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**Old DOOS > Kidney 1 > Flashcards

Kidney 1 Flashcards

1
Q

where is the upper pole of the kidney?

A

12th thoracic vertebra

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2
Q

where is the lower pole of the kidney?

A

3rd lumbar vertebra

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3
Q

how many vertebral bodies doe a kidney span?

A

3.5 vertebral bodies

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4
Q

renal blood flow gets how much of cardiac output?

A

20% of CO

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5
Q

what is the normal GFR

A

100-125 ml/min

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6
Q

if you have a problem with the renal artery what is compromised?

A

the entire kidney

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7
Q

what nephron as associated w/ maximal ability to concentrate urine?

A

juxtamedullary nephrons

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8
Q

what is the beginning of an individual nephron

A

glomerulus

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9
Q

what region of the glomerulus is nonvascular w/ some contractile components. Sensitive to injury by certain diseases

A

mesangial region

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10
Q

portion of distal convoluted tubule. forms basis for glomerular tubular feedback.

A

macula densa

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11
Q

cells that aren’t inside the glomerulus. Cells aren’t a part of the vascular epithelium

A

extraglomerular mesangial cells

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12
Q

part of epithelial cells that surround the vascular component

A

food processes (pedicles) of podocytes

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13
Q

what type cell is a podocyte?

A

epithelial cell

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14
Q

3 things to remember about the kidney

A

there are vascular components (dzs due to BVs coming into kidney)
dzs that primarily injury the glomerulus (not necessarily the tubules)
injuries primarily to tubules and interstitium (don’t affect glomerulus)

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15
Q

with damage to the glomerulus what will you see on dipstick?

A

proteinuria

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16
Q

with a problem w/ the tubules what would you expect to see?

A

fluid or electrolyte management

wasting of sodium, glucose, amino acids

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17
Q

60-80% of everything that is filtered by the glomerulus is reabsorbed where?

A

proximal tubule

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18
Q

all resabsorptive functions of any of the tubules (proximal, loop of henle, distal, collecting duct) requires what?

A

energy (primarily glucose)

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19
Q

where is bicarbonate reabsorbed?

A

proximal tubules

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20
Q

what else is reabsorbed in the proximal tubule?

A

Na
glucose
phosphorus

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21
Q

where is carbonic anhydrase found?

A

proximal tubules

diuretic affect this

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22
Q

section of nephron where concentration of medullary space happens.

A

loop of henle

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23
Q

what happens in the descending part of the loop of Henle

A

water goes out, fluid becomes concentrated (1200)

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24
Q

what happens in the ascending loop of henle?

A

transport NaCl out
hypertonic area
sensitive to ischemic loss

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25
Q

what happens in the thick part of the ascending loop of henle?

A

Na, K, and 2 Cl are transported out

back to normal osmole concentration of body

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26
Q

where do loop diuretic works?

A

thick part of ascending loop of Henle

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27
Q

what does ADH do in the thick ascending limb?

A

ADH acts to cause fluid reabsorption

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28
Q

where do thiazide diuretic swork?

A

distal convoluted tubule

block Na/K co-transport system

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29
Q

where do you form free water because Na is moved out of luminal cells but the membrane is impermeable to water.

A

distal convoluted tubule

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30
Q

where does aldosterone have a significant effect and causes Na reabsoprtion and K and hydrogen secretion

A

cortical collecting duct

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31
Q

where do the potassium sensitive diuretics act?

A

cortical collecting duct

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32
Q

area where final acidification occurs. Na/K exchange mechanism. fine tuning of acid/base balance occurs.

A

medullary collecting duct

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33
Q

where does the formation of Tamm-Horsfall protein occur? (forms matrix of casts of urine)

A

distal tubule

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34
Q

pressure that is a result of plasma protein in blood

A

oncotic pressure

35
Q

pressure determined by blood pressure

A

hydrostatic pressure

36
Q

what is glomerular filtration a function of

A

surface area
permeability
hydrostatic/ oncotic pressures

37
Q

what is creatinine production rate?

A

10-20 mg/kg/ 24 hours

38
Q

how do you figure out 24 hour creatinine production?

A

15 mg/kg/24 hours x weight in kgs

39
Q

an adequate 24 hour urine collection should have how much protein?

A

1 gram

40
Q

what’s the most creatinine will increase in 24 hours?

A

2 points

41
Q

what is the formulation for CC?

A

[(140-age) X LBW] / 72 X Scr (mg/dl)

42
Q

what is LBW for females?

A

45.5 + (2.3 x each inch from 60 inches)

43
Q

what is LBW for males?

A

50.0 + (2.3 x each inch from 60 inches)

44
Q

a serum creatinine of -1.0 corresponds to what GFR?

A

100

45
Q

a serum creatinine of -4.0 corresponds to what GFR?

A

25

46
Q

a serum creatinine of -8.0 corresponds to what GFR?

A

12.5

47
Q

when serum creatinine doubles, GFR decreases by what?

A

50%

48
Q

why can plasma creatinine increase?

A

increased release from muscles
decreased proximal tubular secretion
analytical interference (lab erros)

49
Q

what drugs cause decreased proximal tubular secretion

A

cimetidine
triamterene (diuretic)
trimethoprim

50
Q

what is the better determinate for renal failure

A

creatinine

51
Q

what is the normal BUN/ creatinine ratio

A

20:1

52
Q

what can cause an increased Bun to creatinine ratio

A 
effective volume depletion
GI bleed
early obstructive uropathy
catabolic states/ sepesis 
increased protein intake
steroids
tetracycline
53
Q

what can cause a decreased BUN/Cr ratio (<10:1)

A

Liver dz
low protein
rhabdomyolysis

54
Q

what is urine production <50-100 mL/ 24 hours

A

anuria

55
Q

what is urine production of 100-480 ml/24 hours

A

oliguria

56
Q

what is urine output of >3 L/ 24 hours

A

polyuria

57
Q

what is high output state?

A

0.5-1.0 Liters/hour

58
Q

labs to get with kidney disease

A

CBC
CMP
urinalysis
urine eosinophils

59
Q

best initial imaging in renal disease

A

US and doppler (renal blood flow)

60
Q

gives anatomical features and function (secretion of isotopes)

A

isotopic renogram

61
Q

what is the concern w/ gadolinium?

A

exacerbating renal failure

62
Q

what does negative urinary sediment means?

A

water like

63
Q

what does bland urinary sediment mean?

A

non-diagnostic

64
Q

what does an active urinary sediment mean?

A

diagnostically suggestive

65
Q

what does an angry urinary sediment mean?

A

diagnostic implications

66
Q

where do dysmorphic rbcs come from?

A

injured glomeruli

67
Q

how many WBCs per high powered field have some diagnostic significance

A

3-5 WBCs

68
Q

if you see a red blood cell cast what does that indicate?

A

glomerulonephritis

69
Q

what does a WBC cast indicate?

A

from kidney, they were in tubular fluid
pyelonephritis
tubular interstitial condition

70
Q

what does a fatty cast indicate?

A

major lipid disorders

nephrotic syndrome

71
Q

what will a polarized fatty cast look like?

A

looks like clovers

72
Q

what does a granular cast indicate?

A

concentrated urine and low flow state

73
Q

what crystals look like a coffin?

A

phosphate crystals

74
Q

what HIV drug can produce stones and cause obstructive neuropathy

A

indinavir

75
Q

most frequent cause of hematuria

A 
urinary tract infection
stones
exercise, trauma
endometriosis
sickle cell
polycystic kidney disease
cancers
BPH
intrinsic glomerular dz
76
Q

what is glomerular protineuria usually

A

albumin

77
Q

when does orthrostatic proteinuria go away

A

at night

but will be >2.0 grams during the day

78
Q

what can cause tubular proteinuria?

A

microglobulins
albumin
usually <1.5-2 grams a day

79
Q

whey do you look at the retinas?

A

window to microvasculature

80
Q

mild albunimuria is associated with what?

A

increased CV risk

81
Q

what can hyperfiltration due to only having one kidney lead to?

A

focal glomerular necrosis

proteinuria can get worse

82
Q

do you see dysmorphic RBCs with diabetic disease?

A

No usually of a vascular origin not an inflammatory origin

83
Q

what can statins cause?

A

heme positivity on a UA

statins can lead to rhabdomyolysis

84
Q

if you see a 3+ blood on urine but not RBC casts what is the cause?

A

breakdown of myoglobin

**Old DOOS (11 decks)

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