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Step 1 First Aid 15: Renal

Step 1 First Aid 15: Renal

by talonjanderson, May 2014

Subjects: 1 15 aid first renal step

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233 Cards in this Set

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	ureters pass under ___ or ___	uterine a. vas deferens
	___ of total bodyweight is water	60%
	2 compartments of total body water	ICF ECF
	ICF is ___ of total body water	2/3
	2 parts of ECF	interstitial fluid plasma
	interstitial fluid is ___ of ECF	3/4
	plasma volume is measured via ___ (2)	radiolabeled albumin evans blue
	ECF is measured via ___ (2)	inulin mannitol
	negative charge of glomerular BM is from ___ this is lost in ___	heparan sulfate nephrotic syndrome
	formula for clearance of substance X	C_x = U_xV/P_x where C_x = clearance of x, U_x = urinary concentration of x, V = urine flow rate, P_x = plasma concentration of x
	if C_x < GFR, then ___	x is reabsorbed
	if C_x > GFR, then ___	x is secreted
	because ____, ____ (2) can estimate GFR	they are neither reabsorbed nor secreted inulin clearance creatinine clearance (slightly secreted though)
	starling forces equation for GFR	GFR = K_f[(P_GC - P_BS) - (Pi_GC - Pi_BS)]
	renal plasma flow may be estimated by ___ this is because ___	CL_PAH it is primarily secreted and only slightly filtered
	RPF in terms of RBF	RPF = RBF(1-HCT)
	estimated RPF (from PAH) over/underestimates RPF	underestimates
	definition of filtration fraction (FF) normal value of FF	FF = GFR/RPF 20%
	Ang II works on ___ arteriole effect is ___ effect is blocked by ___	efferent constriction ACEI or ARB
	PGs work on ___ arteriole effect is ___ effect is blocked by ___	afferent dilation NSAIDs
	afferent arteriole constriction does ___ to RPF ___ to GFR ___ to FF	lowers lowers no change
	efferent arteriole constriction does ___ to RPF ___ to GFR ___ to FF	lowers raises raises
	plasma protein concentration increase does ___ to RPF ___ to GFR ___ to FF	no change lowers lowers
	ureter constriction does ___ to RPF ___ to GFR ___ to FF	no change lowers lowers
	definition of free water clearance	C_H2O = V - C_osm where V = urine flow rate, C_osm = clearance of osmoles = U_osmV/P_osm i.e. C_H2O = V(1 - U_osm/P_osm)
	when ADH is present, C_H2O is ___ otherwise, it's ___	<0 >0
	quantity of x excreted in terms of GFR (filtered load)	filtered load = (GFR)(P_x)
	2 related measures of urinary transit of substance x	filtered load excretion rate
	filtered load is product of ___ (2)	GFR P_x
	excretion rate is product of ___ (2)	V U_x
	(excretion rate)_x = (filtered load)_x if ___	x is neither reabsorbed nor filtered
	glucosuria occurs at plasma glucose levels above ___ mg%	160
	___ happens above plasma glucose of 350mg%	saturation of Glc transporters
	2 disease resulting from deficient PT AA transporters	Hartnup cystinuria
	descending limb of LOH is ___ for water ascending limb is ___	permeable (water efflux from urine) impermeable (electrolyte efflux)
	5 substances with secretion > reabsorption on plot of [TF]/[P] vs. distance along PT, this is represented as ___	PAH inulin creatinine urea Cl- slope > 1
	4 substances with reabsorption > secretion	Glc AAs HCO3- P_i
	2 parts of juxtaglomerular apparatus	JG cells macula densa
	JG cells are ___ cells in ___	smooth muscle afferent arteriole
	macula densa cells are ___ cells in ___	epithelial early DCT
	renin is secreted by ___ in response to ___ (3)	JG cells hypoTN reduced Na+ at macula densa NE (beta_1 R)
	renin acts via ___	converting angiotensinogen -> Ang I
	EPO is made by ___ cells of ___	endothelial peritubular capillaries
	2nd hydroxylation of D3 is done by ___ cells enzyme is ___ it is induced by ___	proximal tubule 1alpha hydroxylase PTH
	3 physiologic states which cause K+ shift OUT of cell	acidosis severe exercise hyperosmolarity
	2 drugs which cause K+ shift OUT of cell mechanism of both is ___	beta blocker digoxin Na+/K+ ATPase inhibition
	acidosis causes hyperkalemia because ___	H+/K+ exchanger swaps extracellular H+ for intracellular K+
	2 drugs which cause K+ shift INTO cell mechanism is ___	insulin beta agonists Na+/K+ ATPase activation
	2 kinds of acidosis	respiratory metabolic
	2 defining lab values for respiratory acidosis	pH<7.4 PCO2>40 mmHg
	2 defining lab values for metabolic acidosis	pH<7.4 PCO2<40 mmHg
	2 kinds of metabolic acidosis	anion gap high anion gap normal
	anion gap definition	AG = Na+ - (Cl- + HCO3-)
	anion gap is comprised of ___ (4)	anionic protein P_i citrate sulfate
	elevated anion gap metabolic acidisis means ___ (2)	HCO3- was lost the unmeasured anions have increased to take its place
	non-elevated anion gap metabolic acidosis means ___ (2)	HCO3- was lost Cl- has increased to take its place
	4 causes of non-anion gap metabolic acidosis	diarrhea glue sniffing RTA hyperchloremia
	normal anion gap	8-12 mEq/L
	2 kinds of alkalosis	metabolic respiratory
	2 lab values for metabolic alkalosis	pH>7.4 PCO2>40 mmHg
	2 required lab values for respiratory alkalosis	pH>7.4 PCO2<40 mmHg
	4 causes of metabolic alkalosis	diuretics vomiting antacids hyperaldosteronism
	2 causes of respiratory alkalosis	hyperventilation aspirin intoxication (early)
	3 types of RTA	1 2 4
	type 1 RTA is caused by ___ in ___	deficient H+ excretion collecting tubule
	type 1 RTA is associated with ___ (2)	hypokalemia Ca2+ stones
	type 2 RTA is caused by ___ in ___	deficient HCO3- reabsorption proximal tubule
	type 2 RTA is associated with ___ (2)	hypokalemia hypophasphatemic rickets
	type 4 RTA is caused by ___ (2)	hypoaldosteronism aldosterone insensitivity
	type 4 RTA is associated with ___	hyperkalemia
	hyperkalemia in type 4 RTA causes ___ in PT this causes ___	reduced NH3 excretion aciduria
	dd of RBC casts (3)	GN ischemia malignant HTN
	dd of WBC casts (3)	tubulointerstitial inflammation acute pyelonephritis transplant rejection
	cause of granular casts	ATN
	cause of waxy casts	RF (main chronic)
	presence of casts means urinary complaint is ___	of renal origin
	3 kinds of causes of RPGN	anti-GBM disease immune complex vasculitis pauci-immune vasculitis
	___ causes anti-GBM RPGN	Goodpasture's disease
	5 immune complex causes of RPGN of these ___ (2) also cause plain GN	essential cryoglobulinemic HSP cutaneous leukocytoclastic SLE PAN HSP SLE
	GN causes ___ (2) in urine	hematuria RBC casts
	GN causes ___ (4) derangements of renal function	azotemia oliguria HTN proteinuria
	proteinuria in GN is ___	<3.5g/day
	post-strep GN has ___ (2) on LM, ___ on EM, and ___ on IF	hypercellular glomeruli (proliferative) neutrophilic infiltrate subepithelial deposits lumpy-bumpy pattern
	post-strep GN happens mostly in ___ end-point is ___ causative strep species is ___	kids spontaneous resolution S. pyogenes
	immune complexes in post-strep GN consist of ___ (3)	IgG IgM C3
	2 lab values for post-strep GN	high ASO low C3
	4 components of RPGN cresents	glomerular parietal epitheilum fibrin plasma protein MQs
	fibrin, plasma protein and MQs of RPGN crescents are located in ___	urinary (Bowman's) space
	2 causes of diffuse proliferative GN	SLE MPGN
	diffuse proliferative GN has ___ on EM, and ___ on IF	subendothelial deposits lumpy-bumpy pattern
	diffuse proliferative GN represents WHO class ___ SLE renal disease	4
	class I SLE renal disease	no changes
	class II SLE renal disease	mesangial GN
	class III SLE renal disease	focal proliferative GN
	class V SLE renal disease	diffuse membranous GN
	most common form of SLE renal disease	class IV
	on LM, DPGN has ___ aka ___ on EM it has ___ on IF it has ___	capillary wall thickening wire looping subendothelial deposits lumpy bumpy pattern
	IgA nephropathy GN has ___ on LM it commonly occurs after ___ (2)	mesangial IC deposits URI gastroeneteritis
	___ is the MCC of nephrotic syndrome in adults it is caused by ___ (4)	diffuse membranous GN (DMGN) SLE (class V) drugs infections solid tumors
	on LM, DMGN has ___ (2) on EM it has ___	capillary wall thickening GBM thickening subepithelial deposits
	DMGN subepithelial deposits have ___ appearance	spike and dome
	___ is MCC of nephrotic syndrome in kids	minimal change disease (MCD)
	on LM, MCD has ___ on EM it has ___	minimal change foot process effacement
	MCD patients lose ___ but not ___	albumin globulins
	MCD tx	CS
	most common glomerular disease in HIV patients	FSGS
	T/F: FSGS is usually secondary to systemic disease	false: usually idiopathic
	idiopathic FSGS is more common in ___ (2 ethnicities)	hispanic black
	___% of FSGS reach end-stage disease within 10 years	50
	in FSGS, IF identifies ___ (2) deposits. these are not ___s.	IgM C3 ICs
	in FSGS, ____ is visible on EM in non-sclerotic areas	foot-process effacement
	idiopathic FSGS is caused by defect in ___. for example, ____ (3 proteins).	filtration slit nephrin podocin alpha-actinin
	in membranous nephropathy complement causes capillary damage directly via ___ and indirectly via ____ from ____ (2)	MAC MAC-triggered ROS and protease release epithelial cells mesangial cells
	2 kinds of MPGN are ___. ___ is much more common than the other.	immune complex MPGN dense deposit disease immune complex MPGN
	in both kinds of MPGN, ____ cells try to phagocytose ____, after which they ___. in response ____ cells secrete more ____, which causes loss of ____.	mesangial subendothelial deposits proliferate endothelial GBM capillary lumen
	deposits in IC MPGN are ___ (4)	IgG C3 C4 C1
	deposits in dense deposit disease are ___ (2)	C3 properdin
	in MPGN serum C3 is high/low	low
	amyloidosis deposits accumulate in ___ (2)	mesangium subendothelium
	3 GBM changes in DM	thickening more collagen IV less proteoglycans
	___ is a useful early test in DM	microalbuminuria
	2 DM risk factors for DM nephropathy	uncontrolled DM HTN
	___ are essential drugs for arresting DM nephropathy	ACEIs
	all DM has ___. this is caused by ___. some patients progress to ___ and others to ___.	diffuse GBM thickening non-enzymatic glycation diffuse GS nodular GS
	nodular GS has ____ surrounded by ___. nodular GS is aka ___	PAS + nodules dilated capillaries Kimmelstiel-Wilson disease
	microalbuminuria is ____/day macroproteinuria is ___/day	>30mg >300mg
	in addition to GS, ____ (2) are DM associated nephropathies	hyaline arteriolosclerosis pyelonephritis
	exposure to ___ such as in ___ (occupation) is a risk factor for Goodpasture	volatile hydrocarbons gasoline workers
	3 problems in Alport's syndrome	nephritis deafness ophthalmic disorders
	2 inheritance patterns for Alport's. the more common is ___.	XLR AR XLR
	Alport's is caused by mutations in ___.	collagen IV
	Alport's appears as ___ on EM	lamellation of GBM
	in nephrotic syndrome ANP is high/low	low
	2 complications of nephrotic syndrome	infection thrombosis
	infection in nephrotic syndrome is because of ___ thrombosis in nephrotic syndrome is because of ___	loss of Igs loss of anticoagulants
	IgA nephropathy is aka ___. it is caused by accumulation of ___ (2) in ___. this activates ___.	Berger's disease IgA C3 mesangium alternate complement pathway
	IgA nephropathy may appear via LM as ___ (3)	normal focal GN mesangial cell proliferation
	IgA nephropathy is associated with ___ (2).	celiac liver disease
	IgA nephropathy is a mild/severe disease.	mild
	T/F: in MCD renal function is normal.	true
	MCD is occasionally associated with ___ and rarely with ___ (3)	nephrin deficiency HLy NSAIDs atopy
	3 systemic diseases causing nephrotic syndrome	SLE amyloidosis DM
	2 complications of kidney stones	hydronephrosis pyelonephritis
	___ is most common kind of kidney stone	Ca2+
	2 kinds of Ca2+ kidney stone	Ca2+ oxalate Ca2+ phosphate
	Ca2+ stones are radio-___	opaque
	Ca2+ stone crystal shape	rectangular with X
	4 causes of Ca2+ stones	hyper-PTH hypervitaminosis D cancer milk-alkali syndrome
	2 causes of Ca2+ oxalate crystals	ethylene glycol poisoning (antifreeze) vitamin C abuse
	2nd most common kidney stone	struvite (15%)
	struvite is either ___ or ___	NH4MgSO4 NH4Mg(PO3)3
	struvite stones can cause ___	staghorn calculi
	staghorn calculi can cause ___	UTI
	struvite stones are radio-___	opaque
	struvite stones are caused by ___	urease + bacteria
	5 urease + bugs	Proteus vulgaris Klebsiella HP Ureaplasma Staph
	struvite crystal shape	rectangular
	3rd most common kidney stone	urate (5%)
	urate crystals are associated with ___ (2)	leukemia MPD (high cell turnorver rate)
	urate crystals are radio-___	lucent
	4th most common kidney stone	cystine (1%)
	main cause of cystine stones	cystinuria
	cystine crystals shape	hexagonal
	cystine crystals can cause ___	staghorn calculi
	cystine crystals are radio-___	opaque (faintly)
	4 ectopic hormones associated with RCC	EPO ACTH PTHrP PRL
	RCC is associated with ___	VHL
	___ is most common renal malignancy in kids	Wilms'
	Wilms' tumor contains ___	embryonic glomeruli
	growth disorder associated with Wilms' tumor	hemihypertrophy
	___ on chromosome ___ is a gene linked to Wilms' tumor it is a ___ gene	WT1 11 tumor-suppressor
	complex including Wilms' tumor	Wilms' tumor Aniridia Genitourinary malformation mental-motor Retardation (WAGR)
	symptom suggestive of transitional cell ca	painless hematuria
	TCC is associated with ___ (4)	Phenacetin (analgesic) Smoking Aniline dyes CTX (Pee SAC)
	pyelonephritis primarily affects ___ of kidney	cortex
	pyelonephritis has ___ casts in ___ this is called ___	eosinophilic tubules thyroidization
	2 causes of diffuse cortical necrosis	obstetric catastrophe septic shock
	2 mechanisms of diffuse cortical necrosis	DIC vasospasm
	___ is reversible but requires ___ to prevent death	ATN supportive dialysis
	ATN is associated with ___ (3)	shock crush injury (myoglobinuria) toxins
	ATN has ___ phase followed by ___ occurring at ___	oliguric recovery 2--3 weeks
	death from ATN occurs in ___ phase	oliguric
	prerenal azotemia is caused by ___	reduced RBF
	postrenal azotemia is caused by ___	BILATERAL outflow obstruction
	prerenal ARF has ___ urine osmolality ___ urine Na+ ___ FENa and ___ BUN/Cr ratio	high (>500) low (<10) <1% >20
	renal ARF has ___ urine osmolality ___ urine Na+ ___ FENa and ___ BUN/Cr ratio	low (<350) high (>20) >2% <15
	postrenal ARF has ___ urine osmolality ___ urine Na+ ___ FeNa and ___ BUN/Cr ratio	low (<350) very high (>40) >4% >15
	electrolyte disorder in RF	hyperkalemia
	acid-base disorder in RF	metabolic acidosis
	uremia syndrome includes ___ (5)	nausea pericaditis encephalopathy platelet dysfunction asterixis
	skeletal disorder in RF cause is ___	renal osteodystrophy deficient 1,25-OHD
	metabolic disorder in RF	dyslipidemia (hyper-TAG)
	Fanconi's syndrome is deficient ___ in ___	metabolite transport PT
	4 metabolites lost in Fanconi's syndrome	Glc AAs phosphate uric acid
	2 kinds of Fanconi's syndrome	congenital acquired
	3 kinds of causes of Fanconi's	Wilson's glycogen storage disease drugs
	2 drugs causing Fanconi's	cisplatin expired tetracycline
	simple renal cysts are located in ___ they are benign/symptomatic	cortex benign
	medullary renal cysts pw ___ (2) prognosis is good/bad	concentrating defect small kidney on US bad
	4 sx of hyponatremia	disorientation stupor coma seizure
	3 sx of hypernatremia	irritability delirium coma
	hypochloremia is associated with ___ (4)	metabolic alkalosis hyperaldosteronism hypokalemia hypovolemia
	hyperchloremia is associated wtih ___	non-anion gap metabolic acidosis
	2 sx of hypokalemia	paralysis arrhythmia
	2 EKG signs of hypokalemia	U wave flattened T wave
	U wave is ___ it has same polarity as ___ it is caused by ___	small deflection after T wave T wave septal repolarization
	T/F: u wave is pathological	false: present in 50% of normal EKG
	sx of hyperkalemia	arrhythmia
	2 EKG signs of hyperkalemia	peaked T wave wide QRS
	2 sx of hypocalcemia	tetany neuromuscular irritability
	T/F: hypercalcemia can occur without hypercalciuria	true
	2 sx of hypomagnesemia	neuromuscular irritability arrhythmia
	3 sx of hypermagnesemia	delirium decreased DTRs cardiopulmonary arrest
	2 sx of hypophosphatemia	bone loss osteomalacia
	2 sx of hyperphosphatemia	kidney stones metastatic calcification
	4 indications for mannitol	high ICP high intraocular pressure drug OD shock
	2 mannitol SEs	pulmonary edema dehydration
	mannitol is contraindicated in ___ (2)	CHF anuria
	acetazolamide mechanism	CA inhibition
	CA does ___	H2O + CO2 <--> H2CO3
	in PT, filtered ___ combines with secreted ___ to make ___	HCO3- H+ H2CO3
	normally, CA facilitates ___ therefore, inhibition causes ___ this causes ___	HCO3- reabsorption HCO3- excretion metabolic acidosis
	6 indications for acetazolamide	open angle glaucoma pseudotumor cerebri cystinuria altitude sickness metabolic alkalosis dural ectasia
	furosemide causes increased ___ excretion	Ca2+
	6 furosemide SEs	Ototoxicity Hypokalemia Dehydration Allergy (sulfa) Nephritis (interstitial) Gout
	___ is a non-sulfonamide loop diuretic it can be used in the presence of ___	ethacrynic acid gout
	4 indications for thiazide	HTN CHF idiopathic hypercalciuria nephrogenic DI
	7 thiazide SEs	hypokalemic metabolic alkalosis hyponatremia hyperGlycemia hyperLipidemia hyperUricemia hyperCalcemia sulfa allergy
	triamterene acts at same channel as ___	amiloride
	___ diuretics cause acidemia ___ (2) cause alkalemia	acetazolamide loop diuretics thiazide
	___ diuretics cause hypercalciuria ___ cause hypocalciuria	loop diuretics thiazide
	10 ACEI SEs	Cough Angioedema Proteinuria Taste changes hypOtension Pregnancy problems Rash Increased renin Lower Ang II hyperkalemia
	ACEIs are contraindicated in ___ because ___	bilateral renal artery stenosis they lower GFR

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