Renal 2

Question 1

3 effects of Angiotensin 2

Answer 1

• Vasoconstriction, efferent more than afferent arterioles
• Sodium retention
• Aldosterone release

** Renin is released from Macula Densa in response to decreased renal blood flow, i.e. decreased GFR. Renin converts Angiotensinogen (from liver) to Angiotensin 1. Lung endothelium converts Angiotensin 1 to 2.

Question 2

What type of kidney injury is seen in diabetic nephropathy?

Answer 2

Nodular glomerulosclerosis

Question 3

How does Aspirin harm the kidneys?

Answer 3

Inhibits prostaglandin function.
Normally when Renin-Angiotensin system is activated, Prostaglandins work to further dilate Afferent Arterioles (combined with efferent arteriolar dilation, this slows renal blood flow but increases GFR)

Question 4

4 broad etiologies of gross hematuria

Answer 4

1. Bladder – cystitis, cancer
2. Renal – glomerulonephritis
3. Ureteral – Nephrolithiasis
4. Prostate – BPH

Question 5

How does acute glomerulonephritis typically present?

Answer 5

Hematuria
+
Evidence of glomerular injury,
e.g. hypertension, proteinuria, dysmorphic RBCs, RBC casts

Question 6

How does acute cystitis usually present?

Answer 6

Dysuria 
\+
Increased urinary frequency
\+ 
WBCs & Nitrites on U/A

Question 7

Which diuretics affect K+ & how?

Answer 7

All cause K+ loss in urine except ACE-Inhibitors & potassium sparing, i.e. Spironolactone (ARB), Eplerenone (ARB) , Triamterene (ENaC blocker), & Amiloride (ENaC blocker)

Question 8

Which diuretics affect Calcium & how?

Answer 8

Loops lose Ca

Thiazides reabsorb Ca

Question 9

Which diuretics affect NaCl & how?

Answer 9

All diuretics cause increased NaCl excretion in urine

Question 10

Which diuretics can affect acid/base status & how?

Answer 10

Acidemia: carbonic anhydrase inhibitors & K-sparing diuretics

Alkalemia: Loops, Thiazides

Question 11

Loop diuretic for use in patients with sulfa allergy?

Answer 11

Ethacrynic acid

Can cause hyperuricemia – don’t use to treat gout

Question 12

Diuretic that causes hyperchloremic metabolic acidosis?

Answer 12

Acetazolamide
(Carbonic anhydrase inhibitor)

Also can cause paresthesias, NH3 toxicity, & sulfa allergy

Question 13

Loop diuretics side effects?

Answer 13

Ototoxicity, Hypokalemia/calcemia, Dehydration, Allergy, Nephritis (interstitial), Gout

“OH DANG!”

Question 14

Thiazides side effects?

Answer 14

Hypokalemic metabolic alkalosis, hyponatremia, sulfa allergy, &
hyperGLUC (glucose, lipids, uric acid, calcium)

Question 15

ACE Inhibitor side effects?

Answer 15

Cough, Angioedema, Teratogen (fetal renal problems), Cr increase (dec GFR), Hyperkalemia, Hypotension
“Captopril’s CATCHH”

Avoid in bilateral renal artery stenosis as they will further decrease GFR & cause renal failure