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Quick Notes for Step 1 > Renal > Flashcards

Renal Flashcards

1
Q

Aldosterone

A

Na reabsorbed, K+ and H+ excreted

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2
Q

PAH

A

Freely filtered and also secreted by a carrier protein-mediated process
- Secretion can be saturated at high blood concentration

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3
Q

Renal Papillary Necrosis

A

Associated with ischemia –> gross hematuria and proteinuria

  • Sickle Cell (disease and trait)
  • Diabetes
  • Acute pyelonephritis
  • Chronic phenacetin
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4
Q

Removal of one Kidney: GFR changes

A

Immediate decrease in GFR by 50%, will increase to about 80% after several weeks

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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
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6
Q

Nephrotic Syndromes

A

FSGS, Membranous, minimal change, diabetic glomerulonephropathy, amyloidosis

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7
Q

Nephritic Syndromes

A

PSGN, RPGN, IgA glom., Alport

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8
Q

Both Nephritic and Nephrotic

A

Diffuse proliferative (aw/ SLE) and Membranoproliferative

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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)
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10
Q

Pelvic Surgery Risk

A

Ureters at risk during pelvic surgeries (may be ligated) → hydronephrosis

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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)

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12
Q

Cystinuria

A

From defective amino acid transport (decreased reabsorption of cysteine from urine); COLA
- Hexagonal Crystals

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13
Q

Kidney Stones: Calcium Oxalate

A

MC

X-box shape (envelope) or Dumbell

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14
Q

Kidney Stones: Calcium phosphate

A

Alkaline pH

X-box shape (envelope) or Dumbell

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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

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16
Q

Kidney Stones: Uric Acid

A

Rhomboid or rosettes

- aw/ gout, or leukemia (high cell turnover)

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17
Q

Kidney Stones: Cysteine

A

Hexagonal

  • MC in children
  • can form from staghorn calculi
  • Sodium nitroprusside test +
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18
Q

UTI w/ +leukocyte esterase and nitrite

A

E. faecalis or S. saprophyticus

- Most enterobacteriaceae (Gm- enteric rods): +nitrite

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19
Q

Tx for UTI/Pyelonephritis w/ E. Coli

A

Ciprofloxacin

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20
Q

HUS

A
  • HUS: microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury
    (Diarrhea associated)
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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
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22
Q

IgA Nephropathy vs PSGN

A

IgA is seen after a few days (IgA deposits), PSGN is after a few weeks

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23
Q

Renal Cell Carcinoma (RCC)

A

Clear Cell Carcinoma (MC subtype) from epithelial cells of proximal tubule

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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
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25
Q

Acyclovir: Renal Side Effect

A

Obstructive crystalline nephropathy and acute renal failure if not adequately hydrated

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26
Q

Wilm’s Tumor:

A

Chr 11
MC renal malignancy in children (age 2-4)
Huge flank mass containing embryonic glomerular structures
aw/ WAGR, Denys-Drash, Beckwith-Wiedemann

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27
Q

Hydronephrosis

A

Ureteropelvic junction MC site of obstruction

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28
Q

Tx for Nonobstructive Urinary Retention (atonic bladder)

A

Cholinergic Agent

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29
Q

Only radiolucent stones (visible)

A

Uric Acid Stones

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30
Q

Diabetic Neuropathy: Detrusor

A

Overflow Incontinence due to impaired detrusor contractility

- TCAs can be used for diabetic peripheral neuropathy but will have anticholinergic effect

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31
Q

Cisplatin: Renal Side effect

A

Nephrotoxicity that can be prevented with amifostine

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32
Q

Ethylene glycol or methanol poisoning Antidote

A

Fomepizole

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33
Q

RPGN (rapidly progressive crescenteric glomerulonepritis)

A
  • 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)
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34
Q

In the true pelvis, ureter is anterolateral to _________

A

Internal iliac artery (uterine artery is medial)

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35
Q

Drug-Induced Acute Interstitial Nephritis (AIN)

A

1-3 weeks after drug (fever, rash, oliguria); eosinophilia
and azotemia
- diuretics, penicillin derivatives, sulfonamides, rifampin
- may occur months later w/ NSAIDs

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36
Q

Loop Diuretics Effect on Prostglandins

A

Loop diuretics also stimulate prostaglandin release → increased RBF and GFR → enhanced drug delivery

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37
Q

Formation of Stones Prevented w/:

A

Citrate and high fluid intake

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38
Q

Stress Incontinence

A

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

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39
Q

Urge Incontinence

A
  • detrusor overactivity, sudden urge to urinate
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40
Q

Overflow Incontinence

A
  • involuntary, continuous leakage, full bladder
  • Due to impaired detrusor contractility (diabetic neuropathy)
  • Bladder outlet obstruction (tumor blocking urethra)
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41
Q

Membranous Nephropathy has Antibodies to:

A

Phospholipase A2

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42
Q

Pauci Immune (Type 3 RPGN)

A
  • no Ig or complement deposits, but it is still crescenteric
  • ANCA antibodies
  • Often aw/ Wegeners
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43
Q

Modified Smooth Muscle Cells in the Afferent Arteriole

A

Renin synthesizing JG (juxtaglomerular) cells

- can hypertrophy/hyperplasia w/ chronic renal hypoperfusion

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44
Q

Ureteric Bud (Metanephric Diverticulum)

A

Collecting duct system (collecting ducts and tube, major and minor calyces, renal pelvis, and ureters)

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45
Q

Metanephric Mesoderm

A

glomeruli, Bowman’s space, proximal tubules, loop of Henle, and distal convoluted tubule

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46
Q

Mesonephros

A

Wolffian ducts, ductus deferens, epididymis

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47
Q

Acetazolamide

A

Carbonic anhydrase inhibitor that acts on Proximal tubule

- increased excretion of HCO3 (so alkaline urine), may develop metabolic acidosis

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48
Q

ATN: Maintenance Stage

A

Decreased urine output, fluid overload, high BUN and creatinine, HYPERkalemia

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49
Q

ATN: Recovery Phase

A

Gradual increase in urine output –> high volume diuresis
- Decreased K, Mg, PO4, and Ca
(HYPOkalemia)

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50
Q

Causes of Oligohydramnios: (3)

A

ARPKD, Posterior urethral valves, or bilateral renal agensis

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51
Q

Renal Artery

A

Renal –> segmental –> lobar –> interlobar –> arcuate –> interlobular

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52
Q

Isotonic Fluid Loss

A

Hemorrhage, Diarrhea, and Vomiting

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53
Q

Hypotonic Fluid Loss

A

Dehydration, Alcoholism, and DI

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54
Q

ICF Volume Changes

A

Inverse to Osmolarity

55
Q

Radiolabeled Albumin measures:

A

Plasma Volume

56
Q

Inulin measures:

A

Extracellular Volume

57
Q

RPF =

A

RBF(1-Hct)

58
Q

FF =

A

GFR/RPF (normal is 20%)

59
Q

Afferent Arteriole

A

Dilated by prostaglandins (inhibited by NSAIDs)

60
Q

Efferent Arteriole

A

Constricted by Ang II (inhibited bye ACEi and ARBs)

61
Q

Ammonia In Nephron

A

Secreted in Proximal Tubule

62
Q

Urine is Concentrated in:

A

Thin Descending Loop and Collecting Duct (depending on ADH)

63
Q

Urine is Diluted in:

A

Thick Ascending Tubule and Distal Convoluted Tubule

64
Q

Urea Secreted in:

A

Thin ascending tubule

65
Q

Fanconi Syndrome

A

Reabsorption problem in proximal tubule
Increased excretion of all amino acids, glucose, HCO3, and PO4
- may cause metabolic acidosis

66
Q

Bartter Syndrome

A

Na/K/2Cl transporter inhibited
- hypokalemia, metabolic alkalosis, and hypercalciuria
(similar to loop diuretics)

67
Q

Gitelman Syndrome

A

NaCl transporter defect in distal tubule
- hypokalemia, metabolic alkalosis, NO hypercalciuria
(similar to thiazide diuretics)

68
Q

Liddle Syndrome

A

Overactive/constitutive ENac Channel (too much Na reabsorption)
- hypertension, hypokalemia, metabolic alkalosis
- low aldosterone
Tx: amiloride or triamterene

69
Q

Proximal Tubule absorbs (below the line)

A

HCO3, Glucose, and Amino Acids

70
Q

Relative Concentrations along Proximal Tubule

A

> 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
Q

Low Serum Mg2+ causes:

A

Tetany and Torsades de Pointes

more Ca released from SR

72
Q

Winter’s Formula

A

PCO2 = 1.5 [HCO3] + 8 (+/- 2)

73
Q

Anion Gap with Metabolic Acidosis

A

MUDPILES

Methanol, Uremia, DKA, Propylene Glycol, Iron tablets or INH, Lactic acidosis, Ethylene Glycol. Salicylates (late)

74
Q

Metabolic Acidosis w/out anion gap

A

HARDASS

Hyperalimentaion, Addisons, Renal tubular acidosis, Diarrhea, Acetazolamide, Spironolactone, Saline infusion

75
Q

Salicylates

A

Early Respiratory Alkalosis
Later Metabolic Acidosis
pH will be low/acidic to normal

76
Q

Waxy Casts

A

Chronic renal failure

77
Q

Muddy brown casts

A

ATN

78
Q

Fatty Casts (oval bodies)

A

Nephrotic syndrome

79
Q

Pyuria, without casts

A

Acute cystitis

80
Q

Hematuria, without casts

A

Bladder cancer or Kidney stones

81
Q

Membranous Nephropathy

A
  • GBM thickening
  • Spike and dome
  • Caucasian (MC)
  • aw/ Phospholipase A2 antibody
  • SLE, NSAIDs, penicillamine, HBV, HCV, solid tumors
  • Poor steroid response
82
Q

Minimal Change Disease

A
  • Glomeruli normal, foot process effacement
  • Children after recent infection
  • aw/ Hodgkins
  • Great response to steroids
  • Selective albuminuria
83
Q

Membranoproliferative Glomerulonephritis (2 types) (MPGN)

A
  • Hypercellular and thickened GBM
    I: subendothelial deposits, tram track (GBM splitting)
    • HBV, HCV
      II: intramembranous complex deposits (dense deposits)
    • Low C3
84
Q

Diabetic Glomerulonephropathy

A
  • thick GBM w/ non-enzymatic glycosylation

- Kimmelsteil wilson nodules (mesangial expansion)

85
Q

Acute Post-streptococcal Glomerulonephritis (PSGN)

A
  • 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
Q

Diffuse Proliferative Glomerulonephritis (DPGN)

A
  • wire looping (chicken wire) capillaries, subendothelial deposits
  • SLE or MPGN (MC cause of death in SLE)
87
Q

IgA Nephropathy (Berger)

A
  • mesangial proliferation and deposits (of IgA)
  • aw/ Honoch Schonlein purpura
  • aw/ URI or acute gastroenteritis
88
Q

Alport Syndrome

A
  • X-linked mutation in type IV collagen
  • Deafness and eye problems
  • Glomerulonephritis that will almost always become ESRD
89
Q

Stones that form in Alkaline Environment

A

Calcium Phosphate and Ammonium Magnesium Phosphate (struvite)

90
Q

Radiolucent Kidney Stones

A

Uric Acid

- not visible on xray (can see on ultrasound)

91
Q

Calcium Stones caused by:

A

Hypercalciuria (normocalcemia), ethylene glycol ingestion, Vit C abuse, or Crohns

92
Q

Sodium nitroprusside test +

A

Cystine Stones

93
Q

Staghorn Caliculi

A

Ammonium magnesium phosphate (struvite): adults

Cystine: children

94
Q

RCC treatment

A

Resistant to chemo and radiation

- must resect

95
Q

Renal oncocytoma

A

Benign epithelial tumor (well circumscribed)

  • yellow brown central stellate scarring
  • Large eosinophilic cells
96
Q

RCC: Paraneoplastic

A

EPO, ACTH, and PTHrP

97
Q

Transitional Cell Carcinoma: Causes

A

Phenacetin, Smoking, Aniline Dyes, and Cyclophosphamide

also rubber, plastic, textile manufacturing

98
Q

Squamous Cell Carcinoma of Bladder: Causes

A

Chronic irritation

Schistosoma haematobium, chronic cystitis or nephrolithiasis, smoking

99
Q

Wilm’s Tumor: WAGR syndrome

A
  • WAGR syndrome:

wilms tumor, aniridia, genital abnormalities, motore retardation (WT1 deletion)

100
Q

Wilm’s Tumor: Denys-Drash Syndrome

A
  • Denys-Drash Syndrome:

wilms tumor, renal disease, male pseudohermaphroditism (WT1 mutation)

101
Q

Wilm’s Tumor: Beckwith-Wiedmann Syndrome

A
  • Beckwith-Wiedemann syndrome:

wilms tumor, neonatal hypoglycemia, muscle hemihypertrophy, organomegaly of tongue (WT2 mutation, IGF2 specifically)

102
Q

Thyroidization of Kidney

A

Eosinophilic casts resembling thyroid tissue

Chronic/recurrent pyelonephritis

103
Q

ATN by Nephrotoxic Drugs

A

aminoglycosides (MC), radiocontrast agents, lead, cisplatin, Crush injury

104
Q

Diffuse Cortical Necrosis of kidney

A

Vasospasm, DIC

aw/ obstetric problems like abruptio placentae, or septic shock

105
Q

Prerenal Azotemia

A

Increased Na reabsorption

Increased BUN/Creatinine

106
Q

Intrinsic Renal Failure

A

MC due to ATN
Impaired reabsorption of Na and BUN
Decreased BUN/Creatinine

107
Q

Postrenal Azotemia

A

Outflow obstruction ( only if bilateral)
Less reabsorption of Na
Mild increase in BUN/Creatinine

108
Q

Uremia: abnormal bleeding

A

Impaired platelet aggregation/adhesion due to uremic metabolites –> increased bleeding time only
(PT, PTT, platelet count are all normal)

109
Q

Renal Osteodystrophy

A

Can hydroxylate Vit D so low Ca and high PO4 causing secondary hyperparathyroidism –> thinning of bones

110
Q

Associations with ADPKD

A

Berry aneurysms
MVP
Hepatic cysts

111
Q

Associations with ARPKD

A

Hepatic fibrosis
Portal hypertension
Potter Syndrome

112
Q

Medullary Cystic Disease

A

Inherited tubulointerstitial fibrosis (AD)
Can’t concentrate urine
Medullary cysts and shrunken kidney

113
Q

Simple vs Complex Cysts

A

Simple: in outer cortex, filled with ultrafiltrate, MC, usually asymptomatic
Complex: have septated or solid component (removed because risk of RCC

114
Q

Loop Diuretic for patients allergic to sulfa:

A

Ethacrynic Acid

  • can cause hyperuricemia
  • side effects similar to loop diuretics
115
Q

Thiazide: Side effects

A 
- Block NaCl symporter in distal tubule
Hyperglycemia
Hypercalcemia
Hyperuricemia
Hyperlipidemia
Hyponatremia and Hypokalemia
Metabolic Alkalosis
116
Q

Spironolactone: Side Effects

A

Gynecomastia, antiandrogen effects

117
Q

K+ Sparing Diuretics

A

Aldosterone Antagonists: spironolactone and eplerenone
ENac inhibitors: triamterene and amiloride
- all can cause hyperkalemia –> arrhythmia

118
Q

MC cause of Fetal Hydronephrosis

A

Inadequate recanalization of ureteropelvic junction

antenatal hydronephrosis is by vesicoureteral junction

119
Q

Lowest pH in nephron

A

Distal Tubule and Collecting Duct

where stones will obstruct

120
Q

Increased risk of Varicocele or Hypercoagulation w/ Nephrotic Syndrome

A

Antithrombin and anticoagulant factors get lost in the urine leading to an overall state of hypercoagulability

121
Q

Hyaline arteriolosclerosis of Renal Arteries

A

Nonmalignant HTN or Diabetes

122
Q

Euvolemic Hyponatremia

A

SIADH
- appropriately concentrated urine, low serum sodium and osmolality but normal fluid volume due to compensation by ANP/BNP

123
Q

Densely immunostaining protein containing cells near glomerulus:

A

JG cells w/ renin inside

124
Q

Tamm-Horsfall Glycoprotein

A

can accumulate in lumen to make hyaline casts in prerenal azotemia

125
Q

Causes of Central DI (5)

A

Pituitary tumor/resection, head trauma, brain tumor/infiltrative lesion, brain metastases

126
Q

Causes of Nephrogenic DI (4)

A

Drugs (lithium, amphoteicin B, ciplastin, gentamicin)
Hypercalcemia
Hypokalemia
Postobstructive Diuresis

127
Q

Xanthogranulomatous Pyelonephritis

A

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
Q

Schistosomiasis

A

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
Q

NSAIDs can cause:

A

Acute Interstitial Nephritis
Membranous Nephropathy
Papillary Necrosis

130
Q

Rhabdomyolysis

A
  • 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
Q

Loop Diuretic Effects on Nephron

A
  • inhibits Na/K/2Cl symporter in thick ascending
  • decreases water absorption in the descending loop
  • decreases osmolarity of medullary interstitium
132
Q

Renal Failure and Toe Gangrene following an invasive vascular procedure

A

Atheroembolic renal disease

- cholesterol emboli obstructing renal arterioles

133
Q

Unilateral Renal Artery Stenosis

A

Usually a cause of secondary hypertension

- kidney affected by stenosis often gets atrophied due to oxygen and nutrient deprivation

Quick Notes for Step 1 (18 decks)

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