Renal, but shit I got 99% Flashcards
Hyperurcemia as a s/e diruetics
Thiazide
Furosemide
What drugs will decrease mortality in CHF
ACE/ARB
BB
spironolactone
What is at least 1 good reason to rx a thiazide
htn
What is at least 1 good reson NOT to use a thiazide
Thiazides are implicated in Lithium toxicity
What do thiazides do
Block DCT– Na/Cl channel
happens to also ↓ Ca excretion
What is a genetic problem that looks exactly like life long thiazide use
Gitelman
What 2 drugs treat Calcium renal stones
Thiazide
Citrate
Namethe thiazides
Hydrochlorothiazide
Chlorthalidone
Metolazone
What is triamterene
K sparing diuretic
acts on collecting tube
Why does CKD have hypocalcemia as a trait
In CKD, PO4 cannot clear due to ↓ GFR
PO4 binds Ca–> hypoca
↑ PHT due to ↓ Ca
Further a problem b/c kidney not making vit d–> even less Ca
How do you fix a low Ca in CKD
Calcitriol and Ca supplements
What are the most important steps in evaluating metabolic alkoloasuis
Volume Status
Urine Cl
What are the most common reasons for metabolic alk
Vomiting- Loss of H/ Cl
Thiazide/ Loop- loss of H/ Cl
What is almost always present for development of acute pylo
Vesicoureteral reflux or other anatomic problem
usually more likely to get normal UTI
What are the 3 different types of Rapidly progressive glomerulonephritis
1- Anti-GMB RPGN (goodpature)
2- Immune Complex RPGN (PSGN, SLE, IgA/ henoch sconein purpura)
3- Pauci Immune RPGN (no immunoglob) ex weCners- anca
When Does ADPKD present
40-50 years
newborns- cycts way too small to see
When do Waxy Casts present
CKD
What is the best way to detect early nephrOpathy
UA albumin
What receptors does ADH act on
V1- vasoconstriction
V2- antidiuretic
Where is PAH reabsorbed
para-aminohippuric acid is not reabsorbed anywhere
When would you see a WBC cast
Pyelo
Transplant reject
tubulointerstitial inflammation
How do you calculates filtration fraction
FF= GFR / RPF
What are the side effects of loop diuretics
Ototoxicity HypoK Dehydration Allergy (sulfa) Alkalosis Nephritis Gout
OH DAANG
Why do loop diuretics cause ototoxicity
loops inhibit Na/K/2Cl in ascending loop
similar inhibition in inner ear–> ototoxicity
How is acyclovir metabolized
Renal
May crystallize in tubes–> tubular damage
Aggressive hydration = prevention
Describe the proteinuria of minimal change disease
highly SELECTIVE proteinuria- loss of charge selectivity
loss of only small proteins (albumin)
NO loss of large (IgG)
What is the most common primary renal tumor
Renal Cell carcinoma
often asymptomatic
Polycythemia often seen due to tumor –> ↑ EPO
What is Conn syndrome/ what is rx
primary hyperaldosteronism
rx: eplerenone (less s/e vs spironolactone)
What does aldosterone excess look like
Hypertension, met alk, ↓ renin
What kind of incontinence does Oxybutynin treat
Urge
Anti-M drug
How would you treat post op failure to void
Bethanechol - direct M agonist
a1 blocker
What is a normal post void volume
Less than 50 CC
How is bradykinin metabolized
By ACE
that’s why ACE has ↑ bradykinin
How does cyclosporin work
Calcineuron inhibitor ( prevents IL 2 and thus T cells)
What does grapefruit juice do to p450
inhibits p450
What diuretic can treat glaucoma
acetazolamide- carbonic anhydrase inhibitors
↓ HCO3 ↓ Aqueous humor –> better pressure
What might MCD be related too
defect in immune fx, b/c MCD is often seen with uri, vacancies, etc
define overflow incontinence
due to incomplete emptying
when bladder pressure exceeds sphincter–> continuous urine leakage
Define stress incontinence
loss of pelvic floor support
cough–> ↑ pressure–> brief UA loss
What is the triad of hemolytic uremic syndrome
- microangiopathic hemolytic anemia
- thrombocytopenia
- acute kidney injury
Describe Henoch Schonlein purpura
vasculitis
IgA immune deposition in skin, kidney, joint, intestine
presents with palpable purpura
Describe Kawasaki
medium vessel arteritis
Fever, conjunctivitis, cervical LAD, strawberry tongue
What is a common cause of death in ADPKD
berry aneurysm
How does one calculate net filtration
(Pc- Pi) - (nc-ni)
hydrostatic difference - oncotic difference
How is paraaminohippuric acid filtered
Freely filtered
Carrier mediated process into tube cells (secretion from blood to tube)
Which part of the kidney will have the argest issues with ischemia
straight proximal tubule
Thick ascending limb
These areas use ↑↑ ATP and thus have highest O2 demand
What causes acute tubular necrosis
decreased renal perfusion
hypovolemia, shock, surgery
what is a bad prognostic factor for PSGN
presentation in adults
kids do better
What does angiotensin 2 do in the kidney
constricts efferent
ACE inhibitor therefor–> dilated efferent
What would look special in ethylene glycol poisoning in ATN (vs other ATN)
ethylene glycol will have Calcium Oxalatecrystals
What is the most common site for mets from a RCC
lung
RCC shows abundant clear cytoplasm
What is the defect in fabray
x linked a-galactosidase A deficiency
What should all DM patients with kidney problems be started on
ACE inhibitors
ARB
helps prevent the progression of diabetic nephropathy
What lab value can tell you GFR
Insulin or creatinine clearance
What lab value can tell you renal plasma flow
PAH clearance
How do you calculate the clearance of anything (s)
Clearance = ([UAs] x UA flow rate) // ([PlasamS])
How do you calculate the excretion of anything (s)
excretion= (GFR)([plasma-s]) - (tubular reabsorption s)
