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RENAL Flashcards

1
Q

During what week does the metanephros first appear?

A

5th week of gestation

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2
Q

What structure is the ureteric bud derived from? Name 4 structures that the ureteric bud gives rise to.

A

Derived from caudal end of mesonephros.

Gives rise to ureter, pelvises, calyces, and collecting ducts

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3
Q

Most common site of obstruction in fetus

A

Ureteropelvic junction

Last to canalize!

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4
Q

An infant is born with holoprosencephaly, short arms, and short legs. In utero, you noted little amniotic fluid. What is the most likely cause of death, and what was the original cause of this disease?

A

This is Potter Syndrome. Oligohydramnios –> compression of the fetus –>limb deformities, facial deformities, and pulmonary hypoplasia (cause of death).
This was the failure of the ureteric bud to form.

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5
Q

Cause of horseshoe kidney and major association

A

Kidneys failed to ascend due to entrapment by inferior mesenteric artery. Associated with Turner syndrome.

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6
Q

What substance makes the basement membrane of the glomerulus negatively charged?

A

Heparan sulfate

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7
Q

Describe the pathogenesis of nephrotic syndrome.

A

The charge barrier is lost (heparan sulfate fused with basement membrane gives it a negative charge), resulting in albuminuria, hypoproteinemia, generalized edema, and hyperlipidemia.

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8
Q

2 substances used to calculate GFR

A

Inulin

Creatinine

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9
Q

Equation for Effective Renal Plasma Flow

A

ERPF = clearance of PAH

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10
Q

Equation for Renal Blood Flow

A

RBF = RPF/(1-hct)

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11
Q

Equation for filtration fraction

A

GFR/RPF

Normal = 20%

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12
Q

Equation for filtered load

A

GFR x Plasma concentration

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13
Q

Equation for excretion rate

A

V x Urine concentration

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14
Q

What is the maximal serum glucose concentration at which glucose can be absorbed in the tubules?

A

350 mg/dL

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15
Q

How does constriction of the AFFerent arteriole affect GFR, RBF, and FF?

A

GFR and RBF both decrease.

No change in FF.

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16
Q

How does constriction of the EFFerent arteriole affect GFR, RBF, and FF>?

A

Increase GFR
Decrease RBF
Increase FF

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17
Q

How does dilation of the AFFerent arteriole affect GFR, RBF, and FF?

A

Increased GFR and RBF

No change in FF

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18
Q

How does dilation of the EFFerent arteriole affect GFR, RBF, and FF?

A

Decreased GFR
Increased RBF
Decreased FF

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19
Q

How does an increase in serum protein affect GFR, RBF, and FF?

A

Decrease GFR
NO change in RBF
Decrease in FF

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20
Q

How does ureter stone obstruction affect GFR, RBF, and FF?

A

Decrease GFR
No change in RBF
Decrease FF

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21
Q

How do ACE inhibitors affect GFR, RBF, and FF?

A

Decrease GFR
Increase RBF
DEcrease FF

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22
Q

How do NSAIDs affect GFR, RBF, and FF?

A

Decrease GFR
Decrease RBF
No change in FF

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23
Q

What is the role of the principle cells in the collecting duct/distal tubule?

A

Reabsorb H20 and Na+

Secrete K+

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24
Q

What is the role of the intercalated cells in the collecting duct/distal tubule?

A

Secrete H+ or HCO3-

Reabsorb K+

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25
What are the 2 types of intercalated cells?
H+ secreting cells | HCO3- secreting cells
26
What effect does aldosterone have on the intercalated cells and principle cells of the collecting duct?
Stimulates intercalated cells to secrete acid. | Increases Na+ reabsorption and K+ secretion in principle cells.
27
What are the critical steps involved in excreting dilute urine?
Dilution of fluid in thick asc segment as solute is reabsorbed and water remains in the lumen (d/t impermeability of water in the thick asc limb). The absence of ADH renders the distal tubule and cortical collecting duct impermeable to water. Tubular fluid is diluted even more as solute is removed from the tubular fluid in the distal tubule and cortical collecting duct but water remains. Because of the low fluid osmolality in the collecting duct and the slight permeability of the medullary collecting duct to urea, urea enters the tubule from the medullary interstitium thereby keeping the osmolality of the medullary interstitium low.
28
Which segment of the renal tubule is responsible for concentrating urine?
Collecting duct
29
Which segment of the renal tubule is responsible for diluting urine?
Thick ascending limb
30
Where does water reabsorption occur in the Loop of Henle?
Thin descending limb
31
Which part of the renal tubule is always impermeable to water?
Thick ascending limb
32
Equation for plasma osmolality
2[Na+] + [glucose]/18 + [BUN]/2.8
33
6 things that shift potassium out of cells causing hyperkalemia
``` Low insulin Beta blockers Acidosis Digoxin Cell lysis (e.g. leukemia) ACE inhibitors ```
34
4 things that shift potassium into cells causing hypokalemia
Insulin Beta agonist Alkalosis Cell creation proliferation (e.g. tumor)
35
Peaked T waves on EKG fits what electrolyte disturbance?
Hyperkalemia
36
Which electrolyte disturbance can cause decreased DTRs?
Hypermagnesemia
37
Which electrolyte disturbance can cause flattened T waves, U waves on EKG?
Hypokalemia
38
Causes of increased anion gap acidosis
``` Methanol Uremia DKA Propylene glycol INH or iron tablets Lactic acidosis (cyanide, CO, hypoxia Ethylene glycol Salicylates or shock ```
39
Defining features of nephritic syndrome
Proteinuria < 3.5 g/day Hematuria with RBC casts in urine HTN, oliguria, azotemia
40
Which glomerular disease would you suspect with IF showing granular pattern of immune complex deposition and LM showing diffuse capillary thickening?
Membranous glomerulonephritis
41
Most common nephrotic syndrome in adults
Membranous glomerulonephropathy
42
Which nephrotic syndrome is associated with hepatitis B and HCV?
Membranoproliferative glomerulonephritis Type I
43
Which glomerular disease would you suspect with EM showing subendothelial humps and tram-track apperance?
Membranoproliferative glomerulonephropathy
44
Which glomerular disease would you suspect with EM showing spiking of the GBM due to electron dense subepithelial deposits?
Membranous glomerulonephropathy
45
Glomerular histology reveals multiple mesangial nodules. This lesion is indicative of what disease?
Diabetic glomerulonephritis (these are Kimmelstiel-Wilson nodules).
46
3 glomerular diseases that decrease serum complement levels
Post-Streptococcal glomerulonephritis Membranoproliferative glomerulonephritis type II Lupus nephritis
47
Which glomerular disease would you suspect with deposition of IgG, IgM, IgA, and C3 in the mesangium?
IgA nephropathy
48
Which glomerular disease would you suspect with granular pattern of immune complex deposition and LM displaying hypercellular glomeruli?
Acute Post Streptococcal Glomerulonephritis
49
This disease is characterized by nephritis, deafness, and cataracts.
Alport Syndrome
50
A tumor in the kidney is found to be actually a hamartoma comprised of blood vessels, smooth muscle, and adipose tissue. What associated d/o does this patient most likeyl have?
Angiomyolipoma assoc with tuberous sclerosis
51
Rare presentation of renal cell CA
Left-sided varicocele due to involvement of left renal vein by CA blocking drainage of left spermatic vein --> varicocele.
52
4 paraneoplastic syndromes seen with Renal Cell CA
EPO (polycythemia) Renin --> HTN PTHrP (hypercalcemia) ACTH
53
Pathogenesis of Renal Cell CA
Loss of VHL (3p) tumor suppressor gene which leads to increased IGF-1 (promotes growth) and increased HIF transcription factor (increases VEGF and PDGF)
54
Deletion of WT1
WT1 = tumor suppressor gene This results in WAGR syndrome -- Wilms Tumor + Aniridia + Genital abnormalities + mental/motor retardation. WT1 is located at 11p13
55
Mutations of WT1
Denys-Drash syndrome -- Wilms tumor + progressive renal (glomerular) dz + male pseudohermaphroditism CHROMOSOME 11
56
Composition of Wilm's Tumor
Malignant tumor comprised of blastema (immature kidney mesenchyme), primitive glomeruli and tubules, and stromal cells
57
Mutations in WT2 gene cluster particularly IGF-2
Beckwith Wiedemann syndrome -- Wilms tumor + neonatal hypoglycemia + muscular hemihypertrophy + organomegaly (including tongue) Imprinted genes at 11p15.5
58
4 risk factors for transitional cell CA
Smoking Phenacetin (from acetaminophen) Aniline Dyes Cyclophosphamide
59
What are the classic features of drug-induced Acute Interstitial Nephritis?
Acute renal failure caused by NSAIDs, penicillin, diuretics Fever, rash, eosinophilia*, azotemia May progress to renal papillary necrosis
60
4 causes of renal papillary necrosis
Chronic analgesic abuse DM Sickle cell trait or disease Severe acute pyelonephritis
61
In what disease are brown, granular casts seen in the urine?
Acute Tubular Necrosis
62
BUN:Cr ratio, FENa, and urine osmolarity in ATN
BUN:Cr < 15 FENa>2% Urine osm<500 mOsm/kg
63
Which segments of the kidney tubule are particularly susceptible to ischemic damage?
Proximal tubule Medullary segment of thick ascneding limb Need a ton of ATP
64
Which segment of the renal tubule is most susceptible to nephrotoxic damage?
Proximal tubule
65
6 causes of nephrotoxicity
``` Aminoglycosides Heavy metals Myoglobinuria Ethylene glycol Radiocontrast dye Urate (e.g. tumor lysis syndrome -- > rapid death of cells -- > increased [uric acid]) ```
66
What should you think of when you see oxalate crystals in the urine?
Ethylene glycol
67
BUN:Cr, FENa, and urine osmolality in prerenal azotemia
BUN:Cr > 15 (reabsorption of fluid and BUN ensues since low blood flow activates RAS, which increases reabsorption of H2O and a causing additional BUN to be reabsorbed) FENa < 1% (tubular function remains intact) URine osmolality > 500 mOsm/kg
68
Early post-renal azotemia values for BUN:Cr, FENa, and urine osmolality
BUN:Cr > 15 FENa < 1% Urine osmolality > 500mOsm/Kg
69
Long-standing post-renal azotemia values for BUN:Cr, FENa, and urine osmolality
BUN:Cr < 15 FENa>2% Urine osm < 500 mOsm/kg
70
3 associations with ADPKD
Berry aneurysm Hepatic cysts Mitral valve prolapse
71
Histological appearance of renal cell CA
Polygonal clear cell CA
72
Histological appearance of chronic pyelonephritis
Atrophic tubules containing eosinophilic proteinaceous material resemble thyroid follicles Waxy casts in urine
73
When are fatty casts seen in urine?
Nephrotic syndrome
74
When are epithelial cell cast seen in urine?
Renal tubular damage
75
When are waxy casts seen in urine?
End stage renal disease

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