GU 1 (Step up son) Flashcards
What happens in proximal convoluted tubule?
Glucose, amino acids, metabolites, and sodium (2/3) are reabsorbed
Cl- and H2O go along gradient
HCO3- is reabsorbed via carbonic anhydrase
Organic acids (uric acid) and bases are SECRETED
What happens in the descending loop of Henle?
Permeable to water…deeper increases osmotic gradient –> reabsorption of water/concentration of urine
What happens in the ascending loop of Henle?
Active reabsorption via Na+/K+/2Cl- cotransporter
Reabsorption of Mg2+, Ca2+, and K+ via paracellular diffusion
What happens in the distal convoluted tubule?
Impermeable to water
Na+ and Cl- are reabsorbed via Na+/Cl- transporter
Ca2+ reabsorbed via PTH activity
What happens in the collecting tubule and duct?
Aldosterone causes principal cells to reabsorb Na+ and secrete K+
Intercalated cells secrete H+ and reabsorb K+
ADH drives H2O reabsorption
Why do loop diuretics help with treating pulmonary edema caused by volume overload?
Beyond getting rid of fluid, the also have a direct pulmonary vasodilatory effect
Where do loop diuretics work? What are the side effects?
Loops inhibit Na/K/2Cl cotransporter in the ascending limb
Ototoxicity
Hyperuricemia
Hypokalemia
Hypocalcemia
Where do thiazides work? What are the side effects?
Thiazides inhibit Na/Cl cotransporter in the distal convoluted tubule
Hypokalemia
HyperGLUC…Glucose, Lipids, Uric acid, Calcium
What causes pyelonephritis?
E. coli (most common)
Staph sapro, Klebsiella, and proteus also can
Candida in immunocompromised
How is pyelonephritis treated?
Fluoroquinolones
Aminoglycosides (gentamicin)
3rd gen cephalosporins
What can happen if a pregnant woman gets pyelo?
preterm labor and low birth weight
What kind of kidney stones will not show up on AXR?
Uric acid stone
What is a pathologic difference between calcium oxalate stones and calcium phosphate stones?
Calcium oxalate: idiopathic
Calcium phosphate: Hyperparathyroidism
What causes persistent hematuria in patients less than 20?
Glomerular disease
What causes persistent hematuria in patients between 20 and 50?
Adult PCKD
Neoplasm (bladder, kidney, prostate)
Glomerular disease
What causes persistent hematuria in patients Older than 50?
Adult PCKD
BPH
Neoplasm (bladder, kidney, prostate)
Glomerular disease
What is a possible complication of PCKD?
Subarachnoid hemorrhage (15% of PCKD patients) MVP
What is elevated with renal cell carcinoma? What other malignancies cause this?
Erythropoietin
Hepatocellular carcinoma
Pheochromocytoma
Hemangioblastoma
Watch out for Acute Interstitial Nephritis (AIN) after starting a new drug (it’s a long list)…
…look for signs of ARF, N/V, malaise, rash, fever; also eosinophilia
A kid comes in concerned about brown pee and swelling. On review, he had a fever, sore throat, and tender lumps on his neck a couple of weeks ago. What is a possible diagnosis? What would be seen on labs? How should he be treated?
Likely poststreptococcal glomerulonephritis
UA: hematuria and proteinuria
Antistreptolysin O titer (ASO): high
Electron microscopy (EM) of GBM: bumpy deposits* of IgG and C3
Self-limited…supportive if necessary (edema, HTN)
What is seen with EM of IgA nephropathy (Berger disease)? How should it be treated?
Mesangial cell proliferation
Occasionally self-limited
ACEI and statin for prolonged proteinuria
Corticosteroids if becomes nephrotic (proteinuria > 3.5g/day)
REVIEW: How is Goodpasture syndrome treated?
Plasmapheresis
Corticosteroids and immunosuppressive agents can help
Mom brings young infant in because of hematuria. Also says that the baby doesn’t react to whistling and other high-pitched sounds and the baby’s eyes are cloudy. What is a likely diagnosis? What would be seen on EM? What can be done?
This is likely Alport Syndrome (defect in collagen IV in basement membrane)
EM shows a split basement membrane*
ACEI helps w/ proteinuria
Transplant can be complicated by Alport induced Goodpastures
What causes the crescents with rapidly progressive glomerulonephritis (RPGN)? What is it called if ANCA+? How is it managed?
Basement membrane wrinkling with inflammatory cells and fibrous material in Bowman capsule
Pauci-Immune RPGN
Steroids, plasmapheresis, and immunosuppressive agents kinda help…but transplant is usually required
What happens with Lupus nephritis? How is it treated?
Proliferation of endothelial and mesangial cells
Corticosteroids
ACEI
Statin
REVIEW: Granulomatosis with polyangiitis (Wegener’s) has what lab elevation?
c-ANCA
SUMMARY: How are nephritic syndromes treated?
Corticosteroids
ACEI and Statins to reduce proteinuria
What is the most common nephrotic syndrome in kids? what is seen on EM? how is it treated?
Minimal Change Disease
Effacement of foot processes
Steroids
What is the most common nephrotic syndrome in adults? How is it treated?
Focal Segmental Glomerular Sclerosis (FSGS)
Steroids, cytotoxic agents, ACEI, statins
Rarely transplant…usually recurs anyway
What type of nephrotic syndrome presents with spike and dome BM thickening? What abnormal treatment is required?
Membranous globerulonephritis
Requires anticoagulation…renal vain thrombosis
A patient with either a systemic infection or autoimmune condition comes in for progressively frothy urine that may be getting a little darker. What is a concern? What would be seen on EM if that were the case?
Membanoproliferative glomerulonephritis
Train tracks
A patient comes in w/ hx of uncontrolled DM now having frothy urine. What is the pathology of the disease? What might be seen on EM? How is it managed?
Diabetic nephropathy (diffuse or nodular) results from basement membrane and mesangial thickening
BM thickening for sure Round nodules (Kimmelstiel-Wilson nodules) w/ nodular type
DM treatment
Dietary protein restriction
ACEI
What is the most common cause of acute renal failure?
Drugs –> ATN –> ARF
What is indicated by hematuria and red cell casts on UA?
Glomerular or vasculitic disease
What is indicated by epithelial casts?
ATN
What is indicated by pyuria with waxy casts?
Interstitial disease or obstruction
What is indicated by pyuria alone?
Infection
How is FENa calculated? what does it indicate?
FENa = (urine Na/serum Na)/(urine cr/serum cr)
Less than 1% –> prerenal
Greater than 2% –> ATN
How should ARF be managed?
Prevent fluid overload Stop drugs causing ATN Low protein diet Steroids Dialysis
