Renal Flashcards
Hydronephrosis in fetus
failure of utereopelvic junction to canalize
Potter’s syndrome
oligohydramnios
compression of fetus
pulmonary hypoplasia
death
Horseshoe kidney
ascension blocked by IMA
assc with Turner syndrome
What can cross ureters and cause urine backup?
accessory renal artery
Characteristics of Glc renal clearance
threshold-past where you see Glc in urine (160mg/dL)
splay-gradual appearance of Glc in urine
full saturation of Glc transporters at 250mg/dL
Pellegra sx
Not B3 deficiency
Hartnup’s disease
deficiency of neutral AA transport
Tryptophan important loss
Impact of fluid by adrenal insufficiency
increased ICF (pulls ECF out) decreased ECF decreased osmolarity (lose salt)
Impact of fluid by SIADH
increased ICF
increased ECF
decreased osmolarity
Impact of fluid by diabetes insipidus
decreased ICF/ECF increased osmolarity (loss of water)
Impact of fluid by primary aldosteronism
decreased ICF (pulled out by salt)
increased ECF
increased osmolarity
PTH on proximal tubule
inhibits Na+/phosphate cotransport
decreased phosphate resorption
AT II on proximal tubule
increased Na+/H+ exchange
increased Na+/HCO3- resorption
PTH on distal convoluted tubule
increased Ca2+/Na+ exchange
increased Ca2+ resorption
Aldosterone on collecting tubule
increased Na+ channels on luminal side
increased Na+ resorption
Renal BP control
myogenic response (stretch constricts-Ca2+ mediated) tubuloglomerular feedback (macula densa) PGE/NO (vasodilate) epi/NE/endothelin (vasoconstrict)
Beta1 receptors on kidney action
increase renin secretion by juxtaglomerular cells
Alpha1 receptors on kidney action
increase Na+/K+ pump in proximal tubule
Central Diabetes insipidus
lack of ADH secretion
responds to desmopressin
chromosome 20 defect
Nephrogenic diabetes insipidus
genetic loss of V2R/AQP-2 or lithium toxicity
no desmopressin response
EPO production
made by peritubular capillary bed
in response to hypoxia
increases RBC production
VIt D and kidneys
converts 25-OH Vit D to 1,25-(OH)2 Vit D (active form)
NSAIDs impact on kidneys
decrease PGE which dilate arterioles
can cause acute renal failure
Insulins impact on K+
shifts K+ into cells
causing hypokalemia
Hyperkalemia impact on heart
wide QRS complex
peaked T waves
ABG for metabolic acidosis
decreased bicarb
decreased PCO2
decreased pH
ABG for respiratory acidosis
increased bicarb
increased PCO2
decreased pH
Type 1 renal tubular acidosis
defect in H+ excretion
increased risk for Ca2+/phosphate stones
Type 2 renal tubular acidosis
defect in tubule bicarb resorption
Sign of azotemia
increased BUN and creatinine
decreased GFR
Fatty casts in urine
nephrotic syndrome
granular casts in urine
acute tubular necrosis
waxy casts in urine
chronic renal failure
Focal segmental glomerulosclerosis
collapse of glomeruli (HIV/blacks/heroin assc)
hyalinosis
effacement of foot processes
IgM and C3
Membranous nephropathy
adult caucasian males
GBM thickening
spike and dome (immune complex deposits)
granular immunofluorescence
Minimal change disease
2-6 y/o post infection and Hodgkin lymphoma assc
foot process effacement
selective loss of albumin
responds to corticosteriods
Amyloidosis
congo red stain
apple green birefringence
assc with multiple myeloma
Membranoproliferative GN
type 1:tram track due to GBM splitting
C3/C4/IgG
type 2:ribbon like, only C3
assc with HBV/HCV
Diabetic glomerulonephropathy
nonenzymatic glycosylation
nodular glomerulosclerosis
Kimmelstiel-Wilson lesion
hyaline arteriosclerosis
Acute poststrep GN
lumpy bumpy appearance (immune complex deposition)
child post URT infection
periorbital edema
IgG/IgM/C3
Rapidly progressive GN
crescent moon shape
seen in Goodpasture’s (linear IF)/Wegeners’s (c-ANCA)/microscopic polyangiitis (p-ANCA)
petechial hemorrhage on cortical surfaces
Diffuse proliferative GN
SLE or PMGN
wire looping of capillaries
IgG and C3 deposition
granular on IF
Berger’s disease
related to Henoch-Schoenlein purpura
mesangial proliferation
IgA in mesangium
aka IgA nephropathy
Alport syndrome
mutation of type IV collagen, X linked
split basement membrane
deafness/eye problems
Ca2+ kidney stones
acid-oxalate/basic-phosphate
can result from ethylene glycol/Vit C
hypercalciuria/normocalcemia
Struvite kidney stones
Mg2+/NH4+/phosphate
caused by infection (urease (+))
acidify urine to tx
Uric acid kidney stones
radiolucent
assc with hyperuricemia
seen in diseases with increased cell turnover (leukemia)
Cystine kidney stones
hexagonal crystals
congenital defect in cysteine resorption
Renal cell carcinoma
yellow color/upper pole of kidney
assc with Von Hippel-Lindau (chromosome 3 deletion) and tuberous sclerosis
mets to lung/bone
Wilm’s tumor
2-4 y/o
deletion of suppressor gene WT1 chromosome 11
embryonic glomerular structures
Anirida/GI malformation/MR (Beckwith Wiedemann syndrome)
Transitional cell carcinoma
painless hematuria
assc with aniline dyes/cyclophosphamide
Acute pyelonephritis
WBC casts
neutrophils
affects cortex (not glomeruli)
tubular necrosis
Chronic pyelonephritis
Eosinophilic casts
vesicoureteral reflux
corticomedullary scarring
thyroidization of kidney
Drug induced interstitial nephritis
eosinophils/azotemia
1-2 wks after drug use (but months with NSAIDs)
hypersensitivity rxn
Acute tubular necrosis
HgCl/CCl4/ethylene glycol all cause
metabolic acidosis and oliguria
granular casts
assc with renal ischemia
Renal papillary neccrosis
sloughing off of renal papillae
hematuria/proteinuria
DM/sickle cell/acute pyelonephritis/chronic phenacetin use
Prerenal azotemia labs
increased BUN/creatinine ratio
decreased GFR
Intrinsic renal azotemia labs
due to acute tubular necrosis
decreased BUN/creatinine ratio
fluid backflow
Postrenal azotemia labs
normal BUN/creatinine ratio
outflow obstruction
Renal osteodystrophy
failure of Vit D hydroxylation
increased PTH (secondary to increased phosphate)
subperiosteal thinning of bone
Chromophobe renal carcinoma
(+) Hale’s colloidal iron stain
halo around nucleus
tan-brown color
ADPKD
multiple lg bilateral cysts
mutation of PKD1/PKD2
assc with berrry aneurysms
destroys kidney parenchyma
ARPKD
infantile PKD
sponge like appearance of medulla/cortex
hepatic fibrosis
assc with Potter’s syndrome (oligohydramnios)
Medullary sponge kidney
assc with Marfan’s/Ehler’s Danlos
dilations of collecting ducts
adult onset
Acetazolamide use
glaucoma
altitude sickness
pseudotumor cerebri (increased ICP)
Furosemide adverse effects
loop diuretic
ototoxicity/gout
sulfa allergy
Use of ethacrynic acid
for pts with sulfa allergy who cannot use furosemide
HCT adverse effect
hyperlipidemia
sulfa allergy
hyperglycemia
Spironolactone adverse effects
gynecomastia
hyperkalemia
ACE-I’s contraindication
bilateral renal artery stenosis
