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401 Cards in this Set
- Front
- Back
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Why is the left kidney rather than the right one harvested for transplantation?
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Because the left kidney has a longer renal vein
2010-456 |
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Ureters pass _____ (over/under) the uterine artery and the ductus deferens.
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Under (remember: "water [ureters] under the bridge [artery and ductus deferens]")
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What substance is used to measure plasma volume?
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Radiolabeled albumin
2010-457 |
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What substance is used to measure extracellular volume?
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Inulin
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What fraction of total body water is extracellular vs intracellular fluid?
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One third extracellular fluid, two thirds intracellular fluid
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Nonwater mass comprises _____% of total body weight (in kilograms), while total body water (in liters) makes up _____% of total body weight.
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40% nonwater mass; 60% total body water
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Extracellular fluid consists of _____ (high/low) sodium chloride and _____ (high/low) potassium, whereas intracellular fluid consists of _____ (high/low) sodium chloride and _____ (high/low) potassium.
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High; low; low; high (remember: HIKIN': HIgh K INtracellular)
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What fraction of the extracellular fluid is plasma volume vs interstitial volume?
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One fourth plasma volume, three fourths interstitial volume
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What is the 60-40-20 rule of body weight?
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60% of total body weight is made up of total body water, 40% is made up of intracellular fluid, and 20% is made up of extracellular fluid
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What is the normal value for plasma osmolarity?
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290 mOsm
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The fenestrated capillary endothelium of the glomerular filtration barrier is responsible for the filtration of plasma by what characteristic, size or charge?
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Size
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Albuminuria, hypoproteinemia, generalized edema, and hyperlipidemia are hallmarks of what syndrome?
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Nephrotic syndrome; resulting from loss of the charge barrier in the glomeruli
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What are the two characteristics on which the glomerular barrier bases plasma filtration?
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Size and net charge of plasma molecules
2010-457 |
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What are the three components of the glomerular filtration barrier?
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Fenestrated capillary endothelium (size barrier), fused basement membrane with heparan sulfate (negative charge barrier), and epithelial layer that consists of podocyte foot processes
2010-457 |
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What kind of charge does heparan sulfate have?
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Negative; as a result, negatively charged proteins are kept in plasma
2010-457 |
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The epithelial layer of the glomerular filtration barrier is formed by which cells?
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Podocyte foot processes
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The fused basement membrane of the glomerulus containing heparan sulfate is responsible for the filtration of plasma molecules by which characteristic, size or charge?
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Net charge
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If renal clearance is less than the glomerular filtration rate of substance x, then there is net tubular _____ (reabsorption/secretion) of x.
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Reabsorption
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If renal clearance is greater than the glomerular filtration rate of substance x, then there is a net tubular _____ (reabsorption/secretion) of x.
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Secretion
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What is the formula for calculating the clearance of substance x, the volume of plasma from which the substance is cleared completely per unit of time?
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Renal clearance of x = the urine concentration of x times the urine flow rate divided by the plasma concentration of x (Cx = Ux × V/Px)
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Creatinine clearance slightly _____ (overestimates/underestimates) the glomerular filtration rate because creatinine is _____ (secreted/reabsorbed) by the renal tubules.
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Overestimates; secreted; the plasma concentration of creatinine is slightly lower than it would be from filtration alone
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What exogenous substance can be used to calculate the glomerular filtration rate and why?
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Inulin, because it is freely filtered and is neither reabsorbed nor secreted
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Clearance of what endogenous substance approximates glomerular filtration rate?
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Creatine
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What is the formula for calculating the glomerular filtration rate that relates glomerular capillary and Bowman's space pressures?
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Glomerular filtration rate = Kf [(Pgc - Pbs) - (πgc - πbs)]; where Kf is the filtration constant; Pgc is glomerular capillary pressure; Pbs is Bowman's space pressure; πgc is glomerular capillary colloid osmotic pressure; and πbs is Bowman's space colloid osmotic pressure (normally close to a value of 0)
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What is the value of normal glomerular filtration rate?
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Approximately 100 mL/min
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How is the glomerular filtration rate calculated if inulin is used?
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Glomerular filtration rate = the urine concentration of inulin times the urine flow rate divided by the plasma inulin concentration (Uinulin × V/Pinulin)
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The clearance of what substance is used to estimate renal plasma flow?
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Para-aminohippurate
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Why is para-aminohippurate used to estimate renal plasma flow?
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Para-aminohippurate is actively secreted from the proximal tubule into the urine; the concentration of para-aminohippurate in the renal vein is zero
2010-457 |
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What is the formula for estimating renal blood flow if renal plasma flow is known?
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Renal blood flow = renal plasma flow divided by (1 - the hematocrit), or RBF = RPF/(1 - Hct); in a normal individual, renal blood flow will be approximately double the renal plasma flow
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What is the formula for estimating the effective renal plasma flow using para-aminohippuric acid?
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Effective renal plasma flow = urine concentration of para-aminohippuric acid times the urine flow rate divided by the plasma concentration of para-aminohippuric acid (UPAH × V/PPAH)
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Effective renal plasma flow _____ (over-/under-) estimates true renal plasma flow by approximately _____%.
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Under; 10; it is an underestimate because 10% of renal blood flow perfuses the kidney parenchyma rather than being filtered through the glomerulus
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Angiotensin II causes a(n) _____ (decrease/increase) in renal plasma flow, a(n) _____ (decrease/increase) in glomerular filtration rate, and a _____ (constant/decreased/increased) filtration fraction.
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Decrease; increase; increased
2010-458 |
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What are the effects of prostaglandins on the glomerulus?
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Prostaglandins cause dilation of the afferent arteriole and an increased glomerular filtration rate
2010-458 |
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What type of drug blocks the effect of angiotensin II on the efferent arteriole?
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Angiotensin-converting enzyme inhibitors
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Prostaglandins cause a(n) _____ (decrease/increase) in renal plasma flow, a(n) _____ (decrease/increase) in glomerular filtration rate, and a _____ (constant/decreased/increased) filtration fraction.
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Increase; increase; constant
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What is the path of blood flow leading to the afferent arteriole?
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Renal artery to interlobar artery to interlobular artery to afferent arteriole
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What is the path of vasculature coming from the efferent arteriole?
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Efferent arteriole to vasa recta to interlobular vein to interlobar vein to renal vein
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What are the effects of angiotensin II on the glomerulus?
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Angiotensin II causes constriction of the efferent arteriole and increased glomerular filtration rate
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In terms of filtration in the glomerulus, the filtered load is equal to the glomerular filtration rate multiplied by what?
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The plasma concentration
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How is the filtration fraction for a molecule determined?
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By determining the ratio of the glomerular filtration rate to renal plasma flow
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What type of drug blocks the effect of prostaglandins on the afferent arteriole?
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Nonsteroidal antiinflammatory drugs
2010-458 |
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Decreased plasma protein concentration causes _____ (decrease/increase/no change) in renal plasma flow and _____ (decrease/increase/no change) in glomerular filtration rate, which in turn results in _____ (decrease/increase/no change) in the filtration fraction.
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No change; increase; increase
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Increased plasma protein concentration causes _____ (decrease/increase/no change) in renal plasma flow and _____ (decrease/increase/no change) in glomerular filtration rate, which in turn results in _____ (decrease/increase/no change) in the filtration fraction.
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No change; decrease; decrease
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Constriction of the afferent arteriole causes _____ (decrease/increase/no change) in renal plasma flow and _____ (decrease/increase/no change) in glomerular filtration rate, which in turn results in _____ (decrease/increase/no change) in the filtration fraction.
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Decrease; decrease; no change
2010-458 |
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Constriction of the efferent arteriole causes _____ (decrease/increase/no change) in renal plasma flow and _____ (decrease/increase/no change) in glomerular filtration rate, which in turn results in _____ (decrease/increase/no change) in the filtration fraction.
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Decrease; increase; increase
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Constriction of the ureter causes _____ (decrease/increase/no change) in renal plasma flow and _____ (decrease/increase/no change) in glomerular filtration rate, which in turn results in _____ (decrease/increase/no change) in the filtration fraction.
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No change; decrease; decrease
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How is free water clearance calculated?
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Free water clearance = urine flow rate minus the osmolar clearance (V - Cosm)
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In the presence of antidiuretic hormone, free water clearance is _____ (greater than/less than/equal to) zero.
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Less than (water is retained)
2010-458 |
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What is free water clearance?
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A measure of the kidney's ability to dilute urine
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As part of the free water clearance calculation, how is the total clearance of osmoles calculated?
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Osmolar clearance = urine osmolarity times the urine flow rate divided by plasma osmolarity (Cosm = Uosm V/Posm)
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What is the free water clearance equal to in isotonic urine?
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Zero; isotonic urine is seen with use of loop diuretics
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In the absence of antidiuretic hormone, free water clearance is _____ (greater than/less than/equal to) zero.
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Greater than; the body has net loss of water relative to osmoles
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What is the formula for the amount of a substance secreted by the kidneys?
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Secretion = excreted - filtered
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What is the formula for the amount of a substance reabsorbed in the kidneys?
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Reabsorption = filtered - excreted
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What is the formula for excretion rate?
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Excretion rate = V × Ux; where V is the urine flow rate and Ux is the urine concentration of x
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What is the formula for filtered load?
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Filtered load = glomerular filtration rate × Px; where Px is the plasma concentration of x
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At what concentration of plasma glucose is the transport mechanism of the proximal tubule completely saturated?
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350 mg/dL
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Glucosuria is an important clinical clue to what condition?
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Diabetes mellitus
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At normal plasma glucose concentrations, how does the proximal tubule handle glucose in the urine?
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Glucose is completely reabsorbed from the urine
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In the nephron, glucose at normal plasma concentrations is reabsorbed in which structure? By which transporter?
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Glucose is reabsorbed in the proximal tubule by sodium/glucose cotransport
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When plasma glucose levels exceed 200 mg/dL, what finding may result on urinalysis?
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Glucosuria; due to inability of the glucose reabsorption mechanism of the proximal tubule to deal with the filtered load of urine glucose
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What is Hartnup's disease?
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Deficiency of neutral amino acid (tryptophan) transporter, resulting in pellagra due to niacin deficiency
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How and where are amino acids reabsorbed in the kidney?
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Amino acids are filtered and then reabsorbed from the urine at the level of the proximal tubule by three distinct sodium-dependent transporters with competitive inhibition within each group
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Is the thick ascending limb of the loop of Henle a concentrating or a diluting segment?
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Diluting
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Sodium/potassium exchange and sodium/hydrogen exchange in the collecting tubule of a kidney nephron is regulated by which hormone?
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Aldosterone
2010-459 |
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In the thick ascending loop of Henle of a kidney nephron, which two ions are indirectly reabsorbed as a result of the active reabsorption of sodium, potassium, and chloride?
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Magnesium and calcium
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Which three ions are actively reabsorbed in the thick ascending loop of Henle of a kidney nephron?
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Sodium, potassium, and chloride
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Does the thin descending loop of Henle reabsorb water passively or actively?
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Passively
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Is the reabsorption in the early proximal tubule hypertonic, isotonic, or hypotonic?
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Isotonic
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In the collecting tubule of a kidney nephron, which ion is reabsorbed in exchange for secreting potassium or hydrogen ion?
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Sodium
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Which segment of the kidney nephron does the hormone antidiuretic hormone (vasopressin) act on?
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The collecting tubules
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Which hormone controls the reabsorption of calcium in the early distal convoluted tubule of a kidney nephron?
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Parathyroid hormone
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Does the early distal convoluted tubule make the urine hypotonic, isotonic, or hypertonic?
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Hypotonic
2010-459 |
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The reabsorption of water in the collecting tubule of a kidney nephron is regulated by which hormone?
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Antidiuretic hormone (vasopressin)
2010-459 |
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What does angiotensin II do in the early proximal convoluted tubule?
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Angiotensin II stimulates the sodium/hydrogen ion exchange, causing increased sodium and water reabsorption, thereby permitting contraction alkalosis
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What type of cell in the collecting tubule of a kidney nephron is responsible for sodium/potassium exchange and the reabsorption of water?
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The principal cell
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What two ions are actively reabsorbed in the early distal convoluted tubule of a kidney nephron?
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Sodium and chloride
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Which segment of the kidney nephron does the hormone aldosterone act on?
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The collecting tubules
2010-459 |
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The thin descending loop of Henle is _____ (impermeable/permeable) to water, whereas the thick ascending loop of Henle is _____ (impermeable/permeable) to water.
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Permeable; impermeable
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Does the thick ascending limb of the loop of Henle make the urine hypotonic, isotonic, or hypertonic?
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Hypotonic
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The thin descending loop of Henle in a kidney nephron is permeable to _____ (sodium/water) but not to _____ (sodium/water).
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Water; sodium
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Does the thin descending loop of Henle make the urine in the tubule hypertonic, isotonic, or hypotonic?
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Hypertonic
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What substances are reabsorbed in the early proximal convoluted tubule?
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Glucose, amino acids, bicarbonate, sodium, chloride, and water
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What substance is secreted into the lumen of the early proximal convoluted tubule of the kidney nephron and acts as a buffer for hydrogen ions?
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Ammonia
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Antidiuretic hormone action at V2 receptors results in what action?
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Insertion of aquaporin water channels on the luminal side of the collecting tubules resulting in increased water reabsorption
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Is the early distal convoluted tubule a concentrating or a diluting segment?
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Diluting
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In the thin descending loop of Henle, water is passively reabsorbed, because the tonicity of the medulla is _____.
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Hypertonic
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On what type of cell in the collecting tubule of a kidney nephron is the vasopressin receptor of the V2 type located?
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The principal cell
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How does parathyroid hormone increase phosphate excretion in the kidney?
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It inhibits Na+/phosphate cotransport in the proximal tubule
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Along the length of the proximal tubule, does the relative concentration of chloride increase, decrease, or stay the same?
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Increases; chloride is reabsorbed distally in the nephron
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The concentration of amino acids in urine along the length of the proximal tubule decreases; therefore, there is _____ (net reabsorption/net secretion/balanced reabsorption and secretion).
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Net reabsorption; amino acids are entirely reabsorbed within the proximal tubule
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The concentration of sodium ion along the length of the proximal tubule remains constant; therefore, there is _____ (net reabsorption/net secretion/balanced reabsorption and secretion).
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Net reabsorption
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Reabsorption of which electrolyte drives water reabsorption, thus nearly matching total osmolarity throughout the length of the proximal tubule?
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Sodium
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Which exogenous substance filtered at the glomerulus quickly increases in concentration along the proximal tubule because there is net secretion?
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Para-aminohippurate
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The ratio of solute concentration in the tubular fluid vs plasma (TF/P) can indicate the level of secretion or reabsorption of that solute along the proximal renal tubule. Because the TF/P ratio of chloride, potassium, sodium, phosphate, bicarbonate, amino acids, and glucose is less than that of inulin, there is net _____ (reabsorption/secretion) along the proximal tubule.
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Reabsorption
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The ratio of solute concentration in the tubular fluid vs plasma (TF/P) can indicate the level of secretion or reabsorption of that solute along the proximal renal tubule. If the TF/P ratio of that solute is less than that of inulin, there is net _____ (reabsorption/secretion) along the proximal tubule.
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Reabsorption
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Along the length of the proximal tubule, does the concentration of inulin increase, decrease, or stay the same as water is reabsorbed?
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Increases, because there is no net secretion or reabsorption of inulin
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The concentration of bicarbonate along the length of the proximal tubule decreases; therefore, there is _____ (net reabsorption/net secretion/balanced reabsorption and secretion).
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Net reabsorption; bicarbonate is reabsorbed more avidly than most other ions
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Angiotensin I is cleaved to angiotensin II by what enzyme?
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Angiotensin-converting enzyme; the reaction occurs in the lungs
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What stimulates the macula densa of the nephron leading to release of renin?
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Decreased sodium delivery to the macula densa cells
2010-460 |
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What is the name of the cell type that produces renin in the kidney?
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Juxtaglomerular cells
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Juxtaglomerular apparatus cells are modified cells of what type?
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Smooth muscle
2010-460 |
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When blood pressure drops, what proteolytic enzyme is released by the kidneys?
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Renin
2010-460 |
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What is the site of action of angiotensin-converting enzyme?
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The lungs
2010-460 |
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What hormone, which is released from the atria, may act as a "check" on the renin-angiotensin system to prevent volume overload?
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Atrial natriuretic peptide
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What is the physiologic function of renin?
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Renin cleaves angiotensinogen from the liver into angiotensin I
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Antidiuretic hormone primarily regulates _____ (osmolarity/blood volume), while aldosterone primarily regulates _____ (osmolarity/blood volume). However, in _____ (low/high) volume states, both antidiuretic hormone and aldosterone act to protect _____ (osmolarity/blood volume).
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Osmolarity; blood volume; low; blood volume
2010-460 |
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What are the effects of aldosterone secretion?
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Aldosterone secretion from the adrenal cortex increases sodium channel and sodium/potassium pump insertion in principal cells and enhances potassium and hydrogen excretion by upregulating potassium channels in the principal cells and hydrogen ion channels in the intercalated cells. These actions create a favorable gradient for sodium and water reabsorption
2010-460 |
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Which hormone in the renin-angiotensin-aldosterone system alters baroreceptor response to prevent reflex bradycardia?
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Angiotensin II; otherwise, the increase in blood pressure caused by angiotensin II would lead to a slower heart rate
2010-460 |
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One action of angiotensin II is to stimulate the release of aldosterone from which organ?
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The adrenal cortex
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One action of angiotensin II is to stimulate the release of antidiuretic hormone from which gland?
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The posterior pituitary
2010-460 |
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What five actions of angiotensin II serve to increase intravascular volume and blood pressure?
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Vasoconstriction, stimulation of sodium resorption in the proximal tubule, the release of aldosterone from the adrenal cortex, the release of antidiuretic hormone from the posterior pituitary, and the stimulation of thirst via the hypothalamus
2010-460 |
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Atrial natriuretic peptide _____ (decreases/increases) renin secretion and _____ (decreases/increases) the glomerular filtration rate.
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Decreases; increases
2010-460 |
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What are the results of renin release by the juxtaglomerular cells?
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Angiotensin II and aldosterone levels increase, leading to increased circulating volume and blood pressure
2010-461 |
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Juxtaglomerular cells, which are components of the juxtaglomerular apparatus, are modified smooth muscle cells of what arteriole of the glomerular vasculature?
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The afferent arteriole
2010-461 |
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By what mechanism does the juxtaglomerular apparatus maintain and regulate the glomerular filtration rate?
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Via the renin-angiotensin system
2010-461 |
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What are three triggers of renin release by the juxtaglomerular cells?
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Decrease in renal blood pressure, decrease in sodium delivery to the distal tubule, and increase in sympathetic tone
2010-461 |
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The macula densa, which is a component of the juxtaglomerular apparatus, senses levels of which ion?
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Sodium
2010-461 |
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What two components are part of the juxtaglomerular apparatus of the kidney?
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Juxtaglomerular cells and macula densa
2010-461 |
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The macula densa, which is a component of the juxtaglomerular apparatus, is part of what section of the kidney nephron?
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The distal convoluted tubule
2010-461 |
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What are the direct and indirect effects of parathyroid hormone on the kidneys?
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Parathyroid hormone directly acts on the kidney to increase renal calcium reabsorption and decrease renal phosphate reabsorption; it acts indirectly by stimulating the proximal tubule cells to make 1,25(OH)2 vitamin D, which increases the intestinal absorption of both calcium and phosphate
2010-461 |
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What enzyme is released by the juxtaglomerular cells in response to decreased renal arterial pressure and increased renal sympathetic discharge (β1 effect)?
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Renin
2010-461 |
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Name four key hormones/enzymes released by the kidney that contribute to its endocrine function.
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Erythropoietin, 1α-hydroxylase, renin, and prostaglandins
2010-461 |
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What effect do prostaglandins have on glomerular filtration rate?
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They increase glomerular filtration rate by dilating the afferent arteriole
2010-461 |
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What class of drugs can cause acute renal failure by inhibiting the renal production of prostaglandins?
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Nonsteroidal antiinflammatory drugs
2010-461 |
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What is the effect of nonsteroidal antiinflammatory drugs on the afferent arteriole of the kidney glomerulus?
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Prevention of the vasodilation of the afferent arteriole by prostaglandins, reducing the glomerular filtration rate
2010-461 |
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What enzyme from the kidney is activated by parathyroid hormone and what is the function of that enzyme?
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1α-Hydroxylase, which converts 25-OH vitamin D to 1,25(OH)2 vitamin D
2010-461 |
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What hormone is released by the endothelial cells of renal peritubular capillaries in response to hypoxia?
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Erythropoietin
2010-461 |
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Which vitamin does parathyroid hormone stimulate conversion of to an active form and what is the effect of this vitamin on the gut?
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1,25(OH)2 vitamin D, which increases both calcium and PO43- absorption from the gut
2010-462 |
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On what segment of the kidney nephron does aldosterone exert its effects?
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The distal convoluted tubule
2010-462 |
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What is the effect of atrial natriuretic peptide on the kidney's glomerular filtration rate and sodium excretion?
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It increases both the glomerular filtration rate and sodium filtration, with no compensatory sodium reabsorption in the distal nephron to lower volume
2010-462 |
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What are the effects of aldosterone on the kidney?
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Aldosterone increases sodium reabsorption, indirectly increases potassium secretion, and increases hydrogen ion secretion
2010-462 |
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Parathyroid hormone increases serum calcium levels by acting on which two target organs?
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Kidney and bone
2010-462 |
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Which cells of the collecting tubules have antidiuretic hormone receptors?
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The principal cells
2010-462 |
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What effect does antidiuretic hormone have on the number of water channels and thus reabsorption of water in the collecting tubule of a kidney nephron?
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Antidiuretic hormone increases the number of water channels and thus increases water reabsorption
2010-462 |
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How does angiotensin II help to decrease additional volume loss in low-volume states?
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By increasing glomerular filtration rate and filtration fraction, via constriction of the efferent arteriole, while simultaneously increasing sodium reabsorption proximally and distally
2010-462 |
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On what segments of the kidney nephron does parathyroid hormone exert its effects?
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The proximal and distal convoluted tubules, increasing calcium reabsorption and phosphate secretion
2010-462 |
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What hormone is secreted by the pituitary in response to increased plasma osmolarity?
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Antidiuretic hormone (vasopressin)
2010-462 |
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Which hormone is secreted by the adrenal cortex in response to decreased blood volume (via angiotensin II) and increased plasma potassium?
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Aldosterone
2010-462 |
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Which hormone is secreted by the parathyroid gland in response to a decrease in plasma calcium?
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Parathyroid hormone
2010-462 |
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What is the effect of angiotensin II on the glomerular filtration rate and thus the filtration fraction?
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Angiotensin II increases the glomerular filtration rate and filtration fraction by increasing the vasoconstriction of the efferent arteriole; there is a compensatory increase in sodium reabsorption in the proximal and distal nephron
2010-462 |
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By what mechanism does digitalis cause hyperkalemia?
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Digitalis blocks the sodium-potassium adenosine triphosphatase pump from pumping potassium into the cell in exchange for sodium, thus leaving the potassium outside of the cell
2010-462 |
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By what mechanism does acidosis or alkalosis cause potassium shifts out of or into the cell, respectively?
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Changes in pH alter the activity of the K+/H+ exchanger; in acidosis (high H+ concentration), H+ is sequestered in cells in exchange for K+, increasing serum K+ concentrations; the opposite occurs with alkalosis
2010-462 |
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Name six things that can cause hyperkalemia by causing a shift of potassium out of cells.
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Insulin deficiency, β-blockers, acidosis, hyperosmolarity, digitalis, and cell lysis
2010-462 |
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By what mechanism does stimulation of the β-adrenergic system cause hypokalemia?
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By stimulating the sodium-potassium adenosine triphosphatase pump to pump potassium into the cell in exchange for sodium out of the cell
2010-462 |
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By what mechanism does insulin cause potassium shifts across cellular membranes?
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Insulin stimulates the sodium-potassium adenosine triphosphatase pump to pump potassium into the cell in exchange for sodium out of the cell
2010-462 |
|
|
Name four things that can cause hypokalemia by causing a shift of potassium into cells.
|
Insulin, β-agonists, alkalosis, and hypo-osmolarity
2010-462 |
|
|
What is the primary electrolyte disturbance in respiratory alkalosis?
|
Decreased partial pressure of carbon dioxide
2010-463 |
|
|
In the state of respiratory acidosis, the renal compensatory response has what effect on serum bicarbonate?
|
Bicarbonate levels increase in serum
2010-463 |
|
|
What is the primary electrolyte disturbance in respiratory acidosis?
|
Increased partial pressure of carbon dioxide
2010-463 |
|
|
Using the Henderson-Hasselbach equation, what can be calculated if bicarbonate and partial pressure of carbon dioxide are known?
|
pH, because pH = pKa + log (bicarbonate / [0.03] partial pressure of carbon dioxide)
2010-463 |
|
|
What is the compensatory respiratory response to metabolic acidosis and in what direction does partial pressure of carbon dioxide change?
|
Hyperventilation, which causes the partial pressure of carbon dioxide to decrease
2010-463 |
|
|
What is the primary electrolyte disturbance in metabolic alkalosis?
|
Increased serum bicarbonate
2010-463 |
|
|
To compensate, PCO2 _____ (decreases/increases) by _____ mmHg for every 1 mEq/L increase in HCO3-.
|
Increases; 0.7; 1
2010-463 |
|
|
What is the compensatory respiratory response to metabolic alkalosis and in what direction does partial pressure of carbon dioxide change?
|
Hypoventilation, which causes the partial pressure of carbon dioxide to increase
2010-463 |
|
|
In metabolic acidosis, a reduction in bicarbonate is the primary disturbance. How is the expected compensatory change in partial pressure of carbon dioxide calculated?
|
Winter's formula: partial pressure of carbon dioxide = 1.5(bicarbonate) + 8 ± 2
2010-463 |
|
|
What is the primary electrolyte disturbance in metabolic acidosis?
|
Decreased serum bicarbonate
2010-463 |
|
|
In the state of respiratory alkalosis, in what direction does bicarbonate change as a result of a compensatory response?
|
Bicarbonate decreases
2010-463 |
|
|
What primary acid-base disturbance is present when the arterial pH is <7.4 and the partial pressure of carbon dioxide level is <40 mmHg?
|
Metabolic acidosis
2010-463 |
|
|
If the arterial pH is > 7.5 and the partial pressure of carbon dioxide is > 40 mmHg, which acid/base compensatory mechanism is in use?
|
Respiratory compensation (hypoventilation to increase carbon dioxide)
2010-463 |
|
|
What type of acid-base disturbance does aspirin overdose initially lead to? As the aspirin is metabolized, what type of acid-base disturbance does it become?
|
Respiratory alkalosis initially, then metabolic acidosis
2010-463 |
|
|
What is the formula for calculating the anion gap?
|
Anion gap = sodium - (chloride + bicarbonate)
2010-463 |
|
|
What primary acid-base disturbance is present when the arterial pH is <7.4 and the partial pressure of carbon dioxide level is >40 mmHg?
|
Respiratory acidosis
2010-463 |
|
|
What is the differential diagnosis for a non-anion gap metabolic acidosis?
|
Diarrhea, glue sniffing, renal tubular acidosis, and hyperchloremia
2010-463 |
|
|
What primary acid-base disturbance is present when the arterial pH is > 7.4 and the partial pressure of carbon dioxide level is<40 mmHg?
|
Respiratory alkalosis
2010-463 |
|
|
Hyperventilation, seen early in high-altitude exposure, can lead to a _____ (respiratory/metabolic) _____ (acidosis/alkalosis).
|
Respiratory, alkalosis
2010-463 |
|
|
Hypoventilation can lead to which state of acid-base imbalance?
|
Respiratory acidosis
2010-463 |
|
|
What are the possible causes of metabolic acidosis with an anion gap?
|
Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde/phenformin, Iron tablets/Isoniazid, Lactic acidosis, Ethylene glycol, and Salicylates (remember: MUD PILES)
2010-463 |
|
|
What is the primary acid-base disturbance when the arterial pH is > 7.4 and the partial pressure of carbon dioxide level is > 40 mmHg?
|
Metabolic alkalosis
2010-463 |
|
|
What are four causes of metabolic alkalosis?
|
Vomiting, diuretic or antacid use, and hyperaldosteronism
2010-463 |
|
|
Acidemia is defined by an arterial pH value that is _____ (greater than/less than/equal to) 7.4, and alkalemia is defined by an arterial pH value that is _____ (greater than/less than/equal to) 7.4.
|
Less than; greater than
2010-463 |
|
|
A normal anion gap falls into what range of values?
|
8-12 mEq/L
2010-463 |
|
|
What mechanisms or disease states can lead to respiratory acidosis?
|
Airway obstruction, acute or chronic lung disease, opioids, narcotics, sedatives, and the weakening of respiratory muscles
2010-463 |
|
|
Which type of renal tubular acidosis is characterized by a defect in the hydrogen pump, type 1, 2, or 4?
|
Type 1
2010-464 |
|
|
Which two types of renal tubular acidosis are associated with hypokalemia?
|
Type 1 and type 2
2010-464 |
|
|
In type 1 renal tubular acidosis, there is a defect in the hydrogen ion pump, leading to a failure to _____ (acidify/alkalinize) urine.
|
Acidify; as a result, the body's pH decreases
2010-464 |
|
|
Which type of renal tubular acidosis is characterized by the inhibition of ammonia excretion, type 1, 2, or 4?
|
Type 4
2010-464 |
|
|
In type 2 renal tubular acidosis, there is a failure to reabsorb _____.
|
Bicarbonate
2010-464 |
|
|
Which type of renal tubular acidosis is a defect of the collecting tubules?
|
Type 1; the collecting tubules cannot secrete H+ ions
2010-464 |
|
|
In type 4 renal tubular acidosis, there is hypoaldosteronism leading to hyperkalemia, which causes inhibition of _____ excretion.
|
Ammonia
2010-464 |
|
|
Which type of renal tubular acidosis is characterized by renal loss of bicarbonate, type 1, 2, or 4?
|
Type 2
2010-464 |
|
|
If a patient has a pH of 7.40, a plasma bicarbonate of 32, and a partial pressure of carbon dioxide of 48, that patient has a _____ (compensated/uncompensated) metabolic _____ (acidosis/alkalosis).
|
Compensated; alkalosis
2010-464 |
|
|
If a patient had high blood pH, a high plasma bicarbonate level, and a low blood hydrogen ion level, what acid-base disturbance would be present?
|
Metabolic alkalosis
2010-464 |
|
|
If a patient had a low blood pH, a slightly elevated plasma bicarbonate level, and a high blood hydrogen ion level, what acid-base disturbance would be present?
|
Acute respiratory acidosis
2010-464 |
|
|
If a patient has a pH of 7.18, a plasma bicarbonate of 14, and a partial pressure of carbon dioxide of 40, that patient has a _____ (compensated/uncompensated) metabolic _____ (acidosis/alkalosis).
|
Uncompensated; acidosis
2010-464 |
|
|
If a patient had slightly low blood pH, a high plasma bicarbonate level, and a slightly elevated blood hydrogen ion level, what acid-base disturbance would be present?
|
Chronic respiratory acidosis
2010-464 |
|
|
If a patient has a pH of 7.33, a plasma bicarbonate of 12, and a partial pressure of carbon dioxide of 21, that patient has a _____ (compensated/uncompensated) metabolic _____ (acidosis/alkalosis).
|
Compensated; acidosis
2010-464 |
|
|
If a patient has a pH of 7.50, a plasma bicarbonate of 31, and a partial pressure of carbon dioxide of 40, that patient has a _____ (compensated/uncompensated) metabolic _____ (acidosis/alkalosis).
|
Uncompensated; alkalosis
2010-464 |
|
|
If a patient had a high blood pH, a slightly low plasma bicarbonate level, and a very low blood hydrogen ion level, what acid-base disturbance would be present?
|
Acute respiratory alkalosis
2010-464 |
|
|
If a patient had a low blood pH, a low plasma bicarbonate level, and a high blood hydrogen ion level, what acid-base disturbance would be present?
|
Metabolic acidosis
2010-464 |
|
|
If a patient had a slightly elevated blood pH, a low plasma bicarbonate level, and a slightly low blood hydrogen ion level, what acid-base disturbance would be present?
|
Chronic respiratory alkalosis
2010-464 |
|
|
In patients with acute cystitis, _____ (red blood cells/white blood cells) are found in the urine, as are the _____ (presence/absence) of casts.
|
White blood cells; absence
2010-464 |
|
|
What types of casts would be seen in the urine of a patient with advanced renal disease or chronic renal failure?
|
Waxy casts
2010-464 |
|
|
What types of casts would be seen in the urine of a patient with acute tubular necrosis?
|
Granular ("muddy brown") casts
2010-464 |
|
|
Name three diseases in which white blood cell casts are seen on urinalysis.
|
Tubulointerstitial disease, acute pyelonephritis, or transplant rejection
2010-464 |
|
|
_____ (Red blood cells/White blood cells) are seen in the urine of patients with bladder cancer; also significant is the _____ (presence/absence) of casts.
|
Red blood cells; absence
2010-464 |
|
|
Name three diseases in which red blood cell casts are seen on urinalysis.
|
Glomerulonephritis, renal ischemia, or malignant hypertension
2010-464 |
|
|
The presence of casts in the urine indicates disease of which organ?
|
The kidneys; as opposed to the bladder or lower urinary tract
2010-464 |
|
|
Name five primary glomerular causes of nephrotic syndrome.
|
Minimal change disease, membranous glomerulonephritis, focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, mesangial proliferative glomerulonephritis
2010-465 |
|
|
Which four diseases can cause pauci-immune rapidly progressive glomerulonephritis?
|
Wegener's granulomatosis, microscopic polyarteritis, Churg-Strauss syndrome, and polyarteritis nodosa
2010-465 |
|
|
Name three categories of etiologies for rapidly progressive glomerulonephritis.
|
Antiglomerular basement membrane antibodies, immune-complex mediated glomerulonephritis, and pauci-immune glomerulonephritis
2010-465 |
|
|
Name seven causes of nephritic syndrome.
|
Immunoglobulin A nephropathy (Berger's disease), poststreptococcal glomerulonephritis, systemic lupus erythematosus, thrombotic thrombocytopenic purpura - hemolytic uremic syndrome, Alport's syndrome, membranoproliferative glomerulonephritis, and Henoch-Schönlein purpura
2010-465 |
|
|
Name three secondary causes of nephrotic syndrome.
|
Diabetic nephropathy, amyloidosis, and systemic lupus erythematosus
2010-465 |
|
|
Which four diseases can cause immune-complex mediated rapidly progressive glomerulonephritis?
|
Henoch-Schönlein purpura, hypersensitivity vasculitis, cryoglobulinemia, and systemic lupus erythematosus
2010-465 |
|
|
What are the major symptoms of Goodpasture's syndrome?
|
Hemoptysis and hematuria
2010-466 |
|
|
What six features are the hallmarks of nephritic syndrome?
|
Hematuria, hypertension, oliguria, azotemia, with proteinuria and red blood cell casts in the urine
2010-466 |
|
|
Which cause of nephritic syndrome is characterized pathologically by crescent-moon-shaped deposits in the urinary space seen by light microscopy and immunofluorescence?
|
Rapidly progressive (crescentic) glomerulonephritis
2010-466 |
|
|
What cause of nephritic syndrome is characterized pathologically by a linear staining pattern with anti-glomerular basement membrane antibodies on immunofluorescence?
|
Goodpasture's syndrome
2010-466 |
|
|
What glomerular pathology is associated with mild renal disease that often follows an upper respiratory infection or gastroenteritis in adults?
|
Immunoglobulin A glomerulopathy (Berger's disease)
2010-466 |
|
|
What is the pattern of immunofluorescence in acute poststreptococcal glomerulonephritis?
|
Granular
2010-466 |
|
|
What cause of nephritic syndrome is characterized on histopathology by a basement membrane that appears to be split?
|
Alport's syndrome
2010-466 |
|
|
What do the crescent deposits in "crescentic" glomerulonephritis consist of?
|
Fibrin and plasma proteins with glomerular parietal cells, monocytes, and macrophages
2010-466 |
|
|
A genetic mutation in which protein results in Alport's syndrome?
|
Collagen IV mutation
2010-466 |
|
|
Which cause of nephritic syndrome is characterized by mesangial deposits of immunoglobulin A seen on immunofluorescence and electron microscopy?
|
Immunoglobulin A nephropathy (Berger's disease)
2010-466 |
|
|
Which two ANCA-positive vasculitides can result in rapidly progressive glomerulonephritis?
|
Wegener's granulomatosis and microscopic polyarteritis
2010-466 |
|
|
A 10-year-old boy presents with swollen ankles and periorbital edema, which were beginning to resolve without intervention. On electron microscopy, a kidney biopsy is found to have subepithelial immune complex humps. What form of nephritic syndrome does he have?
|
Acute poststreptococcal glomerulonephritis
2010-466 |
|
|
What are the findings on light microscopy and immunofluorescence in diffuse proliferative glomerulonephritis?
|
"Wire-looping" of capillaries on light microscopy and granular immunofluorescence due to subendothelial immune complex deposition
2010-466 |
|
|
Which condition is associated with nerve disorders, ocular disorders, and deafness?
|
Alport's syndrome; symptoms are due to a mutation in type IV collagen
2010-466 |
|
|
Which cause of nephritic syndrome is characterized pathologically by enlarged hypercellular glomeruli, the presence of neutrophils, and a "lumpy-bumpy" appearance on light microscopy?
|
Acute poststreptococcal glomerulonephritis
2010-466 |
|
|
What is the underlying mechanism resulting in diffuse proliferative glomerulonephritis due to systemic lupus erythematosus?
|
Subendothelial anti-DNA immune complex deposition
2010-466 |
|
|
Diffuse proliferative glomerulonephritis is the most common cause of death in which systemic disease?
|
Systemic lupus erythematosus
2010-466 |
|
|
Wegener's granulomatosis is _____ (c-ANCA/p-ANCA) positive, while microscopic polyarteritis is _______ (c-ANCA/p-ANCA) positive.
|
c-ANCA; p-ANCA
2010-466 |
|
|
Name three disease processes that result in rapidly progressive glomerulonephritis.
|
Goodpasture's syndrome, Wegener's granulomatosis, and microscopic polyarteritis
2010-466 |
|
|
What type of hypersensitivity reaction is Goodpasture's syndrome?
|
Type II hypersensitivity
2010-466 |
|
|
Which type of renal pathology may present clinically as either nephritic or nephrotic syndrome?
|
Membranoproliferative glomerulonephritis
2010-467 |
|
|
Name three conditions that can predispose patients to nephrotic syndrome due to amyloidosis.
|
Multiple myeloma, tuberculosis, and rheumatoid arthritis; many chronic conditions are risk factors
2010-467 |
|
|
In diabetic glomerulonephropathy, what causes mesangial expansion?
|
Nonenzymatic glycosylation of the efferent arterioles, leading to an increased glomerular filtration rate and thus mesangial expansion
2010-467 |
|
|
What is the most common glomerular disease seen in patients with HIV?
|
Focal segmental glomerular sclerosis
2010-467 |
|
|
An 8-year-old girl who recently had viral gastroenteritis presents with edema and frothy urine. A renal biopsy shows foot process effacement on electron microscopy. What is her diagnosis and how would you treat her?
|
Minimal change disease, which should be treated with corticosteroids
2010-467 |
|
|
Which types of nephrotic syndrome are characterized pathologically by a granular pattern seen on immunofluorescence?
|
Membranous and membranoproliferative glomerulonephritis
2010-467 |
|
|
What four features are the hallmarks of nephrotic syndrome?
|
Massive proteinuria, edema, fatty casts, and hyperlipidemia
2010-467 |
|
|
What are the electron microscopy findings in type I and type II membranoproliferative glomerulonephritis?
|
Type I findings consist of a "tram-track" appearance due to glomerular basement splitting caused by mesangial ingrowth; type II findings consist of "dense deposits"
2010-467 |
|
|
What are the characteristic findings of focal segmental glomerular sclerosis on light microscopy?
|
Sclerosis and hyalinosis of renal glomeruli
2010-467 |
|
|
What is the pathogenesis of minimal change disease?
|
The effacement of epithelial foot processes on the glomeruli leads to the selective loss of albumin from plasma (not globulins) due to glomerular basement membrane polyanion loss and failure of the charge barrier
2010-467 |
|
|
Type I membranoproliferative glomerulonephritis is associated with hepatitis _____ and type II membranoproliferative glomerulonephritis is associated with _____ nephritic factor.
|
B; C3
2010-467 |
|
|
In diabetic glomerulonephropathy, what causes the increased permeability and thickening of the glomerular basement membrane?
|
Nonenzymatic glycosylation of the glomerular basement membrane
2010-467 |
|
|
What are the characteristic findings in membranous glomerulonephritis on electron microscopy?
|
A "spike and dome" appearance with subepithelial deposits
2010-467 |
|
|
Name four etiologies of membranous glomerulonephritis.
|
Drugs, infections, systemic lupus erythematosus, and solid tumors
2010-467 |
|
|
What is the most common cause of nephrotic syndrome in adults?
|
Membranous glomerulonephritis
2010-467 |
|
|
In a patient with nephrotic syndrome due to amyloidosis, what are the characteristic findings on immunofluorescence?
|
Apple-green birefringence on a Congo red stain
2010-467 |
|
|
What cause of nephrotic syndrome is characterized pathologically by Kimmelstiel-Wilson lesions, mesangial expansion, and basement membrane thickening of renal glomeruli on light microscopy?
|
Diabetic glomerulonephropathy
2010-467 |
|
|
When lupus presents as nephrotic syndrome, what renal pathology is likely to be found?
|
Membranous glomerulonephritis; diffuse capillary thickening with granular immunofluorescence
2010-467 |
|
|
Membranoproliferative glomerulonephritis is associated with _____ (hepatitis B virus/HIV), while focal segmental glomerulosclerosis is associated with _____ (hepatitis C virus/HIV).
|
Hepatitis B virus; HIV
2010-467 |
|
|
Which type of nephrotic syndrome is characterized pathologically by diffuse capillary and basement membrane thickening seen on light microscopy?
|
Membranous glomerulonephritis
2010-467 |
|
|
What type of glomerular disease is characterized on histopathology by mesangial deposits?
|
Immunoglobulin A nephropathy
2010-467 |
|
|
What type of glomerular disease is characterized on histopathology by subendothelial deposits?
|
Lupus glomerulonephritis
2010-467 |
|
|
What type of glomerular disease is characterized on histopathology by large, irregular subepithelial deposits or "humps"?
|
Acute glomerulonephritis
2010-467 |
|
|
What type of kidney stone develops most often as a consequence of the genetic disease cystinuria?
|
Cystine kidney stone
2010-468 |
|
|
An 80-year-old man with leukemia presents with hematuria and right-sided flank pain. With his medical history, what type of kidney stone is he at greatest for developing and how would you expect it to appear on x-ray?
|
Due to his leukemia (a disease with high cell turnover) he is at risk for developing uric acid stones due to hyperuricemia, which are radiolucent and do not appear on x-ray
2010-468 |
|
|
What type of kidney stone is strongly associated with hyperuricemia (gout)?
|
Uric acid kidney stones
2010-468 |
|
|
Infection by what class of microbe causes the development of kidney stones composed of ammonium magnesium phosphate (struvite)?
|
Urease-positive bugs (Proteus vulgaris, Staphylococcus, Klebsiella) make urine alkaline and favor formation of struvite stones
2010-468 |
|
|
What types of kidney stones appear radiolucent on x-rays?
|
Struvite (which can be either radiolucent or radiopaque) and uric acid
2010-468 |
|
|
Are cystine stones treated with alkalinization or acidification of the urine?
|
Alkalinization of urine
2010-468 |
|
|
What is the second most common type of kidney stone composed of?
|
Ammonium magnesium phosphate (struvite)
2010-468 |
|
|
What types of conditions lead to increased risk for development of calcium kidney stones?
|
Conditions that cause hypercalcemia, such as cancer, increased parathyroid hormone, increased vitamin D, and milk-alkali syndrome
2010-468 |
|
|
What is the term for a very large kidney stone? Which type of stone is most likely to present this way?
|
A hexagonal stone, which is most likely a cystine kidney stone
2010-468 |
|
|
What types of kidney stones appear radiopaque on x-rays?
|
Struvite (which can be radiopaque or radiolucent), calcium, and cystine stones (which appear faintly radiopaque)
2010-468 |
|
|
Both antifreeze and vitamin C abuse can result in the formation of what type of crystals?
|
Oxalate crystals
2010-468 |
|
|
Of what element are kidney stones most commonly composed?
|
Calcium in the form of calcium oxalate, calcium phosphate, or both
2010-468 |
|
|
Name two severe complications that result from the presence of kidney stones.
|
Hydronephrosis and pyelonephritis
2010-468 |
|
|
Via what route does renal cell carcinoma metastasize? To which organs?
|
Renal cell carcinoma spreads hematogenously via invasion of the inferior vena cava; it most commonly metastasizes to lung and bone
2010-468 |
|
|
What is the cellular origin of renal cell carcinoma?
|
Polygonal clear cells of the renal tubule
2010-468 |
|
|
Name four paraneoplastic syndromes associated with renal cell carcinoma.
|
Ectopic erythropoietin, ACTH, parathyroid hormone-related protein, and prolactin secretion
2010-468 |
|
|
Deletions on which chromosome are associated with renal cell carcinoma?
|
Gene deletion on chromosome 3
2010-468 |
|
|
What genetic disease is associated with bilateral renal cell carcinoma?
|
von Hippel-Lindau disease
2010-468 |
|
|
What is the most common renal malignancy in adulthood?
|
Renal cell carcinoma
2010-468 |
|
|
Name six clinical manifestations of renal cell carcinoma.
|
Hematuria, palpable mass, secondary polycythemia, flank pain, fever, and weight loss
2010-468 |
|
|
Renal cell carcinoma is most common in which demographic?
|
Men ages 50-70
2010-468 |
|
|
What lifestyle factors are associated with an increased incidence of renal cell carcinoma?
|
Smoking and obesity
2010-468 |
|
|
Wilms' tumor is a component of the WAGR disease complex. What are the other components?
|
WAGR complex: Wilms' tumor, Aniridia, Genitourinary malformation, and mental-motor Retardation
2010-468 |
|
|
What gene deletion is associated with Wilms' tumor?
|
The deletion of WT1 on chromosome 11 (tumor suppressor gene)
2010-468 |
|
|
How does Wilms' tumor most commonly present?
|
As a large palpable abdominal mass and/or hematuria in young children; it may be associated with genetic hemihypertrophy syndromes
2010-468 |
|
|
What is the most common renal malignancy of early childhood (ie, 2-4 years old)?
|
Wilms' tumor
2010-468 |
|
|
In which four anatomic structures of the urinary tract can transitional cell carcinoma occur?
|
Renal calyces, renal pelvis, ureters, and bladder
2010-468 |
|
|
What is the most common clinical presentation of bladder cancer?
|
Painless hematuria
2010-468 |
|
|
What is the most common tumor of the urinary tract system?
|
Transitional cell carcinoma
2010-468 |
|
|
What exposures are associated with transitional cell carcinoma?
|
Phenacetin, Smoking, Aniline dyes, and Cyclophosphamide (remember: "problems in the Pee SAC")
2010-468 |
|
|
In chronic pyelonephritis, what substance can fill the tubules of the renal nephrons?
|
Eosinophilic casts, a histopathologic biopsy finding known as thyroidization of the kidney
2010-468 |
|
|
What gross anatomic changes of the kidneys occur with chronic pyelonephritis?
|
Coarse, asymmetric corticomedullary scarring and blunted calices
2010-468 |
|
|
A patient who presents with fever, nausea, vomiting, and costovertebral angle tenderness likely has what condition?
|
Acute pyelonephritis
2010-468 |
|
|
In acute pyelonephritis, the renal cortex is _____ (affected/spared), the glomeruli are _____ (affected/spared), and the vessels are _____ (affected/spared).
|
Affected; spared; spared
2010-468 |
|
|
What finding on urinalysis would suggest pyelonephritis in a febrile patient with flank tenderness?
|
White blood cell casts
2010-468 |
|
|
What are the presenting symptoms of drug-induced interstitial nephritis?
|
Fever, rash, hematuria, and costovertebral angle tenderness 1-2 weeks after drug exposure
2010-468 |
|
|
How long after the ingestion of a substance does drug-induced interstitial nephritis occur? What lab findings are suggestive of the diagnosis?
|
After approximately 1-2 weeks a patient may present with pyuria (eosinophils) and azotemia
2010-468 |
|
|
Name five types of drugs that are associated with interstitial nephritis.
|
Nonsteroidal antiinflammatory drugs, rifampin, diuretics, penicillin derivatives, and sulfonamides
2010-468 |
|
|
Name two disease processes that are associated with diffuse cortical necrosis.
|
Obstetric catastrophes, such as abruptio placentae, and septic shock
2010-469 |
|
|
What is the pathologic consequence on the kidneys of severe vasospasm and disseminated intravascular coagulation, often secondary to obstetric complications?
|
Diffuse cortical necrosis
2010-469 |
|
|
Define diffuse cortical necrosis of the kidneys.
|
Acute generalized infarction of cortices of both kidneys
2010-469 |
|
|
What is the most common cause of renal failure in hospitalized patients?
|
Acute tubular necrosis
2010-469 |
|
|
How long does it take to recover from acute tubular necrosis?
|
2-3 weeks
2010-469 |
|
|
What are three causes of acute tubular necrosis?
|
Renal ischemia (shock), crush injury to muscles (myoglobulinuria), and toxins
2010-469 |
|
|
What is the pathophysiology of acute tubular necrosis?
|
Loss of renal tubule cell polarity, epithelial cell detachment, necrosis, and granular ("muddy brown") casts; the findings are due to acute toxic or ischemic injury
2010-469 |
|
|
What is the treatment for acute tubular necrosis?
|
Dialysis until recovery of kidney function occurs
2010-469 |
|
|
During which phase of acute tubular necrosis do most deaths occur?
|
During the initial oliguric phase if dialysis is not initiated
2010-469 |
|
|
What is the clinical presentation of renal papillary necrosis?
|
Gross hematuria and proteinuria as the result of sloughing of the renal papillae
2010-469 |
|
|
Name four conditions associated with renal papillary necrosis.
|
Diabetes mellitus, acute pyelonephritis, chronic phenacetin use, sickle cell anemia
2010-* |
|
|
Is urine osmolality highest in patients with prerenal, intrarenal, or postrenal causes of acute renal failure?
|
Prerenal
2010-469 |
|
|
Reduced glomerular filtration rate as a result of hypotension and reduced renal blood flow results in the retention of what three substances by the kidney?
|
Sodium, water, and urea are retained in an attempt to maintain blood volume
2010-469 |
|
|
A patient's urine osmolarity is <350 mOsm/L, urine sodium level is >20 mEq/L, fractional excretion of sodium is >2%, and the blood urea nitrogen/creatinine ratio is <15:1. Does the patient most likely have a prerenal, renal, or postrenal etiology of his acute renal failure?
|
Renal
2010-469 |
|
|
Is the fractional excretion of sodium lowest in patients with prerenal, renal, or postrenal causes of acute renal failure?
|
Prerenal; a low fractional excretion of sodium shows the kidneys are functional and working to maintain blood volume
2010-469 |
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What finding is seen on urinalysis of patients with acute renal failure as a result of intrinsic renal disease?
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Epithelial/granular casts
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What is acute renal failure?
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A renal condition characterized by an abrupt decline in renal function with elevated blood urea nitrogen and creatinine levels over several days
2010-469 |
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Is the blood urea nitrogen/creatinine ratio lowest in patients with prerenal, renal, or postrenal causes of acute renal failure (acute kidney injury)?
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Renal; the injured kidneys are unable to absorb urea to maintain blood volume
2010-469 |
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True or False? Unilateral postrenal outflow obstruction can lead to acute renal failure.
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False; bilateral, not unilateral, postrenal outflow obstruction leads to acute renal failure
2010-469 |
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Is the urine sodium level highest in patients with prerenal, renal, or postrenal causes of acute renal failure?
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Postrenal
2010-469 |
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Name four possible causes of postrenal outflow obstruction that can lead to acute renal failure.
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Kidney stones, benign prostatic hyperplasia, congenital anomalies, and neoplasia
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Name two main causes of acute intrinsic renal failure.
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Acute tubular necrosis and toxic injury
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What are three general categories of renal dysfunction that can lead to acute renal failure?
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Prerenal (eg, hypotension and reduced renal blood flow), intrinsic renal (eg, tubular necrosis), and postrenal (outflow obstruction)
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Why does the blood urea nitrogen to creatinine ratio increase in patients who have low renal blood flow?
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When renal blood flow and glomerular filtration rate are reduced, urea is retained to attempt to preserve blood volume; the resulting increase in blood urea nitrogen is also known as prerenal azotemia
2010-469 |
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A patient's urine osmolarity is >500 mOsm/L, urine sodium level is <10 mEq/L, fractional excretion of sodium is <1%, and the blood urea nitrogen/creatinine ratio is >20:1. Does the patient most likely have a prerenal, renal, or postrenal etiology of his acute renal failure?
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Prerenal
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A patient's urine osmolarity is <350 mOsm/L, urine sodium level is >40 mEq/L, fractional excretion of sodium is >4%, and the blood urea nitrogen/creatinine ratio is >15:1. Does the patient most likely have a prerenal, renal, or postrenal etiology of his acute renal failure?
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Postrenal
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By what mechanism does renal failure lead to anemia?
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Impaired erythropoietin production
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Name three cardiovascular consequences of excess sodium and water retention in patients with renal failure.
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Congestive heart failure, hypertension, and pulmonary edema
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Name six signs and symptoms of uremia.
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Nausea, anorexia, pericarditis, asterixis, encephalopathy, and platelet dysfunction
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What acid-base disorder is a consequence of renal failure?
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Metabolic acidosis
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What electrolyte abnormality resulting from renal failure can lead to cardiac arrhythmia?
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Hyperkalemia
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What are the two main forms of renal failure?
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Acute (acute tubular necrosis or rapidly progressive glomerulonephritis) and chronic (diabetes and hypertension)
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Renal osteodystrophy as a part of the clinical abnormalities in patients with uremia is a result of the failure of what kidney function?
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Production of active vitamin D, resulting in hypocalcemia and leading to a secondary increase in parathyroid hormone, resulting bone loss
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In renal failure, is the total body sodium level (as opposed to serum concentration) abnormally high or low?
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High
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In renal failure, is the potassium level abnormally high or low?
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High
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What is Fanconi's syndrome?
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A disease caused by defects in the proximal tubule transport of amino acids, glucose, phosphate, uric acid, and electrolytes
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What is the result of the decreased proximal tubular sodium reabsorption of Fanconi's syndrome?
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Hypokalemia; if the proximal tubule does not reabsorb sodium, the distal tubule must excrete more potassium to reabsorb sodium
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Which drugs can cause Fanconi's syndrome?
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Expired tetracycline, cisplatin
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What metabolic diseases can cause Fanconi's syndrome?
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Wilson's disease and glycogen storage diseases
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What is the result of the decreased bicarbonate reabsorption associated with Fanconi's syndrome?
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Metabolic acidosis (type 2 renal tubular acidosis)
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What is the complication of the decreased phosphate reabsorption associated with Fanconi's syndrome?
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Rickets
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What are the characteristics of renal medullary cystic disease?
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Small kidneys on ultrasound, cysts in the medullary area that can sometimes lead to fibrosis and progressive renal insufficiency with urinary concentrating defects, and a very poor prognosis
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What is autosomal dominant polycystic kidney disease?
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An autosomal-dominant disease characterized by multiple bilateral cysts that destroy the kidney parenchyma during adulthood
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What mutation causes autosomal dominant polycystic kidney disease (formerly adult polycystic kidney disease)?
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An autosomal dominant mutation in the APKD1 or APKD2 gene
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What liver disease is associated with autosomal recessive polycystic kidney disease?
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Congenital hepatic fibrosis
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Name three nonrenal pathologies associated with autosomal dominant polycystic kidney disease.
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Polycystic liver disease, berry aneurysms, and mitral valve prolapse
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Name the autosomal recessive disease that presents with multiple bilateral kidney cysts and renal failure in infancy.
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Autosomal recessive polycystic kidney disease (infantile polycystic kidney disease)
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What are the complications of autosomal recessive polycystic kidney disease in utero and after the neonatal period?
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Renal failure in utero from autosomal recessive polycystic kidney disease can lead to the Potter sequence; after the neonatal period, potential complications include hypertension, portal hypertension, and progressive renal insufficiency
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Name five clinical manifestations of autosomal dominant polycystic kidney disease.
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Flank pain, hematuria, hypertension, urinary tract infection, and progressive renal failure in adulthood
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What is the cause of death associated with autosomal dominant polycystic kidney disease?
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Death is most commonly due to complications of chronic kidney disease or hypertension (due to increased renin production)
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What are three consequences of high serum levels of magnesium?
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Delirium, decreased deep tendon reflexes, and cardiopulmonary arrest
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U waves on electrocardiogram, flattened T waves, arrhythmias, and paralysis are consequences of a low serum level of what electrolyte?
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Potassium
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What are the symptoms of hypercalcemia?
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Delirium, renal stones, and abdominal pain
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High serum levels of chloride are usually a result of what primary acid-base disturbance?
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Non-anion gap acidosis
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What are the consequences of low phosphate levels?
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Bone loss and osteomalacia
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What are the consequences of high phosphate levels?
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Metastatic calcification and renal stones
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What are two consequences of low serum levels of magnesium?
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Neuromuscular irritability and arrhythmias
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What are the consequences of low sodium levels?
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Disorientation, stupor, and coma
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What are four causes of low serum levels of chloride?
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Metabolic alkalosis, hypokalemia, hypovolemia, and elevated aldosterone
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What are the symptoms of hypocalcemia?
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Tetany and neuromuscular irritability
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What are the electrocardiogram findings associated with hyperkalemia?
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Peaked T waves and widened QRS complexes
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On what segment of the kidney nephron do antidiuretic hormone antagonists exert their effects?
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Collecting duct
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On what segment of the kidney nephron do potassium-sparing agents exert their diuretic effects?
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Collecting tubule
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On what segment of the kidney nephron do loop agents such as furosemide exert their diuretic effects?
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The ascending limb of the Loop of Henle
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In the thin descending limb of the loop of Henle, the filtrate is _____ (hypotonic/isotonic/hypertonic) to blood plasma.
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hypertonic
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On what segment of the kidney nephron does the diuretic acetazolamide exert its effects?
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Proximal convoluted tubule
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On what segment of the kidney nephron do thiazides exert their diuretic effects?
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Distal convoluted tubule
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In the thick ascending limb of the loop of Henle and the distal convoluted tubule, the filtrate is _____ (hypotonic/isotonic/hypertonic) to blood plasma.
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hypotonic
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On what three segments of the kidney nephron do osmotic agents such as mannitol exert their diuretic effects?
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Proximal convoluted tubule, thin descending loop of Henle, and collecting duct
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In the proximal convoluted tubule, the filtrate is _____ (hypotonic/isotonic/hypertonic) to blood plasma.
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isotonic
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What two toxicities are associated with mannitol?
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Pulmonary edema and dehydration
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What are the clinical uses of mannitol?
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To treat shock, drug overdose, and elevated intracranial/intraocular pressure
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In what two conditions is mannitol contraindicated?
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Anuric renal failure, congestive heart failure
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What is the mechanism of action of mannitol?
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Mannitol acts as an osmotic diuretic, increasing osmolarity within the renal tubules producing increased urine volume
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What are the four clinical uses of acetazolamide?
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To treat glaucoma, metabolic alkalosis, and altitude sickness, and to cause urinary alkalinization
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What is the mechanism of action of acetazolamide?
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It acts as a carbonic anhydrase inhibitor, causing self-limited sodium bicarbonate diuresis and a reduction in total-body bicarbonate stores
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What four toxicities are associated with acetazolamide?
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Hyperchloremic metabolic acidosis (ACIDazolamide causes ACIDosis), neuropathy, ammonia toxicity, and sulfa allergic reactions
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What is the effect of the diuretic furosemide on calcium handling in the kidney nephron?
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Furosemide increases calcium excretion (remember: "loops lose calcium")
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Name six toxicities associated with use of loop diuretics; use the mnemonic "OH DANG!"
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Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis (interstitial), and Gout
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What are three (general) the clinical uses of furosemide?
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To treat edematous states (congestive heart failure, cirrhosis, nephrotic syndrome, pulmonary edema), hypertension, and hypercalcemia
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What is the mechanism of action of furosemide?
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It inhibits the sodium-potassium-chloride cotransport system in the thick ascending limb of the loop of Henle, thereby abolishing the hypertonicity of the medulla and preventing the concentration of urine
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Name one loop diuretic.
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Furosemide, also known as Lasix
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Name five toxicities of ethacrynic acid.
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Ototoxicity, hypokalemia, dehydration, and interstitial nephritis
2010-473 |
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Ethacrynic acid has a mechanism of action similar to which other drug?
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Furosemide
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Which loop diuretic is used to diurese patients who are allergic to sulfa drugs?
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Ethacrynic acid
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Name seven toxicities associated with hydrochlorothiazide.
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Hypokalemic metabolic alkalosis, hyponatremia, hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia, and sulfa allergy
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Serum levels of which substances are increased as a result of the effects of hydrochlorothiazide?
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Glucose (hyperGlycemia), lipids (hyperLipidemia), uric acid (hyperUricemia), and calcium (hyperCalcemia) (remember: HyperGLUC)
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What is the mechanism of action of hydrochlorothiazide?
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It reduces the diluting capacity of the kidney nephron by inhibiting sodium chloride reabsorption in the early distal tubule
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_____ (Furosemide/Hydrochlorothiazide) increases calcium excretion, whereas _____ (furosemide/hydrochlorothiazide) decreases calcium excretion.
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Furosemide; hydrochlorothiazide
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Name four clinical uses of hydrochlorothiazide.
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To treat hypertension, congestive heart failure, idiopathic hypercalciuria, and nephrogenic diabetes insipidus
2010-473 |
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What is the mechanism of action of spironolactone?
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It exerts its effects by competitively antagonizing the aldosterone receptor in the cortical collecting tubule
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Name four potassium-sparing diuretics.
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Spironolactone, triamterene, amiloride, and eplerenone (remember: the K+ STAys)
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What are the toxicities of the potassium-sparing diuretics?
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Hyperkalemia (leading to arrhythmias) and endocrine effects with spironolactone (gynecomastia and antiandrogen effects)
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What is the mechanism of action of triamterene and amiloride?
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They exert their effects by blocking sodium channels in the cortical collecting tubule
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What are the three clinical uses of potassium-sparing diuretics?
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To treat hyperaldosteronism, potassium depletion, and congestive heart failure
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What mechanism underlies "volume contraction alkalosis"?
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Volume contraction leads to increased angiotensin II, which causes an increased hydrogen-sodium exchange in the proximal tubule and increased bicarbonate reabsorption
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Which two classes of diuretics may reduce the blood pH?
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Carbonic anhydrase inhibitors and potassium-sparing diuretics
2010-474 |
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Which diuretics increase potassium excretion in the urine, thus causing a potential decrease in serum potassium?
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All of them, except for the potassium-sparing diuretics
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By what two mechanisms does potassium loss caused by loop diuretics and thiazide diuretics lead to alkalosis?
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Potassium loss leads to potassium ions exiting the cells in exchange for hydrogen ions entering the cell, leading to alkalosis; also, in a low-potassium state, hydrogen ions (as opposed to potassium ions) are exchanged for sodium ions in the cortical collecting tubule, which leads to alkalosis
2010-474 |
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By what mechanism do loop diuretics cause increased excretion of calcium in the urine?
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Loop diuretics abolish the lumen-positive potential in the thick ascending limb of the loop of Henle, causing decreased paracellular calcium reabsorption, leading to increased urinary calcium and hypocalcemia
2010-474 |
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Which type of diuretics increases urine calcium excretion?
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Loop diuretics
2010-474 |
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What is the mechanism by which potassium-sparing diuretics cause acidemia?
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Hyperkalemia leads to potassium entering all cells via the H+/K+ exchanger in exchange for H+ exiting cells
2010-474 |
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By what mechanisms do thiazide diuretics decrease urinary calcium?
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Volume depletion leads to enhanced paracellular calcium resorption in the loop of Henle; the increased sodium gradient in the tubule leads to increased sodium/calcium exchange and increased calcium resorption
2010-474 |
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Which two classes of diuretics may increase the blood pH?
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Loop diuretics and thiazides
2010-474 |
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What is the mechanism by which carbonic anyhydrase inhibitors cause acidemia?
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Acetazolamide causes the kidney to excrete more bicarbonate, decreasing the body's pH
2010-474 |
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Which types of diuretic reduce urine calcium excretion and increases serum calcium?
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Thiazides
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Name the adverse effects of angiotensin-converting enzyme inhibitors; use the mnemonic CAPTOPRIL.
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Cough, Angioedema, Proteinuria, Taste changes, hypOtension, Pregnancy problems (fetal renal damage), Rash, Increased renin, and Lower angiotensin II
2010-474 |
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The names of angiotensin-converting enzyme inhibitors typically end in what suffix?
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The suffix -pril
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Angiotensin-converting enzyme inhibitors can cause acute renal failure (acute kidney injury) in patients with which condition?
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Bilateral renal artery stenosis; these patients are dependent on angiotensin II to maintain their glomerular filtration rate
2010-474 |
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What enzyme do captopril, enalapril, and lisinopril inhibit?
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Angiotensin-converting enzyme
2010-474 |
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What class of diuretics can be used in place of angiotensin-converting enzyme inhibitors if cough is a problematic adverse effect?
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Angiotensin II receptor antagonists such as losartan
2010-474 |
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What are three clinical uses of angiotensin-converting enzyme inhibitors?
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To treat hypertension and congestive heart failure and to slow the progression of diabetic renal disease
2010-474 |
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Losartan is an example of what class of drug?
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An angiotensin II receptor antagonist
2010-474 |
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Why is renin released from the kidneys when angiotensin-converting enzyme inhibitors are used?
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There is a loss of feedback inhibition (ie, the lack of angiotensin II production and subsequent aldosterone release results in a drop in blood pressure, causing renin release)
2010-474 |
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What electrolyte disturbance can result from angiotensin-converting enzyme inhibitor toxicity?
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Hyperkalemia
2010-474 |
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What is the mechanism by which angiotensin-converting enzyme inhibitors can cause angioedema?
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Angiotensin-converting enzyme inhibitors prevent the inactivation of bradykinin, a potent vasodilator; increased bradykinin levels can lead to angioedema in susceptible individuals
2010-474 |
