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STEPH (NFR) Nephrology Fellowship Reviewer > TMA/TI/Diuretics/Cyst > Flashcards

TMA/TI/Diuretics/Cyst Flashcards

1
Q

thrombocytopenia, hemolytic anemia and dysfunction of affected organs

A

Thrombotic microangiopathy

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2
Q

renal dominant disease

A

hemolytic uremic syndrome

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3
Q

Predominant neurological involvement

A

ttp

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4
Q

severe adamts13 deficienct

A

ttp

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5
Q

most sensitive marker of hemopysis due to cell lysis and tissue ischemia

A

elevated ldh

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6
Q

pathological features of tma - blood

A

schistocytes

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7
Q

glomerular capillary wall thickening with thrombi

A

Acute hus

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8
Q

initial treatment of choice in TTP

A

Plasma exchange

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9
Q

recombinized humanized monoclonal antibody that functionally blocks C5, 1st line treatment for children

A

Eculizumab

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10
Q

predominant pathogen in stec-hus

A

E coli 0157

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11
Q

classical prodromal feature of stec-hus

A

Bloody diarrhea

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12
Q

Principal effector mediating tubulointerstitial fibrosis

A

fibroblasts

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13
Q

final common pathway leading to eskd

A

Fibrosis

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14
Q

abrupt deterioration in renal function and characterized by inflammation and edema in the renal interstitium

A

Acute interstitial nephritis

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15
Q

1/3 of cases of drug related ain are caused by

A

antibiotics

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16
Q

pathology of infection causing ain

A

Direct injury

medications used

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17
Q

hallmark pathology of ain

A

Infiltration of inflammatory cells with associated edema usually sparing glomeruli and blood vessels

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18
Q

epithelial cell degenration resembling patchy tubular necrosis with some disruption of the tbm

A

Tubulitis

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19
Q

dress syndrome

A

drug rash
eosinophilia
systemic symptoms
40% of drug induced ain

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20
Q

rising serum crea level but little or no evidence of glomerular or arterial disease, no prerenal factors, no obstruction + clinical hx of exposure to a high risk drug

A

ain

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21
Q

provide confirmatory evidence of AIN

A

Urine eosinophils

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22
Q

gold standard dx of ain

A

Renal biopsy

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23
Q

lymphocytic infiltrates in the peritubular areas of the interstitium usually with edema

A

ain

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24
Q

management of ain

A

withdrawal of factor, supportive care

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25
Q

time when medication should be discontinued that recovery is expected

A

within 2 weeks

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26
Q

dose of steroids in ain

A

prednisone 1mkd po for 2-3 weeks followed by tapering over 3-4 weeks

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27
Q

given to patients who fail to respond to a 2 week course of steroid therapy in ain

A

cyclophosphamide 4 week 2mkd

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28
Q

immunosuppresive agent used in granulomatosis interstitial nephritis

A

Mycophenopate mofetil

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29
Q

used in patients with circulating anti-tbm and anti-gbm antibodies

A

Plasmapharesis

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30
Q

worse prognosis in ain

A

increasing ageb

biopsy of diffuse disease + interstitial fibrosis

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31
Q

amount of analgesic to vayse analgesic nephropathy

A

6 tablets daily for > 3 years

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32
Q

decreased renal size, bumpy contours and papillary calcification

A

analgesic nephropathy

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33
Q

identified risk factor in lithium for ain

A

Duration of therapy

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34
Q

most powerful predictor of ultimate progression to eskd in lithium as cause of ain

A

> 2.5 mg/dL

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35
Q

Tx for lead nephropathy

A

Chronic edta chelation

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36
Q

Bone pain (itai-itai or ouch ouch disease) + osteopenia + renal failure

37
Q

hypertension and frequent gout in Ain

38
Q

presenting feature of sarcoidosis

A

Nephrolithiasis

39
Q

common cause of chronic renal failure in sarcoidosis

A

nephrocalcinosis

40
Q

pathogenesis in sarcoidosis

A

disordered ca metabolism (hypercalcemia or hypercalciuria)

41
Q

noncasseating granulomas of giant cells, histiocyyes and lymphocytes; focal lymphocytic infiltrates and periglomerular fibrosis, no immune deposits

A

Sarcoidosis

42
Q

tx for patients with sarcoidosis who could not tolerate corticosteroids and effective in decrasing vitamin D and calcium

A

Ketoconazole

43
Q

renal failure caused by tubulointerstitial nephritis associated with uveitis

A

Tinu syndrome

44
Q

Tx for tinu syndrome

45
Q

most profibrogenic and tubulotoxic fatty acids

A

oleate and linoleatr

46
Q

most susceptible to luminal attack by C5b-9

A

Renal tubular epithelial cells

47
Q

marker of tissue fibroblasts

A

fibroblasts specific protein I

48
Q

most numerous cells in ain

A

lymphocytes (CD4+ Tcells)

49
Q

inhibits procimal bicarbonate and Na cl reabsorption at the proximal tubule

A

Carbonic anhydrase inhibitor

50
Q

inhibits sodium water reabsorption proximal tubule

A

osmotic diuretics

51
Q

inhibits nkcc at medullary and cortical thick ascending limb

A

Loop diuretics

52
Q

inhibits ncc at distal tubule

A

Thiazide diuretics

53
Q

enac and mineralocorticoid blocker at connecting and collecting tubules

A

distal K sparing diuretics

54
Q

prototypic osmotic diuretic

55
Q

level of albumin that enhances furosdemide metabolism but decreases tubular secretion of active diuretic

A

Low serum albumin

56
Q

enhance thiazide binding and tubular action

A

mineralocorticoids, glucocorticoids and estrogens

57
Q

actions of thiazide and thiazide like

A

increase water excretion of Na K Cl Mg; reduce Ca

58
Q

prevent amphotericin induced hypoK and hypoMg

59
Q

First line agent fir ECV expansion in cirrhotic ascites

A

spironolactone + furosemide (100/40)

60
Q

natriuretic antihypertensive; inhibit nacl reabsorption in the proximal tubule and diluting segment, inc in gfr

A

Adenosine type 1 receptor antagonist: Aminophylline

61
Q

recombinant form of b type natriuretic peptide causes natriuresis and relaxation of smooth muscle cell

A

nesiritide

62
Q

observation that diuretics no longer produce a negative Na balance

A

Diuretic braking phenomenon

63
Q

how to overcome diuretic braking

A

diuretic Na restriction or addition of a second diuretic

64
Q

strategies to overcome diuretic braking

A
  1. restrict dietary salt to prevent postdiuretic salt retention
  2. another class of diuretic
  3. multiple daily dosing or diuretic with prolonged action
  4. Do not stop abruptly
  5. Prevent or reverse diuretic induced metabolic alkalosis
65
Q

inadequate clearance of edema despite a full dose of diuretic

A

Diuretic resistance

66
Q

mainstay therapy for acute decompensated heart failure

A

vasodilator and diuretic therapy

67
Q

first line treatment in chronic heart failure

A

Diuretics and ace/arbs
Second: bblocker
3rd: Mra or hydralazine-isdn
final: digoxin, icd

68
Q

diuretic that impair carbohydrate tolerance and precipitate dm

A

Hyperglycemia

69
Q

more common ain in the young

A

tinu and sle

70
Q

more common ain in elderly

A

drug induced

71
Q

gold standard ain dx

72
Q

distal rta with atin

A

sjogren syndrome

73
Q

most common dx test in ain

A

urine eosinophil test

74
Q

key finding of atin

A

interstitial inflammation and tubulits

75
Q

hyperca, hypercalciuria urinary concn defects nephrocalcinosis nephrolithiasis and aki/ckd

focal lymphocytic infiltrate and interstitial noncaseating granulomas of giant cells histiocytes and lymphocytes

A

sarcoidosis

76
Q

dry eyes dry mouth, lymphoplasmacytic interstitial infiltrate, ati

A

sjogren syndrome

77
Q

multi system do with elev serum igg4 salivary glands, pancreas retroperitoneum and kidneys
igg4 possible plasma positive in a stori form pattern

A

iig4 related

78
Q

uveitis painful red eyes photophobia

mixedwith noncaseating granuloma formation

79
Q

number of eosinophil per 20x

80
Q

4 leading anticancer agents

A

ifosfamide (atn)
bcg
tki (tma)
pemetrexed

81
Q

dx criteria for aristocholic acid induced interstitial nephrotis

A 
egfr < 60 
2 of the 3 
- hypocellular interstitial fibrosis 
- ingestion of aa containing products 
- dna adducts in the renal tissue or urinary tract
82
Q

chronic tubulointerstitial disease in families, ingestion of bread contaminated with aa

A

balkan endemic nephropathy

83
Q

progressive ckd, gout and hypertension, fanconi

A

lead nephropathy

84
Q

zn smelter workers
ca phos stones
fanconi

85
Q

most commonly isolated organisms from abscesses

A

p. mirabilis
e. colo
Kleb pneumo
s. aureus

86
Q

cut off for medically managed cysts

87
Q

txfor infected renal cyst

A

cotri, chloramphenicol, fqx 4 weeks

88
Q

Adpkd criteria

A

at least 3 15-39 yo
2 cysts in each 40-59
> 60: 4 or more cysts in the kidnet

STEPH (NFR) Nephrology Fellowship Reviewer (29 decks)

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