Shit - Renal UWorld

Question 1

Kidney transplant prevention: drug names and MOA

Answer 1

Cyclosporin and tacrolimus

Block calcineurin → prevent dephosphorylation of NFAT → NFAT cant go to nucleus to increase IL-2 TC → T-cells dont proliferate and differnentiate, preventing graft attack

Cyclosporin: binds cyclophillin, which blocks calcineurin

Tacrolimus: binds FKBP, which blocks calcineurin

Question 2

Where is most H2O resorbed?

Answer 2

PCT

*no matter what condition*

Question 3

Estimates of:

GFR

RPF

Answer 3

GFR = creatinine/inulin

RPF = PAH

CLEARANCE!

Question 4

HCP: 4 s/s

Answer 4

Palpable purpura (buttocks and legs)

Arthralgias (large joints)

IgA neohropathy

GIT pain/bleeding (risk of intussiception)

Question 5

HSV Rx renal problems:

Acyclovir/Famicyclovir/valacylovir

Ganciclovir

Foscarnet

Cidofovir

Answer 5

Acyclovir/Famicyclovir/valacylovir: obstructive crystalline nephropathy (prevent with hydration) and ARF (allergy)

Ganciclovir: some renal toxicity (crystalline)

Foscarnet: Low Mg causing PTH inhibition causing hypocalcemia and hyperphosphatemia; can cause seizures

Cidofovir: nephrotoxic, decrease with probenecid and IV saline

Question 6

1st dose effect of ACE-I and risk factors

Answer 6

1st dose hypotension

Low Na or BV (other diuretics), low BP, renal impairments, heart failure, high renin or aldosterone levels

Question 7

Hemmorhagic cytitis: causes and s/s

Answer 7

Caused by isophosphamide/cyclophosphamide, via metabolism to acrolein

s/s = hematuria, dysuria, frequency and urgency

Question 8

Renal sign of Multiple Myelomas

Answer 8

Eosinophilic casts (NOT cells):

BJP overwhelm absorptive capacity –> ppt out with Tamm-Horsefall protein –> directly toxic to epi cells (atrophy) and block the lumen.

Question 9

ARF with ACE-I:

Answer 9

Bilateral renal artery stenosis

Decompensated HF

Chronic kidney disease

Volume depletion

Question 10

Diuretic causing ototoxicity

Answer 10

Loops (furosemide, bumetanide, torsemide)

Question 11

Ototoxic drugs:

Answer 11

Loops. sialicylates, aminoglycosides, vancomycin, cisplatin

Question 12

Hypercellularity of PSGN via:

PSGN buzzwords:

Answer 12

Leukocyte invation (PMN and macro) + endothelial proliferation + messangial proliferation

Buzzwords: IF = starry sky + lumpy bumpy

EM = humps

Question 13

Digoxin-renal link

Answer 13

Old age decreases renal clearance, which can cause digoxin toxicity (decreased muscle mass may prevent concomitant increase in creatinine)

Toxicity:

• Cholinergic (with blurry yellow vision)
• arrythmyas and AV block
• hyperkalemia

Question 14

Stress Incontience: cause, s/s, etiology

Answer 14

Decreased sphincter control

leak with increased intra-abd pressure

weak sphincter (EUS), woman, old

Question 15

Urge incontinents: cause, s/s, etiology

Answer 15

overactive detrussor

sudden overwhelming urge (and dont make it sometimes), frequency

frontal lobe probelm (cant control micturiction reflex)

Question 16

overflow incontience: cause, s/s, etiology

Answer 16

cause: decreased detrussor contractility, outlet obstruction, loss of sensory

s/s full bladder that cant empty fully, constant dribbling

etiology: diabetic autonomic neuropathy

Question 17

anti-PLA2-R IgG4 Abs

Answer 17

Idiopathic membranous nephropathy

Question 18

Necessary condition for ascending pyelonephrisits

Answer 18

VUR!

Can be congenital, or from increased urinary retention or recurrent UTIs

Question 19

Important urine buffers

Answer 19

NH₃ → NH₃⁺

HPO₄^2- → H₂PO₄^-

Question 20

Kidney stone @ high pH

Answer 20

Ammonuim magnesium phosphate (struvite)

Question 21

Ethylene glycol effect on kidneys

Answer 21

Metabolized to glycolic acid and oxalic acid

Glycolic acid is directly toxic to renal tubules

Oxalic acid binds Ca forming Ca-oxalate stones

Question 22

Earliest manifestation if diabetic nephropathy

Answer 22

microalbuminuria

(via loss of negatively charged heparin sulfate via upregulation of heparinases)

Question 23

Activators of RAS

Answer 23

Macula densa

Internal baro-R

B1 adrenergic (on JG)

Question 24

Mechanism to test cause of metabolic alkalosis

Answer 24

Urine Cl-

Vomiting or NG suction = loss of HCl, so fix with saline and Cl-

Thiazide/Loop = loss of Na and Cl, so fix with saline and Cl-

Mineralocorticoid excess; CANNOT fix with saline because of constant mienralocorticoid activity

Question 25

RPF, GFR, and FF in severe hypovolemia

Answer 25

Decreased RPF, which causes a decreased GFR

BUT compensation from RAS causes ang-II efferent vasocontriction to try to maintain GFR

So decrease in RPF > decrease in GFR; so FF increases

[low num/very low denom = higher number]

[eff constiction without hypovolemia also causes increased FF, but GFR is increased while RPF is only slightly decreased]

Question 26

Areas of nephron most succeptible to:

1) ischemic injury
2) nephrotoxic

Answer 26

ischemia = PCT and thick ascending limb

nephrotoxic = PCT

Question 27

GMB collagen type

Answer 27

IV

Abs to a3 chain of IV = goodpastures

Mutated col IV = alports