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Renal Flashcards

1
Q

What happens to : Pronephros, Mesonephros, Metanephros

A

Pronephros: degenerates at week 4
Mesonephros: degerates and creates ureteric bud (ureter, pelvises, calyces, collecting duct) and male genital sytem
Metanephros: kidney

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2
Q

Most common site of fetal renal obstruction

A

ureteropelvic junction

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3
Q

What is Potters sequence/syndrome?

A

oligohydramnios -> compression of fetus -> limb deformities, facial deformities, and pulmonary hypoplasia

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4
Q

What etiology of Potters?

A

babies can’t Pee (potters). ARPKD, posterior urethral valves, renal agenesis

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5
Q

What is horseshoe kidney?

A

bottom of kidneys fuse while in pelvis. when they ascend from the pelvis they get stuck on the inferior mesenteric artery but work just fine.

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6
Q

What is horseshoe kidney associated with?

A

turners syndrome (a single x chromosome)

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7
Q

What causes multicystic dysplastic kidney ?

A

abnormal interaction between ureteric bud and metanephric mesenchyme

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8
Q

Ureters course

A

water under the bridge. ureters under uterine artery/ductus deferens. all retroperitoneal

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9
Q

inulin

A

tells you GFR cause it is filtered out but not secreted or resorbed at all

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10
Q

Glomerulous filter components

A

fenestrated capillary endothelium (size), heparan sulfate basement membrane (negative charge barrier), epithelial podocyte foot processes

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11
Q

PAH

A

both filtered out and entirely secreted so it measures total glomerulous flow rate

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12
Q

normal filtration fraction

A

20%

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13
Q

effect of prostaglandins on filtratin

A

(paracrine) dialate afferent ateriole -> more RPF and GFR but FF static

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14
Q

effect of Angiotensin II on filtration

A

constricts efferent arteriole. decrease RPF, increase GFR and FF

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15
Q

where and how is glucose resporbed? exceptions?

A

Na cotransport in PCT 100%. uncontrolled diabetes and normal pregnancy

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16
Q

nephrogenic cause of pellagra and symptoms

A

deficient sodium-tryptophan transporter -> low W -> cant make niacin -> dermatitis, diarrhea, disturbed (mental)

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17
Q

PTH effect on nephron

A

inhibit na/phosphate coreuptake in PCT, enhance calcium/sodium coreuptake in DCT

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18
Q

AT II effect on PCT

A

stimulates Na/H antiport -> acidify urine, more CO2/bicarb uptake, Na uptake, water uptake

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19
Q

loop diuretics hit?

A

triporter (Na/K/2Cl) of Thick ascending loop

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20
Q

What does aldosterone modulate in nephron?

A

Aldosterone inserts mineralocorticoid Na-channel on lumin of collecting duct. Na goes in exchanged for H and K.

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21
Q

what does ADH do to the nephron?

A

inserts aquaporin in collecting tubule

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22
Q

describe renin-angiotensin-aldosteron system

A

(liver) angiotensinogen –(renin/kidney)–> angiotensin I –(ACE/kidney/lung)–> Angiotensin II –> Aldosterone release (adrenal) and ADH (posterior pituitary)

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23
Q

effects of Angiotensin II

A

vasoconstriction (up BP), constrict efferent arteriole, Aldosterone release from adrenal, ADH release from posterior pituitary, PCT Na/H antiport (absorb Na/bicarb/water), stimulate thirst, limits reflex bradycardia

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24
Q

what inhibits bradykinin?

A

ACE

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25
what upregulates renin?
low BP (JG cells), low sodium (macula densa), high sympathetic tone
26
ANP
released from atria due to high volume to relax smooth mucles via cGMP and increase GFR and lower renin. No compensatory Na reabsoption
27
Juxtaglumerulous cells
afferent arteriole release renin
28
macula densa cells
distal convoluted tube sense NaCl
29
kidney effects RBCs by
EPO
30
kidney processing of vitamin D
converts 2,5-oh vit D ---(1alpha-hydroxylase)--> 1,2,5 oh which is active form. parathyroid hormone activates
31
What shifts K out of cells?
DO Insulin LAB(eta): digitalis, hyperOsmolarity, Insulin deficency, Lysis of cells, Acidosis, Beta adrenergic antagonist
32
Serum Na high/low symptoms
low: nausea, malaise, stupor, coma. high: irritability, stupor, coma
33
Serum K high/low symptoms
low: U waves on ECG, flattened T waves, arrhythmias, muscle weakness high: wide qrs, peaked T waves, arrhythmias, muscle weakness
34
Serum Ca high/low symptoms
low: tetany, seizures high: Stones, bones (pain), groans (ab pain), psyc overtones (anxiety, odd)
35
Serum Mg high/low symptoms
low: tetany, arrhythmias high: decreased reflexes, lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia
36
Serum Phosphate high/low
low: bone loss, osteomalacia high: renal stones, metastatic calcifications, hypocalcemia
37
Metabolic acidosis labs
pH low, pCO2 low, HCO3 low (hyperventalation response immediate)
38
Metabolic alkalosis
pH high, pCO2 high, HCO3 high (hypoventalation response immediate)
39
Respiratory acidosis
pH low, pCO2 high, HCO3 high (bicarb renal retention delayed)
40
Respiratory alkalosis
pH high, pCO2 low, HCO3 low (renal response)
41
What is anion gap and what is abnormal?
Anion gap = Na - (Cl+HCO3). normal is 8-12
42
anion gap metabolic acidosis etiology
MUDPILES: Methanol, Uremia, Diabetic Keto, Propylene glycol, Iron tablets, Lactic acidosis, Ethylene glycol, Salicylates
43
non-anion gap metabolic acidosis etiology
HARD ASS: Hyperalimentation, Addisons Disease, Renal tubular acidosis, Diarrhea, Acetazolamide, Spironolactone, Saline infusion
44
Renal tubular acidosis type 1
distal: collecting duct can't excrete H. hypokalemia. calcium phosphate kidney stones. urine pH > 5.5
45
Renal tubular acidosis type 2
proximal: PCT cant reabsorb HCO3. Seen in fanconi syndrome. urine pH
46
Renal tubular acidosis type 4
hyperkalemic: hypoaldosterone or response of collecting tubule -> can't secrete K. high K = can't release ammonia to buffer -> acidic pee
47
casts in urine
means is from the kidney
48
rbc casts
glomerulonephritis, ischemia, malignant hypertension
49
wbc casts
tubulointerstitial inflammation, acute pyelonephritis, transplant rejection
50
fatty casts "oval fat bodies"
nephrotic
51
granular casts "muddy brown"
acute tubular necrosis
52
waxy casts
advanced renal disease/kidney failure
53
hyaline casts
nonspecific, even normal
54
Focal segmental glomerulosclerosis. type, LM, EM
#1 nephrotic. LM: segmental sclerosis/hyalinosis. EM: foot process effacement (same as minimal change).
55
Focal segmental glomerulosclerosis associations
HIV, heroin, massive obesity, interferon
56
Membranos nephropathy type, LM, EM, IF
#2 Nephrotic. LM: diffuse capillary and GBM thickening. EM: "spike and dome" subendothelial deposits. IF: granular. This is SLE nephrotic (also idopathic or drug-induced)
57
Minimal Change disease
Children Nephrotic. LM: normal. EM: foot process effacement. Loss of albumin not globulins cause GBM anions gone.
58
Amyloidosis nephropathy
Nephrotic LM: congo red shws apple-green birefringence. associated with chronic conditions.
59
Membranoproliferative glomerulonephritis
Nephrotic/Nephritic. Type I: subendothelial immunocomplex deposits. granular IF "tram-track". associated HBV, HCV Type II: intramembranous IC "dense deposits". Associated C3 nephritic factor
60
Diabetic glomerulonephropathy
Nephrotic. Nonenzymatic glycosylation of GBM and efferent arteriole. LM: mesangial expansion/gbm thickening/glomerulous eosinophilic nodules (Kimmelstel-wilson)
61
Acute poststreptococcal glomerulonephritis: LM, EM, IF, epidemiology
Nephritic. LM: large gloms, neutrophils, "lumpy-bumpy". EM: subepithelial IC. IF: granular. seen in kids w/ periorbital edema, dark urine.
62
Rapidly progressive glomerulonephritis causes
Nephritic or Nephrotic. Goodpastures, wegeners, microscopic polyangiitis
63
goodpastures hypersensitiveity type, IF, antibody targets
type II, kidney and lung basement menbrane antibodies, linear IF
64
Wegeners vs microscopic polyangitits
Both RPGN. Wegeners (c-ANCA) vs Microscopic Poly Angitis (p-ANCA)
65
Bergers Disease
IgA nephritic syndrome. Purpura, URI, GI-itis. LM: mesangial proliferation. EM: mesangial IC. IF: IgA IC deposites
66
Alports
Nephritic. Mutation in type IV collagen(x linked) -> BM splitting. Nephritis/deafness/eye problems
67
Kidney stone types
calcium, ammonium/magnesium phosphate, uric acid, cystine
68
which kidney stones are opaque vs lucent
opaque: calcium, ammonium magnesium phsphate, cystine lucent: uric acid
69
vitamin c cause what kinda stones
calcium
70
ethelene glycol (anti freeze) stones type
calcium
71
urease-positive bugs cause what kinda stones?
ammonium
72
staghorn calculi stones?
ammonia stones. serve as plateform for uti
73
#1 renal cancer?
Renal cell carcinoma
74
genetic association with renal cell carcinoma?
Chrom 3 deletion (VHL syndrome)
75
renal cell carcinoma presentating symp
hematuria, mass, pain. paraneoplastic syndrome cause EPO (polycythemia), ACTH, PTHrp. often presents with mets cause retroperotoneal
76
renal cell carcinoma histology and age group
PCT cells: polygonal, lots of lipids (clear). Men 50-70 with smoking and obesity
77
renal cell carcinoma treatment
resection, resistant to chemo and radio
78
Wilms tumor (nephroblastoma)
childhood renal cancer. embryonic glomeruli. due to deletion of WT1 gene on Ch 11.
79
WAGR complex (brandon your a warg!)
Wilms tumor, aniridia (no iris), genitourinary malformation, retardation
80
Transitional cell carcinoma
urinary tract cancer. painless bloody pee. | Pee SAC: Phenacetin, Smoking, Aniline dyes, Cyclophosphamide
81
thyroidization of the kidney
chronic pyelonephritis
82
Drug induced interstitial nephritis
occurs a week or two later with eosinophile urine, azotemia.
83
diffuse cortical necrosis
bilateral widespread infarction. associated with obstetric catastrophes (abruptio placentae)
84
Azotemia
High urine bun and low serum creatinine
85
``` Prerenal azotemia Urine osmolality Urine Na FeNa Serum bun/creatinine ```
Urine osmolality > 500 (normal) Urine Na 20% (high) Kidney is working to conserve volume
86
``` Intrinsic renal failure Urine osmolality Urine Na FeNa Serum bun/creatinine ```
BUN is high cause kidneys are fucked Urine osmolality 40 (normal) FeNa >2% (high) Serum bun/creatinine
87
Posterrenal azotemia
BUN is high cause cant excrete
88
renal osteodystrophy
can't make activated vitamin D, hypocalemia, and hyperphosphatemia so bones thin. also has secondary compensatory hyperparathyroidism
89
ADPKD
cysts destroy kidney. PKD1 or PKD2 genes. Associations: berry aneurysms, mitral valve prolapse, benign hepatic cysts
90
ARPKD
infantile, recessive. hepatic fibrosis, potters sequence

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