Kaplan guy - renal Flashcards
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?
rapidly progressive glomerular nephritis
will respond to steroids
tubulointerstitial disease causes kidney damage by deposition of what?
Calcium, uric acid, and toxic drugs
If the BUN:Cr is greater than 20:1, what am I thinking?
What is another tell tale sign of this?
pre-renal failure is occurring
this could be dehydration, or CHF - ultimately there isn’t enough blood reaching the kidneys
small urine production
first line tx for HTN is…
MOA? where?
AE?
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
What are three examples of thiazide diuretics?
chlorthalidone
chlorothiazide
hydrochlorothiazide
What is post-renal failure and examples? What might be the BUN:Cr ratio?
obstruction - kidney stone, enlarged prostate - urine can’t be excreted
15:1
DM and HTN cause damage to the small vessels of the kidney causing…
hyaline arteriolosclerosis - narrowing of the small vessels
What are three small vessel vasculitities that damage the small vessels of the kidney?
henoch schonlein purpura
granulomatosis with polyangitis (wegner)
churg strauss
What is churg-strauss syndrome?
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
How do you treat Churg-straus syndrome?
- suppress immune system
- glucocorticoids
- cyclophosphamide or azathioprine
fibrinous exudate leaking out of the glomerular basement membrane causing fibrous scarring leads to…
crescenteric glomerular nephritis
In tubulointerstitial disease casts are formed by…
endothelial cells of the proximal tubule
Who benefits the most from thiazide diuretics?
elderly and AA
What are risk factors for essential HTN?
BMI, race, sodium intake, age, sedentary lifestyle
How does the neurological system sense HTN?
distention of baroreceptors in the carotid sinus and aortic arch sending signals to the solitary nucleus of the medulla
activation of parasympathetic M2 receptors will..
decrease HR
inhibition of Beta-1 receptors will…
decrease HR
activation of alpha-1 receptors will
increase peripheral resistance
What is the biggest concern about concentric hypertrophy due to HTN v hypertrophy d/t exercise?
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
How much Na should be in the urine? If it is greater than this, what does that mean?
should be minimal (<1%)
if greater, then think inter-renal failure, indicator for tubular function
What is the formula for clearance through the urine?
([U] x V)/ [P]
concentration in the urine x flow rate of urine divided by the concentration in the plasma
What is the formula for renal blood flow (RBF)?
= RPF/ (1-Hct)
What is the formula for Renal plasma flow (RPF)?
= RBF x (1-Hct)
What = RPF?
PAH clearance
What is the formula for GFR?
creatinine or inulin clearance
What is FF formula?
= GFR/RPF
What is filtered load?
GFR x plasma concentration
filtered load - excretion rate is called
reabsorption rate
excretion rate is
urine concentration x urine flow rate
constriction of either the afferent arteriole or the efferent arteriole will cause…
decreased flow to the kidney, decreases RPF
dilation of either the afferent or efferent arteriole will cause..
increase flow to the kidney, increasing RPF
Constriction of the efferent arteriole would cause what to GFR?
increased pressure, increasing GFR
What does constriction of the afferent arteriole do to GFR?
decrease pressure, decrease GFR
enalapril will act by dilating..
efferent arteriole
pre diabetes is what Hgb A1c?
5.7 - 6.5
Diabetes has a Hgb A1c of
>6.5
glucose should be reabsorbed in the kidney up to what point?
What will happen if this is exceeded?
blood glucose of about 280
after that point it will be excreted in the urine (so glucose in the urine means BG >280)
PAH can be secreted and excreted to a certain point…
until all transporter maxiumums are met and then it will remain constant
What is the formula for determining serum osmolality?
2 (Na) + (glucose/18) + (BUN/2.8)
My pt has hyponatremia. How do I know if this is accurate?
look at serum osmolality
if serum osmolality is low, it is true hyponatremia
if serum osmolality is normal, it is pseudohyponatremia
What might cause pseudohyponatremia and what can it be a/w?
increased water intake diluting the serum or from taking a diuretic
might also be seeing hyperglycemia, hyperproteinemia, or hyperlipidemia
How do you figure true sodium level if pt is diabetic?
for every 100 mg/dL of glucose above normal, sodium should be dropped by 1.6
In a euvolemic pt with true hyponatremia, what could be causes?
SIADH (causing less urea to be cleared, elevated BUN)
hypothyroidism
How is serum urea (BUN roughly) related to urine output?
decreased urine production means increased serum urea (increased BUN)
Diabetes inspidus will cause what kind of Na abnormality?
hypernatremia - because the system is pushing out all the water
What can happen if you correct hyponatremia too quickly?
osmotic demyelination syndrome/central pontine myelinolysis
What happens if you correct hypernatremia too quickly?
cerebral edema
What are 6 common causes of hypokalemia?
- insluin - shifts K into cells
- diuretic - urine K loss
- B2 agonists- shifts K into cells
- bicarb - shifts K into cells
- laxative abuse - loss in stool
- vomiting - loss in emesis
genetic mutation of the thiazide-sensitive Na-Cl symporter located in distal convoluted tubule of the kidney
ssx?
Gitelman syndrome
decreased chloride, potassium, magnesium
increased pH
muscle cramps, weakness, numbness, thirst, waking up to urinate
congenital lack of Na/K/Cl transporter
how does this work/what happens?
Bartter’s syndrome
lack positive charge in urine, so Ca2+ and Mg2+ get lost rather than reabsorbed - similar to furosemide diuretic
NSAIDs will inhibit prostaglandins and cause constriction of…
afferent arteriole, decreasing GFR and can throw pt into AKF
What is the first line tx for osteoarthritis, why?
acetaminophen - fewer AEs on kidney and GI
PGs protect the mucosa of teh stomach, releasing bicarb, increases blood supply to mucosa cells
nephrotic syndrome with normal glomerulus with oval fat body with maltese cross
dx?
Who?
minimal change disease
MC in kids, except for adults with Hodgkins
subepithelial deposits forming spike and dome appearance
dx?
membranous nephropathy
segmental damage to glomerulus
dx?
focal segmental glomerulosclerosis
subepithelial hump formation (singular)
post-streptococcal glomerulonephritis
effacement of foot processes of podocytes
dx?
minimal change disease
thickening of glomerular basement membrane with a double contour/tram tracking
dx?
membranoproliferative glomerular nephritis
accumulation of immune complexes along the subepithelial side of the basement membrane?
membranous nephropathy
crescent formation in most of the glomerulus with fibrin strands between cell layers
crescenteric glomerulonephropathy
rapidly progressive glomerulonephropathy
anitbodies to glomerular basement membrane
goodpastures syndrome
non-enzymatic glycosylation of GBM and arterioles
diabetic nephropathy
- fusion of podocytes with damage
- caused by immunizations, URI, Hodgkins
- normotensive
- no CKD
dx? tx?
minimal change disease
steroids
- 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?
focal segmental glomerulosclerosis
steroids
leukocyte in mesangium of basement membrane
dx?
membranoproliferative glomerulonephritis
- subendothelial deposits
- deficient in C1, C4, C3, and C2
- HBV and HCV
Type 1 membranoproliferative GN
- intraglomerular basement membrane dense deposit
- deficient in C3
- normal C1 and C4
dx?
Membranoproliferative GN
type 2
- 1-4 weeks sp pharyngitis
- immune complex mediated
- GAS strains that are nephritigenic
- glomerulus enlarged and hypercellular
- subepithelial hump
post-streptococcal GN
- abs v collagen type IV
- hemoptysis and hematuria
- linear pattern of immunoflurescence
dx? tx?
goodpasture syndrome
plasmapheresis or immunosuppressive agents and steroids
How do I differentiate Wegners from Goodpastures?
Wegners will have URT involvement like ulcers in nose or pharynx
What is the normal pH of urine?
5.5
What is the MC stone seen in alkaline urine?
calcium stone/calcium oxalate
What type of stone is more common in women with UTIs? What is in this?
struvite stone
Magnesium ammonium phosphate
What type of stones are more common in men with gout, or chemotherapy?
uric acid stones
WBC casts in urine make you think…
pyelonephritis or interstitial nephritis
fatty casts/ oval fat bodies with maltese cross
nephrotic syndrome
brownish granular casts
acute tubular necrosis
eosinophils in urine
acute interstitial nephritis
dysmorphic erythrocytes
glomerular bleeding
periorbital edema in pt, what is first thing I look at?
kidneys being the source
What are the cells of origin for renal cell carcinoma?
how do I dx?
proximal rental tubular cells
nephrectomy and then biopsy - do not biospy for risk of spreading in vivo
hematuria, abdominal mass, flank pain
triad of renal cell carcinoma
L sided varicocele… thought process to malignancy?
L spermatic vein ends in L renal vein, with renal cell carcinoma, this might be blocked causing the varicocele
What things should you not biopsy for dx for fear of risk of spreading?
renal cell carcinoma
hepatic carcinoma
choriocarcinoma
medullary thyroid carcinoma
HTN, hypercholesterolemia, edema
nephrotic syndrome
nodular appearance in glomerulus
Kimmesteil Wilson
rupture of GBM with fibrosis
rapidly progressive/crescenteric
kimmesteil wilson
diabetic nephropathy
non-enzymatic glycosylation of GBM
diabetic nephropathy or kimmesteil wilson
cysts with cartilage and immature collecting ducts
muticystic renal dysplasia
injury from leukocytes on GBM
nephritic syndrome
hematuria with URI
IgA nephropathy
MC pathogen causing pyelo?
E. coli
radiopaque stones
calcium oxalate
stone in pt <20 yo
cysteine stones, ppt bc doesnt get reabsorbed, can prevent with cysteine chelator
MCC of renal cancer in children?
wilms tumor
IgA deposits in mesangial region
IgA nephropathy
deafness, cataracts, and GN?
Alport syndrome
small kidneys with mononuclear infiltrate
chronic glomerulonephritis
large kidneys with chronic renal failure
diabetes and polycystic kidney disease
MC stone in acidic urine
uric acid stone
tumor with vessels, muscles, and lipids
angiomyolipoma
decreased concentration of urine and hematuria
sickle cell nephropathy
