Rx_2.15 (Renal)

Question 1

Strongest risk factor for bladder cancer (transitional cell carcinoma)

Answer 1

• **exposure to aniline dyes
  
  • = synthetic dyes used in textile mills
• smoking is a risk factor in extended exposures

Question 2

Defect in transporter of neutral amino acids ==>

Answer 2

• Dx = “Hartnup’s dz”
• defective transporter @ small intestine & kidney
  
  • ==> wasting of neutral amino acids (except proline)
• ==> sx of niacin deficiency (pellagra) = neurologic impairment and dermatitis
  
  • tryptophan (neurtral) + B₆ can make niacin

Question 3

Neutral amino acids

Answer 3

• tryptophan
• phenylalanine
• glycine
• alanine
• valine
• isoleucine
• leucine
• methionine
• proline

Question 4

Common early finding of APCKD

Answer 4

• HTN
  
  • avg age @ onset = 30
• • family hx of kidney problems

Question 5

Common drug used to tx transplant patients + MOA/SE

Answer 5

• cyclosporine
• MOA:
  
  • binds cyclophillin ==l calcineurin ==> blocks production of IL-2 and receptor
  • IL-2 = necc. for diffentiation of T lymphocytes and clonal expansion of antigen-selected cytotoxic T lymphocytes
• SE
  
  • nephrotoxic effects

Question 6

Renal biopsy in diabetic nephropathy

Answer 6

• loss of heparan sulfate moieties that form negatively charged filtration barrier ==> increased filatration of serum proteins into urine
• Kimmelstiel-Wilson nodules
  
  • eosinophillic, periodic acid-Schiff-positive
• expansion of mesangium on light microscopy
  
  • nonspecifc linear deposition of albumin, IgG, complement
  • no immune deposits on EM

Question 7

Renal biopsy: diffuse granular IgG and C3 on IF ==> dx?

Answer 7

• immune complex glomerulonephritis
  
  • e.g. PSGN

Question 8

Renal biopsy: positive anti-light chain antibody staining of IF ==> dx?

Answer 8

• multiple myeloma or lymphoproliferative disorders
• light chains precipitate in renal tubules ==> acute renal failure

Question 9

Renal biopsy: positive fibril staining w/Congo red ==> dx?

Answer 9

• renal amyloidosis due to deposition of amyloid A
  
  • beta-pleated sheets of serm amyloid A
• associated w/Rheumatoid arthritis

Question 10

PTH actions (general) + @ kidney

Answer 10

• PTH ==> protection of serum ionized [Ca²⁺]
  
  • works to increase Ca levels and decreased phosphate levels
• ==> bone resorption ==> calcium and phosphate into ECF
• @ kidney
  
  • ==> decreased phosphate reabsorption
  • stimulates 1-a-hydroxylase activity ==> produces 1,25-OH vit D (from 25-OH vit D)
    
    • ==> increased Ca²⁺ @ gut

Question 11

Celecoxib: MOA

Answer 11

• COX-inhibitor ==> decreased PG production

Question 12

Common cause of respiratory acidosis + acute physiologic response

Answer 12

• Apnea ==> increased pCO₂ ==> respiratory acidosis
• Carbonic anhydrase: CO₂ + H₂O ==> H₂CO₃ ==> H⁺ + HCO₃^-
• physiologic response = buffering
  
  • H⁺ enters cells and binds to intracellular proteins
  • hemoglobin
  • bone matrix

Question 13

Chronic compensation for respiratory acidosis

Answer 13

• enhanced renal secretion of hydrogen ions
• takes aprox. 6-12 hours to set in and 3-4 days to peak
• @ chronic acidotic pts. (e.g. COPD):
  
  • produce carbonic acid
    
    • retain bicarb and excrete H
  • exchange Na for H
  • secreting NH₃ into the urine to trap H ion there in form of the ammonium ion

Question 14

Common complication of EHEC

Answer 14

• EHEC ==> (usually) self-limiting, bloody diarrhea that lasts 5-10 days
• hemolytic uremic syndrome
  
  • anemia
  • thrombocytopenia
  • acute renal failure
  • **most common cause of acute renal failure in children