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PP Renal Flashcards

0
Q

What is Goldblatt’s kidney?

A

Flea-bitten kidney (blown capillaries)

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1
Q

Which part of the nephron concentrates urine?

A

Medulla

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2
Q

What is Uremia?

A

Azotemia + symptoms

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3
Q

What is Azotemia?

A

Increase BUN/Cr

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4
Q

What is nephritic kidney disease?

A

Increases size of fenestration => vasculitis
Inflammatory process
When involves glomeruli it leads to: hematuria and RBC cast in urin
A/ w : Azotemia ( BUN/Cr >15), oliguria, hypertension and proteinuria < 3.5

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5
Q

What is nephrotic kidney disease?

A

Lost BM charge due to deposition on heparin sulfate => massive proteinuria > 3.5 , Hyperlipidemia, fatty cast, edema.
A/w: Thromboembolism and increase risk of infection

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6
Q

What is seen in RPGN?

A

LM and EM- crescent-moon shape
Crescent consist of fibrin and plasma protein with glomerular parietal cells, monocytes and macrophages
Several disease processes may result in this pattern including:
- Goodpasture’s syndrome
- Granulomatosis with polyangitis ( Wegener’s)
- Microscopic polyangitis

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7
Q

What is Pot-Strep GN?

A 
LM- "lumpy bumpy" appearance 
EM- Subepithelial immune complex humps
IF- granular appearance due to IgG/IgM/C3/deposition along GBM
Most frecuen in children 
Resolve spontaneously
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8
Q

What is Interstitial Nephritis?

A

Urine eosinophils

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9
Q

What is Lupus Nephritis?

A

Subepithelial

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10
Q

What is Membranous Nephropathy?

A

LM- diffuse capillary and GBM thickening
EM- “spike and dome” appearance with Subepithelial deposits
IF - granular

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11
Q

What is MPGN?

A

Type I - subendothelia IC deposit with granular IF; “Tram-tracks” appearance. A/w HBV, HCV
Type II - intramembranous IC deposit; “dense deposit”. A/w C3 nephritic factor

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12
Q

What is MCD?

A 
LM- normal glomeruli
EM- foot process effacement
MC nephrotic syndrome in Children 
No renal failure 
Loss of charge barrier
Trigger by a recent infection or an immune stimulus
Respond to Corticosteroids
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13
Q

What is FSGS?

A

LM- segmental sclerosis and hyalinosis
EM- effacement of foot process
A/w: HIV infection
MCC of nephrotic syndrome in Adults

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14
Q

What are the vasculitis with low C3?

A 
"PMS in Salt Lake City"
Post-Strep GN
MPGN type II
SBE
Serum sickness
Lupus
Cryolgobulinemia
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15
Q

What’s is the most common cause of kidney stone?

A

Dehydration

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16
Q

What is the most common type of kidney stones?

A

Calcium oxalate

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17
Q

What type of kidney stone have coffin-lid crystals?

A

Triple phosphate

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18
Q

What type of kidney stone have rosette crystals?

A

Uric acid

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19
Q

What type of kidney stone have hexagonal crystals?

A

Cystine

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20
Q

What type of kidney stone have envelope or dumbbell-shaped crystals?

A

Oxalate

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21
Q

What disease has Aniridia?

A

Wilm’s tumor

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22
Q

What disease has Iridocyclitis?

A

Juvenile rheumatoid arthritis

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23
Q

What is phimosis?

A

Foreskin scarred at penis head ( foreskin stuck smooshed up)

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24
Q

What is Parphimosis?

A

Foreskin scarred at penis base ( retraction of foreskin => strangulated penis)

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25
Q

What is Urge incontinence?

A

Urgency leads to complete voiding ( detrusor spasticity -> small bladder vol)

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26
Q

What is Stress incontinence?

A

Weak pelvic floor muscles (estrogen effect)

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27
Q

What is the Overflow incontinence?

A

Runs down leg but can’t complete empty bladder

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28
Q

What structure have one way valves?

A

Urethra

Ejaculatory duct

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29
Q

What structures have fake sphincters?

A

Ureters
LES
Ileocecal valve

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30
Q

What has WBC casts?

A

Acute Pyelonephritis

Acute Interstitial Nephritis

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31
Q

What has WBC cast + eosinophils?

A

Interstitial nephritis (allergies)

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32
Q

What has WBC cast +RBC cast?

A

Glomerulonephritis

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33
Q

What has Fat cast?

A

Nephrotic syndrome

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34
Q

What has Waxy cast?

A

Chronic renal failure

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35
Q

What has Tubular cast?

A

ATN

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36
Q

What has Granular “Muddy brown” casts?

A

ATN

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37
Q

What has Hyaline casts?

A

Normal sloughing

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38
Q

What has Epithelial cast?

A

Normal sloughing

39
Q

What has Crescents?

A

RPGN

40
Q

How do you measure afferent renal function?

A

Creatinine (or insulin)

41
Q

How do you measure efferent renal function?

A

BUN ( or PAH)

42
Q

What is the afferent arteriole’s job?

A

Filter

43
Q

What is the efferent arteriole’s job?

A

Secrete

44
Q

How to you test the afferent arteriole function?

A

GFR ( inulin or creatinin)

45
Q

How to you test the efferent arteriole function?

A

RPF ( PAH)

46
Q

What is pre-renal failure?

A

Low flow to kidney (BUN:Cr >20)

47
Q

What is renal failure?

A

Damage glomerulus ( BUN:Cr <20)

48
Q

What is post-renal failure?

A

Obstruction (haven’t peed in last 4 days)

49
Q

What is the job of the proximal tumble?

A

Reabsorb: glucose, AA, salt and bicarb
Isotonic reabsorption
Secrets: H

50
Q

What is the job of the thin descending Loop of Henle?

A

Reabsorbs water

Concentrating segment

51
Q

What is the job of the thick ascending Loop of Henle?

A

Actively reabsorbing Na, K, Cl, Mg, Ca without water
Impermeable to water
Makes urine less concentrated
Na/K/Cl Symport is inhibit bay loops diuretics

52
Q

What is the job of the early distal tubule?

A

Actively reabsorbing NaCl
Makes urine hypotonic
PTH give the signal to reabsorb Ca and excrete Phosphate

53
Q

What is the job of the collecting duct?

A

Reabsorbs Na by excreting K and H ( regulated by Aldo)

54
Q

What does the macula densa do?

A

Measures osmolarity

Monitoring Na levels

55
Q

What does the J-G apparatus do?

A

Measures volume

56
Q

What is Fanconi’s syndrome?

A

Old tetracycline use => urine phosphate, glucose, aa

57
Q

What is Bartter’s syndrome?

A

Baby w/ defective triple transporter (low Na, Cl, K w/ normal BP)

58
Q

What is Psychogenic Polydipsia?

A

No concentration ability -> cerebral edema

59
Q

What is Hepatorenal syndrome?

A

High urea from liver -> increase glutaminase -> NH4-> GABA -> kidney stop working

60
Q

What is Type 1 RTA?

A

Defect in CT ability to excrete H
Urine pH> 5.5
A/w hypokalemia
Increase risk for Ca phosphate kidney stone

61
Q

What is Type 2 RTA?

A

Defect in PT HCO3 reabsorption
Urine pH < 5.5
A/w hypokalemia

62
Q

What is Type 3 RTA?

A

RTA I + II -> normal urine pH

63
Q

What is Type 4 RTA?

A

Hypoaldosteronismo or lack of CT respond to Aldo
Hyperkalemia
Decrease urine pH

64
Q

What is Central Pontine Myelinolysis?

A

Due to correcting Na faster than 0.5mEq/hr

65
Q

Whic are the principal structures of the kidney embryology?

A

Pronefrons
Mesonephrons
Metanephrons

66
Q

What is the pronephron?

A

Week 4, then degenerate

67
Q

What are the Mesonephrons?

A

Function as kidneys in 1st trimester
Gives rise to the male genitalia ( Wolfian duct)
Give rise to the Uereteric bud = collecting system

68
Q

What is Metanephrons?

A

Permanent kidney
Appear in the 5th week of gestation
Need to fuse with the Ureteric Bud to form the kidney

69
Q

Wha structure drive from de Metanephric Mesoderm?

A

Ascending / Descending Loop of Henle
Bowman’s Capsule
Glomerular tuft

70
Q

The Ureteric Bud gives rise to?

A

Collecting System

71
Q

What structures compose the Collecting system?

A

Ureters
Pelvis
Calyces
Collecting duct

72
Q

By which mechanism JG cells release Renin?

A

Beta adrenergic stimulation
Low Na in the DCT ( by macula densa)
Low pressure in the afferent arterioles of the Glomerulus

73
Q

Which are the components of the Glomerural Filtration Barrier?

A 
Capillary endothelium ( fenestrated) 
Fused basement membrane with heparin sulfate ( negative charge barrier)
Epithelial layer consisting of podocyte foot process
74
Q

Under what structures the Ureters pass?

A

Under Uterine Artery and under Ductus Deferens

75
Q

Renal clearance?

A

Volume of plasma per unit of time (vol / time)
Cx= UxV/Px
Cx > GFR = net tubular secretion
Cx < GFR = net tubular reabsorption

76
Q

Filtration Fraction?

A

GFR/ RPF

77
Q

Calculations of reabsorption and secretion rate?

A 
Filtered load = (GFR)(Px)
Excretion rate = (V)(Ux)
Net Excretion Rate = Filtered load - Tubular reabsorption of substance
Reabsorption = filtered - excreted
Secretion = excreted - filtered
78
Q

What is the max serum Glucose [ ] at which glucose can be absorbed by tubules?

A

350mg/dL

79
Q

What two types of cells compose the CD and the last segment of the DT?

A

Principals cells -> Na reabsorption, K secretion

Intercalated cells -> K reabsorption, H and HCO3 secretion

79
Q

What are the two type of intercalated cells?

A

H secreting cells -> Alfa or type A cells

HCO3 secreting cells -> beta or type B cells

80
Q

Which are the functions of Angiotensin II?

A

Vascular Smooth muscle - vasocontriction -> increase BP
Constrict efferent arteriole -> increase FF
Release of Aldo -> increase reabsorption of Na and Water
Release ADH -> increase water reabsorption
Increase PT Na/H activity -> reabsorption of Na, water and HCO3
Stimulate hypothalamus -> thirst

81
Q

What causes K to shift out of cells -> hyperkalemia?

A 
Low insulin
Beta blocker
Acidosis
Digoxin
Cell lysis
82
Q

What causes K to shift into cells -> hypokalemia?

A

Insulin
Beta agonist
Alkalosis
Cell proliferation

83
Q

Which are the MUDPILES?

A 
Methanol
Uremia
DKA
Propylene glycol
Iron or INH
Lactic acidosis
Ethylene glycol
Salicylate
84
Q

What has RBC cast?

A

Glomerulonephritis

85
Q

What has bacterial cast?

A

Pyelonephritis

86
Q

What has epithelia cast?

A

Renal tubular damage

87
Q

What has Fatty cast “oval fat bodies”?

A

Nephrotic syndrome

88
Q

White are the Nephrotic Syndrome ?

A
  1. FSGH
  2. Membranous Nephropathy
  3. MCD
  4. Amyloidosis
  5. Diabetic Glomerulonephropathy
89
Q

Which are the Nephritic Syndrome?

A
  1. Acute Poststreptococcal Glomerulonephritis
  2. RPGN
  3. Diffuse proliferative Glomerulonephritis
  4. Berger’s disease ( IgA Nephropathy)
  5. Alport’s syndrome
90
Q

What is Amyloidosis?

A

LM- Congo red stain show Apple-green birefringence under polarized light

91
Q

What is Diabetic Glomerulonephropathy ?

A

Nonenzymatic glycosylatio (NEG) of GBM -> increase permeability, thickening
NEG of efferent arteriole -> increase GFR-> mesangial expansion
LM - mesangial expansion

92
Q

What is Diffuse Proliferative Glomerulonephritis?

A

Due to SLE or MPGN
LM- “wire looping” of capillaries
EM- Subepithelial and sometimes intramembranous IgG based IC often with C3 deposition
IF- granular

93
Q

What is Berger’s disease ( IgA Nephropathy)?

A

Related to Henoch-Schönlein purpura
LM- mesangial proliferation
EM- mesangial IC deposits
IF- IgA-base IC deposit in mesangium

94
Q

What is Alport’s syndrome?

A

Mutation in type IV collagen -> spits BM
X-linked
Can’t see, can’t pee, can’t hear me

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