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Nephrology Flashcards

1
Q

From which embryonic structure does the kidney originate?

A

Urogenital ridge of the intermediate mesoderm

This is the primary source for kidney development during embryogenesis.

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2
Q

What develops at the end of week 3 of kidney embryology?

A

Pronephros

The pronephros is the first stage of kidney development and degenerates by the end of week 4.

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3
Q

What happens to the pronephros by the end of week 4?

A

Degenerates completely

The pronephros and its adjacent duct disappear during this period.

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4
Q

Which structure develops caudal to the pronephros during the 4th week?

A

Mesonephros

The mesonephros is the second stage of kidney development.

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5
Q

What does the mesonephros form in the male reproductive system?

A

Mesonephric (Wolffian) duct

This structure is crucial for male reproductive development.

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6
Q

When does the metanephros develop?

A

5th week

The metanephros is the definitive kidney that forms later in embryonic development.

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7
Q

What are the two main sources for the development of the metanephros?

A

Metanephric blastema and ureteric bud

These structures are essential for forming the definitive kidney.

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8
Q

What components make up the excretory system of the kidney?

A

Metanephric blastema - nephrons

Nephrons include glomeruli, Bowman’s capsule, PCT, loop of Henle, and DCT.

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9
Q

What components make up the collecting system of the kidney?

A

Ureteric bud - collecting ducts, calyces, renal pelvis, ureters

These structures are responsible for urine collection and drainage.

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10
Q

How do the kidneys migrate during development?

A

Ascend from the pelvis into the retroperitoneum

This migration is crucial for proper positioning and function of the kidneys.

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11
Q

From which artery do the kidneys gain their blood supply during development?

A

Abdominal aorta

This connection forms the renal arteries that supply the kidneys with blood.

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12
Q

What is the basic structural and functional unit of the kidney?

A

Nephron

There are approximately 1 million nephrons per kidney.

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13
Q

What are the two main components of a nephron?

A

Glomerulus and attached renal tubule

These components work together to filter blood and form urine.

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14
Q

In what order does blood flow through the nephron?

A

Afferent arteriole - glomerular capillaries - efferent arteriole - vasa recta - renal venules

This sequence describes the path of blood through the nephron.

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15
Q

What is the primary function of the kidneys related to protein metabolism?

A

Excretion of nitrogenous products of protein metabolism (urea, Cr)

Cr refers to creatinine, a waste product formed from muscle metabolism.

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16
Q

Which organic substances do the kidneys excrete?

A

Organic acids (urate) and organic bases (ion)

These substances include waste products from metabolic processes.

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17
Q

What types of drugs do the kidneys help break down and excrete?

A

Antibiotics and diuretics

This includes various medications that need to be cleared from the body.

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18
Q

What hormone synthesis occurs in the kidneys?

A

Erythropoietin production (cortex)

Erythropoietin is crucial for red blood cell production.

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19
Q

What role do the kidneys play in vitamin D metabolism?

A

Activation of vitamin D

Vitamin D is converted to its active form, 1,25 (OH)2 Vitamin D, in the kidneys.

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20
Q

What is the function of the glomerulus?

A

Site where blood constituents are filtered through to the kidney tubules for excretion or reabsorption

The glomerulus is essential for initiating urine formation.

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21
Q

What is the filtration barrier in the kidneys composed of?

A

Endothelium, GBM, podocytes

GBM refers to the glomerular basement membrane.

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22
Q

How does the filtration barrier prevent albumin from passing through?

A

Due to its size and negative charge, which is repelled by the negatively-charged GBM

This mechanism helps maintain protein levels in the blood.

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23
Q

What are the structural functions of the cells in the glomerulus?

A

Support glomerular capillaries; can alter GFR through contractile mechanisms

GFR refers to the glomerular filtration rate.

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24
Q

What secretory functions do glomerular cells have?

A

Matrix components, pro- and anti-inflammatory cytokines

These secretions help regulate the filtration process.

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25
What is the role of the visceral epithelium in the glomerulus?
Helps form the plasma filtration apparatus; contains a podocyte progenitor population ## Footnote Podocytes are specialized cells that play a key role in filtration.
26
Fill in the blank: The kidneys control ______ concentration.
Potassium ## Footnote Maintaining potassium levels is crucial for heart and muscle function.
27
True or False: The kidneys are involved in glucose homeostasis.
True ## Footnote The kidneys help maintain glucose supply during prolonged fasting.
28
What is the function of gluconeogenesis in the kidneys?
Production of glucose from lactate, pyruvate, and other precursors ## Footnote This process is vital during times of low glucose availability.
29
What do the kidneys alter to maintain acid-base balance?
Acid-base balance ## Footnote This involves regulating the excretion of hydrogen ions and bicarbonate.
30
What substances do the kidneys help regulate in terms of homeostasis?
Ca2+, Mg2+, PO43- ## Footnote These ions are essential for various physiological processes.
31
What does GFR stand for?
Glomerular Filtration Rate ## Footnote GFR is a measure of the rate of fluid transfer between glomerular capillaries and Bowman's space.
32
What is the average GFR in adults?
180 L/d or 125 mL/min/1.73 m² ## Footnote 99% of the filtrate is reabsorbed.
33
What is the normal urine output in adults?
0.5-2.0 m kg/h ## Footnote Urine output can vary based on several factors.
34
At what age does GFR typically start to decrease?
Around age 40 ## Footnote GFR is highest in early adulthood.
35
What is renal autoregulation?
The process that maintains constant GFR over mean arterial pressures of 70-180 mmHg ## Footnote It involves two mechanisms: myogenic mechanism and tubuloglomerular feedback.
36
What is the myogenic mechanism?
Release of vasoactive factors in response to changes in perfusion pressure ## Footnote For example, low GFR leads to decreased perfusion pressure and release of prostaglandins.
37
What does tubuloglomerular feedback involve?
Changes in Na+ delivery to macula densa lead to changes in afferent arteriolar tone ## Footnote For example, high GFR increases Na+ delivery, leading to afferent constriction and decreased GFR.
38
What is the filtration fraction (FF)?
FF = GFR/RPF ## Footnote Normal FF is approximately 0.2 or 20%.
39
How does angiotensin II affect renal function?
Constricts renal efferent arterioles, increasing GFR ## Footnote This helps maintain GFR during low blood pressure situations.
40
What triggers renin release from the juxtaglomerular apparatus?
Low Na+ delivery to the macula densa ## Footnote This is an indicator of decreased RPF.
41
What is the role of renin in the RAAS pathway?
Converts angiotensinogen to angiotensin I ## Footnote Renin is an important enzyme in regulating blood pressure and fluid balance.
42
What factors stimulate renin release?
1. Renal artery hypotension 2. Sympathetic activation 3. Low Na+ delivery to macula densa ## Footnote These factors indicate a need for increased blood volume or pressure.
43
What are some effects of angiotensin II?
1. Increased total body water 2. Sodium retention 3. Increased vascular tone 4. Increased systemic blood volume and pressure ## Footnote Angiotensin II plays a crucial role in regulating blood pressure.
44
What is the gold standard for measuring GFR?
Inulin clearance and iothalamate radiotracer ## Footnote These methods are rarely used clinically.
45
How is GFR estimated clinically?
Using serum creatinine concentration ## Footnote Known as estimated GFR (eGFR).
46
What is the formula for estimating GFR using creatinine?
GFR = [Crlurine × urine flow rate] ## Footnote This formula relates creatinine concentration in urine and plasma.
47
True or False: Most renal functions decline in parallel with a decrease in GFR.
True ## Footnote This correlation highlights the importance of GFR in assessing renal function.
48
What is the normal range for urine pH?
4.5-7.0 ## Footnote Persistent alkalinity may indicate a UTI with urease-producing bacteria like Proteus.
49
What causes glycosuria?
* Hyperglycemia > 9-11.1 mmol/L * Increased UFR (e.g. pregnancy) * Proximal tubule dysfunction (e.g. Fanconi syndrome) * SGLT2 inhibitors (e.g. -flozin drugs) ## Footnote These inhibit glucose reabsorption from the filtrate.
50
What does a dipstick test primarily detect?
Albumin ## Footnote Other proteins like Bence-Jones, Ig, and Tamm-Horsfall may be missed.
51
What is microalbuminuria?
Morning ACR of 20 mg/mmol ## Footnote Greater levels indicate macroalbuminuria.
52
What is the gold standard for measuring total protein in urine?
24-hour timed urine collection ## Footnote Discard the first morning specimen.
53
What does the presence of leukocyte esterase indicate?
Infection or inflammation in the urinary tract ## Footnote Commonly associated with UTIs.
54
What converts endogenous nitrates to nitrites in urine?
Some bacteria, most commonly E. coli ## Footnote Nitrites have high specificity but low sensitivity for UTIs.
55
In which conditions are ketones positive in urine?
* Alcoholic ketoacidosis * Diabetic ketoacidosis * Prolonged starvation * Fasting ## Footnote Ketones indicate fat metabolism.
56
What does a positive hemoglobin test indicate?
* Hemoglobinuria (hemolysis) * Myoglobinuria (rhabdomyolysis) * True hematuria (RBCs seen on microscopy) ## Footnote Each condition implies different underlying issues.
57
What should be done with urine during a 24-hour urine collection?
* Discard first morning specimen * Collect all subsequent urine for 24 hours * Refrigerate between voids * Collect second morning specimen ## Footnote This ensures accurate measurement.
58
What does active sediment in urine microscopy suggest?
Parenchymal kidney disease ## Footnote Includes red cell casts and white cell casts.
59
What is hematuria defined as?
>2 RBCs per HPF ## Footnote Dysmorphic RBCs or casts suggest glomerular bleeding.
60
What defines pyuria?
>4 WBCs per HPF ## Footnote Indicates possible infection or inflammation.
61
What does persistent sterile pyuria indicate?
* Chronic urethritis * Prostatitis * Interstitial nephritis * Calculi * Allergic cystitis * Interstitial cystitis * Papillary necrosis * Renal tuberculosis * Viral infections * Neisseria gonorrhoeae * Chlamydia trachomatis infection ## Footnote These conditions may not show up in cultures.
62
How are eosinophils detected in urine?
Using Wright's or Hansel's stain ## Footnote This method is unaffected by urine pH.
63
What are fat bodies in urine indicative of?
Heavy proteinuria (e.g. nephrotic syndrome) ## Footnote They are renal tubular cells filled with lipid droplets.

Toronto notes (2 decks)

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