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1st Aid Memorize > Renal > Flashcards

Renal Flashcards

1
Q

What cells release erythropoietin?

A

Interstitial cells in the peritubular capillary bed

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2
Q

What cells activate 25-OH-vitamin D?

A

Proximal tubule cells

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3
Q

What enzyme is used to convert 25-OH-vitamin D to active form?

A

1-alpha-hydroxylase

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4
Q

What cells release renin?

A

JG cells (afferent arteriole)

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5
Q

What is the action of prostaglandins in the glomerulus?

A

vasodilate afferent arteriole to increase RBF

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6
Q

What is the action of ang II at the glomerulus?

A

vasoconstrict efferent arteriole to increase GFR and FF (and to reabsorb Na from the proximal and distal nephron)

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7
Q

What is the role of ANP at the glomerulus?

A

Increase GFR and increase Na filtration with NO compensatory Na reabsorption (volume loss and Na loss)

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8
Q

What is the overall effect of aldosterone on the glomerulus?

A

Increases Na reabsorption
Increases K secretion
Increases H secretion

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9
Q

What things lead to K+ shift OUT of cells?

A 
Digitalis
hyperOsmolarity
Lysis of cells
Acidosis
Beta-blockers
Insulin deficiency

(DO LAB for insulin deficiency)

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10
Q

What things cause K+ shift IN to cells?

A

hypoosmolarity
Insulin (increase Na/K ATPase)
Alkalosis
Beta-agonists (increase Na/K ATPase)

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11
Q

Electrolyte deficiency: nausea, malaise, stupor, coma

A

Na

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12
Q

Electrolyte deficiency: tetany, torsades de pointes

A

Mg

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13
Q

Electrolyte deficiency: bone loss, osteomalacia

A

PO4

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14
Q

Electrolyte deficiency: U waves on ECG, flattened T waves, arrhythmias, muscle weakness

A

K

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15
Q

Electrolyte deficiency: Tetany, seizures, QT prolongation

A

Ca

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16
Q

Electrolyte surplus: low DTRs, lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia

A

Mg

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17
Q

Electrolyte surplus: Renal stones, metastatic calcifications, hypocalcemia

A

PO4

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18
Q

Electrolyte surplus: irritability, stupor, coma

A

Na

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19
Q

Electrolyte surplus: kidney stones, bone pains, abdominal pain, anxiety, alteredmential status

A

Ca

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20
Q

Electrolyte surplus: Wide QRS, peaked T waves on ECG, arrhythmias, muscle weakness

A

K

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21
Q

Causes of Respiratory Acidosis (Pco2 > 40)

A

Hypoventilation (airway obstruction, acute lung disease, chronic lung disease, opioids, weak respiratory muscles)

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22
Q

Causes of metabolic acidosis (high anion gap > 8-12)

A 
MUDPILES:
Methanol
Uremia
DKA
Propylene glycol
Iron tablets; INH
Lactic acidosis
Ethylene glycol (oxalic acid)
Salicylates (late)
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23
Q

Cuases of non-anion gap metabolic acidosis (8-12)

A 
HARD-ASS
Hyperalimentation
Addison disease
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion
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24
Q

Causes of Respiratory Alkalosis (Pco2 < 40)

A

Hyperventilation (hysteria, hypoxemia, salicylates (early), tumor, pulmonary embolism)

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25
Q

Causes of metabolic alkalosis

A

Loop diuretics
Vomiting
Antacid use
Hyperaldosteronism

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26
Q

Type of renal tubular acidosis with:

  • pH>5.5
  • Hypokalemia
  • High urine pH
A

Type 1

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27
Q

Type of renal tubular acidosis with:

  • pH <5.5
  • Hyperkalemia
  • High urine pH
A

Type 4

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28
Q

Type of renal tubular acidosis with:

  • pH <5.5
  • Hypokalemia
  • Low/normal urine pH
A

Type 2

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29
Q

Problem in type 1 RTA

A

DISTAL defect in alpha intercalated cells to secrete H+ (no HCO3- is generated)

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30
Q

Problem in type 2 RTA

A

Defect in PROXIMAL tubule HCO3- reabsorption results in increase excretion of HCO3- in urine

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31
Q

Problem in type 3 RTA

A

Hyperkalemia from hypoaldosteronism or K+ sparing diuretics impairs ammoniagenesis in the PT which decreases buffering capacity and decreases H+ secretion into urine

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32
Q

Causes of type 1 RTA

A

Ampho B toxicity
Analgesic nephropathy
Congenital anomalies (obstruction) or urinary tract

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33
Q

Causes of type 2 RTA

A

Fanconi syndrome (ex. Wilson disease)
Lead/aminoglycoside toxicity
Carbonic anhydrase inhibitors
Multiple myeloma (light chains)

34
Q

Hyaline casts

A

can be normal finding (concentrated urine)

35
Q

Waxy casts

A

Advanced (chronic) renal disease

36
Q

Granular casts (muddy brown)

A

Acute tubular necrosis

37
Q

Fatty casts (oval fat bodies)

A

Nephrotic syndrome

38
Q

WBC casts

A

Tubulointerstitial inflammation
Acute pyelonephritis
Transplant rejection

39
Q

RBC casts

A

glomerulonephritis
ischemia
malignant HTN

40
Q

Pyuria no casts

A

Acute cystitis

41
Q

Hematuria no casts

A

Bladder cancer

Kidney stone

42
Q

Nephritic or nephrotic: Acute PSGN

A

Nephritic

43
Q

Nephritic or nephrotic: FSGS

A

Nephrotic

44
Q

Nephritic or nephrotic: amyloidosis

A

Nephrotic

45
Q

Nephritic or nephrotic: MPGN

A

both

46
Q

Nephritic or nephrotic: Alport syndrome

A

Nephritic

47
Q

Nephritic or nephrotic: Diffuse Proliferative GN

A

both

48
Q

Nephritic or nephrotic: RPGN

A

nephritic

49
Q

Nephritic or nephrotic: minimal change disease

A

Nephrotic

50
Q

Nephritic or nephrotic: IgA glomerulonephropathy

A

Nephritic

51
Q

Nephritic or nephrotic: Membranous nephropathy

A

Nephrotic

52
Q

Nephritic or nephrotic: Diabetic glomerulonephropathy

A

Nephrotic

53
Q

Proteniuria level in nephrotic syndrome

A

> 3.5 g/day

54
Q

Most common kidney stone presentation

A

patient with normocalcemia and hypercalciuria (calcium oxalate stone)

55
Q

Which kidney stone is radiolucent?

A

uric acid

56
Q

Enveloped shaped crystals

A

Calcium stones

57
Q

Coffin lid crystals

A

Ammonium magnesium phosphate stone

58
Q

Hexagonal crystals

A

Cystine stone

59
Q

Rhomboid or rosette crystals

A

uric acid

60
Q

Stones that precipitate at high pH

A

Calcium PHOSPHATE

Ammonium magnesium phosphate

61
Q

Stones that precipitate at low pH

A

Calcium OXALATE
Uric acid
Cystine

62
Q

Cause of ammonium magnesium phosphate (struvite) stones

A

Urease positive bug infection (proteus, staphylococcus, klebsiella, etc)

63
Q

Treatment for calcium stones

A

thiazides

citrate

64
Q

Treatment for struvite stones

A

eradicate infection

remove stone

65
Q

Treatment for uric acid stone

A

alkalinizaiton of urine

66
Q

Treatment of cystine stones

A

alkalinizaiton of urine

hydration

67
Q

Causes of uric acid stones

A

leukemia

hyperuricemia (gout)

68
Q

Causes of cystine stones

A

Cystinuria

69
Q

Test for cystine stones

A

sodium nitroprusside test positive

70
Q

Cystitis with ammonia smelling urine

A

Proteus mirabilis

71
Q

Viral cause of acute infectious cystitis

A

Adenovirus (hemorrhagic cystitis)

72
Q

What is positive in labs for acute infectious cystitis?

A

leukocyte esterase

73
Q

Thyroidization of kidney

A

chronic pyelonephritis

74
Q

What parts of glomerulus are most sensitive to ischemia?

A

proximal tubule

thick ascending limb

75
Q

Type of ARF with:
Urine osmolality >500
Urine Na 20

A

Prerenal azotemia

76
Q

Type of ARF with:
Urine osmolality 40
FENa >2%
Serum BUN/Cr <15

A

Intrinsic renal failure

77
Q

Type of ARF with:
Urine osmolality 40
FENa >1% (mild) or >2% (severe)
Serum BUN/Cr >15 (varies)

A

Postrenal azotemia

78
Q

Causes of prerenal azotemia

A

Low RBF (hypotension) so urea is retained by kidney to conserve volume

79
Q

Causes of postrenal azotemia

A

Outflow obstruction (bilateral due to stones, BPH, neoplasia, etc)

80
Q

Causes of Intrinsic renal failure

A

ATN or ischemia/toxins (patchy necrosis leads to debris obstructing tubule and fluid backflow across necrotic tubule which impairs BUN reabsorption)

1st Aid Memorize (21 decks)

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