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GU/Nephrology 6% Flashcards

1
Q

Proximal convoluted tubules (resorb/secrete) ____

What medication work here?

A 
Resorb
All organic nutrients (glucose, AA)
Bicarb
Na, Cl
75-90% of H2O

Acetazolamide
Mannitol

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2
Q

Thin Descending Limb of Loop of Henle (resorbs/secretes) ___

A

Resorbs
H20 passively

Impermeable to Na and solutes

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3
Q

Thick Ascending Limb of Loop of Henle (resorbs/secretes) ___

What medication work here?

A

Resorbs
Actively Na+, K+, Cl-
Indirectly resorbs Mg+ and Ca+

Loop diuretics –> inhibit water, Na, K, Cl cotransport

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4
Q

Early distal convoluted tubule (resorbs/secretes) ____

Other functions?

What medication work here?

A

SECRETES
Organic acids, toxins, drugs
K+, H+

Dilutes urine by actively resorbing Na+ and Cl-

Thiazide diuretics –> impairs urinary dilution

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5
Q

____ determine final osmolarity of urine via ____

What medication work here?

A

Distal collecting tubules
Via Aldosterone, ADH

K-sparing diuretics: inhibit aldosterone mediated Na/H2O absorption –> hyperkalemia, metabolic acidosis

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6
Q

Nephrotic syndrome is characterized by ___ (4)

A

Proteinuria
Hypoalbuminemia
Hyperlipidemia
Edema

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7
Q

80% of nephrotic syndrome in children =

Microscopy findings:

Tx:

A

Minimal change disease

Loss of foot processes of podocytes
Loss of negative charge of glomerular basement membrane

Tx: Prednisone

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8
Q

Sclerosis(fibrosis) within glomerulus

Seen in ___

Tx:

A

Focal segmental glomerulosclerosis

Seen in HTN in blacks

Tx: steroids

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9
Q

Thickened glomerular basement membrane

Caused by:

A

Membranous Nephropathy

Caused by SLE, viral hepatitis, malaria, drugs (Pencillamine)
D/t immune complex deposition

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10
Q

MC cause of nephrotic syndrome in adults

A

Diabetes mellitus

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11
Q

Gold standard of dx of nephrotic syndrome

Urinalysis shows:

A

24 hrs urine protein collection > 3.5 g/d

Oval fat bodies “maltese cross shaped”

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12
Q

Acute glomerulonephritis is characterized by (4)

A

HTN
Hematuria (RBC casts)
Dependent edema (proteinuria)
Azotemia (build up of nitrogen waste in blood)

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13
Q 
All of the following are causes of Acute glomerulonephritis EXCEPT:
A. IgA Nephropathy (Berger's dz)
B. Goodpasture's syndrome
C. Post infectious 
D. Membranousproliferative GN
E. Vasculitis
A

TRICK QUESTION. All are causes of AGN.

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14
Q

IgA Nephropathy (a.k.a. ____)

T/F: MC cause of AGN in children worldwide

When does it usually occur? Why?

Dx?

Tx?

A

Berger’s dz

False. MC cause of AGN in ADULTS worldwide

Young men within days after URI or GI infection d/t IgA overproduction

Dx: IgA depositis in mesangium w/ immunostaining

Tx: ACE-I + Corticosteroids

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15
Q

Post infectious AGN occurs MC after ____

Presentation:

Dx:

Tx:

A

Group A Beta-hemolytic Strep (can occur after any infection)

Skin/pharyngeal infection
2-14 y/o boys w/ puffy eyelids, facial edema, cola colored/dark urine

Dx: Increased antistreptolysin (ASO) titers
Low serum complement (C3)

Tx: supportive, abx

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16
Q

Rapidly progressive glomerulonephritis (RPGN) is (good/bad) prognosis

Bx findings?

Tx?

A

bad prognosis –> rapid progression to ESRD

Cresent formation d/t fibrin and plasma protein deposition

Tx: steroids + cyclophosphamide

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17
Q

+ Anti-GBM antibodies seen in ____

Results in ___

Often occurs ____

Dx:

Tx:

A

Goodpasture’s syndrome

Kidney failure and HEMOPTYSIS (d/t ab against type 4 collagen of GBM in kidney and lung alveoli)

Often occurs after URI

Dx: Linear IgG deposits

Tx: High dose steroid immunosuppression + Cyclophosphamide + plasmapharesis

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18
Q

Vasculitis AGN is characterized by ___

2 types:

A

lack of immune deposits, + ANCA ab

Microscopic polyangiitis = vasculitis of small renal vessels –> + P-ANCA
Granulomatosis w/ polyangiitis (Wegener’s) = necrotizing vasculitis –> + C-ANCA

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19
Q

Gold standard dx of AGN

A

renal bx

Urinalysis: RBC casts, high specific gravity > 1.020osm

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20
Q

WBC casts are pathognomonic for ___

Other clinical features?

A

acute tubulointerstitial nephritis (AIN)

EOSINOPHILIA
fever
maculopapular rash
arthralgia

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21
Q

4 causes of intrinsic AKI

MC type?

A

Acute Tubular Necrosis (ATN) = MC type of intrinsic AKI
Acute tubulointerstitial nephritis (AIN)
Glomerular (AGN)
Vascular

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22
Q

Medication that may cause Acute Tubular Necrosis

A

Aminoglycosides

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23
Q

Inflammatory or allergic response in interstitium, sparing glomeruli and blood vessels =

Commonly caused by ____

A

Acute tubulointerstitial nephritis (AIN)

PCN, NSAIDs, Sulfa drugs

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24
Q

All of the following are features of ATN EXCEPT:
A. Epithelial cell casts and muddy brown casts
B. High specific gravity
C. Hypokalemia
D. High phosphate

A

B, C
LOW specific gravity
HYPERkalemia

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25
Narrow waxy casts seen in ___ Broad waxy casts seen in ___
Chronic ATN/Glomerlonephritis End stage renal disease
26
``` ATN or Prerenal? Low specific gravity Creatinine rapidly improves w/ IVF BUN:Cr > 20:1 UNA > 40 , FeNa > 2% Cr increases at 0.3-0.5 mg/dL/day ```
Low specific gravity: ATN Creatinine rapidly improves w/ IVF: Prerenal Creatinine does NOT improve w/ IVF = ATN BUN:Cr > 20:1 = Prerenal BUN:Cr 10-15:1 = ATN UNA > 40 , FeNa > 2% = ATN Cr increases at 0.3-0.5 mg/dL/day = ATN Cr increases slower than 0.3 mg/dL/day = prerenal
27
Causes of HYPERphosphatemia | Associated Ca, Phosphate and PTH levels of each?
Renal failure (MC) : dec. Ca, inc. phosphate, inc. PTH Primary hypoparathyroidism: dec. Ca, inc. phosphate, dec. PTH Vit D intoxication: inc. Ca, inc. phosphate, dec. PTH
28
Causes of HYPOphosphatemia
``` Primary HYPERparathyroidism Excessive IV glucose, Tx for DKA Refeeding syndrome in ETOHics Respiratory alkalosis Vit D deficiency (dec Ca and dec phosphate) ```
29
Polycystic Kidney Dz = autosomal (dominant/recessive) d/o d/t mutation of ____ gene(s). Characterized by ___ Extrarenal manifestations:
AD PKD1, PKD2 formation and enlargement of kidney cysts in other organs (LIVER, spleen, pancreas) Vasopressin stimulates cystogenesis --> ESRD Cerebral "berry" aneurysms** Mitral valve prolapse **
30
Chronic kidney disease staging Normal GFR =
``` 0 = at risk; normal GFR and urine 1 = kidney damage w/ normal GFR (>90) 2 = GFR 89-60 3 = GFR 59-30 4 = GFR 29-15 5 = GRF < 15 ``` Normal GFR = 120-130
31
Best predictor of disease progression in CKD
Proteinuria
32
Hematologic complications of CKD
Anemia of chronic disease = normochromic, normocytic anemia Inc. ferritin, dec. serum Fe, dec. TIBC Tx: Oral FeSO4 Erythropoietin or Darbepoetin-alpha
33
"salt and pepper" appearance of skull on x ray Labs:
Osteitis Fibrosis Cystica d/t CKD Increased osteoclast activity Increased PO4, HYPOcalcemia (d/t decreased vit D production from kidney) --> Inc PTH --> 2ndary hyperparathyroidism
34
SIADH causes (iso/hypo/hyper)volemic (hyper/hypo)tonic (hyper/hypo)natremia Become clinically symptomatic w/ (increased/decreased) oral free H2O intake ``` (increase/decrease) serum osm (increase/decrease) NA (hyper/hypo)uricemia (increase/decrease) BUN (increase/decrease) urine osm (increase/decrease) UNa ```
SIADH causes ISOvolemic HYPOtonic HYPOnatremia --> increase free water retention + impaired water excretion Become clinically symptomatic w/ INCREASED oral free H2O intake ``` DECREASED serum osm <280 DECREASED Na<135 HYPOuricemia DECREASED BUN INCREASED urine osm >300 INCREASED UNa > 20 ```
35
Central DI = Nephrogenic DI = Become clinically symptomatic w/ (increased/decreased) oral free H2O intake What happens?
Central DI = ADH (Vasopressin) deficiency Nephrogenic DI = ADH insensitivity Become clinically symptomatic w/ DECREASED oral free H2O intake Both end with production of LARGE amount of DILUTE urine
36
Lithium causes (central/nephrogenic) DI
Nephrogenic DI
37
Dx of Diabetes Insipidus
Fluid deprivation test: continued production of dilute urine Desmopressin Stimulation test: differentiates nephrogenic vs central DI Central: reduction of urine output, increase Uosm --> response to ADH Nephrogenic: continued production of dilute urine
38
Tx of Central DI: Nephrogenic DI:
Central DI: Desmopressin/DDAVP, Carbamazepine Nephrogenic DI: Na/protein restriction -->HCTZ, indomethacin
39
Alpha-1 activation causes afferent arteriole (dilation/constriction) which (increases/decreases) GFR. This causes (more/less) water to be excreted, thus H2O (conservation/depletion).
Alpha-1 activation causes afferent arteriole CONSTRICTION which DECREASES GFR. This causes LESS water to be excreted, thus H2O CONSERVATION.
40
Water homeostasis is determined by ___. Stimuli include ___(2) Na homeostasis is determined by ___. Stimuli include ___(2)
Water: ADH; hypovolemia, hyperosmolarity* Na: Aldosterone; hypovolemia, hyperkalemia
41
Tx of: Isovolemic hypotonic hyponatremia Hypervolemic hypotonic hyponatremia Hypovolemic hypotonic hyponatremia Hypertonic hyponatremia Severe Iso/hypervolemic hyponatremia
Isovolemic hypotonic hyponatremia: H2O restriction Hypervolemic hypotonic hyponatremia: H20 + Na restriction Hypovolemic hypotonic hyponatremia: Normal saline Hypertonic hyponatremia: Normal saline until hemodynamically stable --> 1/2 normal saline Severe Iso/hypervolemic hyponatremia: Hypertonic saline w/ Furosemide
42
Hypomagnesemia causes (increased/decreased) DTR, (hypo/hyper)calcemia
HYPOmagnesemia causes INCREASED DTR, HYPOcalcemia --> Trousseau's, Chvostek's sign
43
Tx of hypermagnesemia
Mild-moderate: IV fluids, Furosemide Severe: calcium gluconate --> antagnoizes toxic effects of magnesium, stabilizes cardiac membrane
44
PPI, amphotericin B, cisplatin, cyclosporine, aminoglycosides can cause ____
HYPOmagnesemia
45
Metabolic acidosis may cause (hypo/hyper)kalemia
HYPERkalemia | Metabolic alkalosis causes HYPOkalemia
46
Tx of hyperkalemia
IV calcium gluconate Insulin w/ glucose: shift K+ intracellularly Beta2 agonists (4-8x dose for asthma) Kayexalate: enhances GI potassium excretion
47
MC cause of epididymitis/orchitis in children and men >35 Tx:
Enteric organisms: E. coli, Klebsiella Fluoroquinolones Cephalexin, amoxicillin in children
48
Acute orchitis MC caused by
Mumps**
49
Dx of testicular torsion Best initial: Gold standard:
Best initial: Testicular doppler US | Gold standard: Radionuclide scan
50
Sudden onset of left-sided varicocele in older men may possibly suggest ____ Right sided varicocele in children <10 y/o may possibly suggest ___
Renal cell carcinoma Retroperitoneal malignancy
51
Orchiopexy recommended for cryptorchidism in ____
6 month old, before 1 year old
52
MC type of testicular cancer
Seminoma (germinal cell tumors)
53
T/F: Seminomas are radiosensitive and show elevated alpha-fetoprotein and beta-HCG
False: seminomas are radiosensitive BUT lack tumor markers "Seminomas are Simple & Sensitive" Nonseminomatous Germ Cell Tumors are RADIORESISTENT and have ELEVATED alpha-fetoprotein and beta-HCG
54
Tx of complicated cystitis in pregnancy
Amoxicillin, nitrofurantoin x 7-14 days
55
T/F: Phimosis is a urologic emergency
False. Paraphimosis is a urologic emergency
56
Tx of acute prostatitis
Fluoroquinolones, Bactrim Ampicillin w/ gentamicin x 1 month
57
Tx for BPH that has positive effect on clinical course of BPH
5-alpha reductase inhibitors (Finasteride) Vs. alpha-1 blockers (Tamsulosin) provides rapid sx relief but NO effect on BPH clinical course
58
90% of bladder cancers are ___
transitional cell
59
MC abdominal malignancy in children
Wilm's tumor (Nephroblastoma) MC in children w/i 1st 5 years of life
60
Dx of Renovascular HTN
Renogram (best noninvasive) Captopril test: increase plasma renin activity 1 hr p administration Renal angiography = gold standard
61
Tx of Renovascular HTN
Sx: angioplasty w/ stent = definitive ACE-I/ARB BUT CI in pts w/ bilateral stenosis or solitary kidney b/c ACEI markedly reduces renal blood flow + GFR
62
Tx of priapism
``` Terbutaline* = beta-adrenergic agonist Phenylephrine = selective α1-adrenergic receptor ```
63
Infant that develops urethritis, neonatal pneumonia and neonatal conjunctivitis 2-5 days after birth, think ___ pathogen. 5-7 days after birth, think ___
2-5 days: Gonococcal 5-7 days: Chlamydia
64
Tx of Stress incontinence: Urge incontinence: Overflow incontinence:
Stress incontinence: Alpha agonists (Midodrine, Pseudoephedrine) --> increase urethral sphincter tone/urethral urine flow resistance Urge incontinence: - -Antichoinergic (Oxybutynin, Tolterodine, Propantheline) --> block cholinergic receptors in bladder --> decrease involuntary contraction strength (overactive detrusor mm) - -TCAs: central and peripheral anticholinergic effect + alpha adrenergic agonist - -Mirabegron (beta-3 agonist) --> bladder relaxant Overflow incontinence: Cholinergics (Bethanacol) --> increase detrusor mm activity
65
Bence Jones protein in urine is seen in ____.
Multiple Myeloma
66
Glucose is excreted into urine when blood glucose exceeds ____
180-200 mg/dL
67
Unilateral small kidney on US describes ___
renal artery stenosis
68
Bactrim can cause (hyper/hypo)kalemia, (increase/decrease) serum creatinine, cause ___ kidney injury, thus a poor choice in CKD 4 patients.
HYPERkalemia DECREASED Cr Acute interstitial nephritis (AIN)
69
``` Phototherapy treats ____ by _____. SE include (4) ```
Physiologic jaundice in newborns converts bilirubin to lumirubin SE: fever, rash, diarrhea, dehydration
70
Type of kidney stone that is radiolucent
Uric acid
71
Best dx of diverticulosis
Barium edema | MORE specific than colonoscopy
72
Nitrites on UA indicates presence of ___
Enterobacteriaceae: E. coli, Klebsiella, Proteus, Serratia, Salmonella
73
Tx of enterobiasis (a.k.a ___)
Pinworms Mebendazole, albendazole
74
Uncomplicated pyelonephritis tx
fluoroquinolone | Cipro x 14 days
75
Chronic renal disease is characterized by (hyper/hypo)kalemia, (hyper/hypo)calcemia, (hyper/hypo)phosphatemia, metabolic (acidosis/alkalosis).
HYPERkalemia HYPOcalcemia HYPERphosphatemia Metabolic ACIDOSIS

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