Renal Flashcards
Aldosterone
Na reabsorbed, K+ and H+ excreted
PAH
Freely filtered and also secreted by a carrier protein-mediated process
- Secretion can be saturated at high blood concentration
Renal Papillary Necrosis
Associated with ischemia –> gross hematuria and proteinuria
- Sickle Cell (disease and trait)
- Diabetes
- Acute pyelonephritis
- Chronic phenacetin
Removal of one Kidney: GFR changes
Immediate decrease in GFR by 50%, will increase to about 80% after several weeks
Focal Segmental Glomerulosclerosis (FSGS)
HIV associated nephrotic syndrome; glomerular capillary wall collapse
- foot process effacement (similar to minimal change)
- black and hispanics
- HIV, Heroin, Sickle cell, IFN treatment
- inconsistent steroid response
Nephrotic Syndromes
FSGS, Membranous, minimal change, diabetic glomerulonephropathy, amyloidosis
Nephritic Syndromes
PSGN, RPGN, IgA glom., Alport
Both Nephritic and Nephrotic
Diffuse proliferative (aw/ SLE) and Membranoproliferative
Along Proximal Tubule: Increases and Decreases in Concentration
- Increases concentration: PAH, creatinine, inulin, and urea (Water reabsorbed so more concentrated)
- Decreases concentration: bicarb, glucose, and amino acids (These are reabsorbed)
Pelvic Surgery Risk
Ureters at risk during pelvic surgeries (may be ligated) → hydronephrosis
Blood Supply to Proximal 1/3 of Ureter
Branches of the Renal Artery (superior vesicular artery does the rest of the ureter)
Cystinuria
From defective amino acid transport (decreased reabsorption of cysteine from urine); COLA
- Hexagonal Crystals
Kidney Stones: Calcium Oxalate
MC
X-box shape (envelope) or Dumbell
Kidney Stones: Calcium phosphate
Alkaline pH
X-box shape (envelope) or Dumbell
Kidney Stones: Magnesium ammonium phosphate (struvite)
Coffin Shape
Alkaline pH
- aw/ Urease + bugs (proteus, Staph, Klebsiella)
- Staghorn may act as UTI nidus
Kidney Stones: Uric Acid
Rhomboid or rosettes
- aw/ gout, or leukemia (high cell turnover)
Kidney Stones: Cysteine
Hexagonal
- MC in children
- can form from staghorn calculi
- Sodium nitroprusside test +
UTI w/ +leukocyte esterase and nitrite
E. faecalis or S. saprophyticus
- Most enterobacteriaceae (Gm- enteric rods): +nitrite
Tx for UTI/Pyelonephritis w/ E. Coli
Ciprofloxacin
HUS
- HUS: microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury
(Diarrhea associated)
Henoch Schonlein Purpura
- systemic vasculitis caused by IgA Complex deposition that will also be seen with arthralgias and acute glomerulonephritis
- Small vessel leukocytoclastic angiitis in children
- aw abdominal pain and often palpable skin lesions; may have glomerulonephritis
IgA Nephropathy vs PSGN
IgA is seen after a few days (IgA deposits), PSGN is after a few weeks
Renal Cell Carcinoma (RCC)
Clear Cell Carcinoma (MC subtype) from epithelial cells of proximal tubule
Nephron Segment w/ Highest Osmolarity
Bottom of loop of Henle
- Absorb water in descending loop (impermeable to solutes) → concentrates
- Absorb NaCl in ascending loop (impermeable to water) dilutes