Renal UWorld 1 Flashcards by Will Culligan

What is under the 12th rib?

Medially: parietal pleura
Laterally: kidney (fractured rib can lacerate kidney)

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Tx of mucormycosis and side effects

Amphotericin B. High renal toxicity. Renal vasoconstriction, reduced GFR. Acute tubular necrosis, renal tubular acidosis, severe hypokalemia and hypomagnesema

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Fabry Disease

X-linked recessive lysosomal storage disesae: deficiency in a-galactosidase A –> buildup of ceramide trihexoside in tissues. Presents with decreased sweating, angiokeratoma, peripheral neuropathy/pain. Can cause cardio/renal disease, progress to renal failure.

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DKA urine findings

Kidneys are attempting to correct: high H+, low bicarb (to try to recycle it and get it back up to normal), high H2PO4- and NH4+ to help get rid of more acid

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Initial tx for acute decompensated CHF

Loop diuretics

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Most potent class of diuretic

Loop

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Side effects of loop diuretics

OH DANG: ototoxicity, hypokalemia, dehydration, allergy, nephritis, gout

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Diuretic that causes gynecomastia

Spironolactone

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Wegener’s granulomatosis with angiitis: 3 major symptoms, marker

Lung - cough, hemoptysis, etc.
Upper respiratory
Renal disease - RPGN, aka crescentic

c-ANCA

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PAH (para-aminohippurate) used to estimate

Filtered and secreted, not resorbed. Estimates renal plasma flow

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Kidney transplant: fever, decreased urine, and interstitial infiltration by mononuclear cells one week after. What kind of rejection? Mediated by what? Prevention?

Acute. Mediated by host T-cell sensitization against graft MHC antigens. Prevention with calcineurin inhibitors and steroids.

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Renal cell carcinoma: Chromosomal deletion? Involving what genes?

3p deletion, involving vHL gene (hereditary form of RCC).

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Von Hippel-Lindau disease

Autisomal dominant deletion of VHL gene on chromosome 3p. Cerebellar hemangioblastomas, renal cell carcinomas, pheochromocytomas. VHL is a tumor suppressor.

NOTE: VHL disease is rare, but deletions/mutations are pretty common

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What drug prevents recurrence of calcium oxalate stone formation?

HCTZ or citrate. Need something that decreases calcium in urine. HCTZ causes hypovolemia –> salt reabsorption, including passive Ca. Also, by inhibition of Na/Cl cotransporter –> activation of basolateral Na/Ca antiporter, enhancing Ca reabsorption

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Proteinuria > 4.5g in 24 hours, glomerular capillary wall thickening with no increase in cellularity, stain shows irregular spikes from GBM. Hx of colon cancer. Dx?

Membranous glomerulopathy

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Acute angle glaucoma treatment

Acetazolamide, c.a. inhibitor. Block NaHCO3 and water reabsorption. Also reduces aqueous humor production

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Nephrotic syndrome associated with IgG antibodies to phospholipase A2 receptor

Membranous nephropathy

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Nephrotic syndrome associated with SLE

membranous nephropathy

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antibodies to GBM and alveolar BM

Goodpasture syndrome, a rapidly progressive, crescentic, glomerularnephritis

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In Crescent glomerulonephritis (RPGN), what is the crescent made of?

Fibrin, plasma proteins (C3b), IgG

Filtration fraction

= GFR/RPF
Normal = 20%

RPF = (1-Hct)(Renal blood flow)

What can you use to estimate GFR?

Creatinine clearance

What can you use to estimate PAH clearance

Renal plasma flow

Remember RPF = (1-Hct)(Renal blood flow)

Aspirin OD: what happens?

1) Respiratory alkalosis via salicylate induced hyperventilation (immediate)
2) Anion gap metabolic acidosis via accumulation of organic acids (hours)

Winter's formula: what is it and how is it used?

Used for predicted respiratory compensation for a metabolic acidosis: PCO2 = 1.5 [HCO3] + 8, +/- 2 If measured PCO2 is different from predicted, there is a mixed disturbance

Calculation of anion gap

AG = Na - (Cl + HCO3) in a metabolic acidosis

Metabolic acidosis with normal anion gap

HARDASS | Hyperalimentation, addison disease, renal tubular acidosis, diarrhea, acetazolimide, spironolactone, saline infusion

Metabolic acidosis with high anion gap

Indicates presence of some unmeasured anion (acid) MUDPILES Methanol, uremia, dka, propylene glycol, Iron tabs, lactic acidosis, ethylene glycol, salicylates

Hyperacute rejection of transplant mediated by

Preformed antibodies against donor antigens. Type II hypersensitivity

Immediate hypersensitivity

Type I hypersensitivity. Occurs after initial exposure to antigen --> IgE class switching. Anaphylaxis, urticaria, asthma, seasonal allergies.

Calculate GFR

= k (Pc-Pb) - (oncotic pc - oncotic pb) C is capillary, b is bowman

Where is potassium resorbed/secreted?

Most 65% resorbed in PCT, 25% in loop, and then secretion in principal cells of DCT

Calculation of Renal blood flow

RBF = RPF / (1-Hct) RPF = PAH clearance = (urine conc x urine flow) / serum conc

How is vitamin D modulated in kidney?

25-OH-D3 is converted to active form, 1,25-diOH-D3 in kidney. Active form is also called calcitriol

How does chronic renal disease affect bone? (2 ways)

Diminished urinary excretion of phosphate --> elevated serum phosphate --> calcium phosphate complexes form --> less Ca available for tissues. High phosphate and low Ca --> PTH secretion. Decreased renal calcitriol production --> decreased Ca absorption --> increased Ca excretion --> low serum Ca and high serum phosphate. This all results in PTH mobilizing Ca from bones to raise serum Ca, causes renal osteodystrophy, bone pain and signs of osteopenia

Amphoterecin B premature ventricular beats are from

nephrotoxicity, including hypokalemia and hypomagnesemia

Principal site for uric acid crystals

collecting ducts due to low pH

Prevention of tumor lysis syndrome

Intracellular ions like K, uric acid, and phosphorus are released into serum. Alkalization of urine and hydration, which prevents uric acid from precipitating

If the renal artery is clamped, what cell types would undergo hypertrophy and hyperplasia?

Compensation would be the renin angiotensin system, so the JG apparatus and macula densa would hypertrophy/hyperplasia. Smooth muscle cells of afferent and efferent glomerular arteries synthesize renin.

Sudden onset flank pain, hematuria, and left sided varicocele in the setting of a nephrotic syndrome

Suggests renal vein thrombosis. Nephrotic syndrome is hypercoagulable state due to loss of anticoagulant factors like antithrombin III.

Oliguria, anorexia, flank pain, calcium oxalate crystals in a homeless alcoholic. Toxic renal injury due to

ethylene glycol

Side effects of osmotic diuretics. Overaggressive tx can lead to?

normal side effects = pulmonary htn, headache, nausea, vomiting Overaggressive treatment leads to volume depletion, hypernatremia, death.

Why are osmotic diuretics useful in increased intracranial pressure?

Water distribution from tissues to plasma

Causes of secondary hyperaldosteronism, and findings

Caused by renovascular or malignant hypertension, renin-secreting tumor, or diuretic use. Hypertension, hypokalemia, high renin, high aldo

Findings in primary hyperaldosteronism

Hypertension, hypokalemia, low renin, high aldo

Poststreptococcal glomerulonephritis: biopsy, LM, IF, EM findings

LM: glomeruli large and hypercellular with leukocyte infiltration and proliferation of endothelial and mesangial cells. EM: electron-dense subepithelial IC humps IF: Granular appearance, "starry sky" or "lumpy bumpy" due to IgM, IgG, and C3 deposition.

Acute tubular necrosis secondary to low cardiac output: what part of the kidney is hurt most?

Proximal tubule and thick ascending loop of henle

Low cardiac output, high BUN and Cr, low urine flow, muddy brown casts in urine

Ischemic acute tubular necrosis