14. Renal Flashcards
What artery prevents a horseshoe kidney from ascending in the abdomen?
IMA
What fundamental problem creates Potter sequence?
oligohydramnios
What cell type releases renin?
juxtaglomerular cells
What are the 3 stimuli that induce renin release?
- beta-adrenergic stimulation
- low renal arterial BP (sensed by JG cells)
- decreased Na+ in distal convoluted tubule (sensed by macula densa)
What effect will a renal stone that obstructs the ureter have on GFR and FF?
- decreased GFR
- no change in RPF
- thus, decreased FF
What is the maximal serum glucose concentration at which glucose can be absorbed in the tubules?
350 mg/dL
What vitamin deficiency results from Hartnup disease?
niacin (B3) –> pellagra
note: Hartnup disease is when there is deficiency of neutral amino acid transporters in proximal renal tubular cells (ex. tryptophan)
- thus, decreased tryptophan for conversion to niacin
What is the equation for the renal clearance of any substance?
Renal clearance = UV/P
- U = urine concentration of particular substrate (mg/mL)
- V = urine flow rate (mL/min)
- P = plasma concentration of substrate (mg/dL)
What segment of the renal tubule matches each of the following statements?
- reabsorbs 67% of the fluid and electrolytes filtered by the glomerulus
prox tubule
What segment of the renal tubule matches each of the following statements?
- site of secretion of organic anions and cations
prox tubule
What segment of the renal tubule matches each of the following statements?
- always impermeable to water
thick ascending limb
What segment of the renal tubule matches each of the following statements?
- permeable to water only in the presence of ADH
late distal tubule, collecting duct
What segment of the renal tubule matches each of the following statements?
- site of Na/2Cl/K co-transporter
thick ascending limb
What segment of the renal tubule matches each of the following statements?
- site of isotonic fluid reabsorption
prox tubule
What segment of the renal tubule matches each of the following statements?
- site responsible for diluting urine
thick ascending limb
What segment of the renal tubule matches each of the following statements?
- only site where glucose and amino acids are reabsorbed
prox tubule
What segment of the renal tubule matches each of the following statements?
- water reabsorption in the loop of Henle
thin descending limb
What are the 2 main cell types of the collecting duct?
- principal cell
- intercalated cell
What type of diuretic is each of the following drugs?
- triamterene
K+ sparing
What type of diuretic is each of the following drugs?
- acetazolamide
carbonic anhydrase inhibitor
What type of diuretic is each of the following drugs?
- hydrochlorothiazide
thiazide
What type of diuretic is each of the following drugs?
- bumetanide
loop
What type of diuretic is each of the following drugs?
- spironolactone
K+ sparing (aldo-antagonist)
What type of diuretic is each of the following drugs?
- ethacrynic acid
loop (non-sulfa)
What type of diuretic is each of the following drugs?
- mannitol
osmotic diuretic
What type of diuretic is each of the following drugs?
- metolazone
thiazide
What type of diuretic is each of the following drugs?
- chlorthalidone
thiazide
What type of diuretic is each of the following drugs?
- furosemide
loop
What type of diuretic is each of the following drugs?
- amiloride
K+ sparing
What type of diuretic is each of the following drugs?
- torsemide
loop
What diuretic or class of diuretic would be most useful in each of the following situations? - acute pulmonary edema
loop
What diuretic or class of diuretic would be most useful in each of the following situations? - idiopathic hypercalciuria (--> calcium stones)
thiazide
What diuretic or class of diuretic would be most useful in each of the following situations? - glaucoma (2)
acetazolamide, mannitol
What diuretic or class of diuretic would be most useful in each of the following situations? - mild to moderate CHF with expanded ECV
loop
What diuretic or class of diuretic would be most useful in each of the following situations? - in conjunction with loop or thiazide diuretics to retain K+
K+ sparing
What diuretic or class of diuretic would be most useful in each of the following situations? - edema associated with nephrotic syndrome
loop
What diuretic or class of diuretic would be most useful in each of the following situations? - increased intracranial pressure
mannitol
What diuretic or class of diuretic would be most useful in each of the following situations? - mild to moderate hypertension
thiazide
What diuretic or class of diuretic would be most useful in each of the following situations? - hypercalcemia
loop
What diuretic or class of diuretic would be most useful in each of the following situations? - altitude sickness
acetazolamide
What diuretic or class of diuretic would be most useful in each of the following situations? - hyperaldosteronism
spironolactone, eplerenone
What is the site of action of the thiazides?
distal convoluted tubule
A patient with heart failure exacerbation needs medical diuresis but has a sulfa allergy. What diuretic can be used?
Ethacrynic acid (loop)
Which electrolyte disturbance fits each of the following presentations?
- correcting too rapidly may result in central pontine myelinolysis
hypo Na+
Which electrolyte disturbance fits each of the following presentations?
- peaked T waves
hyper K+
Which electrolyte disturbance fits each of the following presentations?
- tetany
hypo Ca2+, hypoMg2+
Which electrolyte disturbance fits each of the following presentations?
- arrhythmias
hyper K+, hypo K+, hypo Mg2+
Which electrolyte disturbance fits each of the following presentations?
- decreased deep tendon reflexes
hyper Mg2+
Which electrolyte disturbance fits each of the following presentations?
- flattened T waves, U waves on EKG
hypo K+
What factors/substances cause hyperkalemia? (8)
- acidosis
- low insulin
- beta-blocker
- digitalis
- cell lysis (rhabdo, crush injury)
- hyperosmolarity
- K+ sparing diuretics
- ACE inhibitors (b/c of decrease in aldosterone)
What factors/substances cause hypokalemia? (5)
- insulin
- beta agonist
- alkalosis
- loops
- thiazides
What are the causes of acidosis with elevated anion gap?
MUD PILES
- methanol
- uremia
- diabetic ketoacidosis
- propylene glycol
- iron tablets/isoniazid
- lactic acidosis
- ethylene glycol
- salicylates (late)
A patient is found to have both glomerulonephritis and pulmonary vasculitis. What two diagnoses should be considered?
- Goodpasture
- GPA (Wegener)
An 8 yo girl presents with abdominal pain, hip and knee pain, and purpura on the backs of the arms and legs. U/A shows microscopic hematuria and mild proteinuria. What is the most likely diagnosis?
IgA nephropathy (HSP)
Which glomerular disease would you suspect most in a patient with the following findings?
- linear pattern of IgG deposition on IF
Goodpasture
Which glomerular disease would you suspect most in a patient with the following findings?
- lumpy-bumpy deposits of IgG, IgM, and C3 in the mesangium
PSGN
Which glomerular disease would you suspect most in a patient with the following findings?
- Deposits of IgA in the mesangium
IgA nephropathy
Which glomerular disease would you suspect most in a patient with the following findings?
- anti-GBM antibodies, hematuria, hemoptysis
Goodpasture
Which glomerular disease would you suspect most in a patient with the following findings?
- crescent formation in the glomeruli
RPGN (crescentic)
Which glomerular disease would you suspect most in a patient with the following findings?
- wire-looping appearance on LM
lupus-nephritis
What are the defining features of nephrotic syndrome? (3)
- proteinuria > 3.5 g/day
- hypoalbuminemia
- peripheral edema
Glomerular histology reveals multiple mesangial nodules. This lesion is indicative of what disease?
Diabetic glomerulonephropathy
- Kimmelstiel-Wilson lesions
Which glomerular disease would you suspect most?
- most common nephrotic syndrome in adults
FSGS
Which glomerular disease would you suspect most?
- EM: effacement of epithelial foot processes
minimal change
Which glomerular disease would you suspect most?
- nephrotic syndrome associated with hep B
membranoproliferative glomerulonephritis (MPGN)
Which glomerular disease would you suspect most?
- nephrotic syndrome associated with HIV
FSGS
Which glomerular disease would you suspect most?
- EM: subendothelial humps and tram-track appearance
MPGN
Which glomerular disease would you suspect most?
- LM: segmental sclerosis and hyalinosis
FSGS
Which glomerular disease would you suspect most?
- purpura on back of arms and legs, abdominal pain, IgA nephropathy
Henoch-Schonlein purpura (HSP)
Which glomerular disease would you suspect most?
- EM: spiking of the GBM due to electron-dense subepithelial deposits
membranous nephropathy
What is the WAGR complex?
Wilm’s tumor
Aniridia
GU malformation
Retardation (mental)
What are the risk factors for transitional cell carcinoma? (3)
- smoking
- aniline dyes
- cyclophosphamide
What GU pathology fits each of the following descriptions?
- most common tumor of the urinary tract
TCC
What GU pathology fits each of the following descriptions?
- most common renal malignancy of early childhood (age 2-4)
Wilm’s
What GU pathology fits each of the following descriptions?
- most common type of renal stone
calcium
What GU pathology fits each of the following descriptions?
- type of renal stone associated with Proteus vulgaris
struvite stones
What GU pathology fits each of the following descriptions?
- red cell casts
acute glomerulonephritis
What GU pathology fits each of the following descriptions?
- waxy casts
chronic renal failure (long standing kidney disease)
What are the classic features of drug-induced acute interstitial nephritis? (4)
fever, rash, eosinophilia, azotemia
What changes will be seen in a BMP in a pt with renal failure? (3)
- high K+
- low Ca2+
- high BUN and Cr
