Renal Flashcards
1
Q
Aldosterone
A
Na reabsorbed, K+ and H+ excreted
2
Q
PAH
A
Freely filtered and also secreted by a carrier protein-mediated process
- Secretion can be saturated at high blood concentration
3
Q
Renal Papillary Necrosis
A
Associated with ischemia –> gross hematuria and proteinuria
- Sickle Cell (disease and trait)
- Diabetes
- Acute pyelonephritis
- Chronic phenacetin
4
Q
Removal of one Kidney: GFR changes
A
Immediate decrease in GFR by 50%, will increase to about 80% after several weeks
5
Q
Focal Segmental Glomerulosclerosis (FSGS)
A
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
6
Q
Nephrotic Syndromes
A
FSGS, Membranous, minimal change, diabetic glomerulonephropathy, amyloidosis
7
Q
Nephritic Syndromes
A
PSGN, RPGN, IgA glom., Alport
8
Q
Both Nephritic and Nephrotic
A
Diffuse proliferative (aw/ SLE) and Membranoproliferative
9
Q
Along Proximal Tubule: Increases and Decreases in Concentration
A
- Increases concentration: PAH, creatinine, inulin, and urea (Water reabsorbed so more concentrated)
- Decreases concentration: bicarb, glucose, and amino acids (These are reabsorbed)
10
Q
Pelvic Surgery Risk
A
Ureters at risk during pelvic surgeries (may be ligated) → hydronephrosis
11
Q
Blood Supply to Proximal 1/3 of Ureter
A
Branches of the Renal Artery (superior vesicular artery does the rest of the ureter)
12
Q
Cystinuria
A
From defective amino acid transport (decreased reabsorption of cysteine from urine); COLA
- Hexagonal Crystals
13
Q
Kidney Stones: Calcium Oxalate
A
MC
X-box shape (envelope) or Dumbell
14
Q
Kidney Stones: Calcium phosphate
A
Alkaline pH
X-box shape (envelope) or Dumbell
15
Q
Kidney Stones: Magnesium ammonium phosphate (struvite)
A
Coffin Shape
Alkaline pH
- aw/ Urease + bugs (proteus, Staph, Klebsiella)
- Staghorn may act as UTI nidus
16
Q
Kidney Stones: Uric Acid
A
Rhomboid or rosettes
- aw/ gout, or leukemia (high cell turnover)
17
Q
Kidney Stones: Cysteine
A
Hexagonal
- MC in children
- can form from staghorn calculi
- Sodium nitroprusside test +
18
Q
UTI w/ +leukocyte esterase and nitrite
A
E. faecalis or S. saprophyticus
- Most enterobacteriaceae (Gm- enteric rods): +nitrite
19
Q
Tx for UTI/Pyelonephritis w/ E. Coli
A
Ciprofloxacin
20
Q
HUS
A
- HUS: microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury
(Diarrhea associated)
21
Q
Henoch Schonlein Purpura
A
- 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
22
Q
IgA Nephropathy vs PSGN
A
IgA is seen after a few days (IgA deposits), PSGN is after a few weeks
23
Q
Renal Cell Carcinoma (RCC)
A
Clear Cell Carcinoma (MC subtype) from epithelial cells of proximal tubule
24
Q
Nephron Segment w/ Highest Osmolarity
A
Bottom of loop of Henle
- Absorb water in descending loop (impermeable to solutes) → concentrates
- Absorb NaCl in ascending loop (impermeable to water) dilutes
25
Acyclovir: Renal Side Effect
Obstructive crystalline nephropathy and acute renal failure if not adequately hydrated
26
Wilm's Tumor:
Chr 11
MC renal malignancy in children (age 2-4)
Huge flank mass containing embryonic glomerular structures
aw/ WAGR, Denys-Drash, Beckwith-Wiedemann
27
Hydronephrosis
Ureteropelvic junction MC site of obstruction
28
Tx for Nonobstructive Urinary Retention (atonic bladder)
Cholinergic Agent
29
Only radiolucent stones (visible)
Uric Acid Stones
30
Diabetic Neuropathy: Detrusor
Overflow Incontinence due to impaired detrusor contractility
| - TCAs can be used for diabetic peripheral neuropathy but will have anticholinergic effect
31
Cisplatin: Renal Side effect
Nephrotoxicity that can be prevented with amifostine
32
Ethylene glycol or methanol poisoning Antidote
Fomepizole
33
RPGN (rapidly progressive crescenteric glomerulonepritis)
- ANCA associated
- Also called Pauci Immune GN due to lack of Ig or C3 deposits
- Crescents (fibrin and protein) on light microscopy
- Goodpastures (anti-GBM, linear IF), Wegeners, or Microscopic polyangiitis)
34
In the true pelvis, ureter is anterolateral to _________
Internal iliac artery (uterine artery is medial)
35
Drug-Induced Acute Interstitial Nephritis (AIN)
1-3 weeks after drug (fever, rash, oliguria); eosinophilia
and azotemia
- diuretics, penicillin derivatives, sulfonamides, rifampin
- may occur months later w/ NSAIDs
36
Loop Diuretics Effect on Prostglandins
Loop diuretics also stimulate prostaglandin release → increased RBF and GFR → enhanced drug delivery
37
Formation of Stones Prevented w/:
Citrate and high fluid intake
38
Stress Incontinence
MC after age 45, due to loss of pelvic floor support and incompetent urethral sphincter (innervated by S3, S4)
- Increased abdominal pressure (cough, sneeze, etc) can cause brief involuntary urine loss
39
Urge Incontinence
- detrusor overactivity, sudden urge to urinate
40
Overflow Incontinence
- involuntary, continuous leakage, full bladder
- Due to impaired detrusor contractility (diabetic neuropathy)
- Bladder outlet obstruction (tumor blocking urethra)
41
Membranous Nephropathy has Antibodies to:
Phospholipase A2
42
Pauci Immune (Type 3 RPGN)
- no Ig or complement deposits, but it is still crescenteric
- ANCA antibodies
- Often aw/ Wegeners
43
Modified Smooth Muscle Cells in the Afferent Arteriole
Renin synthesizing JG (juxtaglomerular) cells
| - can hypertrophy/hyperplasia w/ chronic renal hypoperfusion
44
Ureteric Bud (Metanephric Diverticulum)
Collecting duct system (collecting ducts and tube, major and minor calyces, renal pelvis, and ureters)
45
Metanephric Mesoderm
glomeruli, Bowman's space, proximal tubules, loop of Henle, and distal convoluted tubule
46
Mesonephros
Wolffian ducts, ductus deferens, epididymis
47
Acetazolamide
Carbonic anhydrase inhibitor that acts on Proximal tubule
| - increased excretion of HCO3 (so alkaline urine), may develop metabolic acidosis
48
ATN: Maintenance Stage
Decreased urine output, fluid overload, high BUN and creatinine, HYPERkalemia
49
ATN: Recovery Phase
Gradual increase in urine output --> high volume diuresis
- Decreased K, Mg, PO4, and Ca
(HYPOkalemia)
50
Causes of Oligohydramnios: (3)
ARPKD, Posterior urethral valves, or bilateral renal agensis
51
Renal Artery
Renal --> segmental --> lobar --> interlobar --> arcuate --> interlobular
52
Isotonic Fluid Loss
Hemorrhage, Diarrhea, and Vomiting
53
Hypotonic Fluid Loss
Dehydration, Alcoholism, and DI
54
ICF Volume Changes
Inverse to Osmolarity
55
Radiolabeled Albumin measures:
Plasma Volume
56
Inulin measures:
Extracellular Volume
57
RPF =
RBF(1-Hct)
58
FF =
GFR/RPF (normal is 20%)
59
Afferent Arteriole
Dilated by prostaglandins (inhibited by NSAIDs)
60
Efferent Arteriole
Constricted by Ang II (inhibited bye ACEi and ARBs)
61
Ammonia In Nephron
Secreted in Proximal Tubule
62
Urine is Concentrated in:
Thin Descending Loop and Collecting Duct (depending on ADH)
63
Urine is Diluted in:
Thick Ascending Tubule and Distal Convoluted Tubule
64
Urea Secreted in:
Thin ascending tubule
65
Fanconi Syndrome
Reabsorption problem in proximal tubule
Increased excretion of all amino acids, glucose, HCO3, and PO4
- may cause metabolic acidosis
66
Bartter Syndrome
Na/K/2Cl transporter inhibited
- hypokalemia, metabolic alkalosis, and hypercalciuria
(similar to loop diuretics)
67
Gitelman Syndrome
NaCl transporter defect in distal tubule
- hypokalemia, metabolic alkalosis, NO hypercalciuria
(similar to thiazide diuretics)
68
Liddle Syndrome
Overactive/constitutive ENac Channel (too much Na reabsorption)
- hypertension, hypokalemia, metabolic alkalosis
- low aldosterone
Tx: amiloride or triamterene
69
Proximal Tubule absorbs (below the line)
HCO3, Glucose, and Amino Acids
70
Relative Concentrations along Proximal Tubule
> 1 is solute reabsorbed much slower than water
= 1 is solute and water are reabsorbed at the same rate
> 1 is solute is reabsorbed more quickly than water
71
Low Serum Mg2+ causes:
Tetany and Torsades de Pointes
| more Ca released from SR
72
Winter's Formula
PCO2 = 1.5 [HCO3] + 8 (+/- 2)
73
Anion Gap with Metabolic Acidosis
MUDPILES
| Methanol, Uremia, DKA, Propylene Glycol, Iron tablets or INH, Lactic acidosis, Ethylene Glycol. Salicylates (late)
74
Metabolic Acidosis w/out anion gap
HARDASS
| Hyperalimentaion, Addisons, Renal tubular acidosis, Diarrhea, Acetazolamide, Spironolactone, Saline infusion
75
Salicylates
Early Respiratory Alkalosis
Later Metabolic Acidosis
pH will be low/acidic to normal
76
Waxy Casts
Chronic renal failure
77
Muddy brown casts
ATN
78
Fatty Casts (oval bodies)
Nephrotic syndrome
79
Pyuria, without casts
Acute cystitis
80
Hematuria, without casts
Bladder cancer or Kidney stones
81
Membranous Nephropathy
- GBM thickening
- Spike and dome
- Caucasian (MC)
- aw/ Phospholipase A2 antibody
- SLE, NSAIDs, penicillamine, HBV, HCV, solid tumors
- Poor steroid response
82
Minimal Change Disease
- Glomeruli normal, foot process effacement
- Children after recent infection
- aw/ Hodgkins
- Great response to steroids
- Selective albuminuria
83
Membranoproliferative Glomerulonephritis (2 types) (MPGN)
- Hypercellular and thickened GBM
I: subendothelial deposits, tram track (GBM splitting)
- HBV, HCV
II: intramembranous complex deposits (dense deposits)
- Low C3
84
Diabetic Glomerulonephropathy
- thick GBM w/ non-enzymatic glycosylation
| - Kimmelsteil wilson nodules (mesangial expansion)
85
Acute Post-streptococcal Glomerulonephritis (PSGN)
- enlarged and hypercellular
- Starry sky, lumpy bumpy ( IgG, IgM, and C3 deposition)
Type III Hypersensitivity
- low C3
- Subepithelial humps on EM
- Few weeks after GAS infection (of skin or pharynx)
- Increased anti-DNase B
- cola colored urine and facial edema
86
Diffuse Proliferative Glomerulonephritis (DPGN)
- wire looping (chicken wire) capillaries, subendothelial deposits
- SLE or MPGN (MC cause of death in SLE)
87
IgA Nephropathy (Berger)
- mesangial proliferation and deposits (of IgA)
- aw/ Honoch Schonlein purpura
- aw/ URI or acute gastroenteritis
88
Alport Syndrome
- X-linked mutation in type IV collagen
- Deafness and eye problems
- Glomerulonephritis that will almost always become ESRD
89
Stones that form in Alkaline Environment
Calcium Phosphate and Ammonium Magnesium Phosphate (struvite)
90
Radiolucent Kidney Stones
Uric Acid
| - not visible on xray (can see on ultrasound)
91
Calcium Stones caused by:
Hypercalciuria (normocalcemia), ethylene glycol ingestion, Vit C abuse, or Crohns
92
Sodium nitroprusside test +
Cystine Stones
93
Staghorn Caliculi
Ammonium magnesium phosphate (struvite): adults
| Cystine: children
94
RCC treatment
Resistant to chemo and radiation
| - must resect
95
Renal oncocytoma
Benign epithelial tumor (well circumscribed)
- yellow brown central stellate scarring
- Large eosinophilic cells
96
RCC: Paraneoplastic
EPO, ACTH, and PTHrP
97
Transitional Cell Carcinoma: Causes
Phenacetin, Smoking, Aniline Dyes, and Cyclophosphamide
| also rubber, plastic, textile manufacturing
98
Squamous Cell Carcinoma of Bladder: Causes
Chronic irritation
| Schistosoma haematobium, chronic cystitis or nephrolithiasis, smoking
99
Wilm's Tumor: WAGR syndrome
- WAGR syndrome:
| wilms tumor, aniridia, genital abnormalities, motore retardation (WT1 deletion)
100
Wilm's Tumor: Denys-Drash Syndrome
- Denys-Drash Syndrome:
| wilms tumor, renal disease, male pseudohermaphroditism (WT1 mutation)
101
Wilm's Tumor: Beckwith-Wiedmann Syndrome
- Beckwith-Wiedemann syndrome:
| wilms tumor, neonatal hypoglycemia, muscle hemihypertrophy, organomegaly of tongue (WT2 mutation, IGF2 specifically)
102
Thyroidization of Kidney
Eosinophilic casts resembling thyroid tissue
| Chronic/recurrent pyelonephritis
103
ATN by Nephrotoxic Drugs
aminoglycosides (MC), radiocontrast agents, lead, cisplatin, Crush injury
104
Diffuse Cortical Necrosis of kidney
Vasospasm, DIC
| aw/ obstetric problems like abruptio placentae, or septic shock
105
Prerenal Azotemia
Increased Na reabsorption
| Increased BUN/Creatinine
106
Intrinsic Renal Failure
MC due to ATN
Impaired reabsorption of Na and BUN
Decreased BUN/Creatinine
107
Postrenal Azotemia
Outflow obstruction ( only if bilateral)
Less reabsorption of Na
Mild increase in BUN/Creatinine
108
Uremia: abnormal bleeding
Impaired platelet aggregation/adhesion due to uremic metabolites --> increased bleeding time only
(PT, PTT, platelet count are all normal)
109
Renal Osteodystrophy
Can hydroxylate Vit D so low Ca and high PO4 causing secondary hyperparathyroidism --> thinning of bones
110
Associations with ADPKD
Berry aneurysms
MVP
Hepatic cysts
111
Associations with ARPKD
Hepatic fibrosis
Portal hypertension
Potter Syndrome
112
Medullary Cystic Disease
Inherited tubulointerstitial fibrosis (AD)
Can't concentrate urine
Medullary cysts and shrunken kidney
113
Simple vs Complex Cysts
Simple: in outer cortex, filled with ultrafiltrate, MC, usually asymptomatic
Complex: have septated or solid component (removed because risk of RCC
114
Loop Diuretic for patients allergic to sulfa:
Ethacrynic Acid
- can cause hyperuricemia
- side effects similar to loop diuretics
115
Thiazide: Side effects
```
- Block NaCl symporter in distal tubule
Hyperglycemia
Hypercalcemia
Hyperuricemia
Hyperlipidemia
Hyponatremia and Hypokalemia
Metabolic Alkalosis
```
116
Spironolactone: Side Effects
Gynecomastia, antiandrogen effects
117
K+ Sparing Diuretics
Aldosterone Antagonists: spironolactone and eplerenone
ENac inhibitors: triamterene and amiloride
- all can cause hyperkalemia --> arrhythmia
118
MC cause of Fetal Hydronephrosis
Inadequate recanalization of ureteropelvic junction
| antenatal hydronephrosis is by vesicoureteral junction
119
Lowest pH in nephron
Distal Tubule and Collecting Duct
| where stones will obstruct
120
Increased risk of Varicocele or Hypercoagulation w/ Nephrotic Syndrome
Antithrombin and anticoagulant factors get lost in the urine leading to an overall state of hypercoagulability
121
Hyaline arteriolosclerosis of Renal Arteries
Nonmalignant HTN or Diabetes
122
Euvolemic Hyponatremia
SIADH
- appropriately concentrated urine, low serum sodium and osmolality but normal fluid volume due to compensation by ANP/BNP
123
Densely immunostaining protein containing cells near glomerulus:
JG cells w/ renin inside
124
Tamm-Horsfall Glycoprotein
can accumulate in lumen to make hyaline casts in prerenal azotemia
125
Causes of Central DI (5)
Pituitary tumor/resection, head trauma, brain tumor/infiltrative lesion, brain metastases
126
Causes of Nephrogenic DI (4)
Drugs (lithium, amphoteicin B, ciplastin, gentamicin)
Hypercalcemia
Hypokalemia
Postobstructive Diuresis
127
Xanthogranulomatous Pyelonephritis
Rare form of chronic pyelonephritis
- especially aw/ Proteus infection
- Tumor-like growth, upper urinary tract infection, and lipid-laden foamy macrophages (make this neither acute pyelo nor cancer)
128
Schistosomiasis
Schistosomiasis - particularly endemic in Africa
aw/ chronic cystitis
- Calcifications of the bladder wall (pathognomonic)
- Chronic infection is associated with an increased risk of squamous cell carcinoma of the bladder
129
NSAIDs can cause:
Acute Interstitial Nephritis
Membranous Nephropathy
Papillary Necrosis
130
Rhabdomyolysis
- Extreme exercise followed by renal failure
| - Dark urine (without actual blood in it) is due to myoglobinuria, which can cause a false positive urine dipstick.
131
Loop Diuretic Effects on Nephron
- inhibits Na/K/2Cl symporter in thick ascending
- decreases water absorption in the descending loop
- decreases osmolarity of medullary interstitium
132
Renal Failure and Toe Gangrene following an invasive vascular procedure
Atheroembolic renal disease
| - cholesterol emboli obstructing renal arterioles
133
Unilateral Renal Artery Stenosis
Usually a cause of secondary hypertension
| - kidney affected by stenosis often gets atrophied due to oxygen and nutrient deprivation
