Renal UWorld 3 Flashcards
Calcineurin inhibitors
Cyclosporine, tacrolimus. Immunosuppressants used for transplant rejection and prophylaxis. Cyclosporine used also for psoriasis and rheumatoid arthritis.
Toxicity = nephrotoxicity and diabetes. Cyclosporine also has hypertension, hirsutism, gingival hyperplasia
Calcineurin
Intracellular messenger turned on by TCRs. Activates NFAT, a transcription factor that activates transcription of NF-kB and IL-2 -> promotes growth and differentiation of T-cells. Frequent target of immunosupression therapy.
3 main therapeutic catagories for BPH tx
1) alpha-antagonists (terazosin, tamulosin): relaxes smooth muscle in bladder neck and prostate. Works within days/weeks. Can cause hypotension and dizziness.
2) 5-alpha reductase inhibitors (finasteride, dutasteride): inhibits testosterone conversion to DHP. Reduces prostate volume (“fixed” cause), works in 6-12 months. Decreased libido and ED.
3) Antimuscarinics (tolterodine): used for men with overactive bladder and incontinence.
How is PAH excreted? Can this be saturated?
- Freely filtered –> cannot be saturated
- Secreted in PCT –> carriers CAN be saturated
Treatment for minimal change disease
Corticosteroids (rapid response)
Nephritic syndrome with enlarged and hypercellular glomeruli
Post strep glomerular nephritis
Lab findings in post strep glomerulonephritis
high ASO and anti-DNase B titers, decreased C3 and complement, presence of cryoglobulines
Units for filtration fraction, GFR, RPF, normal values
FF (unitless) = GFR (ml/min) / RPF (ml/min)
0.2 = 125 / 625
What happens to filtration fraction in severe hypovolemia?
Increases. Both GFR and RPF decrease, but GFR decreases less because of angiotensin II
Vasopressin: receptor, mechanism
V2 receptor, increases permeability to water and urea
Gross painless hematuria in an older patient should be seen as a sign of:
Urothelial cancer until proven otherwise
histology of renal cell carcinoma
“Clear cell carcinoma”. Originates from proximal tubule cells –> polygonal clear cells filled with lipids and carbohydrates
Majority of free water reabsorption in nephron happens in
Proximal tubule, even if the pt is dehydrated
Which diuretics cause hypercalcemia? Hypocalcemia?
Thiazides cause hypercalcemia - proximal and distal Ca reabsorption
Loops cause hypocalcemia - Ca wasting in loop
In water deprivation, where is urine most dilute? Most concentrated?
Dilute = distal tubule, concentrated = collecting duct
High Cl, low K, metabolic acidosis
Acetazolamide
64 y/o man with persistent back pain, constipation, easy fatigability for several months. Low Hb, Cr = 2.9, biopsy shows atrophic tubules with large obstructing eosinophilic casts
Multiple myeloma
4 symptoms in an elderly pt that make you think multiple myeloma
anemia, constipation (hypercalcemia), bone pain (back and ribs, due to osteoclast activation factor and bone lysis), renal failure
Bence Jones proteinuria
light chains which can precipitate to for eosinophilic casts
Muddy brown granular and epithelial cell casts with free tubular epithelial cells
Ischemic tubular necrosis
Pyuria and white cell casts
acute pyelonephritis
Bicarb in DKA
Serum bicarb is decreased, and acidosis increases H secretion –> bicarb reabsorption –> urinary bicarb is also low
DKA: PaCO2
Because of the metabolic acidosis, it should be going down as compensation.
Painless hematuria 2-3 days after URI, IgA deposits in mesangium on IF
IgA nephropathy
