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[h] Nephrology System Flashcards

[i] Master this session in just 5 minutes.

[q] …………… is a defect in ability of α intercalated cells to secrete H and regenerate HCO3 —> metabolic acidosis but an inappropriately high urine pH and hypokalemia.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IERpc3RhbCByZW5hbCBUdWJ1bGFyIEFjaWRvc2lzIChUeXBlIEkpLg==

Cg==

Cg==[Qq]

[q] ………….. is a defect in PCT HCO3 reabsorption –> ↑ excretion of HCO3 in urine and subsequent metabolic acidosis with hypokalemia and acidified  urine.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFByb3hpbWFsIHJlbmFsIFR1YnVsYXIgKEFjaWRvc2lzIFR5cGUgSUkpLg==

Cg==

Cg==[Qq]

[q] …………. is a type of renal tubular acidosis due to hypoaldosteronism or aldosterone resistance —> hyperkalemia, metabolic acidosis, and acidified urine.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEh5cGVya2FsZW1pYyByZW5hbCB0dWJ1bGFyIGFjaWRvc2lzICh0eXBlIDQpLg==

Cg==

Cg==[Qq]

[q] Whats is the most likely diagnosis?

53 years old patient presenting with hypertension, abdominal and flank pain, gross hematuria + abdominal ultrasound shows bilateral multiple cyst in both kidney and multiple cysts in the liver?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEF1dG9zb21hbCBkb21pbmFudCBwb2x5Y3lzdGljIGtpZG5leSBkaXNlYXNlLg==

Cg==

Cg==[Qq]

[q] Whats is the most likely diagnosis?

1 year old infant presenting with systemic hypertension, progressive renal insufficiency, and portal hypertension from congenital hepatic fibrosis + History of prenatal oligohydramnios?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEF1dG9zb21hbCByZWNlc3NpdmUgcG9seWN5c3RpYyBraWRuZXkgZGlzZWFzZS4=[Qq]

[q] Whats is the most likely diagnosis?

60 years old patient with history of hypertension, DM presenting with ischemic stroke, symptoms of acute kidney injury, reticular, lacy skin discoloration/erythema that blanches on pressure + fundus examination shows bright, yellow, refractile plaques in the retinal artery + Renal biopsy shows needle-shaped cholesterol crystals that partially or completely obstruct renal arterioles weeks after after cardiac catheterization?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEF0aGVyb2VtYm9saWMgcmVuYWwgZGlzZWFzZS4=

Cg==

Cg==[Qq]

[q] ………………. is the most common renal neoplasm, accounting for approximately 70% of all kidney tumors.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFJlbmFsIGNlbGwgY2FyY2lub21hIChSQ0MpLg==[Qq]

[q] Renal cell carcinoma (RCC) usually originate from the epithelium of the …………?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHByb3hpbWFsIHJlbmFsIHR1YnVsZXMu[Qq]

[q] Microscopically, clear cell carcinoma (the most common subtype of RCC) appears as cuboidal or polygonal cells with clear abundant cytoplasm and eccentric nuclei. The cytoplasm appears clear due to …………….?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHRoZSBoaWdoIGdseWNvZ2VuIGFuZCBsaXBpZCBjb250ZW50IG9mIHRoZSB0dW1vciB0aGF0IGRpc3NvbHZlcyBkdXJpbmcgdGlzc3VlIHByZXBhcmF0aW9uLg==[Qq]

[q] Sporadic tumors of Renal cell carcinoma (RCC) classically arise in adult males (average age is 60 years) as (single or bilateral) tumor in the (superior or inferior) pole of the kidney; major risk factor for sporadic tumors is ……………..?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHNpbmdsZSwgc3VwZXJpb3IsIHNtb2tpbmcu[Qq]

[q] Hereditary tumors of Renal cell carcinoma (RCC) arise in younger adults and are often (single or bilateral).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGJpbGF0ZXJhbC4=[Qq]

[q] Whats is the most likely diagnosis?

64 years old patient presenting with hematuria, flank pain, and palpable abdominal mass + Lab findings shows: Hb= 19 gram and hypercalcemia + ultrasound shows a single mass in the superior pole of the left kideny?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFJlbmFsIGNlbGwgY2FyY2lub21hLg==[Qq]

[q] Involvement of the left renal vein by Renal cell carcinoma blocks drainage of the left spermatic vein leading to …………..?  and inferior vena cava obstruction can occur by intraluminal extension of the tumor leading to ………..?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHZhcmljb2NlbGUsIHN5bW1ldHJpYyBiaWxhdGVyYWwgbG93ZXIgZXh0cmVtaXR5IGVkZW1hLg==

Cg==

Cg==[Qq]

[q] Renal cell carcinoma hematogenously spread. ……….. are the most common site found in about half of all cases of disseminated disease. …….. metastases are the next most common?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFRoZSBsdW5ncywgQm9uZS4=[Qq]

[q] Immunotherapy using …………. are used for advanced/metastatic cases of Renal cell carcinoma.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGFsZGVzbGV1a2luLg==[Qq]

[q] ………… is a benign epithelial cell tumor arising from collecting ducts. It presents with painless hematuria, flank pain, abdominal mass. Histology shows large eosinophilic cells with abundant mitochondria (oncocytes) without perinuclear clearing (vs chromophobe renal cell carcinoma).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFJlbmFsIG9uY29jeXRvbWEu[Qq]

[q] Whats is the most likely diagnosis?

3 years old child presenting with fever, firm, smooth, unilateral abdominal mass that doesn’t cross the midline and hematuria, and hematuria?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFdpbG1zIHR1bW9yLg==

Cg==

Cg==[Qq]

[q] ………… is the most common renal malignancy of early childhood (ages 2-4).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFdpbG1zIHR1bW9yLg==

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Cg==[Qq]

[q] Gross painless hematuria in an older adult should be considered a sign of ……….. cancer until proven otherwise.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHVyb3RoZWxpYWwu[Qq]

[q] ………… is the major determinant of prognosis of bladder carcinoma.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFR1bW9yIHBlbmV0cmF0aW9uIG9mIHRoZSBibGFkZGVyIHdhbGwu[Qq]

[q] Risk factors for urothelial (Transitional) cell carcinoma are …………….?, while risk factors for Squamous cell carcinoma of the bladder are ………..?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IChQaGVuYWNldGluLCBTbW9raW5nLCBBbmlsaW5lIGR5ZXMsIGFuZCBDeWNsb3Bob3NwaGFtaWRlKS4gU2NoaXN0b3NvbWEgaGFlbWF0b2JpdW0gaW5mZWN0aW9uIChjaHJvbmljIGN5c3RpdGlzLCBzbW9raW5nLCBjaHJvbmljIG5lcGhyb2xpdGhpYXNpcyku[Qq]

[q] ………..  is an osmotic diuretic that works by increasing plasma or tubular fluid osmolality which causes extraction of water from the interstitial space into the vascular space or tubular lumen, with subsequent diuresis. Can be used for drug overdose, elevated intracranial/intraocular pressure.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE1hbm5pdG9sLg==

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Cg==[Qq]

[q] Osmotic diuretics should be cautiously used in high-risk patients, such as those with ……………?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGNvbmdlc3RpdmUgaGVhcnQgZmFpbHVyZSAoQ0hGKSBvciBwcmVleGlzdGluZyBwdWxtb25hcnkgZWRlbWEu[Qq]

[q] ………….. is a Carbonic anhydrase inhibitior which results in ↓ H formation inside PCT cell → ↓Na/H antiport → ↑ Na and HCO3 in lumen → ↑ diuresis. It aslo decreases the CSF and aquous humor production. Can be used for treatment of Glaucoma, and Altitude sickness and cause hypokalemia, metabolic acidosis, proximal renal tubular acidosis, and NH3 toxicity.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFjZXRhem9sYW1pZGUu

Cg==

Cg==[Qq]

[q] ………… works by Na/K/2Cl transporter inhibition in thick ascending limb of loop of Henle which results in↓ intracellular K —> ↓ back diffusion of K —> ↓ positive potential —> ↓ reabsorption of Ca and Mg –> ↑diuresis. Can be used for treatment of edematous states (HF, cirrhosis, nephrotic syndrome, pulmonary edema), Hypertension, Hypercalcemia. And cause ototoxicity, hypokalemia, hypomagnesaemia, hypocalcaemia, and hyperuricemia.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IExvb3AgZGl1cmV0aWNzIChGdXJvc2VtaWRlLCB0b3JzZW1pZGUsIGJ1bWV0YW5pZGUpLg==

Cg==

Cg==[Qq]

[q]  ………………. are the agent of choice in the acute setting of pulmonary edema, as they provide the maximum amount of diuresis in the shortest period of time.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IExvb3AgZGl1cmV0aWNzLg==[Qq]

[q] Of the loop diuretics, ……….. appears to have the greatest risk for ototoxicity.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGV0aGFjcnluaWMgYWNpZC4=[Qq]

[q] ………… is a non-sulfonamide inhibitor of cotransport system (Na/K/2Cl) of thick ascending limb of loop of Henle that can be used in patients allergic to sulfa drugs.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEV0aGFjcnluaWMgYWNpZC4=[Qq]

[q] ……….. works by Na/Cl transporter inhibition in the distal convoluted tubules which results in ↑ luminal Na and Cl in DCT –> ↑ diuresis. Can be used for treatment of Hypertension, HF, Idiopathic hypercalciuria and recurrent calcium kidney stones (hypocalcuria), Osteoporosis, and Nephrogenic diabetes insipidus. And cause HyperGlycemia, HyperLipidemia, HyperUricemia, hyperuricemia, HyperCalcemia, and Hypokalemic metabolic alkalosis.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFRoaWF6aWRlIGRpdXJldGljcyAoaHlkcm9jaGxvcm90aGlhemlkZSwgY2hsb3J0aGFsaWRvbmUsIGluZGFwYW1pZGUsIGFuZCBtZXRvbGF6b25lKS4=

Cg==

Cg==[Qq]

[q] In patients with recurrent calcium-based nephrolithiasis, ……… diuretics can help prevent stone formation by decreasing urine Ca excretion.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHRoaWF6aWRlLg==

Cg==

Cg==[Qq]

[q] ………… are competitive aldosterone receptor antagonists in cortical collecting tubule with very mild diuretic effects, but ………..  act at the same part of the tubule by blocking Na channels in the cortical collecting tubule.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFNwaXJvbm9sYWN0b25lIGFuZCBlcGxlcmVub25lLCBUcmlhbXRlcmVuZSBhbmQgYW1pbG9yaWRlLg==

Cg==

Cg==[Qq]

[q] ………… is a newer and more selective aldosterone antagonist that may produce less endocrine effects than spironolactone.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEVwbGVyZW5vbmUu[Qq]

[q] Based on results from the RALES trial, addition of low dose ……….. to standard therapy (ACEIs, digoxin, a diuretic), significantly reduced morbidity and mortality in class III and IV heart failure patients.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHNwaXJvbm9sYWN0b25lLg==[Qq]

[q] Lithium therapy reduces the ability of the kidneys to concentrate urine primarily by antagonizing the action of vasopressin (antidiuretic hormone) in the ………?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGNvbGxlY3RpbmcgdHVidWxlcy4=[Qq]

[q] Diuretics that cause ………….. increase the risk of digoxin toxicity (because K and digoxin work on the same site).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGh5cG9rYWxlbWlhLg==[Qq]

[q] ………. diuretics cause hypercalcemia; but ……….. diuretics cause hypocalcemia.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFRoaWF6aWRlLCBsb29wLg==[Qq]

[q] Levels of renin (increase or decrease) after use of ACEI.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGluY3JlYXNlIGR1ZSB0byBsb3NzIG9mIG5lZ2F0aXZlIGZlZWRiYWNrLg==

Cg==

Cg==[Qq]

[q] …………. cause cough, angiodema, hyperkalemia as side effects.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFuZ2lvdGVuc2luIGNvbnZlcnRpbmcgZW56eW1lIGluaGliaXRvcnMu[Qq]

[q] ……….. is used with caution in bilateral renal artery stenosis, because  it will further ↓ GFR –> acute renal failure.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFDRSBpbmhpYml0b3JzLg==[Qq]

[q] Initiation of ACE inhibitor therapy causes abrupt removal of the vasoconstrictive effects of angiotensin II, resulting in decreased peripheral vascular tone and a precipitous drop in blood pressure in susceptible patients (on diuretics). To prevent the development of first-dose hypotension, therapy should be …………?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHN0YXJ0ZWQgYXQgbG93IGRvc2VzIGFuZCBzbG93bHkgdGl0cmF0ZWQgdXB3YXJkIGFzIG5lZWRlZC4=[Qq]

[q] ………… selectively block binding of angiotensin II to AT1 receptor. Effects similar to ACE inhibitors, but do not increase bradykinin. Can be used for patients intolerate to ACE inhibitors (cough, angioedema).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFuZ2lvdGVuc2luIElJIHJlY2VwdG9yIGJsb2NrZXJzIChMb3NhcnRhbiwgY2FuZGVzYXJ0YW4sIHZhbHNhcnRhbiku

Cg==

Cg==[Qq]

[q] ………… is a direct renin inhibitor, blocks conversion of angiotensinogen to angiotensin I. Same results as ACEIs on BP mechanisms, but does not interfere with bradykinin degradation.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFsaXNraXJlbi4=

Cg==

Cg==[Qq]

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