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81 Cards in this Set
- Front
- Back
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What is normal plasma osmolarity?
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290 mOsm
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What is the effect of insulin deficiency on potassium?
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Hyperkalemia
(decreased Na+/K+ ATPase) |
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What is the effect of beta adrenergic antagonists on potassium?
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hyperkalemia
(decreased Na+/K+ ATPase) |
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What is the effect of acidosis or strenuous exercise on potassium?
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hyperkalemia
(K+/H+ exchange) |
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What is the effect of hyperosmolarity on potassium?
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hyperkalemia
(water diffuses out, brings K+) |
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What is the effect of digitalis on potassium?
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hyperkalemia
(blocks Na+/K+ ATPase) |
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What is the effect of cell lysis on potassium?
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hyperkalemia
(intracellular contents released) |
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What is the effect of insulin on potassium?
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hypokalemia
(increased Na+/K+ ATPase) |
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What is the effect of beta adrenergic agonists on potassium?
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hypokalemia
(increased Na+/K+ ATPase) |
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What is the effect of alkalosis on potassium?
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hypokalemia
(K+/H+ exchange) |
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What is the effect of hypoosmolarity on potassium?
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Hypokalemia
(water diffuses in, takes K+) |
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What is the formula for calculating PCO2 in respiratory compensation for metabolic acidosis?
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For every 1 mEq/L rise in HCO3-...
pCO2 increases by 0.7 |
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What are the possible causes of respiratory acidosis?
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Airway obstruction
Acute lung disease Chronic lung disease Opioids, narcotics, sedatives Weakened respiratory muscles |
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What are the possible causes of an increased anion gap metabolic acidosis?
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MUDPILES:
Methanol (formic acid) Uremia Diabetic ketoacidosis Paraldehyde or Phenformin Iron tablets or Isoniazid Lactic acidosis Ethylene glycol Salicylates |
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What are possible causes of a normal anion gap metabolic acidosis?
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Diarrhea
Glue sniffing Renal tubular acidosis Hyperchloremia |
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What are possible causes of respiratory alkalosis?
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Hyperventilation (e.g. high altitudes)
Early aspirin ingestion |
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What are possible causes of metabolic alkalosis?
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Diuretics
Vomiting Antacid use Hyperaldosteronism |
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Defect in collecting tubule's ability to excrete H+, associated with hypokalemia, risk of Ca++ kidney stones
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Type 1 (distal) renal tubular acidosis
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Defect in proximal tubule HCO3- reabsorption, associated with hypokalemia and hypophosphatemic rickets
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Type 2 (proximal) renal tubular acidosis
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Hypoaldosteronism or lack of collecting tubule response to aldosterone --> hyperkalemia --> inhibition of ammonia excretion in proximal tubule
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Type 3 (hyperkalemic) renal tubular acidosis
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WBCs, no casts in urine
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acute cystitis
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RBCs, no casts in urine
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kidney stones or bladder cancer
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RBC casts in urine
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glomerulonephritis
ischemia malignant hypertension |
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WBC casts in urine
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tubulointerstitial inflammation
acute pyelonephritis transplant rejection |
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granular "muddy brown" casts in urine
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acute tubular necrosis
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waxy casts
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advanced renal disease/ chronic renal failure
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hyaline casts
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nonspecific
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hematuria, RBC casts
azotemia, oliguria, hypertension, proteinuria |
nephrItic syndrome
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fatty casts
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nephrOtic syndrome
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hyperlipidemia, edema, thromboembolism, increased risk of infection
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nephrOtic syndrome
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PE: nephritic, Periorbital edema
LM: hypercellular glomeruli, PMNs, "lump-bumpy" appearance EM: subepithelial IC humps IF: granular |
Acute poststreptococcal glomerulonephritis
Resolves spontaneously |
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PE: progressive nephritic
LM: crescents (made of glomerular parietal cells, monocytes, macrophages) IF: crescents Etiology? |
RPGN:
- Wegener's (c-ANCA) - Microscopic polyarteritis (p-ANCA) - other immune-mediated processes |
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PE: nephritic, male, hemoptyis, hematuria
LM: crescents IF: linear |
RPGN:
- Goodpasture's (Anti-GBM) |
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PE: mixed nephritic/nephrotic
EM: subendothelial ICs, "tram-track" appearance due to the mesangium splitting the GBM IF: granular |
MPGN Type I:
HBV>HCV |
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PE: mixed nephritic/nephrotic
EM: subendothelial ICs, "dense deposits" IF: granular |
MPGN Type II:
C3 nephritic factor |
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PE: mixed nephritic/nephrotic
EM: subendothelial ICs, "wire looping" of capillaries IF: granular |
Diffuse Proliferative GN
SLE |
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PE: URI or acute gastroenteritis, nephritic
LM: ICs in mesangium |
IgA glomerulopathy (Berger's disease): due to increased synthesis of IgA
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PE: nephritic, nerve disorders, ocular disorders, deafness
EM: split basement membrane |
Alport's syndrome (mutation in Type IV collagen)
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Papillary necrosis and chronic interstitial nephritis
Interstitial inflammation and scarring, tubular atrophy |
NSAID nephropathy (decreased PGE --> ischemia)
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PE: nephrotic, most common
LM: diffuse capillary and GBM thickening EM: "spike and dome" appearance + subepithelial deposits IF: granular |
Membranous glomerulonephritis:
drugs SLE solid tumors infection |
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PE: nephrotic, loss of albumin, not globulins, recent infection
LM: normal glomeruli EM: foot process effacement |
Minimal change disease (lipoid nephrosis)
Treat with corticosteroids Most common in children |
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PE: nephrotic, multiple myeloma, chronic disease, TB, rheumatoid arthritis
LM: apple green birefringence on Congo red stain |
Amyloidosis
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PE: nephrotic, increased GFR initially
LM: mesangial expansion, GBM thickening, nodular glomerulosclerosis (hyaline) |
diabetic glomerulonephropathy (non-enzymatic glycosylation of GBM and efferent arteriole)
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PE: HIV
LM: segmental sclerosis/ hyalinosis, tubular injury and microcyts EM: GBM collapse |
Focal segmental glomerulosclerosis
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Infection with Proteus, Staphylococcus, and Klebsiella predisposes to what kind of kidney stone?
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Struvite (ammonium magnesium phosphate):
Urease-positive bugs Can form staghorm calculi = UTI nidus |
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Radiolucent kidney stone
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uric acid stones (associated with gout, high cell turnover)
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hexagonal shaped kidney stones
Treatment? |
cysteine
Treat with alkalinization of urine |
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60 yo male with hematuria, mass, polycythemia, flank pain, fever, weight loss
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renal cell carcinoma
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cells of origin in renal cell carcinoma?
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renal tubular cells --> polygonal clear cells
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paraneoplastic syndromes associated with renal cell carcinoma
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EPO, ACTH, PTHrP, prolactin
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Genetic predispositions to renal cell carcinoma?
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von Hippel-Lindau, deletion on chromosome 3
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Child with no irises, genitourinary malformation, and retardation is also likely to have....
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Wilm's tumor
(WAGR complex) |
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3 yo with palpable flank mass and/or hematuria
Genetic cause? Contains? |
WT1 on chromosome 11
embryonic glomerular structures |
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Associations with painless hematuria
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Transitional cell carcinoma
Pee SAC: Pheacetin Smoking Aniline dyes Cyclophosphamide |
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coarse, asymmetric corticomedullary scarring, blunted calyx
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chronic pyelonephritis
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Drugs responsible for pyuria (eosinophils) and azotemia 1-2 weeks after administration
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NSAIDs, PCNs, sulfas, rifampin - act as haptens --> hypersensitivity
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Obstetric complications and septic shock lead to...
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vasospasm or DIC --> diffuse cortical necrosis
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Causes of acute tubular necrosis
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I AM Afraid My Cidneys Hate BJ's Heavy Metal
Ischemia Myoglobinuria (crush injury) Aminoglycosides Amphotericin Contrast dye Heavy metals Hyperuricemia Bence-Jones |
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Diabetes mellitus
Acute pyelonephritis Chronic acetaminophen use Sickle cell anemia are all associated with |
renal papillary necrosis --> gross hematuria, proteinuria
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Urine osmolality: > 500
Urine Na <10 Fe Na < 1% Serum BUN/Cr > 20 |
Prerenal azotemia
Due to hypotension --> Na, H20, urea retention |
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Urine osmolality < 350
Urine Na >20 Fe Na > 2% Serum BUN/Cr <15 Epithelial/muddy brown casts |
Intrinsic renal azotemia
Due to tubular necrosis --> fluid backflow |
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Urine osmolality < 350
Urine Na > 40 Fe Na > 4% Serum BUN/Cr >15 |
Postrenal azotemia
Due to bilateral outflow obstruction |
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Nausea, anorexia, pericarditis, asterixis, encephalopathy, platelet dysfunction
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uremia
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Causes of combination of:
Rickets Metabolic acidosis Hypokalemia |
Fanconi's syndrome (decreased proximal tubule reabsorption):
Wilson's disease Glycogen storage disorders Drugs (cisplatin, expired tetracycline) |
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An adult with liver cysts, berry aneurysms, and mitral valve prolapse is likely to also have _________
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ADPKD:
HTN hematuria flank pain UTI renal failure anemia |
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Baby is born with widely separated eyes with epicanthal folds, broad nasal bridge, low set ears, and receding chin, has difficulty breathing
Likely to have associated fibrosis of what organ? |
liver
Potter syndrome from ARPKD |
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cortical and medullary cysts
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dialysis cysts
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solitary cysts in cortex
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benign simple cysts
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sequelae of medullary cystic disease
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fibrosis, progressive renal insufficiency, concentrating defects
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disorientation, stupor, coma
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hyponatremia
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irritability, delirium, coma
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hyperkalemia
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secondary to metabolic alkalosis, hypokalemia, hypovolemia, increased aldosterone
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hypochloremia
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secondary to non-anion gap metabolic acidosis
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hyperchloremia
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U waves on ECG, flattened T waves, arrhythmias, paralysis
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hypokalemia
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Peaked T waves, wide QRS, arrhythmia
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hyperkalemia
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tetany, neuromuscular irritability
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hypocalcemia
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delirium, renal stones, abdominal pain
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hypercalcemia
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neuromuscular irritability, arrhythmia
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hypomagnesemia
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delirium, decreased DTRs, cardiopulmonary arrest
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hypermagnesemia
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bone loss, osteomalacia
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hypophosphatemia
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renal stones, metastatic calcifications
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hyperphosphatemia
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