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Uworld > Renal > Flashcards

Renal Flashcards

1
Q

In ADPKD, _______ is nonfunctional and what is it’s function?

A

Polycystin 1, transmembrane glycoprotein important for connective tissue cohesion in cell-cell and cell-ECM interactions

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2
Q

Ethylene glycol can lead to __________ with vacuoles degeneration and ballooning of the _________. You can also see ______ crystals in the tribe

A

Acute tubular necrosis, proximal tubular cells, oxalate

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3
Q

Chronic kidney disease presents with ______phosphatemia, ________parathyroidism, and ______ calcitriol levels

A

Hyperphosphatemia, secondary hyperparathyroidism, decreased calcitriol

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4
Q

Chlorthalidone is a _____ diuretic and it can lead to _____kalemia. This explains muscle weakness and cramping

A

Thiazides, Hypokalemia

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5
Q

______ is a oxidase positive Gram negative rod that is a common cause of UTI with indwelling catheters

A

Pseudomonas

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6
Q

Para-aminohippuric acid has the lowest concentration in which part of the nephron?

A

Bowman’s space, it is not reabsorbed by any part of the nephron.

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7
Q

Hypercalcemia in Multiple myeloma is result of ________ induced by tumor cells.

A

Osteoclasts

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8
Q

PTHrP inc serum Ca by promoting _____ Activity and has NO effect on 1,25 vit D.

A

Osteoclasts

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9
Q

Diffusion speed across a semipermeable membrane increases with

A
  • Higher molecular concentration gradients
  • larger membrane surface areas
  • inc solubility of the diffusing substance
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10
Q

Increased levels of both renin and aldosterone are indicative of ________ hyperaldosteronism. Three causes are

A

Secondary

Renovascular disease (juxtaglomerular cell tumor), malignant hypertension, renin secreting tumors

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11
Q

Imunnofluoresence of post strep glomerulonephritis shows ___, ___, ____

A

IgG, IgM, C3 in the mesangium and basement membrane

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12
Q

Overflow incontinence is common in diabetics and leads to ________ postvoid residual volume.

A

Increased

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13
Q

Loop diuretics act at the ______ of the loop of Henle and block the _____ channel

A

Thick ascending limb, Na/K/Cl

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14
Q

The ureteric bud ultimately gives rise to the ____ system of the the kidney and includes. Failure of this to form leads to ________

A

Collecting
-collecting tubules and ducts, major and minor calyces, renal pelvis, ureters

Potter sequence

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15
Q

The metanephric blastoderm gives rise to the (5 structures)

A 
Glomeruli
Bowman’s space
Proximal tubules
Loop of henle
Distal Convoluted tubules
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16
Q

Filtration fraction equals

A

GFR/RPF

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17
Q

Net filtration pressure equation

A

(Pc-Pi)-(Oc-Oi)

Hydrostatic pressures-oncotic pressures

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18
Q

What amino acid needs to be metabolized by the kidney to maximize acid excretion?

A

Glutamine

This leads to ammonium and bicarbonate

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19
Q

ADH acts in the ____ (part of the kidney). Which part of this does it specifically act on to inc urea and water reabsorption

A

Collecting ducts, medullary

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20
Q

Spironolactone is a _________ antagonist and acts in what part of the kidney?

A

aldosterone, cortical collecting duct

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21
Q

thiazide diuretics block _____ reabsorption in what part of the kidney

A

Na/Cl, distal collecting tubule

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22
Q

acetazolamide blocks ______ in what part of the kidney

A

carbonic anhydrase, proximal tubule

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23
Q

The urachus is a remnant of the _______ that connects the bladder with the yolk sac during fetal development. Failure of this to separate results in discharge of urine form the umbilicus

A

allantois

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24
Q

failure of the central part of the urachus to separate leads to a urachal _____

A

cyst

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25
Q

erythropoeisis stimulating agents treat anemia of _________ but are associated with inc risk of _______ events–> ______ hypertension

A

chronic disease, thromboembolic, worsening

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26
Q

In absence of ADH tubular fluid is most concentrated in what part of kidney?

A

junction between descending and ascending loop of henle (BOTTOM of loop of henle)

-highest osmolarity occurs at the bottom of the loop of henle

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27
Q

Glucose is normally filtered at the glomerulus but if something inhibited this, clearance of glucose would be most similar to ______

A

inulin, which can be approximated as being equal to GFR

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28
Q

acute renal allograft rejection can be _____ or _____ mediated and is seen within ____ after transplant

A

antibody, cell, 6 months

see inc creatinine, malaise

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29
Q

what type of urinary incontinence is associated with urethral hypermobility or dec urethral sphincter tone

A

stress incontinence, from coughing or sneezing

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30
Q

what type of urinary incontinence is associated with detrusor hyperactivity

A

urge, sudden overwhelming urge to urinate

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31
Q

what type of urinary incontinence is associated with impaired detrusor contractility or bladder outlet obstruction

A

overflow, incomplete emptying and persistent involuntary dribbling

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32
Q

_____ renal allograft rejection manifests months to years after transplantation and presents with worsening ____, ____ creatinine and _______ fibrosis

A

chronic, HTN, rise in serum, obliterative vascular

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33
Q

A dense interstitial mononuclear infiltrate is characteristic of ______ graft rejection

A

acute (< 6 months)

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34
Q

Vascular fibrinoid necrosis and neutrophil infiltration of the arterioles, glomeruli, and peritubular capillaries are characteristic of _____ graft rejection

A

hyperacute (minutes to hours)

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35
Q

Aldosterone antagonists (spironolactone, eplerenone) decrease the secretion of __ and __ by what part of the kidney

A

K+,H+, collecting tubule

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36
Q

Aldoesterone increases the number of basolateral_____ and apical _____ found on ____ cells in what part of the kidney

A

Na/K ATPase, sodium, principal, cortical collecting ducts

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37
Q

____1 receptors are located on the jutxtaglomerular cells , which stimulate the release of _____ from sympathetic activation

A

beta, renin

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38
Q

beta adrenergic antagonists inhibit ____ release in the kidney which leads to a ____ in angiotensin 1/2, and aldosterone levels

A

renin, decrease

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39
Q

Deposition of ____ in Bowman’s space is an essential pathological step in cresecent formation

A

fibrin

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40
Q

Acute ureteral obstruction leads to _____ GFR

A

decreased

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41
Q

Vasopressin causes a ___ receptor mediated ____ in water and urea permeability at the inner medullary collecting duct. You get a resulting ___ in urea absorption (dec renal clearance) that _____ the medullary osmotic gradient

A

V2, increase, rise, enhances

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42
Q

In pt with extensive smoking history, painless hematuria, polycythemia (elevated hematocrit), renal mass

A

renal cell carcinoma, most patients asymptomatic and incidental imaging finding

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43
Q

Loss of _______ is responsible for the thrombotic complications of nephrotic syndrome

A

antithrombin III

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44
Q

The most common cause of fever and fatigue with new onset cardiac murmur is _______. Diffuse prolierative glomerulonephritis secondary to circulating ____________ deposition may lead to renal insufficiency

A

infective endocarditis, immune complex

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45
Q

What shows up in the urine with early diabetic signs of renal failure? And how does this happen

A

albumin, normally GBM has negatively charged molecules blocking negatively charged molecules (like albumin) from leaking out but with diabetes there is a progressive loss of this charge

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46
Q

in tumor lysis syndrome, uric acid precipitates at ____ pH and what portion of the nephron has the lowest pH? Also how would you treat tumor lysis

A

low, distal tubules and collecting ducts, tx with alkalinization and hydration

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47
Q

in metabolic acidosis, urine excretion of which two compounds inc to get rid of excess acid without making the pH too low

A

NH4+ and H2PO4-(titratable acids)–> inc H+ excretion

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48
Q

since inulin clearance is typically equal to GFR, what is the equation for net excretion rate

A

(inulin clearance)(plasma concentration of substance)-(tubular reabsorption of substance)

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49
Q

In minimal change disease, loss of _____ charge leads to ______ filtration of these charged proteins. Systemic __ cell dysfunction leads to that leads to podocyte foot fusion

A

negative, increased, T

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50
Q

Most renal cell carcinomas orginiate from the epithelial cells of the ______ and has cuboidal or polygonal cells with clear abundant cytoplasm. What do you see in the cells?

A

proximal renal tubules, glycogen and lipid accumulation

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51
Q

Transitional cell carcinomas are responsible for 90% of tumors involving the renal ____

A

pelvis

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52
Q

Crohn’s disease is associated with a defect in NF-KB which regulates what?

A

cytokine production, dec so inc chance of bacterial overgrowth and exaggereated response=chronic GI inflammation

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53
Q

Intusseception most commonly occurs at the ______ junction

A

ileocecal

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54
Q

Opioid analgesics can cause contraction of _________ in the sphincter of Oddi leading to inc pressures in the common bile duct and gallbladder

A

smooth muscle cells

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55
Q

Most of the K+ filtered by the glomeruli is reabsorbed in the ______ and the _______. The ________ and ______ are the primary sites of K+ concentration in the urine.

A

proximal tubule and loop of henle, late distal and cortical collecting ducts

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56
Q

tubular fluid means

A

fluid going through the nephron

57
Q

Equation for renal plasma flow when you have renal blood flow and hematocrit

A

RPF=RBF x (1-hematocrit)

58
Q

Renal artery stenosis leads to significant renal ______ –> ___ GFR and activation of the ______ system. This leads to inc _____ release by modified smooth muscle (juxtaglomerular) cells within the _____________

A

hypoperfusion, dec, RAAS, renin, afferent arteriole

59
Q

Benign prostatic hyperplasia can _____ resistance to urine flow in the urethra and lead to incomplete bladder emptying during micturirton–> inc risk for _______

A

inc, UTI

60
Q

Flank pain that radiates to groin with a flank mass that develops withina week of pelvic surgery suggests

A

ureteric obstruction, which can be hydronephrosis

61
Q

Sx of fever, maculopapular rash, and sx of acute renal fialure (oliguria and inc creatinine) 1-3 weeks after beginning treatment with a beta lactam antibiotic is suggestive of

A

acute interstital nephritis and the renal interstitum is affected

62
Q

________ is caused by retrograde urine flow from the bladder to the ureter. The upper and lower poles of kidney appear as _______

A

vesicouretal reflux, dilated calyces with overlying renal scarring

63
Q

___________ can present with bilateral hydronephrosis and calcyeal dilation due to _____ of the flow of urine. But it is a malformation of the ________ duct so can only occur in males

A

posterior urethral valves, obstruction, Wolffian

64
Q

Another equation for renal blood flow when you have PAH and hematocrit

A

RBF= (PAH clearance)/ (1-hematocrit)

65
Q

Carbonic anhydrase inhibitors are used to relieve ________ in glaucoma

A

intraocular pressure

66
Q

The graph relationship of serum creatinine and GFR is ______.

A

nonlinear (a downward half parobola)

67
Q

What types of casts in the urine do you see in pyelonephritis

A

white blood cell casts

68
Q

The proximal tubule _______ reabsorbs glucose and what happens when this is at its max

A

completely, excreted in urine

69
Q

Desmopressin binds to V__ receptors which activates __. This then inc ____ which leads to insertion of _______ proteins into the apical membrane of the cortical collecting duct

A

V2, Gs, cAMP, aquaporin

70
Q

Non-anion gap metabolic acidosis: HARDASS

A

Hyperalimentation (IV nutrition), Addison’s disease, Renal tubular acidosis, Diarrhea, Acetazolamide, Spironolactone, Saline Infusion

71
Q

What two parts of the kidney are most affected by renal tubular acidosis and why? Ischemic injury commonly affects the renal______

A

straight proximal tubules & thick ascending loop of Henle b/c they participate in the active (ATP consuming) transport of ions and have high O2 demand, medulla

72
Q

NSAID associated chronic renal injury is characterized by ____________ and ________ necrosis

A

chronic interstitial nephritis, papillary

73
Q

Most children 5-12 with PSGN ________ but how are adults affected

A

recover, poorer prognosis—> complications( inc risk chronic HTN, renal insufficiency)

74
Q

Most patients with acute tubular necrosis experience _________ and regain renal fucntion

A

tubular repithelization

-think if suffer from motor accident–>ischemic trauma

75
Q

Increased urinary _______ prevents formation of kidney stones

A

citrate, b/c citrate binds free Ca facilitating its excretion

76
Q

Inc urinary concentrations of which three things inc risk for kidney stones

A

calcium, uric acid, oxalate

77
Q

How to findurine flow rate

A

GFR= (urine inulin concentration x urine flow rate) / plasma inulin concentration

78
Q

Activation of V1 receptors in vascular smooth muscle by ADH leads to activation of which second messanger system leading to a ____ in total peripheral vascular resistance

A

Gq, increase

79
Q

The concentrations of ____,_____,______,______ increase as fluid runs along the proximal tubule, while concentrations of _______,______,_____ decrease

A

PAH, creatinine, inulin, urea all inc b/c

bicarbonate, amino acids, glucose (all dec b/c mostly reabsorbed)

80
Q

________ is the most common small cell vasculitis in children. _____ immune complexes deposit in walls. What are 4 key associated sx? When does it typically present?

A

Henoch Schonlein Purpura, IgA, after a viral infection

-abdominal pain, joint pain, palpable purpura, IgA nephropathy

81
Q

Enlarged hypercellular glomeruli with deposits of ____ and ____are seen in PSGN

A

IgG, C3 (levels dec)

82
Q

Homogenous deposition of eosinophilic hyaline material in the intima and media of small arteries and arterioles characterizes hyaline arteriosclerosis which is seen in?

A

diabetes

83
Q

1st stage of acute tubular necrosis (initiation)

A

ischemic injury precipitated by shock, hemorrhage

84
Q

2nd stage of tubular necrosis (maintenance)

A

dec urine output, fluid overload, inc Cr/BUN, hyperkalemia

85
Q

3rd stage of tubular necrosis (recovery)

A

gradual inc in urine output leading to high volume diuresis, dec concentrations of K+, Mg++, Ca++, PO4

86
Q

Stimulation of _______ and _______ receptors inc renal blood flow

A

dopamine and bradykinin

-aldosterone and alpha receptors cause vasoconstriction

87
Q

If the pH and CO2 change in opposite directions then it is __________ disturbance

A

primary respiratory disturbance

88
Q

if pH and CO2 change in same direction, then it is a ___________ disturbance

A

primary metabolic

89
Q

BPH is mediated by what hormone and leads to proliferation of __________ cells in the ________ and _______ zones

A

DHT, glandular, periurethral and transitional

90
Q

Treat minimal change disease with?

A

steroids

91
Q

prerenal azotemia is from ______ blood flow to the kidneys and the kidneys retain their ________ and get ___ GFR

A

decreased, concentrating abilities, increased

urine BUN/Cr>20, Osm>500, Frac Na <1%, UNa <20 b/c kidney wants to retain salt to inc blind pressure

92
Q

intrinsic renal failure impaired the ______ abilities of the kidney and get ___ GFR. See _____ casts

A

concentrating, dec, muddy brown

urine Osm <350, UNa>40, Frac Na >2%,

93
Q

post renal azotemia develops from _______. Most common cause is?

A

obstruction, BPH

94
Q

IgA nephropathy can occur during or while having cold. When does PSGN present?

A

2-3 weeks after

95
Q

In someone with bilateral bruits think _______ disease –> bilateral renal artery ______ which leads to. Which drug do you need to be careful using?

A

peripheral vascular disease, stenosis, dec perfusion to kidney=dec GFR, ACE inhibitor because they dec GFR

96
Q

____________ is associated with sub epithelial deposits and no hypercellularity. It is also associated with circulating _____ antibodies to the phospholipase A2 receptor

A

membranous nephroopathy, IgG4 (PLA2R)

97
Q

___________ is associated with sub endothelial deposits and IgG.C3 with hepatitis B/C infection. “tram track appearance”

A

membranoproliferatiive glomerulonephritis type 1

98
Q

_____________ is mediated by C3 nephritic factor

A

membranoproliferative glomerulonephritis type 2

99
Q

CKD leads to ___ GFR which leads to _______ of phosphate–> hypocalcemia

A

dec, decreased excretion, b/c phosphate binds Ca

can lead to renal osteodystrophy, osteomalacia

100
Q

CKD can lead to ____kalemia because of

A

hyperkalemia b/c kidney has dec ability to excrete K+

101
Q

renal artery stenosis can be from ______ HTN and leads to _____kalemia

A

resistant, hypokalemia

102
Q

Goodpasture syndrome shows _____ deposition of IgG. Light microscopy reveals ______ glomerulonephritis

A

linear, cresenteric

103
Q

Myeloproliferative disorders can lead to ______ nephropathy secondary to tumor lysis syndrome

A

urate

-uric acid inc from nucleic acid breakdown

104
Q

Hyperparathyroidism can also lead to the formation of ______stones

A

kidney

105
Q

schistosome ________ leads to bladder cancer

A

haemeabatoium

106
Q

recurrent nephrolithiasis in a kid, think __________. How do you treat?

A

cystinuria, amino acid uria, inc hydration and urinary alkalization

107
Q

The _________ reabsorb >60% of the water filtered by the glomeruli regardless of the patient’s volume status

A

proximal tubules

108
Q

__________ is a complement mediated cell lysis reaction and presents with fever/chills, chest/back pain, hemoglobinuria (brown pee)

A

acute hemolytic transfusion reaction

-“get an emergency blood transfusion after motor vehicle accident”

109
Q

In nephrotic syndrome: get inc liver ________ synthesis–> high TGs, dec _____ pressure–> edema, hypovolemia–>inc _______ secretion

A

lipoprotein, oncotic, aldo/ADH (retain volume)

110
Q

blood flow to the proximal ureter is from the _______ artery

A

renal

111
Q

Renal agenesis can lead to _________

A

potter sequence

112
Q

______ can be used to measure ECF volume

A

inulin

113
Q

Aspirin toxicity typically develops a respiratory _________ and metabolic ________

A

respiratory alkalosis, metabolic acidosis

114
Q

PAH is not reabsorbed by any part of the nephron and tubular concentration is lowest in

A

bowman’s space

115
Q

in metabolic acidosis, kidney inc rates of titratable acids (_______) to help excrete more H+ and urine becomes slightly more acidic

A

H2PO4-, NH3

116
Q

contraction alkalosis is from loss of _________

A

extracellular fluid from diuretic use (furosemide)

117
Q

In SIADH you have _____ volume retention, ____ ANP,, ____ renin, _____ aldosterone

A

inc volume retention, inc ANP (causes the kidney to inc sodium excretion), dec renin and dec aldosterone from inc volume and leads to inc Na excretion

118
Q

Dec plasma protein concentration leds to _____ GFR

A

dec, b/c dec oncotic pressure allows plasma to exit the capillaries which inc filtration fraction and GFR

119
Q

What diuretic in cystinuria can you give to alkalize the urine

A

carbonic anhydrase inhibitor

120
Q

what does aliiskiren block and what drugs is it contraindicated with

A

renin inhibitor, ACEi and ARBs, because it can lead to severe hypotension and exacerbate hyperkalemia

121
Q

What is constantly overactive in Liddle syndrome

A

ENac channels so have inc Na reabsorption with low aldosterone levels

122
Q

renal oncocytomas arise from what cells

A

intercalated cells of collecting ducts

123
Q

renal cell carcinoma arises from what cells

A

proximal tubule cells of kidney

124
Q

transitional cell carcinoma arises from what cells

A

transitional epithelium of urinary collecting system

125
Q

_______ overdose can present with tinnitus, respiratory alkalosis followed by metabolic acidosis. What can you treat with?

A

aspirin, bicarbonate to alkalinize the urine and inc aspirin acid excretion

126
Q

cells in renal cell carcinoma have high amount of _______

A

glycogen and lipids

127
Q

In minimal change disease you see ______ filtration of negatively charged plasma proteins

A

inc

128
Q

eosinophils in kidney analysis think

A

drug induced interstitial nephritis that involves the renal intersitium

129
Q

In mammalian kidney, densely immunostaining protein containing adjacent cells in renal glomerulus are most likely JGA cells that store and secret _______

A

renin (think of where you are with path slides)

130
Q

aldosterone leads to inc K losses in urine and would lead to serum ________

A

alkalosis

131
Q

The kidney compensates for respiratory alkalosis by preferentially excreting _______ in the urine

A

bicarbonate –> alkanized urine

132
Q

kidneys have autoregulatory mechanisms so explain what happens in renal artery stenosis

A

so dec renal plasma flow–>dec GFR–>afferent arteriolar dilation and efferent arteriolar constriction–>restoring GFR –>inc filtration fraction (FF=GFR/RPF)

133
Q

Jones methane silver stain for membranous nephropathy will show

A

thickening of GBM and spikes

134
Q

Auto recessive PCKD is on chromosome

A

6

135
Q

Auto dominant PCKD is on chromosomes

A

4, 16

136
Q

calcineurin inhibitors–> renal damage by?

A

intrarenal vasoconstriction (afferent and efferent constriction)

137
Q

aminoglycosides damage kidney by

A

proximal tubular damage

138
Q

How does acyclovir lead to renal damage

A

forms crystals in the kidney

139
Q

hypo________ can lead to rhabdomyolysis

A

phosphatemia and also hypokalemia

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