Renal Exam 2 (Kerns)

What is the best way to prevent any kind of kidney stone formation?

Increase hydration

How does ethanol impact urine production?

Decreases ADH, which decreases water reabsorption, so more water is lost through urination

T/F: even small amounts of caffeine can cause dehydration via constriction of the afferent arteriole

False, large amounts are need

When urine volume is ___ and solute concentration is ____, solid crystals can begin to form in the kidneys.

low, high

Which of the following can crystallize in the urine?

• Salts

• Organic compounds

• Pharmaceuticals

All of the above

The following drugs can cause what?

• Sulfadiazine

• Acyclovir/indinavir

• Triamterene

• Methotrexate

Drug-induced crystal nephropathy

T/F: most types of kidney stones can be removed with pharmacotherapy treatment

False, only uric acid stones are able to be treated with pharmacotherapy

Post shock wave lithotrispy treatment is focused on what?

To pass the now smaller stone pieces AND prevent formation of new stones

T/F: pain relievers are not needed when passing a kidney stone

False, they can be very painful to pass

Which type of alpha blockers are used to help pass kidney stones?

Alpha 1 selective

____ is more widely used and is used in both sexes, while ____ is primarily only used in males and is less alpha 1 selective.

Tamsulosin, alfuzosin

Alpha 1 antagonist MOA

Inhibit basal tone, increase pressure in the ureter, and relax smooth muscle in bladder neck and prostate

The following describe which type of stone?

• radiopaque

• likely to form in acidic urine

• hyperoxaluria can increase risk

Calcium oxalate

Which of the following can cause hyperoxaluria?

• Genetic conditions that increase oxalate in urine

• Liver defect that increases oxalate in urine

• Diet heavy with oxalate rich foods (beer, chocolate, nuts)

All of the above

The following describe which type of stone?

• radiopaque

• likely to form in alkaline urine

Calcium phospahte

Increase in PTH will do what to calcium levels in URINE?

Increase

The following describe which type of stone?

• radiolucent

• likely to form in acidic urine

• diet high in animal protein

Uric acid

In which environment is this form of uric acid favored?

Alkaline, will dissolve easily

In which environment is this form of uric acid favored?

Acidic, will NOT dissolve

T/F: Allopurinol is both preventative and treatment for uric acid kidney stones

False, it is only a preventative measure

The following are preventatives for what kinds of kidney stones?

• Potassium citrate

• Allopurinol

Uric acid stones

Which drug can be used to TREAT uric acid kidney stones

Sodium bicarbonate

The following describe which type of stone?

• radiopaque

• typically result of infection

• present in alkaline urine

• composed of magnesium, ammonium and phosphate

Struvite

Cystine is a _____ amino acid, so it precipitates in neutral or _____ urine

Basic, acidic

Which type of stone can be formed due to genetic mutations in the SLC genes that cause impaired reabsorption of amino acids?

Cystine

Stone forming inhibitor that forms very soluble complexes with oxalate and phosphate to prevent Ca2+ from binding

Magnesium

Stone forming inhibitor that tightly binds Ca+2 to prevent it from binding oxalate or phosphate

Citrate

T/F: avoiding calcium is best in patients with reoccurring calcium based stones

False, moderate calcium intake is ok

Thiazide diuretics _____ calcium excretion through the urine

Decrease

In the urine, thiazide diuretics _____ sodium, _____ calcium leading to ____ water in the urine.

increase, decrease, more

Which drug prevents cystine stone formation?

Tiopronin

Tiopronin MOA

Binds with cystine and is more water soluble that cystine-cystine dimers, preventing precipitation

T/F: citrate salts can alkalinize the urine

True

The wax matrix of some potassium citrate tablets do what to the half life?

Extend it

Carbonic anhydrase allows for…

transport of NaHCO3 from the lumen to the interstitial space, and water follows

Inhibiting carbonic anhydrase does what to BLOOD pH?

decreases

Inhibiting carbonic anhydrase does what to sodium and HCO3 ions in the URINE?

increases both

Why does the carbonic anhydrase inhibitor, acetazolamide, have a mild diuretic effect?

becuase water follows the sodium ions into the urine

Inhibiting carbonic anhydrase does what to H+ and Cl- ions in the URINE?

decreases both

Ammoniagenesis produces…

HCO3

Where does HCO3 generation occur?

In the kidneys

T/F: only ammoniagenesis generates HCO3

False, distal tubular H+ secretion does as well

Where does H+ secretion occur?

Distal tubules

The concentration of carbonic acid is directly proportional to the amount of ____ dissolved in the blood, so it can be used as a surrogate marker

CO2

pH of blood is determined by the ______ of bicarbonate and PCO2

ratio

High levels of CO2 in the blood do what to pH?

Lower

Kidney damage can cause _______ because they can’t filter excess acids nor can they retain bicarbonate

Metabolic acidosis

PCO2 represents what part of the equation?

Acid

HCO3 represents what part of the equation?

Base

Because an increase in HCO3 drives the equation towards CO2+H2O, what happens to pH?

It increases because H+ ions are used to generate CO2+H2O

Because an increase in CO2 drives the equation towards HCO3 + H+, what happens to pH?

It decreases because H+ ions are generated

CO2 increases and pH decreases

Respiratory acidosis

CO2 decreases and pH increases

Respiratory alkalosis

HCO3 increases and pH increases

Metabolic alkalosis

HCO3 increases and pH increases

Metabolic acidosis

Fomepizole is used to treat…

Methanol and ethylene glycol poisoning

Fomepizole MOA

Inhibits alcohol dehydrogenase, limiting formation of aldehydes that are then converted to toxic products