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UWorld > Renal > Flashcards

Renal Flashcards

1
Q

Name 3 neoplasms associated with VHL gene mutations

A

hemangioblastomas
clear cell renal carcinoma
pheochromocytoma

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2
Q

Acidosis stimulates renal ammoniagenesis, a process by which renal tubular epithelial cells metabolize ____ to _____, generating ammonium that is excreted in the urine and bicarbonate that is absorbed in the blood

A

glutamine to glutamate

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3
Q

In poststreptococcal glomerulonephritis, what is deposited on the glomerular basement membrane

A

IgG, IgM, C3

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4
Q

describe the following for PSGN: immunofluroescence, electron microscopy, light microscopy

A

IF: granular
EM: immune deposits as discrete, electron-dense, subepithelial humps on GBM
LM: enlarged, diffusely hypercellular glomeruli (leukocyte infiltration and mesangial and endothelial cell proliferation)

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5
Q

What arises from the 3 embryonic nephric systems: pronephros, mesonephros, and metanephros

A

pronephros: completely regresses
mesonephros: wolffian ducts (males), regresses and becomes vestigial Gartner’s ducts (females)
metanephros: glomeruli, Bowmans space, proximal tubules, loop of henle, distal tubules

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6
Q

Development of the metanephros begins with formation of the metanephric diverticulum/ureteric bud which penetrates the sacral intermediate mesoderm to induce the formation of the _____

A

metanephric blastema

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7
Q

The ureteric bud/metanephric diverticulum ultimately gives rise to _____

A

the collecting system of the kidney: collecting tubules and ducts, major and minor calyces, renal pelvis, ureters

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8
Q

The metanephros/metanephric blastema gives rise to ______

A 
glomeruli
Bowman's space
proximal tubules
loop of Henle
distal convoluted tubules
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9
Q

What percentage of potassium is absorbed/excreted at the following sites:
PCT
ascending loop of Henle

A

PCT: 65% reabsorbed

ascending loop: 15-30% reabsorbed (Na/K/Cl)

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10
Q

How does the collecting duct handle potassium in hypokalemic vs hyperkalemic states

A

hypokalemia: resorption via H/K ATPase on alpha cells apical membrane
hyperkalemia: principal cells secrete K thorugh apical K channels

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11
Q

What is the blood supply to the ureter

A

proximal ureter: renal artery

distal ureter: superior vesical artery

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12
Q

_____ is a diuretic that works by inhibiting carbonic anhydrase, which effectively blocks NaHCO3 and water reabsorption in the PCT resulting in bicarb wasting

A

acetazolamide

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13
Q

What will a urinalysis reveal on a patient who has an elevated creatinine with initiation of ACE inhibitors

A

typically unremarkable (no hematuria, proteinuria or casts; high creatinine is due to low GFR from inhibiting angiotensin 2 from constricting the efferent arteriole)

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14
Q

An infant presents with dehydration (flat fontanelle, dry mucous membranes), dilute urine in large quantities, and high ADH. what is the diagnosis and what is the treatment

A

nephrogenic diabetes insipidus

tx: hydrochlorothiazide

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15
Q

What electrolyte imbalance presents as muscle cramps, perioral paresthesia, and laryngospasm

A

hypocalcemia

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16
Q

Immunofluorescence microscopy demonstrating linear deposits on the glomerular basement membrane is characteristic of what disease

A

Goodpasture disease (anti-GBM disease)

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17
Q

Anti-glomerular basement membrane disease/Goodpasture disease has antibodies that target ____ leading to subsequent complement deposition

A

type IV collagen

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18
Q

goodpasture disease results in what syndrome of the kidney

A

rapidly progressive (crescentic) glomerulonephritis (RPGN)

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19
Q

Immunofluorescence demonstrating linear deposits of ___ and ___ along the glomerular basement membrane is characteristic anti-glomerular basement membrane disease/Goodpastures

A

IgG C3

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20
Q

Excessive infusion of normal saline (sodium chloride) causes what changes to blood pH, serum bicarb, serum chloride, and urine sodium

A

blood pH: decrease
serum bicarb: decrease
serum chloride: increase
urine sodium: increase

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21
Q

The urachus is a remnant of the ____ that connects the bladder with the yolk sac during fetal development

A

allantois

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22
Q

Failure of the ___ to obliterate at birth can facilitate discharge of urine from the umbilicus

A

urachus

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23
Q

An upper motor neuron lesion in the spinal cord has what effect on the bladder

A

spastic bladder: bladder does not distend/relax properly due to loss of descending inhibitory control from UMN –> urinary frequency, urge incontinence

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24
Q

_____ is secreted in response to hyperphosphatemia and lowers plasma phosphate by reducing intestinal absorption and renal reabsorption of phosphate

A

fibroblast growth factor 23 (FGF23)

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25
Q

What is ACE inhibitors affects on the following levels: renin, angiotensin 1, angiotensin 2, bradykinin, aldosterone

A 
renin: increased
angiotensin 1: increased
angiotensin 2: decreased
aldosterone: decreased
bradykinin: increased
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26
Q

Reduced estrogen causes osteoporosis by decreasing ___ production and increasing ____ production and ____ expression on osteoclast precursors

A

osteoprotegrrin
RANK-L
RANK

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27
Q

How do beta blockers regulate the RAAS system

A

beta blockers inhibit renin release, therefore reducing A1, A2 and aldosterone levels

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28
Q

Pelvic floor strengthening in order to reduce urinary incontinence targets what muscle in order to improve support around the urethra and bladder

A

levator ani

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29
Q

What portion of the nephron is impermeable to water regardless of serum vasopressin levels

A

ascending limb of loop of Henle

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30
Q

Urge incontinence or overactive bladder is caused by what?

A

uninhibited bladder contractions (detrusor instability)

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31
Q

what medication treatment can be used to treat over active bladder syndrome/urge incontinence

A

antimuscarinic (targeting M3)

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32
Q

what effect due beta 3 receptors have on the bladder

A

bladder relaxation

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33
Q

The 4 dibasic amino acids __, ___, ___, and ___ share a common transporter in the intestinal lumen and kidneys

A 
cysteine
ornithine
lysine
arginine
(cola)
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34
Q

What is the result of impaired cellular transport of cysteine, ornithine, lysine, and arginine

A

cystinuria –> cystine kidney stones (hexagonal cystine crystals)

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35
Q

Regardless of a patients hydration status, where is the majority of water always reabsorbed

A

PCT

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36
Q

Severe vomiting leads to what acid base disorder

A 
metabolic alkalosis
(loss of H+ from GI, volume and Cl- depletion induces renal retention of bicarb, hypokalemia induced intracellular shift of H+)
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37
Q

Bilaterally enlarged, cystic fetal kidneys, detected on ultrasound indicate what diagnosis

A

autosomal recessive polycystic kidney disease

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38
Q

what is the genetic cause of autosomal recessive polycystic kidney disease

A

mutation in PKHD1: codes for fibrocystin

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39
Q

Where is the most common site for obstruction causing unilateral fetal hydronephrosis

A

ureteropelvic junction due to inadequate canalization

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40
Q

Why are NSAIDs contraindicated with loop diuretics

A

NSAIDs inhibit prostaglandin synthesis which normally cause vasodilation and mainaint adequate blood flow to kidney
low prostaglandins –> decreased renal perfusion –> decreased GFR –> water and salt retention

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41
Q

what are normal age related changes that cause decline in renal function

A

decreased renal mass and functional glomeruli
decreased renal blood flow
limited hormonal responsiveness (ie renin, PTH)

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42
Q

Why is adding carbonic anhydrase inhibitors, such as acetazolamide, to loop diuretic treatment useful?

A

CA inhibitors cause metabolic acidosis which can offset the metabolic alkalosis caused by loop diuretics

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43
Q

When reintroducing carbohydrates to someone who is malnourished, what possible complications can arise due to phosphate handling

A

increased carbs –> increased insulin –> phosphate redistributed from the serum into muscle and hepatic cells for use during glycolysis –> hypophosphatemia –> refeeding syndrome = muscular weakness, arrhythmias, congestive heart failure

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44
Q

In working up a patient with metabolic alkalosis, total body ____ depletion is often an important pathophysiology and can be tested in the urine

A

chloride

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45
Q

How are GFR and filtration fraction effected by mild vasoconstriction of the efferent arteriole

A

both increase

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46
Q

filtration fraction = GFR / ______

A

renal plasma flow

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47
Q

Where is the bladder located in respect to the peritoneum

A

extraperitoneal (anterioinferior to the peritoneal space)

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48
Q

How can sickle cell cause hematuria

A

sickled cells obstruct small kidney vessels –> ischemia –> renal papillary necrosis

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49
Q

EPO is secreted by what part of the kidney?

A

peritubular interstitial/fibroblasts cells (in response to decreased renal oxygen delivery)

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50
Q

In a patient with a calcium kidney stone, are they most likely to have hyper or hypocalcemia? hyper or hypocalciuria?

A

normocalcemia (plasma calcium levels are regulated by vit D and parathyroid hormone)
hypercalcuria

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51
Q

Postoperative urinary retention with incomplete bladder emptying is thought to involve decreased ___ activity and can be treated with what medications

A 
detrusor (decreased reflex activity)
muscarinic agonist (bethanechol) or alpha 1 blocking drug
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52
Q

As the ureters travels to the toward the bladder, they lie within the retroperitoneum and cross ____ to the common/external iliac arteries to reach the true pelvis. Within the true pelvis, the ureters lie _____ to the internal iliac artery and ____ to the uterine artery.

A

anterior
anterior
posterior

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53
Q

Nonanion gap metabolic acidosis results from the loss of _____. What are two common causes?

A

bicarb
renal tubular acidosis
severe diarrhea

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54
Q

Nonanion gap metabolic acidosis is also referred to as _______ acidosis because the decrease in serum bicarb is comensated for by an increase in serum ____

A

hyperchloremic

chloride

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55
Q

How do PTH and vitamin D differ in renal handling of phosphate and calcium

A

PTH: increase calcium reabsorption and increase phosphate excretion
vit D: increase calcium absorption, only increases phosphate excretion to small extent bc it also feeds back to decrease PTH production

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56
Q

What portion of the bladder is in contact with the peritoneal cavity?

A

dome of bladder
(blunt lower abdominal trauma can abruptly increase intravesicular pressure and rupture the bladder dome, spilling urine into the intraperitoneal cavity)

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57
Q

Increased urea resorption is mediated by what hormone and what is its effects on water absorption

A

antidiuretic hormone
promotes water retention
(ADH –> increased urea permeability in the inner medullary collecting ducts –> increased medullary concentration gradient –> increased free water retention)

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58
Q

Parathyroid hormone lowers serum phosphorus by decreasing phosphorus reabsorption in what portion of the tubule?

A

proximal tubule

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59
Q

Erythropoeisis-stimulating agents can be used to treat anemia of chronic kidney disease but increase risk of ____ and ____

A 
thromboembolic events (due to increased blood viscosity)
hypertension (activation of EPO receptors on vascular endothelial and smooth muscle cells)
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60
Q

Aminoglycosides can cause what type of renal disease

A

acute tubular necrosis
(filtered across glomerulus and concentrate in renal tubules –> epithelial necrosis–> granular casts which can obstruct tubular lumen and lead to rupture of basement membrane)

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61
Q

How can the renal clearance of any substance be calculated?

A

([urine concentration] x [urine flow rate]) / plasma concentration

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62
Q

GFR can be calculated using the ___ or ____ clearance, as these substances are freely filtered at the glomerulus and have relatively insignificant tubular reabsorption or secretion/

A

inulin

creatinine

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63
Q

Renal plasma flow can be determined using the _____ clearance as almost all of it that enters the kidneys is excreted into the urine

A

para-aminohippuric acid (PAH)

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64
Q

how do vaptans affect plasma osmolality, urine output, and urine sodium excretion

A

plasma osmolality: increase
urine output: increase
urinary sodium excretion: no change
(V2 receptor antagonist )

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65
Q

What is a major cause of acute renal failure in young children following bloody diarrhea?

A

hemolytic uremic syndrome (most cases are due to intestinal infection by Shiga toxin)

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66
Q

Hemolytic uremic syndrome is characterized by what triad

A

microangiopathic hemolytic anemia (RBC pass through damaged capillaries and suffer shear injury –> schistocytes)
thrombocytopenia (due to platelet consumption in response to injured endothelium –> microthrombi)
acute kidney injury (via extensive damage to the renal vasculature)

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67
Q

Primary membranous nephropathy is associated with __ antibodies to ______

A

IgG4

phospholipase A2 receptor

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68
Q

Is the serum sodium high or low in each of the following: central diabetes insupidus, nephrogenic DI, primary polydipsia

A

central DI: high
nephrogenic DI: high
primary polydipsia: low

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69
Q

What will happen to urine osmolality in the following during water deprevation: central DI, nephrogenic DI, primary polydipsia

A

central and nephrogenic DI: no change or mild increase

primary polydipsia: increase

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70
Q

Will urine osmolality increase during a water deprivation test when vasopressin is injected in the following: central DI, nephrogenic DI, primary polydipsia

A

central DI: large increase
nephrogenic DI: mild increase
primary polydipsia: no increase

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71
Q

what are the most potent diuretics and used as first line therapy for rapid relief of symptoms in patients with acute decompensated heart failure

A

loop diuretics

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72
Q

Heavy proteinuria can cause regional or generalized interstitial edema because decrease in _____ _____ pressure

A

plasma oncotic

73
Q

At normal plasma concentrations of glucose, tubules reabsorb the entire filtered load of glucose. At higher blood glucose when the threshold of glucose is reach (____mg/dL), glucose is excreted due to the transport maximum being reached

A

200

74
Q

How does acetazolamide cause hypokalemia

A

blocking sodium bicarb absorption in the PCT causes more Na to be reabsorbed more distally which stimulates K excretion

75
Q

Vasopressin and desmopressin cause V2 receptor mediated increase in ____ and ___ permeability in the inner medullary collecting duct

A

water

urea

76
Q

Contrast-induced nephropathy have an acute rise in ___ and ____ within 24-48 hours of contrast administration, followed by a gradual return to baseline

A

BUN

creatinine

77
Q

contrast induced nephropathy causes diffuse necrosis of _____ and ___ casts

A

proximal tubular cells

muddy brown

78
Q

Increased abdominal pressure (coughing, sneezing, or vigorous effort) greater than the ______ pressure can cause brief involuntary urine loss, which is virtually diagnostic of stress incontinence

A

urethral sphincter

79
Q

Exogenous ______ ingestion presents as altered mental status and acute renal failure with renal biopsy revealing ballooning and vacuolar degeneration of the proximal renal tubules

A

ethylene glycol

80
Q

Ethylene glycol poisoning results in ____ stones causing tubular obstruction as well as direct tubular cytotoxicity

A

oxalate

81
Q

Chlorthalidone MOA

A

thiazide diuretic

82
Q

how do thiazides cause muscle weakness

A 
significant hypokalemia
(can possibly cause rhabdomyolysis)
83
Q

How do Beta agonists cause hypokalemia

A

increase activity of Na-K-ATPase pump, driving potassium into cells

84
Q

Fever, neurologic symptoms (progressive lethargy), renal failure, anemia, and thrombocytopenia in the setting of gastrointestinal illness is classic for wheat diagnosis

A

TTP (thrombocytopenic thrombotic purpura) - HUS (hemolytic uremic syndrome)

85
Q

thrombotic microangiopathy (TMA) syndromes share what common pathology

A

platelet activation in arterioles and capillaries
diffuse microvascular thrombosis
microangiopathic hemolytic anemia with schistocytes
thrombocytopenia

86
Q

How does nephrotic syndrome cause hyperlipidemia

A

hypoalbuminemia (lost in urine) -> decreased capillary oncotic pressure –> increased lipoprotein production in liver

87
Q

_____ syndrome is an inherited disorder of proximal tubular transport. Glucose, bicarb, calcium, phosphate, and amino acids are lost in the urine

A

Fanconi

88
Q

What episodic nephritic syndrome with have normal serum complement levels

A

IgA nephropathy

89
Q

Sevelamer MOA

A

nonabsorbable anion-exchange resin that binds intestinal phosphate to reduce absorption

90
Q

Altitude sickness causes what changes in acid base status

A

low partial pressure O2 –> hypoxemia –> hyperventilation –> respiratory alkalosis

91
Q

How do the kidneys respond to altitude sickness induced alkalemia

A

decreased HCO3 reabsorption and H+ secretion

92
Q

Uncorrected creatinine clearance overestimates or underestimates the GFR? By how much?

A

overestimates GFR by 10-20%

creatinine is actively secreted by proximal tubules

93
Q

In urothelial carcinoma, tumor invasion into the _____ layer of the bladder wall carries an unfavorable prognossis

A

muscularis propria

94
Q

Acute Tubular necrosis can be due to what two causes

A

ischemia or toxic insult

95
Q

Describe the 3 phases of acute tubular necrosis

A

initiation phase: original insult - 24-36 hours; slight decrease in urine output
maintenance phase: lasts 1-2 wks, tubular damage is fully established –> oliguria, fluid overload, electrolyte abnormalities
recovery phase: re-epithelization. GFR recovers quickly but tubular cells recover more gradually resulting in transient polyuria and loss of electrolytes

96
Q

what is Conn’s syndrome

A

primary hyperaldosteronism (ie aldosterone secreting tumor)

97
Q

How does cocaine use cause hypokalemia

A

beta adrenergic hyperactivity –> epinephrine release –> increased activity of Na/K ATPase pump and Na/K/2Cl co transporter –> transport potassium intracellularly
adrenergic activity also stimulates insulin release which further promotes intracellular potassium shifting

98
Q

What are the clinical manifestations of Henoch-Schonlein purpura

A

palpable purpura/petechiae lower extremities
arthritis
abdominal pain, GI bleed, intussusception
renal disease

99
Q

what is the pathogenesis of Henoch schonlein purpura

A

(IgA vasculitis)
deposition of IgA in small vessels –> activates compliment
neutrophilic inflammation and vascular damage
often follows upper respiratory infection

100
Q

How do ACE inhibitors cause an increase in creatinine

A

inhibit A2 from causing efferent arteriole constriction –> therefore they cause efferent arteriole dilation

101
Q

Minimal change disease, the most common cause of nephrotic syndrome in children is often idiopathic but what are some possible inciting events

A

respiratory infections
immunizations
insect sting/bite

102
Q

What is the pathophysiology of minimal change disease

A

T cell dysfunction –> production of glomerular permeability factor –> damage to podocytes and decreases anionic properties of glomerular basement membrane –> loss of negative charge results in selective loss of albumin in urine

103
Q

describe the light microscopy, immunofluorescent, and electron microscopy in minimal change disease

A

LM and IF: normal

EM: diffuse podocyte foot process effacement and fusion

104
Q

minimal change disease treatment

A

corticosteroids

105
Q

Increased aldosterone has what effect on K and H handling in the kidney

A

increased K and H

106
Q

_____ accumulates as amyloid in dialysis patients as it is renally cleared but poorly dialyzed. It can cause shoulder pain, carpal tunnel, bone cysts, and pathologic fractures

A

beta 2 microglobulin

107
Q

Chronic inflammatory states, such as rheumatoid arthritis, can cause increased ______ which can lead to a nephrotic syndrome

A

serum amyloid A

108
Q

In myoglobinuria, what will be positive of urine dipstick but negative on microscopic urinalysis

A

blood

109
Q

how can seizures cause acute tubular necrosis

A

myocyte injury -> myoglobin degraded in the kidney releases heme pigment –> toxic to tubular cells –> acute tubular necrosis

110
Q

ACE inhibitors have what effects on the following: renal perfusion, intraglomerular pressure, filtration fraction

A

renal perfusion: decreased
intraglomerular pressure: decreased
filtration fraction: decreased

111
Q

A child presenting with gross hematuria and periorbital edema most likely has what presentation

A

postreptococcal glomerulonephritis

112
Q

Formation of uric acid kidney stone is promoted by what change in urine? How can it be precipitated by diarrhea

A

low urine pH

chronic diarrhea –> chronic metabolic acidosis and production of acidic urine –> formation of uric acid stones

113
Q

how does the prognosis differ between children and adults for PSGN?

A

worse prognosis in adults, they are more likely to develop chronic hypertension and renal insufficiency

114
Q

What is ADH’s main function in the cortical collecting duct vs the medullary collecting duct

A

cortical: increased water absorption
medullary: increased urea absorption

115
Q

Clear cell carcinoma is the most common type of renal cell carcinoma and originates from the ____ cells from where in the kidney

A

epithelial cells of the proximal renal tubules

116
Q

Membranous nephropathy results from immune-complex deposition in what portion of the GBM

A

subepithelial

117
Q

What is seen on electron microscopy of membranous nephropathy

A

irregular, subepithelial, electron-dense immune deposits on glomerular basement membrane and moderate effeacement of podocyte foot processes

118
Q

what is seen on IF and light microscopy of membranous nephropathy

A

IF: diffuse granular of IgG and C3 along capillary loops
LM: diffuse golmerular capillary wall thickening (silver stain reveals spikes and domes)

119
Q

Patiromer MOA

A

nonabsorbable cation exchange resin used to treat hyperkalemia
binds colonic potassium in exchange for calcium

120
Q

Invasive vascular procedures can have what complication that may result in acute kidney injury, livedo reticularis (skin), and blue toe syndrome

A

atheroembolic disease due to cholesterol containing debris from plaques being dislodged from arteries –> shower microemboli into circulation

121
Q

What is a positive tissue transglutaminase antibody assay diagnositic of

A

celiac disease

122
Q

How can celiac disease effect PTH levels?

A

celiac –> decreased vit D absorption –> secondary hyperparathyroid

123
Q

Severe diarrhea causes what acid base distrubance

A

nonanion gap metabolic acidosis

substantial loss of HC03 in stool –> low pH –> compensatory respiratory alkalosis –> low CO2

124
Q

Renal cell carcinoma tends to invade the renal vein. Intraluminal extension of the tumor can obstruct the ____ which produces symmetric bilateral lower extremity edema often associated with prominent development of venous collaterals in the abdominal wall

A

inferior vena cava

125
Q

Renal cell carcinoma causes a variety of paraneoplastic syndromes including erythrocytosis due to excessive ___ release and hypercalcemia due to ____ release

A

erythropoietin

parathyroid hormone related peptide

126
Q

Mannitol administration has what acute effects on the following:
serum sodium concentration, renal tubular flow, glomerular filtrate osmolality

A

serum sodium concentration: decreased
renal tubular flow: increased
glomerular filtrate osmolality: increased

127
Q

What acid base change does salicylate/aspirin toxicity cause

A

primary respiratory alkalosis and primary metabolic acidosis with an anion gap due to increased lactate production

128
Q

how does salicylate/aspirin intoxication cause metabolic acidosis with an anion gap

A

uncoupling of oxidative phosphorylation –> hyperthermia –> increased lactic acid

129
Q

how does salicylate/aspirin toxicity cause respiratory alkalosis

A

stimulation of medullary respiratory center –> hyperventilation

130
Q

prolonged, heavy intake of NSAIDs causes what pathologic changes of the kidney

A

chronic interstitial nephritis

papillary necrosis

131
Q

Multiple myeloma is associated with increased bone resorption which has what results on the following: PTH, urinary calcium, 1,25 D vit D, PTH related protein

A

PTH: decreased
urinary Ca: increased
1,25 vit D: decreased
PTH related protein: normal

132
Q

what is the diagnosis of hypotonic hyponatremia, concentrated urine, and euvolemia

A

SIADH

133
Q

How does BPH cause hematuria

A

hyperplastic prostate cells are supported by the formation of new blood vessels which may be friable

134
Q

How does urinary citrate effect renal calculi occurrance

A

citrate prevents calculi formation by binding ionized calcium in urine, preventing formation of insoluble calcium oxalate complexes

135
Q

In severe hypovolemia, what changes are seen in GFR, RPF, and FF

A

RPF : very decreased
GFR: decreased
FF: increased (=GFR/RPF)

136
Q

Uncontrolled hypertension or diabetes shows what changes in the small arteries and arterioles of a renal biopsy

A

eosinophilic hyaline material in the intima and media= hyaline arteriosclerosis

137
Q

what type of renal stones are flat, yellow, and hexagonal

A

cystine

138
Q

what renal stones are yellow or red-brown diamond or rhombus

A

uric acid

139
Q

what renal stones are rectangular prisms/coffin lids

A

magnesium ammonium phosphate

140
Q

what renal stones are octahedron (square with x in the center)

A

calcium oxalate

141
Q

what renal stones are elongated, wedge shaped and forms rosettes

A

calcium phosphate

142
Q

what stones form more readily in acidic pH?

A

uric acid

cystine

143
Q

what stones form more readily in alkaline pH

A

magnesium ammonium phosphate

calcium phosphate

144
Q

Primary nocturnal enuresis = bed-wetting at or older than age 5, it is caused by what. primarily?

A

brain maturation delay

145
Q

What medication causes nausea, flushing, diaphoresis, decreased heart rate, and pupil constriction?

A

cholinergic agonists

146
Q

how are the following effected in DKA: serum pH, serum bicarb, PaCO2?

A

pH: low
serum bicarb: low
PaCO2: low (compensation)

147
Q

What is the likely cause of dilated calyces with overlying renal cortical atrophy bilaterally, mostly in upper and lower poles

A

reflux nephropathy

148
Q

How does multiple myeloma cause nephropathy?

A

free light chain bodies (bence jones proteins) are filtered by the glomerulus in small amounts and then reabsorbed, when levels exceed reabsorptive capacity –> light chains precipitate with Tamm-Horsfall protein –> casts (glassy eosinophilic casts)

149
Q

large, waxy, eosinophilic casts composed of Bence Jones proteins are diagnostic of what?

A

multiple myeloma

150
Q

The most likely cause of fever and fatigue with new onset cardiac murmur is _____ which could potentially cause what type of kidney damage

A

infective endocarditis

diffuse proliferative glomerulonephritis secondary to circulating immune complex deposition

151
Q

How are patients with chronic kidney disease at risk for osteodystrophy?

A

hyperphosphatemia and hypocalcemia –> secondary hyperparathyroidism –> osteodystrophy

152
Q

Creatinine is freely filtered in the glomerulus and actively secreted where?

A

PCT

153
Q

How is urea handled in the PCT?

A

neither secreted or absorbed

154
Q

How do sodium and potassium concentrations change in the PCT?

A

they are reabsorbed in concentrations approximately equal to water so the concentrations do not change

155
Q

What is the earliest sign of diabetic nephropathy which can be used as a screening tool

A

albuminuria

156
Q

Vascular calcifications occur in patients with chronic kidney disease due to electrolyte abnormalities, ie: _____phosphatemia and ____calcemia (hyper or hypo)

A

hyperphosphatemia

hypercalcemia

157
Q

How does hyperphosphatemia cause neuromuscular excitability

A

phosphate binds free calcium and deposits into tissues
phosphate also triggers fibroblast growth factor 23 –> decreased calcitriol production and intestinal calcium absorption)

158
Q

Fibromuscular dysplasia pathology typically demonstrates alternating fibromuscular webs and aneurysmal dilation with absent _______ –> string of bead appearance.

A

internal elastic lamina

159
Q

In chronic kidney disease, how are the following effected: phosphate, PTH, calcitriol

A

phosphate: increased
PTH: increased
calcitriol: decreased

160
Q

What acid base disturbance can be caused by chronic kidney disease

A

ion gap renal acidosis and compensatory respiratory alkalosis
(accumulation of unmeasured acidic compounds due to decreased GFR)

161
Q

What are presenting features of acute interstitial nephritis

A

fever
rash
eosinophilia
pyuria with white blood cell casts and elevated urine eosinophils

162
Q

How are renal blood flow, GFR, and serum creatinine affected by pregnancy

A

RBF: increased
GFR: increased
Serum creatinine: decreased

163
Q

Spike and dome appearance when stained with silver stains on the GBM are indicative of what diagnosis

A

membranous glomerulopathy

164
Q

To compensate for metabolic acidosis, the kidneys increase buffer excretion: _____ and ______ which bind H+ in order to allow for large amounts of acid to be excreted without precipitously dropping the pH

A

phosphate

ammonium

165
Q

Chronic renal hypo perfusion can cause hyperplasia of what cells?

A

juxtaglomerular apparatus

166
Q

what makes up the crescent in rapidly progressive glomerulonephritis

A

glomerular parietal cells
lymphocytes
macrophages
fibrin

167
Q

The most common renal malignancy is clear cell carcinoma which arises from renal ____ cells

A

proximal tubular

168
Q

In clear cell carcinoma, cells contain large amounts of ____ and _____ that dissolve during routine tissue preparation, leaving clear spaces within the cytoplasm

A

glycogen

lipids

169
Q

lithium induced diabetes insipidus is the result of lithium’s antagonizing effects on the action of ____ on ___ cells in what part of the tubule

A

vasopressin
principal cells
collecting duct

170
Q

How can you determine the renal plasma flow from the hematocrit and renal blood flow

A

RPF = RBF * (1-hematocrit)

171
Q

What cause of rapidly progressive glomeruloscleorsis (crescent formation) is not visualized on IF

A

pauci immune (granulomatosis with polyangitis, microscopic polyangitis, etc.)

172
Q

Goodpasture syndrome is caused by autoantibodies against the ___ chain of _______ in glomerular and alveolar basement membranes

A

alpha 3

type IV collagen

173
Q

what is seen on EM of poststreptococcal glomerulonephritis

A

subepithelial electron dense deposits

174
Q

Creatinine formation depends on ____ and ___, therefore, if these are lower in patients, they can have significantly lower GFRs for any given creatinine level

A

muscle mass

meat intake

175
Q

What are 2 common paraneoplastic syndromes associated with renal cell carcinoma

A

hypercalcemia

erythrocytosis

176
Q

Severe vomiting causes what changes to the following serum concentrations: sodium, potassium, chloride, bicarb

A

sodium: decreased
potassium: decreased
chloride: decreased
bicarb: increased

177
Q

What is seen on urinalysis of a patient with acute tubular necrosis

A

granular, muddy brown casts

178
Q

BPH can lead to progressive bladder outlet obstruction and over time, increased urinary pressures can cause hydronephrosis resulting in what changes in the kidney

A

renal parenchymal atrophy with scarring which can progress to chronic kidney disease

UWorld (19 decks)

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