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Medicine (IM Platinum) > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Site of EPO production

A

Interstitial cells of the peritubular capillaries

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2
Q

Active form of vitamin D

A

1,25 dyhydroxycholecalciferol (calcitriol)
1st hydroxylation in LIVER via 25-alpha hydroxylase
2nd hydroxylation in the KIDNEY via 1-alpha hydroxylase

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2
Q

Contains vasa recta and longer loops of Henle

A

Juxtamedullary nephrons

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3
Q

Components of juxtamedullary apparatus

A

Macula densa - in the walls of distal tubule
JG cells - walls of afferent arteriole
Lacis cells

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4
Q

Detects changes in BP

A

Macula densa

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5
Q

Secretes renin

A

JG cells

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7
Q

Physiologic fxn of RENIN

A

None

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8
Q

Physiologic fxn of angiotensin I

A

None

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9
Q

Physiologic fxn of angiotensin II

A

Vasoconstricts afferent and efferent arteriole
Systemic vasoconstriction
Stimulates thirst
Increases ADH, Cortisol, Epinephrine, Norepinephrine, Aldosterone

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10
Q

Site of aldosterone production

A

Zona glomerulosa of adrenal cortex

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11
Q

Action of aldosterone

A

Inc Na reabsorptrion
K secretion
H secretion

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12
Q

ADH action

A

Insertion of aquaporins/water channels in the distal tubules and collecting ducts

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13
Q

Triggers for ADH secretion

A

Increased plasma osmolarity
Decreased blood volume
Decreased blood pressure

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14
Q

Effect on GFR: Afferent arteriolar vasodilation

A

Increases GFR

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15
Q

Effect on GFR: afferent arteriolar vasoconstriction

A

Decrease GFR

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16
Q

Effect on GFR: efferent arteriolar vasodilation

A

Decrease GFR

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17
Q

Effect on GFR: moderate efferent arteriolar vasoconstriction

A 
Increases GFR
(Inc glomerular capillary hydrostatic pressure)
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18
Q

Effect on GFR: severe efferent arteriolar vasoconstriction

A 
Decreases GFR 
(Inc glomerular capillary oncotic pressure: donnan effect)
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19
Q

Albumin (negatively-charged) attracts positively-charged ions like Na which then attracts water

A

Donnan effect

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20
Q

Absorb K and secrete H

A

Intercalated cells

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21
Q

“Constant load delivered to the distal tubule”, mechanism for autoregulation of GFR

A

Tubuloglomerular feedback

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22
Q

“Percentage of solute reabsorved is held constant”, another mechanism for autoregulation

A

Glomerulotubular feedback

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23
Q

Substances with no Transport Mechanism and Renal Threshold (exhibits Gradient-Time Transport)

A

Sodium, and all passively transported solutes

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24
Q

Ascending limb of LoH is permeable to

A

Sodium
(Mnemonic: ASINding limb is permeable to solute)
Impermeable to water

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25
Q

Descending limb of LoH is permeable to

A

Water, impermeable to solute

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26
Q

Normal pH in arterial blood

A

7.40

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27
Q

Normal pH in venous blood, interstitial blood

A

7.35

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28
Q

Normal pH in intracellular fluid

A

6.0 - 7.4

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29
Q

Normal pH in urine

A

4.5-8.0

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30
Q

Normal pH in gastric HCl

A

0.80

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31
Q

Normal pH in vaginal secretion

A

3.5-4.5

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32
Q

Diuretic causing METABOLIC ACIDOSIS

A

Acetazolamide

Mnemonic: ACIDazolamide

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33
Q

Diuretics causing METABOLIC ALKALOSIS

A

Loop diuretics

Thiazide diuretics

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34
Q

Hyaline cast

A

Ghost-like, no significance in absence of proteinuria

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35
Q

RBC cast, what disease?

A

Nephritic syndrome

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36
Q

WBC cast, what disease?

A

Acute pyelonephritis

Acute tubulo-interstitial nephritis

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37
Q

Rebal tubular cast / granular cast, what disease?

A

Acute tubular necrosis

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38
Q

Fatty cast, what disease?

A

Nephrotic syndrome

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39
Q

Waxy cast, what disease?

A

Chronic renal failure

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40
Q

Compensation depends on adaptive changes produced by renal hypertrophy and adjustments in tubuloglomerular feedback and glomerulotubular balance

A

Bicker’s intact nephron hypothesis

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41
Q

Physiologic adaptations to nephron loss also produce unintended clinical consequences

A

Bricker’s trade off hypothesis

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42
Q

A rise pf at least 0.3mg/dL or 50% higher than baseline within 24-48 hours period

A

Acute kidney injury

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43
Q

Reduction in urine output to 0.5mL/kg per hour for longer than 6 hours

A

Acute kidney injury

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44
Q

Oliguria definition

A
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45
Q

High bone turnover with increased PTH levels

A

Osteitis fibrosa cystica

Classic lesion of secondary hyperParathyroidism

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46
Q

Low bone turnover with LOW or NORMal PTH levels

A

Osteomalacia and adynamic bone disease

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47
Q

Devastating condition seen almost EXCLUSIVELY in patients with advanced CKD and heralded by livedo reticularis

A

Calciphylaxis

Calcific uremic arteriolopathy

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48
Q

Calciphylaxis

A

Calcific uremic arteriolopathy

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49
Q

Ill-defined sensations of sometimes debilitating discomfort in legs/feet relieved by frequent leg movement

A

Restless leg syndrome

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50
Q

Urine-like odor on the breath secondary to breakdown of urea to ammonia in saliva and is often associated with an unpleasant metallic taste

A

Uremic fetor

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51
Q

Seen in patients with CKD who have been exposed to gadolinium

A

Nephrogenic Fibrosing Dermopathy

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52
Q

Stage of CKD where exposure to Gadolinium should be minimized

A

CKD Stage 2 (GFR 30-59mL/min)

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53
Q

Stage of CKD where exposure to Gadolinium should be AVOIDED unless medically necessary

A

CKD Stage 3-5 (GFR

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54
Q
A

FOCAL

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55
Q

> 50% involvement of glomeruli seen in light microscopy

A

DIFFUSE

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56
Q
A

SEGMENTAL

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57
Q

> 50% injury to each glomerular tuft

A

GLOBAL

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58
Q

Kidneys have subscapular hemorrhages with a “flea-bitten” appearance

A

Endocarditis-associated GN

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59
Q

Clasically present with fever, purulent rhinorrhea, nasal ulcers, sinus pain, polyarthralgias/arthritis, cough, hemoptysis, shortness of breath, microscopic hematuria, and 0.5-1g/24H proteinuria

A

Wegener’s granulomatosis with polyangitis

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60
Q

Range of protein in microalbuminuria

A

30-300mg/24H

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61
Q

Autoimmune disease where antibodies are directed against a3 NC1 domain of collagen IV

A

Goodpasture’s disease (anti-GBM disease)

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62
Q

May result from mutations affecting any of five ion transport proteins in the TAL

A

Bartter’s syndrome

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63
Q

Clinical syndrome mimics the effects of chronic ingestion of LOOP DIURETICS

A

Bartter’s syndrome

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64
Q

Due to mutations in the Thiazide-sensitive Na-Cl co-transporter, NCCT, in the DCT

A

Gittelman’s syndrome

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65
Q

Syndrome which resembles effects of THIAZIDE DIURETICS

A

Gittelman’s syndrome

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66
Q

Severe form of bartter’s syndrome in which neonates present with pronounced volume depletion and failure to thrive, fever, vomiting and diarrhea from PGE2 overproduction

A

Hyperprostalandin E syndrome

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67
Q

Mimics a state of aldosterone EXCESS by the presence of early and severe hypertension, often accompanied by HYPOkalemia and metabolic Alkalosis, but plasma aldosterone and renin levels are LOW

A

Liddle’s syndrome

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68
Q

Triad of heavy metal (lead) nephropathy

A

Saturnine gout
Hypertension
Renal insufficiency

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69
Q

Results from long term use of compound analgesic preparations containing phenacetin, aspirin and caffeine

A

Analgesic neohropathy

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70
Q

Renal biopsy finding of interstitial fibrosis and tubular atrophy OUT OF PROPORTION to degree of glomerulosclerosis or vascular disease

A

Tubulointerstitial nephritis

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71
Q

Degenerative changes of the renal arterioles OUT of PROPORTION to the other morphologic defects

A

Chronic uric acid nephropathy

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72
Q

Inability to maximally concentrate urine due to reduced collecting duct responsiveness to AVP and defective transport of sodium and chloride in the loop of Henle

A

Hypercalcemic nephropathy

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73
Q

Pentad of thrombotic thrombocytopenic purpura (TTP)

A 
Hemolytic anemia
Thrombocytopenia
Neurologic symptoms
Fever
Renal failure
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74
Q

MOST SEVERE manifestation characterized by accelerated hypertension, a rapid decline in renal function, nephrotic proteinuria, and hematuria

A

Scleroderma Renal Crisis

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75
Q

ONION SKINNING and can be accompanied by glomerular collapse due ro reduced blood flow

A

Renal lesion in Scleroderma renal crisis

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76
Q

Normal points of narrowing in ureter

A

Ureteropelvic jxn
Ureterovesical jxn
Bladder neck and urethral meatus

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77
Q

Criterion STANDARD in measurement of albuminuria

A

Accurate 24ahour urine collection

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78
Q

MOST useful imaging study in nephrology

A

Renal UTZ

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79
Q

ONLY diagnostic test to elucidate etiology of eraly stage CKD in the absence of a clinical diagnosis

A

renal biopsy

80
Q

MOST sensitive test for RENAL VEIN THROMBOSIS

A

CT angiography

81
Q

STANDARD radiologic procedure for diagnosis of neohrolothiasis

A

helical CT scanning WITHOUT radiocontrast enhancement

82
Q

Most common form of renal replacement therapy

A

Hemodialysis

83
Q

Clear indications for initiation of RRT for patients with CKD

A

Uremic pericarditis
Encephalopathy
Intractable muscle cramping
Anorexia and nausea not attributed to reversible causes such as PUD
Evidence of malnutrition
Fluid and electrolytes abnormalities, principally HYPERkale ia or ECF vol overload, refractory to other measurements

84
Q

Offers the BEST potential for complete rehabilitation

A

Kidney transplantation

85
Q

Educational programs should be commenced in CKD when

A

No later than stage 4 CKD

86
Q

Most common therapeutic modality for ESRD

A

Hemodialysis

87
Q

Dialysis access with HIGHEST long-term patency rate

88
Q

Most important complication of AV graft

A

Thrombosis of graft and graft failure

89
Q

Most common acute complication of hemodialysis, particularly among DM patients

A

Hypotension

90
Q

Preferred buffer in peritoneal dialysis patients

91
Q

Most common additives to peritoneal dialysis solutions

A

Heparin
Antibiotics
Insulin

92
Q

Most common organisms in peritoneal dialysis-related peritonitis

A

Gram-positive cocci including

Staphylococcus (skin origin)

93
Q

ABSOLUTE indication for the urgent initiation of dialysis or for the intensification of dialysis

A

Uremic pericarditis

94
Q

Renal disease associated with multiple myeloma

A

Renal amyloidosis

95
Q

Most common form of AKI

A

Prerenal azotemia

96
Q

Most common cause of CKD

97
Q

Patchy necrosis, PCT and LoH affected, relatively short lengths of tubules affected

A

Ischemic type ATN (in hypovolemia)

98
Q

Extensive necrosis, PCT and DT affected, relatively longer lengths of tubules affected

A

Toxic type ATN (in use of Aminoglycosides, radio-contrast dyes)

99
Q

Acts as ESSENTIAL mediator of increased intraglomerular capillary pressure by selectively increasing efferent arteriolar vasoconstriction relative to afferent arteriolar tone

A

Angiotensin II

100
Q

MAJOR pathway for reducing excess total body K+

A

renal excretion

101
Q

Three broad categories of AKI

A

Prerenal azotemia
Intrinsic renal disease
Postrenal obstruction

102
Q

MOST common clinical associated with prerenal azotemia

A

Hypovolemia
Decreased cardiac output
Medications that interfere with renal autoregulatory responses (NSAIDs and ARBs

103
Q

Most common causes of Intrinsic AKI

A

Sepsis
Ischemia
Nephrotoxins

104
Q

Usual clinical course of contrast-induced neohropathy

A

A rise on SeCrea beginning 24-48houra following exposure
Peaking within 3-5 days
Resolving within 1 week

105
Q

Most common protein in urine and produced in the TAL of LoH

A

Uromodulin/ Tam-Horsfall protein

106
Q

Diseases with LARGE kidneys and CKD

A

DM Nephropathy
HIV-associated nephropathy
Infiltrative diseases
Occ acute interstitial nephritis

107
Q

Provide DEFINITIVE diagnostic information about AKIs and CKDs

A

Kidney biopsy

108
Q

Hallmark of AKI

A

Build-up of nitrogenous waste products, manifested as an elevated BUN concentration (azotemia)

109
Q

DEFINITIVE treatment of hepatorenal syndrome

A

Liver transplantation

110
Q

Continuous RRT preferred in patients with

A

Severe hemodynamic instability
Cerebral edema
Significant volume overload

111
Q

Chronic renal failure typically corresponds to

A

CKD Stage 3-5

112
Q

End-stage renal disease refers to

A

Stage 5 CKD (

113
Q

Protein-creatinine ratio

A

Signifies chronic renal damage-persistence in the urine of:
>17mg of albumin/g creatine in males
>25mg albumin/g creatinine in adult females

114
Q

Good SCREENING test for early detection of renal disease

A

Microalbuminuria (esp in DM)

115
Q

Thiazide diuretics have limited utility in

A

CKD stages 3-5

116
Q

Alkali supplementation may be recommended to slow catabolism and CKD progression when

A

Serum bicarbonate concentration falls below 20-23 mmol/L

117
Q

ONLY indication water restriction

A

Hyponatremia and volume overload

118
Q

OPTImal management of secondary hyperparathyroidism and osteitis fibrosa

A

PREVENTION

119
Q

Major side effect of calcium-based phosphate binders

A

Total-body calcium accumulation and Hypercalcemia

120
Q

Leading cause of morbidity and mortality in patients at every stage of CKD

A

Cardiovascular disease

121
Q

MAJOR risk factor for ischemic cardiovascular disease

A

Presence of any stage of CKD

122
Q

One of the MOST common complications of CKD

A

Hypertension

123
Q

Among the STRONGEST risk factors for the cardiovascular morbidity and mortality in CKD

A

Left ventricular hypertrophy and dilated cardiomyopathy

124
Q

Absence of hypertension may signify the presence of

A

Salt wasting form of renal disease
Effect of antihypertensive therapy
Volume depletion
May signify poor left ventricular fxn

125
Q

CKD patients with DM or proteinuria >1g per24h, blood pressure should be REDUCED to

A

125/75mmHg (salt restriction should be the first line therapy)

126
Q

Anemia seen in CKD

A

Normocytic, normochromic anemia
Seen as EARLY as CKD Stage 3
UNIVERSAL by CKD Stage 4

127
Q

PRIMARY cause of anemia

A

Insufficient production EPO by diseased kidneys

128
Q

ESSENTIAL to ensure an optimal response to EPO in patients with CKD

A

Iron supplementation

129
Q

Target Hgb concentration in CKD

A

100-115g/L

130
Q

Peripheral neuropathy usually becomes clinically evident after the patient reaches

A

CKD stage 4

131
Q

Common in advanced CKD and is often and indication for initiation of dialysis

A

Protein energy malnutrition (consequence of low protein and caloric intake)

132
Q

Assessment of protein-energy malnutrition should begin at -

A

Stage 3 CKD

133
Q

Metfor,in is CONTRAINDICATED when

A

GFR is less than half of normal

134
Q

FIRST line mgt of pruritus in CKD

A

Rule out unrelated skin disorders, such as scabies and treatment of hyperphophatemia

135
Q

Indication for therapy with ACE inhibitor or ARBs

A

Protein excretion >300mg (esp in DM Nephropathy)

136
Q

MOST important initial diagnostic step in evaluation of a patient presenting with elevated serum creatinine is

A

Distinguish newly diagnosed CKD from acute or subacute renal failure

137
Q

Renal failure in GN BEST correlates histologically with

A

Tubulointerstitial nephritis rather than type of inciting glomerular injury

138
Q

“Thyroidization” of kidney

appearance similar to thyroid follicles

A

chronic Gn
Chronic tubulointerstitial nephritis
Chronic pyelonephritis

139
Q

Rbc cast or dysmorphic red blood cells found in the sediment

A

Glomerulonephritis

140
Q

MOST common causes of GN throughout the world

A

Malaria and Schistosomiasis (save for subacute bacterial endocarditis)
Closely followed by: HIV, chronic hep B and C

141
Q

M proteins related to IMPETIGO

A

M types 47, 49, 55, 2, 60, and 57

142
Q

M proteins related to PHARYNGITIS

A

M types 1, 2, 4, 3, 25, 49 and 12

143
Q

Primary treatment or endocariditis-assoc Gn

A

Eradication of the infection with 4-6 weeks antibiotics

144
Q

Wire-loop appearance

A

lupus nephritis

145
Q

Correlate BEST with the presence of renal disease in lupus nephritis

A

Anti-dsDNA antibodies

146
Q

The ONLY reliable method of identifying the morphologic variants of lupus nelhritis

A

Renal biopsy

147
Q

Class with MOST varied course of lupus nephritis

A

Class III nephritis

148
Q

Describes global, diffuse proliferative lesions involving the vast majority of glomeruli

A

Class IV nephritis

149
Q

Has the worst renal prognosis (without treatment)

A

Crescentic GN

150
Q

Predisposed to renal-vein thrombosis and other thrombotic complications (like patients with idiopathic membranous nephropathy)

A

Class V nephritis

151
Q

Signs and symptoms of Nephrotic syndrome

A 
EPAL
Edema
Proteinuria
HypoAlbuminemia
hyperLipidemia
152
Q

Diseases presenting with Nephrotic Syndrome

A 
Minimal change disease (Lipoid)
Membranous GN
DM Nephropathy
Renal amyloidosis
Focal-segmental GN
153
Q

Signs and symptoms of Nephritic syndrome

A 
OHHA
Oliguria
Hematuria
Hypertension
Azotemia
154
Q

Absorbs Na and H2O and secrete K

A

Principal cells

155
Q

Key finding in nephritic syndrome

156
Q

Non nephritic, non nephrotic glomerular disease

A

IgA nephropathy

Membranoproliferative GN

157
Q

Most common GN worldwide

A

IgA nephropathy

158
Q

Recurrent episodes of macroscopic hematuria during or immediately following an URTI often accompanied by proteinuria
Persistent asymptomatic microscopic hematuria

A

IgA nephropathy

159
Q 
Prominent systemic symptoms
Younger age (
160
Q

Anti-PR3 antibodies

A

Wegener’s granulomatosis with polyangitis

161
Q

anti-MPO antibodies

A

Churgg-strauss or microscopic polyangitis

162
Q

Necrotizing triad of Wegener’s granulomatosis

A

Necrotizing vasculitis
Necrotizing Glomerulitis
Necrotizing Granulomas

163
Q

Most prolifetive of the three types of MPGN

A

Type I MPGN

164
Q

MOST common cause of nephrotic syndrome in children

A

Minimal change diseaes (Lipoid nephrosis

165
Q

Most common cause of nephritic syndrome in children

A

Post-strep GN (PSGN)

166
Q

1st lime therapy in minimal change

A

Prednisone

167
Q

Glomeruli located at corticomedullary jxn: so if the renal biopsy is from superficial tissue, the lesion can be MISSED, which sometimes leads to misdiagnosis of MCD

A

Pathologic changes of FSGS are most prominent in

168
Q

Highest reported incidences of renal vein thrombosis, pulmonary embolism and DVT

169
Q

Most common cause of neohrotic syndrome in the elderly

A

Focal segmental glomerulonephritis

170
Q

SENSITIVE indicator for the presence of diabetes

A

Thickening of GB!

171
Q

EARLIEST manifestation of DM Nephropathy

A

Increase in albuminuria

172
Q

Potent risk factor for cardiovascular events and death in patients with type 2 DM

A

Microalbuminuria

173
Q

Schistosoma spp MOST commonly assoc with clinical renal disease

A

Schistosoma mansoni

174
Q

Hallmark of ADPKD

A

Phenotypic heterogeneity

175
Q

Most common cardiac valvular abnormality in ADPKD

A

MVP and aortic regurgitation

176
Q

Most common genetic cause of ESRD in childhood and adolescence

A

Nephronophthisis

177
Q

Most common renal abnormality in tuberous sclerosis

A

Angiomyolipoma

178
Q

Gittelman’s syndrome is distinguished from Most forms of Bartter’s syndrome by the presence of

A

Severe HYPOmagnesemia

HYPOcalciuria

179
Q

Mainstay of treatment for cystinuria

A

HYDRATION, achieve UO of 2.5L/day

180
Q

Hallmark feature of tubolointerstitial neohritis with uveitis

A

Painful anterior uveitis

181
Q

Predominant pathology in chronic tubulointerstital nephritis

A

Interstitial fibrosis

182
Q

Acute tubulointerstitial neohritis most often presents with

A

Acute renal failure

183
Q

1st line therapy in scleroderma renal crisis unless contraindicated

A

ACE inhibitor

184
Q

Most common type of urolithiasis

A

Calcium stones

185
Q

Struvite stones

A

Proteus mirabilis forming staghorn calculi

186
Q

Hereditary, contains sulfur

A

Cystine stones

187
Q

Size of ureteral stones which may pass spontaneously

188
Q

Radiopaque on standard xrays

A

Calcium stones
Struvkte stones
Cystine stones

189
Q

Radiolucent on standard xrays

A

Uric acid stones

190
Q

Most common metabolic abnormality found in patients with nephrolithiasis

A

Idiopathic hypercalciuria

191
Q

Major risk factor for uric acid stone formation

A

Persistently acidic urine

192
Q

Indication of upper GUT involvement

A

Unilateral back or flank pain

193
Q

Fluoroquinolones commonly used in UTI

A

Ofloxacin, ciprofloxacin and levofloxacin

194
Q

All fluoroquinolones are effective against short course therapy for Cystitis except

A

Moxifloxacine

195
Q

Most common cause of bilateral hydronephrosis in boys

A

Ofloxacin, ciprofloxacin and penicillin

Medicine (IM Platinum) (2 decks)

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