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Block 2 SD3 > Renal Final SD3 > Flashcards

Renal Final SD3 Flashcards

1
Q

What are the most common causes of renal kidney disease?

A

Intrinsic -> Tubular

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2
Q

Name the two types of Tubular Renal cell injury?

A

1.) Ischemia and inflammation
2.) Toxins

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3
Q

What are the causes of Ischemia and inflammation of renal tubular cell injury?

A

Sepsis, surgery, hypoperfusion

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4
Q

What type of toxins cause renal tubular cell injury?

A

Direct: aminoglycosides, cis platinum
Vasoconstriction: NSAIDs
Cyclosporin A, radiocontrast

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5
Q

What are the Urine sodium levels for Prerenal azotemia and acute tubular necrosis?

A

Pre-renal Azotemia urine sodium is less than 10-20 (low)

Acute Tubular Necrosis urine sodium is more than 20 -40 (high)

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6
Q

What are the Urine Osmolarity levels for Prerenal azotemia and acute tubular necrosis?

A

Pre-renal Azotemia is more than 500 (high)

Acute Tubular Necrosis is less than 350 (low)

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7
Q

What are the Fe sodium levels for pre-renal azotemia and acute tubular necrosis?

A

Pre-renal Azotemia is less than 1 (low)

Acute Tubular Necrosis is more than 1 (high)

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8
Q

What is the BUN/Cr ratio for pre-renal azotemia and acute tubular necrosis?

A

Pre-renal Azotemia is more than 20:1 (high)

Acute Tubular Necrosis is less than 10:1 (low)

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9
Q

What HST can you see in acute interstitial nephritis?

A

1 and IV

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10
Q

What are the signs and symptoms (inflammatory) of Acute Interstitial Nephritis?

A

Fever, Rash and arthralgias

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11
Q

What drugs cause Acute Interstitial Nephritis?

A

Antimicrobials: Beta-lactams (penicillin, ampicillin, methicillin)
NSAIDS

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12
Q

What are the G stages of eGFR?

A

G1 >90 underlying kidney
G5 <15 ESRD
G3a 45-59 mild moderately
G3b 30-44 moderate severely decreased

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13
Q

What are the findings on an ultrasound for ESRD?

A

Small, echogenic kidneys bilaterally (<10 cm) support diagnosis
Normal or even large (cystic) kidneys

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14
Q

What are the findings on an x-ray for ESRD?

A

1.) Renal osteodystrophy

2.) Subperiosteal reabsorption along radial sides of digital bones of hand

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15
Q

What is the cause for renal osteodystrophy?

A

secondary hyperparathyroidism where PTH levels have been elevated at least 1 year

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16
Q

What causes Renal Artery Stenosis?

A

HT; narrowing of one or both of the renal arteries most often caused by atherosclerosis or fibromuscular dysplasia.

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17
Q

What are the clinical features of renal failure?

A

Tachycardia, hypotension, decreased skin turgor and cool extremities

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18
Q

What is Fibromuscular Dysplasia?

A

Progressive twisting of the blood vessels throughout the body, typically in young women

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19
Q

What are the clinical features of Fibromuscular Dysplasia?

A

String of beads on an angiography
Severe HT, renal failure is unusual, if you stabilize the HT it will restore the kidney function completely (Revascularization)

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20
Q

What is Benign Nephrosclerosis?

A

Gradual decreased blood supply, finely granularity, the size is reduced or normal, grain of a leather appearance, fibrosis, irregular contracted kidney from HT, chronic inflammation

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21
Q

What is Malignant Nephrosclerosis?

A

Renal disease in an accelerated phase of hypertension (malignant HT – BP > 210/120 mm Hg

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22
Q

What other manifestations of malignant nephrosclerosis are present?

A

with end organ damage- CNS+ Eye)

23
Q

What is the pathogenesis of Malignant Nephrosclerosis?

A

Related to damage to vessels by long standing benign HT with increased permeability to proteins, endothelial injury and platelet deposition

24
Q

What can Malignant Nephrosclerosis cause?

A

Fibrinoid necrosis and intravascular thrombosis

25
Q

Which is more severe PKD1 or PKD2?

A

PKD1 and with an early onset

26
Q

Where else in the body can you see cysts for ADPKD?

A

1.) Liver
2.) Pancreas
3.) Seminal vesicle
4.) Abnormal vasculature with Berry aneurysm in circle of Willis and Dilatation of aortic root.

27
Q

What bacteria is more common in Cystitis and Pyelonephritis?

A

Gram Negative
1.) E. Coli
2.) Klebsiella
3.) Proteus mirabilis
4.) Pseudomonas aeruginosa

Gram Positive
1.) Staphylococcus saprophyticus
2.) Enterococcus faecalis (Group D streptococci)
3.) Streptococcus agalactiae (group B streptococci0

28
Q

What are the signs and symptoms of acute pyelonephritis?

A

Upper back and side (flank) pain
High fever
Shaking and chills
Nausea
Vomiting

29
Q

What are the signs and symptoms of Bladder (cystitis)?

A

Pelvic pressure
Lower abdomen discomfort
Frequent, painful urination
Blood in urine

30
Q

What are the signs and symptoms of Urethra (urethritis)

A

Burning with urination
Discharge

31
Q

What is the difference between NGU and Gonococcal urethritis?

A

NGU - mucoid discharge
Gonococcal urethritis - purulent discharge

32
Q

What are the causes of Bladder Carcinoma?

A

1.) Cigarette smoking
2.) Exposure to polynuclear aromatic compounds
-Aniline dyes - leather industry
-Rubber industry

3.) Chronic irritation
-Schistosomiasis
-Bladder stones

33
Q

What is the classic triad of Renal cell carcinoma?

A

1.) Painless Hematuria
2.) Dull flank Pain (Costovertebral angle pain) flank fullness, enlarged kidney
3.) Abdominal mass

Stage 2
Will extend to the perinephric space (Geotrac’s Fascia)

34
Q

What are the determinants of GFR?

A

1.) Filtration coefficient

2.) Glomerular capillary hydrostatic P

3.) Glomerular capillary oncotic P

4.) Bowman’s capsule hydrostatic P

35
Q

An increase in which pressure will lead to decreased GFR?

A

Bowman’s capsule hydrostatic P

36
Q

What is the role of Angiotensin 2 ?

A

Regulation of ECF volume and Blood pH

37
Q

What is the role of RAAS?

A

responsible for increased reabsorption of Na+, Cl- , HCO3- and H2O from renal tubules and ECF volume expansion. Since it also increases excretion of H+ ions, regulates Acid Base Balance.

38
Q

How does Loop diuretics interfere with Ca+ and Mg+ ?

A

by blocking the triple co transporter (Na+, Cl-, K+), It interferes with reabsorption

39
Q

Which major transport protein at the Basal surface of the tubular epithelial cells which is responsible for reabsorption of sodium and secretion of potassium ions?

A

Na+ K+ ATPase pump

40
Q

What would happen if you inhibit the Na+ K+ ATPase?

A

Inhibition of this pump decrease sodium reabsorption and potassium excretion

41
Q

Which cells are affected by the inhibition of the Na+K+ ATPase pump?

A

the principal cells of late distal tubules

42
Q

What is the Tm and Threshold of Glucose?

A

Tm 375 mg/mL
Threshold = 200 mg/ml
375 – 200 = 175 is the splay

43
Q

What is the formula for effective renal plasma flow?

A

ERPF = C (pah) = U (pah) x V / P (pah)

44
Q

What is the formula for renal plasma flow?

A

RPF = C (pah) = U (pah) x V / P (pah) - V (pah)

45
Q

What is the formula for renal blood flow?

A

RBF = RPF / 1 - Hematocrit

46
Q

What is the formula for Excretion rate?

A

Excretion rate = U (conc.) x V

47
Q

What is the formula for Reabsorption rate?

A

Reabsorption rate = Filtered load - Excretion
= (GFR x Plasma (secretion) ) - (U (conc.) x V) mg/min

48
Q

What is the formula for Secretion rate?

A

Secretion rate = Excretion - Filtered load
= (Ucon) x V) - (GFR x P HCO3) mg/min

49
Q

What is the formula for Total acid secretion or net acid secretion?

A

Total Acid secretion = Urine (PO43) + Urine (NH4+) - Urine HCO3

50
Q

What is the formula for Anion Gap?

A

Na - (Cl+HCO3) ; normal range is 8-16

51
Q

What is the formula for HCO3 to dissolve CO2?

A

HCO3 / (0.03) x PCO2

52
Q

What is the formula for Net acid excretion/Total acid excretion?

A

Urine (NH4+) + Urine (PO43) - Urine (HCO3)

53
Q

What is the formula for Net HCO3 reabsorption?

A

Net HCO3 reabsorption = Filtered load of HCO3 + Urine (NH4+) + (titrate) Urine PO43
(Filtered load = GFR x Plasma (HCO3) )

Block 2 SD3 (5 decks)

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