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26 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What type of kidney stones are the most common?
What are two abuses that lead to these and are they radio-opaque? |
Calcium stone (calcium oxalate or calcium phosphate) are most common. They are radio-opaque and are generally caused by hypercalcemia (CHIMPANZEES) but more specifically by Vit C or ethylene glycol (antifreeze) abuse.
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What type of kidney stone can cause staghorn calculi? What leads to this type of stone and what can follow from it?
What worsens this type of stone? |
Ammonium magnesium phosphate (struvite) stones are the second most common and can lead to staghorn calculi that can be a nidus of UTI. These are often caused by urease-positive organisms (staph, klebs, proteus)
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Ammonium magnesium phosphate or struvite stones are worsened by alkaluria.
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What type of kidney stone is radiolucent? What does this occur secondary to?
What is associated with this type of kidney stone? |
Uric acid stones are radiolucent and often occur secondary to diseases with high cell turnover, like leukemia and myeloproliverative disorders.
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Uric acid stones are associated with hyperuricemia and gout.
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What type of kidney stone is detected by a Na cyanide-nitroprusside test? What does this test for? What causes these stones?
How do these stone appear and how do you treat? |
Na cyanide-nitroprusside test detects sulfhydryl groups of a cysteine stone. These stones are due to decreased cysteine reabsorption in the proximal tubule.
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Cystine stones are hexagonal in shape and can rarely form staghorn calculi. Treat them with alkalinization of urine.
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What are the different types of kidney stone?
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1. Ca - most common - antifreeze and vit C
2. Ammonium magnesium phosphate (struvite) - urease-positive infective bug, worse with alkaluria 3. Uric acid - radiolucent, hyperurecemia 4. Cystine - hexagonal, decreased cystine reabsorption at proximal tubule, Tx by alkaluria |
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What is the most common malignancy of the kidney and with what is it associated?
Where does this originate, appear and spread to? |
Renal cell carcinoma is associated with
1. smoking 2. obesity 3. vHL gene deletion on chr 3 4. paraneoplastic syndromes |
Renal cell carcinoma originates in renal tubule cells which appear as polygonal clear cells and spreads hematogenously to IVC.
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Patient is 3 yr old with palpable flank mass and hematuria. What is his condition? What is it associated with and what causes it?
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Wilm's tumor is due to deletion of WT-1 gene on chr 11 and can be part of WAGR complex: Wilm's tumor, Aniridia (no iris), Genitourinary malformation and mental-motor Retardation.
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What is the most common tumor of the urinary tract system? What symptoms are suggestive?
What are causes of this? |
UT tumor: transitional cell carcinoma causes painless hematuria.
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Transitional cell carcinoma is associated with problems in your Pee SAC:
Phenacetin Smoking Aniline dyes Cyclophosphamide |
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What area of the kidney is affected by acute and chronic pyelonephritis?
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Acute pyelo - affects cortex with relative sparing of glomeruli/vessels. WBC casts
Chronic pyelo - corticumedullary scarring and blunted calyx. Eosinophilic casts |
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What is the most common cause of acute renal failure in hospital? What are the three phases of this disease?
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Acute renal failure in hospital = acute tubular necrosis.
1. Inciting event 2. Maintenance (low urine) 3. Recovery (2-3 wks with supportive care) |
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Patient presents with acute onset of gross hematuria. What are possible causes?
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Acute gross hematuria: renal papillary necrosis
1. DM 2. Acute pyelonephritis 3. Chronic phenacetin use (acetaminophen) 4. Sickle cell anemia |
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What are the three types of acute kidney injury or acute renal failure? What are signs of each?
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Acute renal failure:
1. Prerenal azotemia (decreased RBF) - Serum BUN/Cr >20 2. Intrinsic renal (acute tubular necrosis) - Serum BUN/Cr <15 3. Postrenal (outflow obstruction) - elevated BUN/Cr, elevated FeNa, elevated urine Na and urine osmolarity less than 350. |
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How are each affected by the three types of acute renal failure?
Urine osmolarity Urine Na Fe Na BUN/Cr |
Prerenal: urine osmolarity >500, Urine Na < 10, Fe Na < 1% and BUN/Cr >20
Renal: < 350, >20, > 2% and < 15 Postrenal: < 350, > 40, > 4% and > 15 |
In prerenal (often due to hypovolemia) your body holds onto Na so fractional excretion is low and BUN/Cr is high bc the kidneys are reabsorbing both (BUN more) to help reabsorb water.
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Fanconi's syndrome
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Fanconi's syndrome:
- Decreased proximal tubule transport or many things that can be cauesd by Wilson's, glycogen storage diseases and drugs (e.g. cisplatin, old tetracyclines). Complication depends on specific defect (phosphate, HCO3, Na reabsorption problems) |
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ADPKD vs. ARPKD
- Differences - Similarities |
ADPKD (adult)
- Associated with polycystic liver, berry aneurysms, mitral valve prolapse and death from CKD or HTN ARPKD (infantile) - Associated with congenital hepatic fibrosis and Potter's. Death from HTN, portal HTN and progressive renal insufficiency. |
Both ADPKD and ARPKD are associated with damage to the parenchyma.
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Patient has poor ability to concentrate urine and ultrasounds show small kidney. What is the dz and prognosis?
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Medullary cystic disease causes fibrosis (causing small kidney) and progressive renal insufficiency (inability to concentrate urine) and has a poor prognosis
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What are the symptoms of low serum Na and high serum Na?
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Low serum Na:
Disorientation, stupor and coma |
High serum Na:
Irritability, delirium, coma |
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What are the symptoms of low and high serum K?
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Low K:
U waves on ECG Flattened T waves Arrhythmias Paralysis |
High K:
Peaked T waves Wide QRS Arrhythmias |
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What are the symptoms of low and high serum Ca?
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Low Ca:
Tetany Neuromuscular irritability |
High Ca
Delirium Renal stones Abd pain |
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What are the symptoms of low and high serum Mg?
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Low Mg
Neuromuscular irritability Arrhythmias |
High Mg
Delirium Decreased DTRs Cardiopulmonary arrest |
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What are the symptoms of low and high serum PO4-?
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Low PO4-
Bone loss Osteomalacia |
High PO4-
Renal stones Metastatic calcifications (not in damaged tissue) |
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What are the side effects of Loop diuretics?
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Loop diuretics? OH DANG
Ototoxicity Hypokalemia Dehydration Allergy (sulfa) Nephritis (interstitial) Gout |
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When is ethacrynic acid used rather than a loop diuretic?
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Ethacrynic is used for patients who have sulfa allergy to loops (Furosemide). It can also be used during acute gout or hyperuricemia without exacerbation.
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Which diuretics can cause acidemia?
Alkalemia? |
Acidemia:
Carbonic anhydrase inhibitors K sparing diuretics (Na / K and H) |
Alkalemia:
Loop diuretics Thiazide - both cause (1) contraction alkalosis due to AT II --> increased Na/H exchange at PT (2) K loss (3) paradoxical aciduria (H rather than K exchanged for Na in cortical collecting tubule) |
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Which diuretics cause Ca loss? Reabsorption?
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Ca loss:
Loops |
Ca reabsorption:
thiazides |
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What are the ACEi's and what is the ARB to remember?
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ACEi: captopril, lisinopril, enalapril
ARB: losartan (no cough) |
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