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UworldSUN > Urinary > Flashcards

Urinary Flashcards

1
Q

explain primary, secondary, tertiary hyperparathyroidism

A

1- PTH production independent of Ca/PO4 levels. 2- in CKD, PO4 excretion is inhibited and Vit D doesn’t work properly, so increasd PTH. 3- chronic stimulation of PTH leads to PTH secretion independent of Ca levels

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2
Q

45 yo man with transplant 4 years ago, small kidney on ultrasound, having episode of hypertension, what would biopsy show, and what are 3 stages of rejection?

A

chronic rejection (humoral) showing obliterative vascular fibrosis, due to thickening of wall and fibrosis of interstitium, parenchymal atrophy. hyperacute is fibrinoid necrosis and thrombotic occlusion, acute is less than 6 months, showing monocytic infiltration and cell-mediated

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3
Q

describe graph of glucose, PAH, inulin, creatinine, urea

A

inulin and creatinine- filtered only, glucose-filtered and reabsorbed until maximum reabsorption point. PAH- filtered and secreted (RPF), urea- partial reabsorbed and filtered

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4
Q

man travels to africa comes back with hematuria, and thickened bladder wall

A

schistosomiasis haematobium, found in snails, embeds in bladder wall and can cause hydronephrosis and SCC

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5
Q

post-transplant immunosuppresant, what drug blocks directly the IL-2 production?

A

sirolimus

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6
Q

man treated for leukemia develops oliguria and multiple uric acid crystals in renal tubular lumen, dx and why does it happen?

A

uric acid precipitation in collecting ducts due to low pH, in tumor lysis syndrome

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7
Q

how does prerenal ARF affect urine osmolality, urine sodium, FENa, Serum BUN/Cr?

A

high, less than 20, low, high

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8
Q

VHL syndrome and on what chromosome?

A

HARP- hemangiosarcoma, angiosarcoma, RCC, Pheo, 3p

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9
Q

12 yo girl with hypertension and recurrent fever and abdo pain. U/S shows dilated renal calyces and cortical atrophy in upper and lower poles, why?

A

repeated episodes of pyelo due to vesicoureteral reflux. compound papillae (fused) are found in upper and lower poles, so vulnerable to reflux damage. loss of nephrons can lead to HTN

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10
Q

older patient with renal bruit comes with hypertension and is treated with ramipril. then 3 weeks later BP has lowered but creatinine rose. why?

A

ACE-i inhibits angiotensin II, but it also relaxes the efferent arterioles so that GFR can drop and creatinine can increase!

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11
Q

patient with renal transplant takes prednisone, cyclosporine, and motefil, then gets gout, what is mechanism

A

cyclosporine constricts afferent arteriole, commonly implicated in gout attack in renal transplant patients due to inadequate excretion of uric acid

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12
Q

DKA patient, what is urine HCO3, pH and H2PO4

A

low low high

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13
Q

63 yo man having cramping and muscle weakness, after taking amlodipine and cholthalidone. what is the electrolyte abnormality?

A

hypokalemia- thiazide diuretics activate RAAS, increasing K secretion

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14
Q

renal artery stenosis of pig (experiment) causes what findings?

A

hyperplasia of modifed smooth muscle cells of afferent arteriole, which are JG cells- part of JG apparatus (lacis, macula densa (in the DCT) and JG cells) JG cells secrete renin

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15
Q

calcium oxalate calculi patients, has what finding?

A

lower urinary citrate. citrate usally binds Ca, preventing it from binding oxalate

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16
Q

how to calculate filtration fraction given urine and serum concentrations of stuff and urine flow rate of 1?

A

clearance of inulin/creatinine is GFR, clearance of PAH is RPF. GFR/RPF equals FF

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17
Q

3 wk old boy with straw colored discharge from umbilicus, and umbilical hernia

A

patent urachus (allantois remnant). poo is omphalomesenteric (vitelline)

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18
Q

graph of renal blood flow and GFR, what is FF?

A

1-hematocrit is the RPF, so GFR over RPF is FF

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19
Q

massive albuminura in kid after mild infection, what is dx, reason for proteinuria?

A

minimal change disease, loss of anionic properties of GBM

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20
Q

T1DM patient with urinary incontinence, hesitancy, nocturia. what is mechanism?

A

overflow incontinence, detrusor instability, increased post void urinary volume

21
Q

patietn with ischemic colitis and HAGMA, what amino acid is important in acid excretion?

A

glutamine (renal ammoniagenesis) involves converting glutamine to glutamate, which is tehn made into ammonium and bicarb

22
Q

fat guy who has dyspnea and chronic lower extremity swelling, pHTN, admitted then raised creatinine, increased hemoglobin, normal blood sugar/blood pressure, BUN is high, dx?

A

diuretic administration

23
Q

CVRF, older man with HTN, CT scan shows unequal kidnes, dx?

A

RAS

24
Q

rhabdomyolysis leads to what and what do you see?

A

ATN, brown granular casts

25
Q

17 yo boy, hematuria 3 days after illness, some proteinuria, dx?

A

IgA nephropathy

26
Q

how does constricting efferent arteriole affect FF?

A

GFR increases, RPF decreases, so FF increases

27
Q

what does spironolactone do?

A

binds to aldosterone receptor (competitive inhibitor) and decreases sodium reabsorption, decreasepotassium and hydrogen secretion in the collecting ducts

28
Q

ACEi effect on bradykinin?

A

increase, causing cough

29
Q

fetus shows unilateral hydronephrosis, cause?

A

ureteropelvic junction not canalizing properly from uretric bud and metanephric blastema

30
Q

patient with flank pain, hypertension, fever, hematuria and AF and sleep apnea, yellow white well demarcated areas on renal biopsy, with areas of hyperemia, dx?

A

renal wedge infarction

31
Q

stress urge overflow, what’s the difference?

A

stress- pelvic floor,sphincter dysfunction, pressure. urge- detrusor overactivity, sudden urge. overflow- incomplete emptying detrusor hypoactivity, diabetes, obstruction

32
Q

lysine, cysteine, ornithine, arginine cannot be absorbed in GI and Kidneys, what does this cause?

A

cysteine stones

33
Q

what is calcitrol?

A

1,25-dihydroxyvitamin D (more active form). converted from 25-hydroxyvitamin D

34
Q

how does beta blockers affect the RAAS system?

A

synergistic effect with B1 blocker of the heart. there are B1 receptors on the JGA, and so Bb prevent renin release

35
Q

woman with weakness lethargy, GI symptoms, LOW, smoker, hypercalcemia, lung shows mass. what is causing the hypercalcemia?, what type of Lung CA is this?

A

PTHrP- humoral hypercalcemia of malignancy caused by the PTHrP released by squamous cell CA of lung

36
Q

bipolar patient on medication, why thirsty and frequent urination?

A

lithium blocks ADH (vasopressin) in the collecting ducts, causing peripheral DI

37
Q

young woman dead after severe headache, had intracranial hemorrhage, autopsy shows tortuous carotid arteries lacking internal elastic lamina and alternating areas of fibrotic webs and aneurysmal dilation, string of beads appearance, what is dx and associated finding?

A

FMD, RAS

38
Q

uracil is found from bacterial DNA, what enzyme made this?

A

primase

39
Q

which diuretics cause hypercalcemia and how?

A

thiazide, by dereasing NaCl reabsorption, decreases [Na] in the cell, increasing Na /Ca exchanger activity at the basolateral side

40
Q

guy in accident gets blood trnasfusion then develops fever, chest/back pain, chills, breathlessness and dark urine. what is happening?

A

acute transfusion reaction caused by type 2 hypersensitivity, anti-ABO antibodies attacking the donor RBC, which then leads to complement activation and cell lysis

41
Q

PAH extraction ratio (arterial PAH -Venous PAH) /arterialPAH) is 90% until a certain PAH concentration then extraction ratio decreases, why?

A

carrier transport is reached. PAH is filtered and secreted. filtration cannot be saturated but secretion happens in PCT so it can

42
Q

transplanted kidney and proximal ureter, and the distal part has ischemia later. what is the blood supply of health ureter?

A

renal artery because transplanted kidney and ureter is supplied by renal artery anastamosed with external iliac. distal ureter ischemia is a common complication in the transplant

43
Q

what does ADH do in contributing to a high medullary concentration gradient?

A

increasing absorption of urea that is concentrated after aquaporin channels are inserted, in the medullary portion of collecting duct

44
Q

right renal artery clip, what do you see as a result?

A

increase in sodium excretion in the unaffected kidney due to pressure natriuresis (hypertension caused by angiotensin 2). Aldosterone yes is also released but recall that it is only responsible for 2% of the reabsorption of sodium

45
Q

urge incontinence, what drug and how?

A

oxybutinin, anti-muscarinic, prevents contraction of detrusor

46
Q

50yo man with flank pain, abdo fullness and LOW, grossly shows spherical mass yellow in the kidney, dx and where does it arise from?

A

RCC from the proximal tubules

47
Q

woman with fluid overload presents with hearing problems, dx?

A

loop diuretic can cause ototoxicity

48
Q

man with PCKD presents with deep constant pain in extremities, calcium is low. what do you expect phosphate and PTH and calcitriol levels to be?

A

high, high, low

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