Terms in this set (39)
40 y f has urinary incontinence with sneezing or minimal activity. What is the cause?
Urethral sphicter dysfunction.
Good figure on Q: 10962
What part of the nephron absorbs the most water in a dehydrated person?
The Proximal tubule reabsorbs > 60% of filtered water regardless of hydration status.
This nephritic syndrome presents with deafness from childhood.
Type IV collagen disorder. Results in splitting of the basement membrane
What will Losartan do to Renin/ang1/ang2/aldosterone/bradykinin levels?
Increase: Renin, Ang1, Ang2
ARBs are Angiotensin II receptor blockers, so you still get the benefit of bradykinin breakdown while getting the aldosterone inhibition (like you do from ACE-I, which decrease Ang2)
Where is Para-aminohippuric acid (PAH) concentration lowest in the nephron?
Majority of PAH is secreted in the proximal convoluted tubule and not reabsorbed.
Patient has hypertension, hypokalemia (high K+ excretion in urine), hyperaldosteronism, and high renin. What is the cause?
Renin-producing tumor (Juxtaglomerular cell tumor), malignant hypertension, renal artery stenosis.
In tumor lysis syndrome, where does the uric acid precipitate in the nephron and why?
Collecting tubules because of the increased acidity of the urine.
Prevent it by alkalinizing the urine, hydration, and allopurinol.
What portion of the nephron is impermeable to water?
Thick and thin ascending limbs of the loops of Henle
What cells would undergo hyperplasia and hypertrophy in response to renal hypoperfusion?
Juxtaglomerular cells (specialized SMCs of the afferent arteriole). JG cells are what secrete Renin.
Macula densa cells are in the distal tubule and monitor salt and tubular flow rate. They signal the nearby JG cells to make renin. Q 7569
35 y m has anion gap metabolic acidosis. He is treated and his mental status improves, has increased bicarbonate and sodium levels, decreased serum osmolarity and hypokalemia. What did he have and what did they give him for treatment?
Insulin with Normal saline. Hypokalemia caused by the effect of insulin, which drives K+ into the cell.
What diuretic promotes hypercalcemia and where does it act?
Hydrochlorothiazide--acts in the distal convoluted tubule
Patient has duodenal ulcer and lost lots of blood and develops prolonged oliguria. Renal biopsy shows epithelial necrosis of tubules, tubulorrhexis, and intratubular casts. What does he have and what are the dangerous complications of the maintenance and recovery stages?
Acute tubular necrosis
Maintenance--Hyperkalemia/metabolic acidosis. Low urine output/fluid overload
Recovery--Hypokalemia. High urine output
32 y f hospitalized with fever and hematuria. Renal biopsy shows a ton of neutrophils in the interstitium and some in the tubular lumen. Whats the dx?
Q:833 for picture
What is Beckwith-Wiedemann syndrome and what chromosome is associated?
Combination of Wilms tumor, neonatal hypoglycemia, muscular hemihypertrophy, organomegaly (
Chromosome 11 on the WT2 gene, particularly IGF-2
What happens to RPF, GFR and FF in severe hypovolemia?
Big decrease in RPF, Small decrease in GFR, Increase in FF
What prevents a horseshoe kidney from ascending into the proper location and what does that predispose them to?
Urinary tract obstruction and development of hydronephrosis.
What structure is amyloid made out of?
17 y f ran a triathlon yesterday. Today she has 150/90, bilateral crackles on lower lobes, muscle tenderness, serum creatinine is 4 with 3+ protein and 4+ blood. What does she have and what is the cause?
Acute tubular necrosis
Myoglobinuria from muscle breakdown (usually seen in a crush injury)
What diuretic combo is best for someone with ascites and why?
Loop diuretics (furosimide) and a K+ sparing (spironolactone). The combination helps maintain a good K+ concentration.
What is a concerning side effect with the initial dose of ACE inhibitor and what other drug is it important to know about before starting the ACE inhibitor?
Hypovolemia due to another diuretic (e.g. thiazides)
Patient has a knee problems and she has mild renal insufficiency and 1+ protein in urine. Has a knee replacement and doesn't take analgesics any more. What kidney problem was she having?
Chronic interstitial nephritis and/or papillary necrosis due to chronic NSAID use
16 y m has sudden onset hematuria and left-sided abdominal pain that waxes and wanes. Urine microscope analysis shows hexagonal crystals. Dx? Basis for disease?
Defect in proximal tubule and intestinal AA transport of Cysteine, Ornithine, Lysine, and Arginine (COLA)
Alkalize the urine (acetazolamide)
58 y m has right-sided mass that demonstrates rounded polygonal cells with abundant clear cytoplasm. What is the dx and where did it originate from?
Renal cell carcinoma. Originates from proximal renal tubules. Appears as a golden yellow mass.
34 y has balooning and vacuolar degeration of proximal renal tubules and multiple oxalate crystals in the tubular lumen. Dx and cause and tx?
Acute tubular necrosis caused by ethylene glycol (antifreeze). Usually causes high anion gap metabolic acidosis
The extraction ratio of PAH is almost 90% at arterioal plasma concentrations lower than 20 mg/dL. Higher concentrations give a progressively lower ratio. Why?
The carrier transport (secretion by proximal tubule) is saturated.
PAH is filtered and secreted but not reabsorbed, so its a good estimator of
Renal plasma flow
Ureters pass in what relation to the internal iliac and the uterine artery?
Ureter passes over the internal iliac and under the uterine vessels (water under the bridge)
What does canagliflozin do and what organ fxn test should be checked prior to administration?
Inhibits Na/Glucose transport in the proximal conv. tubule
Check renal fxn tests
In the presence of ADH, where in the nephron is the lowest osmolality?
Distal convoluted tubule
Proximal = secretes isotonic fluid
30 y f has generalized weakness and paresthesia. BP 190/100 and very low plasma renin activity and normal serum creatinine. Dx and electrolyte pattern?
Primary mineralcorticoid excess (hyperaldosteronism)
Causes increased reabsorption of Na+ to increase BP. Excessive Na+ and edema are prevented by
ANP and increased pressure natriuresis
Na+ = normal
K+ = Low
HCO3 = high (increased H+ excretion)
47 y m was treated for sinusitis w/ ampicillin later develops fever, maculopapular skin rash, and oliguria. Creatinine 2.4. Urine has RBCs neutrophils, eosinophils. Dx and cause?
Acute interstitial nephritis from beta-lactam use.
Common causes: NSAIDs, penicillins, diuretics
What actually makes up the crescents in rapidly progressive glomerulonephtitis?
Fibrin and macrophages
Old guy in septic shock, anion gap, and increased lactic acid. What is the cause of the increased anion gap? Causes of lactic acidosis?
Increased metabolic rate (e.g. exercise)
Reduced oxygen delivery (e.g. shock)
Diminished lactate catabolism due to hepatic failure
Decreased oxygen utilization (cyanide poisoning)
Enzymatic defectsi in glycogenolysis or gluconeogenesis (Von gierke)
After an outbreak of strep skin infection in a small community, several patients get cola-colored urine and facial edema. Dx and what is the biggest factor affecting prognosis? Electron microscopy shows?
Age--almost all kids resolve, but 25% of adults develop rapidly progressive glomerulonephritis
Electron microscopy shows subepithelial humps
Patient comes in with Diabetic ketoacidosis. BP 96/58, pulse 112. ABG: pH 7.27, PaCO2 = 40 mmHg, HCO3 = 12. What is the diagnosis (include compensated or uncompensated) and what is wrong with the patient?
Metabolic acidosis with no compensitory respiratory alkalosis.
--common in DKA due to pulmonary edema or decreased mental status.
Respiratory compensation should be CO2 = (1.5 x serum CO3) + 8 +/- 2
What portion of the nephron does K+ sparing diuretics work on? Thiazides?
K+ sparing = Collecting tubule
Thiazides = Distal convoluted tubule
73 y m has cyanotic toe discoloration following coronary angioplasty. Has creatine of 2.4. Whats the Dx and what would renal biopsy show?
Atheroembolic disease of renal arteries.
Needle shaped cholesterol crystals that partially or completely obstruct renal arterioles.
8 y m has puffy face, cola-colored urine, and had a skin infection 3 weeks ago. IHC of glomerulus shows starry-sky appearance. Whats the Dx and what makes up the supepithelial deposits?
IgG, IgM, C3--subepithelial 'humps'
Also see hypercellular, inflamed glomeruli on H&E.
52 y f has 2 day hx of left flank pain. Has had multiple episodes of pyelonephritis in past 3 years. Urinalysis shows 12-18 WBC, lymphocytes, macros, Proteus mirabilis. Gross examination shows 3 cm mass on lower pole of kidney, epithelioid cell predominate with partially clear and granular to foamy cytoplasms, eccentric nuclei, normochromic, symmetric without significant pleomorphism. Dx?
How do you calculate renal blood flow given urine and serum PAH concentrations? What if you're given renal blood pressures?
Renal blood flow = Renal plasma flow/(1-Hct)
Renal plasma flow = Urine PAH x Urine flow/Serum PAH
Renal blood flow = (Renal artery pressure - Renal Vein pressure)/ Renal vascular resistance