Term
| In anion gap acidosis what protein accounts for most of the gap due to its negative charge? |
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Definition
| Albumin, so hypo must be corrected |
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Term
| What is the molecular cause of lactic acidosis? |
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Definition
| Pyruvate is converted to lactate by LDH during shock, hypoemia, severe exercise, CO/CN poisoning, increased pyruvate production, or impaired utilization of pyruvate by PC or PDH into Acetyl Coa |
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Term
| Ketoacidosis is when liver normally converts FFA to triglycerides, CO2 and H2O, but can be converted to Ketoacids, acetoacetic acid, and ß-Hydroxybutyric acid. What are 3 common causes? |
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Definition
| T1DM, fasting, excessive alcohol |
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Term
| Why are methanol and ethylene glycol toxic? |
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Definition
| Turned into acidic agents by alchol dehydrogenase, tx with ethanol |
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Term
| Which of the following cause normal anion gap acidosis (hyperchloremic) - GI losses of HCO3, Renal tubular acidosis disease, hypoaldosteronism, Carbonic Anhydrase inhibitors (aceta), ingested ammonium chloride? |
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Definition
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Term
| What is the difference between Type 1 distal, Type 2 proximal, and Type 4 hypoaldos Renal tubular acidosis? |
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Definition
| Type 1 - defect in H/K ATPase in collecting tubules cant excrete protons, Type 2 - defect in proximal bicarb resoprtion, Type 4 low aldos doesnt stim the H+-ATPase in collecting tubule |
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Term
| HCO3 is only used to treat acidosis when pH is below 7.10. What is important to remember when treating? |
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Definition
| Hypokalemia can result from acidosis. Protons move into cells and K moves out and gets excreted. |
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Term
| Name some causes of metabolic alkalosis. |
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Definition
| Vomting, diarrhea (losss of bicarb), loop or thiazide diuretics, antacids, blood transfusion, loss of fluid containg Cl- |
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Term
| Where are the central and peripheral chemoreceptors controlling respiration and what stims them? |
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Definition
| Central is meduallry brainstem via CO2, peripheral is aortic and carotid bodies stimed by hypoxemia and H+ |
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Term
| What are some causes of respiratory alkalosis? |
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Definition
| High altitude, CHF, pulmonary disease, direct stim of respiratory drive like sepsis, preggers, neuro disorders, hepatic failure |
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Term
| HTN, advanced age, T2DM, calcineurin inhib tox can lead to small vessel hyaline arteriosclerosis resulting in decreased lumen size and contracitility. How does this affect kidney function? |
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Definition
| Glomer ischemia and scarring and kidney contraction |
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Term
| What are two causes of secondary hypertension? |
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Definition
| Renal artery stenosis and pheochromocytoma |
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Term
| When is hyplerplastic ateriosclerosis seen? |
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Definition
| More severe HTN resulting in concentric lamination, smooth muscle cell proliferation, and narrowed lumen |
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Term
| What are the findings of early and late malign hTN in glomer? |
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Definition
| Early - Fibrin in lumen and media, endothelial cell swelling, and fibrinoid necrosis; Late - Onion skinngin concentric smooth muscle cells and basal lamina accumulation |
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Term
| What are a few causes of Adult HUS causing thrombotic microangiopathy? |
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Definition
| Verotoxin, preggers, drugs, antiphos syndrome, malign HTN |
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Term
| What disease are these fidings seen in glomer - thrombi in arterioles, swollen endothelial cells, subendothelial fibrin, mesangiolysis, membrane splitting? |
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Definition
| Thrombotic microangopathy |
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Term
| Which of the following are glomer lesions seen in diabetes - thickened capillary loop basement membranes, hyalinsosi, capsular drops, diffuse mesangial sclerosis with matrix, nodular sclerosis from matrix and Kimmelstiel-Wilson lesion (large pink sclerosed nodule) |
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Definition
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Term
| Glycosylation of matrix proteins in diabtes causes decreased endo cell adherence, protein degradation resistance, and cause circulating proteins to bind and induce inflammation on numerous cell types - what is the cause of all this? |
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Definition
| Advanced glycation end products, activation o fprotein kinase C, intracellular hyperglycemia (disturbs polyol path) |
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Term
| What is tea and toast syndrome? |
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Definition
| Excessive liquid and poor nutrient intake causing hyponatremia |
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Term
| What are some common causes of SIADH? |
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Definition
| Malign, drugs, CNS probs, N/V, pain, hypoglycemia |
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Term
| A small increase in Na can correct cerebral edema and seizures. When should you use tx options such as water restriction and salt supplement or increase water excretion? |
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Definition
| Water restrict eu/hypervolemic patients, normal saline for hypovolemics, hypertonic saline for severe hyponatremia or SIADH, water loss with vaptans |
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Term
| Vaptans are a class of drug used to treat excess ADH in CHF, cirrhosis, SIADH, how so? |
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Definition
| Vasopressin receptror 2 antags |
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Term
| What type of diuretic can you consider in hypernatremia? |
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Definition
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Term
| What are the types of fluid to use for hypernatremia correction? |
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Definition
| Shock=normal saline, past salt loss = D5 ½ NS, water deprives= D5 |
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Term
| What ist he diff btw simple and dialysis kidney cysts? |
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Definition
| Simple are benign incidental, and cortex only; dialysis occur due to obstruction of tubulues due to fibrosis, occur in cortex and medulla, can rarely form adeomas or bleed |
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Term
| ADPKD presents in adults with multiple large, bilateral, cysts that destroy parenchyma of enlarged kidneys. What are presting symptoms? |
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Definition
| Flankpain, hematuria, HTN, UTI, progressive renal failure which may be asymptomatic |
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Term
| ADPKD is most common has a AD mutation in PKD1/polycystin 1 gene on chrome 16 which affects cell membrane associated proteins. What are some associated manifestations of this mutation? |
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Definition
| Live cysts, berry aneurysms in circle of willis, mitral valve prolapse. |
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Term
| ARPKD presents in childhood and affets the PKHD1 gene creating fibrocystin (which also hits liver). Where do the cysts present and what replaces the cortex and medulla? |
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Definition
| Parenchyma; cuboidally lined cylindrical collecting ducts |
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Term
| Name this disease - most common abdominal mass in newborn, abnormal renal structures like cartilage and collecting ducts, nearly all cases associated with anomly in urinary tract, results in abnormal differentiation, variable degree of cystic formation. |
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Definition
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Term
| What is diff btw medullary sponge and cystic disease? |
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Definition
| Sponge is collecting duct cysts with good prog, cystic is medulla cysts with poor prog |
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Term
| Sometimes granulomas form in drug-induced interstitial nephrtisi what type of hypersentivity is it? |
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Definition
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Term
| Name this type of pyelonephritis - hematogenous spread, white cell casts are pathonomic, affects medulla with sparing of glomeruli, PMNs in lumens, patchy interstitial inflamm, presents with fever and CVA tenderness, most associated with UTI. |
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Definition
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Term
| What is the most common pathogen for ascending peylo? |
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Definition
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Term
| Ascending pyelo can be due to congenital malformations, incomplete emptying, women hormones, spinal cord injry, outflow obstructions, valve reflux. But why are infection concentrated at poles of kidney? |
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Definition
| Because the papillae at poles have concave tips allowing reflux of urine whereas middle are convex and resistant to flow |
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Term
| Name this disease - chronic obstruction of urine flow or reflux, can lead to hydronephrosis which dilates the renal pelvis and causes atrophy, coarse coticomeduallary scarring, blunted calyx, eosinos casts in tubules. |
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Definition
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Term
| What are the acute and chronic results of hydronephrosis? |
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Definition
| Acute - obstruction causes mild diltation and impairs glomer filtration, Chronic - flitration is less impaored, howevere there is dilation and atrophy of parenchyma and then fibrosis |
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Term
| Out of all stages of CKD 1-5 which is most common? |
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Definition
| 3 with kidney damage and moderate GFR drop |
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Term
| What stage of CKD does end-stage renal disease perisist and dialysis start? |
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Definition
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Term
| What are the two most common causes of CKD? |
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Definition
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Term
| Which of the following are signs of uremia - renal osteodystrophy, muscle weakness, anemia, platelet dysfunction, hyperkalemia, hyponatremia, acidosis, edema, encephalopathy, HTN, hyperlipidemia, N/V? |
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Definition
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Term
| What drugs are used to prevent or slow CKD or diabetic renal disease? |
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Definition
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Term
| Can the progression of CKD be stopped or cured? |
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Definition
| No, the rate of progression can be slowed |
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Term
| Why is anti-coagulants contraindicated in atheroembolic renal disease? |
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Definition
| They may trigger embolization |
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Term
| Serum HCO3 and PCO2 always change in the same direction, so how do yo know if metabolic or respiratory acidosis? |
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Definition
| If HCO3 drops then PCO2 drops its metabolic, If PCO2 ups and then HCO3 ups, then respiratory |
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Term
| In acid-base homeo stasis, if we lose Cl- then what do we also lose to incur alkalosis? |
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Definition
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Term
| What is the anion gap formula? |
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Definition
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Term
| What are some cause of up and down anion gap acidosis? |
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Definition
| Up - up albumin, down K,Ca,Mg, lactate, ketones, uremia, drug tox; Down - down albumin, up K, Ca, Mg, multiple myeloma |
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