Renal

Front 1

normal cr values`

Back 1

1.5 men - av. 1.15
1.2 women - av. 0.95

Front 2

what conditions lead to low cr valuesx

Back 2

cirhossis
pregnancy
extremes of age/nutrition

Front 3

what conditions can increase cr wo changing kidney fc

Back 3

bactrim
cimetidine
rhabdo
if BUN:Cr ratio <10:1 with normal BUN and urine output

Front 4

Cockroft and Gault depends on

Back 4

age
weight
sex

Front 5

the same Cr will be associated w the worst kidney function in a

Back 5

old skinny woman

Front 6

echogenicity in chronic v. acute

Back 6

normal - acute
increased - chronic

Front 7

granular casts

Back 7

ARF

Front 8

waxy casts

Back 8

CKD

Front 9

factors that elevate BUN only

Back 9

corticosteroids
GI bleeding
catabolism
increased protein intake

Front 10

prerenal v ATN
urine Na
FENA
BUN/Cr
urine specific gravity
urinary sediment

Back 10

pre v ATN
<20 >40meq/L
<1% >3%
<15:1 normal
>1.015 1.010
none granular

Front 11

calculated FENA

Back 11

Clna/Clcr = (Una/Pna)/(Ucre/Pcre)

Front 12

vasodilates aff a

Back 12

PGE2

Front 13

vasoconstricts eff a

Back 13

ANG II

Front 14

what drugs contraindicated in prerenal

Back 14

ANG II, ACEi bc shift autoregulation curve to the right --> fall in GFR

Front 15

Rx for prerenal azotemia

Back 15

give volume, manage K (with Ca)

Front 16

types of ATN

Back 16

ischemic (80%) in outer medulla PT (pars recta and TALH)
toxic PT (pars convoluta)

Front 17

common causes of toxic ATN

Back 17

aminogylcosides, amphotericin, IV contrast, Cis Platinum

Front 18

criterion for HRS

Back 18

hepatic failure, portal htn
kidney disease (cr 1.5< or cl<40
no proteinuria
no improvement w volume expansion

Front 19

2nd hit in hrs

Back 19

something that causes
most often bacterial peritonitis

Front 20

pvr in hrs

Back 20

LOW bc glucagon and NO dilate splanchnic bed

Front 21

mech of glucagon

Back 21

inhibits effect of AII and NE to VC splanchnic bed
HRS

Front 22

why do kidneys fail in HRS

Back 22

low blood flow (bc of sym activation) and glomeruli shrink (bc mesangial cells contract)

Front 23

contraindicated in HRS

Back 23

NSAIDs and ACEi

Front 24

DX of HRS

Back 24

Cr hard to interpret bc low baseline with cirrhosis
same Na profile as prerenal BUT wont respond to volume

Front 25

Rx of HRS

Back 25

glucagon ANT
TIPs - shunt from portal circulation of systemic--> reduced portal HTN

Front 26

effect of pregnancy on:
GFR
Cr
tract
size
SVR
Na
acid/base

Back 26

increases substantially
low
dilates
larger
reduced (relaxin)
hyponatremia
alkalosis (respiratory bc of progesterone)

Front 27

gestational diabetes inspididus mech:

Back 27

placenta makes vasopressinase bc destroy ADH --> DI

Front 28

definition of gestational HTN

Back 28

AFTER 20 WEEKS, HTN wo Proteinuria

Front 29

definition of pre-eclampsia

Back 29

AFTER 20 WEEKS, HTN W PROTEINURIA

Front 30

mech of pre-eclampsia

Back 30

cytotrophoblast fails to invade --> failure of development of capacitanc vessles (spiral arteries) and instead become resistance vessels

Front 31

SS of pre-eclampsia

Back 31

edema, headaches, visual disturbances, abd/chest pain

Front 32

labs for pre-eclampsia

Back 32

increased Cr (>.8), proteinuria, thrombocytopenia (<100,000)

Front 33

risk factors for pre-eclampsia

Back 33

1st pregnancy
multiple gestations
hydatiform mole
pre-existing vascular disease
metabolic syndrome
thrombophilia

Front 34

Path of pre-eclampsia

Back 34

glomerular endotheliosis

Front 35

Rx for preeclampsia:

Back 35

lower bp to <110
NEVER USE ACEi, ARBs (bc teratogenic)

Front 36

chinese herb nephropathy
agent
mech
loc
effect

Back 36

aristolochic acid
permanent DNA damage, inhibit tubular protein reabsorption
PT
increased risk for uroepithelial chancer
--> chronic tubulointerstitial fibrosis

Front 37

St. John's Wart

Back 37

induced p450 pathway

Front 38

grapefruit juice

Back 38

inhibits p450 pathway

Front 39

star fruit
agent:
effect:

Back 39

oxalate
stones

Front 40

ephedra

Back 40

alpha-adrenergic Ag --> stones

Front 41

noni juice

Back 41

lots of K

Front 42

licorice

Back 42

inhibits 11-beta hydoxysteroid dehydrogenase pathway
allows cortisol to bind to ALDO receptors --> "aldo-like" effect
lots of Na reabsorption, loss of K

Front 43

Lead
exposure:
effect:
location:
DX:
RX:

Back 43

lead-based paints, ammunition, home-brewed ETOH
acute: FANCONI SYNDROME
Chronic: GOUT, HTN, CKD
PT
DX: bones scans, chelation test
RX: chelation if caught early

Front 44

Cadmium
exposure:
outcome:
Rx:

Back 44

mining, fish, cigarettes
CKD, HTN, OSTEOPEROSIS
Rx: none

Front 45

Fanconi's syndrome:

Back 45

impaired reabsorption at PT -->:
1) type II RTA
2) reduced reabsorption of all major electrolytes at PT

Front 46

conductive transfer

Back 46

diffusion, only in dialysis

Front 47

convective transfer

Back 47

ultrafiltration, in dialysis and normal pts

Front 48

hyaline casts

Back 48

benign finding

Front 49

hydrophilic drugs have a __ Vd

Back 49

small

Front 50

hydrophobic drugs have a ___ Vd

Back 50

large

Front 51

drugs with a lot of receptor binding have a ___ Vd

Back 51

very large

Front 52

more difficult to dialyze a drug if...

Back 52

has a high Vd
lots of protein binding
large
water soluble

Front 53

effect of CKD on protein binding

Back 53

reduced (ex of dilantin)

Front 54

effect of CKD on p450

Back 54

slows it down

Front 55

effect of 50% saline

Back 55

--> ECFV expansion and reduced Na

Front 56

calculate osmolarity/tonicity

Back 56

osm = 2*na+glu/18+BUN/3
ton+ same-BUN (bc exerts no force)

Front 57

Causes of hyponatremia

Back 57

increased water intake or impaired exretion
reduced GFR
CHF
nephritic syndrome
cirrhosis
adrenal insufficiency or hypothroidism
thiazides
SIADH (CNS, pulmonary, nausea and pain, nicotine, drugs)

Front 58

effect of rapid Na correction in chronic hyponatremia

Back 58

osmotic demyelination syndrome

Front 59

for every 100mg/dl increase in glucose, Na changes...

Back 59

decreased by 1.6

Front 60

in correcting Na, never exceed

Back 60

12meq/24hrs

Front 61

important pharmalogical cause of nephrogenic diabetes insipidus

Back 61

Li

Front 62

in assessing hypernatremia, low urine osmolarity suggests

Back 62

water diuresis (central or nephrogenic --- central responds to ADH given to pt)

Front 63

which types of stones are radio-opaque

Back 63

calcium oxalate
cystine
triple phospahte
ca-phosphate

Front 64

which stones are radio-lucent

Back 64

uric acid, xanthine, ephedrine

Front 65

which stones are in acidic urine

Back 65

calcium oxalate, uric acid, cystine

Front 66

which stones are in basic urine

Back 66

the phosphates, triple and ca

Front 67

crystal of ca oxalate

Back 67

envelopes/dumbbells

Front 68

crystals of uric acid stones

Back 68

rhomboids/stellate

Front 69

crystals of cystine stones

Back 69

benzene rings

Front 70

crystals of triple phosphate stones

Back 70

coffins

Front 71

epitaxy

Back 71

growth of one crytsal over another type of core

Front 72

% of ppl w ca-oxalate stones who have high Ca

Back 72

1/3

Front 73

how to reduce Ca levels in ppl with Ca-oxalate stones

Back 73

reduced Na intake

Front 74

how to avoid excess oxalate

Back 74

avoid things with Vit C and oxalate

Front 75

high uric acid most often -->?

Back 75

ca-oxalate (epitaxy)

Front 76

to rx cystine stones

Back 76

alkanalize the urine

Front 77

triple phosphate stones associated with

Back 77

urease producing infections

Front 78

AG =

Back 78

Na - Cl - HCO3

Front 79

causes of AG acidosis

Back 79

A MUD PIES

ASA
methanol
uremia
diabetic ketoacidosis,
phenformin or paraldehyde
idiopathic
lactic acidosis
ethanol or ethylene glycol

Front 80

causes of non-AG acidosis

Back 80

RTA (II-PT, I-DT)
severe diarrhea
early renal failure

Front 81

causes of metabolic alkalosis

Back 81

vomiting
diuretics
primary or secondary hyperaldosteronism

Front 82

microalbuminuria important bc tells

Back 82

early kidney damage in DM
risk factor bc of endothelial dysfunction

Front 83

confounders for dipstick

Back 83

concentrated urine
infection
hematuria

Front 84

fatty casts

Back 84

glomerular disease

Front 85

oval fat bodies

Back 85

glomerular disease

Front 86

kidney responsible for following as endocrine orgin

Back 86

reinin
ANG II
EPO
1,24 (OH)2 D3

Front 87

which 3 secondary GNs have low complement?

Back 87

PSGN
MPGN
Lupus