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Step 1 > Renal > Flashcards

Renal Flashcards

1
Q

When is the ureteric bud fully canalized?

A

10wk

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2
Q

What do the
pronephros
mesonephros
metanephros become?

A

Pronephros- degenerates
Mesonephros- male gential system (interim kidney for 1st trimester)
Metanephros- filtration portion of kidney

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3
Q

Where does the ureteric bud start?

A

collecting duct

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4
Q

What presents as limb deformities, facial anomalies, low-set ears, retrognathia

A

Potter sequence (oligohydramnios)

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5
Q

What vessel does a horeshoe kidney get trapped under?

A

IMA

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6
Q

What is the cause of multicystic dysplastic kidney?

A

abnormal interaction between ureteric bud and metanephric mesenchyme

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7
Q

What percentage of body weight is

  • total body water
  • ICF
  • ECF?
A

60% total body water
40% ICF
20% ECF

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8
Q

What are is used to measure plasma volume? ECF?

A

plasma volume- radiolabeled albumin

ECF- inulin

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9
Q

How is clearance calculated?

A

Cx=UxV/Px

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10
Q

What is a normal GFR?

A

100ml/min

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11
Q

What is used to calculate GFR? RPF?

A

GFR- inulin, creatinine clearance

RPF- PAH

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12
Q

What is FF? What is a normal value?

A

FF=GFR/RPF

normal= 20%

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13
Q

What is the effect of Ang II on RPF/GFR/FF? Why is this?

A

Ang II preferentially restricts efferent arteriole

decr RPF, incr GFR, incr FF

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14
Q

What is the effect of prostaglandin on RPF/GFR/FF? Why is this?

A

prostaglandins dilate afferent arterioles

incr RPF, incr GFR, FF constant

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15
Q

What is the threshold of glucosuria? When are transporters fully saturated?

A

threshold- 200mg/dL

saturated- 375 mg/dl

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16
Q

What presents as a pellagra-like disease with neutral amminoaciduria?

A

Hartnup disease

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17
Q

What is the treatment of Hartnup disease?

A

High protein diet and nicotinic acid

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18
Q

What does effect does Ang II have on kidney absorption?

A

PCT- stimulates Na/H exchange- incr abs Na, H20, HCO3

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19
Q

What do loop diuretics work on?

A

NaKCC of thick ascending loop of Henle

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20
Q

How do loop diuretics affect absorption of Mg, Ca?

A

diminish + potential in thick ascending limb

Mg2+, Ca2+ no longer diffuse down gradient (decr reabsorption)

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21
Q

What are the effects of PTH on the kidney?

A

inhibit Na/PO4 cotransport in PCT

incr Ca/Na exchange in DCT

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22
Q

What renal tubular defect presents as metabolic acidosis, glucosuria, amnioaciduria?

A

Fanconi syndrome

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23
Q

What is defective in Fanconi syndrome?

A

Reabsorptive defect in PCT

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24
Q

What renal tubular defect presents as hypokalemia, metabolic alkalosis, and hypercalciuria?

A

Bartter syndrome

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25
Q

What renal tubular defect presents as hypokalemia, metabolic alkalosis, no hypercalciuria?

A

Gitelman syndrome

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26
Q

What renal tubular defect presents as hypertension, hypokalemia, metabolic acidosis, decr aldost?

A

Liddle syndrome

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27
Q

What is the treatment of Liddle syndrome?

A

Amiloride

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28
Q

What is defective in Bartter syndrome?

A

Na/K/CC in thick ascending loop of Henle

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29
Q

What is defective in Liddle syndrome?

A

Incr Na+ reabsorption in distal and collecting tubules (aut dom- incr ENac activity)

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30
Q

What is defective in Gitelman syndrome?

A

Reabsorptive defect of NaCl in DCT

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31
Q

What is the autonomic stimulation of the kidney?

A

Incr sympathetic tone (B1 receptors)

incr renin secretion

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32
Q

What effect does AT II have on baroreceptor reflect?

A

limits reflex bradycardia

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33
Q

What is the stimulus and effect of ANP?

A

stimulus- incr volume in atria

effect- relaxes smooth muscle via cGMP- incr GFR, decr renin

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34
Q

What cells secrete EPO?

A

interstitial cells in peritubular capillary bed

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35
Q

What is the effect of insulin on K+ levels? What is the mechanism?

A

Shifts K+ into cell via incr activity of Na/K ATPase (INsulin, K+ IN cell)

36
Q

What is the effect of digitalis on K+?

A

shifts out of cell- causes hyperkalemia

37
Q

What is the effect of B-adrenergic stimulus on K+ levels?

A

B-adrenergic antag- K+ out of cell

B-adrenergic agonist- K+ into cell

38
Q

What does a wide QRS and peaked T wave indicate?

A

Hyperkalemia

39
Q

What does U waves and flattened T waves indicate?

A

Hypokalemia

40
Q

Alteration in what electrolyte causes tetany and torsades de pointes?

A

hypomagnesemia

41
Q

Alteration in what electrolyte causes decr DTRs, bradycardia, hypotension, hypocalcemia?

A

Hypermagnesemia

42
Q

Alteration in what electrolyte causes irritability, stupor, coma?

A

high serum Na

43
Q

Alteration in what electrolyte causes nausea, malaise, stupor, coma?

A

low serum Na

44
Q

Alteration in what electrolyte causes tetany, seizures, prolonged QT?

A

low serum Ca

45
Q

What is the henderson-hasselbach equation?

A

pH=6.1+ log[HCO3]/0.03PCO2

46
Q

What is Winter’s formula?

A

PCO=1.5[HCO3]+8+/-2

predicts mixed acid base disorder

47
Q

How is an anion gap calculated?

A

AG=Na-(Cl+HCO3)

Normal=8-12

48
Q

What are the effects of salicylates on arterial pH?

A

early- respiratory alkalosis

late-anion gap metabolic acidosis

49
Q

Compare Type 1, 2, and 4 renal tubular acidosis

A

Type 1- distal, pH > 5.5
defect in ability of a-intercalatd cells to secrete H+
Type 2- proximal, pH<5.5
defect in proximal tubule HCO3- reabsoprtion
Type 4- hypoaldosteronism, aldost resistance or K+ sparing diuretic

50
Q

What do fatty casts indicate?

A

Nephrotic syndrome

51
Q

What do granular casts indicate?

A

acute tubular necrosis

52
Q

What do waxy casts indicate?

A

advanced renal disease/ chronic renal failure

53
Q

What do hyaline casts indicate?

A

Can be normal

often seen in concentrated urine

54
Q

Describe findings for nephrotic syndrome vs nephritic syndrome

A

nephortic- massive proteinuria, hyperlipidemia, fatty casts, edema
nephritic- hematuria, RBC casts in urine (inflammatory process)

55
Q

Nephrotic syndrome that presents with segmental sclerosis and hyalinosis

A

focal segmental glomerulosclerosis

56
Q

Nephrotic syndrome that presents with diffuse capillary and GBM thickening, spike and dome appearance with subepithelial deposits

A

Membranous nephropathy

57
Q

Nephrotic syndrome that shows apple-green birefringence with Congo-red stain

A

Amyloidosis

58
Q

Nephrotic or nephritic syndrome that shows subendothelial immune complexes, tram-track appearance

A

Type I membranoproliferative glomerulonephritis

59
Q

Nephrotic or nephritic syndrome that shows intramembranous IC deposits (“dense deposits”)

A

Type II membranoproliferative glomerulonephritis

60
Q

Nephrotic syndrome that shows mensangial expansion, GBM thickening, eosinophilic nodular glomerulosclerosis

A

Diabetic glomerulonephropathy

61
Q

What is the pathogenesis of diabetic glomerulonephropathy (2 parts)

A

NEG of GBM: incr permeability/thickening

NEG of efferent arterioles: mesangial expansion (incr GFR)

62
Q

What kidney syndrome is associated with HBV and HCV?

A

Type I MPGN

63
Q

What kidney syndrome is associated with C3 nephritic factor?

A

Type II MPGN

64
Q

What is the etiology of Goodpasture syndrome?

A

Type II hypersensitivity

Ab against GBM, alveolar BM

65
Q

What type of immune reaction is acute poststreptococcal GN?

A

Type III hypersensivity

66
Q

Presents with peripheral and periorbital edema, dark urine, hypertension

A

acute poststreptococcal GN

67
Q

Presents with a cresent-moon shape in glomerulus

A

RPGN

68
Q

What is the defect in Alport syndrome?

A

Type IV collagen defect

69
Q

What presents as glomerulonephritis, deafness, eye problems

A

Alport syndrome

70
Q

What is the treatment of Uric acid kidney stones?

A

alkalinization of urine

71
Q

What is the treatment of cystine kidney stones?

A

alkalinization of urine

72
Q

What type of calcium kidney stones are associated with incr, decr pH?

A

Incr pH- CaPO4

decr pH- Caoxalate

73
Q

What type of kidney stones are envelope or dumbell shape?

A

Calcium

74
Q

What type of kidney stones are coffin lid shape?

A

Ammonium magnesium phosphate

75
Q

What type of kidney stones are rhomboid or rosette shape?

A

Uric acid

76
Q

What type of kidney stones are hexagonal?

A

Cystine

77
Q

How does renal cell carcinoma metastasize? What are common sites?

A

hematogenously

lung and bone

78
Q

What gene deletion is associated with renal cell carcinoma?

A

deletion on chromosome 3

hereditary=VHL

79
Q

What is the underlying cause of squamous cell carcinoma of bladder?

A

chronic iritation– squamous cell metaplasia

schistosoma hematobium, smoking

80
Q

Describe the pathology of renal oncocytoma

A

large eosinophilic cells with abundant mitochondria, no perinuclear clearing

81
Q

What infection is associated with hemorrhagic cystitis?

A

adenovirus

82
Q

What areas are spared in acute glomerulonephritis?

A

glomeruli and vessels

83
Q

Presents as thyroidization of the kidney

A

chronic pyelonphritis

84
Q

What areas of the kidney (specifically) are most susceptible to ischemic vs nephrotoxic damage?

A

ischemic: proximal tubule, thick ascending limb
nephrotoxic: proximal tubule

85
Q

Compare BUN/Cr and FENa for Prerenal, intrinsic renal, and postrenal azotemia

A

Prerenal: BUN/Cr >20, FENa 2%
Postrenal: >15, >1-2%

86
Q

Compare simple vs complex renal cysts

A

Simple- outer cortex, filled with ultrafiltrate- often benign/incidental
complex cysts- septated, enhanced, solid components- require follow up (risk RCC)

87
Q

What is the inheritance and genetic assoc of ADPKD?

A

Aut Dom
PKD1- Chr 16
PKD2- Chr 4

Step 1 (34 decks)

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