Q-bank Flashcards by Shanna Tucker

What happens to Afferent and Efferent arterioles as systemic BP increases?

Afferent constricts and efferent dilates (in response to decreased Renin)

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How does kidney treat Creatinine?

Freely filtered and secreted in PCT

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What is Diabetes Insipidus characterized by?

Polyuria, Polydipsia, and hypernatremia

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What is the most common cause of Potter sequence?

Malformation of Ureteric buds

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In which part of the nephron does the osmolarity stay the lowest?

Early DCT, even in presence of high ADH levels

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Where does PTH act to increase reabsorption of Ca2+?

DCT

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In Nephrotic Syndrome, one gets hyperlipidemia due to increases in what?

Cholesterol, LDL, and TG’s

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Where is the Macula Densa located?

Right at the junction of the cortical Thick ascending limb and the early DCT

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How does a Carbonic Anhydrase inhibitor affect H+ excretion?

It decreased H+ (NH+) excretion

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What is Acetazolamide?

CA inhibitor

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Where is Carbonic Anhydrase located?

PCT

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Where is phosphate reabsorbed? How?

PCT (Na+-Phosphate Co-transporter) or Active Transport

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Where does the majority of H2O and salt reabsorption occur?

PCT ~65% (even in the presence of ADH)

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If hyponatremia is corrected to fast, which part of the brain can be demyelinated?

Basis Pontis

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What is the pH fof Calcium kidney stones?

Ca-Phos are Basic and Ca-oxalate are Acidic

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What is the pH for Ammonium Mg-Phos kindey stones?

Alakaline

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What is the pH for Uric Acid kidney stones?

Acidic

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What is the pH for Cystine kidney stones?

Acidic

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What causes Ammonium Mg-Phos kidney stones?

Urease(+) bacteria, commonly indwelling catheters

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What can DIC cause in the kidneys?

Diffuse Cortical Necrosis

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What do urinary casts indicate?

Hematuria/pyuria of RENAL origin

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Define Creatinine excretion

Creatinine excretion= GFR x Plasma Concentration

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Describe Diabetic Glomerulonephropathy

Mesangial expansion, GBM thickening, and glomerulosclerossis (Kimmelstiel-Wilson lesions, PAS+)

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Why does Creatinine clearance slightly overestimate GFR?

Because Creatinine is freely filtered, but also 10-15% secreted into PCT

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What kind of cells does Wilms tumor have?

Blastemic, epithelial, and stromal cell types

What is Berger Disease?

IgA deposits in mesangial cells Usually follows URI or gastoenteritis Recurrent episodes of hematuria

What do you see on biopsy of Rapidly Progressive Glomerulonephritis?

Crescents (Bowman's capsule)

What can cause Rapidly Progressive Glomerulonephritis?

1. anti-GBM 2. ANCA+ vasculitis 3. Immune complex deposition

Define respiratory acidosis

Increased PCO2

Define metabolic acidosis

Decreased HCO3- (because being used up)

Which part of the eye is composed of Type IV collagen?

Lens of the eye

What is the most common Nephrotic Syndrome in children?

Minimal Change Disease

In terms of susceptibility, how does the cortex compare to the medulla?

The medulla has lower O2-tension--> Cortex is more susceptible to hypoxia

What are the major complications of Kidney stones?

Hydronephrosis and pyelonephritis

What stimulates ADH release?

Increased plasma osmolarity

What is the shape of Cystine kidney stones?

Hexagonal

What test can be used to test Cystine stones?

Nitroprusside Test, which will be PURPLE

How does ADPKD present?

40-50 yo, severe HTN, hematuria, renal insufficiency, anemia (decreased EPO)

ADPKD is due to mutations in which genes?

PKD1 and PKD2

What is the underlying pathology of Minimal Change Disease?

Abnormal release of Lymphokines by T-cells

For Acute Poststreptococcal Glomerulonephritis, what is seen on biopsy?

EM: subepithelial "humps and lumps"

What are the symptoms of Acute Poststreptococcal Glomerulonephritis?

Periorbital edema, Coca-cola-colored urine, HTN, oliguria

In Sickling Crisis, where are you most likely to get sickling in nephron vasculature?

In the Vasa Recta (lowest O2-tension, high osmolarity)

What can Sickling Crisis lead to in the kidneys?

Papillary Necrosis (due to sickling in vasa recta)

How can hyoerglycemia lead to ADH-resistance?

Decreases ability to maintain medullary osmolar gradient

What can increase Renin secretion?

Increase sympathetic activity and Decrease in Na-/Cl- in Macula Densa

What is the equation for Creatinine Excretion?

Plasma Creatinine Conc. x GFR

What kind of medication can you use to treat neurogenic bladder?

Muscarinic AchR Antagonist (Tolterodine)

What is a neurogenic bladder?

A bladder that does not empty properly due to a neurologic condition. Urinary incontinence

How do you distinguish Pre-renal failure from Renal or post-renal? (BUN:Cr ratio)

Pre-renal: Increased BUN:Cr ratio | Renal/Post-renal: Decreased BUN:Cr ratio

How do you distinguish Pre-renal failure from Renal or post-renal? (FENa)

Pre-renal: FENa, 2%

How do NSAIDs cause kidney damage?

They inhibit Prostaglandins, which are renal protective b/c they dialte afferent arteriole

How do Loop Diuretics affect AngII and Renin levels?

Increase Renin and AngII

What do Loop Diuretics inhibit?

Na+/Cl-/K+ co-transporter

Which Loop Diuretic for pts w/ sulfa allergies?

Ethancrynic acid

What kind of electrolyte abnormalities can Loop Diuretics cause?

Hypokalemia, Hypochloremic Alkalosis, Hypocalcemia, Hypomagnesemia

Which Abx canNOT be taken w/ antacids?

Fluroquinolones

How do ACE-Inhibitors work?

Prevent constriction of Efferent Arteriole--> Decrease GFR

What do Macula Densa cells monitor?

Na/Cl delivery in DCT | Decrease Na/Cl--> constrict Aff. Arteriole--> Decrease GFR

What do the JG cells monitor?

Blood Pressure | Decrease BP in Aff. Arteriole--> Renin--> AngII--> Constrict mostly Eff. Arteriole--> Increase GFR

How do ACE-Inhibitors affect Na+ and K+ levels?

Decreases Na+ reabsorption and Increases serum K+

What do you see on ECG with Hyperkalemia?

Peaked T-waves, flattened P-waves, and Widened QRS waves

What is the mechanism of Spironolactone?

Antagonist at Aldosterone Recepor

Which diuretic is best for a pt w/ Hypokalemia and ankle swelling?

ADH-receptor antagonist

As a side effect, Thiazides can increase reabsorption of what?

Calcium

Which diuretics increase Free H2O excretion w/o affecting Na+ and K+ excretion?

ADH

What are the effects of Aldosterone?

Increase Na+ reabsorption Increase K+ secretion Increase H+ secretion

How do diuretics cause increases in Aldosterone?

Lead to volume depletion--> Renin release--> AngII release---> Aldosterone release

How do diuretics affect Aldosterone levels?

Increase

What ECG changes do you see with Hypokalemia?

U-waves Widened/Flattened T-waves ST depressions

How can you prevent formation of uric acid stones from Tumor Lysis Syndrome?

Allopurinol and hydration

How do you treat STRESS incontinence?

Alpha-agonist

How do you treat URGENCY incontinence?

Muscarinic-AchR antagonist

When should K+-sparing diuretics be avoided?

In setting of Hyperkalemic state (burns, crush injury etc.)