- Increase H2O reabsorption in CT - Decrease Urine Volume Increase Urine Specific Gravity

Renal Flashcards by ashley lovorn

Where in the kidney is glucose, bicarb, AA and metabolites reabsorbed?

PCT

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What does the MeSonephros become?

CRUMS
(urinary system OUT of kidney)
- collecting duct
- renal pelvis
- ureters
-major/minor calyces

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What does the MeTanephros become?

“Renal Parenchyma” or “Kidney Proper”
- glomerulus
- PCT
- Loop of Henle
- DCT
- Collecting Tubule

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What structure can connect the umbilicus and the bladder; sometimes has discharge leaking from it in children?

patent urachus

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What structure is due to a failure to close the distal part of the urachus; leads to periumbilical tenderness and purulent discharge?

urachal sinus

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Formula and Indicators for TBW

TBW= ICF + ECF

Indicators: D2O

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Formula and Indicators for ECF

ECF = plasma + interstitial fluid

Indicators: Mannitol and Inulin

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What type of channels does ADH act on?

aquaporin channels in the collecting duct

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MOA of ADH

Increase H2O reabsorption in CT
Decrease Urine Volume
Increase Urine Specific Gravity

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What is Angiotensin II’s affect on GFR?

increases GFR

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MOA of aldosterone

Acts on the Na+/K+ pumps in the DCT
- Increases Na+ absorption (water follows)

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Describe what happens in SIADH (urine vs. plasma)

too much ADH
very concentrated urine
dilute plasma (hyponatremia)

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Describe what happens in Aldosterone deficiency (urine vs. plasma)

no aldosterone; hyponatremia
lots of urine with Na+ following

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What is the affect of B-blockers and Digoxin on Potassium?

Increased K+

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What is the affect of B-agonists on K+?

Decreased K+

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Hyper_____ can cause muscle cramps or rhabdomyolysis.

Hyperkalemia (if K+ too high)

*also can cause muscle weakness if K+ too low

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_____ in the urine, can bind to Ca2+ and help to decrease the risk for calcium kidney stones.

Citrate

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Formula for Renal Clearance

Concentration = [Urine Osm x Urine Flow Rate] / Plasma Osm

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Name the indicator used for GFR

Inulin or Creatinine clearance

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Constriction of Afferent Arteriole does what to GFR?

decreased GFR

due to activation of renal sympathetic nerves

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What affect does ANP have on GFR?

increased GFR
DECREASES
Renin, AT II, Aldo, NaCL, and ADH

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Describe the Changes in RPF, GFR and FF

NSAIDS

Increases Prostaglandins Dilate the Afferent Arteriole
- Increase RPF
- Increase GFR
- FF remains Constant

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Describe the Changes in RPF, GFR and FF

ACE Inhibitor

Angiotensin II Constricts the Efferent Arteriole
- Decrease RPF
- Increase GFR
- Increase FF

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Describe the Changes in RPF, GFR and FF

Afferent Arteriole Constriction

Decrease RPF
Decrease GFR
FF remains constant

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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)?

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