renal Flashcards
pronephros degenerate when
week 4
mesonephros contribute to
male genital system
when do mesonephros function
function as kidney for 1st trimester
when do metanephros appear
5th week
where is the ureteric bud derived from
caudal end of mesonephric duct
by what week is the ureteric bud / collecting system fully canalized?
10th week
what does the ureteric bud give rise to
ureters
pelvis
calyces
collecting ducts
interaction between mesonephros (ureteric bud) and metanephric mesenchyme leads to formation of what
glomerulus through DCT
what is last to be recanalized
ureteropelvic junction
what is the most common site of obstruction + hydronephros in fetus
ureteropelvic junction because it is the last to recanalize
most common cause of death in fetus with potter sequence
respiratory failure due to pulmonary hypoplasia
multicystic dysplastic kidney occurs because of what
abnormal interaction between urereteric bud and metanephric mesenchyme
what causes potter sequence
oligohydramnios due to failure of ureteric buds to develop
what rib injury could damage kidney
11 or 12
what kidney is taken during donor transplant and why
left because it has a longer renal vein
macula densa cells live inside what part of kidney
DCT
what cells secrete renin
juxtaglomerular cells
what charge do glomerular basement membranes have and why
negative to prevent proteins from escaping
what do the ureters pass under in females
uterine artery
what do the ureters pass under in males
vas deferens
where do JG cells live
in the afferent arteriole
what spinal level are the kidneys at
T12 through L3
what kidney is larger
left
where is the location of the kidneys in relation to one another
right kidney is lower and `more lateral than the left due to the liver
what molecule can approximate plasma volume
albumin
what molecule can approximate extracellular volume
inulin
how much of body weight is fluid
60%
how much of body fluid is ECF
20%
how much of body fluid is ICF
40%
How much of ECF is plasma volume
25%
how much ECF is interstitial fluid
75%
what makes basement membrane negatively charged
heparan sulfate
what is the size barrier in glomerulus
fenestrated capillary endothelium
renel clearance equation
C=UV/P
what substances predict GFR
inulin and creatinine
normal GFR
100 mL/min
if creatinine is used to estimate GFR, is it accurate?
slightly overestimates GFR
relationship between GFR and creatinine
every time GFR is cut in half, creatinine doubles
RPF is estimated by
PAH
eRPF underestimates RPF by how much
10%
RBF equation in terms of hematocrit
RPF/1-Hct
FF equation
GFR/RPF
normal FF
20%
filtered load equation
GFR x plasma concentration
excretion rate equation
E=UV
reabsorption equation
R= filtered - excreted
secretion equation
S= excreted- filtered
at what glucose level does glucosuria start
200 mg/dL
at what glucose level are all the glucose transporters saturated
375 mg/dL
hartnup inheritance
autosomal recessive
hartnup etiology
deficiency of neutral amino acid transporters in the PCT and on enterocytes = lose tryptophan –> niacin deficiency –> pellagra
rx. hartnup
high protein diet and nicotinic acid
3 Ds of pellagra
diarrhea
dementia
dermatitis
how is glucose reabsorbed and where
in the PCT via Na glucose cotransporter
how does osmolarity of filtered fluid change in PCT
no change - isotonic reabsorption
thin descending loop of henle reabsorbs what
water only - concentrating segment
how does the thin descending loop reabsorb water
passively due to medullary hypertonicity
ADH works on what cell type
principal cells
expired tetracyclines can cause what
fanconi syndrome
tenofovir can cause
fanconi syndrome
where is defect in fanconi
PCT
inheritance of bartter syndrome
autosomal recessive
inheritance of gitelman syndrome
autosomal recessive
inheritance of liddle syndrome
autosomal dominant
metabolic symptoms in fanconi
metabolic acidosis (losing bicarb)
metabolic symptoms in bartter
hypokalemia (losing K) and hypercalciuria (losing Ca)
metabolic alkalosis
bartter affects what channels
Na-K-Cl transporter in the thick ascending loop
Gitelman is a defect in what part of the nephron
DCT (Na Cl reabsorption)
liddle syndrome is associated with what type of mutation
gain of function (increased Na+ reabsorption via ENaCs in the collecting tubule)
Rx liddle syndrome
Amiloride
only renal tubular defect to cause hypercalciuria
bartter
only renal tubular defect to cause acidosis
fanconi
syndrome of apparent mineralocorticoid excess is actually an excess of _____, why?
cortisol - because deficiency of 11-beta hydroxysteroid dehydrogenase that normally converts cortisol –> cortisone
syndrome of apparent mineralocorticoid excess can be acquired from what food
licorice (glycyrrhetic acid)
what makes ACE
endothelial cells of pulmonary vasculature
what cells sense decreased bp
juxtaglomerular
what cells sense decreased Na
macula densa
JG cells are what type of cells
modified smooth muscle cells
where is EPO released from
interstitial cells in peritubular capillary bed
what part of nephron converts vit d to active form
PCT
how do prostaglandins affect the nephron
vasodilate the afferent arteriole
where does PTH affect nephron
DCT (increased Ca reabsorption) and less PO4 reabsorption (PCT)
ANP net effect in nephron
Na+ loss and volume loss
wide QRS, peaked T waves
hyperkalemia
tetany
hypocalcemia
QT prolongation
hypocalcemia
torsades de pointes
hypomagnesemia
stones bones groans overtones
hypercalcemia
u waves on ecg
hypokalemia
flattened T waves
hypokalemia
decreased DTR
hypermagnesemia
muscle weakness
hyperkalemia
how does pH relate to hco3- and pco2
pH is proportional to HCO3/pCO2
how to calculate anion gap
anion gap = Na-Cl - HCO3
dysplastic kidney inheritance
not inherited
AR PKD presents when
presents in infants
AD PKD presents when
presents in young adults
dysplastic kidney vs. PKD
dysplastic kidney usually has abnormal tissue in the parenchyma (like cartilage)
ARPKD presentation
kid with portal hypertension (due to hepatic cysts)
ADPKD presentation
hypertension (too much renin), hematuria, renal failure, associated with berry aneurysms and hepatic cysts and MVP
main cause of death in ADPKD
berry aneurysm
mutations that lead to ADPKD
APKD1 and APKD2
PKD presents with what kind of kidneys
enlarged
medullary cystic kidney disease presentation
shrunken kidneys with parenchymal fibrosis
medullary cystic kidney disease inheritance
autosomal dominant
most common renal congenital anomaly
horseshoe kidney
unilateral renal agenesis causes what in the other kidney
hypertrophy of other kidney + renal failure later in life
most common ADPKD mutation
PKD1, chr. 16
less common ADPKD mutation
PKD2, chr 4
shrunken kidneys on ultrasound
medullary cystic kidney disease
majority of all renal masses are what
simple cysts (filled with ultrafiltrate)
2 areas of nephron susceptible to ischemia
PCT and medullary Thick ascending limb
most common cause of acute tubular necrosis
aminoglycosides
how to prevent acute tubular necrosis
hydration and allopurinol
eosinophils in urine
acute interstitial nephritis
4 things that can lead to renal papillary necrosis
1) sickle cell
2) severe pyelonephritis
3) diabetes
4) long term analgesic use (phenacetin, aspirin)
most common cause of nephrotic syndrome in caucasian adult
membranous nephyropathy
nephrotic syndrome associated with hodgkins
minimal change disease
spike and dome appearance
membranous nephropathy
tram track appearance
membranoproliferative glomerulonephritis
nephrotic presentation of SLE
membranous nephropathy
kimmelsteil wilson lesion
DM
first sign of DM
microalbuminuria
acute post streptococcal glomerulonephritis is what kind of HS
3
subepithelial immune complex hump
PSGN
crescent moon shaped LM and IF
RPGN
crescents in RPGN are made from
fibrin and macrophages
most common cause of death in lupus patients
DPGN
wire looping of capillaries
DPGN
