Nephrology Flashcards
1
Q
Site of EPO production
A
Interstitial cells of the peritubular capillaries
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
2
Q
Contains vasa recta and longer loops of Henle
A
Juxtamedullary nephrons
3
Q
Components of juxtamedullary apparatus
A
Macula densa - in the walls of distal tubule
JG cells - walls of afferent arteriole
Lacis cells
4
Q
Detects changes in BP
A
Macula densa
5
Q
Secretes renin
A
JG cells
7
Q
Physiologic fxn of RENIN
A
None
8
Q
Physiologic fxn of angiotensin I
A
None
9
Q
Physiologic fxn of angiotensin II
A
Vasoconstricts afferent and efferent arteriole
Systemic vasoconstriction
Stimulates thirst
Increases ADH, Cortisol, Epinephrine, Norepinephrine, Aldosterone
10
Q
Site of aldosterone production
A
Zona glomerulosa of adrenal cortex
11
Q
Action of aldosterone
A
Inc Na reabsorptrion
K secretion
H secretion
12
Q
ADH action
A
Insertion of aquaporins/water channels in the distal tubules and collecting ducts
13
Q
Triggers for ADH secretion
A
Increased plasma osmolarity
Decreased blood volume
Decreased blood pressure
14
Q
Effect on GFR: Afferent arteriolar vasodilation
A
Increases GFR
15
Q
Effect on GFR: afferent arteriolar vasoconstriction
A
Decrease GFR
16
Q
Effect on GFR: efferent arteriolar vasodilation
A
Decrease GFR
17
Q
Effect on GFR: moderate efferent arteriolar vasoconstriction
A
Increases GFR (Inc glomerular capillary hydrostatic pressure)
18
Q
Effect on GFR: severe efferent arteriolar vasoconstriction
A
Decreases GFR (Inc glomerular capillary oncotic pressure: donnan effect)
19
Q
Albumin (negatively-charged) attracts positively-charged ions like Na which then attracts water
A
Donnan effect
20
Q
Absorb K and secrete H
A
Intercalated cells
21
Q
“Constant load delivered to the distal tubule”, mechanism for autoregulation of GFR
A
Tubuloglomerular feedback
22
Q
“Percentage of solute reabsorved is held constant”, another mechanism for autoregulation
A
Glomerulotubular feedback
23
Q
Substances with no Transport Mechanism and Renal Threshold (exhibits Gradient-Time Transport)
A
Sodium, and all passively transported solutes
24
Q
Ascending limb of LoH is permeable to
A
Sodium
(Mnemonic: ASINding limb is permeable to solute)
Impermeable to water
25
Descending limb of LoH is permeable to
Water, impermeable to solute
26
Normal pH in arterial blood
7.40
27
Normal pH in venous blood, interstitial blood
7.35
28
Normal pH in intracellular fluid
6.0 - 7.4
29
Normal pH in urine
4.5-8.0
30
Normal pH in gastric HCl
0.80
31
Normal pH in vaginal secretion
3.5-4.5
32
Diuretic causing METABOLIC ACIDOSIS
Acetazolamide
| Mnemonic: ACIDazolamide
33
Diuretics causing METABOLIC ALKALOSIS
Loop diuretics
| Thiazide diuretics
34
Hyaline cast
Ghost-like, no significance in absence of proteinuria
35
RBC cast, what disease?
Nephritic syndrome
36
WBC cast, what disease?
Acute pyelonephritis
| Acute tubulo-interstitial nephritis
37
Rebal tubular cast / granular cast, what disease?
Acute tubular necrosis
38
Fatty cast, what disease?
Nephrotic syndrome
39
Waxy cast, what disease?
Chronic renal failure
40
Compensation depends on adaptive changes produced by renal hypertrophy and adjustments in tubuloglomerular feedback and glomerulotubular balance
Bicker's intact nephron hypothesis
41
Physiologic adaptations to nephron loss also produce unintended clinical consequences
Bricker's trade off hypothesis
42
A rise pf at least 0.3mg/dL or 50% higher than baseline within 24-48 hours period
Acute kidney injury
43
Reduction in urine output to 0.5mL/kg per hour for longer than 6 hours
Acute kidney injury
44
Oliguria definition
45
High bone turnover with increased PTH levels
Osteitis fibrosa cystica
| Classic lesion of secondary hyperParathyroidism
46
Low bone turnover with LOW or NORMal PTH levels
Osteomalacia and adynamic bone disease
47
Devastating condition seen almost EXCLUSIVELY in patients with advanced CKD and heralded by livedo reticularis
Calciphylaxis
| Calcific uremic arteriolopathy
48
Calciphylaxis
Calcific uremic arteriolopathy
49
Ill-defined sensations of sometimes debilitating discomfort in legs/feet relieved by frequent leg movement
Restless leg syndrome
50
Urine-like odor on the breath secondary to breakdown of urea to ammonia in saliva and is often associated with an unpleasant metallic taste
Uremic fetor
51
Seen in patients with CKD who have been exposed to gadolinium
Nephrogenic Fibrosing Dermopathy
52
Stage of CKD where exposure to Gadolinium should be minimized
CKD Stage 2 (GFR 30-59mL/min)
53
Stage of CKD where exposure to Gadolinium should be AVOIDED unless medically necessary
CKD Stage 3-5 (GFR
54
FOCAL
55
>50% involvement of glomeruli seen in light microscopy
DIFFUSE
56
SEGMENTAL
57
>50% injury to each glomerular tuft
GLOBAL
58
Kidneys have subscapular hemorrhages with a "flea-bitten" appearance
Endocarditis-associated GN
59
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
Wegener's granulomatosis with polyangitis
60
Range of protein in microalbuminuria
30-300mg/24H
61
Autoimmune disease where antibodies are directed against a3 NC1 domain of collagen IV
Goodpasture's disease (anti-GBM disease)
62
May result from mutations affecting any of five ion transport proteins in the TAL
Bartter's syndrome
63
Clinical syndrome mimics the effects of chronic ingestion of LOOP DIURETICS
Bartter's syndrome
64
Due to mutations in the Thiazide-sensitive Na-Cl co-transporter, NCCT, in the DCT
Gittelman's syndrome
65
Syndrome which resembles effects of THIAZIDE DIURETICS
Gittelman's syndrome
66
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
Hyperprostalandin E syndrome
67
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
Liddle's syndrome
68
Triad of heavy metal (lead) nephropathy
Saturnine gout
Hypertension
Renal insufficiency
69
Results from long term use of compound analgesic preparations containing phenacetin, aspirin and caffeine
Analgesic neohropathy
70
Renal biopsy finding of interstitial fibrosis and tubular atrophy OUT OF PROPORTION to degree of glomerulosclerosis or vascular disease
Tubulointerstitial nephritis
71
Degenerative changes of the renal arterioles OUT of PROPORTION to the other morphologic defects
Chronic uric acid nephropathy
72
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
Hypercalcemic nephropathy
73
Pentad of thrombotic thrombocytopenic purpura (TTP)
```
Hemolytic anemia
Thrombocytopenia
Neurologic symptoms
Fever
Renal failure
```
74
MOST SEVERE manifestation characterized by accelerated hypertension, a rapid decline in renal function, nephrotic proteinuria, and hematuria
Scleroderma Renal Crisis
75
ONION SKINNING and can be accompanied by glomerular collapse due ro reduced blood flow
Renal lesion in Scleroderma renal crisis
76
Normal points of narrowing in ureter
Ureteropelvic jxn
Ureterovesical jxn
Bladder neck and urethral meatus
77
Criterion STANDARD in measurement of albuminuria
Accurate 24ahour urine collection
78
MOST useful imaging study in nephrology
Renal UTZ
79
ONLY diagnostic test to elucidate etiology of eraly stage CKD in the absence of a clinical diagnosis
renal biopsy
80
MOST sensitive test for RENAL VEIN THROMBOSIS
CT angiography
81
STANDARD radiologic procedure for diagnosis of neohrolothiasis
helical CT scanning WITHOUT radiocontrast enhancement
82
Most common form of renal replacement therapy
Hemodialysis
83
Clear indications for initiation of RRT for patients with CKD
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
Offers the BEST potential for complete rehabilitation
Kidney transplantation
85
Educational programs should be commenced in CKD when
No later than stage 4 CKD
86
Most common therapeutic modality for ESRD
Hemodialysis
87
Dialysis access with HIGHEST long-term patency rate
Fistula
88
Most important complication of AV graft
Thrombosis of graft and graft failure
89
Most common acute complication of hemodialysis, particularly among DM patients
Hypotension
90
Preferred buffer in peritoneal dialysis patients
Lactate
91
Most common additives to peritoneal dialysis solutions
Heparin
Antibiotics
Insulin
92
Most common organisms in peritoneal dialysis-related peritonitis
Gram-positive cocci including
| Staphylococcus (skin origin)
93
ABSOLUTE indication for the urgent initiation of dialysis or for the intensification of dialysis
Uremic pericarditis
94
Renal disease associated with multiple myeloma
Renal amyloidosis
95
Most common form of AKI
Prerenal azotemia
96
Most common cause of CKD
DM
97
Patchy necrosis, PCT and LoH affected, relatively short lengths of tubules affected
Ischemic type ATN (in hypovolemia)
98
Extensive necrosis, PCT and DT affected, relatively longer lengths of tubules affected
Toxic type ATN (in use of Aminoglycosides, radio-contrast dyes)
99
Acts as ESSENTIAL mediator of increased intraglomerular capillary pressure by selectively increasing efferent arteriolar vasoconstriction relative to afferent arteriolar tone
Angiotensin II
100
MAJOR pathway for reducing excess total body K+
renal excretion
101
Three broad categories of AKI
Prerenal azotemia
Intrinsic renal disease
Postrenal obstruction
102
MOST common clinical associated with prerenal azotemia
Hypovolemia
Decreased cardiac output
Medications that interfere with renal autoregulatory responses (NSAIDs and ARBs
103
Most common causes of Intrinsic AKI
Sepsis
Ischemia
Nephrotoxins
104
Usual clinical course of contrast-induced neohropathy
A rise on SeCrea beginning 24-48houra following exposure
Peaking within 3-5 days
Resolving within 1 week
105
Most common protein in urine and produced in the TAL of LoH
Uromodulin/ Tam-Horsfall protein
106
Diseases with LARGE kidneys and CKD
DM Nephropathy
HIV-associated nephropathy
Infiltrative diseases
Occ acute interstitial nephritis
107
Provide DEFINITIVE diagnostic information about AKIs and CKDs
Kidney biopsy
108
Hallmark of AKI
Build-up of nitrogenous waste products, manifested as an elevated BUN concentration (azotemia)
109
DEFINITIVE treatment of hepatorenal syndrome
Liver transplantation
110
Continuous RRT preferred in patients with
Severe hemodynamic instability
Cerebral edema
Significant volume overload
111
Chronic renal failure typically corresponds to
CKD Stage 3-5
112
End-stage renal disease refers to
Stage 5 CKD (
113
Protein-creatinine ratio
Signifies chronic renal damage-persistence in the urine of:
>17mg of albumin/g creatine in males
>25mg albumin/g creatinine in adult females
114
Good SCREENING test for early detection of renal disease
Microalbuminuria (esp in DM)
115
Thiazide diuretics have limited utility in
CKD stages 3-5
116
Alkali supplementation may be recommended to slow catabolism and CKD progression when
Serum bicarbonate concentration falls below 20-23 mmol/L
117
ONLY indication water restriction
Hyponatremia and volume overload
118
OPTImal management of secondary hyperparathyroidism and osteitis fibrosa
PREVENTION
119
Major side effect of calcium-based phosphate binders
Total-body calcium accumulation and Hypercalcemia
120
Leading cause of morbidity and mortality in patients at every stage of CKD
Cardiovascular disease
121
MAJOR risk factor for ischemic cardiovascular disease
Presence of any stage of CKD
122
One of the MOST common complications of CKD
Hypertension
123
Among the STRONGEST risk factors for the cardiovascular morbidity and mortality in CKD
Left ventricular hypertrophy and dilated cardiomyopathy
124
Absence of hypertension may signify the presence of
Salt wasting form of renal disease
Effect of antihypertensive therapy
Volume depletion
May signify poor left ventricular fxn
125
CKD patients with DM or proteinuria >1g per24h, blood pressure should be REDUCED to
125/75mmHg (salt restriction should be the first line therapy)
126
Anemia seen in CKD
Normocytic, normochromic anemia
Seen as EARLY as CKD Stage 3
UNIVERSAL by CKD Stage 4
127
PRIMARY cause of anemia
Insufficient production EPO by diseased kidneys
128
ESSENTIAL to ensure an optimal response to EPO in patients with CKD
Iron supplementation
129
Target Hgb concentration in CKD
100-115g/L
130
Peripheral neuropathy usually becomes clinically evident after the patient reaches
CKD stage 4
131
Common in advanced CKD and is often and indication for initiation of dialysis
Protein energy malnutrition (consequence of low protein and caloric intake)
132
Assessment of protein-energy malnutrition should begin at -
Stage 3 CKD
133
Metfor,in is CONTRAINDICATED when
GFR is less than half of normal
134
FIRST line mgt of pruritus in CKD
Rule out unrelated skin disorders, such as scabies and treatment of hyperphophatemia
135
Indication for therapy with ACE inhibitor or ARBs
Protein excretion >300mg (esp in DM Nephropathy)
136
MOST important initial diagnostic step in evaluation of a patient presenting with elevated serum creatinine is
Distinguish newly diagnosed CKD from acute or subacute renal failure
137
Renal failure in GN BEST correlates histologically with
Tubulointerstitial nephritis rather than type of inciting glomerular injury
138
"Thyroidization" of kidney
| appearance similar to thyroid follicles
chronic Gn
Chronic tubulointerstitial nephritis
Chronic pyelonephritis
139
Rbc cast or dysmorphic red blood cells found in the sediment
Glomerulonephritis
140
MOST common causes of GN throughout the world
Malaria and Schistosomiasis (save for subacute bacterial endocarditis)
Closely followed by: HIV, chronic hep B and C
141
M proteins related to IMPETIGO
M types 47, 49, 55, 2, 60, and 57
142
M proteins related to PHARYNGITIS
M types 1, 2, 4, 3, 25, 49 and 12
143
Primary treatment or endocariditis-assoc Gn
Eradication of the infection with 4-6 weeks antibiotics
144
Wire-loop appearance
lupus nephritis
145
Correlate BEST with the presence of renal disease in lupus nephritis
Anti-dsDNA antibodies
146
The ONLY reliable method of identifying the morphologic variants of lupus nelhritis
Renal biopsy
147
Class with MOST varied course of lupus nephritis
Class III nephritis
148
Describes global, diffuse proliferative lesions involving the vast majority of glomeruli
Class IV nephritis
149
Has the worst renal prognosis (without treatment)
Crescentic GN
150
Predisposed to renal-vein thrombosis and other thrombotic complications (like patients with idiopathic membranous nephropathy)
Class V nephritis
151
Signs and symptoms of Nephrotic syndrome
```
EPAL
Edema
Proteinuria
HypoAlbuminemia
hyperLipidemia
```
152
Diseases presenting with Nephrotic Syndrome
```
Minimal change disease (Lipoid)
Membranous GN
DM Nephropathy
Renal amyloidosis
Focal-segmental GN
```
153
Signs and symptoms of Nephritic syndrome
```
OHHA
Oliguria
Hematuria
Hypertension
Azotemia
```
154
Absorbs Na and H2O and secrete K
Principal cells
155
Key finding in nephritic syndrome
RBC cast
156
Non nephritic, non nephrotic glomerular disease
IgA nephropathy
| Membranoproliferative GN
157
Most common GN worldwide
IgA nephropathy
158
Recurrent episodes of macroscopic hematuria during or immediately following an URTI often accompanied by proteinuria
Persistent asymptomatic microscopic hematuria
IgA nephropathy
159
```
Prominent systemic symptoms
Younger age (
```
HSP
160
Anti-PR3 antibodies
Wegener's granulomatosis with polyangitis
161
anti-MPO antibodies
Churgg-strauss or microscopic polyangitis
162
Necrotizing triad of Wegener's granulomatosis
Necrotizing vasculitis
Necrotizing Glomerulitis
Necrotizing Granulomas
163
Most prolifetive of the three types of MPGN
Type I MPGN
164
MOST common cause of nephrotic syndrome in children
Minimal change diseaes (Lipoid nephrosis
165
Most common cause of nephritic syndrome in children
Post-strep GN (PSGN)
166
1st lime therapy in minimal change
Prednisone
167
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
Pathologic changes of FSGS are most prominent in
168
Highest reported incidences of renal vein thrombosis, pulmonary embolism and DVT
MGN
169
Most common cause of neohrotic syndrome in the elderly
Focal segmental glomerulonephritis
170
SENSITIVE indicator for the presence of diabetes
Thickening of GB!
171
EARLIEST manifestation of DM Nephropathy
Increase in albuminuria
172
Potent risk factor for cardiovascular events and death in patients with type 2 DM
Microalbuminuria
173
Schistosoma spp MOST commonly assoc with clinical renal disease
Schistosoma mansoni
174
Hallmark of ADPKD
Phenotypic heterogeneity
175
Most common cardiac valvular abnormality in ADPKD
MVP and aortic regurgitation
176
Most common genetic cause of ESRD in childhood and adolescence
Nephronophthisis
177
Most common renal abnormality in tuberous sclerosis
Angiomyolipoma
178
Gittelman's syndrome is distinguished from Most forms of Bartter's syndrome by the presence of
Severe HYPOmagnesemia
| HYPOcalciuria
179
Mainstay of treatment for cystinuria
HYDRATION, achieve UO of 2.5L/day
180
Hallmark feature of tubolointerstitial neohritis with uveitis
Painful anterior uveitis
181
Predominant pathology in chronic tubulointerstital nephritis
Interstitial fibrosis
182
Acute tubulointerstitial neohritis most often presents with
Acute renal failure
183
1st line therapy in scleroderma renal crisis unless contraindicated
ACE inhibitor
184
Most common type of urolithiasis
Calcium stones
185
Struvite stones
Proteus mirabilis forming staghorn calculi
186
Hereditary, contains sulfur
Cystine stones
187
Size of ureteral stones which may pass spontaneously
188
Radiopaque on standard xrays
Calcium stones
Struvkte stones
Cystine stones
189
Radiolucent on standard xrays
Uric acid stones
190
Most common metabolic abnormality found in patients with nephrolithiasis
Idiopathic hypercalciuria
191
Major risk factor for uric acid stone formation
Persistently acidic urine
192
Indication of upper GUT involvement
Unilateral back or flank pain
193
Fluoroquinolones commonly used in UTI
Ofloxacin, ciprofloxacin and levofloxacin
194
All fluoroquinolones are effective against short course therapy for Cystitis except
Moxifloxacine
195
Most common cause of bilateral hydronephrosis in boys
Ofloxacin, ciprofloxacin and penicillin
