Renal 2 Flashcards
linear deposits along the GBM indictae __ disease
deposits composed of __/__
anti-GBM ab target __ collagen
microscopy shows __ w monos/macros
MPGN has proliferating __ cels and inc __ matrix
GBM appears __ in Alport syndrome
Goodpasture
IgG/C3
type 4
golmerular crescents
mesangial, mesangial
lamellated
some PAH is __ by glomerulus into BS
majority is __ into PT and is never ___
therefore, tubular fluid conc of PAH is lowest in __ and highest in __
preexisting __ and __ onset are poor prognostc factors for PSGN
filtered
secreted, reabsorbed
Bowman Space, collecting tubule
__ places pt at inc risk for nephrolithiasis
usually occurs via crhonic met __ such as distal RTA or chronic diarrhea
high dietary __ actually dec risk of nephrolithiasis
__ is used in tx of heart failure
anti-androgenic effects block __ receptor and dec __ prodxn
__ androgen/estrogen ratio leading to Gynecomastia/dec libido/impotence
use __ instead as it is more selective
hypocitraturia
acidosis
Ca
Spironolactone
androgen, testosterone
dec
epleronone
ureters pass posterior to the __ vessels w/in the retropeitoneum
they then pass anterior to the __/__ arteries into the true pelvis
there, they lie anterior to the __ artery and medial to ovarian vessels
__ artery crosses over anterior surface of ureter
EIA/Testicular vessels lie __ and are not near the ureters
gonadal
common/external
internal iliac artery
uterine
deeper
pt w indwelling bladder catheter are at an inc risk of common/noncommon __
lactose fermenting gram neg rod is __/___/___
lactose fermenting gram pos rod is ___
__ is oxidase pos, nonlactose fermenting, gram neg
UTI
E coli, K pneumo, enterobacter
Enterococcus
P auerigonosa
embryonic kidney development starts w P/M/M
derived from __ cord from the __ ridge of intermediate mesoderm
Proneprhos is first, forms and __
Mesonpehros forms Midportion, persists in __
Wolffian ducts form __ duct system
in females, it regresses and becomes __ duct
True kidney is __
ureteric bud (met diverticulum) sprouts off caudally
induces formation of metanephric ___
UB gives rise to collecting __/__, __/__ calyces, renal __ and U__
MB forms G, B, P/D tubules and LoH
pronephros, mesonephros, metanephros
nephrogenic, urogenital
regresses
males
repro
Gartners
metanephros
blastema
ducts/tubules, minor/major, pelvis, ureter
glomeruli, BS, proximal/distal tubule, LoH
COLA share common transporter in intestine/kidneys
C__ is AR defective transporter
dec absorption, but normal levels of aa bc they can be absorbed as o___
impaired tubular absorption in kidney leads to __ stones
RF include __ urine pH, __ nidus, and urine __
pathognomonc for __ crystals
Cysteine, ornithine, lysine, arginine
cystinuria
oligopeptides
cystine
low, crystal, supersaturation
cystine
TLS occurs w chemo for __
rapid turnover inc release of __/__/__ to serum
uric acid is soluble at physiologic pH but will __ in acidic urine
occurs in __ tubule/__ duct
tx w __ urine and H__, inc urine __
lymphoma
K, phos, UA
crystalize
distal, collecting
alkaline, hydration, flow
cather assc UTI signicant RF is __ of catheter use
avoid __ caths, use __ technique, remove __ asap
ab not __
PTH responsible for Ca reabsorption in __ tubules and __ ducts
MM has __ VD levels due to dec activity of 1ahydroxylase
urine Ca will be __
duration
unnecc, sterile, catheter
useful
distal, collecting
low
high
__ indiates nephropathy in a diabetic pt
treat w __/__ control and __/__ to stop progression to CKD
avoid __ bc it inc glucose
PAH is filtered by glomerulus and is not __
as blood PAH inc, tubular fluid PAH in BS will __
PAH is secreted in PCT in __ process
this can be __, and then PAH will be present in urine
microalbuminuria
glycemic/BP, ACEI/ARB
thiazides
saturable
inc
carrier mediated
saturated
acute renal failure, fever, oliguria wks after transplant is acute __ rejection
see dense infiltrate of __ against interstitium, tubules, intima
tx w calcinuerin inhibs like C/T
GVHD occurs in __ transplant
graft __ directed against host antigens due to lack of host __ cells
must match exact ___
acute humoral immunity causes necrotizing __ w PMN infiltrate
cellular
monocytes
cyclosporine, tacrolimus
bone marrow
T cells, T cells
HLA
vasculitis
pt RV HTN needs __ mediated vasoconstriction to maintain GFR
if use __, this dec AT2, causing dilation of EA, reducing __/__
normal pts, serum creatinine can rie __% after ACEI, but is __
carefully use ACEI in pt w CAD bc of risk of __
AT2
ACEI
GFR, FF
30, reversible
RV HTN
aminoglycosides, contrast, cisplatin, amphotericin B, foscarnet can all cause __ necrosis
Sulfonamides, MTX, acyclovir, triamtere can precipitate in __ causing obstruction
lithium/Cyclosporine can cause _ interstitial nephritis
drug induced tubular
renal tubules
chronic
EPO stimulating agents can tx __ of CKD
can prevent need for __, but inc risk of __ events and __ due to inc blood viscosity/mass
dec renal blood flow results in acute tubular __
initiating stage precip by H/M
maintenance stage is O\_\_ pt develops \_\_ overload w wg/edema \_\_kalemia inc \_\_/\_\_ leads to met acid low Na/Ca but high \_\_/_ urinalysis w \_\_ casts, high \_\_
recovery phase has mssive __, leads to dec levels of __ such as potassium
anemia
transfusion, thromboembolic, HTN
necrosis
hemorrhage, MI
oliguric fluid hyper H/K Phos, Mg muddy brown, FeNa
diuresis, electrolytes
Excessive diuretic use dec distal Na delivery, leading to activation of the RAAS
thus, aldosterone acts, resulting in hypo__ and metaboic __
Loops throw off the __ conc gradient, thus pt cannot conc urine so serum electrolytes are __
pt on thiazide diuretic has normal __ gradient, absorbing water, leading to hypoNa/hyperCa
kalemia, acidosis
CCM, low
CCM conc
S__ inhibits mTOR signalling
blocks cell __/__
binds to FK506__ protein, interrupting __ transduction
prevents progression from __ to __ and lymph prolif
__ inhibits the 26s protesome in MM
__ inhibits IMP dehydrogenase
inhibits __/__ cell prolif and promotes T cell __
sirolimus
growth/prolif
FKBP, IL2
G1 to S
borzotemib
mycophenalate
B/T, apoptosis
ACE I cause peripheral __ to reduce afterload to heart
dec contractile __ and myocardial __
slow progression of __/__ formation
__ occurs when there is a limit to absorption
determed by __ for active reabsorption
occurs for __, which is completely reasborbed in the __
when it exceeds Tm, __ occurs
PAH is freely __ into tubular lumen, thus is always __ to a greater degree than filtered
VD
force, oxygen demand
LVH, scar
transport max
receptors
glucose, PCT
glucosuria
secreted, excreted
thick/thin ascending LoH are __ to water passage, regardless of ADH
NaK2Cl cotransporters work to create the ___ gradient
ADH inc water permeability to the //__
DKA causes met acidosis, and __ falls
this induces __ via a chemoreceptor reflex causing respiratory ___
impermeable
CCM conc
DCT, cortical/medullary collectign duct
HCO3
ventilation, alkalosis
polyuria that resolves w desmopressin dx __
cortical collecting duct is impermeable to __
ADH activates urea transporters on the __ collecting duct, dec renal urea clearance
this allows urea to generate the ___
central DI
urea
medullary
CCM conc gradient
younger pt w flu like sx, fever, new systolic murmur has ____
may have inc creatitine/hematuria/proteinuria suggesting nephritic ___
see capillary wall thickening w __/__ deposits
similar to __/__ on LM
ADPKD extrarenal manifestations __ cyst and IC __
scans show multiple renal/liver cysts that do not ___
may have __ cysts at birth
IE
glomerulonephritis
subendo/subepi
PSGN, MPGN
liver, anuerysm
enhance
microscopic
Thin basement membrane disease is due to mutation in __
only abnorm is ___
__ occurs as recurrent, self limited, painless hematuria w/in 5 days of a URI
__ IgA deposits
type 2 RPGN aka __ occurs after formation of /__//__
type 4 collagen
thin basement membrane
IgA nephropathy
mesangial
Immune complex RPGN
IgA neph, HSP, PSGN, SLE
proximal tubular cell balooning and vacuolar degen occur in pt w __
oxalate crystals indicate __ poisoning
may have __ casts and __ necrosis
fever, rash, ARF w/in weeks of starting B lactam indicate \_\_\_ as dx other meds include S, R, D, N presents w inc \_\_/\_\_ in serum \_\_ in urine vi Hansel/wright stain may see T\_\_ and \_\_ form
affects renal __ resulting in E/__ infiltration
acute tubular necrosis
ethylene glycol
tubular, PT
acute interstitial nephritis Sulfonamides, rifampin, diuretics, NSAIDs IgE, eosinophils eosinophls tubulitis, granulomas
interstitium, edema, leuk
pt w metabolic acidosis results in renal ___
renal epithelial cells metabolize __ to glutamate, forming __/__
ammonium is then transported and __ in urine, allowing for __ reabsorption as a buffer
this process is important for __ excretion in chronic acidosis
glutamine, NH4/HCO3
excreted
HCO3
acid
RBF is regulated by renal __/__ and ___
use RPF and __ instead
RPF= __ clearance
urine PAH x urine flow rate
plasma PAH
RBF= __/___
arteries/veins, resistance
Hct
PAH
PAH clearance/1-Hct
horseshoe kidneys are fused at the __ poles
pt at inc risk of __ obs, recurrent __ and __ in kids/__ in adults
as kidney ascends from __ region in early life, horshoe is caught bw __/___
pt w atherosclerosis at risk for ___
look for renal __/__
__ discepancy bw kidneys w __ of affected kidney, __ kidney enlarges
lower
UPJ, infections, wilms/RCC
sacral, IMA/IVC
RAS
bruit/HTN
size
atrophy, contra
water deprivtion test causes urine osmolarity to be __ in central/complete Nephro DI w inc serum osmolarity
w desmopressin, pt w central DI will have __ in urine osmolarity, while __ do not
partial nephrogenic DI will have slow, steady rise in urine osmolarity after ___
low
inc, complete NDI
water deprivation
__ is most common renal tumor
__ may result as paraneoplastic process due to EPO prodxn
hydronephrosis can present w HTN, dec __, and __
may have palpable __/__
__ has discrete, posterior nodules on prostate
diffuse, symmetric enlargement/firmness indicates ___
RCC
polycythemia
RF, sepsis
bladder/kidney
prostate cancer
BPH
__ is common cause of ATN
pt has inc __ and __, normal __/__ ratio and o__
ischemic injury damages the renal __ which has minimal blood supply
__ tubule and __ LoH are most commonly affected bc they use __ transport of ions/oxygen demand
__ of PT epithelial cells, loss of brush border
cell __ and __ of TBM
look for __
ischemic event
creat/BUN
oliguria
medullla
PCT, thick ascending
ATP dependent
flattened, necrosis, denuding
muddy brown casts
flank pain/mass post pelvic surgery suggests _ obs
vulnerable to surgery esp
w pelvic __/h
ureter is __ but normal urine __ and serum __
__ kidney will compensate
ureter
LAN, hysterectomy
dilated, output/creatinine
contralateral
