Renal 1 Flashcards
Sporadic renal cell carcinoma gene deletion
Deletion of VHL gene on chromosome 3p
Associated w/ von Hippel Lindau disease
Von Hippel-Lindau
AD
Deletion/mutation of VHL on 3p
- Cerebellar hemangioblastomas
- Clear cell renal carcinomas
- Pheochromocytomas
Location of lowest pH in the nephron
Distal tubules
Collecting ducts
Tumor lysis syndrome
- Occurs when tumors w/ high cell turnover are treated w/ chemo
- Lysed tumor cells release intracellular ions (K, PO4, uric acid) into serum
Complications associated w/ tumor lysis syndrome
Uric acid crystallization => obstructive uropathy & acute renal failure
Why??
Because uric acid has pKa of 5.4 and precipitates in low pHs
Prevention of tumor lysis syndrome
- Urine alkalinization
- Hydration
- High urine flow
- High pH
Prevents crystallization and precipitation of uric acid
Indwelling catheter UTI
(-) lactose, g(-) rod, (+) oxidase
Pseudomonas aeruginosa
Anti-glomerular basement membrane Abs react w/ what?
Type IV collagen
Leads to RPGN, also pulm hemorrhage (hematuria and hemoptysis)
THINK CRESCENTS on LM
Post-strep GN leads to what on EM?
Subepithelial immune complex deposition!
Composed of IgG, IgM, and C3
THINK HUMPS
Which area of the nephron is ALWAYS impermeable to water? Regardless of vasopressin levels
Ascending loop of henle
Where Na/K/2Cl transport occurs
Cancers of people who smoked or with occupation exposure to rubber, plastics, aromatic amine-containing dyes, textiles, leather
Transitional cell carcinoma of the bladder
Which structure obstructs ascent of a horseshoe kidney?
Inferior mesenteric artery
Kidney is fused at the poles
Chronic transplant rejection cause
Chronic, low grade immune response refractory to immunosuppressants
Chronic transplant rejection morphology
- Vascular wall thickening & luminal narrowing
- Interstitial fibrosis & parenchyma atrophy
Presents w/ worsening HTN, progressive ^ serum Cr
Renal failure + pulm/upper resp sx…?
Think Wegener’s vasculitis
p-ANCA
Pauci-immune RPGN, ANCA, (-) Ig/complement deposition, crescent formation
Microscopic polyangiitis or Granulomatosis w/ polyangiitis (Wegener’s)
Left 12th rib overlies which internal organs
Medially:
Parietal pleura
Laterally:
Kidney
Antiphospholipid antibody syndrome
- Presence of APA
- Can be secondary to SLE (APA is not present in all pts w/ SLE)
- Elevated aPTT in coag studies
- Leads to venous/arterial thromboembolism => recurrent pregnancy loss
- False (+) for RPR/VDRL
What is the filtration fraction?
- Portion of renal plasma flow filtered from the glomerular caps
- GFR:RPF ratio
Acute ureteral constriction or obstruction does what to the GFR and FF?
Both are decreased
Once you determine a pt has a metabolic alkalosis, what should you look at next?
Urine Chloride
Metabolic alkalose w/ low urine Cl is due to…?
- Vomiting/nasogastric aspiration
- Prior diuretic use
Saline responsive
Metabolic alkalosis w/ high urine Cl and hypo/euvolemia
- Current diuretic use (saline responsive)
- Bartter & Gitelman syndrome (non-saline)
Metabolic alkalosis w/ high urine Cl and hypervolemia?
Excess mineralocorticoid activity
- 1ar hyperaldosteronism
- Cushing
- Ectopic ACTH production
Non-saline responsive
Ureter relation to ovarian/gonadal vessels?
Posterior
Before true pelvis
Ureter relation to common/external iliac a.
Anterior
Before true pelvis
Ureter relation to internal iliac
Anterior
w/in true pelvis
Ureter relation to ovarian vessels
Medial
w/in true pelvis
GO REVIEW RESORPTION/EXCRETION ON A NEPHRON
NOW
Where is most of K filtered by glomeruli resorbed back into serum?
Proximal tubule
LOH
Frequent UTIs and pyelonephritis?
Think Vesicoureteral reflux
Pyelo wouldn’t occur w/o this
How do you determine RPF from RBF?
RPF = RBF * (1-Hct)
A good rule of thumb for comparing GFR and serum Cr?
Everytime GFR halves => Cr doubles
Where is angiotensin I converted into angiotensin II?
Pulm vasculature
Function of Angiotensin II?
Potent vasoconstrictor
- in systemic circulation => ^ BP
- in efferent arterioles => maintains GFR
Also - stimulates adrenal gland => release of aldosterone => Na retention => ^ afterload
Foscarnet
- Pyrophosphate analog
- Used for ganciclovir-resistant CMV
- Chelates calcium => hypomagnesemia & v PTH release => hypocalcemia
Seizures!
Most common cause of unilateral fetal hydronephrosis
Uteropelvic junction (connection site between kidney and ureter) - Due to inadequate canalization
Detected in 2nd trimester
Significant renal hypoperfusion causes what?
Activation of RAAS system
Chronic hypoperfusion => hypertrophy & hyperplasia of afferent arteriole
What is located in the afferent arteriole in the kidney?
Modified SM cells (juxtaglomerular cells) => synthesize renin
Loop diuretics do what?
- Blocks Na/Cl transport => ^ed Na, Cl, and fluid excretion
- Stimulates prostaglandin release => vasodilatory effects => ^ RBF => ^ GFR and drug delivery
NSAIDs fuck up that shit b/c of decreased prostaglandins
Bethanechol
Muscarinic agonist
How does anesthesia affect urinary system?
Post-op urinary retention
- Incomplete bladder emptying
- decreased micturition reflex
- Decreased contractility of bladder detrusos
- +/- increased vesical sphincter tone
Aldosterone excess leads to what?
- HTN
- Hypokalemia
- Metabolic alkalosis
- Depressed renin
Conn syndrome
