Rx_2.3 (Renal)

Question 1

Furosemide: MOA, uses, SE

Answer 1

• MOA: inhibits sodium-potasium-chloride co-transporter @ ascending LOH
• uses:
  
  • CHF
  • acute pulmonary edema
  • hyeprcalcemia
• SE:
  
  • hypokalemia
  • hypocalcemia
  • alkalosis
  • ototoxicity
  • volume depletion
  • nephritis

Question 2

Presentation of Adult Polycystic Kidney Disease

Answer 2

• growth of renal cysts ==> renal failure by copressing adjacent normal parenchyma
• presents @ 30-40yo
• sx/signs
  
  • abdominal discomfort
  • frequent UTIs
  • hematuria, polyuria, nocturia
  • mild proteinuria
• associated w/berry aneurysms and mitral valve prolapse

Question 3

Cause of Adult Polycystic Kidney Disease (APKD)

Answer 3

• mutation @ polycystin 1 gene
• located @ chromosome 16

Question 4

Presentation of post-strep kidney disease

Answer 4

• 1-3 weeks after streptococcal pharyngitis ==>
• poststrep glomerulonephritis (nephritic syndrome)
  
  • hematuria
  • hypertension
  • azotemia
  • oliguria
• positive antistreptolysin O antibodies

Question 5

Complication in chronic renal disease (e.g. @ noncompliant diabetic patients)

Answer 5

• osteomalacia <== kidney’s inability to maintain normal vitamin D production

Question 6

Sx of chronic renal failure

Answer 6

• edema, HTN, pulmonary edema, CHF
• hyperkalemia, hyperphosphatemia
• hypocalcemia
• renal osteodystrophy
• uremia
• anemia
• N/V
• peripheral neuropathy
• pruritis

Question 7

Steps for understanding acid-base status

Answer 7

1. check arterial pH
   
   1. pH < 7.4 = acidemia
   2. pH > 7.4 = alkalemia
2. check PCO₂
   
   1. acidemia
      
      1. PCO₂ > 40 mmHG = respiratory acidosis
      2. PCO₂ < 40 mmHG = metabolic acidosis w/compensation
   2. alkalemia
      
      1. PCO2 < 40 mmHG = respiratory alkalosis
         PCO2 > 40 mmHG = metabolic alkalosis w/compensation
3. In metabolic acidosis: check anion gap
   
   1. AG = Na⁺ - (Cl^- + HCO₃^-)

Question 8

Causes of respiratory acidosis

Answer 8

• respiratory acidosis = due to hypoventilation ==> increased acid production
• possible causes:
  
  • airway obstruction
  • acute lung dz
  • chronic lung dz
  • opiods, sedatives
  • weakening of respiratory muscles

Question 9

Causes of anion gap metabolic acidosis

Answer 9

• AG > 12 meQ/L
• MUDPILES:
  
  • Methanol (formic acid)
  • Uremia
  • Diabetic ketoacidosis
  • Propylene glycol
  • Iron tablets or INH
  • Lactic acidosis
  • Ethylene glycol (oxalic acid)
  • Salicytates (aspirin) (late)

Question 10

Causes of non-anion gap metabolic acidosis

Answer 10

• AG = 8-12 mEq/L
• HARD-ASS:
  
  • Hyperalimentation
  • Addison disease
  • Renal tubular acidosis
  • Diarrhea
  • Spironolactone
  • Saline infusion

Question 11

Causes of respiratory alkalosis

Answer 11

• PCO₂ < 40 mmHG
• due to hyperventilation:
  
  • hysteria
  • hypoxemia (e.g. high altitude)
  • salicylates (early)
  • tumor
  • pulmonary embolism

Question 12

Causes of metabolic alkalosis

Answer 12

• PCO₂ > 40 mmHg
• loop diuretics
• vomiting
• antacid use
• hyperaldosteronism

Question 13

Drugs associated w/crystal-induced nephropathy

Answer 13

• protease inhibitor; e.g. indinavir
• drug crystallizes in urine ==>
  
  • hematuria
  • crystals in urine

Question 14

Minimal change disease impact on glomerular capillary oncotic pressure and GFR

Answer 14

• MCD = nephrotic syndrome ==> proteinuria
• epithelial cell foot process effacement ==> protein w/in bowman’s space ==>
  
  • increased oncotic pressure @ BS
  • decreased oncotic pressure @ GC
• ==> increased GFR

Question 15

Starling equation

Normal GFR

GFR lab estimate (general)

Answer 15

• GFR = K_f [(P_GC - P_BS) - (Π_GC - Π_BS)]
• Normal GFR = ~100 mL/min
• Cr clearance = approximate measure