Term
| EKG findings of hypokalemia |
|
Definition
| tachyarrythmias, ST segment depression, flattening and inversion of T waves and U waves |
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|
Term
| EKG findings of hyperkalemia |
|
Definition
| tall peaked T wave, flat P wave, flat sine wave, narrow QRS, tachyarrhythmias |
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|
Term
| intracellular K+ movement stimulated by what 4 things? |
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Definition
| insulin, thyroid hormone, beta adrenergic receptor activation, alkaline pH (beta, thyroid & insulin speed up the Na-K-ATPase while alkaline pH causes intracellular shift of K+) beta and insulin also increase NHE (increase intracellular Na --> stimulates Na-K-ATPase activity) + hypokalemic periodic paralysis (exercise, high carb); barium and chloroquine intoxication |
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Term
| 3 steps to treating life threatening hyperkalemia |
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Definition
| 1. Ca salts (antagonize membrane effect of K+) 2. insulin or glucose (increase intracellular shift of K) 3. remove K+ from body (kayexalate, dialysis, diuretics, mineralcorticoids) |
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Term
| net secretion of K+ is possible ONLY when Na reabsorbed at the collecting tubule is...? |
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Definition
| more than the Cl- that is absorbed at the collecting tubule (creates electrical charge imbalance, which is met by secretion of K+) |
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|
Term
|
Definition
| weakness, rhabdomyolysis, cardiac arrhythmias, supraventricular tachycardia, AV conduction delays, tachyarrhythmia, fibrillation |
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Term
|
Definition
| defect in NKCC in thick ascending limb |
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|
Term
|
Definition
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|
Term
|
Definition
| increased ENaC on lumenal side of cortical collecting duct |
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|
Term
| what are the non-absorbable anions that cause hypokalemia? |
|
Definition
| beta-hydroxybutyrate in ketoacidosis and bicarbonate in metabolic alkalosis |
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|
Term
| how does metabolic acidosis cause hypokalemia? |
|
Definition
| increased distal delivery of Na as acidosis inhibits proximal reabsorption of NaCl. acidosis stimulates aldosterone secretion directly |
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|
Term
|
Definition
| weakness, paralysis, arrhythmias, conduction delays with AV blocks, tachyarrhythmias, fib, cardiac arrest |
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|
Term
| compare type I and type II pseudohypoaldosteronism. |
|
Definition
| typeI: loss of function mutation of ENaC and defect in mineralcorticoid receptors (hyperkalemic, volume depleted); typeII: WNK mutation--> difficulty secreting k+(vol expanded, hypertensive) |
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Term
| common causes inappropriate secretion of ADH |
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Definition
| lung disease, CNS disease, nausea, certain drugs, certain cancers (small cell most common) |
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|
Term
| drugs that cause SIADH (4) |
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Definition
| phenothiazines, tricyclic antidepressants, selective seratonin reuptake inhibitors (fluoxetine), chlorpropamide |
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|
Term
| formula to determine water requirement to correct hypernatremia |
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Definition
| (change Na x TBW)/goal Na |
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|
Term
| how do we tell the difference between hyponatremia caused by SIADH and that caused by volume depletion? |
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Definition
| SIADH: normal or increased effective vascular volume, urine Na >20, serum urate <3.5, BUN <10, serum creatinine <1 (all values opposite in volume depletion states) |
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|
Term
| formula to calculate sodium requirement in hyponatremia |
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Definition
|
|
Term
| describe how we adjust serum Na to changes in serum glucose |
|
Definition
| adjust by a factor of 1.6 mEq/L for each 100 mg/dL change in glucose (in either direction) |
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|
Term
| what is the formula for effective osmolality? |
|
Definition
| (serum Na in mEq/L x2) + (serum glucose in mg/dL/18) |
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|
Term
| what is considered inappropriately dilute urine in the presence of hypernatremia? |
|
Definition
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|
Term
| in hypernatremic state if urine osmolality is >700 mOsm/L what is on our differential? |
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Definition
| (hypernatremia must be d/t inadequate water intake) thirst defect, mental impairment, no water, severe illness, GI or skin losses of water |
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|
Term
| in hypernatremia if urine osmolality is <700 mOsm/L what is on our differential? |
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Definition
| (must be d/t inadequate water intake and excessive water loss) diabetes insipidus, renal failure, loop diuretics |
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|
Term
| which drug affects the Na-H exchanger indirectly? |
|
Definition
| Carbonic anhydrase inhibitors (they reduce bicarb reabsorption in the proximal tubule) |
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|
Term
| what disease affects the NKCC? what drug works here? |
|
Definition
| bartter's syndrome; blocked by loop diuretics |
|
|
Term
| what disease affects the NCCT? what drug works here? |
|
Definition
| gitelman's syndrome; blocked by thiazides |
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|
Term
| what drug affects the ENaC? what disease works here? |
|
Definition
| ENaC blockers, aldosterone antagonists; liddle's syndrome |
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|
Term
| what is the equation for the FE of Na? |
|
Definition
| U/P Na ratio x P/U creatinine ratio |
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|
Term
| where do osmotic diuretics work? |
|
Definition
| throughout nephron segments to increase water excretion; to increase NaCl excretion, inhibits passive NaCl reabsorption at thick ascending limb and prox tubule. |
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|
Term
| how do diuretics cause hypokalemia? |
|
Definition
| secondary hypoaldosteronism and increased delivery of Na to the collecting duct (exception: k sparing drugs) |
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|
Term
| which diuretics cause metabolic alkalosis? acidosis? |
|
Definition
| alkalosis = thiazides, loops; acidosis = carbonic anhydrase, k sparing |
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|
Term
| which diuretics cause hyperuricemia? |
|
Definition
| all except those that work at prox tubule (carbonic anhydrase, osmotic agents) bc diuretics induce volume depletion --> increase reabsorption of urate in prox tubule |
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|
Term
| which diuretics DONT contain sulfa moiety? |
|
Definition
| k sparing diuretics + 2 loops (ethacrynic acid, torsemide) |
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|
Term
| which diuretics cause hypocalciuria? |
|
Definition
| most pronounced with thiazides, but occurs in all diuretics (all increase reabsorption of Ca in prox tubule bc of vol depletion except diuretics that work at prox tubule and NOT loops) |
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|
Term
| which diuretics cause inhibition of Mg reabsorption? |
|
Definition
| loops inhibit Mg reabsorption in the loop of henle, thiazides inhibit reabsorption in distal convoluted tubule |
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|
Term
| clinical uses of carbonic anhydrase? |
|
Definition
| glaucoma, metabolic alkalosis, mountain sickness, familial periodic paralysis |
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|
Term
| main AE of loop diuretics? |
|
Definition
| ototoxicity (ethacrynic acid most toxic) |
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|
Term
| which diuretics cannot be taken with food? |
|
Definition
|
|
Term
| what is the definition of osmotic diuresis? |
|
Definition
| solute excretion of 1440 mOsm/day (60 mOsm/hr) or more |
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|
Term
| what is the most common cause of chronic hyperkalemia? |
|
Definition
| hyporeninemic hypoaldosteronism. (pathogenesis: primary salt retention --> low renin --> low aldosterone --> low K secretion) most commonly caused by diabetic nephropathy and interstitial diseases |
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|
Term
| what are 2 conditions that increase mineralcorticoid activity without high aldosterone? |
|
Definition
| apparent mineralcorticiod excess state (genetic defect in enzyme 11-beta-hydroxysteroid dehydrogenase or inhibition of that enzyme by licorice) --> low renin, low aldo, low k, high BP |
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|
Term
| describe renin, aldo, k+ and bp in hyporeninemic hypoaldosteronism. |
|
Definition
| low renin, low aldo, high k, high BP |
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|
Term
| describe pseudohypoaldosteronism type I vs type II |
|
Definition
| type I: ENaC defect or aldosterone receptor defect (high renin, high aldo, high k, low bp); type II: gordon's syndrome, hyper functioning NCCT (low renin, low aldo, high k, high bp) |
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|
Term
| describe renin, aldo, k+ and bp levels in dexamethasone-suppresible hyperaldosteronism |
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Definition
| low renin, high aldo, low k, high bp |
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Term
| if urine has no red cells on microscopic exam but has + dipstick test for blood, how do we tell the diff b/w hemoglobin and myoglobin? |
|
Definition
| presence of high serum creatine kinase --> clue for myoglobinuria (muscle damage produced myoglobinuria and high CK) |
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|
Term
| what are the urine biomarkers that can predict the development of acute renal failure before any rise in serum creatinine and predict its prognosis? |
|
Definition
| KIM-1, NGAL, fatty acid binding protein, interleukin 18 |
|
|
Term
| what are the absolute indications for intervention of BPH? |
|
Definition
| acute urinary retention, chronic urinary retention, life-threatening UTIs, evidence of bladder or kidney damage |
|
|
Term
| what are the 2 non-invasive blood tests we use to dx bladder cancer? |
|
Definition
| FISH for homozygous deletion of p16 gene; NMP 22 |
|
|
Term
| which testicular cancer presents suddenly as a large testicular mass? |
|
Definition
|
|
Term
| what is the biomarker for seminomas? |
|
Definition
| PLAP and occasionally B-HCG |
|
|
Term
| what are the neonatal testicular cancers and what are their defining features? |
|
Definition
| yolk sac (endodermal sinus tumors) excellent prognosis, schiller-duval bodies (glomerular like), AFP marker |
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|
Term
| which testicular tumor can be cured easily? |
|
Definition
| choriocarcinoma - by actinomycin D |
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|
Term
| what stage do seminomas vs non-seminomas present at? |
|
Definition
| seminomas stage I, non-seminomas stage II or III |
|
|
Term
| mode of metastases for seminomas vs non-seminomas |
|
Definition
| seminomas lymph; non-seminomas blood |
|
|
Term
| radiosensitivity of seminomas vs nonseminomas |
|
Definition
| seminomas radio-sensitive; non-seminomas radio-opaque |
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|
Term
| placental alkaline phosphatase is present in? |
|
Definition
|
|
Term
| alpha feto-protein is present in? |
|
Definition
|
|
Term
| B-HCG useful serological test for? |
|
Definition
| embryonal carcinomas and choriocarcinomas |
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|
Term
| zones: prostate cancers 80% in? bph? |
|
Definition
| prostate cancer mostly in peripheral zone; BPH mostly in transition zone |
|
|
Term
| 3 important causes of bladder cancer |
|
Definition
| cigs, cyclophosphamide, schistosomiasis |
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|
Term
| most common genetic mutations leading to bladder cancer |
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Definition
|
|
Term
| what saprophytes normally colonize the distal urethra, vaginal vestibule in women? |
|
Definition
| diptheriods, a-hemolytic strep |
|
|
Term
| what are 3 risk factors of UTIs for women? |
|
Definition
| diaphragms with spermicides, recent sex, hx of previous UTIs |
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|
Term
| discuss epididymitis in men under and over 35 |
|
Definition
| under 35 prob GC or CT (assoc with STD); over 35 prob E. coli or other uropathogens assoc with prostatic enlargement |
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|
Term
| hepatitis B often associated with what renal pathology? |
|
Definition
|
|
Term
| hepatitis C most commonly associated with which renal pathology? |
|
Definition
| membranoproliferative nephritis |
|
|
Term
| malignancy most commonly associated with which renal pathology? |
|
Definition
|
|
Term
| what is the commonest cause of idiopathic membranous nephropathy |
|
Definition
| antibodies against phospholipase A2 receptors |
|
|
Term
| name 3 types of radio-opaque stones |
|
Definition
| Ca (oxalate, phosphate), struvite, cysteine |
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|
Term
| name 2 radio lucent stones |
|
Definition
|
|
Term
| what is the composition of a struvite stone |
|
Definition
|
|
Term
| name the inhibitors of stone formation |
|
Definition
| citrate, Mg, osteopontin, tamm-horsfall protein |
|
|
Term
|
Definition
| it's a cofactor required for activation of the FGFR1 receptor. when this receptor is activated, FGF-23 (produced by osteocytes and osteoblasts) binds and acts on prox tubule to inhibit phosphate reabsorption and 1-hydroxylation of vit D |
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|
Term
| describe x-linked hypophosphatemic rickets |
|
Definition
| inactivation of PHEX, which is the catabolic enzyme for FGF-23 (both produced by osteoblasts and osteocytes) --> overexpression of FGF-23 --> acts on prox tubule to inhibit phosphate reabsorption and 1-hydroxylation of vit D --> RENAL PHOSPHATE WASTING |
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|
Term
| what are the electrolyte abnormalities associated with uremia? (pH, P, Ca, K, Mg) |
|
Definition
| metabolic acidosis, hyperphosphatemia, hypocalcemia, hyperkalemia, hypermagnesemia |
|
|
Term
| describe the 3 different types of RTA |
|
Definition
|
|
Term
| methanol forms what acid? |
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Definition
|
|
Term
| ethylene glycol makes what acid |
|
Definition
|
|
Term
|
Definition
|
|
Term
| acetomenophen makes what acid |
|
Definition
|
|
Term
| salicylate makes what acid |
|
Definition
| ketoacids and probably lactic acid |
|
|
Term
| what is the BP cut off for pre-htn? stage 1 htn? stage 2? |
|
Definition
| pre htn: >120/80 and <140/90; stage 1: >140/90 and <160/100; stage II: >160/100 |
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