Term
|
Definition
•Removal of metabolic waste products and foreign chemicals
•Regulation of water and electrolyte balances
•Regulation of acid-base balance
•Regulation arterial blood-pressure
•Secretion of hormones (erythropoietin, renin)
•Gluconeogenesis |
|
|
Term
|
Definition
Both kidneys lie on the posterior wall of the abdomen, just outside the peritoneal cavity |
|
|
Term
| Each kidney weighs approximately ____ |
|
Definition
|
|
Term
Medial side contains and indented region
called the ____which passes the renal
artery, vein, nerve supply, and ureter |
|
Definition
|
|
Term
Renal circulation has 2 capillary beds: ____and ___ |
|
Definition
| glomerular and peritubular |
|
|
Term
| The renal corpuscle consists of the ___and ___ |
|
Definition
glomerular capillaries
and
Bowman's capsule |
|
|
Term
| primary restriction point for plasma proteins |
|
Definition
Basement Membrane
--> consists of a meshwork of collagen and proteoglycans which filters a large amount of water and small solutes (large amount of (-) charges from proteoglycans prevents filtration of proteins) |
|
|
Term
Filterability of solutes is determined by ___and ____ |
|
Definition
| size and electrical charge |
|
|
Term
|
Definition
| Excretion = Fitration - Reabsorption + Secretion |
|
|
Term
| How does kidney handle substances like creatinine? |
|
Definition
| Freely filtered and neither reabsorbed or secreted --> excretion = filtration |
|
|
Term
| How does kidney handle substances like electrolytes? |
|
Definition
| Freely filtered, partly reabsorbed and not secreted --> excretion = filtration - reabsorption |
|
|
Term
| How does kidney handle substances like some amino acids and glucose? |
|
Definition
| Freely filtered, completely reabsorbed |
|
|
Term
| For a substance to be reabsorbed it must be transported across two barriers |
|
Definition
(1) tubular epithelial membranes into the renal interstitial fluid and then
(2) the peritubular capillary membranes back into the blood. Thus, reabsorption of water and solutes requires a series of transport steps. |
|
|
Term
| ___ diffusion is controlled by bulk. Give examples |
|
Definition
Passive diffusion
ex.
1. Paracellular diffusion - diffusion between cells
2. Transcellular diffusion - diffusion across cell membranes
3. Osmosis - diffusion from of liquid from region of low solute to high solute |
|
|
Term
| Location of Na+ and K+ ATpase |
|
Definition
basolateral side of the tubular epithelial cells |
|
|
Term
| Difference between the 2 types of active transport system |
|
Definition
1. Primary active transport: Na+, K+ ATPase (Na+ out, K+ in)
2. Secondary active transport: co-transport (Na+ in= glucose and amino acid out) and counter-transport (Na+ in, H+ out) |
|
|
Term
| ~65% of the filtered load of Na+ and water and a slightly lower percentage of filtered chloride are reabsorbed |
|
Definition
Proximal tubulular reabsorption
---> has active transport (secondary active transport --> co-transport and counter-transport) and high metabolic capacity |
|
|
Term
| ~20% of filtered water is reabsorbed here |
|
Definition
|
|
Term
| impermeable to water and are important for concentrating the urine |
|
Definition
| Ascending thin and thick segments |
|
|
Term
metabolic activity which can actively reabsorb
Na+, K+ and Cl- (25% of filtered load). |
|
Definition
|
|
Term
| Calcium, bicarbonate, and magnesium are also reabsorbed in ____ |
|
Definition
|
|
Term
| first part of distal tubule forms the juxtoglomerular complex which provides feedback control for GFR and blood flow |
|
Definition
|
|
Term
| Late distal tubule and cortical collecting duct contain these 2 types of cells |
|
Definition
| Principal cells and Intercalated cells |
|
|
Term
___ cells reabsorb Na+ and water from the lumen
and secrete K+ into the lumen.
|
|
Definition
|
|
Term
___ reabsorb K+ from the lumen and secrete H+ into
the lumen. |
|
Definition
|
|
Term
| Both LDT and CCD are impermeable to ___ |
|
Definition
|
|
Term
| Late distal tubule and cortical collecting duct are controlled by this hormone |
|
Definition
|
|
Term
| This hormone controls water permeability in late distal tubule and cortical collecting duct |
|
Definition
Antidiuretic hormone
--> high antidiuretic = permeable to water
--> low antidiuretic = impermeable to water |
|
|
Term
| ____ collecting duct is permeable to urea and is permeable to urea. |
|
Definition
Medullary collecting duct:
•reabsorbs < 10% of filtered water and sodium
•controlled by ADH (high ADH, water is avidly reabsorbed)
•permeable to urea
•can secrete H+, therefore helps to controls acid-base balance
|
|
|
Term
| This hormone controls urine concentration |
|
Definition
Antidiuretic hormone
- High ADH = excrete concentrated urine
- Low ADH = excrete dilute urine |
|
|
Term
| The 2 basic requirements for forming a concentrated urine. |
|
Definition
1. High level of ADH
2. High renal medullary interstitial fluid osmolarity |
|
|
Term
| Countercurrent exchange occurs in the ___ |
|
Definition
| Vasa recta - keeps (minimizes washout of) solute from medullary interstitium. |
|
|
Term
Two special features of the renal medullary blood flow exist that contribute to the preservation of high solute concentration in the medullary interstitial fluid |
|
Definition
1. Low medullary blood flow, minimizing solute loss from the medullary interstitium.
2. Vasa recta serves as a countercurrent exchanger, minimizing washout of solute from the medullaryinterstitium. |
|
|
Term
| ____ occurs through passive diffusion of water and small MW ions and molecules across the glomerular capillary membrane into Bowman's capsule and the proximal tubule. |
|
Definition
|
|
Term
| Since most proteins are to large to be filtered (>60 kDa), they get impeded by electronegative charges of the basement membrane of the glomerulus, thus protein bound compounds are not filtered and enter the ___ |
|
Definition
|
|
Term
All of these are anionic drugs except:
Probenicid
P-aminohippurate
Cimetidine
Penicillin
|
|
Definition
Probenicid - anionic
P-aminohippurate - anionic
Cimetidine - cationic drug
Penicillin - anionic |
|
|
Term
All of these are cationic drugs except:
Cimetidine
Penicillin
Creatinine
Procainamide
P-aminohippurate |
|
Definition
Cimetidine
Penicillin - anionic
Creatinine
Procainamide
P-aminohippurate - anionic |
|
|
Term
Reabsorptionof water and solutes occurs throughout the ____, whereas drug reabsorption occurs predominantly along the _____. |
|
Definition
nephron = water and solute reabsorption
distal tubule and collecting tubules = drug reabsorption |
|
|
Term
| Explain the absorption of highly ionized compounds |
|
Definition
| Highly ionized compounds are not reabsorbed unless the pH of the urine changes. |
|
|
Term
| Intact Nephron Hypothesis" |
|
Definition
•Renal disease is the net result of reduced number of appropriately functioning nephrons. This results in decreased reabsorption |
|
|
Term
| Single nephron GFR (SNGFR) |
|
Definition
| increases in the remaining nephrons and increase in whole kidney GFR represents the sum of SNGFR of the remaining functional nephrons |
|
|
Term
| The __ and ___ are the two most important clinical laboratory measurements to assay kidney function |
|
Definition
blood urea nitrogen (BUN) and
serum creatinine concentration |
|
|
Term
|
Definition
|
|
Term
| Normal values for creatinine |
|
Definition
|
|
Term
| Strength and 2 weaknesses of Cystatin C as GFR marker |
|
Definition
Strength: concentration is independent of age and gender
Weakness: 1. expensive and limited availability
2. Corticosteroids increases level of Cystatin C |
|
|
Term
| Includes assessment of its chemical and physical composition, most of which can be performed with dipstick testing |
|
Definition
Urinalysis --> dipstick testing
Abnormal substances:
blood, protein, glucose, ketones, urobilinogen and bilirubin, and white blood cells. |
|
|
Term
| When is specific gravity test most powerful? |
|
Definition
when specific gravity is interpreted with the hydration status of the patient and plasmaosmolality. |
|
|
Term
Acetoacetateand acetone are excreted in patients with ___. |
|
Definition
|
|
Term
Presence of nitrite in urine may indicate a ____. |
|
Definition
|
|
Term
Presence of leukocyte esterase may indicate a ____. |
|
Definition
|
|
Term
Presence of heme in urine may indicate a ____, and therefore ____. |
|
Definition
| Heme in urine --> indicates presence of hemoglobin or myglobin --> which is sign of hemolysis or rhabdomyolysis |
|
|
Term
|
Definition
| >3 WBC/HPF & positive leukocyte esterase dipstick --> UTI |
|
|
Term
| Name 5 conditions of the kidney that require microscopic analysis |
|
Definition
Hematuria
Pyuria
Yeast infection
Crystals - kidney stone
Casts - glomerular bleeding |
|
|
Term
| 2 factors considered in Cockroft-Gault SCr calculation |
|
Definition
1. Age
2. Ideal body weight |
|
|
Term
| What 3 factors are considered in MDRD SCr calculation |
|
Definition
1. Age
2. Ethnicity
3. Gender |
|
|
Term
Main use diagnostically is to rule out hydronephrosis and polycystic renal disease. |
|
Definition
| ultrasonography (form of ultrasound) |
|
|
Term
This renal imaging technique is predominantly used to evaluate anatomical features of the renal excretory system. |
|
Definition
|
|
Term
Main use diagnostically in the kidney is to define scars, and cysts. In the renal pelvis it is used to evaluate hydronephrosis, calyceal deformations, and stones. In the ureter it is used to evaluate obstruction and dilation. |
|
Definition
|
|
Term
Main use diagnostically is to define fibromuscular dysplasia, stenotic lesions, arteriosclerosis, arteriodissections, emboli and thrombosis. |
|
Definition
|
|
Term
| THis renal imaging technique is done with the aid of contrast media. |
|
Definition
|
|
Term
| Kidney disease effects these 4 structures of the kidney |
|
Definition
1. Glomeruli
2. Tubules
3. Interstitum
4. Blood vessels |
|
|
Term
| What is the difference between primary and secondary glomerulonephritis |
|
Definition
Primary = originates from kidney
secondary = originates from other system disease ex. DM or HTN |
|
|
Term
| This type of primary glomerulopathy is associted with cell proliferation and infection and causes acute renal failure. |
|
Definition
| Acute proliferative - post-infectious |
|
|
Term
| This type of primary glomerulopathy is associted with cell crescents. |
|
Definition
|
|
Term
| This type of primary glomerulopathy is most common in children (65%). |
|
Definition
|
|
Term
| This type of primary glomerulopathy has no specific morphological feature. |
|
Definition
| Chronic glomerulonephritis |
|
|
Term
|
Definition
- Acute proliferative : Post-infectious & Other
- Rapidly progressive (crescentic)
- Membranous glomerulopathy
- Minimal-change disease
- Focal segmental glomerulosclerosis
- Membranoproliferative
- IgA nephropathy
- Chronic glomerulonephritis
|
|
|
Term
| SYSTEMIC DISEASES WITH GLOMERULAR INVOLVEMENT |
|
Definition
¨Systemic lupus erythematosus (SLE)
¨Diabetes mellitus
¨Amyloidosis
¨Goodpasture syndrome
¨Microscopic polyarteritis/polyangiitis
¨Wegener granulomatosis
¨Henoch-Schonleinpurpura
Bacterial endocarditis
|
|
|
Term
| 3 factors indicated in the pathogenesis of glomerupathies |
|
Definition
1. Anitbody-mediated injury --> activates complement system
2. Cell-mediated injury - T-cell involvement
3. Activation of alternate complement pathway |
|
|
Term
| The alteration of the ___is key in glomerulonephrotis |
|
Definition
|
|
Term
| Dense-deposit deposit disease (membranoproliferative glomerulonephritis type II) is caused by ____ |
|
Definition
| alternative complement pathway activation |
|
|
Term
| Immune complex by antibody is deposited in the __ and ____ |
|
Definition
| endothelium and epithelium |
|
|
Term
| What is foot process effacement? |
|
Definition
Epithelial cell injuryà is a consequence of antibodies specific to epithelial cell antigens, toxins, cytokines, or other factors causing injury; this results in foot process effacement and sometimes detachment of epithelial cells and protein leakage through defective GBM and filtration slits.
|
|
|
Term
| Features seen in hypercellularity |
|
Definition
¡Proliferationof mesangial or endothelial cells
¡Leukocytic infiltrationconsisting of neutrophils, monocytes, and, in some diseases, lymphocytes
¡Formation of crescents. These are accumulations of cells composed of proliferating parietal epithelial cells and infiltrating leukocytes (Fibrin, tissue factor and cytokines such as interleukin-1 (IL-1), tumor necrosis factor (TNF), and interferon-γ) |
|
|
Term
| Features observed in basement membrane thickening |
|
Definition
1. Deposition of amorphous electron-dense material, most often immune complexes, on the endothelial or epithelial side of the basement membrane or within the GBM itself. Fibrin, amyloid, cryoglobulins, and abnormal fibrillary proteins may also deposit in the GBM.
2. Thickening of the basement membrane due to increased synthesis of its protein components, as occurs in diabetic glomerulosclerosis |
|
|
Term
¡the accumulation of material that is homogeneous and eosinophilic by light microscopy, plasma proteins that have insudated from the circulation into glomerular structures |
|
Definition
|
|
Term
¡accumulations of extracellular collagenous matrix, either confined to mesangial areas as is often the case in diabetic glomerulosclerosis, or involving the capillary loops, or both |
|
Definition
|
|
Term
| Progressive renal damage may have two major histological faces |
|
Definition
¡Focal Segmental Glomerulosclerosis (FSGS)
¡Tubulointerstitial Fibrosis - tubular damage and interstitial inflammation |
|
|
Term
| 5 Clinical manifestations of chronic glomerulonephritis |
|
Definition
¨Nephritic syndrome
¨Rapidly progressive glomerulonephritis.
¨Nephrotic syndrome
¨Chronic renal failure
¨Isolated Urinary Abnormalities |
|
|
Term
| Difference between nephritic and nephrotic syndrome |
|
Definition
Nephritic syndrome:
HEMATURIA, azotemia, variable proteinuria, oliguria, edema, hypertension
Nephrotic syndrome: PROTEINURIA, hypoalbuminemia, hyperlipdemia, lipiduria, edema |
|
|
Term
| Symptoms of rapidly progressive GM |
|
Definition
Acute nephritis
Proteinuria
acute renal failure |
|
|
Term
Symptoms of renal failure
|
|
Definition
| axotemia progressing to uria |
|
|
Term
| Symptoms of isolated urinary abnormalities |
|
Definition
|
|
Term
| The most common primary glomerular disease in adults |
|
Definition
Focal segmental glomerulosclerosis (35%) > Membranous glomerulopathy (30%) |
|
|
Term
| _____ are the most common kidney diseases |
|
Definition
|
|
Term
| 3 types of urinary tract infections |
|
Definition
¡Asymptomatic bacteriuria
¡Lower urinary tract infections:
úUrethritis
úCystitis
¡Pyelonephritis |
|
|
Term
| ___ are the normal inhabitants of the intestinal tract that cause UTI |
|
Definition
gram (-) bacilli - 85%:
¡Escherichia coli
¡Proteus
¡Klebsiella
¡Enterobacter
|
|
|
Term
| Micro organisms that cause UTI |
|
Definition
¡Escherichia coli
¡Proteus
¡Klebsiella
¡Enterobacter
¨Streptococcus faecalis
¨Staphylococci
¨Fungi |
|
|
Term
| This virus in immunocompromosed patients cause UTI |
|
Definition
¡Polyomavirus (kidney allografts) , (reactivation of latent infection)
¡Cytomegalovirus
¡Adenovirus |
|
|
Term
| Why is UTI considered an endogeneous infection? |
|
Definition
the infecting organisms are derived from the patient's own fecal flora. |
|
|
Term
| urinary infections are much more common in females due to |
|
Definition
úshorter urethra in females
ú the absence of antibacterial properties such as are found in prostatic fluid
ú hormonal changes affecting adherence of bacteria to the mucosa
ú urethral trauma during sexual intercourse |
|
|
Term
| Pathogenesis of UTI involves the colonization of the ____ and ____ by coliform bacteria |
|
Definition
| distal urethra and introitus (in the female) |
|
|
Term
| Ascending infection (most common) of UTI is caused by these 3 microorganisms. |
|
Definition
Ecoli
Proteus
Enterobacter |
|
|
Term
| Hematogenous infection (least common) of UTI is caused by thse 2 microorganism |
|
Definition
|
|
Term
| ____ is an example of a henatogenous infection that causes endogenous UTI infection |
|
Definition
|
|
Term
| ____ of the urethra increases the risk of bladder infection in UTI |
|
Definition
|
|
Term
| Obstruction of the bladder and outflow of urine can be caused by these 4 factors |
|
Definition
1. Benign prostatic hypertrophy
2. Tumors
3. Calculi
4. Neurogenic bladder dysfunction --> caused by diabetes or spinal cord injury |
|
|
Term
Renal lesion associated with the urinary tract infection |
|
Definition
|
|
Term
| Pyelonephritis is caused by ___ |
|
Definition
| bacterial infections (same as UTI -- majority by gram neg bacilli and fecal bacteria) |
|
|
Term
| Kidney structures effected by pyelonephritis |
|
Definition
1. Tubules
2. Interstitium
3. Pelvis |
|
|
Term
| What is the difference between acute and chronic pyelonephritis? |
|
Definition
Acute - no predisposing risk factors
Chronic - caused by infections or underlying conditions such as vesicourethral reflux or obstruction. |
|
|
Term
| 8 predisposing conditions for acute pyelonephritis |
|
Definition
¨Urinary tract obstruction
¨Instrumentation of the urinary tract (catheterization)
¨Vesicoureteral reflux
¨Pregnancy (Between 4% and 6% of pregnant women develop bacteriuria sometime during pregnancy, and 20% to 40% of these eventually develop symptomatic urinary infection if not treated)
¨Gender and age
¨Preexisting renal lesions (intrarenal scarring and obstruction)
¨Diabetes mellitus
Immunosuppression and immunodeficiency |
|
|
Term
| 4 features of acute pyelonephritis |
|
Definition
- Patchy interstitial suppurative inflammation,
- Intratubular aggregates of neutrophils
- Tubular necrosis
- Glomeruli are usually spared, however, can be invloved in later stages, especially in the case of fungal infection .
|
|
|
Term
| 3 complications of pyelonephritis |
|
Definition
1. papillary necrosis
2. pyenephrosis
3. perinephric abscess |
|
|
Term
| Papillary necrosis of pyelonephritis is cause by ___ and ___ |
|
Definition
| diabetes & urinary tract obstruction |
|
|
Term
| 2 systemic symptoms of infection in acute pyelonephritis is |
|
Definition
|
|
Term
| 3 symptoms of bladder and urethral irritation in acute pyelonephritis are |
|
Definition
Dysuria
frequency
urgency |
|
|
Term
| 3 clinical signs see in urine in acute pyelonephritis are |
|
Definition
Pyuria
Pus cast - indicates kidney involvement
Quantitative urine culture - gives idea on how to treat with antibx |
|
|
Term
Pyelonephritis in kidney allografts caused by ____ |
|
Definition
polyomavirus
- ¨Allograft failure in as many as 1% to 5% of kidney transplant recipients
¨Viral infection of tubular epithelial cell nuclei
¨Nuclear enlargement and intranuclear inclusions |
|
|
Term
| Important features of chronic pyelonephritis is scarring of ___ and ___ of the kidney? |
|
Definition
|
|
Term
Reflux nephropathy is often discovered when ___in children is investigated |
|
Definition
|
|
Term
Loss of tubular function in particular of concentrating ability gives rise to ___ and ____ |
|
Definition
|
|
Term
Unrelieved obstruction of the kidney almost always leads to permanent renal atrophy, termed ___ or ___ |
|
Definition
| hydronephrosis or obstructive uropathy |
|
|
Term
| 7 Features of renal obstruction |
|
Definition
¨Sudden or insidious
¨Partial or complete
¨Unilateral or bilateral
¨Any level of the urinary tract from the urethra to the renal pelvis
¨Intrinsic urinary tract lesions
¨Extrinsic - compression |
|
|
Term
| Initial diagnosis of DIKD often involves __ and ___ |
|
Definition
| elevated serum creatinine and blood urea nitrogen |
|
|
Term
| T/F: Renal insufficiency is irreversible |
|
Definition
Renal insufficiency is often reversible upon discontinuation of therapy, but may eventually lead to ESRD. |
|
|
Term
Nephrotoxicity may also be evidenced by earlier signs of renal tubular function without a loss of GFR, especially markers of ____. |
|
Definition
|
|
Term
| In outpatient setting, ___ nephrotoxicity is most common and best defined. |
|
Definition
NSAID nephrotoxicityis most common and best defined. |
|
|
Term
5 risk factors for NSAID Nephrotoxicity :
|
|
Definition
1.males over 65 years of age
2. high drug dose
3. cardiovascular disease
4. recent hospitalization for nonrenal
5.concomitant use of potentially nephrotoxic drugs |
|
|
Term
| T/F: There are generalizable risk factors are applicable to all drug classes and patient situations since drug toxicity develops as a result of a wide range of mechanisms. |
|
Definition
| There NO generalizable risk factors are applicable to all drug classes and patient situations since drug toxicity develops as a result of a wide range of mechanisms. |
|
|
Term
| ___ injury affects renal hemodynamics |
|
Definition
|
|
Term
| T/F: Hemodynamically mediated acute renal failure can be prevented |
|
Definition
|
|
Term
| Hemodynamically mediated acute renal failure is due to ___ and ___ |
|
Definition
|
|
Term
| Risk factors for drug induced hemodynamic renal failure |
|
Definition
1. preexisting renal insufficiency
2. Decreased renal blood flow due to volume depletion, heart failure, or liver disease. |
|
|
Term
| ___ is used for early assessment of renal toxicity |
|
Definition
|
|
Term
| Glomerular filtrations monitoring for DIKD involves |
|
Definition
1. serum creatinine
2. BUN concentrations
3. urine output measurement |
|
|
Term
For the outpatient setting, nephrotoxicity is often recognized by the symptoms of ___ or ____. |
|
Definition
uremia (malaise, anorexia, and vomiting) or
volume overload (edema) |
|
|
Term
| ___, ___ and ___ for creatinine clearance may quantify the loss of glomerular filtration |
|
Definition
| Serum creatinine or BUN concentrations and urine collection |
|
|
Term
| T/F: Renal tubular function can be altered without loss of glomerular filtration |
|
Definition
|
|
Term
| General indicators of proximal tubular injury: |
|
Definition
(1) metabolic acidosis w/ bicarbonaturia, (2)glycosuria w/out hyperglycemia,
(3) hypophosphatemia and hypouricemia |
|
|
Term
Indicators of distal tubular injury are |
|
Definition
(1) polyuria
(2) metabolic acidosis
(3) hyperkalemia |
|
|
Term
| markers used for early detection of acute kidney injury. |
|
Definition
| kidney injury molecule-1 (KIM-1), n-acetyl-B-D-gucosaminidase, gamma-glutamyltranspeptidase, glutathione-S-transferase, neutrophil gelatinase-associated lipocalin (NGAL), and interleukin-18 |
|
|
Term
___ is upregulated in the urine within 12 hours of ischemic acute tubular necrosis and ____may be detected in the urine within 3 hours of ischemic injury. |
|
Definition
KIM-1 = ischemic acute tubular necrosis
NGAL = ischemic injury |
|
|
Term
| Drug induced nephrotoxicity is ___ with respect to the drugs involved and the lesions produced |
|
Definition
|
|
Term
___ and __ may decrease total renal blood flow.
|
|
Definition
|
|
Term
| Renal blood flow is regulated by __ and ___, while specialized blood flow is regulated by ___ |
|
Definition
RBF: afferent and efferent arterioles
Specialized RBF:
prostoglandins, atrialnatriuretic factor, sympathetic nervous system, RAG, and the macula densa to distal tubular solute delivery |
|
|
Term
| ____ may shut intrarenal blood flow away from superficial nephrons. |
|
Definition
| Radiographic contrast media |
|
|
Term
____ may dilate glomerular efferent arterioles leading to decreased glomerular filtration pressure
|
|
Definition
|
|
Term
| ___ can activate neurohumoral renal hemodynamic control systems that increase renal susceptibility to drug nephrotoxicities |
|
Definition
|
|
Term
Tubular transport systems within the nephron tubule include ___, ___ and ___, which all play a role in the elimination of drugs and metabolites from the body. |
|
Definition
| organic cation transporter (OCT1), organic anion transporter (OAT1) and P-glycoprotein |
|
|
Term
___and ___are agents that appear to mediate nephrotoxicity through intracellular accumulation. |
|
Definition
| Aminoglycosides and cyclosporine |
|
|
Term
| _____appears to increase intracellular concentrations of superoxide ion, hydrogen peroxide, and hydroxyl radicals, while cyclosporine increases hydrogen peroxide, which contributes to oxidative stress and nephrotoxicity |
|
Definition
|
|
Term
| medullary tubular epithelial cells are sensitive to drugs that exacerbate the already hypoxic environment by decreasing energy production or oxygen delivery, and ___ - induced medullary tubular damage, may be due to an imbalance between increased cellular energy requirements and inadequate oxygen delivery. |
|
Definition
|
|
Term
| Hemodynamically Mediated Renal Failure |
|
Definition
•Results from a decrease in blood flow to glomeruli, causing insufficient perfusion pressure to maintain filtration across the glomerular capillaries |
|
|
Term
| ____ and ____ affect the renin-angiotensin system in the kidneys and reduce glomerular capillary hydrostatic pressure |
|
Definition
|
|
Term
| T/F: drug-induced glomerular disease is common. |
|
Definition
|
|
Term
|
Definition
| >3.5 g/day of protein in urine |
|
|
Term
| NSAIDs-induced nephropathy has been associated with a ___ interstitial infiltrate suggesting disordered cell-mediated immunity. |
|
Definition
|
|
Term
| ___ is the most common cause of focal segmental glomerulosclerosis |
|
Definition
|
|
Term
| ___ may cause glomerulosclerosis as a primary lesion |
|
Definition
|
|
Term
| Most common drug-induced (parenteral gold administration) glomerular lesion |
|
Definition
|
|
Term
| __ is the most common cause of membraneous nephropathy |
|
Definition
|
|
Term
| Most common mechanism responsible for drug induced kidney disease |
|
Definition
Acute tubular necrosis
- occurs in proximal or distal tubular epithelia |
|
|
Term
| The primary target of aminoglycoside toxicity is the ___ |
|
Definition
| proximal tubular epithelial cell |
|
|
Term
| Toxicity of aminoglycosides is directly proportional to the number of their ___ since they are reabsorbed by absorptive mediated endocytosis |
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Definition
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Term
Chemotherapeutic agent that causes renal tubular damage due to the heavy metal, platinum. |
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Definition
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Term
| T/F: Cisplastin causes irreversible nephrotoxicity |
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Definition
| False -- nephrotoxicty caused by cisplastin is reversible |
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Term
____ is one of the common causes of hopital-acquired renal failure. |
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Definition
| IV or intra-arterial administration of radiographic contrast media |
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Term
| What cells predominate in the inflammatory infiltrate observed in acute pyelonephritis? |
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Definition
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Term
| Acute allergic interstitial nephritus can be caused by these 2 classes of drugs |
|
Definition
Penicillins - Methicillin
NSAIDs - Fenoprofen |
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Term
| ___causes chronic tubulointerstitialnephritus and impairs ability to concentrate urine due to a dose-related decrease in the collecting duct response to antidiuretic hormone. |
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Definition
|
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Term
| ___and ____ can cause interstitial fibrosis after 6-12 months of therapy. This is a major limitation to therapy after cardiac transplant. |
|
Definition
| Cyclosporin and Tacrolimus |
|
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Term
Prostatic hypertrophy from tricyclic antidepressants. is an example of a ____obstruction |
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Definition
|
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Term
|
Definition
•Triamterene-hydrochlorthiazide (K+ sparing diuretic) only 1/1500 users.
•Laxative abuse may lead to ammonium urate stones. |
|
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Term
| Most effective drug to produce diuresis |
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Definition
| Mannitol (parenteral) and loop diuretics (ascending limb) |
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Term
| ___ and ___ are the most frequently used diuretics in AKI patients. |
|
Definition
| Furosemide and bumetanide |
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Term
| ___ is the most commonly used diuretic for AKI because of its oral and parenteral forms and lower cost |
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Definition
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Term
| Goal of therapy in treating AKI is to maintain urinary output of ____ |
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Definition
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Term
| What volume expansion agent should you give after IV contrast dye administration? |
|
Definition
Normal saline (0.9% NaCl) - 1-1.5ml/kg/hr for 3-12 hrs before dye and 6-12 hrs after dye
Sodium bicarbonate (154 mEq/L in D5W) - 3ml/kg/hr for 1 hr prior to dye administration, then 1 ml/kg/hr for |
|
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Term
| Use this volume expansion agent only if critically ill |
|
Definition
| Isotonic crystalloids (NS) over colloids |
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Term
| __ formulation of amphotericin B is preferred if this agent MUST be used |
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Definition
|
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Term
| WHat is the only prophylaxis recommended to prevent AKI during contrast dye administration |
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Definition
| N-acetylcysteine (Mucomyst) oral formulation - 600mg-1200 mg BID on day before and day of contrast dye |
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Term
| ___ may have direct protective effect in AKI and is primarily used for glycemic control |
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Definition
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Term
| Preferred treatment for hypervolemic patients with AKI |
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Definition
|
|
Term
| How to fix resistance to loop diuretic |
|
Definition
| Add thiazides or K+-sparing diuretics |
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