RENALS 536-540 FA 2015

Question 1

what Causes eferent arteriole constriction

Answer 1

ang 2

Question 2

List the causes of hyperkalemia in cells

Answer 2

digitalis
HyperOsmolarity
Lysis of cells (e.g., crush injury, rhabdomyolysis, cancer)
Acidosis
β-blocker
High blood Sugar (insulin de ciency)
Patient with hyperkalemia? DO LAβS.

Question 3

list the causes of hypokalemia

Answer 3

Hypo-osmolarity
Alkalosis
β-adrenergic agonist ( Na+/K+ ATPase) Insulin ( Na+/K+ ATPase)
Insulin shifts K+ into cells

Question 4

Signs of Low Na

Answer 4

Nausea and malaise, stupor, coma, seizures

Question 5

signs of High Na

Answer 5

Irritability, stupor, coma

Question 6

low K+ signs

Answer 6

U waves on ECG, flattened T waves, arrhythmias, muscle spasm

Question 7

high K+ signs

Answer 7

Wide QRS and peaked T waves on ECG, arrhythmias, muscle weakness

Question 8

Low Ca signs

Answer 8

Tetany, seizures, QT prolongation

Question 9

low Mg

Answer 9

Tetany, torsades de pointes, hypokalemia

Question 10

high Mg

Answer 10

 DTRs, lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia

Question 11

low phosphate causes

Answer 11

Bone loss, osteomalacia (adults), rickets (children)

Question 12

high Phosphate cause

Answer 12

Renal stones, metastatic calci cations, hypocalcemia

Question 13

causes of Resp Acidosis

Answer 13

Hypoventilation –Airway obstruction –Acute lung disease –Chronic lung disease –Opioids, sedative
weakness of resp muscles

Question 14

what is the formula of anion gap

Answer 14

Na - (cl +Hco3)

Question 15

Inc Anion Gap

Answer 15

MUDDLES anion gap
MUDPILES:
Methanol (formic acid) Uremia
Diabetic ketoacidosis Propylene glycol
Iron tablets or Isoniazid Lactic acidosis
Ethylene glycol (oxalic acid) Salicylates (late)

Question 16

normal anion gap btw 8-12 meq/l

Answer 16

HARDASSHARD-ASS:
Hyperalimentation
Addison disease
Renal tubular acidosis Diarrhea Acetazolamide Spironolactone Saline infusion

Question 17

causes of respiratory alkalosis

Answer 17

hyperventilation –Hysteria –Hypoxemia (e.g.,
high altitude) –Salicylates (early) –Tumor
–Pulmonary embolism

Question 18

causes of metabolic alkalosis

Answer 18

Loop/thiazide diuretics –Vomiting

–Antacid use –Hyperaldosteronism

Question 19

what is type 1 (distal) renal tubular acidosis and what drug causes it

Answer 19

Defect in ability of α intercalated cells to secrete H+, hypokalemia and urine pH >5.5.
Inc risk of kidney stones
No new bicarb

Causes: amphotericin B toxicity, analgesic nephropathy, congenital anomalies (obstruction) of urinary tract.

Question 20

what is type 2 (proximal) renal tubular acidosis and what drug causes it

Answer 20

Defect in PCT HCO3− reabsorption excretion of HCO3− in urine and subsequent metabolic acidosis. Urine is acidi ed by α-intercalated cells in collecting tubule. Associated with hypokalemia, risk for hypophosphatemic rickets.
Causes: Fanconi syndrome and carbonic anhydrase inhibitors.

Question 21

what is hyperkalemic renal tubular acidosis (type 4) and what drug causes it

Answer 21

Hypoaldosteronism hyperkalemia NH3 synthesis in PCT NH4+ excretion. Causes: aldosterone production (e.g., diabetic hyporeninism, ACE inhibitors, ARBs, NSAIDs,
heparin, cyclosporine, adrenal insuf ciency) or aldosterone resistance (e.g., K+-sparing diuretics, nephropathy due to obstruction, TMP/SMX).

Question 22

where do you see RBC cast

Answer 22

Glomerulonephritis, malignant hypertension

Question 23

where do you see WBC cast

Answer 23

Tubulointerstitial in ammation, acute pyelonephritis, transplant rejection.

Question 24

what kind of cast do you see in nephrotic syndrome

Answer 24

fatty cast

Question 25

Acute tubular necrosis, what cast do you see?

Answer 25

Granular (“muddy brown”) casts

Question 26

Waxy casts is seen in

Answer 26

End-stage renal disease/chronic renal failure.

Question 27

Nonspecific, can be a normal nding, often seen in concentrated urine samples refers to

Answer 27

Hyaline casts

Answer 28

Focal segmental glomerulosclerosis

Question 29

> 50% of glomeruli are involved

Answer 29

Diffuse proliferative glomerulonephritis

Question 30

Thickening of glomerular basement membrane (GBM)

Answer 30

Membranous nephropathy

Question 31

due to IgG, IgM, and C3

deposition along GBM and mesangium.

Answer 31

Acute post streptococcal glomerulonephritis

Question 32

EM—subepithelial immune complex (IC)

humps.

Answer 32

Acute post streptococcal glomerulonephritis

Question 33

what are the presentation of Acute post streptococcal glomerulonephritis

Answer 33

Presents with peripheral and periorbital edema, cola-colored urine, hypertension.
 inc anti-DNase B titers,  dec complement levels.

Question 34

what type of cast is associated with Maltese cross sign

Answer 34

Fatty cast/oval fat bodies