Key facts Flashcards
1
Q
What muscles does the kidney rest on?
A
Quadratus lumborum, psoas major
2
Q
What artery blocks the ascension of the kidneys in the “horseshoe kidney” deformity?
A
IMA
3
Q
What vertebral level do the kidneys start from and end?
A
Left - T11 - L2
Right - T12 - L3
4
Q
What do the ureters pass on the way down to the bladder? (2 things)
A
Common iliac bifurcation AND
Men: Vas deferens
Women: Uterine artery
5
Q
What is the standard GFR? What is its units?
A
125ml/min
6
Q
Name 5 Kidney functions
A
- Control extracellular fluid concentrations/electrolyte balance
- Produce EPO/Renin
- Manage blood pH
- Metabolise Vitamin D
- Excrete waste products
7
Q
What are the components of the trigone?
A
- Internal ureteric sphincters
- Internal urethral meatus
8
Q
What is the bladder attached to the umbilicus via?
A
The Urachus
9
Q
What is the definition of Osmolality?
A
The number of molecules per kilogram of solvent
10
Q
What is the definition of Osmolarity?
A
The number of molecules per litre of fluid
11
Q
What is an Osmole?
A
A molecule which does not cross the membrane freely
12
Q
Where does secretion into the PCT come from?
A
Peri-tubular capillaries
13
Q
What is the apical side of the lumen?
A
The inside
14
Q
What is the basolateral side of the lumen?
A
The outside
15
Q
What transporter is most common within the kidney on the basolateral side?
A
NaK/ATPase
16
Q
What transporter is very useful in the PCT?
A
NaK/ATPase
17
Q
What type of cells does the PCT have?
A
Simple Cuboidal with Brush Border
18
Q
Name 3 things that are obligately reabsorbed in the PCT
A
- Glucose
- Amino acids
- H+
19
Q
Name 3 apical channels in the PCT
A
Na-H exchanger
Na-Glucose exchanger
Na-AA exchanger
20
Q
What is the dominant anion in the PCT by the end?
A
Cl-
21
Q
What channels are in the Loop of Henle?
A
NKCC2
ROMK
Na/KATPase
22
Q
How would you describe the fluid exiting the Loop of Henle?
A
Hypotonic
23
Q
What are the main channels in the DCT?
A
NCC (NaCl)
ENaC
24
Q
What are the main channels in the CD?
A
ENaC
25
Name 3 Pre-Renal causes of AKI
Cardiogenic shock, Hypovolaemic shock, Normovolaemic shock
26
Name 3 Intra-renal causes of AKI
Nephrotoxic drugs:
- NSAIDs (ACE if already bad)
- Rhabdomyelosis (myoglobin)
- Acute glomerulonephritis
27
Name 3 Post-renal causes of AKI
- Renal calculi
- Bladder cancer
- BPH
28
Name 4 causes of CKD
- Diabetes
- Hypertension
- Obesity
- Age
29
What does a urine dip test for? (7)
pH, nitrites, leucocytes, blood in urine, glucose, ketones, protein
30
What does the Kidney develop from embryologically?
Urogenital ridge of the intermediate mesoderm
31
What germ layer does the kidney develop from?
Intermediate mesoderm
32
Name the 3 stages of kidney development
- Pronephros
- Mesonephros - sprouts ureteric bud
- Metanephros
33
What does the kidney do after development?
Undergoes caudal-cranial shift - L4-T11
34
What separates the urogenital sinus from the hindgut?
The urorectal septum
35
What would a low amniotic fluid in a pregnant woman suggest?
Renal agenesis (bilateral)
36
What is Hypospadias?
Urethral fold fusion error - hole on underside of the penis
37
Name 3 imaging modalities used to check the kidney?
US guided biopsy
CT
IV angiogram
38
Name the sequential naming progression of the kidney blood supply to the nephron
- Segmental
- Interlobar
- Arcuate
- Interlobular
- Afferent
- Efferent
- Peri-tubular capillaries
39
Describe the 3 layers of the glomerular filter
- Endothelial layer with fenestrations
- Glomerular basement membrane
- Podocytes with pedicels
40
What charge is the glomerular basement membrane and what does this help with?
Negative - repels negatively charged proteins to prevent proteinuria
41
Name the two autoregulation responses within the kidneys
- Myogenic autoregulation
| - Tubular glomerular feedback
42
Describe the myogenic autoregulatory response
Afferent arteriole is vasodilated
43
Describe the tubular glomerular feedback response
Macula dense in the DCT, checks Na concentration
If reduced GFR: Renin and Prostaglandins released
If raised GFR: Increased Na+ -> ATP release -> Adenosine -> Afferent vasoconstriction
44
How much does GFR raised in pregnancy? What is the mechanism for this called?
150%
| Compensatory hypertrophy
45
Define "Clearance"
The amount of plasma cleared per unit time
46
What is the equation for the excretion rate?
Amount of substance in urine x urine flow rate
47
What is the equation for clearance?
Amount in urine x Urine flow rate / Total amount in plasma
48
Does Creatinine over or under estimate GFR?
Over, since there is slight secretion back into the tubule
49
What factors affect Creatinine in the body?
Age
Race
Muscle proportion
Protein intake
50
What is eGFR used for? AKI or CKD?
CKD
51
Why is isotonic saline used to increased BP?
Increases extracellular fluid volume, but same osmolarity as the intacellular compartment, so no change in osmolarity and so no movement of fluid into the ICF
52
Where are the low pressure baroreceptors?
Aortic and Pulmonary bodies
53
Where are the high pressure baroreceptors? What nerves do these pass impulses along?
Aortic arch and carotid body - communicate via CN 9 and 10
54
Describe pressure natriuresis
When BP increases, NaKATPase downregulated, so more Na passed out, so BP goes down
55
What AQP is inserted into the apical side of the tubules by ADH?
AQP 2
56
Name the drug that affects NKCC2 in the Loop of Henle
Furosemide
57
What is the name of the drug that affects NCC in DCT 1?
Thiazide
58
What is the name of the drugs that act on ENaC?
Amiloride - blocks the ENaC channels
| Spironolactone - downregulation of Aldosterone effect on NaKATPase
59
What other important anion is absorbed in DCT2 and by what channel? What is its expression controlled by?
NCX channel
Ca2+
Controlled by PTH and Vitamin D
60
Where does HCO3- excretion occur in the CD?
Intercalated cells (principal cells have the ENaC channels)
61
What is the normal osmolarity of blood?
275-295mmol/Kg
62
Describe the body's response to low BP (4)
- RAAS activation
- Sympathetic innervation increase to heart
- Prostaglandins released
- ADH released
63
Describe the effects of Angiotensin 2
Causes Aldosterone release
Causes vasoconstriction of arterioles to raise BP
Increases sympathetic activity
Stimulates ADH
64
Describe the effects of Aldosterone
- Upregulates NaKATPase in DCT
- Stimulates K+ secretion into DCT
- Upregulates NCC in DCT
- Upregulates ENaC
65
Name 3 ADH-related diseases and their pathophysiology
- Central diabetes insipidus - ADH too low, due to hypothalamus damage/ pituitary damage
- Nephrogenic diabetes insipidus - ADH insensitivity
- SIADH - too much ADH - leads to hyponatraemia
66
What does SIADH lead to?
Hyponatraemia
67
How does the Vasa recta work with the counter current mechanism to generate a hyperosmotic interstitium?
Vasa Recta is very hypertonic - passes past the descending limb and absorbs water as it travels up
68
Explain the role of Urea in the counter current exchange system
Urea is usually an ineffective osmole, but can pass through AQPs with water, increasing the osmolarity of the fluid
69
List 4 causes of hyponatraemia
Diuretics
Diarrhoea/Vomiting
SIADH
Heart failure - body tries to maintain volume by retaining fluid
70
What is a risk of giving hypotonic saline too quickly to fix Na balance?
Central Pontine Demyelination Syndrome
71
What happens to the NaKATPase during acidosis?
Downregulated - means K+ cannot exit, meaning hyperkalaemia even worse
72
Name 4 causes of Hyperkalaemia
```
AKI
Addison's disease - reduced Aldosterone, reduced secretion
Diabetic Ketoacidosis
Cell Lysis (injury)
```
73
What does Hyperkalaemia cause?
Heart block/arrhythmias - depolarises the heart tissue, leads to more inactive Na+ channels
Also causes paralytic ileus
74
What is the treatment for hyperkalaemia?
IV Calcium Gluconate
Insulin + Dextrose
Calcium Resonium
75
What does Hypokalaemia cause?
Arrhythmias - heart more excitable
| Paralytic ileus
76
How do NKCC2 channel blockers (Furosemide) cause Hypokalaemia?
ROMK is not inactivated, but NKCC2 is - K+ moved back into urine
77
How do NCC channel blockers (Thiazide) cause Hypokalaemia?
NCC block leads to more Na+ downstream, so Renin release and Prostaglandins, leading to aldosterone upregulation (and thus increased NaKATPase, so more Na out and more K+ being secreted/excreted)
78
How does congestive heart failure lead to Oedema?
Increased venous pressure + RAAS activation, which increases fluid retention
79
How does Cirrhosis lead to ascites?
Leads to:
- reduced albumin creation, so lower oncotic pressure, so less fluid re-enters the blood vessels
- portal hypertension
80
What controls storage?
Sympathetic
81
What levels of the spinal cord control Sympathetic urine storage?
T10-L2
82
What control voiding?
Parasympathetic
83
What levels of the spinal cord control Parasympathetic urine storage?
S2-4
84
What centre in the brain controls storage?
L-centre
85
What centre in the brain controls voiding?
M-centre supplied by para-central lobules
86
Describe the storage of urine
Stretch receptors
B3 of detrusor acted on to cause relaxation
A1 of IUS acted on to cause constriction
nAcH of EUS acted on by pudendal nerve to constriction
87
Describe the voiding of urine
Stretch receptors
M3 of destrusor acted on to cause contraction
Sympathetics inhibited by M centre
88
What is the boundary of the Cauda Equina?
L2-S5
89
Why does Cauda Equina lead to incontinence?
S2,3,4 inibited, no para, no voiding ability
Pudendal nerve also lost, so no EUS
Sympathetics still active though
Needs catheterisation
90
How does an Upper Motor neurone lesion lead to incontinence?
Parasympathetic neurones that are inhibitory will be destroyed
91
Describe the 3 types of urinary incontinence
Stress - involuntary leakage on exertion
Urge - leaking with sudden urgency
Overflow - overfull bladder
92
At what volume is urine felt?
150ml
93
At what volume is urine voided?
500ml
94
Give 4 causes of Urinary Incontinence
Pregnancy, BPH, Prolapse, Obesity
95
What is Glomerulosclerosis?
Destroyed glomerular capillaries
96
What is Glomerulonephritis?
Inflammation of the glomerulus
97
What is the difference between Primary and Secondary Glomerulonephritis?
```
Primary = Disease of the Kidney
Secondary = Systemic disease
```
98
What is Nephrotic syndrome?
Damage to the filter of the glomerulus - podocytes and glomerular basement membrane
- Proteinuria
- Hypoalbuminaemia
- Oedema
99
What is Nephritic syndrome?
Damage with inflammation
- Haematuria
- Hypertension
- GFR reduction
100
List 3 causes of Nephrotic syndrome
Minimal change, FSGS, Membranous
| Diabetes
101
List 3 causes of Nephritic syndrome
IgA nephropathy, Anti-GBM, ANCA vasculitis
102
List 3 treatments for Nephrotic syndrome
Diuretics (for oedema), salt and fluid restriction, steroids, ACE
103
List 3 treatments for Nephritic syndrome
ACE for hypertension, Diuretics if oedema, immunosuppressants
104
Describe the effects of diabetic nephropathy
- Hyperfiltration (osmotic diuresis)
- Thickening of the basement membrane
- Mesangial thickening
- Overt proteinuria develops eventually
Leads to ESRD
105
What is another name for a Lower UTI?
Cystitis
106
What is another name for an Upper UTI?
Pyelonephritis
107
Name 3 risk factors for UTIs
Women (shorter urethra), BPH, incontinence (neurological problems leading to incomplete voiding)
108
What does a fever imply in a UTI?
Upper Urinary tract infection
109
What are the drugs given for a Lower UTI? How long for complicated vs uncomplicated?
Nitrofurantoin
| Trimethoprim
110
What is the drug given for an Upper UTI (pyelonephritis)?
Co-amoxiclav
111
What is measured on a urine dipstick?
Nitrites
112
What is the infective organism in a nitrite negative dip?
Coagulase negative Staph
113
What are the symptoms of an AKI?
Oliguria, acidosis, oedema, fatigue, nausea and vomiting, ureamia
114
What is Acute Tubular Necrosis?
Develops from AKI if left for too long - PCT fucked
115
Name 1 intraluminal causes of Ureteric obstruction
Renal calculi,
116
Name 1 intramural causes of Ureteric obstruction
TCC
117
Name 3 extramural causes of Ureteric obstruction
Fibroid, bladder cancer, retroperitoneal fibrosis
118
What is Pyonephrosis?
Pus build up caused by infection, urological emergency, can get loss of function
119
What is Hydronephrosis?
Swelling of kidney due to urine build-up
120
What is a Renal angiogram used for?
Renal artery stenosis
121
What is a Diuretic urogram used for?
Obstructions
122
What is the treatment for a ureteric obstruction?
JJ Stent
123
What is removed in a radical nephrectomy?
Kidney, ureter, peri-renal fat
124
How is a TCC treated?
Trans-urethral resection of the bladder
125
What section of the prostate is affected in Prostate Cancer?
Peripheral
126
What section of the prostate is affected in BPH?
Transitional
127
Name a gene associated with prostate cancer
BRCA2
128
Name 2 reasons for an increased PSA value (prostate specific antigen)
Just had a DRE done
Infection
Age increase
129
How is prostate cancer diagnosed?
Ultrasound guided biopsy of the prostate
130
What are the cancers that metastasise?
```
British Transport Keeps People Late
Breast
Thyroid
Kidney
Prostate
Lung
```
131
What is the most common presenting complain for patients with Adult Polycystic Kidney Disease?
Hypertension
