Unit 2 Renal path Flashcards
what type of patients should be treated for bacteriuria?
Pregnant pts, pts undergoing traumatic genitourinary procedures (transurethral prostatectomy)
, renal transplant pts.
What patients develop Strep. Agalactiae UTI’s?
Pt’s with diabetic mellitus and pregnant women
What are the characteristics of nephrotic syndrome?
Hypoalbuminemia, edema, and massive proteinuria, fatty lipid casts, lipiduria
What are the side effects of loop diuretics?
Dehydration (dizziness and orthostatic hypotension)
Podagra- gout of the big toe
What are loop diuretics mainly used for
CHF
What are thiazides mainly used for?
Hypertension
Are there any thiazide drugs that can be used IV
No
What are ACE inhibitors mainly used to treat
- HTN
- CHF
- other things
What is a common side effect of ACE inhibitors thats not a dry cough, and why does it cause it?
Increased serum creatinine.
Because it lowers GFR, thus less creatinine excreated
What are the function of leydig cells
they are the principle source of androgen production
What are a leydig tumor cause
Drastic increase in testosterone
Can also increase estrogen production which leads to gynecomastia, loss of libido, ED, infertility.
A pt comes in with dark urine and complains of being very fatigued and sore. they also have muscle pain, what could be happening
Rhabdomyolysis leading to acute tubular necrosis, because the myoglobin from muscle breakdown fucked up the kidney leading to rapid kidney injury
How can you distinguish between PSGN and IgA nephropathy?
Similar symptoms but antistreptolysin O antibodies being in serum suggests PSGN, not IgA nephropathy
what is the most common cause of glomerular hematuria
IgA nephropathy
what is the most common cause of nephrotic syndrome in the US
Focal segmental glomerulosclerosis
What are the common symptoms of FSGS
Proteinuria, edema, and hypertension
coupled with mild hematuria
What kind of drug is acetazolamide, its MOA and uses
Carbonic anhydrase Inhibitor
Inhibits CA in the proximal tubule, leads to diuresis of bicarb, sodium, potassium, and water
Also used for altitude sickness- leads to metabolic acidosis which causes body to breath better at higher altitudes
What is a side effect of acetazolamide?
Paresthesia
What is the hallmark characteristics of normal anion gap metabolic acidosis?
Low serum bicarb, high serum Cl-
What type of metabolic acidosis do all RTA present with
Non-anion gap metabolic acidosis
What should I think about with I see “GI illness”?
Diarrhea–> bicarb loss –> non anion gap metabolic acidosis
What is RTA type 2
Bicarb reabsorption in PCT is FUCKED
leads to hypokalemia, Non anion gap MA, alkaline urine
What is RTA type 1
H+ secretion is fucked in the DCT
leads to Non anion gap MA, hypokalemia, kidney stones
What is RTA type 4
Aldosterone response in collecting duct is impaired
leads to inability to secrete protons and potassium–> metabolic acidosis and hyperkalemia
What is methanol metabolized into
Formaldehyde–> formic acid and lactic acid via alcohol dehydrogenase
What can methanol poisoning lead to
CNS symptoms- dizziness, confusion, coma, etc.
Visual problems
metabolic acidosis
High anion gap and elevated osmolar gap (due to increased formic acid)
What is ethylene glycol metabolized into
glycolic acid—> oxalate acid
What can ethylene glycol poisoning lead to
Similar CNS symptoms to methanol
Renal problems (AKI and stones)
Metabolic acidosis with high anion gap
If theres renal failure is it ethylene glycol or methanol poisoning?
Ethylene glycol
If theres visual problems is it ethylene glycol or methanol poisoning?
Methanol
What is a common side effect of ACE inhibtiors
Angioedema due to increased bradykinin levels
What is a common side effect of spirolactone
Gynecomastia due to estrogen mimic action
What is a common side effects of loop diuretics?
Hypokalemia due to increased Na and water reabsorption in the collecting duct
Ototoxicity due to loop diuretics tendency to concentrate the inner ear
When being shown acid-base disorder questions what should I imediately think?
Whats the bicarb level
Whats the Cl- level
Whats the Pco2 levels
What should I think about thats obvious AF when im given symptoms
What is causing these symptoms
THINK LOGICALLY NOT ANKILLY
dumbass mf start using your smarts brotha
If theres evidence of glomerular damage with hypertension what should i think?
Nephritic syndrome
Nephritic or Nephrotic syndromes will present with what in the question stems
Nephritic- hallmark Hematuria, not trace urine RBCs
Nephrotic- hallmark proteinuria, not trace urine proteins
when I see FeNa in question stem what should I think about
Kidney tubule function. Is it damaged or not
How does hypotension affect the way the kidney handles sodium
Hypotension–> RAAS–> arteriolar constriction–> dec. GFR –> Dec. filtered load –> Increases sodium reabsorption
what causes an increase in PTH secretion
hyperphosphatemia, hypocalcemia, and impaired 1,25- Vit D production
what are some characteristics of lupus nephritis
Arthralgia, myalgia, erythematous skin rash, hypertension, hematuria
What serologic studies confirms lupus nephritis
Anti-double stranded DNA antibody
What is the most common cause of immune deposition in membranous nephropathy
anti-PLA2 antibody.
Bleeding and hypotension for days are indicative of what. and what does that mean for the kidney
Ischemia–> Acute tubular necrosis
What kind of casts are seen in ATN
Brown granular (muddy) casts
Where are deposits seen in berger disease
IgA deposits in the mesangium
Play attention to word choices such as sudden onset mf… how that can help you
Distinguish acute symptoms like kidney stone flank pain compared to slower onset things like nephrotic/nephritic syndromes
Who gets UTI’s from enterococcus faecalis
post surgery pts, especially those given cephasporins
MOA of Trimethoprim
Folate analog.Competitive inhibition of dihydrofolate reductase.
DHF–> THF (tetrahydrofolate) doesnt occur—> decreased nucleotide synthesis—> no cell DNA replication/transcription
MOA of ampicillin
Cell wall analog–> Cell wall crosslinking inhibition (cell wall synthesis)
Tetracycline MOA
Bacterial protein synthesis inhibitor
-broad spectrum
MOA of chloramphenicol
Reversibly binds to bacterial 50s ribosome, thus inhibiting peptide bond formation
What kind of Abx is levofloxacin
fluoroquinolone
MOA of levofloxacin
topoisomerase II inhibitor (DNA gyrase) and topoisomerase IV (separates replicated chromosomal DNA)–> blocks bacterial DNA replication and translation
What population can get Staph. Aureus UTI?
elderly pts with catheter and recently underwent an invasive medical procedure.
What are histological characteristics of renal cell carcinoma
Clear cytoplasm
What causes the cough side effect with ACE inhibitors
increased bradykinin levels, which can also cause angioedema
What can BPH lead to
Obstructive uropathy–> hydronephrosis–> chronic renal failure
What is cortical atrophy of the kidney
Shrinkage or loss of function of the cortex of the kidney
What can cause cortical atrophy of the kidney
Progressive damage to the nephrons such as in..
1) Chronic kidney failure
2) Obstructive uropathy: kidney stones, BPH
3) Chronic Interstitial nephritis- tubules scarred
4)Renal Artery stenosis- ischemia
Which drug causes a decrease formation of CSF and also aqueous humor in the eye
Acetazolamide
What is conivaptan and what is it used for?
a V1/V2 (vasopressin) receptor antagonist (IV used only)
it is used to treat things like SIADH–> increase excretion of free water
also used to treat hyponatremia
What drug lowers intracranial pressure and how
Mannitol, by drawing out free water from the brain
What drugs can cause hypomagnesemia?
Loop and thiazide diuretics
Which drug causes a decrease in plasma renin, AI, AII, and aldosterone. Why?
Metoprolol.
Blocks Beta-1 receptors in the JGA which results in a decrease renin release which drops the levels of the other things too.
What drug decreases renin activity but not production
Aliskiren
Why do renin levels increase with ACE inhibitors?
Because the body doesnt know that ACE is inhibited, it just knows that BP isnt going up, therefore releases more renin.
What is entresto?
Drug combo of sacubitril and valsartan
Why is valsartan given with sacubitril
Since sacubitril normally inhibits the enzyme neprilysin which can degrade AII
Losartan is given to inhibit the AII thats not degraded
What drugs are contraindicated with entresto
ACE inhibitors
Prils, like trils elevate levels of what
Bradykinin–> dry cough and angioedema
What kind of diuretic is chlorthalidone
Thiazide
What is a common side effect of chlorthalidone
sexual dysfunction (erection and impotence)
What drug has shown the ability to significantly slow the progression of albuminuria CKD with hypertension
ACE inhibitors
What classes of drugs treat overactive bladder?
Anti-muscarinics (antiparaysym)
Beta-3 adrenergic agonists
What are the common anti-muscarinic drugs used to treat overactive bladder and how
Oxybutynin
Solifenacin
Tolterodine
MOA- inhibits detrusor muscle
What are the common beta 3 adrenergic agonist drugs used to treat overactive bladder and how
Mirabegron
Vibegron
inhibits detrusor muscle
M1,M2,M3 GPCR effects
M1-Gq
M2-Gi
M3-Gq
A1,A2, B1, B2 GPCR effects
QISS
A1-Q
A2-I
B1-S
B2-S
What drug is a renal vasodilator
Dopamine
Which drug can increase renal perfusion in hypovolemic shock
Dopamine
Which nephritic syndromes have normal vs low complement levels and why
IgA nephropathy - normal levels bc complement dont really like IgA. Also goodpasture
PSGN, Lupus, DPGN cause lower levels of complement because IgG/IgM are involved
What nephritic syndrome should I think of when theres recurrent hematuria episodes that revolve spontaneously?
IgA nephropathy
Which organisms can cause struvite stones and why?
Klebsiella and proteus bc they are urease positive
How do urease positive bacteria cause ammonia magnesium phosphate stones
Urease breaks down urea in ammonia and OH- which alkalizes the urine (inc in pH) and cause cause precipitation of the stone
Eosinophils in urine is associated with what disease and what related symptoms
Acute interstitial nephritis. Rash, fever, acute kidney injury
do urine stones form in dilute or concentrated urine
Concentrated
Why can their be blood positive but RBC negative in a urinalysis
because its detecting HEME not RBC’s
What things can cause rhabdomyolysis
Crush injuries, seizures, drugs (statins)
Where does the most common type of RCC originate from the kidney
Proximal tubules
What is primary polydipsia?
A syndrome of increased fluid consumption due to excessive thirst which can be causes be psychiatry issues or emotional stress.
What drug can be used to treat bipolar
lithium
How does lithium used affect ADH
It lowers its effects thus caused polydipsia and polyuria
Where does ADH act in the kidney tubules
Collecting duct via Aquaporin 2 channels
Should the specific gravity of urine be higher or lower than normal after being water deprived
Higher
ESA’s side effects
hypertension and increased risk for thromboembolic events due to increased blood viscosity
How can albuterol (beta2 agonist), sympathomimetics, and insulin cause hypokalemia
They all stimulate the Sodium-potassium pump which causes potassium to shift intracellularly.
