intro to nephro

Question 1

Glomerulus

Answer 1

tuft of capillaries interposed between the afferent and efferent arterioles-housed in an epithelial cell capsule: bowmans capsule.

Question 2

filtrate must pass through 3 layers

Answer 2

fenestrated endothelial cell, glomerular basement membrane, epithelial cell

Question 3

JGA

Answer 3

contains macula densa and JG cells located in the afferent arteriole. JGA cells also synthesize and store prorenin which is cleaved into active renin and secreted into the afferent arteriole in response to renal hypoperfusion

Question 4

tubuloglomerular feedback

Answer 4

mechanism of autoregulation. mediated by cells in the macula densa which sense the change in NaCl delivery. this helps to regulate GFR.

Question 5

functions of the kidney

Answer 5

regulate volume and composition
adjusting excretion of water and electrolytes
excretion of waste and metabolic breakdown products
hormonal regulation
EPO production
Vitamin D metabolism
renin angiotensin aldosterone axis
regulation of low BP or blood volume

Question 6

hormonal regulation-kidney function

Answer 6

metabolic degradation of peptide hormones such as pituitary hormones, glucagon, insulin

Question 7

renin-angiotensin-aldosterone axis

Answer 7

renin is produced in JGA cells from prorenin. It is secreted into the afferent arteriole in response to various stimuli which cause renal hypoperfusion such as low BP, and decreased effective circulating volume.

Question 8

Renin converts angiotensin 1->2 which causes:

Answer 8

systemic vasoconstriction (raising systemic BP)
Na and water re absorption in PT which helps to restore volume
Secretion of aldosterone

Question 9

upper urinary tract symptoms of renal disease

Answer 9

flank pain or tenderness: renal infection, infarction, GN, rarely obstruction

Question 10

Lower urinary tract infection symptoms

Answer 10

dysuria, frequency, urgency

Question 11

bladder outflow obstruction symptoms

Answer 11

impaired urinary flow, hesitancy, dribbling, incomplete emptying of bladder

Question 12

sphincter or bladder wall dysfunction symptoms

Answer 12

urinary retention, incontinence, enuresis

Question 13

increased urine pH think:

Answer 13

infection with urea splitting organism

systemic alkalosis, renal tubular acidosis, carbonic anhydrase inhibitors

Question 14

urinalysis finding of protein in urine

Answer 14

persistent indicates renal disease.

Question 15

BUN

Answer 15

increases seen with
*dietary intake (high protein)
*high catabolic rate and tissue breakdown (hemorrhage, trauma, glucocorticoid therapy)
*dehydration
normal to low
*muscle wasting and liver disease

Question 16

GFR estimation

Answer 16

24 hour creatinine clearance most common

also can use cockcroft-gault or MDRD formula

Question 17

cockcroft-gault equation

Answer 17

(140-age) X (body weight in kg)/72 X SCr (women multiply result of .85

Question 18

renal ultrasound is used for:

Answer 18

assess size, shape, and location of kidneys.

• masses
• obstruction/hydronephrosis
• fluid collections or other signs of inflammation/infection
• MAY detect nephrolithiasis

Question 19

indications for renal ultrasound

Answer 19

hematuria, acute kidney injury, flank pain, safe during pregnancy

Question 20

intravenous pyelogram

Answer 20

• contrast is administered via IV
• helpful in identifying obstruction and stones
• contrast CT has taken its place in most institutions
• risk of contrast induced nephropathy

Question 21

CT scan

Answer 21

• helpful in evaluation of stones, renal masses, complex cysts, perinephric and vascular pathology
• CI is pregnancy and no contrast with renal disease
• gold standard for nephrolithiasis and doesn’t require contrast

Question 22

renal MRI indications

Answer 22

hematuria, renal mass, suspected renal vascular issue

Question 23

MRI is better than CT for:

Answer 23

characterizing abnormal tissues/masses especially when there is concern for malignancy.

Question 24

cystoscopy indications

Answer 24

• frequent UTIs
• hematuria
• incontinence or overactive bladder
• painful urination, chronic pelvic pain, or interstitial cystitis
• nephrolithiasis that is obstructing and unlikely to pass
• mass, polyp, suspected malignancy

Question 25

voiding cystourethrogram (VCUG)

Answer 25

a radiologic study during which a radiologist observes contrast movement from the bladder and urethra.
-looking for signs of vesicoureteral reflux, extravasation of contrast or obstacle to bladder emptying.

Question 26

indications for VCUG

Answer 26

recurrent UTI, bladder trauma or rupture, suspected obstruction