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143 Cards in this Set
- Front
- Back
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clearance of any substance = ?
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urinary excretion/plasma concentration
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what does the clearance of PAH equal?
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effective renal plasma flow (unless the secreting mechanism is saturated)
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what kind of diuretics are contraindicated in renal failure?
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potassium sparing - exacerbates elevated serum potassium & hyperkalemia can lead to arrhythmia
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tubular fluid with lowest osmolarity is found where?
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macula densa
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how is interstitial fluid volume related to inulin space?
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inulin space approximates ECF volume, so interstitial fluid volume = inulin space - plasma volume
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what percent of total body weight is total body water?
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60%
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what proportion of total body water is ECF and ICF?
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1/3 ECF and 2/3 ICF
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what percent of ECF is plasma volume? interstitial volume?
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1/4 plasma volume and 3/4 insterstitial volume
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how is plasma volume measured?
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radiolabeled albumin
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how is extracellular volume measured?
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inulin
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formula for clearance?
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C=UV/P = [urine] x urine flow rate/[plasma]
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what forms the size barrier of the glomerulus?
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fenestrated capillary endothelium
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what formes the negative charge barrier of the glomerulus?
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fused basement membrane with heparan sulfate
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what is lost in nephrotic syndrome?
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charge barrier - resulting in albuminuria, hypoproteinemia, generalized edema, and hyperlipidemia
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what substance is used to calculate GFR?
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inulin
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creatinine clearance is an approximate measure of what?
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GFR
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what does renal blood flow equal?
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renal plasma flow/1-Hct
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effective renal plasma flow underestimates true renal plasma flow by how much?
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about 10%
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filtration fraction = ?
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GFR/RPF
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what arteriole does AT II act on?
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preferentially constricts efferent arteriole - decreases RPF, increases GFR, so FF increases
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what dilates the afferent arteriole? what effect does this have?
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prostaglandins - increases RPF, GFR so FF remains constant
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afferent arteriole constriction has what effect?
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decreases RPF & GFR - FF remains constant
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efferent arteriole constriction has what effect?
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decreases RPF, increases GFR, so FF increases
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increased plasma protein concentration has what effect on GFR?
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decreases GFR, (RPF stays same so FF decreases)
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decreased plasma protein concentration has what effect on GFR?
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increases GFR (RPF stays same, so FF increases)
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constriction of ureter has what effect on GFR?
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decreases it (also decreases FF)
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free water clearance = ?
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urine flow rate - clearance(osm)
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at what plasma glucose level does glucosuria begin? at what level does the transport mechanism become saturated?
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200; 350
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the osmolarity of the medulla can reach what level?
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1200 mOsm
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on what type of cells does aldosterone act?
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principal cells of collecting ducts - activates Na+/K+ pump; intercalated cells - stimulates H+ secretion
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portion of the nephron that reabsorbs all of the glucose & AAs, and most of the bicarbonate, sodium, and water; secretes ammonia, which acts as a buffer for H+
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early proximal convoluted tubule
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portion of the nephron that passively reabsorbs water via medullary hypertonicity
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thin descending limb
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portion of the nephron that contains the NKCC and indirectly induces the absorption of Mg2+ and Ca2+; impermeable to water
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thick ascending limb
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location of the nephron in which calcium reabsorption is under the control of PTH?
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early distal convoluted tubule
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actions of the early distal convoluted tubule?
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actively reabsorbs Na+, Cl-; reabsorbs calcium under PTH control
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portion of the nephron that reabsorbs sodium in exchange for secreting potassium or H+? what regulates this?
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collecting tubules; aldosterone
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reabsorption of water in this portion of the nephron is under control of ADH (vasopressin)
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collecting tubules
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actions of angiotensin II?
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1. potent vasoconstriction 2. release aldosterone from adrenal cortex, 3. release ADH from post pit 4. stimulate hypothalmus to increase thirst 5 increase intravascular volume and BP
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what may be released from atria as a check on the RAA system, e.g. in CHF?
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ANP
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what cells secrete renin?
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juxtaglomerular cells - in response to decreased renal BP, decreased Na+ delivery to distal tubule, and increased sympathetic tone
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how can NSAIDs cause acute renal failure in high vasoconstrictive states?
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by inhibiting the renal production of prostaglandins, which keep the afferent arterioles vasodilated to maintain GFR
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where does ADH bind? what is the result?
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binds to receptors on principal cells, causing an increase in the number of water channels/aquaporins and increased H2O reabsorption
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what is ANF secreted in response to? what does it do?
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secreted in response to increased atrial pressure, causes increased GFR and increased Na+ excretion
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what effect does aldosterone have?
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secreted in response to decreased blood volume (via AT II) and increased plasma K+ - causes increased Na+ reabsorption and increased K+ and H+ secretion
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angiotensin II causes increased absorption of what?
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Na+ and HCO3-
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primary disturbance in metabolic acidosis?
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decreased HCO3- (causes hyperventilation/ decreased PCO2)
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primary disturbance in metablic alkalosis?
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increased HCO3- (causes hypoventilation/ increased PCO2)
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primary disturbance in respiratory acidosis?
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increased PCO2 (causes increased renal HCO3- absorption)
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primary disturbance in respiratory alkalosis?
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decreased PCO2 (causes decreased renal HCO3- absorption)
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acidosis with PCO2 >40?
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respiratory acidosis
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acidosis with PCO2 <40?
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metabolic acidosis with compensation
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alkalosis with PCO2 <40?
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respiratory alkalosis
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alkalosis with PCO2 >40?
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metabolic alkalosis with compensation
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causes of respiratory acidosis?
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hypoventilation - airway obstruction, acute/chronic lung disease, opiods, narcotics, sedatives, weakening of respiratory muscles
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causes of anion gap metabolic acidosis?
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MUD PILES: methanol, uremia, diabetic ketoacidosis, paraldehyde or phenformin, iron tablets or inh, lactic acidosis, ethylene glycol, salicilates
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causes of non-anion gap metabolic acidosis?
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diarrhea, glue sniffing, renal tubular acidosis, hyperchloremia
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how do you calculate ion gap?
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Na+ - (Cl- + HCO3-)
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causes of respiratory alkalosis?
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hperventilation, aspirin ingestion (early)
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causes of metabolic alkalosis?
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vomiting, diuretic use, antacid use, hyperaldosteronism
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Winter's formula?
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PCO2 = 1.5(HCO3-) + 8 +/-2
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type of metabolic disturbance commonly seen in cardiopulmonary arrest?
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mixed acidosis
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ureter crosses anterior to the origin of what artery to enter the pelvis?
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external iliac
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ovoid, PAS-positive hyaline masses
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Kimmelstiel-Wilson nodule - most specific lesion of diabetic glomerulosclerosis
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nephrotic syndrome in IV drug user or HIV nephropathy
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focal segmental glomerulosclerosis
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renal pathology associated with DIC?
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diffuse cortical necrosis
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Potter's syndrome?
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bilateral renal agenesis - oligohydraminos, limb & facial deformities,pulmonary hypoplasia
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cause of Potter's syndrome?
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malformation of ureteric bud
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why do kidneys stay low in abdomen in horseshoe kidney?
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get trapped under IMA
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RBC casts in urine
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glomerular inflammation (nephritic syndromes), ischemia, or malignant hypertension
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WBC casts in urine
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tubulointerstitial disease, acute pyelonephritis, glomerular disorders
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granular casts in urine
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acute tubular necrosis
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waxy casts in urine
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advanced renal disease/CRF
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hyaline casts in urine
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nonspecific
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LM: glomeruli enlarged and hypercellular, neutrophils, lumpy-bumpy; EM: subepithelial humps; IF: granular pattern
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acute postreptococcal glomerulonephritis
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LM and IF: crescent moon shape
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rapidly progressive (crescentic) glomerulonephritis
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finding on immunofluorescence in Goodpasture's?
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linear pattern
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IF and EM findings in Berger's disease?
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mesangial IgA deposits
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split basement membrane
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Alport's syndrome
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mutation in Alport's? characteristic findings?
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collagen IV; nerve deafness and ocular disorders
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hematuria, hypertension, oliguria, azotemia
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nephritic syndrome
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findings in nephrotic syndrome
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massive proteinuria, hypoalbuminemia, peripheral and periorbital edema, hyperlipidemia
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LM: diffuse capillary and BM thickening; IF: granular pattern; EM: spike and dome
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membranous glomerulonephritis
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findings in minimal change disease/lipoid nephrosis?
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LM: normal glomeruli; EM: foot process effacement
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LM: segmental sclerosis and hyalinosis
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focal segmental glomerular sclerosis - most severe disease in HIV patients
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findings in diabetic nephropathy
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LM: Kimmelstiel-Wilson 'wire loop' lesions, basement membrane thickening
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findings in membranous glomeruloneprhitis in SLE
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wire-loop lesion with subendothelial deposits
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most common type of kidney stones?
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calciium oxalate, calcium phosphate, or both
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second most common type of kidney stone; can form staghorn calculi that can be nidus for UTIs
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ammonium magnesium phosphate (struvite)
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infection with what type of organism leads to struvite kidney stones?
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urease-positive bugs - proteus vlugaris, staph, klebsiella
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kidney stones often seen as a result of diseases with increased cell turnover, such as leukemia and myeloproliferative disorders
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uric acid
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types of radiolucent kidney stones?
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uric acid and cystine
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gene association with renal cell carcinoma?
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deletion of VHL gene on chromosome 3
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where does renal cell carcinoma originate?
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renal tubule cells (polygonal clear cells)
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renal cell carcinoma is associated with what syndromes?
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paraneoplastic (ectopic EPO, ACTH, PTHrP, and prolactin)
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gene association with Wilm's tumor?
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deletion of tumor suppressor WT1 on chromosome 11
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WAGR complex?
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Wilm's tumor, Aniridia, genitourinary malformation, and mental-motor retardation
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most common tumor of the urinary tract system?
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transitional cell carcinoma
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transitional cell carcinoma is associated with what?
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phenacetin, smoking, analine dyes, and cyclophosphamide
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white cell casts in urine are pathognomonic for what?
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acute pyelonephritis
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chronic pyelonephritis?
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coarse, asymmetric corticomedullary scarring; tubules can contain eosinophilic casts (thyroidization of the kidney)
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most common cause of acute renal failure?
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acute tubular necrosis
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what is acute tubular necrosis associated with?
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renal ischemia (e.g. shock), crush injury (myoglobinuria), toxins
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when does death most often occur in ATN?
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during initial oliguric stage
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what is renal papillary necrosis associated with?
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diabetes, acute pyelonephritis, chronic phenacitin use
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what is uremia?
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clinical syndrome marked by increased BUN and creatinine and associated symptoms
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metabolic disturbance seen in renal failure?
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metabolic acidosis due to decreased acid secretion and decreased HCO3- generation
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low serum chloride concentration is secodary to what?
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metabolic alkalosis
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high serum chloride concentration is secondary to what?
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non-anion gap acidosis
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most common cause of nephrotic syndrome in adults?
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membranous glomerulonephritis
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how does renal cell carcinoma typically present?
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as a mass or hematuria
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loop diuretic indicated for the treatment of edema associated with CHF, cirrhosis, and renal disease?
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furosemide
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two principal causes of rapidly progressive glomerulonephritis?
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anti-glomerular basement membrane and primary systemic vasculitis
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drugs implicated in the pathogenesis of acute interstitial nephritis?
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NSAIDs, beta-lactam antibiotics (cepalothin & methicillin), sulfonamides, diuretics (furosemide and thiazides), phenytoin, cimetidine, methyldopa
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EM: subendothelial humps, tram-track
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membranoproliferative glomerulonephritis
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when is mannitol contraindicated?
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anuria, CHF
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clinical use of mannitol?
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shock, drug overdose, decrease intracranial/intraocular pressure
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how does mannitol work?
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increases tubular fluid osmolarity, producing increased urine flow
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mechanism of acetazolamide?
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carbonic anhydrase inhibitor - causes self-limited NaHCO3 diuresis and reduction in total body HCO3- stores
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where does acetazolamide act?
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proximal convoluted tubule
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toxicity of acetazolamide?
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hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy
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clinical use of acetazolamide?
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glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness
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mechanism of furosemide?
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sulfonamide loop diuretic - inhibits NKCC of thick ascending limb; abolishes hypertonicity of medulla, preventing concentration of urine
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what effect does furosemide have on calcium excretion?
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increases it - Loops Lose calcium
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clinical use of furosemide?
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edematous states (CHF, cirrhosis, nephrotic syndrome, pulmonary edema), hypertension, hypercalcemia
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toxicity of furosimide?
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ototoxicity, hypokalemia, dehydration, allergy (sulfa), nephritis (interstitial), gout
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drug for diuresis in patients allergic to sulfa drugs?
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ethacrynic acid
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diuretic that can be used in hyperuricemia, acute gout?
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ethacrynic acid
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mechanism of hydrochlorothiazide?
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inhibits NaCl reabsorption in distal convoluted tubule, reducing diluting capacity of the nephron, decreases calcium excretion
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clinical use of hydrochlorothiazide?
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hypertension, CHF, idiopathic hypercalciuiria, nephrogenic diabetes insipidus
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diuretic used in nephrogenic diabetes insipidus?
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hydrochlorothiazide
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toxicity of hydrochlorothiazide?
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hypokalemic metabolic alkalosis, hyponatremia, hyperGlycemia, hyperLipidemia, hyperUricemia, and hyperCalcemia and sulfa allergy
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what are the potassium sparing diuretics?
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Spironolactone, Triamterene, Amiloride, eplercone
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mechanism of spironolactone?
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competitive aldosterone receptor antagonist in cortical collecting tubule
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how do triamterene and amiloride act?
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cortical collecting tubule - block Na+ channels
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clinical use of K+ sparing diuretics?
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hyperaldosteronism, K+ depletion, CHF
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toxicity of K+ sparing diuretics?
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hyperkalemia, endocrine effects (e.g. spironolactone causes gynecomastia, antiandrogen effects)
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diuretics causing acidosis?
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carbonic anhydrase inhibitors, K+ sparing diuretics
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diuretics causing alkalosis?
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loop diuretics, thiazides
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diuretic that increases urine calcium?
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loop diuretics
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diuretics that decrease urine calcium?
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thiazides
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name 3 ACE inhibitors
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captopril, enlapril, lisinopril
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mechanism of Losartan?
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AT II receptor antagonist - not ACE inhibitor and so doesn't cause cough
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toxicity of ACE inhibitors?
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cough, angioedema, proteinuria, taste changes, hypOtension, pregnancy problems (fetal renal damage), rash, increased renin, lower angiotensin II; hyperkalemia
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