Pp Clues Renal Flashcards
Which part of the nephron concentrates urine?
Medulla
What is the course of the ureter?
The ureter passes under the uterine artery, and under the deferens.
What is the 60/40/20 rule?
60% total body water
40% ICF
20% ECF
What is Goldblatt’s kidney?
HTN:Flea-bitten kidney (blown capillaries)
What is Uremia?
Azotemia + symptoms
What is Azotemia?
↑BUN/Cr
What is Nephritic kidney disease?
↑Size of fenestrations => vasculitis
What is Nephrotic kidney disease?
Lost BM charge due to deposition on heparin sulfate => massive proteinuria and lipiduria
What is seen in RPGN (Rapidly Progressive Glomerulonephritis)?
Crescents
What is Post-Strep GN?
MCC in children
Subepithelial, IgG/C3/C4 deposition, ASO Ab
impetigo/pharyngitis
What is Interstitial Nephritis findings ?
focal segmental necrotizing GN
Urine eosinophils or eosinophilic casts
asthma/ panca/
What is Lupus Nephritis?
Subepithelial
diffuse proliferative GN
decrease complement
What is MGN?
(Membranoglomerulonephrits)
Deposition of “something”
What is MPGN findings (Membranoproliferative Glomerulonephritis)?
Tram-tracks (type II has low C3)
What is MCD (Minimal Change Disease)?
Kids, fused foot processes, no renal failure, loss of charge barrier
which conditions shows FSGS (Focal Segmental Glomerulosclerosis)?
AA, HIV pts, HTN, Diabetes
What are the vasculitis w/ low C3?
“PMS in Salt Lake City”*
Post-strep GN
MPGN Type II
SBE
Serum sickness
Lupus
Cryoglobulinemia
What is the most common cause of kidney stones?
Dehydration
What are the most common
type of kidney stones?
Calcium phosphate
What type of kidney stones have coffin- lid crystals?
Triple phosphate
What type of kidney stones have rosette crystals?
Uric acid
What type of kidney stones
have hexagonal crystals?
Cystine
COLA
Enveloped-shaped stones or dumbbell-shaped crystals?
Oxalate
What disease has Aniridia?
Absent partial or complete of iris
Wilm’s tumor
What disease has Iridocyclitis?
Juvenile rheumatoid arthritis
What is Phimosis?
Foreskin scarred at penis head
(foreskin stuck smooshed up)
What is Paraphimosis?
Foreskin scarred at penis base (retraction of foreskin => strangulates penis)
What is Urge incontinence?
Urgency leads to complete voiding (detrustorspasticity → small bladder vol)
What is Stress incontinence?
Weak pelvic floor muscles (estrogen effect)
What is Overflow incontinence?
Runs down leg but can’t complete
empty of bladder
spastic/tight sphinter
What structures have one-way valves?
Urethra, ejaculatory duct
What structures have fake sphincters?
Ureters, LES, Ileocecal valve
What has WBC casts?
Nephritis
What has WBC casts only?
Pyelonephritis (sepsis)
What has WBC casts + eosinophils?
Interstitial nephritis (allergies)
What has WBC casts + RBC casts?
Glomerulonephritis
What has Fat casts?
Nephrotic syndrome
What has Waxy casts?
Chronic renal failure
What has Tubular casts?
ATN
What has Muddy brown casts?
ATN
What has Hyaline casts?
Normal sloughing
What has Epithelial casts?
Normal sloughing
What has Crescents?
RPGN
How do you measure afferent
renal function?
Creatinine (or inulin)
How do you measure efferent
renal function?
BUN (or PAH)
What is the afferent arteriole’s job?
Filter
What happens if you constrict the afferent arteriole?
RPF goes down
GFR goes down
FF (GFR/RPF) stays unchanged
What is the efferent arteriole’s job?
Secrete
What happens if you constrict the efferent arteriole?
RPF goes down
GFR goes up
FF (GFR/RPF) goes up
How do you test afferent arteriole function?
GFR
What is normal GFR?
100 mL/min
How do you test efferent arteriole function?
RPF
What happens if you increase plasma protein concentration?
RPF stays unchanged
GFR goes down
FF (GFR/RPF) goes down
What is pre-renal failure?
Low flow to kidney (BUN:Cr >20)
What is renal failure?
Damage glomerulus (BUN:Cr <20)
What is post-renal failure?
Obstruction (haven’t peed in last 4 days)
What is the job of the proximal tubule?
Reabsorb glucose, amino acids, salt, and bicarb
What is the job of the thin ascending limb?
Reabsorbs water
What is the job of the thick ascending limb?
Make the concentration gradient by reabsorbing Na, K, Cl, Mg, Ca without water
What is the job of the early distal tubule?
reabsorbing NaCl (hypotonic)
What is the job of the late distal tubule and collecting duct?
Final concentration of urine by reabsorbing water, excretion of acid
What does the macula densa do?
Measures osmolarity
What does the J-G apparatus do?
Measures volume
What is Fanconi’s syndrome?
Old tetracycline use => urine phosphates, glucose, amino acids
severe electrolite inbalance
What is Bartter’s syndrome?
Baby w/ defective triple transporter (low Na, Cl, K w/ normal BP)
What is Psychogenic polydipsia?
No concentrating ability →cerebral edema
What is Hepatorenal syndrome?
High urea from liver →increase activity of glutaminase→NH4+→GABA→ kidney stops working
What is Type 1 RTA?
Distal renal tubular acidosis: H/K in CD is broken→high urine pH (UTI, stones, Li)
What is Type 2 RTA?
Proximal RTA: bad CA →lost all bicarb → low urine pH (multiple myeloma)
What is Type 3 RTA?
RTA I + II → normal urine pH (5-6)
What is Type 4 RTA?
Infarct J-G → no renin → no Aldo → high K (DM,NSAIDS, ACE-I, Heparin)
What is Central Pontine Myelinolysis?
Due to correcting Na faster than 0.5mEq/hr
Urachal cyst
Urine drains from umbilicus
Exstrophy of bladder risk
Bladder cancer persists
To pee
M3 agonist. Bethanecol
B2 Antig: non selective B blocker
A1 antagonist:zozin
Not to pee
M3 antagonist :oxybutyine
B2 agonist albutorol, terbutaline
A1 agonist Ephedrine
B3 agonist: mirabegran
Urge incontinence
drug
Oxybutyine
Mirabegram
WBC cast
RBC cast
Eosinophil cast
Fatty cast
Waxy cast
Hyaline cast
Metanephros give rise to
adult kidney
2 barriers that prevent protein from leaking out vessel
heparin sulphate
small fenestrations
Proteinuria with nephrotic syndrome
basement membrane loss neg charge
protein leaks out freely
All protein low
mcc of nephrotic syndrom in children
minimal change dz
mcc nephritic syndrome in adult
HTN and DM
MCC of nephritic syn in children
Berger’s
PSGN
Nephrotic syn in adult
FSGN
membranous nephropathy
Ig-A nephropathies
Berger’s
HSP
Alport’s
mcc of membranous nephropathy
deposition in the membrane
amyloid
drugs
immune complex(MPGN)
Lipoid nephrosis: Minimal change disease mcc
2 weeks post URI
autoimmune: T cells and macrophages and fat deposition
effacement of foot
RTA 1
distal H/K defective: high urine PH
RTA II
Proximal CA
urine pH is very low 3-4 (distal HK)
Acidosis with hypokalemia, look at
RTA
RTA 3
combination of 1 and 2 so the pH is normal with acidic plasma
RTA 4 is associated with
diabetes: infarction of JG apparatus
low renin and Aldo
crescents in the kidney
RPGN
granulomatosis with polyangiitis(Wegener)
Goodpasture’s
use to treat ADH by sensitizing receptor
Thiazides
hypercalcemia