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LCK STEP > CHAPTER: Renal > Flashcards

CHAPTER: Renal Flashcards

1
Q

The kidney develops in 3 nephros parts - name each part and its role

A 
1st = PRO-nephros - degenerates by wk 4
2nd = MESO-nephros - 1st trimester kidney
3rd = META-nephros - permanent kidney that has 2 parts: uretric bud (from bottom of meso duct) + metanephric mesenchyme
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2
Q

What adult structures arise from the :
Meso-nephros
Uretric bud
Metanephric mesenchyme

A

Meso = male vas deferans
Metanephric mesenchyme = glomerulus -> DCT
Uretric bud = (everything else) ureter, renal pelvis + calyces, CDs

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3
Q

What is causing fetal hydronephrosis if it is:

  1. Obstructive + unilat
  2. Non-ob + unilat
  3. Bilateral in a boy
A
  1. Kink in ureto-pelvic jxn - makes sense since the junction is the last part of the system to become hollow
  2. Incomplete CLOSURE of the vesicouretral jxn
  3. Posterior urethral valves -> may also cause Potter sequence
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4
Q

No uretric bud means….

A

No kidney = agenesis aka the primordial tissue was never even there

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5
Q

What are you thinking if a baby has unilat vs bilat cystic kidney on US

A

Unilat = multicystic dysplastic kidney (NOT inherited)
Ureteral bud is there - kidney exists
But doesn’t cause metanephric mesenchyme to differentiate - no glom -> DCT
Kidney is not fxnal - mass of cystic CT
Bilat = AR PCKD (can cause Potter’s)

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6
Q

If a kid presents with recurrent UTIs due to asynchronous muscle contractions + vesicoureteral reflux - what deformation are you thinking?

A

Duplex collecting system
2 pelvises -> 2 ureters -> 2 diff insertions into bladder
There was an early separation of the ureteric bud

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7
Q

Which kidney do you use for transplant and why?

A

L kidney b/c longer renal vein (has to cross over aorta)

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8
Q

Walk through renal BF from renal art -> afferent art

A 
Lobe - arch - LOB
Renal art
Segmental art
Interlobar art
Arcuate art
Interlobular art
Afferent art
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9
Q

SAD PUCKER for retroperitoneal organs

A 
Supra-renal (adrenals)
Aorta + IVC
Duodenum pts 2-4
Pancreas except top 1/3
Ureters (water under bridge)
Colon - ascending + descending 
Kidneys
Esophagus - lower 2/3
Rectum
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10
Q

The ureter has 3 sources of blood supply - name them. What dermatomes does kidney pain localize to?

A

Top 1/3 = renal art
Middle 1/3 = middle iliac + gonadal art
Lower 1/3 = int iliac
T10/11 dermatomes = CVA tenderness (T10 = belly button)

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11
Q

2 things you can measure with inulin

A

GFR - 100% filtered, no secretion or absorption

ECF (also mannitol) = 1/3 of TBW

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12
Q

Where do NSAIDs affect the kidney

A

PGs dilate the AFFERENT arteriole, so NSAIDs cause constriction
PGs secreted from kidney, work paracrine
X PGs -> ↓RPF -> ↓GFR
No change to FF = GFR/RPF

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13
Q

Fanconi syndrome

A

Many causes defective PCT

  1. Metabolic acidosis - can’t reabsorb bicarb
  2. ↑U AA, glucose, bicarb, P
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14
Q

Bartter syndrome

A 
X Na/K/2Cl - AR
Looks like chronic loop diuretic use:
1. Metabolic alkalosis
2. HypoK (duh) 
3. ↑U Ca (duh)
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15
Q

Gitelman syndrome

A

X NaCl @ DCT - AR
Looks like chronic thiazide use (metabolic alkalosis)
↓U Ca (duh)

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16
Q

Liddle syndrome - present, inheritance, treat

A

Presents as HTN w/ ↓aldo - weird!
GOF of ENAC - AD
+ Amiloride

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17
Q

Syndrome of apparent mineralcorticoid excess - inheritance + treat

A

X 11 beta OH deH
Can’t inactivate cortisol -> will cross react to bind aldo R (looks like excess aldo @ CD but really ↑cortisol)
Presents as HTN w/ ↓Pk + metabolic acidosis (excess aldo)
+ CS - exog CS ↓prod of endog CS

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18
Q

What food can cause acquired SAME (↑cortisol)

A

BLACK licorice

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19
Q

What type of RTA causes basic urine w/ hypoK? Name drug that can cause this?

A 
T1 RTA (normal gap metabolic acidosis)
Alpha int cells @ CD won't secrete H+
Means you hold H, waste K (hypoK)
↑Risk Ca stones (basic urine) + ↑bone turnover
AMPHO B
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20
Q

What type of RTA causes acid urine w/ hypoK? 1 disease cause vs 1 drug cause

A 
T2 RTA (normal gap metabolic acidosis)
X HCO3 reabsorbed @ PCT 
But urine gets acidified by alpha int cells @ CD
Idk why hypoK
1. Fanconi = defective PCT
2. CA Is
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21
Q

What type of RTA causes acidic urine w/ hyperK?

A 
T3 RTA (normal gap metabolic acidosis)
Hypoaldo 
Waste Na, hold K -> hyperK ↓NH3 syn @ PCT -> ↓NH4 excretion = acid urine
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22
Q

MUDPILES = gap metabolic acidosis (K+Na - Cl+HCO3)

A 
Methanol
Uremia
DKA
Propylene glycol 
Iron tab or INH
Lactic acidosis
Ethylene glycol --> oxalic acid
Salicylates
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23
Q

HARD ASS = non-gap metabolic acidosis

A 
Hyperalimentation = feeding tube
Addison disease
RTA
Diarrhea
Acetazolamide (T2 RTA)
Spironolactone
Saline infusion
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24
Q

Signs of hyper vs hypo Mg

A

Hypo: torsades, tetany (no just hypoCa), hypoK
Hyper: ↓DTR, ↓HR + BP, ↓Ca, cardiac arrest

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25
Q

Why might chronic NSAID use cause renal pap necrosis?

A

X PGs -> constrict afferent arteriole

Chronically ↓renal BF states = ischemia = renal pap necrosis

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26
Q

Where in the kidney is dopamine made - what is its effects at high vs low doses?

A

PCT - goal = naturesis
↓dose = dilates interLOBULAR, afferent + efferent = ↑RBF
↑dose = vasoconstrict

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27
Q

Where does PTH ↑Ca reabsorb vs ↑P excrete

A

DCT reabsorb Ca

Trash P at PCT

28
Q

How does ANP/BNP cause natriuresis

A

↑cGMP -> relax SM -> dilate A art + constrict E art
↑GFR = ↑Na filtered w/o ↑Na reabsorption
This is how diuretics are limited in effectiveness

29
Q

What is the JGA - what 2 cells make it up?

A

JG cells = SM @ afferent art
Macular densa = Cl sensor @ DCT
Apparatus secretes renin

30
Q

Casts seen in ESRD

A

Waxy

31
Q

Nephritic syndromes are characterized by immune complexes. What cell mediated the damage to the glomerulus in these diseases?

A

C5a attracts neutrophils

32
Q

Lumpy bump IF + subEPI humps

A

Post strep GN

33
Q

SLE presentation of nephritic vs nephrotic

A 
Phritic = diffuse prolif GN ask IC deposit 
Phrotic = mebranous
34
Q

Wire looping capillaries LM + sub-endo IC on EM + granular IM

A

Diffuse proliferative GN

35
Q

Basket weave EM w/ splitting of the BM

A

Alport - X dominant

36
Q

Hep B/C infection w/ tram track LM, granular IF, GBM splitting

A

Type 1 membranoprolif GN - sub-endo

Tram track - membranous

37
Q

Excess C3 nephritic factor stabilizes C3 convertase and causes what GN

A

Type 2 membranoprolif GN - intramembranous deposits, overall tram track on LM (membranous

38
Q

Frothy urine means what casts

A

Fat - think nephrotic

39
Q

What type of cancer might cause MCD

A

Hodgkins - RS secreting cytokines effaces foot processes

40
Q

HIV + sickle cell pts presenting with nephrotic syndrome - which one

A

FSGS

41
Q

LM tram track, granular IF, spike + dome EM

A

Membranous nephropathy

Spike + dome is sub-epi

42
Q

2 non-enzymatic glycosylation changes to the glomerulus in diabetes // why give ACE Is to diabetic patients

A

@ GBM @ diffuse thickening
@ efferent art -> narrow lumen -> ↑GFR -> mesangial expansion
Give ACE to counteract AGT 2 constrict at efferent ↓GFR and minimize mesang prolif

43
Q

Describe why nephrotic syndromes are a hyper-coag with ↑infection risk

A

Hypercoag - lost AT3 in urine

Lose Ig in urine = ↑infections

44
Q

Which 3 stones form in acid urine - what does each look like

A

Ca oxalate - envelope or dumbell
Uric acid - (duh basic would neutralize) diamond or rosette
Cystine - cystinuria AR - hexagonal
Defective reabsorb COLA - cyteine, orthinine, lysine, arginine

45
Q

Hydronephrosis if untreated causes atrophy of what 2 parts of the kidney

A

cortex + medulla

46
Q 
RCC
Originates from what cells
Histo of cells
Color of tumor 
RF
Mets via and to 
Treat
A 
From PCT
Clear cell RCC = filled with fat 
Therefore gold/yellow color
SMOKING + obesity
Carcinoma that mes via blood - renal vein -> lung + bone, impt to know b/c commonly see the met 1st
Aldesleukin = IL 2 to ↑NK 
RESISTANT to chemo + radiation
47
Q

Renal oncocytoma - histo, cell arise from, gross

A

From CD
Eosinophilic cells
Central scar on gross

48
Q

3 ways a Wilm’s tumor can present depending on WT1 vs WT 2 mutation

A

WT1: WAGR = Wilms, no iris, GU malform, mental retard
WT1: Wilms, male pseudohermaphroditism
WT2: Wilms, big tongue, organomeg, hemihypertrophy

49
Q

4 RF for urothelial/transitional cell bladder cancer + 2 types

A

Smoking, analine dyes, cyclophosphamide (+mensa)
Flat = early p53 mut, starts high grade
Papillary = low -> high grade
Ex of field effect tumor - multifocal + likely to recur

50
Q

Detursor muscle instability leads to

A

Urgency incontinence = any vol in bladder causes urge to void immediately + leak
+ AntiM = oxybutynin
Vs detrusor underactivity = overflow incontinence

51
Q

3 causes of bladder adenocarcinoma

A
  1. @dome due to urachal remnant
  2. Cystitis grandularis = chronic inflam (cystitis) causes columnar metaplasia (glandularis)
  3. Extrophy = congenital malformation a tthe bottom of the ant ab + bladder walls (born with bladder outside belly)
52
Q

Sterile pyuria indicates what cause of UTI (- culture, + WBC)

A

Neisseria or chlamydia - treat for both!

53
Q

Imaging of acute pyelo

A

@ cortex - striated parenchymal enhancement

Aka light up the outside of kidney

54
Q

Where does the kidney normally scar with chronic vesicouretral reflux?

A

Upper + lower poles

55
Q

2 changes to the kidney with chronic pyelo

A

Cortico/med scarring + blunted calyx

“Thyroidization of kidney” - eos casts

56
Q

2 major causes of diffuse cortical necrosis

A

DIC + vasospasm

57
Q

2 major imaging findings for renal osteodystrophy

A

Subperiosteal thinning

Tissue calcifications

58
Q

Why is BUN/Cr ration ↑ w/ pre-renal azotemia/AKI

A

Pre-renal means kidney think being under-perfused
↓GFR -> RAAS -> ↑Na reabsorb -> H2O follows -> BUN follows
Goal = reabsorb to gain vol

59
Q

Ethylene glycol poisoning cause what 2 things

A

Gap metabolic acidosis + Ca oxalate crystals

60
Q

Ps that cause acute interstitial nephritis

A

Drugs that produce haptans -> eosinophils in urine is pathoneumo
Pee = diuretics
Pain free - NSAIDs
Penicillin + cephalosporins (vs aminoG cause ATN)
PPIs
RifamPin

61
Q

3 stages of ATN

A

Inciting event
Maintenance = ↓urine - metabolic acidosis + ↑K + uremia
Recovery = tons of urine, risk of hypoK

62
Q

4 causes of renal pap necrosis

A

Sick cell
Acute pyelo
NSAIDs
Diabetes

63
Q

Heart problem in AD PCKD - what parts of the kidney does AR vs AD PCKD affect

A

Mitral valve prolapse
AD - cortex + medulla
AR = babies = CD
Both HUGE cystic kidneys

64
Q

If you have cysts in the medulla only of the kidney how will the kidney as a whole look?

A

Shrunken - medullary cystic kidney disease

65
Q

Simple vs complex renal cysts on US

A

Simple: filled with fluid

Complex - septated, enhanced, solid components, bad b/c ↑RCC risk

LCK STEP (27 decks)

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