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MSS - Renal Exam 1 > Comprehensive Review > Flashcards

Comprehensive Review Flashcards

1
Q

level of left kidney

A

TV11-LV2

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2
Q

level of right kidney

A

TV12-LV3

lower because of liver
easier to palpate

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3
Q

hormones of kidney?

A

renin
erythropoietin
calcitriol

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4
Q

posterior to kidney

A

diaphragm
psoas major
quadratus lumborum
transversus abdominus

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5
Q

psoas test

A

pain with extension of thigh

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6
Q

anterior to left kidney

A 
descending colon
spleen
pancreas
stomach
jejunum
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7
Q

anterior to right kidney

A

ascending colon
liver
duodenum

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8
Q

nephrotosis

A

dropped kidney to pelvis
because lack of fascia/fat

loin to groin pain

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9
Q

pararenal fat

A

external to fascia

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10
Q

perirenal fat

A

between kidney and fascia

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11
Q

perinephric abscess

A

can’t spread contralateral

can spread inferior

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12
Q

renal arteries

A

branch of aorta LV1/2

right longer and posterior to IVC

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13
Q

renal vein

A

drain to IVC

left longer

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14
Q

left renal vein gets drainage from?

A

gonadal
left interior phrenic
left suprarenal

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15
Q

renal vein entrapment

A

nutcracker syndrome
left renal vein compressed by aorta and SMA

hematuria, ab pain, left testicular pain

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16
Q

constrictions of ureter?

A

renal pelvis/ureteric junction
brim of pelvis
ureter entry to bladder

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17
Q

ureter artery?

A

upper 1/3 - renal artery/vein
middle 1/3 - gonadal, aorta, common iliac a/v
lower 1/3 - internal iliac a/v

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18
Q

ureter lymph?

A

upper - lumbar
middle - common iliac
lower - common, external, internal iliac

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19
Q

muscle in urinary bladder?

A

detrusor

trigone - between orifices

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20
Q

trigone muscle?

A

inner - ureteric

outer - detrusor

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21
Q

ligaments of bladder?

A

lateral ligament of bladder

puboprostatic

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22
Q

cystocele

A

fallen bladder

bc of weakened ligaments

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23
Q

male urethra?

A

intramural
prostatic
membranous
penile

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24
Q

sphincter urethrae muscle

A

skeletal and smooth muscle

-regulates incontinence

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25
Q

female urethra

A

superior (pelvic) and inferior (perineal)

Skenes gland

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26
Q

micturition?

A

bladder fills - activates stretch receptors
-to spinal cord levels S2, S3, S4 pelvic splanchnic nerves

ascend to micturition center
descend to motor GVE-P of pelvic splanchnic

contract detrusor
relax sphincter urethrae
-sympathetic internal AND somatic external

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27
Q

kidney stones?

A

refer pain to T10-L2

pain loin to groin

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28
Q

kidney autonomic

A

renal plexus

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29
Q

kidney sympathetic

A

preganglionic - T10-L1
-lesser, least, lumbar splanchnic

postganglionic - aorticorena/renal ganglia - renal plexus

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30
Q

kidney parasympathetic

A

pregang - vagus

postgang - wall of organ

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31
Q

ureter autonomic

A

renal plexus - upper

inferior hypogastric - lower

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32
Q

ureter sympathetic

A

pregang - T10-L1
-lesser, least, lumbar splanchnic

postgang - various ganglia

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33
Q

ureter parasympathetic

A

pregang - vagus (upper)
-pelvic splanchnic (lower)
postgang - walls of organs

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34
Q

bladder autonomic

A

inferior hypogastric plexus

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35
Q

bladder sympathetic

A

pregang - T10-L2
-lumbar/sacral splanchnic
postgang - various ganglia

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36
Q

bladder parasympathetic

A

pregang - pelvic splanchnic
postgang - walls of organs

afferent - stretch

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37
Q

urinary and repro from what?

A

intermediate mesoderm

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38
Q

pronephros

A

week 4

vestigial

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39
Q

mesonephros

A

thoracic/upper lumbar
-to 3 months

tubules to wolffian duct (mesonephric duct)

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40
Q

metanephros

A

permanent kidney

by 3rd month

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41
Q

metanephric blastema

A

becomes nephron

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42
Q

uteric duct

A

from mesonephric duct

-forms collecting duct, calyces, pelvis, ureter

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43
Q

ascent of kidney

A

week 9

rotate medially

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44
Q

kidney blood supply?

A

originally common iliac

eventially, renal artery from aorta

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45
Q

urorectal septum

A

splits cloaca

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46
Q

urogenital sinus

A

cranial (vesical) - bladder
-continuous with allantois

middle (pelvic) - urethra in female
-in male - prostatic and membranous

gonadal (phallic) - male penile urethra

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47
Q

renal hypoplasia

A

ureteric bud doesn’t branch
-lack nephron differentiation

persistant fetal lobulation

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48
Q

renal dysplasia

A

cystic disease

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49
Q

autosomal recessive cystic dx?

A

CD cyst

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50
Q

autosomal dominant cystic dx?

A

CD and nephron cysts

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51
Q

renal agenesis

A

ureteric bud doesn’t form or doesn’t differentiate the metanephric blastema

unilateral or bilateral

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52
Q

potter

A

bilateral renal agenesis

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53
Q

horseshoe kidney

A

inferior poles fuse

stuck on IMA

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54
Q

ectopic kidney

A

doesn’t ascend

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55
Q

wilm’s tumor

A

malignant, before age 5

WT1 mutation

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56
Q

duplication of ureter

A

splitting of ureteric bud

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57
Q

ectopic ureter

A

two ureteric budes form

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58
Q

urachal anomalies

A

allantois persists

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59
Q

exstrophy of bladder

A

ventral lateral body wall defect
bladder exposed
often with episadias

60
Q

exstrophy of cloaca

A

ventral lateral body wall defect
bladder exposed and rectum exposed

more severe

61
Q

renal lobe

A

pyramid + cortex

62
Q

collagen in LD?

A

type 4 globular

63
Q

LRI and LRE?

A

high laminin and heparan sulfate (a proteoglycan)

64
Q

size barrier?

A

less than 5200 freely

greater than 69000 doesn’t go

65
Q

charge barrier?

A

cations easier flow

66
Q

tubules?

A

acidophilic - mitochondria

67
Q

PCT

A

cuboidal with dense microvilli

68
Q

PST

A

shoter cells than PCT

-in medullary rays

69
Q

LH

A

simple squamous, thin

70
Q

DST

A

cuboidal
paler staining
apically placed nuclei

71
Q

DCT

A

simple cuboidal
-only in cortex

returns to corpuscle of origin

60% shorter than PCT
-influenced by aldosterone

72
Q

aldosterone

A

in DCT

  • reabsorb Na and bicarb
  • secrete K, H, ammonia

increases salt reabsorption**

73
Q

JG cells?

A

secrete renin

74
Q

macula densa

A

monitor Na+

75
Q

CD

A

cuboidal than columnar cells

76
Q

ADH

A

increased water permeability in collecting duct

77
Q

light cells

A

water release (aquaporins)

78
Q

dark cells

A

acid base balance

79
Q

alpha cells

A

H+ secretion

80
Q

beta cells

A

HCO3- secretion

81
Q

type I in renal interstitium

A

vasodilator (prostaglandins)

82
Q

leukotrienes

A

vasoconstrictors

83
Q

renal lobule

A

bordered by interlobular arteries

medullary ray, labyrinth around ray, renal corpuscle, DCT, PCT

84
Q

artery flow in kidney?

A

aorta - renal artery - segmental artery - interlobar artery - arcuate artery - interlobular artery - afferent - G cap - efferent -vasa recta OR peritubular cap

85
Q

vein flow in kidney?

A

vasa recta skips interlobular*
peritubular goes to interlobular

interlobular - arcuate - interlobar - segmental - renal - IVC

86
Q

outflow tract?

A

transitional epithelium mucosa with lamina propria

inner long/outer circular muscular

adventitia

87
Q

transitional epithelium

A

stratified epithelium

  • dome surface
  • tight junctions
88
Q

ureter

A

stellate lumen

89
Q

urethra

A

stellate lumen
high elastin

pseudostratified to stratified squamous

90
Q

transcellular fluid

91
Q

high in ECF?

A

Na Cl HCO3

92
Q

high in ICF?

A

K Mg PO4 protein

93
Q

tonicity

A

depends on impermeant solutes

94
Q

ECF and ICF?

95
Q

Vd?

A 
volume of distribution
-less than 3 only plasma
-14 to plasma and interstitum
40-45 to total body water
over 45 to all tissues
96
Q

oncotic pressure

A

determined by large molecules

97
Q

estimate plasma osmolality?

A

2x [Na]

or plus glucose/18 and urea/2.8
-with diabetes or renal failure

98
Q

hypoxia?

A

increased ICF Na

cell swells

99
Q

body fluid balance?

A

depends on volume and osmolarity

100
Q

crystalloid

A

electrolytes that will distribute

101
Q

colloid

A

large proteins that stay in vasculature

102
Q

causes of edema

A

altered starling forces

renal retentno of Na+ and H2O

103
Q

non-pitting edema

A

swollen cells

-increaed ICF volume

104
Q

pitting edema

A

increased interstitial fluid

105
Q

thirst

A

increased due to ANG II

106
Q

aldosterone

A

increased due to ANG II

107
Q

salt craving

A

decreased plasma Na+ response

108
Q

sympathetics in kidney?

A

increased sodium and water retention

109
Q

isoosmotic contraction/expansion

A

only change in volume

diarrhea, vomit, hemorrhage, 0.9% salt

110
Q

hyperosmotic volume contraction

A

loss of H2O

dehydration, diabetes

111
Q

hyperosmotic volume expansion

A

gain NaCl

NaCl intake, mannitol infusion

112
Q

hypoosmotic volume contraction

A

loss NaCl

hypoaldosteronism
adrenal insufficiency
diuresis

113
Q

hypoosmotic volume expansion

A

gain H2O

SIADH
psychogenic polydipsia (drink alot of water)
114
Q

volume regulators?

A

SNS
RAAS
ANP (acts to decrease volume)

115
Q

osmoregulators?

A

ADH

thirst

116
Q

BUN/Cr greater than 20

117
Q

filtration fraction

A

GFR / renal blood flow

118
Q

ANG II

A

vasoconstriction of efferent arterioles

119
Q

sympathetics

A

vasoconstriction of afferent arterioles

120
Q

cortex

A

majority of blood flow

121
Q

endothelin

A

vasoconstriction

-released in response to kidney damage

122
Q

increase in RBF and GFR?

A

bradykinin, prostaglandins, NO

123
Q

renal blood flow

A

20% of cardiac output

124
Q

sympathetics?

A

smooth muscle contraction
granular - more renin
more reabsorption
more thirst

125
Q

clearance = ?

126
Q

GFR estimate?

A

inulin clearance

127
Q

cystatin C

A

also for GFR estimate

128
Q

PAH clearance?

A

renal plasma flow

129
Q

glomerular slit diaphragm?

A

CD2AP, CD2, nephrin

130
Q

minimal change density

A

lose negative change in barrier

131
Q

contraction of glomerular mesangial cells

A

shortens capillaries
lowers Kf
lowers GFR

132
Q

first half PT

A

Na reabsorption

glucose and amino acids as well

133
Q

second half PT

A

chloride reabsorption

134
Q

thick ascending LOH?

A

Na/2Cl/K cotransport

Na/H countertransport

135
Q

intercalated cells

A

in distal tubule

-H ATPase secretion

136
Q

principle cells

A

in distal tubules
-reabsorb Na and secrete K

Na/K ATPase

137
Q

secreted in PT

A

organic acids/bases, drugs

138
Q

inulin

A

marker for GFR

3:1 ratio

139
Q

TF/P ration

A

inulin - 3
glucose - 0
PAH - 10 secreted

140
Q

PAH secretion

A

tertiary active transport

141
Q

weak acids

A

neutral when protonated

142
Q

weak bases

A

neutral when deprotonated

143
Q

aspirin overdose

A

give patient bicarbonate

144
Q

dipstick

A

sensitive to albumin

145
Q

sulfosalicylic acid

A

sensitive to all proteins

146
Q

albumin

A

small size and negative charge

147
Q

ACE inhibitor

MSS - Renal Exam 1 (8 decks)

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