Renal 1 Flashcards
nephritic presentation following rash/infection think ___
Dysmorphic __, __ casts in urine
slight elevation in __/__ ratio
immune complexes formed on the __ side of BM
T cells, monocytes, eosinophils may be presnt in acute ___ folowing antibiotics
PSGN
red cells, RBC
BUN/creatinine
epithelial side
AIN
patient w bilateral RAS tx w ___ can lead to acute renal failure
other cx include ___ HF, hypo__ and chronic __ disease
locally produced __ in AA counterract effects of AT2
ACEI
congestive, volemia, kidney
VD
pt w DKA has __ ABG
kidney responds by inc __ resorption via Carbonic anhydrase
forms H2CO3, broken down and __ diffuses across BM membrane back to circulation
inc __ secretion via acidosis
Na/H antiporter in __ nephron and H/K ATPase are is important in __ segments via __ cells
Inc __ excretion
most importantly, __ and __
this helps to __ acid released in urine
urine will show ___ pH, __ HCO3, and __ H`2PO4
MA
HCO3
HCO3
H
proximal
distal nephron
a intercalated
buffer
H2PO4, NH3
dec
dec, dec, inc
pt w recent blood transfusion develops fever, chills, hpoTN, dyspnea, Chest/back pain and hemoglobinuria has __ rxn
this is __ HS rxn, w/in min/hours
usually due to __ Incompat
caused by IgM anti __ antibodies in recipient binding to donor __
activation of __ C3a and C5a produces Vd and sx of __
activation of __ leads to complement mediated __
Type 1 HS rxn occurs against __ in blood
usually in __ def pt
acute hemolytic
3
ABO ABO, RBC analphylatoxins septic shock MAC, cell lysis
plasma proteins
IgA
bilateral, enlarged cystic fetal kidneys w oligohydramnios suggsts ___ dx
mutation in __ gene for fibrocystn
dilation of renal __ and _ ducts
can present w O bc amniotic fluid is composed of fetal __
may have flat face, ilmb deforms, and pulm hypoplasia aka __ sequence
later comps include H and H comps
pt needs D or T for rx
On US, see bilateral enlarged __ kidneys
ARPKD PKHD1 tubules, bile oligohydramnios urine potter
HTN, hepatic
dialysis, transplant
echogenic
proximal ureter receives blood from branches of the__ artery
distal ureter receives blood from __ artery
donor kidney is placed __
blood supply occurs w anastamoses of donor __ w recipient __ artery
distal portion is susceptible to __,, usually 5-10 days later
presents w urine __
renal
superior vesicular
retroperitoneal
renal artery, external iliac
ischemia
leakage
internal urethral sphincter under __ control
sympathetic __
PNS __
EUS is under __ ctrol by __ nerve
in filling, symp closes __ and inhibits detrusor __
PNS causes detrusor __ and IUS __
autonomic
contracts
relaxes
voluntary, pudendal
IUS, contraction
contraction, relaxation
urge incontince can be caused by infart to __ cortex and __ capsule
impaired detrustor contractility/BOO lead to __ incontinence
detrusor overactivity seen in __ incontinence
frontal, internal
overflow
urge
hypovolemia causes ___ RPF and __
leads to release of __ to constrict EA, causing a slight rise in __
hypovolemia results in __ of systemic vessels, esp __ arteries lowering the RPF
dec, GFR
AT2, GFR
VC, renal arteries
__ allograft rejection occurs gradually
see worsening __ and rise in __
damage mediated by low grade __/__ responses against alloantigens
over time, fibrous __ thickening occurs
renal ischemia/inflam then leads to ___ and interstital fibrosis
chronic
HTN, creatitine
cellular/humoral
intimal
tubular atrophy,
dense mononuclear infiltrate seen in __ rejection of transplant
usually less than __ m
pt has rise in __ and H__
__ type occurs w PMN and necrotizing vasculitizis
__ type occurs w lymphs/endothelitis
vasc fibrinoid necrosis and PMN infiltration seen in ___ graft rejection
occurs w/in ___
acute cellular
6
creatinine, HTN
humoral
cellualr
hyperacute
min
UTI caused by __ flora and are usually gram neg __
woman have short __ which facilitates UTI
bladder __ usually does not allow bacterial attachment
urine is __ due to high urea/osmolarity
urine __ washes bacteria out
vesicoureteral __ predisposes to pyelonephritis
suppression of endogenous flora/high freq of sex inc risk of ____
fecal, rod
urethra
mucosa
bacteriocidal
flow
reflux
UTI
__ stones occur w low urine __ or ___ and high __ conc
such as G, high cell __ or chronic ___
Met acidosis leads to inc excretion of __ ions, lowering urine pH
w dehydration, fluid is __ leading to formation of uric acid stones
Uric acid, pH, volume, UA
gout, turnover, diarrhea
H
concentrated
SCC, renal/bladder/breast/ovarian all cause HHM due to inc __
PTH is __, PTHrp us ___
breast/MM lead to O__ and hypercalcemia
PTH/PTHrp/VD is ___
Lymphoma can upregulate __ leading to hyperCa
PTH will be __ and VD will be __
PTHrp
low, high
osteolysis
low
125OHVD
low, high
__ is used to tx cerebral edema/inc ICP
inc plasma/tubular fluid __, so water moves from interstitium into __
primarily works on __ and __ in kidney
SE include HA/N/V, volume __ and ___ edema, met __ and hyper__
avoid in pt w __ or preexisting ___
Mannitol
osmolarity
vasc space
PT, LoH
depletion, pulm, Kalemi
CHF, pulm edema
gram positive cocci in pairs/chains that have gamma hemolysis is __
common cause of __
__ positivity, can grow in __/__
found in normal __
__ can decompose H2O2
thus, present in __
pigment is __
oxidase positivity is the possesion of __ oxidase
seen in P
enterococcus
UTI
PYR, bile/NaCl
intestinal flora
Catalse
Staph aureus
golden brown
cytochrome
pseudomonas
alpha hemolytic strep that is optochin resistant/bile insoluble
alpha hemolytic strep optochin/bile sensitive __
beta hemolytic strep PYR pos and Bactitracin sensitive
Beta hemolytic strep that os PYR neg
strep viridians
strep pneumo
strep pyo
strep agalactiae
aldosteone inc number of BL ___ pumps and apical __ channels in principal cells of collecting duct
inc __/__ sec
- is sparing diuretic that blocks ENAC Na channels in DCT/Collecting duct to inc Na excretion
use muscarinic agonist __ for postoperative urinary retention
anesthesia/analgesia cause __ of bladder, dec __ reflex, dec __ of detrusor, and incomplete ___
P__ is a1 agonist that promotes urine retention
O__ is antimuscarinic used for urge incont
Na/K atpase, Na
H/K
Triamterine/amiloride
Bethanechol
distension, micturation, contractility, emptying
phenylephrne
oxybutinin
__ is DNA Dependent RNA polymerase for the production of RNA primers to allow replication
DNA poly 1 has 5-3 __ activity
replaces __ w DNA
DNA poly 1/3 has 3-5 activity for __
primase
exonuclease
primers
proofreading
__ used for nephrolithiasis
inhibits __ to dec intracellular Na
thus, Ca is ___
__ induced by thiazides inc Na/H2O reabsorption in PT w __ reabsorption
__ inc risk of Ca stone formatin as Ca Phos released from bone
Ca reabsorption in loop of henle is __/__ cellular
Paracellular transport depnds on __ transport, inhib by LD
Thiazides, Na/Cl
reabsorbed
Hypovolemia, Ca
Acetazolamide
para/trans
NaK2Cl
nodular glomerulosclerosis has __ in mesangium
stain __ on HE stain, and + for __
usually due to __
pt will have GBM __ and mesangial matrix __
leads to __ syndrome w __ urine
__ has hypercellular glomeruli thickening/splitting of GBM
__ IC deposition
__ glomerulonephritis occurs w solid tumor
capillary wall thickening and __ on stain
diffuse wire loops seen in __ w lupus
KW nodules eosinophilic, PAS DM thickening, deposition nephrotic, bland
membranoproliferative
subendothelial
membranous
spikes
Diffuse PGN
_ nephropathy presents w slight inc creatinine, proteinuria, tubular dysfxn, hematuria
NSAIDS concentrate in renal __, damaging oxidative __
resuts in chronic __ w inflamm/fibrosis/atrophy
eventually, get __ w chronic inflammation
overtime, can lead to __ necrosis
analgesic
medlla, phosphorylation
IN
calcification
ischemic
lack of urine output in utero leads to __ sequence
usually due to renal __
cause of death is __
serum creatinine has nonlinear, neg relationship w __
creatitine can be normal until GFR is less than __
if GFR halves, ceatinine __
potter
agensis
pulm hypoplasia
GFR
60
doubles
net renal excretion rate for substance is __ rate minus total __ rate
TFR is equal to __ multiplied by __ of substance a
GFR is approximated by __
Net excretion rate eq
(Inulin clearance x __ of subs A) - Tubular __ of subs a
total filtration, reabsorption
GFR, plasma conc
inulin
plasma conc, reabsorption
tx patient w acute decomp heart failure w __ diuretic
inhibit __ transporter on TAL of LoH
dec medullar __ gradient
CA inhibs block NaCl and NaHCO3 __ in PCT
used for G/acute __ sickness
mannitol inhibits__/__ reabsoprtion in PCT and DL
loop
NaK2Cl
conc
reabsorption
glaucoma, mountain
Na, water
Vasopressin inhibits free water __
acts on __ receptor for VC/prostaglandins
__ receptor for ADH
___ interstitium has highest osmolarity of kidney
this drives __ reabsorption
ADH inc number of passive __ transporters in inner medullary collecting duct
urea allows for __ absorption in medullary collecting duct and formation of conc urine
excretion
V1
V2
medullary
water
urea
water
diffusion across semipermeable membrane is proportional to __ difference, __ of membrane, and __ of substance
inversely proportional to mebrane __ and __ of molecule
conc, SA, solubiiluty
thickness, MW
Lithium toxicity sx
acute: N/V/D, __ sequelae
later, A/T/F
tx w __
interracts w __ diuretics, N, ___ inhibs, T/M
neuro
ataxia, tremor, fasciculation
dialysis
thiazide, NSAIDs, ACE, tetracycline, metro
cANCA is found in __ dx
found in ___
autoantibody directed against __ enzymes of human PMN/monocytes
GPA is type __ pauci immunemediated RPGN
majority of Ca stones caused by _calciuria and __ calcemia
__uricosuria inc risk of Ca nephrolithiasis
hyperoxaluria (foods like choc/nuts/spinach) inc risk for ___
hypo__uria inc risk of Ca stones
GPA
cytoplasm
lysosomal
3
hyper, normo
hyper
Ca stones
citraturia
HUS occurs w \_\_ producing orgs injure \_\_ of arterioles/capillares leads to formation of \_\_ and MHA platelet consumption leads to \_\_\_ triad of \_\_, \_\_, \_\_ pt has no \_\_
DIC pt has bleeding and __
shiga toxin endothelium schistosytes thrombocytopenia MHA, thrombocytopenia, AKI bleeding
bruising
MM
fatigeud due to __
constipation due to __
elevated serum __
__ failure
__ nephropthy due to excretion of light chains aka __ protein
filtered, reabsorbed, and precipitate w __ proteins
leads to tubule __ and __ injury
may have large __ casts on microscopy
anemia HperCa protein renal Myeloma cast bence jones tam horstfall
obs, epithelial
eosinophilic
goss painless hematuria in older adult is always __ cancer
biopsy w rounded/polygonal cells and abundant clear cytoplasm is ___
originates from __ epithelial cells
high amount of __/__ which are washed away by stains, leaving __ spaces
urinary tract
RCC
proximal tubule
glycogen/lipids
clear
water deprivation stimulates release of __ from PP gland
stimulates __ of principal cells to release cAMP
__ inserts into apical membrane
in proximal tubule, water/electrolytes reabsorbed, so fluid is __ w plasma
in DL of LoH, water is reabsorbed, so tubular fluid is __
__ is reabsorbed in thin/thick LoH, so tubular fluid becomes __
primary region of urine __ via NaCl reabsorption
DCT is imperm to __, so elevtrolytes reabsorbed and fluid is __
in collecting duct, water is __ reabsorbed, forming hyper__ fluid
ADH
principal cells
Aquaporin 2
isotonic
hypertonic
electrolytes, hypotonic
diluting
water, hypotonic
avidly, tonic
MCD caused by __ dysreg
responds well to __
overproduction of glomerular ___ factor, damaging __
loss of __ property of GBM leads to __ in urine
dec __ pressure results in fluid shift to interstitium
triggers __/__ release for Na/Water retention
pt responds to low albumin by inc __-__ prodxn
__ is dec in consequence
immune CS perm, podocytes anionic albumin
oncotic
ADH/aldosterone
Lipoprotein/albumin
LPL
metabolic problems have pH and HCO3 change in __ direction
in resp acidosis, HCO3 will __
in resp alkalosis, bicarb will __
tx for DKA is __/__
dec prodxn of ketone bodies causing __ in serum bicarb
insulin causes __ shift of K, thus pt needs replacement
saline normalizes serum __ and dec serum ___
same
inc
dec
insulin/saline
inc
intracellular
sodium
fever, ab pain, renal scarring in upper/lower poles of kidney is __ dx
ureter enters bladder at __ angle
if more perp, flaps cannot close leading to __ flow
condition known as __ reflux
pt at risk for chronic __
compound papillae always open, this __/__ poles more susceptible to scarring
overtime, can lead to __
__ is renal malformation w mutliple noncommuncating cysts in kidney w interveing dysplastic tissue
can present w severe __
recurrent pyelonephritis
oblique
retrograde
vesicoureteral
pyelonephritis
upper/lower
HTN
MCDK
renal insuff
VC of EA inc hydrostatic pressure of glomerular capillaries, __ GFR and __ RPF
overtime, this leads to flow mediated rise in __ pressure, this __ GFR
FF will be __
constriction of AA causes __ in both GFR/RPF
thus FF is __
inc, dec
oncotic, dec
inc
dec
same
CKD dec GFR, thus causing inc __
this reduces __ and inc levels of __ which both reduce calcitriol synth
overtime, as PTH inc, OC stimulate __
this leads to friable bones and __ fibrosa
pt will have __ pain and f
phosphate
Ca, FGF23
bone turnover
osteitis
bone, fractures
