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Step 1 prep > Renal > Flashcards

Renal Flashcards

1
Q

What are the 3 stimuli for renin release?

A
  1. Beta adrenergic stimulation
  2. Low sodium in the DCT (sensed by macula densa cells)
  3. Low renal arterial bp (sensed by JG cells)
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2
Q

What’s the equation for renal clearance?

A

CL=U*V/P
U=urine concentration of substance
V=urine flow rate
P=plasma concentration

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3
Q

How do we estimate GFR?

A

Clearance of inulin (UV/P)

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4
Q

What’s going on if the clearance of a substance is less than the GFR?

A

Substance is being reabsorbed by the tubules

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5
Q

What’s occurring if the clearance of a substance is more than the GFR

A

Substance is being secreted into the tubular lumen

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6
Q

What is a normal GFR?

A

~100ml/min

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7
Q

Does creatinine clearance overestimate or underestimate GFR?

A

Slightly overestimates GFR bc a little bit of creatinine is secreted from the tubules

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8
Q

What is PAH clearance used to estimate?

A

Renal plasma flow

CL of PAH

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9
Q

Why is PAH used to estimate RPF?

A

PAH is freely filtered and secreted.

All the PAH going to the kidney will be excreted!

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10
Q

What’s the equation for Filtration fraction?

A

FF=GFR/RPF

  • GFR estimated with creatinine clearance
  • RPF estimated with PAH clearance
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11
Q

What’s a normal FF?

A

20%

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12
Q

how do prostaglandins affect the GFR and RPF?

A

PG dilate the afferent arteriole, which will increase the RPF and GFR

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13
Q

What is the effect of NSAIDs on the GFR and RPF?

A

NSAIDs will block PG synthesis, leading to vasoconstriction of the afferent arteriole. This would decrease the GFR and RPF

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14
Q

Do NSAIDs affect the FF?

A

No, GFR and RPF are both decreased equally, so the FF would be the same

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15
Q

What is the effect of Angiotensin II on the glomerulus?

A

Angiotensin II preferentially constricts the Efferent arteriole. This creates a backpressure that will lead to increased GFR but decreased RPF (increased FF)

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16
Q

How do ACE inhibitors affect FF?

A

ACEIs inhibit the formation of AngT II, so this would lead to a vasodilation of the efferent arteriole. This would increase RPF but decrease GFR, leading to a Decreased FF

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17
Q

What’s the equation for filtered load of a substance?

A

FL=GFR*P

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18
Q

Equation for Excretion rate?

A

Excretion rate=U*V

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19
Q

How do you determine how much of a substance was reabsorbed?

A

filtered-excreted

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20
Q

How do you determine how much of a substance is secreted?

A

Excreted-filtered

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21
Q

Is glucose filtered?

A

Glucose and amino acids are freely filtered but reabsorbed by the renal tubules

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22
Q

How is glucose reabsorbed in the renal tubules?

A

Na/Glucose co-transporter in the PCT

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23
Q

How are amino acids reabsorbed?

A

Na cotransport

-There are separate transporters for neutral, positive and negative amino acids

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24
Q

Deficiency of transporter for neutral AAs. Leads to an inability to make niacin bc no tryptophan

A

Hartnup dz
inability to make niacin:
“3 D’s of pellagra”
-Dermatitis, Diarrhea, Dementia”

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25
Q

What substance is required for active secretion of anions in the PCT?

A

alpha-ketoglutarate exchanged for anions on the basolateral membrane. The anion is then secreted into the lumen

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26
Q

Which part of the loop of Henle is responsible primarily for water reabsorption?

A

Thin descending limp is impermeable to Na, so lots of water reabsorption occurs here

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27
Q

What is the thick ascending limb primarily impermeable to?

A

Water

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28
Q

What are 3 important points to remember about the thick ascending limb?

A
  1. Impermeable to water
  2. Ca and Mg are reabsorbed here
  3. Na/2Cl/K symporter is inhibited by loop diuretics
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29
Q

How does PTH increase Calcium levels?

A

Stimulates bone resorption
Stimulates kidneys to activate vitamin D
Stimulates kidneys to reabsorb more Ca (DCT)

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30
Q

Which diuretic is used to treat acute glaucoma?

A

Mannitol

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31
Q

Which diuretic is used to treat chronic glaucoma?

A

Acetazolamide

32
Q

Drug class: Triamterene

A

K sparing diuretic

33
Q

Drug class: Acetazolamide

A

Carbonic anhydrase inhibitor

34
Q

Drug class: Hydrochlorothiazide

A

Thiazide diuretic

35
Q

Drug class: Bumetanide

A

Loop diuretic

36
Q

Drug class: Spironolactone

A

K sparing diuretic

37
Q

Drug class: Chlorothiazide

A

Thiazide diuretic

38
Q

Drug class: Ethacrynic acid

A

Loop diuretic

39
Q

Drug class: Mannitol

A

Osmotic diuretic

40
Q

Drug class: Metolazone

A

Thiazide diuretic

41
Q

Drug class: Chlorthalidone

A

Thiazide diuretic

42
Q

Drug class: Furosemide

A

Loop diuretic

43
Q

Drug class: Amiloride

A

K sparing diuretic

44
Q

Drug class: Torsemide

A

Loop diuretic

45
Q

What are the diagnostic criteria for Nephrotic syndrome?

A

Proteinuria >3.5g/day
Hypoalbuminemia
Peripheral edema

46
Q

Glomerular histology reveals multiple mesangial nodules. This lesion is indicative of waht dz?

A

Diabetic nephropathy

-Kimmelstiel-Wilson nodule

47
Q

Kid presents with episodes of gross hematuria and high-frequency hearing loss. What’s the dz?

A

Alport syndrome

-“Can’t see, can’t pee, can’t hear high C”

48
Q

Linear pattern of IgG deposition on Immunoflourescence?

A

Goodpasture syndrome

-Anti-GBM antibodies

49
Q

Lumpy-bumpy deposits of IgG, IgM and C3 in the mesangium

A

Poststreptococcal glomerulonephritis

50
Q

Deposits of IgA in the mesangium

A

IgA nephropathy

51
Q

Anti-GBM antibodies, Hematuria, hemoptysis

A

Goodpasture syndrome

52
Q

Nephritis, deafness, cataracts

A

Alport syndrome

53
Q

Crescent formation in glomeruli

A

Rapidly progressing GN

54
Q

Wire loop on LM

A

Lupus nephritis

55
Q

MC nephrotic syndrome in children

A

Minimal change dz

56
Q

MC nephrotic syndrome in adults

A

Focal segmental glomerulosclerosis

57
Q

Kimmelstiel-Wilson lesions (nodular glomerulosclerosis)

A

Diabetic nephropathy

58
Q

EM: effacement of podocyte foot processes

A

Minimal change dz

59
Q

Nephrotic syndrome associated with Hep B

A

Membranoproliferative GN

60
Q

Nephrotic syndrome associated with HIV

A

Focal segmental glomerulosclerosis

61
Q

EM: subendothelial humps and tram-track appearance

A

Membranoproliferative glomerulonephritis

62
Q

LM: segmental sclerosis and hyalinosis

A

Focal segmental glomerulosclerosis

63
Q

Purpura on the back of arms and legs, abdominal pain, IgA nephropathy

A

Henoch-Schonlein purpura

64
Q

Apple-green birefringence with congo-red stain under polarized light

A

Amyloidosis

65
Q

EM: spiking of the GBM due to subepithelial deposits

A

Membranous nephropathy

66
Q

RBC cast indicates:

A

Glomerular damage (GN, malignant HTN, etc)

67
Q

WBC cast indicates

A

Acute pyelonephritis

68
Q

Bacterial cast indicates:

A

Pyelonephritis

69
Q

Epithelial cast indicates

A

ATN, toxic ingestions

70
Q

Waxy cast indicates

A

Chronic renal failure, low urine flow situations

71
Q

Hyaline cast indicates

A

Normal, dehydrated

72
Q

Fatty cast indicates

A

Nephrotic syndrom

73
Q

Granular cast

A

Chronic renal dz, ATN

74
Q

MC tumor of the urinary tract system

A

Transitional cell carcinoma

75
Q

MC renal malignancy of early childhood

A

Wilm’s tumor (flank mass)

76
Q

Fever, rash, hematuria, Eosinophilia

A

Classic presentation of Acute interstitial nephritis

Step 1 prep (14 decks)

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