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286 Cards in this Set
- Front
- Back
Renal Embroyology:
Pronephros |
forekidney
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Mesonephros
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midkidney-> uteric bud-> collecting duct, calyses, ureters and renal pelvis
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Metanephros
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hindkidney-> permanent kidney
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Urogenital sinus
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allantois -.> urachus -> bladder
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The Kidney Bean blood flow
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Cortex -> medulla -> pyramids -> papillae, callyces, hilum
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Kidney Anatomy: where do arteries run with respect to the veins?
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Arteries run under the veins due to their high pressure
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Where is the Right kidney located?
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The right kidney sits at the L2 (lower) due the liver is in the way.
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Where is the Right renal artery located?
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It runs underneath or posterior to IVC, long course
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Where is the Left renal vein located?
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It runs anterior to the aorta, long course.
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what is its significance of the left renal vein?
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the left renal vein runs along the aorta.
so, when there is an aortic aneurysm, the blood supply to this kidney is affected and its hurt first. |
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What is the importance of the Right gonadal vein
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Right gonadal vein drains into the IVC (inferior vana cava) therefore it would spread faster if there was metastasis
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where does the left gonadal vein drain into?
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to the left renal vein
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What is the osmolarity of the cortex?
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Isotonic (osmolarity is the same as in plasma)
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What is the cortex succeptible to?
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DIC
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What is the osmolarity of the medulla?
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hypertonic (concentrates your urine)
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What is the medulla succeptible to?
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Clots
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When do nephrons get longer?
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when it is warm to concentrate urine.
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Dehydration status: What happens when one has a 5% loss, 10% loss and 15% loss
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5%: thirsty
10%: tachycardia 15%: decrease BP/ capillary refill |
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Rehydration: what is the bolus?
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normal saline : 20cc/kg
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Rehydration: How do we calculate replacement
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Replacement is calculated based on Na:
Measure weight loss 1kg -> 1L Give 1/2 (minus the bolus) over 8 hours Give 1/2 over the next 16 hours |
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Maintenance: how much and what kind of fluid do we use for the following
Adults: Kids: Dehydrated adult Dehydrated kid Shock Hyponatremia |
Adults: 1/2 normal saline
Kids: 1/4 normal saline Dehydrated adult: normal saline Dehydrated kid: 1/2 normal saline Shock: Lactate ringer's or normal saline (154 mEq salt/L Hyponatremia: 3% NaCl |
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How much do I give to the following?
Adult: Kid <8 y/o: 1st 10kg 2nd 10kg after that per hour Burn deficit: |
Adult: 1.5 cc/kg/hr (=urine output)
Kid <8 y/o: 1st 10kg: 100cc/kg/day 2nd 10kg: 50cc/kg/day after that: 20cc/kg/day per hour: 4/2/1 cc/kg/day Burn deficit: 4cc normal saline/kg/% burn ( parkland formula) |
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What are the values of the survival electrolytes:
NaCI: we need __mEq/ kg/day = ___mEq/3L urine/day= ___mEq/L => use __NS K: we need ___mEg/ kg/day = ___mEq/3L urine/day= ___ mEq/L =>add ___mEq K/L |
NaCl: we need 3 mEq/kg/day = 225 mEq/3L urine/day = 75 mEq/L= > 1/2 NS
K: 1.75mEq/kg/day = 56 mEq/3L urine/day = 20 mEq/l => add 20mEq K/L |
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Burns: what are the rule of 9's:
head + neck: chest: Back: each arm: Each leg: Genitalia; |
head + neck: 9%
chest: 18% Back: 18% each arm: 9% Each leg: 18% Genitalia: 1% |
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Burn Classification:
1st degree: 2nd degree: 3rd degree: |
1st degree: red (epidermis)
2nd degree: blister 3rd degree: painless neuropathy (dermis) |
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RAA axis: what part of the kidney senses it and what does it senses?
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the low volume is sensed by the macula densa
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Describe the RAA axis
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When the macula densa senses the low volume, it sends a signal to the J-G apparatus to release renin. Renin converts anginotensinogen to ATI the AT I moves to the lungs and is converted to AT II by ACE enzyme. AT II has 4 functions
1) vasoconstriction to increase BP 2) increases thirst 3) releases ADH which absorbs water 4) releases aldosterone which absorbs water and secretes K/H+ |
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What is the average weight in an adult and kid?
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adult: 75 kg =165.346 lb
kid: 35 kg = 77.1617 lb |
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Dialysis: describe hemodialysis and peritoneal dialysis
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hemodialysis: forearm AV fistula (done in the hospital)
peritoneal dialysis: peritoneum catheter (done at home) |
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Burn Tx: and its side effects
Most: Cartilage: Eyes: |
Most: silver sulfadiazine (leukopenia)
Cartilage: Sulfamylon (acidosis) Eyes: Triple antibiotic |
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function of aldosterone
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controls volume (Na)
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function of ADH
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controls water
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describe the bradykinin pathway
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kininogen ⇢ (kallikrein)⇢ bradykinin ⇢ (ACE)⇢ degraded bradykinin
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Bradykinin functions:
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⇨dilates veins
⇨proteinuria ⇨cough |
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Acid base disorders: how is it read
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Normal:
1) pH=7.4 2) pCO2 "acid" = 40 3) HCO3 = 24 Note: ⇨if 1 & 2 go in the same direction (ie. increased or decreased) =metabolic ⇨If 2 & 3 go in the same direction = compensated ⇨opposite directions = respiratory or mixed, respectively |
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Respiratory alkalosis: examples and Tx:
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Restrictrive lung Dz
(anxiety, pregnancy, gram - sepsis, PE) Tx: breath into a bag |
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Respiratory acidosis: examples Tx:
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Obstructive lung Dz (COPD, drugs). Tx: hyperventilation, ⇧FiO₂
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metabolic alkalosis: defintion and examples. Tx:
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Low volume state (vomiting, diuretics, GI blood loss). Tx. hydration
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Metabolic acidosis: definition and examples. Tx:
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acid production ( MUDPILES, RTA II, diarrhea).
Tx: bicarbonate if pH < 7.2 |
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oliguria vs anuria
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oliguria: < 400 cc/day
anuria: < 100 cc/day |
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pre-renal failure definition and etiology.
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Definition: hypoperfusion to the kidney
1) low volume state (AT II constricts efferent -->⇧BUN,⇩Cr 2) vasculitis |
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Pre-Renal Failure: BUN/Cr and FeNa
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BUN/Cr: >20
FeNa: <1% |
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pre-renal failure: treatment
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fluid bolus (increase flow to the kidney)
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Renal problem: definition, examples
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damaged glomerulous ie. ATN, SLE, Wegener's, Renal artery stenosis
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Renal problem:
what happens to the Cr/RPF levels, BUN urine osmolarity Tx what if you need to give a renal excreting drug/ |
⇧Cr/⇧RPF (cannot filter)
⇩serum BUN (filter less therefore secrete less), then ⇧(no blood flow). Urine osmolarity = 300 (near serum osmolarity) -> kidney can't concentrate urine Tx: Fluid, Diet: low Na/K/PO₄/protein; No renal-excreted meds Note: if you give a renal excreting drug, make sure to give enough volume. |
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Post-renal failure: definition
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there is an obstruction and has not peed in the last 4 days
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Most common cause of post renal failure in newborns
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malimplantation of ureter
post-urethral valve obstruction |
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Most common cause of post renal failure in kids
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strictures (UTI's)
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Most common cause of post renal failure in adults
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scarring (STD's, Nitrofurantoin)
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Most common cause of post renal failure in women > 40 y/o
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uterine prolapse, cystocele
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Most common cause of post renal failure in men > 40 y/o
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BPH, nephrolithiasis
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Post-renal failure Tx:
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catheter to get urine out (have a lot of urine stored in bladder)
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ESRD
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white powder means that there is urea in sweat
=>pruritis, excoriations. Patient will also present with pallor and ecchymosis |
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fake sphincters
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ureters, lower esophageal sphincter and ileocecal valve
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Urinalysis: color
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pus, blood
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urinalysis:
Specific Gravity is High: (2) |
dehydration, SIADH
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urinalysis:
Low pH: |
Salicylate O/D
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urinalysis:
High pH: (2) |
UTI, RTA Type I
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urinalysis:
Protein is High |
leaky glomeruli
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urinalysis:
Glucose is High |
DM
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urinalysis:
Ketones are High (3) |
DKA, starvation, isopropanol toxicity
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urinalysis:
High Bilirubin |
hemolysis
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Urinalysis:
High Urobilinogen (2) |
hemolysis or conjugated hyperbilirubinemia
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urinalysis:
Nitrite ( + ) |
Gram (-) bacteria
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urinalysis
Nitrite (-): |
Enterococcus
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urinalysis
Leukocyte Esterase: |
WBC's
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urinalysis
RBC (3) |
stones, tumor, GN
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urinalysis
WBC (3) |
UTI, prostatitis, vaginitis
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urinalysis
Casts: |
Kidney dz
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urinalysis
Crystals (2) |
Kidney stones, Ethylene Glycol toxicity
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urinalysis
Squamous Epithelium: |
degree of contamination
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what is Nephritic syndrome?
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increased size of fenestrations=> vasculitis (HTN)
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Urine: nephritic syndrome
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increase BUN/ Cr
⇩GFR oliguria, Blood, and WBC casts in the urine |
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"RPGN":
Rapidly Progressive Glomerulonephritis |
Crescent formation=> scars
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Post-Strep Glomerulonephritis "PSGN":
presentation strain deposits Ab Tx |
hematuria 2wk after sore throat
• Strain 12 • Subepithelial • Inflamed glomerulus w/ IgG, C3,C4 deposition • Anti-streptolysin Ab "ASO" (periorbital swelling) • Tx: Furosemide (tx symptoms) |
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what is Interstitial Nephritis and what is it commonly caused by?
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urine eosinophils
Caused by Fluoroquinolones |
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what are vaculitides? (7)
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Vasculitidies:
• Wegener's: • Goodpasture's: • Henoch-Schonlein Purpura • Polyarteritis Nodosa • Subacute Bacterial Endocarditis • Serum Sickness • Cryoglobulinemia |
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Wegener's: antibody and tx
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c-ANCA Ab
(Tx: Cyclophosphamide +Prednisone) |
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Goodpasture's:
ab presentation tx |
anti-GBM Ab
hematuria+ hemoptysis (Tx: plasmapheresis) |
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Subacute Bacterial Endocarditis,
Serum Sickness, Cryoglobulinemia what do they have in common? |
they all have ⇩C3.
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what is nephrotic syndrome? explain the hyperlipedemia, hypercoagulability, and edema that is seen.
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Def: lost BM charge due to deposition on heparin sulfate =>proteinuria and lipiduria
• Edema (due to oncotic forces) • Liver: makes proteins to compensate (⇧LDL, hypercoagulability, ⇧DVT/renal vein thrombosis) • Urine: Protein (>3.5g), Lipid (maltese crosses) • increase Risk Spontaneous Bacterial Peritonitis |
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Membranous Glomerulonephritis "MGN":
most common in what type of people associated with what disease? biopsy? |
• Most common in grown-ups
• Hep B (spike&dome, thick BM) |
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Membranous Glomerulonephritis "MGN":
what are the common drugs that can cause it? (4) treatment? (2) |
• Penicillamine, Captopril, Mercury, Gold
• Tx: Prednisone, Chlorambucil |
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which diseases give subepithelial deposits?
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Subepithelial:
• SLE • PSGN |
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Minimal Change Disease "MCD":
what group of people is it most common in? describe MCD Tx |
• Most common in children
• Fused foot processes, autoimmune • Tx: Prednisone (the only curable nephrotic process) |
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Focal Segmental Glomerulosclerosis "FSG":
who are at risk |
⇧Risk in African Americans and HIV patients
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Diabetic Nephropathy: describe and Tx
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• Glomerulosclerosis
• kimmelstiel-wilson nodules • Tx: Restrict protein <0.8g/kg |
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Systemic Lupus Erythematosus "SLE": C3, Ab, deposits and Tx
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• ⇩C3, anti-ds DNA
• Subepithelial deposits • Tx: pulsatile Cyclophosphamide |
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Membranoproliferative Glomerulonephritis "MPGN": describe and Tx
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• ⇩C3, tram tracks"
• Tx: ASA,Dipyramidole |
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IgA Nephropathy: C3 levels, presentation, associated with what diseases?
|
• Normal C3
• URI, then hematuria • Assoc w/ HIV, celiac disease, liver disease |
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what is total body water and how is it measured?
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60% weight (measure w/ D₂O)
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what are the components of total body water
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>>2/3 intracellular
>>1/ 3 extracellular |
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what are the two parts of extracellular compartment
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o 1/4 plasma
o 3/4 interstitial (plasma - proteins) |
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what part of total body water decreases with excercise? and how is it measured?
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>>1/ 3 extracellular
>>measure w/ inulin) |
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how is the 1/4 plasma compartment measured?
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o 1/4 plasma (measure w/ albumin*)
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what compartment does the isotonic saline goes
|
o 3/4 interstitial (plasma - proteins) ⇦isotonic saline goes
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which compartment of the total body water has K+ and Mg2+ in it?
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2/3 intracellular compartment
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what does the ff mean? -emia and -uria?
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-emia: blood
-uria: urine |
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how is osmolarity approximated?
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2 (Na) + Glucose/18 + BUN/3 = 300 Osm/kg
|
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what ions can contribute to the osmolarity
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Na(or glucose, mannitol, methanol, ethylene glycol)
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what is clearance?
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Clearance = FF + secretion - reabsorption
Clearance = excretion (total of all processes) Secrete= add to the urine (active process) Reabsorb = subtract from urine |
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what is FF?
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FF= GFR/RPF "ftltration fraction" is how much of the plasma the glomerulus ftlters
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what is the job of an afferent arteriole?
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Afferent: filtration just uses diffusion)
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how is GFR measured in the lab? in real life?
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GFR: can measure with inulin lab or.creatinine (physiologic) ⇨ 100% ftltered. In real life Cr is inversely proportional.
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what is blood flow per hour
|
>>RBF to kidney = 20% of CO = 1L/hr
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how much is filtered by the glomerulous?
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20% of fluid that comes to glomerulus (RBF) is filtered = >200cc/hr
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how much fluids should we drink in a day? and why?
|
RBC are not ftltered (45%) => GFR=125cc/hr => 3L urine per day=> drink 3L H20 per day.to replace
|
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what are the normal values of
BUN, Cr, GFR |
Normals:
BUN: 10-20 Cr: 0.6-.2 GFR: 125 |
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what are some ways to calculate the GFR?
|
>>Cockroft-Gault: (140-age)(weight)/ (72)(serum Cr)
>>MDRD: (age)(serum Cr)(a bunch of numbers) >>GFR = UV /P "UV peed" >>(GFR1) (Cr1) = (GFR2) (Cr2) |
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what does
GFR: mean? <60 <10 |
GFR:
<60: Renal failure <10: End-stage renal disease |
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calculation of FeNa
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FeNa: (Una/Pna)(Pcr/Ucr)
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what is the function of efferent arteriole and what does it need to do its job?
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secretion (needs transport proteins) =>
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what arteriole of the kidney is hurt first in the lower energy state
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efferent arteriole
|
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how is secretion measured in the lab? physiologic? how is it calculated/
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Can measure with PAH (lab) or BUN (physiologic)
>>RPF1BUN1 = RPF2 BUN2 |
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NSAIDs: effect on arterioles
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constricts afferent arterioles
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AT -II: effect on arterioles
|
contricts efferent arterioles
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ACE-I:effect on arterioles
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dilates efferent arterioles
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afferent arteriole: job, measurement and test
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Job: ⇧filter
measurement: ⇩creatine, inulin test: GFR |
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efferent arteriole: job, measurement and test
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Job: ⇧secrete
measurement: ⇩BUN, PAH test: RPF |
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what does it mean when there is a small kidney
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hypertensive nephropathy
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most common cause of secondary hypertension?
|
renal artery stenosis
|
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what happens during renal artery stenosis?
|
Increased velocity helps blood get past clot into bad kidney
• Increased pressure on contralateral kidney destroys it => malignant HTN |
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what test is done for renal artery stenosis? what is considered positive?
|
Test: captopril renal scan in both renal arteries: 1.5 difference=> stenosis
|
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what is Goldblatt's Kidney
|
"flea bitten kidney" (blown capillaries). hyperthensive nephropathy
|
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Dx: renal artery stenosis
< 30) y/o: > 30) y/o |
< 30) y/o: fibromuscular Dysplasia
> 30) y/o: Atherosclerosis |
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treatment of hypertensive nephropathy
|
Remove contralateral kidney (nephrectomy)
• Remove ipsilaterteral blood clot (atherectomy) • No ACEI!(dilates efferent arterioles => ⇩blood flow to kidney) |
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give 5 diseases that can cause big Kidneys?
|
PCKD
Medullary Cystic/Sponge Kidney Amyloidosis DM Scleroderma |
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Azotemia:
|
increase BUN/ Cr
|
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Uremia:
|
azotemia + sx (bleeding,
pericarditis, encephalopathy) |
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PCKD: what are its two types and mode of inheritance
|
PCKD = polycystic kidney disease
• Infantile type (AR): • Adult type (AD): |
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PCKD: complications if its the infantile type and unilateral
|
if unilateral => no problems
|
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PCKD: complications if its the adult type and bilateral
1st sign what happens to the kidneys? (3) other presentataions: (3) |
o HTN - 1st sign
o Renal failure, azotemia, liver cysts o Diverticulosis, mitral prolapse, berry aneurysms (post communicating artery) |
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Medullary Cystic/Sponge Kidney:
presentation and why? why do they get more stones? |
>>"Polyuria, polydipsia (can't concentrate urine b/ c of medulla problem)
>> Low vol state => high pH = > Ca ppt => kidney stones |
|
what would see on a sonogram in Medullary Cystic/Sponge Kidney
|
bubbles (cystic) or holes (sponge
|
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Amyloidosis:
|
apple green bifringence with Congo Red stain
|
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:most common cause of ESRD
|
Diabetes Milliteus
|
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Scleroderma:
|
tight skin, fibrosis
|
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Proteinuria Dx: Benign, Malignant :
|
benign (1 + to 2+): increase Protein concentration. gradient (stand, exercise, fever)
malignant (3+ to 4+): Renal problem=> 24-hr urine; measure protein |
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where are common places where stones gets stuck
|
Ureter Constrictions: stones get stuck here
• Hilum (especially staghorn calculi) • Pelvic rim • Utero-vesicular junction (where ureter enters bladder) |
|
3 causes of painful hematuria
|
• UTI
• Kidney stone • Renal infarct |
|
6 causes of painless hematuria
|
• TB
• Kidney tumor • Glomerulonephritis • Prostate disease • Sickle cell trait • Acute Intermittent Porphyria- abdominal pain |
|
how do kidney stones present?
when do kidney stones recur? |
Backpain radiating to groin due to Dehydration => painful hematuria +colic
Kidney stones: 50% recur in 10 yrs |
|
when do kidney stones reoccur?
|
Kidney stones: 50% recur in 10 yrs
|
|
Coffin-lid
|
Triple P04
|
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Rosette:
|
Uric acid
|
|
Hexagonal:
|
Cystine
|
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Envelope:
|
Oxalate
|
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Calcium Pyrophosphate:
shape 3 common causes Tx: and how does it do this? |
>>amorphous shape
>>Cause: IBD, HyperPTH, Pseudogout >>Tx: Thiazide diuretics ( decreased Ca concentration in urine) |
|
Triple Phosphate:
aka crystals type of stone |
>>(MgNH4P04):
>>coffin-lid crystals >>Stuvite = Staghorn calculus |
|
Triple Phosphate: pathogen
|
>>Cause: Proteus, Urease (+) Bugs
|
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Triple Phosphate: Tx
|
Tx: lower urine pH
"lower the coffin" |
|
Uric acid stone shape
|
Rhombic "rosette" crystals
|
|
4 causes of uric acid stones
iatrogenic disease drugs (2) |
Gout, Chemotherapy (purines => uric acid), HCTZ, Furosemide
|
|
treatment for uric acid stones
|
Tx: raise urine pH (oral bicarbonate or citrate)
"raise: little boy peeing up" |
|
what stone is not seen on x-ray
what test should be done? |
Note: not seen on x-ray => do IVP
" U can't see me!": uric acid stones |
|
Cystine: describe crystals
|
yellow-brown hexagonal crystals
|
|
cystine: cause and Tx
|
Cause: Homocystinuria
Tx: raise urine pH |
|
what is the most common kidney stones and shape?
|
Calcium Oxalate
envelope or dumbbell shape crystals |
|
what is the cause of oxalate stones and Tx
|
Cause: Malabsorption => Ca trapped in fat => Ca can't bind oxalate to excrete it.
>>Tx: Thiazide diuretics |
|
most common cause of oxalate crystals in caucasian kids
|
Cystic Fibrosis
|
|
most common cause of oxalate AA kids
|
celiac sprue
|
|
2 other common cause of oxalate
|
Ethylene Glycol poisoning
High Vit. C ( increase oxalate secretion) |
|
most common cause of oxalate in adults
|
Crohn's, Vegetarians
|
|
Kidney Stone Tx:
< .4cm >.4-4cm > 4cm Septic: |
Kidney Stone Tx:
< .4cm: Rehydration, Opiates >.4-4cm: Lithotripsy (shatter it w/ sound waves) => hematuria > 4cm: Surgery Septic: Stent placement to drain pus |
|
how does urinary reflux lead to renal failure?
|
>>Reflux makes ureters dilate => hydronephrosis =>pyelonephritis => renal failure
|
|
where is the ureter located?
|
Ureter: runs on top of psoas muscle, inferior and behind bladder
|
|
Bilateral Hydronephrosis:
|
dilation of ureters due to urine reflux>
|
|
Unilateral Hydronephrosis:
cause presentation |
stones=> colic (pain comes in waves), radiates to groin
|
|
what is the residual volume of the bladder?
|
residual volume= 100cc
|
|
how does UTI happen?
how does cranberry juice prevent UTI? |
urinary tract has podocytes
Cranberry Juice: prevents bacteria from adhering to bladder |
|
most common viral UTI
|
Adenovirus
|
|
most common bacterial UTI
|
Bacterial:
1) E. Coli 2) Proteus 3) Klebsiella 4) Enterococcus |
|
treatment for klebsiella UTI
|
Tx: Bactrim
|
|
Urethritis: presentation and pathogen
|
urethral infection => dysuria alone
(Chlamydia or Gonorrhea) |
|
Cystitis:
define presentation tx |
bladder infection => frequency, urgency
(Tx: Bactrim or Nitrofurantoin) |
|
Honeymoon cystitis:
|
Staph saprophyticus from penis head => female UTI
|
|
Prostatitis:
cause presentation |
bacteria climbed the urethra to prostate,
uncomfortable in sitting position |
|
Prostatitis: most common pathogen in the young and old, tx
|
Young: N. gonorrhea,
Old: E. coli Tx: Bactrim IV or Norfloxacin |
|
Pyelonephritis:
define cast presentation tx |
ascending infxn from nephron
=> WBC casts, costovertebral angle tenderness (Tx: Ceftriaxone) |
|
Balanitis
|
penis head inflammation
|
|
Phimosis:
|
foreskin scarred at penis head
(foreskin stuck smooshed up) |
|
Paraphimosis:
|
foreskin scarred at base of penis head
(retraction of foreskin strangulates penis) |
|
Prostatic abscess:
presentation DRE results pathogen |
repeated UTIs that improve w/ abx
prostate fluctuance (Staph aureus) |
|
Exstrophy of Bladder:
describe complication tx |
urachus stuck outside => cancer risk
(Tx: surgery at birth) |
|
Congenital bladder obstruction
|
posterior urtethral valves close when bladder contracts
|
|
drugs that can cause urinary retention:
|
BPH drugs, Ipratroprium, Quinidine
|
|
Hypospadia: define and tx
|
urinary opening near anus (penis fuses dorsal to ventral, zips up tip to base)
Tx: delay circumcision so the prepuce can be used for reconstruction, repair at 6mo |
|
what part of the urinary system is injured in a Seatbelt Trauma?
|
superior surface of bladder
|
|
Thoracic Aortic Dissection:
3 example presentation |
tearing pain, unequal BP/pulses, CXR widened mediastinum
|
|
2 types of aortic dissection:
|
Type A: ascending aorta
Type B: descending aorta |
|
Type A aortic dissection:
location associations/causes mngmt. |
location: ascending aorta
association: Marfan's, syphilis management: emergency surgery |
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Type B aortic dissection:
location associations/causes mngmt/tx |
location: descending aorta
causes: atherosclerosis in elderly, trauma in young tx.HTN (Nitroprusside+ Esmolol) |
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Abdominal Aortic Dissection:
Define location etiology diagnosis |
def: ripping pain, pulsating abdominal mass
MC location: 90% occur below left renal artery MC cause: atherosclerosis Dx: US or CT (if pt is hypotensive) |
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Abdominal Aortic Dissection: mngmt:
<4cm, >6cm, emergency treatment |
<4cm => control HTN, get CT/MRI/Angiogram
>6cm=> control HTN, surgery Emergency Tx: Tie aorta off, open heart massage; NO CPR! |
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what are the 2 types of aneurysm
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Types:
o True: all 3 layers o Pseudo: intima/ media only (Ex: femoral a. catheter injection) |
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CI for Abdominal Aortic Dissection
why? |
No Steriods with Aneurysms
(causes stress demargination of WBCs => thinner walls) |
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complicaiton of Abdominal Aortic Dissection repair
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Repair => emboli => Ant spinal cord infarction => loss of pain/temp/DTR
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Urinary Incontinence: management
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do cystometry
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Urge Incontinence
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urgency => complete voiding
"Gotta go right now!" |
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Urge Incontinence: Tx
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1) Urinate frequently to train detrusor
2) oxybutinin Imipramine Glycopyrrolate (anti cholinergic) Tolterodine |
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Stress Incontinence: define and test performed
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weak pelvic floor muscles (estrogen effect), pee when you sneeze
Q-tip test: > 30° change |
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Stress Incontinence: treatment
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1) Kegel exercise
2) Pessary (stick a plastic stopper in to plug it up ) 3) Pseudoephedrine (α1-agonist) 4) Kelly plication |
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One-way valves
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• Urethra
• Ejaculatory duct |
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Overflow Incontinence
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persistant dribble, but can't completely empty bladder
|
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Overflow Incontinence: give 2 causes
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1) obstruction
2) Detrusor hypotonia |
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Overflow Incontinence: give 2 Tx of detrusor hypotonia
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o Tx: Bethanechol (increase detrusor contractions, muscarinic agonist)
o Tx: intermittent self-catheterization |
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Overflow Incontinence: detrusor hypotonia is associated with what 2 diseases?
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DM, Multiple Sclerosis
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Ectopic Ureter:
|
continuous urine leakage in a child
|
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what is a Casts:
|
take nephron's shape from PT
|
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WBC casts
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Nephritis
|
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WBC casts only=>
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Pyelonephritis (sepsis)
|
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WBC + Eosinophils => and tx
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Intetstitial nephritis and allergies
Tx: steroids |
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WBC + RBC casts=>
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Glomerulonephritis (hematuria => vasculitis => HTN)
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Fat casts:
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Nephrotic syndrome
|
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waxy casts:
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ESRD
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Tubular casts:
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ATN
|
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Muddy brown casts:
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ATN
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Hyaline casts:
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Normal sloughing
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Epithelial casts:
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Normal sloughing
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Crescents:
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RPGN
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FeNa: normal
• Pre-renal • Renal • Post |
FeNa: 1-10% normal
• Pre-renal < 1% • Renal > 2% • Post > 4% |
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Urine Na= normal
• Pre-renal • Renal • Post |
UNa= 10-20 normal
• Pre-renal <20 mEq/L • Renal >20 mEq/L • Post >40 mEq/L |
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Proximal Tubule: location, function and what does it secrete?
|
in cortex (isotonic)
Job: reabsorb glucose, amino acids, salt, bicarb, water Secrete: H+ (not excrete, keeps circulating) |
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main reactions in the PTC
|
Main Rxns:
• H2C03 =>(CA) =>C02 + H20 • Na/Mg/P04/ aa/ glucose/lactate co-transporter • HC03-/Cl- antiporter |
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PCT: % of Na, glucose, aa, bicarbonate are reabsorbed
|
Reabsorb:
• 70% Na • 70% H20 • filtered HC03- • 99% glucose • 90% aa |
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where is the water reabsorbed
|
70% H20 (reabsorbed intercellularly - tiny space between cells)
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what happens to HCO3- when reabsorbed
|
filtered HC03- (into plasma) ~ "contraction alkalosis"
|
|
transport maximum of glucose
|
99% glucose (<1.26 = transport maximum)
|
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Fanconi's syndrome
|
(old tetracycline): urine phosphates, glucose, amino acids=> low energy state
|
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Carbonic Anhydrase Inhibitors:
example it usage it has what compound? |
>>Acetazolamide
Tx: incr. ICP, acute glaucoma, mountain sickness, pseudotumor cerebri >> it has sulfur |
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Thin Descending Limb: function
|
reabsorbs water
|
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Thick Ascending Limb:
function and describe the urine tonicity: |
>>hypotonic
>>make the concentration gradient by reabsorbing Na, K, Cl, Mg, Ca without water |
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main rxns of thick ascending limb
|
• 25% Na/K/2Cl co-transporter
• Na/Ca or Na/Mg co-transporter • Not water-permeable |
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Bartter's syndrome:
|
baby w/ defective triple transporter (low Na, Cl, K w/ normal BP)
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Psychogenic polydipsia:
|
no concentrating ability ~> cerebral edema
|
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Post-obstructive diuresis: def and Tx
|
remove obstruction => medulla feels diluted, can't concentrate
(Tx: replace vol) |
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Loop Diuretics
kind of acid, MOA made up of what compound looses what ion? |
def: weak acid
blocks triple transport system in thick loop of Henle (Na/Cl/K+ and Ca/Mg) has sulfur looses Ca |
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what must be replaced when someone is in loop diuretics?
|
must replace K+
|
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what kind of compound does loop diuretic compete with
what does it lead to? |
competes for uric acid excretion => gout
|
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what are the loop diuretics (4)
|
Bumetanide
Torsemide Furosemide Ethacrynic acid |
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Furosemide SE and what is it used for?
|
SE: reversible hearing loss, Stephen Johnson syndrome,
Usage: ciliates lung lymphatics (use with renal failure and pulmonary edema) |
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Ethacrynic acid
|
does not have sulfur
|
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Early Distal Tubule:
Job: |
to concentrate urine by reabsorbing NaCl (hypotonic)
|
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Early Distal Tubule:
the three Main Rxns: |
• Macula Densa (MD): measures osmolarity and volume
• NaCl co-transporter • Ca2+ reabsorption (Vit D stimulates Ca ATPase) |
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what do they measure?
JG: MD: |
JG: measures volume
MD: measures osmolarity |
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Thiazide Diuretics: kind of acid, has what compound and SE
|
Thiazide Diuretics:
weak acids, have sulfur 'Hyper GLUC" HyperGlycemia HyperLipidemia High Uric acid HyperCalcemia |
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name the Thiazide Diuretics: (4)
|
Metolazone
Chlorthalidone indapamide Hydrochlorothiazide |
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thiazide diuretic that is used to treat oxalate stones
|
Hydrochlorothiazide
|
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function of Late DT collecting Duct:
what happens when there is hyperkalemia in the blood? |
>>Def: Hyperkalemia (in blood) => acidosis (in cell)
>>Job: final concentration of urine by reabsorbing water, excretion of acid (isotonic) |
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where is Vit D/Ca-ATPase reabsorbed?
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Late DT collecting Duct:
|
|
2 types of cell in the Late DT collecting Duct:
|
Principle cells:
Intercalated cells: |
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Principle cells: what are the three different channels in it and what steroid or hormone regulates it?
|
• H20 channels <= ADH
• (lose 90%) K+ channel <=Aldo • Na channel <= Aldo |
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Intercalated cells: what are the 2 pump in it and which one is activated by aldosterone?
|
• H/K. ATPase
• H secretion-ATPase <=Aldo |
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Hepatorenal syndrome:
|
high urea from liver increase glutaminase ⇨ NH4 + ⇨ GABA ⇨causes heart to stop pumping ⇨ kidney stops working.
|
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In respiratory acidosis how does the kidney make bicarb in CD?
|
by Carbonic Anhydrase enzyme,
it makes new bicarb in CD: H2CO3 ⇨ H+ + HCO3· |
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Glutaminase: breaks Gln ⇨ Glu + NH4 ⇨ NH3 + H+.
when is this active? why? |
activated when liver fails.
to make acid from CD |
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other CD acid sources:
|
1) H+ ATPases
2) Urea cycle (90% in liver, 10% in CD): NH4 ⇨ NH3 + H+ |
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Spironolactone: MOA, SE, tx
|
MOA: K+ sparing diuretic, blocks Aldo and p450
SE: gynecomastia, galactorrhea, tx Conn's and hirsuitism |
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Triamterene: type of diuretic, MOA and tx for what disease?
|
K+ sparing diuretic
blocks Na channels directly, tx: Meninier's |
|
Amiloride
|
K+ sparing diuretic
blocks Na channels directly, sodium wasting |
|
Renal Tubular Acidosis I:
what happens to serum hydrogen and potassium levels? |
serum ⇧H/⇩ K
|
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RTA Type I (distal):
etiology 4 associated syndromes |
H /K pump in CD is broken⇨ high urine pH.
(inflammation, autoimmune dz, stones, Li) |
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RTA Type II (proximal): urine pH
3 associated with what syndromes? |
bad Carbonic Anhydrase⇨ lost all bicarb ⇨ low urine pH
(multiple myeloma, Fanconi's, metals) |
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RTA Type III
|
I + II ⇨ normal fine pH 5.3
|
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Type IV: RTA
associated with what syndromes etiology |
infarct at the J-G apparatus ⇨ no renin ⇨ no Aldo ⇨ high K
(DM, NSAIDs, ACE-I, Heparin, sickle cell) "HANDS" |
|
J -G apparatus
function |
measures volume and secretes renin
|
|
PT: what does it absorb? 4
|
glucose/aa/ bicarb/NaCl
|
|
Thin AL:
|
reabsorbs water
|
|
Thick AL:
|
reabsorbs ions only ⇨ makes concentration gradient
|
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Macula Densa: funciton
|
measures osmolarity
|
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Early DT: function
|
reabsorbs NaCl ⇨ starts concentration of urine
|
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Late DT /CD: function
|
reabsorbs water/ excretes H+ ⇨ final concentration of urine
|
|
Anion Gap:
|
Na - (Cl + HCO3)
normal +9-14mEq/L |
|
High Anion Gap: def and examples
|
Def: Buffer H+ by losing HC03-
''MUDPILES" Methanol- turns into formic acid ⇨kills retina Uremia DKA Paraldehycde INH/ Iron Lactic acid (Ex: bowel ischemia) Ethanol/Ethylene Glycol (antifreeze) - turns into glycoxylate => Kidney stones Salicylates: asa |
|
Low Anion Gap:
|
Multiple Myeloma
|
|
Non-Anion Gap: def (HCO3 and Cl-) and examples
|
⇩HC03 or⇧ Cl
Diarrhea Fanconi's RTA (type II) Acid ingestion |
|
which one has a longer renal artery?
|
aorta is on the left and therefore right renal artery is longer
|
|
how does thiazide work as a treatment for nephrogenic DI?
|
thiazide is used as its side effect (making more porins). it stops the Na/K+ pump and therefore holds on to more sodium and the porins help absorb water.
|
|
which one has the longest renal vein?
|
left renal vein is longer because the IVC is on the right. "I am Right"
|
|
polyuria and polydipsia DDX
next best step of management. |
psychogenic and DI
do water deprivation test first |
|
maximum parkland formula
|
50% is maximum
|
|
70 kg man, 65% burn fluid management
|
70 x 50%= 2450 x 4cc =9800
4900 first 8 hrs and 4900 next 16 hrs, 2nd day: 4900 and 3rd day give none (massive enuresis) |
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70 kg man, 65% burn fluid management if the urine out put is 15,20 and 15 an hour.
|
give more fluids since his urine output should be .5-1.5 cc/hr. 70kg urine output is 35-105/hr. (70 x.5) = 35 and 70 x 1.5 =105
therefore the normal urine output range for this man is 35-105/hr |
|
70 kg man, 65% burn fluid management if the urine out put is 300,250 and 270 an hour. Next best step of management
|
lower down fluids
|
|
70 kg man, 65% burn fluid management if the urine out put is in 48 hours is 50-100 and the third day its 300 and 250. what is the next best step of management?
|
none, this is the massive eneuresis
|
|
management of a dehydrated patient and exception.
|
Give .9% saline because its isotonic, it fills up the vascular space and eventually go into the cell because cell are hypertonic. If patient was given hypertonic solution, the BP will go up but at the expence of the cells. The only time we give hypertonic solution in a dehydrated patient is when Na <120mg/dl. We give 3% because this person has SIADH and without Na, cells are least likely to depolarize.
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