renal 551 - 555

Question 1

cause of death for ADPKD?

Answer 1

death from complications of chronic kidney dz or HTN caused by inc renin

Question 2

3 pathologic conditions associated with ADPKD?

Answer 2

berry aneurysms, mitral valve prolapse, benign hepatic cysts

Question 3

5 clinical symptoms of ADPKD?

Answer 3

flank pain, hematuria, HTN, urinary infection, progressive renal failure

Question 4

what are 2 genes associated with ADPKD?

Answer 4

85%, ch 16, PKD1

15%, ch 4, PKD2

Question 5

all diuretic will inc urine NaCl except for what?

Answer 5

acetazolamide

Question 6

urine K+ inc with what 2 types of diuretics?

Answer 6

loop, thiazide

Question 7

explain 3 mech how loop and thiazide cause alkalemia?

Answer 7

1. volume contraction: inc ATII –> inc Na+/H+ exchange in PCT –> in bicarb absorption (contraction alkalosis)
2. K+ loss leads to K+ exiting all cells (via H+/K+ exchanger) in exchange for H+ entering cells
3. in low K+ state, H+ (rather than K+) is exchanged for Na+ in cortical collecting tubule –> alkalosis and paradoxical aciduria

Question 8

which diuretics is the only one that leads to hypokalemic metabolic acidosis (not hypokalemic metabolic alkalosis)?

Answer 8

acetazolamide

Question 9

which diuretic can cause pseudotumor crebri and in what other condition can also lead to “psudotumor crebri” as well?

Answer 9

acetazolamide, vit A toxicity

Question 10

name 4 toxicity of acetazolamide

Answer 10

hyperchloremic metabolic acidosis
paresthesias
NH3 toxicity
sulfa allergy

Question 11

name 6 toxicity of loop

Answer 11

OH DANG

ototoxicity (especially with aminoglycoside)
hypokalemia
dehydration
sulfa allergy
nephritis (interstitial)
gout (due to Ca2+ loss)_

Question 12

name 5 aminoglycosides

Answer 12

gentamicin
neomycin
amikacin
tobramycin
streptomycin

Question 13

what is ethacrynic acid?

Answer 13

phenoxyacetic acid derivative (not a sulfonamide)

Question 14

how does loop prevent the concentration of urine?

Answer 14

abolish hypertonicity of medulla

Question 15

name all the side effects of thiazide

Answer 15

Hyper GLUC

Hypokalemic metabolic alkalosis
Hyponatremia

hyperGlycemia
hyperLipidemia
hyperUricemia
hyperCalcemia

Sulfa allergy

Question 16

name 2 competitive aldosterone receptor antagonist

Answer 16

spironolactone, eplerenone

Question 17

name 2 other K+ sparing that block Na+ channel at the cortical collecting tubule

Answer 17

triamterene, amiloride

Question 18

name 3 thiazide

Answer 18

chlorthalidone
hydrochlorothiazide
indapamide

Question 19

name 3 loops

Answer 19

furosemide
bumetanide
torsemide

Question 20

name 4 contraindications with ace inhibitors

Answer 20

1. cough
2. angioedema (contraindicated with C1 esterase inhibitor def)
3. pregnancy (fetal renal malformation)
4. bilateral renal artery stenosis
5. NSAIDs

Question 21

why should you be careful using ACE inhibitors with NSAIDs?

Answer 21

ACE inhibitors lead to dilation of efferent arterioles by blocking ATII and NSAIDs lead to constricting afferent arterioles and both contribute to dec GFR and possibly renal failure

Question 22

what is the mech of angiotensin II receptor blockers and how are they diff from ACE inhibitors?

Answer 22

block angiotensin II to AT1 receptor, thus, effects similar to ACE inhibitors, but do not increase bradykinin –> thus no cough side effects

Question 23

what is Aliskiren and what is its contraindication?

Answer 23

direct renin inhibitor, contraindicated in diabetics taking ACE inhibitors or ARBs