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PEARLS book Flashcards

1
Q

the bladder, controlled by a sphincter, contracts to expel urine via the urethra with _______ stimulation

A

parasympathetic (Ach)

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2
Q

network of capillaries involved in the 1st step of urine formation by filtering the blood

A

Glomerulus

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3
Q

Receives blood from afferent arteriole and leaves via efferent arteriole

A

Glomerulus

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4
Q

Crescent shaped structure that receives ultra filtrate from the glomerulus and is the beginning of the neprhon

A

Bowman’s Capsule

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5
Q

Bowmans capsule + glomerulus =

A

renal corpuscle

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6
Q

GFR depends on..

A

age
sex
body size
race

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7
Q

Most active secretion happens in the _____ convoluted tubule

*ie..uric acid, K+, H+, drugs, foreign substances, creatinine, bile salts

A

DISTAL

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8
Q

removal of substances from blood to be excreted into urine

A

Secretion

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9
Q

Most reabsorption occurs at the _____ tubule

A

PROXIMAL

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10
Q

Saturation and Rate of Flow affect…

A

Reabsorption

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11
Q

Tubular reabsorption of vital substances
Isotonic reabsorption of all organic nutrients (i.e. glucose, AAs), most bicarb, Na, Cl and 75-90% of H20

occurs….?

A

PROXIMAL convoluted tubule

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12
Q

Passively absorbs H20 but impermeable to sodium and solutes at the _____ DESCENDING Loop of Henle

A

THIN

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13
Q

Impermeable to H20 but actively reabsorbs Na, K, Cl via Na/K/2Cl co-transporter happens at the ______ ASCENDING Loop of Henle

*loop diuretics work here

A

THICK

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14
Q

Loop diuretics work on which part of the Loop of Henle?

A

Thick Ascending

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15
Q

Main job of Distal Convoluted Tubule…

*Thiazisde diuretics work here

A

Tubular secretion!

*most active secretion occurs here (i.e. acids, toxins, drugs)

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16
Q

Thiazide diuretics work at the…

A

Distal Convoluted Tubule

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17
Q

Distal tubule determines the final _____ of urine (via Aldosterone and ADH)

A

OSMOLARITY

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18
Q

Aldosterone causes an increased Sodium…..

A

reabsorption

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19
Q

ADH does what to the concentration of urine

A

Increases!

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20
Q

This hormone helps regulate BP by controlling aldosterone secretion

A

Renin

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21
Q

Controls real blood flow and GFR as well as controls renin release

A

Juxtaglomerular Apparatus

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22
Q

Juxtaglomerular (JG) cells are specialized smooth cells of _____ arteriole. These cells release renin if low BP

A

AFFERENT

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23
Q

NaCl sensor found in the distal convoluted tubule

A

Macula densa

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24
Q

Decreased BP detected by JG cells
Decreased Cl delivery to Macula dense
Increased Beta1 activation

stimulate….

A

Renin secretion

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25
Q

Kidney disease characterized by:

  • Proteinuria
  • HYPOalbuminemia
  • HYPERlipidemia
  • Edema
A

nephrOtic syndrome

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26
Q

Gold standard dx of NephrOtic Syndrom

A

24 hour urine protein collection

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27
Q

Urinalysis shows: Proteinuria, Oval fat bodies “maltese cross shaped”*

Also…HYPOalbuminemia, HYPERlipidemia

A

NephrOtic syndrome

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28
Q

Minimal change dz
Focal segmental glomerulosclerosis
Membranous nephropathy

All can cause primary (idiopathic)..

A

NephrOtic syndrome

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29
Q

Diabetes**
SLE
Erythematosus
Amyloidosis

All can secondary…

A

NephrOtic syndrome

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30
Q

Immunologic inflammation of glomeruli causing PROTEIN and RBC leakage into urine**

A

Acute glomerulonephritis

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31
Q

HTN, hematuria (RBC casts), dependent edema (proteinuria) and azotemia are HALLMARK! for…

A

Acute glomerulonephritis

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32
Q

Most common cause of Acute glomerulonephritis

A

IgA nephropathy (Berger Dz)

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33
Q

MC cause of acute glomerulonephritis
*often affects young males within days (24-48H) after URI or GI infection

  • diagnosed with IgA deposits
  • Tx= ACEi plus corticosteroids
A

IgA nephropathy (Berger Dz)

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34
Q
  • IgA nephropathy (Berger dz)
  • Post infectious (i.e. after GABHS)
  • Membranoproliferative/ Mesangiocapillary

can all cause…

A

Acute glomerulonephritis

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35
Q

Rapidly progressive acute glomerulonephritis is associated with what kind of prognosis?

(Goodpasture’s syndrome, Vasculitis)

A

POOR

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36
Q

Clinical manifestations:

  • Hematuria** (hallmark!)
  • Edema
  • HTN*
  • Fevers, abdominal/flank pain
  • AKI (oliguria**)
A

Acute glomerulonephritis

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37
Q

Urinalysis shows Hematuria (RBC casts)**,
dysmorphic RBCs, proteinuria, high specific gravity

Increased BUN and Cr

A

Acute glomerulonephritis

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38
Q

GOLD STANDARD FOR DX OF ACUTE GLOMERULONEPHRITIS?

A

RENAL BIOPSY***

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39
Q

Most of the time glomerulonephritis is…

A

self limiting!

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40
Q

Glomerulonephritis..aka

A

Nephritic syndrome

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41
Q

Pathophysiology= immune mediated glomerular inflammation leading to glomerular damage and PROTEINURIA AND RBC LOSS**

A

Nephritis syndrome

42
Q

Predominant feature of nephrOtic syndrome

43
Q 
Edema**
Increased BUN/Cr
transudative pleural effusion**
DVTs
Frothy urine

Nephrotic or Nephritic?

A

Nephrotic!

44
Q

Hematuria, HTN*
Azotemia (increase BUN/Cr)
Oliguria (under 400 ml a day)
Fever, abd, flank pain

Nephrotic or Nephritic?

45
Q

Hypocellular biopsy..

A

Nephrotic

HYPERcellular biopsy would be nephritic

46
Q

Acute tubular necrosis
Acute tubulointerstitial nephritis
Acute glomerulonephritis
Vascular

All causes of what kind of kidney failure?

47
Q

If not corrected, pre renal failure can lead to….

A

intrinsic renal failure

48
Q

Reduced renal perfusion (nephrons structurally in tact!)

49
Q

autosomal dominant disorder due to mutations in either genes PKD1 or PKD2
*pts usually in 20s-40s
(autosomal recessie type seen in children)

A

Polycystic kidney dz

50
Q

Multisystemic progressive disorder characterized by formation and enlargement of kidney cysts in other organs (liver*, spleen, pancreas)

Vasopressin stimulates cystogenesis, leading to end stage renal dz over time

A

Polycystic kidney dz

51
Q
  • Adbominal/flank pain
  • Palpable flank mass
  • HTN, hematuria, micro albuminuria
  • Extra renal: cerebral “berry” aneurysms**, hepatic cysts, mitral valve prolapse*, colonic diverticula
A

Polycystic kidney dz

52
Q

most widely used diagnostic test in Polycystic kidney dz?

A

Renal ultrasound!**

genetic testing should also be done

53
Q

Are CTs/MRI more sensitive than ultrasound for polycystic kidney dz?

54
Q

Treatment for…
Simple cyst: observation, period reevaluation
Multiple cyst: supportive, INCREASE FLUID INTAKE, control HTN, possibly dialysis or renal transplant

A

Polycystic kidney dz

55
Q

CKD must be chronic kidney damage for longer than….

56
Q
  • Proteinuria
  • Abnormal urine sediment
  • Abnormal urine/serum chemistries
  • Abnormal imaging studies
  • Inability to buffer pH
  • Inability to make urine
  • Inability to excrete nitrogenous waste
  • Decreased synthesis of Vitamin D/ Erythropoietin
57
Q

At risk pts: DM, HTN, chronic NSAID use, ethnic minority, over 60 yo, SLE, post transplanted kidney, am hx kidney dz
*Normal GFR, normal urine

Stage?

58
Q

Kidney damage with normal GFR (or above 90)
Kidney damage= proteinuria, abnormal UA, serum, imaging

Stage?

59
Q

GFR 89-60

Stage?

60
Q

GFR 59-30

Stage?

61
Q

GFR 29-15

Stage?

62
Q

GFR under 15
*End stage renal dz (uremia requiring dialysis or transplant)

Stage?

63
Q
  • Diabetes (MC cause!)..due to diabetic nephropathy
  • HTN (2nd MC cause)
  • Glomerulonephritis

Causes of..

64
Q

Single best predictor of CKD progression?

A

Proteinuria

65
Q

Renal ultrasound will show what in CKD?

A

Small kidneys

66
Q
  • HTN control (under 130/80)
  • Diabetes control (A1C under 6.5)
  • Proteinuria control (ACEI or ARB)

control these for…

A

CKD management

67
Q
  • Hematologic complications (anemia, coagulopathy)

- Renal osteodystrophy (bone dz)

A

CKD complications

68
Q

Periostal erosions, bony cysts on X ray, “salt and pepper” appearance of the skull on X ray

*increased PO4
*HYPOcalcemia
*decreased vitamin D
(PTH increases)

A

Renal osteodystrophy

69
Q

non-physiologic excess of increased ADH from pituitary or ectopic source..leads to free water retention and impaired water excretion

  • HypoNa
  • Kidneys unable to dilute urine
A

SIADH

MC of euvolemic HypoNa

70
Q

Causes include:
CNS: stroke, head trauma, meningitis, CNS tumor
Pulm: small cell lung ca
Meds: narcotics, NSAIDs, anticonvulsants, SSRIs

A

SIADH

MC cause of euvolemic HypoNa

71
Q

Pts usually only become symptomatic with increased oral free H2O intake

  • symptoms of HypoNa
  • urine has increased osm (concentrated!)
72
Q

Tx for SIADH

A

fluid restriction

IV hypertonic saline w furosemide

73
Q
  1. hyperosmolarity (increase concen of Na), decreased water
  2. decreased effective arterial volume (hypovolemia)

stimulate….

74
Q

Does hypovolemia always take precedence over hypoosmolarity?

75
Q

The kidney regulates Na via…

A

Aldosterone

Aldosterone causes Na retention

76
Q

Twice the Na concentration roughly equals serum…

A

Osmolality

77
Q

90% of bladder cancer is…

A

Transitional cell

*most present early and respond well to tx

78
Q 
Risk factors...
Smokin****
occupational exposure: dyes, rubber, leather
age over 40
white males
A

Bladder cancer

79
Q

Painless micrscopic or gross hematuria** biggest sign for…

A

bladder cancer

80
Q

Cytoscopy with biopsy** gold standard for dx…

A

bladder cancer

81
Q

Transurethral resection used for what kind of bladder cancer

A

localized or superficial

82
Q

Cystectomy used for what kind of bladder cancer

A

Invasive (advanced or involving muscular layer)

83
Q

BCG immune therapy can be used for…

A

recurrent bladder cancer

84
Q

95% of tumor originating in the kidney are….

  • tumor of proximal convoluted renal tubule cells
  • lack of warning signs, variable presentations, resistant to chemo/XRT
A

renal cell carcinoma

85
Q 
Smoking**
dialysis
HTN
obesity
men

risk factors for…

A

Renal cell carcinoma (RCC)

86
Q

Classic triad:

  1. hematuria
  2. flank/abdominal pain
  3. palpable mass

(also..L sided varicocele, HTN, HyperCa)

87
Q

Diagnosis of RCC made with….

88
Q

If RCC is localized, tx=?

A

Radical nephrectomy

89
Q

Nephroblastoma MC children under 5yo

palpable, painless abdominal mass, hematuria, HTN, anemia

A

Wilm’s tumor

90
Q

Wilms tumor tx

A

Nephrectomy followed by chemo

91
Q
  1. calcium (increase protein and salt intake)
  2. uric acid (high protein food)
  3. struvite (Proteus, klebsiella, pseudomonas)
  4. cystine (genetic)
A

stones of nephrolithiasis

92
Q

Mg ammonium phosphate stones that may form staghorn calculi in renal pelvis

A

Struvite stones

93
Q
  • Renal colic
  • Costovertebral angle tenderness
  • Groin pain
A

Nephrolithiasis

94
Q

UA= microscopic hematuria, pH under 5 (uric acid or cystine) or pH above 7.2 (struvite)

A

Nephrolithiasis

95
Q

MC 1st diagnostic test in nephrolithiasis

A

noncontrast CT abdomen/pelvis

96
Q

80% chance of spontaneous passage
tx with opiates and NSAIDs

if stone is less than ___mm

97
Q

Shock wave lithotripsy, uretoscopy, percutaneous nephrolithotomy

may be needed if stone is greater than ___mm

98
Q 
E.coli******
Staph saprophyticus (in sexually active women)

most common causes of…

99
Q

greater than 100,000 in clean catch specimen

*urine culture=definitive dx!

100
Q

Fluoroquinolones** (Cipro)
Trimethoprim-Sulfamethaxazole
Nitrofurantoin

101
Q

Hypocalcemia is often associated with..

A

Hypomagnesemia

Bc magnesium is needed to make PTH

Renal (15 decks)

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