DIT Renal Flashcards
What does ureteric bud do?
HIGH YIELD
caudal end of metanephros and makes COLLECTING SYSTEM and induces metanephros to differentiate into renal tubular epithelial structures
If fails, could cause POTTER SEQUENCE
Potter sequence mneonic?
from oligohydramnios so compression of fetus
POTTER
Pulm hypoplasia Oligohydramnios Twisted face (wrinkles) Twisted skin Extremity defects Renal failure (in utero)
What syndrome is associated with horseshoe kidney?
Turner syndrome
3 things that tell that special cell to release renin?
JG release renin when:
Beta adrenergic
Low pressure in afferent arteriole
Low sodium sensed by macula densa and signal is relayed to it
Fluid compartment. How is body weight dispersed for water volume, intracellular and extracellular?
60, 40, 20 rule
60% of weight is water
40% of weight is intracellular
20% is extracellular
Inulin is useful for what?
Freely filtered by glomeruli and not reabsorbed. So the clearance of it is equal to the GFR
Clearance equation?
UV over P=Cl urine concentration times flow rate divided by plasma concentration
Use inulin if you want it b/c not reabsorbed or secreted and it is freely filtered. (creatinine is more practical but no need to calculate that)
Normal is 100
Renal plasma flow is calculated how?
PAH b/c almost all of the PAH to kidney is pissed out b/c filtered and not reabsorbed. IT IS ALSO secreted so blood to tubules ALSO gets rid of it.
SO RPF= UV/P for PAH
Filtration fraction? NEED TO KNOW
GFR/RPF. Glom filt rate/renal plasma flow
(clearance creatinine/clearance PAH is good estimate)
it is normally 20%
Do #4 on pg 511
ok
What is Hartnup disease?
Deficiency of transporter for neutral AA in PCT of kidney
Can’t absorb tryptophan and CANT MAKE NIACIN
3 D's of pellagra Dermatitis Diarrhea Dementia Death
Psammoma bodies are in what?
PSaMMomA
Papillary adenocarcinoma
Serous cystadenocarcionoma
Meningioma
Mesothelioma
Flash cards for session 3
make them
Acetazolamide works where? Used for what?
Carbonic anhydrase
Won’t reabsorb it in the kidney so your urine is more basic, which helps to get rid of acidic toxins
ALSO ALTITUDE sickness to adapt for resp alkalosis
Psuedotumor cerebri
Chronic glaucoma
It is a sulfa drug (a if PFACTSSS)
What diuretic decreases calcium?
Loops loose calcium. used if hypercalcermia
Side effects of loop diuretics?
OH DANG
Ototoxicity Hypokalemia Dehydration Allergy (sulfa) Nephritis Gout
Non sulfa loop diuretic?
Ethacrynic acid
If you need loop who has a sulfa allergy
NER USE FOR GOUT
HCTZ mechanism? Toxicity?
Inhibits NaCl reabsorption in early distal tubule
hypokalemic metabolic alkalosis, hyponatremia
HyperGLUC Glucose Lipidemia Uricemia Calcemia
SULFA
Potassium sparing diuretics?
K+ STAys
Spironolactone, Triamterene, amiloride. and Eplerenone (eplerenone has less androgen affect)
T and A block Na channels in convoluted tubule
Drugs that cause nephrogenic diabetes insipidus? Mechanism?
Lithium blocks aquaporins in kidney that have been inserted into principle cells as does
DEMECLOCYCLINE (which makes sense b/c that is SIADH tx)
other causes: hypercalcemia, and hereditary mutation of ADH receptor
Potassium shift out of cell is caused by?
DO INSULIN LAB
Digitalis hyperOsmolarity Insulin deficiency Lysis of cells Acidosis Beta Blocker
Tx for hyperkalemia?
Dextrose and insulin Beta agonist (albuterol or soemthing) bicarb to put into alkalosis
Tx for nephrogenic diabetes insipidus? 3 of them
HCTZ
K+ sparing
Indomethacin (less prostaglandin, less renal blood flow)
What happens with MPTP exposure?
Dopamine is gone b/c MPTP converted to MPP which destroys substantia nigra
Acid base result in PE?
Resp alkalosis b/c so much breathing to try to get rid of hypoxemia.
What is renal tubular acidosis? What is mnemonic for each kind? pH of urine for each?
Renal tubule problems causing non-anion gap acidosis
Type 1: H excretion problem in alpha intercalated (H is 1 letter) in distal convuluted tubule and so no HCO3 is made and acidosis with HYPOKALEMIA (duh, can’t trade H for K). Higher pH and more bone turnover so risk of calcium stones
Type 4: NH4! 4 letters in aldosterone. Aldosterone receptors don’t work, so high aldosterone levels (or K+ sparing diuretics). No NH4 mdd in proximal tubules so no buffer and then you get normal urine pH
Type 2 is leftover. Defect in proximal tubule HCO3 reabsorption so excrete more HCO3 and acidosis. alpha intercalated acidify urine so HYPOKALEMIA happens and normal low pH of urine. HYPOPHOSPHATEMIA and can have rickets
Anion gap acidosis?
MUDPILES Methanol Uremia DKA Propylene glycol INH or Iron tabs Lactic Acidosis Ethylene glycol Salicylates
Kid with puffy eyes 2 weeks after a skin infection comes in with cocacola urine. What are findings for: (which is the one we HAVE TO KNOW)
LM
IF
EM?
poststreptococacola glomerulonephritis
LM: enlarged and hyper cellular glomeruli (hypercel menangium, may see neutrophils)
IF: starry sky with lumpy bumpy IgG, IgM and C3 deposition
EM: MUST KNOW sub epithelial immune complex humps (HUMP DAYYYY)
remember epithelium is podocytes
Labs with high antiDNAse B and low complement?
Acute post streptococcal glomerulonephritis
Kid has URI or gastroenteritis with purpuric nodules on his ass and legs. What findings would you see for:
LM
IF
EM
IgA nephropathy (purpuric nodules are Henoch Schonlein purpura)
LM: mesangial proliferation
IF: IgA deposits in mesangium
EM: mesangial deposits
Alport syndrome symptoms? Findings on biopsy of kidney?
Splitting of basement membrane b/c collagen type 4 issue.
Can’t see (cataracts), can’t pee, can’t hear high c
What disease can cause rapidly progressive glomerulonephritis?
What do you see on LM?
Crescentic glomeruloneprhtisi:
Goodpasture (Linear on IF)
Granulomatosis with polyangitis (wegeners)
Microscopic polyangitis
Lupus
Lupus is associated with what nephritis?
LM?
IF?
Diffuse proliferative glomerulonephritis (diffuse means lots of glomeruli, proliferative b/c cells proliferate)
anti-dsDNA. WIRE LUPUS!
LM: wire loops b/c deposits line basement membrane
IF: granular. Makes sense
Kid had recent immunization now has nephrotic syndrome. Risk of hypercoag b/c loss of antithrombin. Anyway, what type of nephrotic syndrome doe he have?
Tx?
Minimal change disease.
EM: effacement of foot processes and albumin leaks out
CORTICOSTEROIDS just give it if they fit the mold and they should respond
Black, fat, HIV has what kind of findings on kidney biopsy?
LM
EM?
LM: segmental sclerosis (FSGSclerosis)
EM: effacement of foot process like minimal change disease)
Findings with membranous nephropatphy on biopsy?
LM
IF
EM
Most common for white adutls
LM: BM thickening (MEMBRANOUS in the name)
IF: granular for immune complex
EM: spike and dome with sub epithelial humps
Patient with hepatitis has nephrotic syndrome. What kind is it? what do you see on:
LM
IF
EM?
Membranoproliferative glomperulonephritis is caused by hepatitis,, lupus and subacute endocarditis.
IF: Tram track from GBM splitting with mesangial growth
EM: tram track again
Think of it as membrane is growing b/c that is is the name and can have nephritis and RBC case b/c name
SUBENDTHELIAL IM deposits
Round pink nodule in kidney is what?
Kimmelsteil wilson lesion b/c diabetic glomerulonephropathy with noneznzymatic glhycosylation fucking things up and causing larger membranes
Flashcards for post quiz on page 525
do it
Renal tumor in kids is associated with what problem genetically?
What is the complex associated with it?
Wilms tumor on chrom 11
WAGR complex
Wilms tumor
Aniridia (NO IRIS)
Genitourinary malformation
Retardation
What hormones can be made by RCC?
Well associated with VHL and chrom 3.
Secrete EPO, ACTH, PTHrP and Prolactin
What is a risk for RCC and transactional cell carcinoma?
Smoking! (RCC is obesity too. TCC is aniline dies and cyclophosphamide)
What is thyroidization of the kidney?
From chronic pyelonephritis with eosinophilic casts resembling thyroid tissue
Prerenal azotemia finding caused by what? What is finding?
Poor kidney perfusion so reabsorb urea!!!!
BUN:Creatinine>20
Patient has been taking antibiotics for a few weeks and has pyuria and azotemia. What is mechanism?
Other symptoms?
Acute Interstitial nephritis b/c drug acts as haptens in kidney.
Also can have fever, flank pain, hematuria, rash.
