First Aid

Question 1

3 causes of hydronephrosis

Answer 1

Urinary tract obstruction
Retroperitoneal fibrosis
Vesicoureteral reflux

Question 2

4 causes + the trigger of Potter sequence

Answer 2

ARPKD
Obstructive uropathy (post urethral valves)
Bilateral renal agenesis
Chronic placental insufficiency

Oligohydramnios

Question 3

Artery affected + 5 conditions ass w/ horseshoe kidney

Answer 3

Inferior mesenteric artery

Hydronephrosis (ureteropelvic junction obstruction)
Renal stones
Infection
Chromosomal aneuploidy syndromes (Turner, T13, T18, T21)
Renal cancer (Wilms, renal cell carcinoma)

Question 4

3 ass w/ Duplex collecting system

Answer 4

Vesicoureteral reflux
Ureteral obstruction
High risk of UTIs

Question 5

GFR + eRPF estimation

Answer 5

GFR: inulin, creatinin
eRPF: PAH

Question 6

Effects of prostaglandins, angiotensin II on GFR, RPF, FF

Answer 6

Prostaglandins: aff art dilation, high RPF, high GFR, no diff in FF

Angiotensin II: eff art constriction, low RPF, high GFR, high FF

Question 7

Effect of hypovolemia + acute ureteral obstruction on GFR, RPF, FF

Answer 7

Hypovolemia: v.low RPF, low GFR, eff art constriction, high FF
If still low RPF, v.low GFR, renal failure

Acute ureteral obstr: low GFR, low FF

Question 8

Proximal convoluted tubule

Answer 8

Reabsorbs all glucose, aa, most HCO-, Na, Cl, PO4/3-, K, H2O, uric acid
Secretes NH3 (buffer H+)
PTH: PO4/3- excretion
ATII: Na, H2O, HCO3- reabsorption

Question 9

Thin ascending loop of Henle

Answer 9

Passively reabsorbs H2O

Makes urine hypertonic

Question 10

Thick ascending loop of Henle

Answer 10

Impermeable to water

Reabsorbs Na, K, 2Cl and Mg, Ca

Question 11

Distal convoluted tubule

Answer 11

Reabsorbs Na, Cl
Makes urine hypotonic
PTH: Ca reabsorption

Question 12

Collecting tubule

Answer 12

Aldosterone in principal cells: reabsorbs Na in exchange for secreting K and H
Aldosterone in alpha-intercalated cells: H secretion, HCO3-/Cl- exchanger activity
ADH: H2O reabsorption

Question 13

4 findings in Fanconi syndrome

Answer 13

Generalized reabsorptive defect in PCT
High excretion of ~all aa, glucose, HCO3-, PO4/3-
Metabolic acidosis
Hereditary defects, ischemia, multiple myeloma, nephrotoxins/drugs, lead poisoning

Question 14

4 findings in Bartter syndrome

Answer 14

Reabsorptive defect in thick ascending loop of Henle
Affects Na/K/2Cl cotransporter
Hypokalemia
Metabolic alkalosis w/ hypercalciuria

Question 15

5 findings in Gitelman syndrome

Answer 15

Reabsorptive defect of NaCl in DCT
Hypokalemia
Hypomagnesemia
Metabolic alkalosis
Hypocalciuria

Question 16

6 findings in Liddle syndrome

Answer 16

High Na reabsorption in collecting tubules (high ENaC activity)
Aldosterone ~ undetectable
Hypertension
Hypokalemia
Metabolic alkalosis
Ttt: Amiloride

Question 17

7 findings in Syndrome of Apparent Mineralocorticoid Excess

Answer 17

Deficiency of 11beta-hydroxysteroid dehydrogenase (hereditary or acquired from licorice)
Excess cortisol + MC receptor activity
Hypertension
Hypokalemia
Metabolic alkalosis
Low aldosterone
Ttt: corticosteroids

Question 18

2 loops for negative feedback of AT II

Answer 18

Short loop: if high AT II, stimulates AT recept on JG cells, inhibit renin release
Long loop: high BP + Na on intrarenal barorecept + macula densa, lowers renin

Question 19

4 kidney endocrine functions

Answer 19

Erythropoietin
Calciferol
Prostaglandins
Dopamine

Question 20

3 types of Renal tubular acidosis

Answer 20

Distal (type 1): pH>5.5, alpha-intercalated cells dont secrete H+, metab acidosis, hypoK
Proximal (type 2): pH<5.5, defect in PCT HCO3- reabs, metab acidosis, hypoK
Hyperkalemic (type 4): pH<5.5, hypoaldo, hyperK, low NH4+ excretion

Question 21

3 findings + 5 Nephritic syndromes

Answer 21

GBM disruption
Proteinuria < 3.5g/day
HTN, high BUN+creat, oliguria, hematuria, RBC casts

Acute poststreptococcal glomerulonephritis
Rapidly progressive glomerulonephritis
IgA nephropathy (Berger ds)
Alport syndrome
Membranoproliferative glomerulonephritis

Question 22

3 findings + 5 Nephrotic syndromes

Answer 22

Podocyte disruption (charge barrier)
Massive proteinuria > 3.5g/day
Hypoalbuminemia, hyperlipidemia, edema

Focal segmental glomerulosclerosis (1* or 2*)
Minimal change disease (1* or 2*)
Membranous nephropathy (1* or 2*)
Amyloidosis (2*)
Diabetic glomerulonephropathy (2*)

Question 23

3 findings + 2 Nephritic-nephrotic syndromes

Answer 23

Profound GBM damage (charge barrier)
Proteinuria > 3.5g/day
Features of nephrotic sd

Diffuse proliferative glomerulonephritis
Membranoproliferative glomerulonephritis
+ in any form of nephrotic sd

Question 24

Treatment of renal cell carcinoma

Answer 24

Localized: resection
Advanced/metastatic: immunotherapy or targeted therapy
Resistant to chemotherapy and radiation therapy

Question 25

2 indications + adverse effects of Mannitol

Answer 25

Drug overdose
Elevated intracranial/intraocular pressure

Pulmonary edema
Dehydration
CI in anuria, HF

Question 26

5 indications of Acetazolamide

Answer 26

Glaucoma
Urinary alkalinization
Metabolic alkalosis
Altitude sickness
Pseudotumor cerebri

Question 27

3 indications + 7 adverse effects of sulfonamide loop diuretics

Answer 27

Edematous states
HTN
Hypercalcemia

Ototoxicity, hypoK, dehydration, allergy (sulfa), metabolic alkalosis, nephritis (interstitial), gout

Question 28

5 indications + 7 adverse effects of Thiazide diuretics

Answer 28

HTN, HF, idiopathic hypercalciuria, nephrogenic diabetes insipidus, osteoporosis

Hypokalemic metabolic alkalosis, hypoNa, hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia, sulfa allergy
+/- hypoMg

Question 29

5 indications + 2 adverse effects of K+ sparing diuretics

Answer 29

Hyperaldosteronism, K+ depletion, HF, hepatic ascites (spironolactone), nephrogenic DI (amiloride)

HyperK, endocrine effects (spironolactone)

Question 30

Acidemia + alkalemia w/ diuretics

Answer 30

Acidemia: carbonic anhydrase inhibitor, K+ sparing
Alkalemia: loop diuretics, thiazides

Question 31

4 indications + 6 adverse effects of ACE inhibitors

Answer 31

HTN (prevent heart remodeling), HF (lower mortality), proteinuria, diabetic nephropathy (slow GBM thickening)

Cough, angioedema (CI in C1 est inh def), teratogen, high creat, hyperK, hypotension

Question 32

4 indications + 4 adverse effects of ARBs

Answer 32

HTN, HF, proteinuria, diabetic nephropathy w/ intolerance to ACEI

HyperK, low GFR, hypotension, teratogen