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Board questions > Kaplan guy - renal > Flashcards

Kaplan guy - renal Flashcards

1
Q

complement helps form pore to allow RBCs out causing nephritic syndrome - this can crack the vessel causing fibrinous exudate in Bowman’s capsule resulting in what?

How can this be treated?

A

rapidly progressive glomerular nephritis

will respond to steroids

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2
Q

tubulointerstitial disease causes kidney damage by deposition of what?

A

Calcium, uric acid, and toxic drugs

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3
Q

If the BUN:Cr is greater than 20:1, what am I thinking?

What is another tell tale sign of this?

A

pre-renal failure is occurring

this could be dehydration, or CHF - ultimately there isn’t enough blood reaching the kidneys

small urine production

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4
Q

first line tx for HTN is…

MOA? where?

AE?

A

thiazide diuretic

acts in distal convoluted tubule, blocking Na/Cl- channels, creating a negative Na gradient

increased amount of Ca2+ to be reabsorbed via Na/Ca Antiporter causing hypercalcemia

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5
Q

What are three examples of thiazide diuretics?

A

chlorthalidone

chlorothiazide

hydrochlorothiazide

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6
Q

What is post-renal failure and examples? What might be the BUN:Cr ratio?

A

obstruction - kidney stone, enlarged prostate - urine can’t be excreted

15:1

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7
Q

DM and HTN cause damage to the small vessels of the kidney causing…

A

hyaline arteriolosclerosis - narrowing of the small vessels

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8
Q

What are three small vessel vasculitities that damage the small vessels of the kidney?

A

henoch schonlein purpura

granulomatosis with polyangitis (wegner)

churg strauss

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9
Q

What is churg-strauss syndrome?

A

eosinophilic granulomatosis with polyangitis (allergic granulomatosis)

autoimmune dz of small and medium vessels

  • prodromal stage of airway inflammation (asthma or allergic rhinitis)
  • hypereosinophilia causing tissue damage to lungs and digestive tract
  • third stage is vasculitis leading to cell death
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10
Q

How do you treat Churg-straus syndrome?

A
  • suppress immune system
    • glucocorticoids
    • cyclophosphamide or azathioprine
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11
Q

fibrinous exudate leaking out of the glomerular basement membrane causing fibrous scarring leads to…

A

crescenteric glomerular nephritis

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12
Q

In tubulointerstitial disease casts are formed by…

A

endothelial cells of the proximal tubule

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13
Q

Who benefits the most from thiazide diuretics?

A

elderly and AA

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14
Q

What are risk factors for essential HTN?

A

BMI, race, sodium intake, age, sedentary lifestyle

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15
Q

How does the neurological system sense HTN?

A

distention of baroreceptors in the carotid sinus and aortic arch sending signals to the solitary nucleus of the medulla

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16
Q

activation of parasympathetic M2 receptors will..

A

decrease HR

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17
Q

inhibition of Beta-1 receptors will…

A

decrease HR

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18
Q

activation of alpha-1 receptors will

A

increase peripheral resistance

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19
Q

What is the biggest concern about concentric hypertrophy due to HTN v hypertrophy d/t exercise?

A

subendocardial ischemia - with exercise you produce VEGF to increase number of vessels; concentric hypertrophy doesn’t create VEGF and so there are few vessels in the subendothelial wall that penetrate the full depth to supply O2

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20
Q

How much Na should be in the urine? If it is greater than this, what does that mean?

A

should be minimal (<1%)

if greater, then think inter-renal failure, indicator for tubular function

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21
Q

What is the formula for clearance through the urine?

A

([U] x V)/ [P]

concentration in the urine x flow rate of urine divided by the concentration in the plasma

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22
Q

What is the formula for renal blood flow (RBF)?

A

= RPF/ (1-Hct)

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23
Q

What is the formula for Renal plasma flow (RPF)?

A

= RBF x (1-Hct)

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24
Q

What = RPF?

A

PAH clearance

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25
Q

What is the formula for GFR?

A

creatinine or inulin clearance

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26
Q

What is FF formula?

A

= GFR/RPF

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27
Q

What is filtered load?

A

GFR x plasma concentration

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28
Q

filtered load - excretion rate is called

A

reabsorption rate

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29
Q

excretion rate is

A

urine concentration x urine flow rate

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30
Q

constriction of either the afferent arteriole or the efferent arteriole will cause…

A

decreased flow to the kidney, decreases RPF

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31
Q

dilation of either the afferent or efferent arteriole will cause..

A

increase flow to the kidney, increasing RPF

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32
Q

Constriction of the efferent arteriole would cause what to GFR?

A

increased pressure, increasing GFR

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33
Q

What does constriction of the afferent arteriole do to GFR?

A

decrease pressure, decrease GFR

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34
Q

enalapril will act by dilating..

A

efferent arteriole

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35
Q

pre diabetes is what Hgb A1c?

A

5.7 - 6.5

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36
Q

Diabetes has a Hgb A1c of

A

>6.5

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37
Q

glucose should be reabsorbed in the kidney up to what point?

What will happen if this is exceeded?

A

blood glucose of about 280

after that point it will be excreted in the urine (so glucose in the urine means BG >280)

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38
Q

PAH can be secreted and excreted to a certain point…

A

until all transporter maxiumums are met and then it will remain constant

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39
Q

What is the formula for determining serum osmolality?

A

2 (Na) + (glucose/18) + (BUN/2.8)

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40
Q

My pt has hyponatremia. How do I know if this is accurate?

A

look at serum osmolality

if serum osmolality is low, it is true hyponatremia

if serum osmolality is normal, it is pseudohyponatremia

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41
Q

What might cause pseudohyponatremia and what can it be a/w?

A

increased water intake diluting the serum or from taking a diuretic

might also be seeing hyperglycemia, hyperproteinemia, or hyperlipidemia

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42
Q

How do you figure true sodium level if pt is diabetic?

A

for every 100 mg/dL of glucose above normal, sodium should be dropped by 1.6

43
Q

In a euvolemic pt with true hyponatremia, what could be causes?

A

SIADH (causing less urea to be cleared, elevated BUN)

hypothyroidism

44
Q

How is serum urea (BUN roughly) related to urine output?

A

decreased urine production means increased serum urea (increased BUN)

45
Q

Diabetes inspidus will cause what kind of Na abnormality?

A

hypernatremia - because the system is pushing out all the water

46
Q

What can happen if you correct hyponatremia too quickly?

A

osmotic demyelination syndrome/central pontine myelinolysis

47
Q

What happens if you correct hypernatremia too quickly?

A

cerebral edema

48
Q

What are 6 common causes of hypokalemia?

A
  1. insluin - shifts K into cells
  2. diuretic - urine K loss
  3. B2 agonists- shifts K into cells
  4. bicarb - shifts K into cells
  5. laxative abuse - loss in stool
  6. vomiting - loss in emesis
49
Q

genetic mutation of the thiazide-sensitive Na-Cl symporter located in distal convoluted tubule of the kidney

ssx?

A

Gitelman syndrome

decreased chloride, potassium, magnesium

increased pH

muscle cramps, weakness, numbness, thirst, waking up to urinate

50
Q

congenital lack of Na/K/Cl transporter

how does this work/what happens?

A

Bartter’s syndrome

lack positive charge in urine, so Ca2+ and Mg2+ get lost rather than reabsorbed - similar to furosemide diuretic

51
Q

NSAIDs will inhibit prostaglandins and cause constriction of…

A

afferent arteriole, decreasing GFR and can throw pt into AKF

52
Q

What is the first line tx for osteoarthritis, why?

A

acetaminophen - fewer AEs on kidney and GI

PGs protect the mucosa of teh stomach, releasing bicarb, increases blood supply to mucosa cells

53
Q

nephrotic syndrome with normal glomerulus with oval fat body with maltese cross

dx?

Who?

A

minimal change disease

MC in kids, except for adults with Hodgkins

54
Q

subepithelial deposits forming spike and dome appearance

dx?

A

membranous nephropathy

55
Q

segmental damage to glomerulus

dx?

A

focal segmental glomerulosclerosis

56
Q

subepithelial hump formation (singular)

A

post-streptococcal glomerulonephritis

57
Q

effacement of foot processes of podocytes

dx?

A

minimal change disease

58
Q

thickening of glomerular basement membrane with a double contour/tram tracking

dx?

A

membranoproliferative glomerular nephritis

59
Q

accumulation of immune complexes along the subepithelial side of the basement membrane?

A

membranous nephropathy

60
Q

crescent formation in most of the glomerulus with fibrin strands between cell layers

A

crescenteric glomerulonephropathy

rapidly progressive glomerulonephropathy

61
Q

anitbodies to glomerular basement membrane

A

goodpastures syndrome

62
Q

non-enzymatic glycosylation of GBM and arterioles

A

diabetic nephropathy

63
Q
  • fusion of podocytes with damage
  • caused by immunizations, URI, Hodgkins
  • normotensive
  • no CKD

dx? tx?

A

minimal change disease

steroids

64
Q
  • kidney disease in pt with heroin use and HIV, SCA
  • AA and hispanics esp.
  • MCC of nephrotic syndrome in adults
  • hematuria and HTN

dx? tx?

A

focal segmental glomerulosclerosis

steroids

65
Q

leukocyte in mesangium of basement membrane

dx?

A

membranoproliferative glomerulonephritis

66
Q
  • subendothelial deposits
  • deficient in C1, C4, C3, and C2
  • HBV and HCV
A

Type 1 membranoproliferative GN

67
Q
  • intraglomerular basement membrane dense deposit
  • deficient in C3
  • normal C1 and C4

dx?

A

Membranoproliferative GN

type 2

68
Q
  • 1-4 weeks sp pharyngitis
  • immune complex mediated
  • GAS strains that are nephritigenic
  • glomerulus enlarged and hypercellular
  • subepithelial hump
A

post-streptococcal GN

69
Q
  • abs v collagen type IV
  • hemoptysis and hematuria
  • linear pattern of immunoflurescence

dx? tx?

A

goodpasture syndrome

plasmapheresis or immunosuppressive agents and steroids

70
Q

How do I differentiate Wegners from Goodpastures?

A

Wegners will have URT involvement like ulcers in nose or pharynx

71
Q

What is the normal pH of urine?

A

5.5

72
Q

What is the MC stone seen in alkaline urine?

A

calcium stone/calcium oxalate

73
Q

What type of stone is more common in women with UTIs? What is in this?

A

struvite stone

Magnesium ammonium phosphate

74
Q

What type of stones are more common in men with gout, or chemotherapy?

A

uric acid stones

75
Q

WBC casts in urine make you think…

A

pyelonephritis or interstitial nephritis

76
Q

fatty casts/ oval fat bodies with maltese cross

A

nephrotic syndrome

77
Q

brownish granular casts

A

acute tubular necrosis

78
Q

eosinophils in urine

A

acute interstitial nephritis

79
Q

dysmorphic erythrocytes

A

glomerular bleeding

80
Q

periorbital edema in pt, what is first thing I look at?

A

kidneys being the source

81
Q

What are the cells of origin for renal cell carcinoma?

how do I dx?

A

proximal rental tubular cells

nephrectomy and then biopsy - do not biospy for risk of spreading in vivo

82
Q

hematuria, abdominal mass, flank pain

A

triad of renal cell carcinoma

83
Q

L sided varicocele… thought process to malignancy?

A

L spermatic vein ends in L renal vein, with renal cell carcinoma, this might be blocked causing the varicocele

84
Q

What things should you not biopsy for dx for fear of risk of spreading?

A

renal cell carcinoma

hepatic carcinoma

choriocarcinoma

medullary thyroid carcinoma

85
Q

HTN, hypercholesterolemia, edema

A

nephrotic syndrome

86
Q

nodular appearance in glomerulus

A

Kimmesteil Wilson

87
Q

rupture of GBM with fibrosis

A

rapidly progressive/crescenteric

88
Q

kimmesteil wilson

A

diabetic nephropathy

89
Q

non-enzymatic glycosylation of GBM

A

diabetic nephropathy or kimmesteil wilson

90
Q

cysts with cartilage and immature collecting ducts

A

muticystic renal dysplasia

91
Q

injury from leukocytes on GBM

A

nephritic syndrome

92
Q

hematuria with URI

A

IgA nephropathy

93
Q

MC pathogen causing pyelo?

A

E. coli

94
Q

radiopaque stones

A

calcium oxalate

95
Q

stone in pt <20 yo

A

cysteine stones, ppt bc doesnt get reabsorbed, can prevent with cysteine chelator

96
Q

MCC of renal cancer in children?

A

wilms tumor

97
Q

IgA deposits in mesangial region

A

IgA nephropathy

98
Q

deafness, cataracts, and GN?

A

Alport syndrome

99
Q

small kidneys with mononuclear infiltrate

A

chronic glomerulonephritis

100
Q

large kidneys with chronic renal failure

A

diabetes and polycystic kidney disease

101
Q

MC stone in acidic urine

A

uric acid stone

102
Q

tumor with vessels, muscles, and lipids

A

angiomyolipoma

103
Q

decreased concentration of urine and hematuria

A

sickle cell nephropathy

Board questions (24 decks)

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