Renal Flashcards
Mechanism of acetozolamide
Inhibition of carbonic anhydrase –> reduced aqueous humor production –> decreased intraocular pressure
Drug that vasodilates and decreases insulin release
Diazoxide (K+ channel opener)
Side effects of acetozolamide
Hypokalemia, alkaline urine
Metabolic alkalosis after loop and thiazides diuretics
Contraction alkalosis (inhibit tubular reabsorption of sodium and chloride –> loss of salt and water –> retention of bicarbonate in ECF)
Inulin space
Extracellular space (Interstitial fluid volume + plasma volume)
C3 Nephritic factor
Type II Membranoproliferative Glomerulonephritis (stabilized C3 convertase –> overactivation of complement and decreased C3 precursor)
Nephrotic syndrome + HIV/heroin/sickle cell
Focal segmental glomerulosclerosis
Urine protein > 50 mg/kg/day & serum albumin < 3 g/dL
Nephrotic syndrome
Effacement of foot processes on EM
Focal segmental glomerular sclerosis OR Minimal change disease
Respiratory alkalosis -> metabolic acidosis
Salicylate toxicity
Linear or ribbon-like IF pattern in kidney biopsy
anti-GBM disease or diabetes
Vasopressin works where for urea and water reabsorption?
Urea- Medullary segment of collecting duct
H20 - Cortical segment of collecting duct
Where is highest osmolarity in kidney?
Bottom of loop of Henle
Diuretic associated with decreased risk of kidney stones
Thiazides decrease urinary excretion of calcium -> decrease likelihood of calcium oxalate stones
Hormone that stimulates Na-H antiporter in proximal tubule
Angiotension II -> increased Na, H2O, and HCO3 reabsorption -> contraction alkalosis
Hormone that stimulates ENaC production in principal call of collecting tubule
Aldosterone -> negative membrane -> K and H secretion
Hormone that stimulates aquaporins
ADH
Heart distension -> ANP -> ?
Heart distension -> ANP -> cGMP -> PKG -> vasodilation & Na/water loss
Kidney stones from Proteus UTI
Staghorn calculi made of magnesium ammonium phosphate
Antibiotics in which bio-availability decreases with antacids
Fluroquinolones (ofloxacin)
Positive nitroprusside cyanide test on urine
Cystinuria (AR), treat with aggressive hydration and urinary alkalinization
Treatment for neurogenic bladder (no descending pontine control of micturition)
Muscarnic receptor antagonist (tolterodine)
Treatment for acute pyelonephritis
Ciprofloxacin, ofloxacin, ceftriaxone
25-hydroxycholecalciferol -> 1,25-dihydroxycholecalciferol occurs where?
Kidney tubules (enzyme = 1 alpha-hydroxylase, PTH regulates)
Diuretic that blocks Na-Cl symporter in distal tubule
Thiazides -> increased Ca reabsorption -> decreased kidney stones & -> volume depletion -> increased Na reabsorption in collecting tubule -> more negative lumen -> more K secretion & metabolic alkalosis
Type II collagen
Cartilage, vitreous body of eye, nucleus pulposus of intervertebral disks
Type IV collagen is where?
Basement membrane in lungs, kidney, and lens of eye
Sickle cell disease leads to damage where in the kidney?
High osmolarity of renal medulla -> sickling in vasa recta -> papillary necrosis, proteinuria
Renal failure diet
Low-protein, high-carbohydrate, moderate fat intake, low to moderate fluid
PTH does what where?
Increase calcium reabsorption in distal tubule
Causes of rapidly progressive glomerulonephritis
Anti-glomerular basement membrane disease, systemic vasculitis (Wegener granulomatosis, microscopic polyarteritis, Churg-Strauss)
Stimuli for ADH
Plasma osmoles, blood volume depletion
Costovertebral angle tenderness, flank pain, N/V, dysuria, hematuria, urgency + WBC cells and casts in urine
Pyelonephritis
Diuretic that acts upstream of macula densa
Inhibition of carbonic anhydrase in proximal tubule -> osmotic diuresis -> more NaCl reaches macula densa -> more Na in distal tubule -> less renin secretion
Subendothelial deposits, mesangial proliferation, double basement membrane (tram tracks)
Type 1 membranoproliferative glonerulonephritis
Glomerular diseases associated with HCV
Membranoproliferative glomerulonephritis (subendothelial deposits, mesangial proliferation, double basement membrane)
Epithelial cells with brush border in kidney
Proximal convoluted tubule
FeNa 500, urine Na <20
Prerenal failure
Subepithelial deposits and granular IF
Membranous nephropathy
Failure to close what development/adult structure leads to urine leakage through belly button?
Urachus SHOULD obliterate to form median umbilical ligament.
Defect and consequences of Type 2 (proximal)
Defect in proximal tubule HCO3 reabsoprtion -> acidify urine in distal tubule -> urinary pH < 5
Defect and consequences of Type 1 (distal) RTA
Defect in collecting tubule’s H excretion, defect in NH4 excretion -> urinary pH > 5
Childhood abdominal mass with islands of epithelial cells, recognizable glomerular and/or tubular structures
Wilms tumor
Normal anion gap metabolic acidosis
Proximal RTA (failed HCO3 reabsorption -> treat with serum HCO3) or diarrhea
Hypophosphatemic rickets
Increased phosphate wasting in proximal tubule (disregulated hormone in kidney), need calcium and phosphate for hydroxyapatite
- FGF-23 gene
Acid-base disorder in diarrhea
Normal anion-gap, hypechloremic acidosis
Metabolic and respiratory acidosis (high PCo2, low bicarbonate)
Cardiopulmonary arrest (poor oxygenation -> lactic acidosis)
Effects of angiotensin II
Increased systemic vascular resistance (contraction of efferent arterioles) + increased aldosterone -> volume expansion
How kidneys excrete acid
Ammonium ion secretion
Decreased albumin -> ?
Low plasma colloid osmotic pressure
