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S1 - Selected Review > Renal - Amboss > Flashcards

Renal - Amboss Flashcards

1
Q

Amboss Renal

How do you calculate an anion gap?

A

Anion gap = Na⁺ + K⁺ - (Cl⁻ + HCO₃⁻)

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2
Q

Amboss Renal

How can renal plasma flow be estimated using PAH?

A

RPF = (UPAH * Urine flow rate) / PPAH

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3
Q

Amboss Renal

After calculating renal plasma flow (UPAH * urine flow rate / PPAH), how can you figure out what the total renal blood flow is?

A

RBF = RPF / (1 - hematocrit)

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4
Q

Amboss Renal

If you calculate the renal blood flow in a healthy individual, how can you determine cardiac output?

A

CO = Renal blood flow / 0.2

(The kidneys get 20 - 25% of cardiac output.)

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5
Q

Amboss Renal

Treatment is initiated in a patient with prostate cancer. Initially, there is an increase in serum testosterone and DHT, followed by a sustained decrease in both serum hormone levels.

He is being treated with what?

A

Leuprolide

(flutamide would result in a chronically elevated serum testosterone)

(finasteride would result in an elevated serum testosterone but no increase in DHT)

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6
Q

Amboss Renal

Whether sporadic or familial, renal cell carcinomas have an association with deletions in which gene?

A

VHL

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7
Q

Amboss Renal

A patient presents with fever, flank pain, hematuria, and a maculopapular rash. Urinalysis shows eosinophilia, WBCs and RBCs. He reports frequent meloxicam use over the past two weeks for back pain.

Kidney biopsy will likely show interstitial infiltration of what cell type?

A

T cells

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8
Q

Amboss Renal

A patient presents with fever, flank pain, hematuria, and a maculopapular rash. Urinalysis shows eosinophilia, WBCs and RBCs. He reports frequent meloxicam use over the past two weeks for back pain.

Is this renal papillary necrosis?

A

No, this is allergic interstitial nephritis.

RPN usually results from chronic analgesic use; eosinophilia and maculopapular rash are inconsistent with RPN.

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9
Q

Amboss Renal

Which medication types are contraindicated in patients with bilateral renal artery stenosis?

(Why?)

A

ACE inhibitors; ARBs

(inhibition of efferent arteriole constriction –> decreased GFR)

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10
Q

Amboss Renal

A patient presents with a benign tumor in the superior pole of the kidney. Histology shows epithelial cells characterized by an excessive amount of mitochondria, resulting in an abundant acidophilic, granular cytoplasm.

What is the likely diagnosis?

A

Oncocytoma

Note: the large, eosinophilic, granular cells in the image are called ‘oncocytes.’

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11
Q

Amboss Renal

The uremia seen in ESRD is associated with what changes (if any) in pH, serum bicarbonate, anion gap, and pCO2?

A

Anion-gap metabolic acidosis

(low pH, low HCO3-, mildly low pCO2 — a buildup of acids leads to the pH, bicarb, and anion-gap changes and a subsequent respiratory compensation)

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12
Q

Amboss Renal

A normal GFR is in about what range?

A

90 - 125 mL/min

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13
Q

Amboss Renal

Urothelial cancers are strongly linked with exposure to what compound(s)?

A

Aromatic amines (e.g. benzidine - (rubber production, oil refineries, dye-making, etc.), nicotine, arsenic, cisplatin (and other platinum chemotherapeutics), cyclophosphamide

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14
Q

Amboss Renal

As ACE inhibitors cause a dilation of the efferent arteriole, what effect do they have on GFR, renal plasma flow, and filtration fraction?

A

GFR - decreased

RPF - increased

FF - decreased

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15
Q

Amboss Renal

What is the earliest diagnostic sign of diabetic nephropathy?

A

Microalbuminuria

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16
Q

Amboss Renal

What are the two major signs of Goodpasture syndrome?

A

Hematuria + hemoptysis

(+ other signs of nephritic syndrome)

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17
Q

Amboss Renal

True/False.

Hematuria and hemoptysis are the major signs of granulomatosis with polyangiitis.

A

False.

Hematuria and hemoptysis are the major signs of Goodpasture syndrome.

Granulomatosis with polyangiitis is initially associated with rhinosinusitis, otitis media, ocular lesions, mucocutaneous granulomas, and vasculitic purpura.

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18
Q

Amboss Renal

Goodpasture syndrome is caused by what main etiology?

A

Anti-GBM antibodies

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19
Q

Amboss Renal

Crescents in Bowman’s space (due to fibrin-deposition) are associated with which generic cause of nephritic syndrome?

A

Rapidly progressive glomerulonephritis

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20
Q

Amboss Renal

Which diuretic category is calcium-sparing?

A

Thiazides

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21
Q

Amboss Renal

Why are serum lipids elevated in nephrotic syndrome?

A

Secondary to the hypoalbuminemia

(hepatic lipoprotein synthesis increases to maintain oncotic pressure)

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22
Q

Amboss Renal

What disorder is associated with recurrent UTIs, bilateral flank masses, hypertension, and elevated serum creatinine?

A

ADPKD

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23
Q

Amboss Renal

A patient with sudden, possibly painful urges to urinate followed by frequent, small-volume voids likely has what condition?

What is the cause?

A

Urge incontinence;

detrusor muscle spasms

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24
Q

Amboss Renal

Name one of the more common causes of stress incontinence in multiparous women.

A

Urethral hypermobility

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25
Q

Amboss Renal

Name the main defective location in the kidney for each of the following:

Fanconi syndrome

Bartter

Gitelman

Liddle

A

‘Fans Bartter and Gitel Liddle back’

PCT

Ascending LoH

DCT

CD

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26
Q

Amboss Renal

Fanconi syndrome, a defect in the PCT, causes what main serum changes?

A

Type 2 tubular acidosis (normal anion gap)

+

Hypokalemia

+

Hypocalcemia

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27
Q

Amboss Renal

Bartter syndrome, a defect in the ascending limb of the Loop of Henle, causes what main effects?

A

Polyuria and muscle cramps; hypo-everything in early childhood

  • hyponatremia
  • hypochloremia
  • hypokalemia
  • hypocalcemia
  • hypomagnesemia
  • metabolic alkalosis
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28
Q

Amboss Renal

Gitelman syndrome is caused by a defect in the ______ __________ in the distal convoluted tubules.

A

Gitelman syndrome is caused by a defect in the Na+-Cl- cotransporters in the distal convoluted tubules.

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29
Q

Amboss Renal

Gitelman syndrome, a defect in the descending convoluted tubule, causes what main effects?

A

Fatigue, muscle cramps, polyuria, chondrocalcinosis in late-childhood

  • hyponatremia
  • hypomagnesemia
  • hypokalemia
  • hypocalcemia
  • hypocalciuria
  • metabolic alkalosis
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30
Q

Amboss Renal

Liddle syndrome is caused by a defect in the ______ in the collecting duct.

A

Liddle syndrome is caused by a defect in the ENaCs in the collecting duct.

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31
Q

Amboss Renal

Liddle syndrome, a defect in the collecting duct ENaCs, causes what main effects?

A

Hypokalemia, metabolic alkalosis, and hypertension in childhood

(all explained by a compensatory increase in sodium and water reuptake)

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32
Q

Amboss Renal

Name the effect of DKA on each of the following in a patient’s urine:

pH

HCO3-

NH4+

K+

A

Low (ketones)

Low (HCO3- reabsorbed)

High (NH4+​ excreted)

High (lost in urine due to osmotic diuresis)

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33
Q

Amboss Renal

A patient with some history of infection(s) presents with RBC casts in their urine. What is the first pathology on your differential to be considered?

A

IgA nephropathy

(Berger’s disease)

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34
Q

Amboss Renal

What type of urinary cast is seen in patients with minimal change disease?

A

Fatty casts

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35
Q

Amboss Renal

RBC casts are associated with what three disease categories?

A

Nephritic syndromes;

glomerular ischemia;

malignant hypertension

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36
Q

Amboss Renal

Identify the shape of each of the following crystal types on urinalysis:

Calcium phosphate

Struvite

Uric acid

Cystine

A

Wedge

Coffin-lid

Rhomboid or needle

Hexagonal

37
Q

Amboss Renal

True/False.

Urine alkalinization is an acceptable prophylaxis for urate nephropathy.

A

True.

38
Q

Amboss Renal

In addition to adequate hydration, which of the following is(are) most useful in preventing calcium nephrolithiasis?

A. High-oxalate diet

B. Vitamin C supplementation

C. Low-protein diet

D. Low-calcium diet

E. High-sodium diet

A

C. Low-protein diet

(The rest are risk factors: A., B., and D. all increases urinary oxalate levels; E. dehydrates the patient.)

39
Q

Amboss Renal

Which nerves innervate the detrusor muscle?

A

The pelvic splanchnic nerves

(damage may lead to atonic bladder)

40
Q

Amboss Renal

How can one prevent formation of all forms of nephrolithiasis?

A

Adequate hydration

41
Q

Amboss Renal

True/False.

Caffeine, coffee, and tea are all useful in decreasing the recurrence rate of nephrolithiasis.

A

True.

(Caffeine increases urinary flow; coffee and tea have antioxidant properties.)

42
Q

Amboss Renal

True/False.

Urinary acidification is useful in the prevention of all types of nephrolithiasis.

A

False.

It is useful in preventing struvite and calcium phosphate stones but not calcium oxalate.

43
Q

Amboss Renal

What are the two locations in which abdominal bruits from renal artery stenosis can be auscultated?

A

The epigastrium (2-3 cm lateral);

over the costovertebral angles

44
Q

Amboss Renal

True/False.

Nephrolithiasis typically results in a normal finding in all of the following:

Serum Ca2+

Serum uric acid

Urine Ca2+

Urine pH

Urine cystine

A

False.

Urine calcium will be increased and urine pH decreased.

45
Q

Amboss Renal

What are the effects of amphotericin B as a result of the nephrotoxicity it sometimes has?

A

Type 1 renal acidosis;

hypercloremic, hypokalemic, normal anion-gap metabolic acidosis

46
Q

Amboss Renal

Which naturally occurring substance combines with calcium in the urinary tract to prevent calcium stone formation?

A

Citrate

47
Q

Amboss Renal

True/False.

Vitamin C is excreted in the urine as citrate, which decreases risk of calcium stone formation.

A

False.

Vitamin C is excreted in the urine as oxalate, which increases risk of calcium stone formation.

48
Q

Amboss Renal

What substance commonly found in high concentrations in energy drinks can increase risk of calcium nephrolithiasis?

A

Oxalate

49
Q

Amboss Renal

Cystinuria is characterized by decreased reabsorption of cystine, orthinine, lysine, and arginine in what location(s)?

A

The kidneys;

the small intestine

50
Q

Amboss Renal

Patients with cystinuria and cystine nephrolithiasis have a positive urinary sodium ________________ test.

A

Patients with cystinuria and cystine nephrolithiasis have a positive urinary sodium cyanide nitroprusside test.

51
Q

Amboss Renal

In treating a spastic neurogenic bladder, one should administer a muscarinic ____gonist.

A

In treating a spastic neurogenic bladder, one should administer a muscarinic agonist.

52
Q

Amboss Renal

What medication type increases urinary glucose excretion?

A

SGLT-2 inhibitors

(-flozins really get the glucose flowin’)

53
Q

Amboss Renal

What effect will dehydration have on the following:

Glomerular filtration rate

Renal plasma flow

Filtration fraction

A

Decreased (< RPF)

Decreased (large decrease)

Increased (FF = GFR/RPF)

(Basically, RPF decreases due to decreased blood volume; GFR decreases due to RAAS efferent arteriole constriction. Since GFR decreases less than RPF, FF actually increases.)

54
Q

Amboss Renal

Name a normal urine osmolality (in mOsms) in each of the following locations:

PCT

Descending LoH

Ascending LoH

DCT (100)

CD (600)

A

300

1200

200

100

600

55
Q

Amboss Renal

Name a normal urine osmolality (in mOsms) in each of the following locations:

PCT (300)

Descending LoH (1200)

Ascending LoH

DCT

CD

A

300

1200

200

100

600

56
Q

Amboss Renal

True/False,

PAH clearance decreases as plasma [PAH] increases.

A

Plasma [PAH] can saturate the organic acid transporters, inhibiting clearance of PAH from the remaining RPF

57
Q

Amboss Renal

Renal cell carcinomas typically arise from which portion of the nephron?

A

The PCT

58
Q

Amboss Renal

Why are the cells in renal cell carcinomas typically clear on microscopy and yellow on gross appearance?

A

High lipid and glycogen content

59
Q

Amboss Renal

Describe the effect of a renal NaCl transporter blocker in the DCT on serum levels of the following:

pH

Potassium

Calcium

Sodium

A

Increased (increased H+ exchange for Na+)

Decreased (increased K+ exchange for Na+)

Increased (unknown mechanism)

Decreased (NaCl reuptake blockage)

60
Q

Amboss Renal

Desmopressin increases collecting duct permeability to what two substances via the V2 receptors?

A

Water (aquaporin2)

Urea (UT-A1​)

61
Q

Amboss Renal

Presence of WBC casts on urinalysis indicates inflammation of the renal ___________.

A

Presence of WBC casts on urinalysis indicates inflammation of the renal interstitium.

62
Q

Amboss Renal

Long-term use of drugs like aspirin, tylenol, opioids, etc. coupled with hematuria is indicative of what?

A

Renal papillary necrosis

63
Q

Amboss Renal

Which segments of the nephron are most affected by ischemia?

A

The straight PCT

+

the distal straight tubule (aka the thick ascending limb)

64
Q

Amboss Renal

A neonate with Potter sequence shows evidence of periportal fibrosis and portal hypertension.

Identify which of the following is the most likely precipitating cause of the presentation:

A. Bilateral renal hypoplasia

B. Mutation of the short arm of chromosome 16

C. Vesicoureteral reflux

D. Nondisjunction of chromosome 18

E. Nondisjunction of chromosome 13

F. Cystic dilation of the collecting ducts

A

F. Cystic dilation of the collecting ducts

(ARPKD - mutation of the fibrocystin gene on the short arm of chromosome 6)

65
Q

Amboss Renal

What is the mechanism of atrial natriuretic peptide?

A

Afferent arteriole dilation

Efferent arteriole constriction

Decreased sodium reabsorption

66
Q

Amboss Renal

The level of ANP is proportional to ________ stretch.

The level of BNP is proportional to ________ volume and pressure overload.

A

The level of ANP is proportional to atrial stretch.

The level of BNP is proportional to ventricular volume and pressure overload.

67
Q

Amboss Renal

True/False.

Post-renal acute kidney injury and hydronephrosis causes renal damage that is typically irreversible.

A

False.

Post-renal acute kidney injury and hydronephrosis causes renal damage is typically reversible with medical intervention.

68
Q

Amboss Renal

Identify the congenital renal syndromes associated with Wilms tumor that are caused by each of the following:

WT1 deletion

WT1 mutation

WT2 mutation

A

WAGR

Denys-Drash

Beckwith-Wiedemann

69
Q

Amboss Renal

Muscarinic agonists ___________ bladder contraction.

Muscarinic antagonists ___________ bladder contraction.

A

Muscarinic agonists increase bladder contraction.

Muscarinic antagonists decrease bladder contraction.

70
Q

Amboss Renal

A patient with oliguria due to short-term hypovolemia (precipitating prerenal ATN in the long-term) is most likely to have what urinalysis results as far as sodium and casts are concerned?

A

Low sodium

+

hyaline casts

71
Q

Amboss Renal

A heterogenous mass arising from the renal pelvis is most likely (90%) to be what kind of tumor?

A

Urothelial carcinoma

72
Q

Amboss Renal

True/False.

Creatinine is freely filtered at the glomerulus, with no passive reabsorbtion or active secretion.

A

False.

Creatinine is freely filtered at the glomerulus, minimally passively reabsorbed, and small amounts are actively secreted.

73
Q

Amboss Renal

Which overestimates renal clearance, creatinine or inulin?

A

Creatinine

(10 - 20% actively secreted)

74
Q

Amboss Renal

True/False.

Inulin is freely filtered at the glomerulus, with no passive reabsorbtion or active secretion.

A

True.

75
Q

Amboss Renal

What are the renal effects seen with tacrolimus-induced injury?

A

Tubular vacuolization

+

possible glomerular scarring and focal segmental glomerulosclerosis

76
Q

Amboss Renal

What are the renal effects seen with sirolimus-induced injury?

A

None.

There are no renal effects of sirolimus use.

77
Q

Amboss Renal

The levator ani are innervated by which nerve roots?

A

S3 - S4

78
Q

Amboss Renal

Which type of diuretic is useful in preventing calcium stones?

A

Thiazides

(calcium-sparing)

79
Q

Amboss Renal

True/False.

Inermittent catheterization can be useful as treatment for patients with neurogenic bladder.

A

True.

80
Q

Amboss Renal

Describe the difference in etiology between the two forms of renal arteriolosclerosis shown in the image.

A

The left image shows hyperplastic arteriolosclerosis due to acute-onset hypertensive emergency;

the right image shows hyaline arteriolosclerosis due to chronic hyperglycemia

81
Q

Amboss Renal

In a pregnant patient with gonorrhea, what is the treatment plan?

A

IM ceftriaxone + oral azithromycin

(The pregnancy does not alter treatment.)

82
Q

Amboss Renal

What drug is a second-line agent used to inhibit uric acid reabsorption in the PCT?

A

Probenecid

83
Q

Amboss Renal

Cigarette smoking and chronic ergotamine use are both risk factors for what?

A

Retroperitoneal fibrosis

(abdominal irradiation, retroperitoneal surgeries, and IgG4-related systemic diseases are also risk factors)

84
Q

Amboss Renal

Name some of the potential treatments for nephrogenic diabetes insipidus.

A

Indomethacin

Thiazides

Amiloride (if lithium-induced)

85
Q

Amboss Renal

Bilateral, irregular areas of dilation and constriction in the renal arteries is characteristic of what form of autoimmune condition causing transmural inflammation and fibrinoid necrosis of the arteries?

A

Polyarteritis nodosa

86
Q

List the main features of type 1 renal tubular acidosis.

(Main issue, pH changes, potassium changes, other issues, etc.)

A

Distal RTA

Impaired H+ secretion

Elevated urine pH

Hypokalemia

Nephrolithiasis

87
Q

List the main features of type 2 renal tubular acidosis.

(Main issue, pH changes, potassium changes, other issues, etc.)

A

Proximal RTA

Impaired HCO3- reabsorption

Initially high but decreasing urine pH

Hypokalemia

88
Q

List the main features of type 4 renal tubular acidosis.

(Main issue, pH changes, potassium changes, other issues, etc.)

A

Hyperkalemic RTA

Impaired aldosterone action (either due to resistance or decreased secretion)

Low urine pH

Hyperkalemia

S1 - Selected Review (14 decks)

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