Renal Flashcards
Name 3 neoplasms associated with VHL gene mutations
hemangioblastomas
clear cell renal carcinoma
pheochromocytoma
Acidosis stimulates renal ammoniagenesis, a process by which renal tubular epithelial cells metabolize ____ to _____, generating ammonium that is excreted in the urine and bicarbonate that is absorbed in the blood
glutamine to glutamate
In poststreptococcal glomerulonephritis, what is deposited on the glomerular basement membrane
IgG, IgM, C3
describe the following for PSGN: immunofluroescence, electron microscopy, light microscopy
IF: granular
EM: immune deposits as discrete, electron-dense, subepithelial humps on GBM
LM: enlarged, diffusely hypercellular glomeruli (leukocyte infiltration and mesangial and endothelial cell proliferation)
What arises from the 3 embryonic nephric systems: pronephros, mesonephros, and metanephros
pronephros: completely regresses
mesonephros: wolffian ducts (males), regresses and becomes vestigial Gartner’s ducts (females)
metanephros: glomeruli, Bowmans space, proximal tubules, loop of henle, distal tubules
Development of the metanephros begins with formation of the metanephric diverticulum/ureteric bud which penetrates the sacral intermediate mesoderm to induce the formation of the _____
metanephric blastema
The ureteric bud/metanephric diverticulum ultimately gives rise to _____
the collecting system of the kidney: collecting tubules and ducts, major and minor calyces, renal pelvis, ureters
The metanephros/metanephric blastema gives rise to ______
glomeruli Bowman's space proximal tubules loop of Henle distal convoluted tubules
What percentage of potassium is absorbed/excreted at the following sites:
PCT
ascending loop of Henle
PCT: 65% reabsorbed
ascending loop: 15-30% reabsorbed (Na/K/Cl)
How does the collecting duct handle potassium in hypokalemic vs hyperkalemic states
hypokalemia: resorption via H/K ATPase on alpha cells apical membrane
hyperkalemia: principal cells secrete K thorugh apical K channels
What is the blood supply to the ureter
proximal ureter: renal artery
distal ureter: superior vesical artery
_____ is a diuretic that works by inhibiting carbonic anhydrase, which effectively blocks NaHCO3 and water reabsorption in the PCT resulting in bicarb wasting
acetazolamide
What will a urinalysis reveal on a patient who has an elevated creatinine with initiation of ACE inhibitors
typically unremarkable (no hematuria, proteinuria or casts; high creatinine is due to low GFR from inhibiting angiotensin 2 from constricting the efferent arteriole)
An infant presents with dehydration (flat fontanelle, dry mucous membranes), dilute urine in large quantities, and high ADH. what is the diagnosis and what is the treatment
nephrogenic diabetes insipidus
tx: hydrochlorothiazide
What electrolyte imbalance presents as muscle cramps, perioral paresthesia, and laryngospasm
hypocalcemia
Immunofluorescence microscopy demonstrating linear deposits on the glomerular basement membrane is characteristic of what disease
Goodpasture disease (anti-GBM disease)
Anti-glomerular basement membrane disease/Goodpasture disease has antibodies that target ____ leading to subsequent complement deposition
type IV collagen
goodpasture disease results in what syndrome of the kidney
rapidly progressive (crescentic) glomerulonephritis (RPGN)
Immunofluorescence demonstrating linear deposits of ___ and ___ along the glomerular basement membrane is characteristic anti-glomerular basement membrane disease/Goodpastures
IgG C3
Excessive infusion of normal saline (sodium chloride) causes what changes to blood pH, serum bicarb, serum chloride, and urine sodium
blood pH: decrease
serum bicarb: decrease
serum chloride: increase
urine sodium: increase
The urachus is a remnant of the ____ that connects the bladder with the yolk sac during fetal development
allantois
Failure of the ___ to obliterate at birth can facilitate discharge of urine from the umbilicus
urachus
An upper motor neuron lesion in the spinal cord has what effect on the bladder
spastic bladder: bladder does not distend/relax properly due to loss of descending inhibitory control from UMN –> urinary frequency, urge incontinence
_____ is secreted in response to hyperphosphatemia and lowers plasma phosphate by reducing intestinal absorption and renal reabsorption of phosphate
fibroblast growth factor 23 (FGF23)
What is ACE inhibitors affects on the following levels: renin, angiotensin 1, angiotensin 2, bradykinin, aldosterone
renin: increased angiotensin 1: increased angiotensin 2: decreased aldosterone: decreased bradykinin: increased
Reduced estrogen causes osteoporosis by decreasing ___ production and increasing ____ production and ____ expression on osteoclast precursors
osteoprotegrrin
RANK-L
RANK
How do beta blockers regulate the RAAS system
beta blockers inhibit renin release, therefore reducing A1, A2 and aldosterone levels
Pelvic floor strengthening in order to reduce urinary incontinence targets what muscle in order to improve support around the urethra and bladder
levator ani
What portion of the nephron is impermeable to water regardless of serum vasopressin levels
ascending limb of loop of Henle
Urge incontinence or overactive bladder is caused by what?
uninhibited bladder contractions (detrusor instability)
what medication treatment can be used to treat over active bladder syndrome/urge incontinence
antimuscarinic (targeting M3)
what effect due beta 3 receptors have on the bladder
bladder relaxation
The 4 dibasic amino acids __, ___, ___, and ___ share a common transporter in the intestinal lumen and kidneys
cysteine ornithine lysine arginine (cola)
What is the result of impaired cellular transport of cysteine, ornithine, lysine, and arginine
cystinuria –> cystine kidney stones (hexagonal cystine crystals)
Regardless of a patients hydration status, where is the majority of water always reabsorbed
PCT
Severe vomiting leads to what acid base disorder
metabolic alkalosis (loss of H+ from GI, volume and Cl- depletion induces renal retention of bicarb, hypokalemia induced intracellular shift of H+)
Bilaterally enlarged, cystic fetal kidneys, detected on ultrasound indicate what diagnosis
autosomal recessive polycystic kidney disease
what is the genetic cause of autosomal recessive polycystic kidney disease
mutation in PKHD1: codes for fibrocystin
Where is the most common site for obstruction causing unilateral fetal hydronephrosis
ureteropelvic junction due to inadequate canalization
Why are NSAIDs contraindicated with loop diuretics
NSAIDs inhibit prostaglandin synthesis which normally cause vasodilation and mainaint adequate blood flow to kidney
low prostaglandins –> decreased renal perfusion –> decreased GFR –> water and salt retention
what are normal age related changes that cause decline in renal function
decreased renal mass and functional glomeruli
decreased renal blood flow
limited hormonal responsiveness (ie renin, PTH)
Why is adding carbonic anhydrase inhibitors, such as acetazolamide, to loop diuretic treatment useful?
CA inhibitors cause metabolic acidosis which can offset the metabolic alkalosis caused by loop diuretics
When reintroducing carbohydrates to someone who is malnourished, what possible complications can arise due to phosphate handling
increased carbs –> increased insulin –> phosphate redistributed from the serum into muscle and hepatic cells for use during glycolysis –> hypophosphatemia –> refeeding syndrome = muscular weakness, arrhythmias, congestive heart failure
In working up a patient with metabolic alkalosis, total body ____ depletion is often an important pathophysiology and can be tested in the urine
chloride
How are GFR and filtration fraction effected by mild vasoconstriction of the efferent arteriole
both increase
filtration fraction = GFR / ______
renal plasma flow
Where is the bladder located in respect to the peritoneum
extraperitoneal (anterioinferior to the peritoneal space)
How can sickle cell cause hematuria
sickled cells obstruct small kidney vessels –> ischemia –> renal papillary necrosis
EPO is secreted by what part of the kidney?
peritubular interstitial/fibroblasts cells (in response to decreased renal oxygen delivery)
In a patient with a calcium kidney stone, are they most likely to have hyper or hypocalcemia? hyper or hypocalciuria?
normocalcemia (plasma calcium levels are regulated by vit D and parathyroid hormone)
hypercalcuria
Postoperative urinary retention with incomplete bladder emptying is thought to involve decreased ___ activity and can be treated with what medications
detrusor (decreased reflex activity) muscarinic agonist (bethanechol) or alpha 1 blocking drug
As the ureters travels to the toward the bladder, they lie within the retroperitoneum and cross ____ to the common/external iliac arteries to reach the true pelvis. Within the true pelvis, the ureters lie _____ to the internal iliac artery and ____ to the uterine artery.
anterior
anterior
posterior
Nonanion gap metabolic acidosis results from the loss of _____. What are two common causes?
bicarb
renal tubular acidosis
severe diarrhea
Nonanion gap metabolic acidosis is also referred to as _______ acidosis because the decrease in serum bicarb is comensated for by an increase in serum ____
hyperchloremic
chloride
How do PTH and vitamin D differ in renal handling of phosphate and calcium
PTH: increase calcium reabsorption and increase phosphate excretion
vit D: increase calcium absorption, only increases phosphate excretion to small extent bc it also feeds back to decrease PTH production
What portion of the bladder is in contact with the peritoneal cavity?
dome of bladder
(blunt lower abdominal trauma can abruptly increase intravesicular pressure and rupture the bladder dome, spilling urine into the intraperitoneal cavity)
Increased urea resorption is mediated by what hormone and what is its effects on water absorption
antidiuretic hormone
promotes water retention
(ADH –> increased urea permeability in the inner medullary collecting ducts –> increased medullary concentration gradient –> increased free water retention)
Parathyroid hormone lowers serum phosphorus by decreasing phosphorus reabsorption in what portion of the tubule?
proximal tubule
Erythropoeisis-stimulating agents can be used to treat anemia of chronic kidney disease but increase risk of ____ and ____
thromboembolic events (due to increased blood viscosity) hypertension (activation of EPO receptors on vascular endothelial and smooth muscle cells)
Aminoglycosides can cause what type of renal disease
acute tubular necrosis
(filtered across glomerulus and concentrate in renal tubules –> epithelial necrosis–> granular casts which can obstruct tubular lumen and lead to rupture of basement membrane)
How can the renal clearance of any substance be calculated?
([urine concentration] x [urine flow rate]) / plasma concentration
GFR can be calculated using the ___ or ____ clearance, as these substances are freely filtered at the glomerulus and have relatively insignificant tubular reabsorption or secretion/
inulin
creatinine
Renal plasma flow can be determined using the _____ clearance as almost all of it that enters the kidneys is excreted into the urine
para-aminohippuric acid (PAH)
how do vaptans affect plasma osmolality, urine output, and urine sodium excretion
plasma osmolality: increase
urine output: increase
urinary sodium excretion: no change
(V2 receptor antagonist )
What is a major cause of acute renal failure in young children following bloody diarrhea?
hemolytic uremic syndrome (most cases are due to intestinal infection by Shiga toxin)
Hemolytic uremic syndrome is characterized by what triad
microangiopathic hemolytic anemia (RBC pass through damaged capillaries and suffer shear injury –> schistocytes)
thrombocytopenia (due to platelet consumption in response to injured endothelium –> microthrombi)
acute kidney injury (via extensive damage to the renal vasculature)
Primary membranous nephropathy is associated with __ antibodies to ______
IgG4
phospholipase A2 receptor
Is the serum sodium high or low in each of the following: central diabetes insupidus, nephrogenic DI, primary polydipsia
central DI: high
nephrogenic DI: high
primary polydipsia: low
What will happen to urine osmolality in the following during water deprevation: central DI, nephrogenic DI, primary polydipsia
central and nephrogenic DI: no change or mild increase
primary polydipsia: increase
Will urine osmolality increase during a water deprivation test when vasopressin is injected in the following: central DI, nephrogenic DI, primary polydipsia
central DI: large increase
nephrogenic DI: mild increase
primary polydipsia: no increase
what are the most potent diuretics and used as first line therapy for rapid relief of symptoms in patients with acute decompensated heart failure
loop diuretics
Heavy proteinuria can cause regional or generalized interstitial edema because decrease in _____ _____ pressure
plasma oncotic
At normal plasma concentrations of glucose, tubules reabsorb the entire filtered load of glucose. At higher blood glucose when the threshold of glucose is reach (____mg/dL), glucose is excreted due to the transport maximum being reached
200
How does acetazolamide cause hypokalemia
blocking sodium bicarb absorption in the PCT causes more Na to be reabsorbed more distally which stimulates K excretion
Vasopressin and desmopressin cause V2 receptor mediated increase in ____ and ___ permeability in the inner medullary collecting duct
water
urea
Contrast-induced nephropathy have an acute rise in ___ and ____ within 24-48 hours of contrast administration, followed by a gradual return to baseline
BUN
creatinine
contrast induced nephropathy causes diffuse necrosis of _____ and ___ casts
proximal tubular cells
muddy brown
Increased abdominal pressure (coughing, sneezing, or vigorous effort) greater than the ______ pressure can cause brief involuntary urine loss, which is virtually diagnostic of stress incontinence
urethral sphincter
Exogenous ______ ingestion presents as altered mental status and acute renal failure with renal biopsy revealing ballooning and vacuolar degeneration of the proximal renal tubules
ethylene glycol
Ethylene glycol poisoning results in ____ stones causing tubular obstruction as well as direct tubular cytotoxicity
oxalate
Chlorthalidone MOA
thiazide diuretic
how do thiazides cause muscle weakness
significant hypokalemia (can possibly cause rhabdomyolysis)
How do Beta agonists cause hypokalemia
increase activity of Na-K-ATPase pump, driving potassium into cells
Fever, neurologic symptoms (progressive lethargy), renal failure, anemia, and thrombocytopenia in the setting of gastrointestinal illness is classic for wheat diagnosis
TTP (thrombocytopenic thrombotic purpura) - HUS (hemolytic uremic syndrome)
thrombotic microangiopathy (TMA) syndromes share what common pathology
platelet activation in arterioles and capillaries
diffuse microvascular thrombosis
microangiopathic hemolytic anemia with schistocytes
thrombocytopenia
How does nephrotic syndrome cause hyperlipidemia
hypoalbuminemia (lost in urine) -> decreased capillary oncotic pressure –> increased lipoprotein production in liver
_____ syndrome is an inherited disorder of proximal tubular transport. Glucose, bicarb, calcium, phosphate, and amino acids are lost in the urine
Fanconi
What episodic nephritic syndrome with have normal serum complement levels
IgA nephropathy
Sevelamer MOA
nonabsorbable anion-exchange resin that binds intestinal phosphate to reduce absorption
Altitude sickness causes what changes in acid base status
low partial pressure O2 –> hypoxemia –> hyperventilation –> respiratory alkalosis
How do the kidneys respond to altitude sickness induced alkalemia
decreased HCO3 reabsorption and H+ secretion
Uncorrected creatinine clearance overestimates or underestimates the GFR? By how much?
overestimates GFR by 10-20%
creatinine is actively secreted by proximal tubules
In urothelial carcinoma, tumor invasion into the _____ layer of the bladder wall carries an unfavorable prognossis
muscularis propria
Acute Tubular necrosis can be due to what two causes
ischemia or toxic insult
Describe the 3 phases of acute tubular necrosis
initiation phase: original insult - 24-36 hours; slight decrease in urine output
maintenance phase: lasts 1-2 wks, tubular damage is fully established –> oliguria, fluid overload, electrolyte abnormalities
recovery phase: re-epithelization. GFR recovers quickly but tubular cells recover more gradually resulting in transient polyuria and loss of electrolytes
what is Conn’s syndrome
primary hyperaldosteronism (ie aldosterone secreting tumor)
How does cocaine use cause hypokalemia
beta adrenergic hyperactivity –> epinephrine release –> increased activity of Na/K ATPase pump and Na/K/2Cl co transporter –> transport potassium intracellularly
adrenergic activity also stimulates insulin release which further promotes intracellular potassium shifting
What are the clinical manifestations of Henoch-Schonlein purpura
palpable purpura/petechiae lower extremities
arthritis
abdominal pain, GI bleed, intussusception
renal disease
what is the pathogenesis of Henoch schonlein purpura
(IgA vasculitis)
deposition of IgA in small vessels –> activates compliment
neutrophilic inflammation and vascular damage
often follows upper respiratory infection
How do ACE inhibitors cause an increase in creatinine
inhibit A2 from causing efferent arteriole constriction –> therefore they cause efferent arteriole dilation
Minimal change disease, the most common cause of nephrotic syndrome in children is often idiopathic but what are some possible inciting events
respiratory infections
immunizations
insect sting/bite
What is the pathophysiology of minimal change disease
T cell dysfunction –> production of glomerular permeability factor –> damage to podocytes and decreases anionic properties of glomerular basement membrane –> loss of negative charge results in selective loss of albumin in urine
describe the light microscopy, immunofluorescent, and electron microscopy in minimal change disease
LM and IF: normal
EM: diffuse podocyte foot process effacement and fusion
minimal change disease treatment
corticosteroids
Increased aldosterone has what effect on K and H handling in the kidney
increased K and H
_____ accumulates as amyloid in dialysis patients as it is renally cleared but poorly dialyzed. It can cause shoulder pain, carpal tunnel, bone cysts, and pathologic fractures
beta 2 microglobulin
Chronic inflammatory states, such as rheumatoid arthritis, can cause increased ______ which can lead to a nephrotic syndrome
serum amyloid A
In myoglobinuria, what will be positive of urine dipstick but negative on microscopic urinalysis
blood
how can seizures cause acute tubular necrosis
myocyte injury -> myoglobin degraded in the kidney releases heme pigment –> toxic to tubular cells –> acute tubular necrosis
ACE inhibitors have what effects on the following: renal perfusion, intraglomerular pressure, filtration fraction
renal perfusion: decreased
intraglomerular pressure: decreased
filtration fraction: decreased
A child presenting with gross hematuria and periorbital edema most likely has what presentation
postreptococcal glomerulonephritis
Formation of uric acid kidney stone is promoted by what change in urine? How can it be precipitated by diarrhea
low urine pH
chronic diarrhea –> chronic metabolic acidosis and production of acidic urine –> formation of uric acid stones
how does the prognosis differ between children and adults for PSGN?
worse prognosis in adults, they are more likely to develop chronic hypertension and renal insufficiency
What is ADH’s main function in the cortical collecting duct vs the medullary collecting duct
cortical: increased water absorption
medullary: increased urea absorption
Clear cell carcinoma is the most common type of renal cell carcinoma and originates from the ____ cells from where in the kidney
epithelial cells of the proximal renal tubules
Membranous nephropathy results from immune-complex deposition in what portion of the GBM
subepithelial
What is seen on electron microscopy of membranous nephropathy
irregular, subepithelial, electron-dense immune deposits on glomerular basement membrane and moderate effeacement of podocyte foot processes
what is seen on IF and light microscopy of membranous nephropathy
IF: diffuse granular of IgG and C3 along capillary loops
LM: diffuse golmerular capillary wall thickening (silver stain reveals spikes and domes)
Patiromer MOA
nonabsorbable cation exchange resin used to treat hyperkalemia
binds colonic potassium in exchange for calcium
Invasive vascular procedures can have what complication that may result in acute kidney injury, livedo reticularis (skin), and blue toe syndrome
atheroembolic disease due to cholesterol containing debris from plaques being dislodged from arteries –> shower microemboli into circulation
What is a positive tissue transglutaminase antibody assay diagnositic of
celiac disease
How can celiac disease effect PTH levels?
celiac –> decreased vit D absorption –> secondary hyperparathyroid
Severe diarrhea causes what acid base distrubance
nonanion gap metabolic acidosis
substantial loss of HC03 in stool –> low pH –> compensatory respiratory alkalosis –> low CO2
Renal cell carcinoma tends to invade the renal vein. Intraluminal extension of the tumor can obstruct the ____ which produces symmetric bilateral lower extremity edema often associated with prominent development of venous collaterals in the abdominal wall
inferior vena cava
Renal cell carcinoma causes a variety of paraneoplastic syndromes including erythrocytosis due to excessive ___ release and hypercalcemia due to ____ release
erythropoietin
parathyroid hormone related peptide
Mannitol administration has what acute effects on the following:
serum sodium concentration, renal tubular flow, glomerular filtrate osmolality
serum sodium concentration: decreased
renal tubular flow: increased
glomerular filtrate osmolality: increased
What acid base change does salicylate/aspirin toxicity cause
primary respiratory alkalosis and primary metabolic acidosis with an anion gap due to increased lactate production
how does salicylate/aspirin intoxication cause metabolic acidosis with an anion gap
uncoupling of oxidative phosphorylation –> hyperthermia –> increased lactic acid
how does salicylate/aspirin toxicity cause respiratory alkalosis
stimulation of medullary respiratory center –> hyperventilation
prolonged, heavy intake of NSAIDs causes what pathologic changes of the kidney
chronic interstitial nephritis
papillary necrosis
Multiple myeloma is associated with increased bone resorption which has what results on the following: PTH, urinary calcium, 1,25 D vit D, PTH related protein
PTH: decreased
urinary Ca: increased
1,25 vit D: decreased
PTH related protein: normal
what is the diagnosis of hypotonic hyponatremia, concentrated urine, and euvolemia
SIADH
How does BPH cause hematuria
hyperplastic prostate cells are supported by the formation of new blood vessels which may be friable
How does urinary citrate effect renal calculi occurrance
citrate prevents calculi formation by binding ionized calcium in urine, preventing formation of insoluble calcium oxalate complexes
In severe hypovolemia, what changes are seen in GFR, RPF, and FF
RPF : very decreased
GFR: decreased
FF: increased (=GFR/RPF)
Uncontrolled hypertension or diabetes shows what changes in the small arteries and arterioles of a renal biopsy
eosinophilic hyaline material in the intima and media= hyaline arteriosclerosis
what type of renal stones are flat, yellow, and hexagonal
cystine
what renal stones are yellow or red-brown diamond or rhombus
uric acid
what renal stones are rectangular prisms/coffin lids
magnesium ammonium phosphate
what renal stones are octahedron (square with x in the center)
calcium oxalate
what renal stones are elongated, wedge shaped and forms rosettes
calcium phosphate
what stones form more readily in acidic pH?
uric acid
cystine
what stones form more readily in alkaline pH
magnesium ammonium phosphate
calcium phosphate
Primary nocturnal enuresis = bed-wetting at or older than age 5, it is caused by what. primarily?
brain maturation delay
What medication causes nausea, flushing, diaphoresis, decreased heart rate, and pupil constriction?
cholinergic agonists
how are the following effected in DKA: serum pH, serum bicarb, PaCO2?
pH: low
serum bicarb: low
PaCO2: low (compensation)
What is the likely cause of dilated calyces with overlying renal cortical atrophy bilaterally, mostly in upper and lower poles
reflux nephropathy
How does multiple myeloma cause nephropathy?
free light chain bodies (bence jones proteins) are filtered by the glomerulus in small amounts and then reabsorbed, when levels exceed reabsorptive capacity –> light chains precipitate with Tamm-Horsfall protein –> casts (glassy eosinophilic casts)
large, waxy, eosinophilic casts composed of Bence Jones proteins are diagnostic of what?
multiple myeloma
The most likely cause of fever and fatigue with new onset cardiac murmur is _____ which could potentially cause what type of kidney damage
infective endocarditis
diffuse proliferative glomerulonephritis secondary to circulating immune complex deposition
How are patients with chronic kidney disease at risk for osteodystrophy?
hyperphosphatemia and hypocalcemia –> secondary hyperparathyroidism –> osteodystrophy
Creatinine is freely filtered in the glomerulus and actively secreted where?
PCT
How is urea handled in the PCT?
neither secreted or absorbed
How do sodium and potassium concentrations change in the PCT?
they are reabsorbed in concentrations approximately equal to water so the concentrations do not change
What is the earliest sign of diabetic nephropathy which can be used as a screening tool
albuminuria
Vascular calcifications occur in patients with chronic kidney disease due to electrolyte abnormalities, ie: _____phosphatemia and ____calcemia (hyper or hypo)
hyperphosphatemia
hypercalcemia
How does hyperphosphatemia cause neuromuscular excitability
phosphate binds free calcium and deposits into tissues
phosphate also triggers fibroblast growth factor 23 –> decreased calcitriol production and intestinal calcium absorption)
Fibromuscular dysplasia pathology typically demonstrates alternating fibromuscular webs and aneurysmal dilation with absent _______ –> string of bead appearance.
internal elastic lamina
In chronic kidney disease, how are the following effected: phosphate, PTH, calcitriol
phosphate: increased
PTH: increased
calcitriol: decreased
What acid base disturbance can be caused by chronic kidney disease
ion gap renal acidosis and compensatory respiratory alkalosis
(accumulation of unmeasured acidic compounds due to decreased GFR)
What are presenting features of acute interstitial nephritis
fever
rash
eosinophilia
pyuria with white blood cell casts and elevated urine eosinophils
How are renal blood flow, GFR, and serum creatinine affected by pregnancy
RBF: increased
GFR: increased
Serum creatinine: decreased
Spike and dome appearance when stained with silver stains on the GBM are indicative of what diagnosis
membranous glomerulopathy
To compensate for metabolic acidosis, the kidneys increase buffer excretion: _____ and ______ which bind H+ in order to allow for large amounts of acid to be excreted without precipitously dropping the pH
phosphate
ammonium
Chronic renal hypo perfusion can cause hyperplasia of what cells?
juxtaglomerular apparatus
what makes up the crescent in rapidly progressive glomerulonephritis
glomerular parietal cells
lymphocytes
macrophages
fibrin
The most common renal malignancy is clear cell carcinoma which arises from renal ____ cells
proximal tubular
In clear cell carcinoma, cells contain large amounts of ____ and _____ that dissolve during routine tissue preparation, leaving clear spaces within the cytoplasm
glycogen
lipids
lithium induced diabetes insipidus is the result of lithium’s antagonizing effects on the action of ____ on ___ cells in what part of the tubule
vasopressin
principal cells
collecting duct
How can you determine the renal plasma flow from the hematocrit and renal blood flow
RPF = RBF * (1-hematocrit)
What cause of rapidly progressive glomeruloscleorsis (crescent formation) is not visualized on IF
pauci immune (granulomatosis with polyangitis, microscopic polyangitis, etc.)
Goodpasture syndrome is caused by autoantibodies against the ___ chain of _______ in glomerular and alveolar basement membranes
alpha 3
type IV collagen
what is seen on EM of poststreptococcal glomerulonephritis
subepithelial electron dense deposits
Creatinine formation depends on ____ and ___, therefore, if these are lower in patients, they can have significantly lower GFRs for any given creatinine level
muscle mass
meat intake
What are 2 common paraneoplastic syndromes associated with renal cell carcinoma
hypercalcemia
erythrocytosis
Severe vomiting causes what changes to the following serum concentrations: sodium, potassium, chloride, bicarb
sodium: decreased
potassium: decreased
chloride: decreased
bicarb: increased
What is seen on urinalysis of a patient with acute tubular necrosis
granular, muddy brown casts
BPH can lead to progressive bladder outlet obstruction and over time, increased urinary pressures can cause hydronephrosis resulting in what changes in the kidney
renal parenchymal atrophy with scarring which can progress to chronic kidney disease
