Review Flashcards
Which of these would be consistent with a finding of diabetes insipidus?
a. Hyponatremia with hyperosmotic urine
b. Hypernatremia, hyperkalemia and hyperosmotic urine
c. Hypoinsulinemia with glucosuria and proteinuria.
d. Hypernatremia, hyperchloremia and hypoosmotic urine.
e. Hypoalbuminemia, euglycemia hypoosmotic urine.
d. Hypernatremia, hyperchloremia and hypoosmotic urine.
disruption of AVP system —> excessive water loss —> hypernatremia and dilute urine
which of the following would occur from a mutation in the nephrin gene?
a. increased ECV
b. heavy proteinuria
c. hypolipidemia
d. hypernatremia
e. hypoalbuminuria
b. heavy proteinuria
nephrin: structural protein of glomerular filtration barrier, loss of integrity leads to hyperfiltration
Blood/urine analysis shows that a patient is hyponatremic with elevated total urine Na+ - a loss of function mutation in which of the following could cause this?
a. mineralocorticoid receptor
b. TGF mechanism
c. ROMK2
d. AT2-R
e. V2-R
a. mineralocorticoid receptor - mutation would prevent aldosterone binding, inhibiting its ability to induce Na+ reabsorption
b. TGF mechanism - monitors GFR by sensing NaCl in urine
c. ROMK2 - K+ pump (for secretion)
d. AT2-R - angiotensin receptor with opposite effects of main AT1-R
e. V2-R - loss of function defines nephrogenic diabetes insipidus (AVP binds here)
effective circulating volume is most dependent upon which of the following?
a. GFR
b. Intravascular volume.
c. Plasma sodium.
d. Cardiac output.
d. Cardiac output.
patient is a 48yo M presenting with chronically elevated blood pressure for the past year. He is currently taking the max prescribed dose of two diuretics and leaves a healthy lifestyle. Aside from a blood pressure of 150/85mmHg, PE is unremarkable. Which of the following is most likely pathogenesis of his resistant hypertension?
a. Catecholamine producing tumor (pheochromocytoma)
b. Tachycardia secondary to hyperthyroidism.
c. Volume overload secondary to acute kidney failure.
d. Renal artery stenosis.
e. Arginine, vasopressin resistance.
d. Renal artery stenosis —> effectively lowers renal perfusion, which is sensed by baroreceptors and causes RAAS activation
key is high BP is only presenting symptom (all others would have other symptoms)
Which two causes of metabolic alkalosis are not fluid responsive?
- Hyperaldosteronism
- Hypokalemia
all other common causes (diuretics, vomiting, contraction alkalosis) will get better with IV fluids
which of these would most appropriate for treatment of essential hypertension?
a. Furosemide.
b. Spironolactone.
c. Eplerenone
d. Thiazide diuretic
e. acetazolamide
d. Thiazide diuretic
furosemide is for more severe conditions like edema from CHF; spironolactone and eplerenone are aldosterone antagonists (strong drugs - save these for high aldosterone)
A patient with hypertension is resistant to a thiazide diuretic, calcium channel blocker, and angiotensin receptor blocker in combination. Blood labs show the following: Na+ 145, K+ 3, Cl- 95, Cr 1.4, BUN 20 - these results are most suspicious for which of the following?
a. constitutive activation of V2R
b. Loss of function of SGLT.
c. Hyperaldosteronism.
d. AT1 insensitivity
e. SIAD
c. Hyperaldosteronism
HTN resistant to 3 meds + hypokalemia + borderline hypernatremia = likely hyperaldosteronism —> Na+ retention, K+ secretion
What is the most common cause of increased blood urea nitrogen (BUN) in the absence of kidney failure?
dehydration - BUN reabsorption is coupled to sodium
what does a urine specific gravity of 1.0 indicate?
urine specific gravity of 1.0 = urine is pure H2O (impossible)
upper limit in humans is 1.035
Which three transporters in the kidneys are responsible for the 100% resorption of glucose from the kidneys?
- SGLT
- GLUT
- Na+/K+ ATPase (follows glucose)
What is the main transporter of sodium in the thick ascending limb (TAL) of the kidney?
NKCC: mediates transport of Na+, K+, and Cl-
A patient is prescribed furosemide for their hypertension. On follow-up, BP is lowered but pulse has risen and weight has dropped. Which of the following aberrant blood labs is most likely?
a. Hyperaldosteronemia, metabolic acidosis, hyperkalemia
b. Depressed PTH, hypercalcemia, hypophosphatemia
c. hypocalcemia, hyponatremia, hypokalemia
c. hypocalcemia, hyponatremia, hypokalemia
furosemide (loop diuretic) blocks NKCC - hypocalcemia because calcium reabsorption is coupled to Na+/K+ in TAL
A patient has a genetic mutation which prevents the targeting of AQP2 into the apical membrane of principal cells. Which of the following describes this disorder?
a. Pseudohyperaldosteronism
b. Nephrogenic diabetes insipidus
c. Nephrotic syndrome.
d. SIAD
e. Polycystic kidney disease.
b. Nephrogenic diabetes insipidus —> AVP resistance and hypernatremia due to H2O wasting
recall AVP binds V1 and V2 receptors
Describe the non-osmotic release of ADH
major physiologic trigger for ADH secretion (from posterior pituitary) is plasma osmolarity, sensed by the hypothalamus —> increased water reabsorption
However, with very low effective circulating volume (ECV), ADH secretion is triggered to increase blood volume (“non-osmotic release”)
this could be triggered by vomiting, diarrhea, hemorrhage, etc
what are the classic causes of renal papillary necrosis? (there’s a pneumonic ofc !)
SAAD papa:
Sickle cell
Acute pyelonephritis
Analgesics (NSAIDs)
Diabetes mellitus
[papa for papillary]
what are the common pathogens that cause UTI? (mnemonic !)
KEEPS:
Klebsiella
E. coli (most common)
Enterococcus
Proteus mirabilis (—> struvite stones)
Staphylococcus saprophyticus
which paraneoplastic syndromes can be caused by renal cell carcinoma? (mnemonic !)
PEAR:
PTHrP (PTH related protein)
EPO
ACTH
Renin
Pt is a 43yo F presenting with flank pain. Creatinine clearance is 50 mL/min, urine protein is normal, fasting blood glucose = 85, mg/dL, serum osmolarity = 285mOsm/kg. Which of the following lab values would most likely be detected in this patient?
a. Elevated plasma creatinine, hypernatremia, reduced BUN.
b. Elevated plasma creatinine, low urine creatinine, elevated BUN.
c. Reduced plasma creatinine, elevated urine creatinine, and normal serum albumin
d. Normal plasma creatinine, hyponatremia, and hypoalbuminemia.
b. Elevated plasma creatinine, low urine creatinine, elevated BUN.
Inverse relationship between GFR (creatinine clearance) and both plasma creatinine and BUN
which of the following intrarenal mechanisms is likely to be involved in the formation of diabetic nephropathy?
a. Increased nephrin expression.
b. Expression of pro fibrotic growth factors.
c. Reduced SGLT function.
d. Auto immune destruction of glomeruli.
b. Expression of pro-fibrotic growth factors.
blood labs for my post surgical. Patient show: sodium = 134 meq/L, fasting glucose = 60 mg/dL, and BUN = 8 mg/dL. Which of the following reflects this patient’s total plasma osmolality relative to normal?
a. Within normal limits.
b. Lower than normal.
c. Higher than normal.
b. Lower than normal.
A 16yo girl sustains a blow to the head. Following, she reports extreme thirst and frequent urination. Blood labs show plasma osmolality = 325mOsm/kg and urine osmolarity = 200 mOsm/kg. What is the most likely cause?
a. Anterior pituitary function.
b. Hyperaldosteronism.
c. Diabetes mellitus.
d. AVP deficit.
d. AVP deficit.
Thirst + frequent urination + hyperosmolarity with hypo osmolality urine = diabetes insipidus
A three-year-old girl is brought to the pediatrician due to polyuria, polydipsia, weakness, and fatigue. She is hypotensive and borderline tachycardic. Blood labs show HCO3- = 32meq/L, pH = 7.50, PRA and PAC elevated. K+ = 3.5meq/L, glucose = 95mg/dL. A loss of function mutation in which of the following is most likely?
a. SGLT2
b. AT2
c. Mineralcorticoid receptor
d. ROMK2
e. V2R
e. V2R
Polydipsia + polyuria + elevated PRA (plasma renin activity) & PAC (plasma aldosterone concentration) in response to hypotension = loss of vasopressin activity
Euglycemia rules out LOF in SGLT2
AT2 function is opposite of AT1 (main receptor) and significance is unclear
MR/ROMK defect would lead to hyperkalemia
Pt is 57yo M with resistant hypertension. He reports feeling well and has normal renal function. BP = 165/80mmHg. K+ = 3 meq/L, Cl- = 100 meq/L, Ca2+ = 10 mg/dL, BUN = 15 mg/dL. further testing would most likely show:
a. Elevated plasma metanephrines.
b. Plasma Na+ = 160 meq/L
c. Elevated plasma catecholamines.
d. Elevated plasma aldosterone: PRA ratio
e. Metabolic acidosis.
d. Elevated plasma aldosterone: PRA (plasma renin activity) ratio
resistant hypertension with hypokalemia = hyperaldosteronism
medullary rays contain which of the following?
a. renal corpuscles.
b. Collecting ducts
c. Distal convoluted tubule’s.
d. Proximal convoluted tubule’s.
e. Papillary ducts
e. Collecting ducts !!
A patient with small cell lung carcinoma presents with Na+ = 122 meq/L, plasma osmolality 250 mOsm/kg H2O, urine specific gravity 1.038. What do these most likely indicate?
a. Dehydration.
b. AVP excess
c. Decreased GFR
d. Hyperadrenal syndrome.
b. AVP excess
Hypo-osmolality with concentrated urine = SIADH
which of the following dermatomes would most likely be associated with loin pain from a stone in the upper portion of the ureter?
a. T10-T12
b. L1-L2
c. S2-S4
a. T10-T12
afferent visceral pain information follows sympathetics from the lesser (T10-T11), least (T12), and lumbar (L1-L2) splanchnic nerves - a stone in the proximal portions of the ureter is more likely to be felt in the loin/flank
As stone to send the pain refers to the groin
occlusion of the umbilical artery in the pelvis may result in reduced perfusion of the:
a. Ureters.
b. Urinary bladder.
c. Kidneys.
d. Urethra.
b. Urinary bladder.
prior to reaching the anterior abdominal wall where it becomes fibrotic postnatally, the umbilical artery gives off some superior vesicle branches to the bladder
A patient with multiple myeloma has an elevation in the total protein levels in the CRM. Which of the following changes would you expect?
a. No change in GFR, increased filtration fraction.
b. Increase GFR, decreased filtration fraction.
c. Decreased GFR, increased filtration fraction.
d. Decreased GFR, no change in filtration fraction.
e. Decreased GFR, decreased filtration fraction.
e. Decreased GFR, decreased filtration fraction.
decreased GFR due to increased plasma osmolarity with no change in RPF – this would decrease filtration fraction
what is the effect of NSAIDs on GFR and RPF and filtration fraction?
Prostaglandins dilate the afferent arteriole —> therefore NSAIDs cause constriction of the afferent arterial
—> reduced GFR and RPF = no change in filtration fraction