Renal Flashcards
Where in the kidney is glucose, bicarb, AA and metabolites reabsorbed?
PCT
What does the MeSonephros become?
CRUMS
(urinary system OUT of kidney)
- collecting duct
- renal pelvis
- ureters
-major/minor calyces
What does the MeTanephros become?
“Renal Parenchyma” or “Kidney Proper”
- glomerulus
- PCT
- Loop of Henle
- DCT
- Collecting Tubule
What structure can connect the umbilicus and the bladder; sometimes has discharge leaking from it in children?
patent urachus
What structure is due to a failure to close the distal part of the urachus; leads to periumbilical tenderness and purulent discharge?
urachal sinus
Formula and Indicators for TBW
TBW= ICF + ECF
Indicators: D2O
Formula and Indicators for ECF
ECF = plasma + interstitial fluid
Indicators: Mannitol and Inulin
What type of channels does ADH act on?
aquaporin channels in the collecting duct
MOA of ADH
- Increase H2O reabsorption in CT
- Decrease Urine Volume
- Increase Urine Specific Gravity
What is Angiotensin II’s affect on GFR?
increases GFR
MOA of aldosterone
Acts on the Na+/K+ pumps in the DCT
- Increases Na+ absorption (water follows)
Describe what happens in SIADH (urine vs. plasma)
- too much ADH
- very concentrated urine
- dilute plasma (hyponatremia)
Describe what happens in Aldosterone deficiency (urine vs. plasma)
- no aldosterone; hyponatremia
- lots of urine with Na+ following
What is the affect of B-blockers and Digoxin on Potassium?
Increased K+
What is the affect of B-agonists on K+?
Decreased K+
Hyper_____ can cause muscle cramps or rhabdomyolysis.
Hyperkalemia (if K+ too high)
*also can cause muscle weakness if K+ too low
_____ in the urine, can bind to Ca2+ and help to decrease the risk for calcium kidney stones.
Citrate
Formula for Renal Clearance
Concentration = [Urine Osm x Urine Flow Rate] / Plasma Osm
Name the indicator used for GFR
Inulin or Creatinine clearance
Constriction of Afferent Arteriole does what to GFR?
- decreased GFR
due to activation of renal sympathetic nerves
What affect does ANP have on GFR?
- increased GFR
- DECREASES
Renin, AT II, Aldo, NaCL, and ADH
Describe the Changes in RPF, GFR and FF
- NSAIDS
Increases Prostaglandins Dilate the Afferent Arteriole
- Increase RPF
- Increase GFR
- FF remains Constant
Describe the Changes in RPF, GFR and FF
- ACE Inhibitor
Angiotensin II Constricts the Efferent Arteriole
- Decrease RPF
- Increase GFR
- Increase FF
Describe the Changes in RPF, GFR and FF
Afferent Arteriole Constriction
- Decrease RPF
- Decrease GFR
- FF remains constant
Formula for Filtration Fraction
GFR/RPF
Name the 6 types of Nephrotic Syndrome
MMFANS
- Minimal Change Dz
- Membranous
- Focal Segmental Glomerular Nephropathy
- Amyloidosis
- Nodular Sclerosing (Diabetes)
- SLE (Lupus!)
What are the 4 main characteristics of Nephrotic Syndrome?
PALE
- Proteinuria > 3.5
- Albuminuria
- Lipidemia
- Edema
Name the 5 types of Nephritic Syndrome.
PRIMA
- Post-streptococcal glomerulonephritis
- Rapidly Progressive Glomerulonephritis
- IgA Nephropathy
- Membranoproliferative Glomerulonephropathy
- Alports
What are the 4 main characteristics of Nephritic Syndrome?
HOAR
- Hypertension
- Oliguria
- Azotemia
- RBC cast
Does Nephrotic Syndrome have blood in the urine (hematuria)?
NO
Waxy Cast in Urine?
End Stage Kidney Disease
Granular Cast/Muddy Brown Cast in Urine?
ATN
Fatty Cast in Urine?
Nephrotic Syndrome
RBC Cast in Urine?
Nephritic Syndrome
WBC Cast in Urine?
Pyelonephritis
Name the Disease.
(+ Nephritic vs. Nephrotic)
Lumpy bumpy
Mimics SLE Type 4
Type III Hypersensitivity
Look for Periorbital Edema!
Nephritis
Post Streptococcal Glomerulonephritis
Name the Disease.
(+ Nephritic vs. Nephrotic)
- NO immunofluorescence
- c-ANCA
- involves Upper [sinus] and Lower Respiratory
Nephritic
Wegner’s
- Rapidly Progressive Glomerulonephritis
Name the Disease.
(+ Nephritic vs. Nephrotic)
(Type II Hypersensitivity)
Lower Respiratory
Anti-glomerular BM antibodies (Type IV collagen)
Nephritic
Goodpasture’s Syndrome
- Rapidly Progressive Glomerulonephritis
Name the Disease.
(+ Nephritic vs. Nephrotic)
HS Purpura
Berger’s
- Mesangial
Nephritic
IgA nephropathy
Name the Disease.
(+ Nephritic vs. Nephrotic)
S/S: Facial Swelling
Tram-Track Appearance on immunofluorescence
Subendothelial deposits (Type 1)
Nephritic
Membranoproliferative glomerulonephritis
Name the Disease.
(+ Nephritic vs. Nephrotic)
Involves Basement Membrane (Type IV collagen)
S/S: blindness, deafness
Hint: “basket weave appearance”
Nephritic
Alports!
Name the Disease.
(+ Nephritic vs. Nephrotic)
Podocyte Effacement/Foot process
Infection/Immune Issues can cause this.
Nephrotic
Minimal Change Disease
treat with prednisone
Name the Disease.
(+ Nephritic vs. Nephrotic)
Anti-Phospholipase A2
Mimics SLE Type 5
Spike and Dome Appearance
Nephrotic
Membranous…
Name the Disease.
(+ Nephritic vs. Nephrotic)
- IV drug use, HIV, Sickle Cell
- Most common in AA and Hispanics
Nephrotic
Focal Segmental Glomerulonephritis
Name the Disease.
(+ Nephritic vs. Nephrotic)
Multiple Myeloma, Sarcoidosis, TB
Bence Jones Proteins
Apple Green Birefringence
Nephrotic
Amyloidosis
Name the Disease.
(+ Nephritic vs. Nephrotic)
BM thickening
Kimmelstein Wilson Nodules (wire loop)
Nephrotic
Nodular Sclerosing (Diabetes)
Name the Vasculitis
- most common form of childhood vasculitis
- Skin Rash (palpable purpura)
- Follows Upper Respiratory Infections
Henoch-Schonlein Purpura
Name the Vasculitis
- Heavy Smokers
- Intermittent Claudication
Buerger’s Disease (thromboangiitis obliterans)
Name the Vasculitis
- Fever > 5 days
- Conjunctivitis (red eyes)
- Strawberry Tongue
Kawasaki Disease
causes acute necrotizing vasculitis of small/medium vessels
Name the Vasculitis
- necrotizing immune complex inflammation
- seen in Hep. B patients
Polyarteritis Nodosa
treat with corticosteroids
Name the Vasculitis
+ p-ANCA
- granulomatous vasculitis with eosinophilia
Churg-Strauss Syndrome
If BUN/Cr ratio is > 15, what type of azotemia is it?
PRERENAL
- anything under 15 is either intrarenal or post renal
What are the 4 causes of ischemia ATN?
MESH
- major surgery
- extensive blood loss
- severe burns
- hemorrhage
What is the main cause of toxic ATN?
NSAIDS
Primary treatment for Cystitis (UTI)?
TMP-SMX (Bactrim)
What are the 4 drugs that can cause Drug Induced Interstitial Nephritis?
PCNS
- Penicillin
- Cephalosporins
- NSAIDS
- Sulfonamides
What bacteria is the most common cause of a UTI?
E. coli
Name the Kidney Disorder
- acute severe colicky flank pain
- hematuria
- Dx: CT scan
Nephrolithiasis (kidney stone)
Name the Kidney Disorder
- dilation of the renal calyces
Hydronephrosis
Tx: treat the obstruction causing the back up of flow
What drug can be used to treat calcium kidney stones?
Hydroclorothiazide
Kidney stone: hexagonal shape
Cysteine stone
Kidney stone: Coffin lid appearance
Struvite stone
Kidney Stone:
- rhomboid shape
- radiolucent
Uric Acid Kidney Stones
What are the 4 AA that can cause Cysteine Kidney Stones?
COLA
- cysteine
- ornithine
- lysine
- arginine
Name the Incontinence
- Laugh/cough and pee comes out
- Due to increased abnormal pressure
- Treatment:
Pessary
Kegel exercise
Stress Incontinence
Name the Incontinence
- Urge that you have to go at random times
- Treatment:
Timed Voiding (timer)
Antimuscarinic
Urge Incontinence
Name the Incontinence
- Cause: inability for nerves to empty the bladder
- Diabetics can get this!!
- Treatment:
Catheterization to empty the bladder
Overflow Incontinence
What are the various causes of High Anion Gap Metabolic Acidosis?
MUDPILES
Methanol,
Uremia,
Diabetic ketoacidosis,
Propylene glycol,
Isoniazid/Iron
Lactic acidosis,
Ethylene glycol,
Salicylates (aspirin)
What are the various causes of Normal Anion Gap Metabolic Acidosis?
HARDASS
hyperalimentation,
Addison’s disease,
renal tubular acidosis, diarrhea,
acetazolamide,
spironolactone,
saline infusion.
Metabolic Acidosis vs. Metabolic Alkalosis
- Vomitting
Hypokalemic
Hypochloremic
Metabolic Alkalosis
Name the Urinary Incontinence Type and its Etiology.
- S/S: leakage with coughing, sneezing, lifting
Stress
- due to decreases urethral sphincter tone
Name the Urinary Incontinence Type and its Etiology.
- S/S: Overwhelming urge to urinate
Urge Incontinence
- Detrusor Muscle Overactivity
Name the Urinary Incontinence Type and its Etiology.
- S/S: incomplete emptying and persistent involuntary dribbling
Overflow Incontinence
- impaired detrusor muscle contractility
- bladder outlet obstruction
