Renal 2 Flashcards

1
Q

linear deposits along the GBM indictae __ disease
deposits composed of __/__
anti-GBM ab target __ collagen
microscopy shows __ w monos/macros

MPGN has proliferating __ cels and inc __ matrix

GBM appears __ in Alport syndrome

A

Goodpasture
IgG/C3
type 4
golmerular crescents

mesangial, mesangial

lamellated

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2
Q

some PAH is __ by glomerulus into BS
majority is __ into PT and is never ___
therefore, tubular fluid conc of PAH is lowest in __ and highest in __

preexisting __ and __ onset are poor prognostc factors for PSGN

A

filtered
secreted, reabsorbed
Bowman Space, collecting tubule

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3
Q

__ places pt at inc risk for nephrolithiasis
usually occurs via crhonic met __ such as distal RTA or chronic diarrhea

high dietary __ actually dec risk of nephrolithiasis

__ is used in tx of heart failure
anti-androgenic effects block __ receptor and dec __ prodxn
__ androgen/estrogen ratio leading to Gynecomastia/dec libido/impotence

use __ instead as it is more selective

A

hypocitraturia
acidosis

Ca

Spironolactone
androgen, testosterone
dec

epleronone

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4
Q

ureters pass posterior to the __ vessels w/in the retropeitoneum
they then pass anterior to the __/__ arteries into the true pelvis
there, they lie anterior to the __ artery and medial to ovarian vessels

__ artery crosses over anterior surface of ureter

EIA/Testicular vessels lie __ and are not near the ureters

A

gonadal
common/external
internal iliac artery

uterine

deeper

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5
Q

pt w indwelling bladder catheter are at an inc risk of common/noncommon __

lactose fermenting gram neg rod is __/___/___
lactose fermenting gram pos rod is ___

__ is oxidase pos, nonlactose fermenting, gram neg

A

UTI

E coli, K pneumo, enterobacter
Enterococcus

P auerigonosa

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6
Q

embryonic kidney development starts w P/M/M
derived from __ cord from the __ ridge of intermediate mesoderm

Proneprhos is first, forms and __
Mesonpehros forms Midportion, persists in __
Wolffian ducts form __ duct system
in females, it regresses and becomes __ duct

True kidney is __
ureteric bud (met diverticulum) sprouts off caudally
induces formation of metanephric ___

UB gives rise to collecting __/__, __/__ calyces, renal __ and U__

MB forms G, B, P/D tubules and LoH

A

pronephros, mesonephros, metanephros
nephrogenic, urogenital

regresses
males
repro
Gartners

metanephros
blastema

ducts/tubules, minor/major, pelvis, ureter

glomeruli, BS, proximal/distal tubule, LoH

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7
Q

COLA share common transporter in intestine/kidneys
C__ is AR defective transporter
dec absorption, but normal levels of aa bc they can be absorbed as o___
impaired tubular absorption in kidney leads to __ stones

RF include __ urine pH, __ nidus, and urine __
pathognomonc for __ crystals

A

Cysteine, ornithine, lysine, arginine
cystinuria
oligopeptides
cystine

low, crystal, supersaturation
cystine

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8
Q

TLS occurs w chemo for __
rapid turnover inc release of __/__/__ to serum

uric acid is soluble at physiologic pH but will __ in acidic urine
occurs in __ tubule/__ duct

tx w __ urine and H__, inc urine __

A

lymphoma
K, phos, UA

crystalize
distal, collecting

alkaline, hydration, flow

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9
Q

cather assc UTI signicant RF is __ of catheter use
avoid __ caths, use __ technique, remove __ asap
ab not __

PTH responsible for Ca reabsorption in __ tubules and __ ducts
MM has __ VD levels due to dec activity of 1ahydroxylase
urine Ca will be __

A

duration
unnecc, sterile, catheter
useful

distal, collecting
low
high

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10
Q

__ indiates nephropathy in a diabetic pt
treat w __/__ control and __/__ to stop progression to CKD
avoid __ bc it inc glucose

PAH is filtered by glomerulus and is not __
as blood PAH inc, tubular fluid PAH in BS will __

PAH is secreted in PCT in __ process
this can be __, and then PAH will be present in urine

A

microalbuminuria
glycemic/BP, ACEI/ARB
thiazides

saturable
inc

carrier mediated
saturated

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11
Q

acute renal failure, fever, oliguria wks after transplant is acute __ rejection
see dense infiltrate of __ against interstitium, tubules, intima
tx w calcinuerin inhibs like C/T

GVHD occurs in __ transplant
graft __ directed against host antigens due to lack of host __ cells
must match exact ___

acute humoral immunity causes necrotizing __ w PMN infiltrate

A

cellular
monocytes
cyclosporine, tacrolimus

bone marrow
T cells, T cells
HLA

vasculitis

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12
Q

pt RV HTN needs __ mediated vasoconstriction to maintain GFR
if use __, this dec AT2, causing dilation of EA, reducing __/__

normal pts, serum creatinine can rie __% after ACEI, but is __

carefully use ACEI in pt w CAD bc of risk of __

A

AT2
ACEI
GFR, FF

30, reversible

RV HTN

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13
Q

aminoglycosides, contrast, cisplatin, amphotericin B, foscarnet can all cause __ necrosis

Sulfonamides, MTX, acyclovir, triamtere can precipitate in __ causing obstruction

lithium/Cyclosporine can cause _ interstitial nephritis

A

drug induced tubular

renal tubules

chronic

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14
Q

EPO stimulating agents can tx __ of CKD
can prevent need for __, but inc risk of __ events and __ due to inc blood viscosity/mass

dec renal blood flow results in acute tubular __
initiating stage precip by H/M

maintenance stage is O\_\_
pt develops \_\_ overload w wg/edema
\_\_kalemia
inc \_\_/\_\_ leads to met acid
low Na/Ca but high \_\_/_
urinalysis w \_\_ casts, high \_\_

recovery phase has mssive __, leads to dec levels of __ such as potassium

A

anemia
transfusion, thromboembolic, HTN

necrosis
hemorrhage, MI

oliguric
fluid
hyper
H/K
Phos, Mg
muddy brown, FeNa

diuresis, electrolytes

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15
Q

Excessive diuretic use dec distal Na delivery, leading to activation of the RAAS
thus, aldosterone acts, resulting in hypo__ and metaboic __

Loops throw off the __ conc gradient, thus pt cannot conc urine so serum electrolytes are __

pt on thiazide diuretic has normal __ gradient, absorbing water, leading to hypoNa/hyperCa

A

kalemia, acidosis

CCM, low

CCM conc

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16
Q

S__ inhibits mTOR signalling
blocks cell __/__
binds to FK506__ protein, interrupting __ transduction
prevents progression from __ to __ and lymph prolif

__ inhibits the 26s protesome in MM

__ inhibits IMP dehydrogenase
inhibits __/__ cell prolif and promotes T cell __

A

sirolimus
growth/prolif
FKBP, IL2
G1 to S

borzotemib

mycophenalate
B/T, apoptosis

17
Q

ACE I cause peripheral __ to reduce afterload to heart

dec contractile __ and myocardial __
slow progression of __/__ formation

__ occurs when there is a limit to absorption
determed by __ for active reabsorption
occurs for __, which is completely reasborbed in the __
when it exceeds Tm, __ occurs

PAH is freely __ into tubular lumen, thus is always __ to a greater degree than filtered

A

VD

force, oxygen demand
LVH, scar

transport max
receptors
glucose, PCT
glucosuria

secreted, excreted

18
Q

thick/thin ascending LoH are __ to water passage, regardless of ADH
NaK2Cl cotransporters work to create the ___ gradient

ADH inc water permeability to the //__

DKA causes met acidosis, and __ falls
this induces __ via a chemoreceptor reflex causing respiratory ___

A

impermeable
CCM conc

DCT, cortical/medullary collectign duct

HCO3
ventilation, alkalosis

19
Q

polyuria that resolves w desmopressin dx __

cortical collecting duct is impermeable to __
ADH activates urea transporters on the __ collecting duct, dec renal urea clearance
this allows urea to generate the ___

A

central DI

urea
medullary
CCM conc gradient

20
Q

younger pt w flu like sx, fever, new systolic murmur has ____
may have inc creatitine/hematuria/proteinuria suggesting nephritic ___
see capillary wall thickening w __/__ deposits
similar to __/__ on LM

ADPKD extrarenal manifestations __ cyst and IC __
scans show multiple renal/liver cysts that do not ___
may have __ cysts at birth

A

IE
glomerulonephritis
subendo/subepi
PSGN, MPGN

liver, anuerysm
enhance
microscopic

21
Q

Thin basement membrane disease is due to mutation in __
only abnorm is ___

__ occurs as recurrent, self limited, painless hematuria w/in 5 days of a URI
__ IgA deposits

type 2 RPGN aka __ occurs after formation of /__//__

A

type 4 collagen
thin basement membrane

IgA nephropathy
mesangial

Immune complex RPGN
IgA neph, HSP, PSGN, SLE

22
Q

proximal tubular cell balooning and vacuolar degen occur in pt w __
oxalate crystals indicate __ poisoning
may have __ casts and __ necrosis

fever, rash, ARF w/in weeks of starting B lactam indicate \_\_\_ as dx
other meds include S, R, D, N
presents w inc \_\_/\_\_ in serum
\_\_ in urine vi Hansel/wright stain
may see T\_\_ and \_\_ form

affects renal __ resulting in E/__ infiltration

A

acute tubular necrosis
ethylene glycol
tubular, PT

acute interstitial nephritis
Sulfonamides, rifampin, diuretics, NSAIDs
IgE, eosinophils
eosinophls
tubulitis, granulomas

interstitium, edema, leuk

23
Q

pt w metabolic acidosis results in renal ___
renal epithelial cells metabolize __ to glutamate, forming __/__
ammonium is then transported and __ in urine, allowing for __ reabsorption as a buffer

this process is important for __ excretion in chronic acidosis

A

glutamine, NH4/HCO3
excreted
HCO3

acid

24
Q

RBF is regulated by renal __/__ and ___

use RPF and __ instead
RPF= __ clearance
urine PAH x urine flow rate
plasma PAH

RBF= __/___

A

arteries/veins, resistance

Hct
PAH

PAH clearance/1-Hct

25
Q

horseshoe kidneys are fused at the __ poles
pt at inc risk of __ obs, recurrent __ and __ in kids/__ in adults

as kidney ascends from __ region in early life, horshoe is caught bw __/___

pt w atherosclerosis at risk for ___
look for renal __/__
__ discepancy bw kidneys w __ of affected kidney, __ kidney enlarges

A

lower
UPJ, infections, wilms/RCC

sacral, IMA/IVC

RAS
bruit/HTN
size
atrophy, contra

26
Q

water deprivtion test causes urine osmolarity to be __ in central/complete Nephro DI w inc serum osmolarity

w desmopressin, pt w central DI will have __ in urine osmolarity, while __ do not

partial nephrogenic DI will have slow, steady rise in urine osmolarity after ___

A

low

inc, complete NDI

water deprivation

27
Q

__ is most common renal tumor
__ may result as paraneoplastic process due to EPO prodxn

hydronephrosis can present w HTN, dec __, and __
may have palpable __/__

__ has discrete, posterior nodules on prostate

diffuse, symmetric enlargement/firmness indicates ___

A

RCC
polycythemia

RF, sepsis
bladder/kidney

prostate cancer

BPH

28
Q

__ is common cause of ATN
pt has inc __ and __, normal __/__ ratio and o__

ischemic injury damages the renal __ which has minimal blood supply
__ tubule and __ LoH are most commonly affected bc they use __ transport of ions/oxygen demand

__ of PT epithelial cells, loss of brush border
cell __ and __ of TBM
look for __

A

ischemic event
creat/BUN
oliguria

medullla
PCT, thick ascending
ATP dependent

flattened, necrosis, denuding
muddy brown casts

29
Q

flank pain/mass post pelvic surgery suggests _ obs

vulnerable to surgery esp
w pelvic __/h

ureter is __ but normal urine __ and serum __

__ kidney will compensate

A

ureter

LAN, hysterectomy

dilated, output/creatinine

contralateral