nephrology and urology Flashcards
most active secretion happens in the
distal convulted tubel
most reabsorption occurs at the
proximal tubule
early proximal convulted tuble
tubular reabsoprtion
acetazolamide and mannitol are diuretics that work on this
loop of hnle
thin descending loop of henre- passively absorbs H20, but does not let sodium and solutes through
THICK ASCENDING limb of loop of henley
impereable to h20 but allows na, k , cl via na/k/2cl trasportor reabsortpi on of magnesium and calciumloop diuretics work on this!!! ---STRONGEST class of diuretics!!
s.e of loop diuretics
hypocalcemia, hypomag, hypokalemia!!
thiazides
more likely to cause hyponatremia
early distal convuluted tuble
tubular SECRETION MAIN JOB!!- dilutes the urine!!
parathyroid hormone acts on the distal tuble to increase calcium reabsorption!!
THIazides also work on this- causing hyponatremia.
distal collecting tubule
determines the final oslmoalarity of urine (via aldosterone and ADH)
potassium sparing diuretics
associated with hyperkalemia and metabolic acidosis
hyperaldosteronism
associated with hypokalemia
ADH
peremable to H20 only in the presense of ADHD
present of ADH—> concentrated urine
ADH absence::: dilute urine
increased adh: production of a concentrated urine during times of hypoveolemia, hyperosmolarity and RAAS activation
nephrotic syndrome
proteinuria, hypoalmbuinemia, hyperlipidemia and EDEMA
glomerular damage causes tubular protein loss into the urine, urine loss of albumin ases hypoalbumin—which causes hyperlipideamia as liver makes more protein!! including lipoprotein
minimal change disease (nephrotic)
80% of nephrotic syndrome in children
podcyte damage seen on electron microscope- loss/fusion/diffuse effacement of the foot process
loss of negative charge
PREdENISON
focal segemental glomerucslerosis(nephrotic)
HTN- african american- heroin abuse
membranous nephropathy (nephrotic)
thickened glomerular basement membrane!!- idiotpathic!- caucsian male
secondary causes (nephrotic)
mc diabetes - for adults
nephoritc syndrome
edema, peripheral, periorital edeam, worse in morning, scorotal edema, DVT!!!
more than 3.5 g/day of urine is nephrotic syndrome
proteinuria, oval fat bodies, maltese cross shaped, hypoalbuminemia, hyperlipidemia
tx: direetics for edema, ACEI or ARBS for proteinuria
acute glomerulonephitis
htn, mehamturia, rbc casts, dependent enemia, azotemia
iga nephropathy- mc cause of agn in adults worldwide- igA mesangial deopsoits
post infectious: MC AFTER GABHS!!!!!cola clored/dark urine!!
increased antistreptolysis tigers, low serum complement
rapidly progressive glomerulephritis: goodpastuerus disease: anti gbm antibodies, kidney failure and hemoptysis- antibodies to glomerular basement membrae of kidney and lung alveoli
corticosteroids and cyclophosphamide
vasculitis: microscopic polyangitis- vasciulitis of small renal vessel: +p-anca
wegner’s: +c-anca: granulomatosis with polyangitis- necrotizing vasculitis!!!
acute glomerulonephritis
hematuria, peripheral, periorbital edema, cola colored/dark urine, oliguria, RBC cast,
DO RENAL BIOPSY!!
loss of protein and RBC loss!!
acute kidney injury
increased serum creatinine or BUN
prerenal
reduced renal perfusion- hypovoleia, MC type of AKI!!!
leads to intrinsic ATN if not orrected
volume repletion is tx
post renal
obstruction