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Ryan's shit list - Step 1 > RSL - Renal > Flashcards

RSL - Renal Flashcards

1
Q

Extracellular compartments:

A

70kg

  • 60% water (42L)
    • 1/3 extracellular fluid (14L)
      • 75% interstitial fluid (10.5L)
      • 25% plasma (3.5L)
    • 2/3 intracellular fluid (28L)
      • 10% RBC volume (2.8L)
  • 40% non-water mass (28kg)
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2
Q

Fanconi Syndrome

(and causes)

A

Causes: PCT

  • Hereditary defects:
    • Wilson’s disease,
    • tyrosinemia,
    • glycogen storage disease,
  • Ischemia
  • Multiple myeloma
  • Nephrotoxins: Expired tetracyclines, tenofovir,
  • Lead poisoning
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3
Q

Bartter

A

Thick ascending loop of henle: Na/K/2Cl

  • Hypokalemia
  • metabolic acidosis
  • Hypercalciuria
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4
Q

Gitelman syndrome

A

DCT

  • Hypokalemia
  • Hypomagnesemia
  • Metabolic alkalosis
  • Hypocalciuria
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5
Q

Liddle syndrome

A

Collecting duct: gain of function (ENaC)

  • Hypokalemia
  • metabolic alkalosis
  • decreased aldosterone

Treat: amiloride

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6
Q

Syndrome of apparent mineralocorticoid excess

A

Collecting duct: (11 B-hydroxysteroid dehydrogenase)

  • Hypokalemia,
  • hypertension
  • metabolic alkalosis

Can be acquired from glycyrrhetic acid

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7
Q

Na+ Low/High serum conc.

A

Low:Nausea, malaise, stupor, coma, seizures

High: Irritability, stupor, coma

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8
Q

K+ low/high []

A
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9
Q

[Ca++] low/high

A

Low Ca++: tetany, seizures, GT prolongation

High Ca++: Kidney stones, Bone pain, diahrea, increased urinary freq, psychiatric changes

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10
Q

[Mg++] low/high

A

Low: Tetany, torsades de pointes, hypokalemia

High: Decreased DTRs, Lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia

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11
Q

[PO4—]

A

Low: Bone loss, osteomalacia, rickets

High: Renal stones, metastatic calcifications, hypocalcemia

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12
Q

Distal (type 1), urine pH >5.5

A

Defect in alpha intercalated cells

  • –> no H+ secretion
    • –> no HCO3- regeneration –> Acidosis
      • –> Kidney stones
    • –> no H+/K+ exchange –> hyperkalemia

Causes:

  • Amphotericin B, analgesic nephropathy, congenital anomalies of urinary tract
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13
Q

Proximal (type 2), Urine pH <5.5

A

PCT HCO3- reabsorption:

  • increased HCO3- excretion –> metabolic acidosis
  • Na+ not reabsorbed –> increased Acid/K+ loss
    • Hypokalemia, low pH

Causes: fanconi syndrome, CA inhibitors

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14
Q

Hyperkalemic (type 4), urine pH <5.5

A

Hypoaldosteronism

  • hyperkalemia –> decreased NH3 synthesis in PCT –> decreased NH4+ excretion

Causes:

  • Low aldosterone (diabetic hyporeninism, ACE inhibitors, ARBs, NSAIDS, heparin, cyclosporine, adrenal insufficiency
  • Aldosterone resistance (K+ sparing diuretics, nephropathy due to obstruction, TMP/SMX)
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15
Q

Post streptococcal Glomerulonephritis

(LM/IF/EM)

A

LM: Hypercellular glomeruli that is enlarged

IF: Starry sky granular appearance. Lumpy bumpy due to IgG, IgM, C3 deposition in GBM and mesangium

EM: Subepithelial imunne complex humps

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16
Q

Rapidly progressive Glomerulonephritis

(LM/IF)

A

LM/IF: Crescent moon shape consisting of fibrina and plasma proteins with glomerular parietal cells, monocytes, macrophages

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17
Q

Good pasture syndrome

A

Type II hypersensitivity –> ab to GBM and Alveolar basement membrane –> hematuria/hemoptysis

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18
Q

Granulomatosis with polyangitis (wegener)

A

PR3-ANCA / c-ANCA

(sinusitis; not seen in good pastures)

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19
Q

Microscopic polyangitis

A

MPO-ANCA / p-ANCA

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20
Q

Diffuse proliferative glomerulonephritis

(LM/IF/EM)

(DT/)

A

LM: wire looping of capillaries

IF: granular

EM: subendothelial and sumetimes intramembranous IgG based IC often with C3 deposition

Often nephrotic / nephritic concurrently

Dt/ SLE or membranoproliferative glomerulonephritis

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21
Q

IgA nephropathy (Berger disease)

(LM/IF/EM)

(disease)

A

LM: Mesangial proliferation

IF: IgA based IC deposits in mesangium

EM: mesangial IC deposits

DT/ Henoch-Schönlein purpura

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22
Q

Alport syndrome

(mutation)

(symptoms)

(EM)

A

Type IV collagen mutation –> thinning and splitting of GBM

Symp: Eyes, glomerulonephritis, sensorineural deafness

EM: Basket weave appearance

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23
Q

Membranoproliferative glomerulonephritis

Type 1: (EM/IF/PAS)(association)

Type 2: (EM)

A

1: hep B / C

  • EM: Subendothelial immune complex deposits
  • IF: granular
  • PAS (LM): tram track appearance

2: C3 nephritic factor (stabolizes C3 convertase)
* EM: intramembranous IC deposits; dense deposits

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24
Q

Focal segmental glomerulosclerosis

(LM/IF/EM)

(Associations)

Treat:

A

LM: Segmental sclerosis and hyalinosis

IF: Non-specific deposits of IgM, C3, C1

EM: Effacement of foot processes similar to minimal change disease

Associations: African american, Hispanic, HIV, Sickle cell, Obesity, Heroin use, IFN treatment,

Treat: inconsistent response to steroids

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25
Q

Minimal change disease

(LM/IF/EM)

A

LM: normal

IF: negative

EM: podocyte effacement

Secondary to: immunization, recent infection

Treat: responds well to steroids

26
Q

Membranous nephropathy

(LM/IF/EM)

(associations)

A

LM: diffuse capillary and GBM thickening

IF: Granular

EM: Spike and dome appearance with subepithelial deposits

Association:

  • ab to PLA2R,
  • ab to drugs (NSAIDS, penicillin),
  • infections (HBV,HCV),
  • SLE,
  • solid tumors
27
Q

Amyloidosis:

(Deposits?)

A

Subepi, subendo, GBM, Mesangium

28
Q

Diabetic glomerulonephropathy

(LM)

A

LM: mesangial expansion, GBM thickening, eosinophilic nodular glomerulosclerosis (kimmelstiel-wilson nodules)

29
Q

Renal Cell carcinoma (histology)

A

PCT –> Polygonal Clear cells filled with lipid and carbohydrates

30
Q

Renal Oncytoma

(origin, histology)

A

Epithelial cells –> Collecting duct

Large eosinophillic cells abundant with mitochondria and no perinuclear clearing

31
Q

Wilms tumor (nephroblastoma)

(ages, presentation, genes)

A

2-4, unilateral flank mass + HTN (DT/renin secretion, WT1/WT2 on ch 11

32
Q

Beckwith-Wiedman syndrome

A
  • Wilms tumor
  • Macroglossia
  • organomegally
  • Neonatal decreased glucose
  • Muscular hemihypertrophy
33
Q

WAGR syndrome

A
  • Wilm’s tumor
  • Aniridia
  • Genitourinary malformation
  • Mental retardation
34
Q

Transition cell carcinoma risk factors

(urothelial CA)

A

Phenacetin

Smoking (napthylamine)

Analine dyes (azo dyes)

Cyclophosphamide

35
Q

Chronic pyelonephritis: histology

A
36
Q

Acute pyelonephritis: Imaging

A

CT

37
Q

Drug induced interstitial nephritis

(Tubulointerstitial nephritis)

A
38
Q

Acute interstitial nephritis Drugs

A
39
Q

Acute tubular necrosis: Stage 1

A

Oliguria; decreased GFR

  • High: BUN, creatinine, Kalemia, acid, urea
40
Q

Acute Tubular necrosis: Stage 3

A

Recovery: polyuric

  • Low BUN, Creatinine, k+, Mg++, Ca++, PO4–, Na+
41
Q

ATN: nephrotoxins

A

aminoglycosides, radiocontrast agents, lead, cisplatin

Crush injury (myoglobinuria)

Hemoglobinuria

42
Q

Calcium stones (precipitation, X-Ray, Appearance, cause, treat)

A

Precipitation:

  • CaPO4: high pH
  • CaOxalate: low pH

X-Ray: Radiopaque

Appearance: Envelope (octahedron; square with X in middle)

Cause: hypercalciuria

Treat: Hydration, Thiazides, Citrate

43
Q

Ammonium magnesium phosphate

(precipitaiton, X-Ray, Appearance, cause, treatment)

A

high pH

Radiopaque

Coffin lid

*AKA struvite; caused by urease positive bugs (Urea –> ammonia)

  • often causes staghorn

Treat: infection, surgical removal of stone

44
Q

Uric acid

(precipitaiton, X-Ray, Appearance, cause, treatment)

A

low pH

radiolucent

Rhomboid or rosettes

low urine volue, arid climates, hyperuricemia, increased cell turnover

Treat: alkalinization of urine, allopurinol

45
Q

Cysteine

(precipitaiton, X-Ray, Appearance, cause, Test, treatment)

A

low pH

radiopaque

Hexagonal

Hereditary PCT transporter loss

(can form staghorn calliculi)

Sodium cyanide nitroprusside test

Treat: alkalinization of urine

46
Q

Calcium stones (precipitation, X-Ray, Appearance, cause, treat)

A

Precipitation:

  • CaPO4: high pH
  • CaOxalate: low pH

X-Ray: Radiopaque

Appearance: Envelope (octahedron; square with X in middle)

Cause: hypercalciuria

Treat: Hydration, Thiazides, Citrate

47
Q

Ammonium magnesium phosphate

(precipitaiton, X-Ray, Appearance, cause, treatment)

A

high pH

Radiopaque

Coffin lid

*AKA struvite; caused by urease positive bugs (Urea –> ammonia)

  • often causes staghorn

Treat: infection, surgical removal of stone

48
Q

Uric acid

(precipitaiton, X-Ray, Appearance, cause, treatment)

A

low pH

radiolucent

Rhomboid or rosettes

low urine volue, arid climates, hyperuricemia, increased cell turnover

Treat: alkalinization of urine, allopurinol

49
Q

Cysteine

(precipitaiton, X-Ray, Appearance, cause, Test, treatment)

A

low pH

radiopaque

Hexagonal

Hereditary PCT transporter loss

(can form staghorn calliculi)

Sodium cyanide nitroprusside test

Treat: alkalinization of urine

50
Q

Calcium stones (precipitation, X-Ray, Appearance, cause, treat)

A

Precipitation:

  • CaPO4: high pH
  • CaOxalate: low pH

X-Ray: Radiopaque

Appearance: Envelope (octahedron; square with X in middle)

Cause: hypercalciuria

Treat: Hydration, Thiazides, Citrate

51
Q

Ammonium magnesium phosphate

(precipitaiton, X-Ray, Appearance, cause, treatment)

A

high pH

Radiopaque

Coffin lid

*AKA struvite; caused by urease positive bugs (Urea –> ammonia)

  • often causes staghorn

Treat: infection, surgical removal of stone

52
Q

Uric acid

(precipitaiton, X-Ray, Appearance, cause, treatment)

A

low pH

radiolucent

Rhomboid or rosettes

low urine volue, arid climates, hyperuricemia, increased cell turnover

Treat: alkalinization of urine, allopurinol

53
Q

Cysteine

(precipitaiton, X-Ray, Appearance, cause, Test, treatment)

A

low pH

radiopaque

Hexagonal

Hereditary PCT transporter loss

(can form staghorn calliculi)

Sodium cyanide nitroprusside test

Treat: alkalinization of urine

54
Q

Calcium stones (precipitation, X-Ray, Appearance, cause, treat)

A

Precipitation:

  • CaPO4: high pH
  • CaOxalate: low pH

X-Ray: Radiopaque

Appearance: Envelope (octahedron; square with X in middle)

Cause: hypercalciuria

Treat: Hydration, Thiazides, Citrate

55
Q

Ammonium magnesium phosphate

(precipitaiton, X-Ray, Appearance, cause, treatment)

A

high pH

Radiopaque

Coffin lid

*AKA struvite; caused by urease positive bugs (Urea –> ammonia)

  • often causes staghorn

Treat: infection, surgical removal of stone

56
Q

Uric acid

(precipitaiton, X-Ray, Appearance, cause, treatment)

A

low pH

radiolucent

Rhomboid or rosettes

low urine volue, arid climates, hyperuricemia, increased cell turnover

Treat: alkalinization of urine, allopurinol

57
Q

Cysteine

(precipitaiton, X-Ray, Appearance, cause, Test, treatment)

A

low pH

radiopaque

Hexagonal

Hereditary PCT transporter loss

(can form staghorn calliculi)

Sodium cyanide nitroprusside test

Treat: alkalinization of urine

58
Q

Calcium stones (precipitation, X-Ray, Appearance, cause, treat)

A

Precipitation:

  • CaPO4: high pH
  • CaOxalate: low pH

X-Ray: Radiopaque

Appearance: Envelope (octahedron; square with X in middle)

Cause: hypercalciuria

Treat: Hydration, Thiazides, Citrate

59
Q

Ammonium magnesium phosphate

(precipitaiton, X-Ray, Appearance, cause, treatment)

A

high pH

Radiopaque

Coffin lid

*AKA struvite; caused by urease positive bugs (Urea –> ammonia)

  • often causes staghorn

Treat: infection, surgical removal of stone

60
Q

Uric acid

(precipitaiton, X-Ray, Appearance, cause, treatment)

A

low pH

radiolucent

Rhomboid or rosettes

low urine volue, arid climates, hyperuricemia, increased cell turnover

Treat: alkalinization of urine, allopurinol

61
Q

Cysteine

(precipitaiton, X-Ray, Appearance, cause, Test, treatment)

A

low pH

radiopaque

Hexagonal

Hereditary PCT transporter loss

(can form staghorn calliculi)

Sodium cyanide nitroprusside test

Treat: alkalinization of urine

Ryan's shit list - Step 1 (27 decks)

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