamide Spironolactone Saline infusion
causes of respiratory alkalosis
hyperventilation –Hysteria –Hypoxemia (e.g.,
high altitude) –Salicylates (early) –Tumor
–Pulmonary embolism
causes of metabolic alkalosis
Loop/thiazide diuretics –Vomiting
–Antacid use –Hyperaldosteronism
what is type 1 (distal) renal tubular acidosis and what drug causes it
Defect in ability of α intercalated cells to secrete H+, hypokalemia and urine pH >5.5.
Inc risk of kidney stones
No new bicarb
Causes: amphotericin B toxicity, analgesic nephropathy, congenital anomalies (obstruction) of urinary tract.
what is type 2 (proximal) renal tubular acidosis and what drug causes it
Defect in PCT HCO3− reabsorption excretion of HCO3− in urine and subsequent metabolic acidosis. Urine is acidi ed by α-intercalated cells in collecting tubule. Associated with hypokalemia, risk for hypophosphatemic rickets.
Causes: Fanconi syndrome and carbonic anhydrase inhibitors.
what is hyperkalemic renal tubular acidosis (type 4) and what drug causes it
Hypoaldosteronism hyperkalemia NH3 synthesis in PCT NH4+ excretion. Causes: aldosterone production (e.g., diabetic hyporeninism, ACE inhibitors, ARBs, NSAIDs,
heparin, cyclosporine, adrenal insuf ciency) or aldosterone resistance (e.g., K+-sparing diuretics, nephropathy due to obstruction, TMP/SMX).
where do you see RBC cast
Glomerulonephritis, malignant hypertension
where do you see WBC cast
Tubulointerstitial in ammation, acute pyelonephritis, transplant rejection.
what kind of cast do you see in nephrotic syndrome
fatty cast
Acute tubular necrosis, what cast do you see?
Granular (“muddy brown”) casts
Waxy casts is seen in
End-stage renal disease/chronic renal failure.
Nonspecific, can be a normal nding, often seen in concentrated urine samples refers to
Hyaline casts
> 50% of glomeruli are involved
Diffuse proliferative glomerulonephritis
Thickening of glomerular basement membrane (GBM)
Membranous nephropathy
due to IgG, IgM, and C3
deposition along GBM and mesangium.
Acute post streptococcal glomerulonephritis
EM—subepithelial immune complex (IC)
humps.
Acute post streptococcal glomerulonephritis
what are the presentation of Acute post streptococcal glomerulonephritis
Presents with peripheral and periorbital edema, cola-colored urine, hypertension.
inc anti-DNase B titers, dec complement levels.
what type of cast is associated with Maltese cross sign
Fatty cast/oval fat bodies
