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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
Q

what upregulates renin?

A

low BP (JG cells), low sodium (macula densa), high sympathetic tone

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26
Q

ANP

A

released from atria due to high volume to relax smooth mucles via cGMP and increase GFR and lower renin. No compensatory Na reabsoption

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27
Q

Juxtaglumerulous cells

A

afferent arteriole release renin

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28
Q

macula densa cells

A

distal convoluted tube sense NaCl

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29
Q

kidney effects RBCs by

A

EPO

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30
Q

kidney processing of vitamin D

A

converts 2,5-oh vit D —(1alpha-hydroxylase)–> 1,2,5 oh which is active form. parathyroid hormone activates

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31
Q

What shifts K out of cells?

A

DO Insulin LAB(eta): digitalis, hyperOsmolarity, Insulin deficency, Lysis of cells, Acidosis, Beta adrenergic antagonist

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32
Q

Serum Na high/low symptoms

A

low: nausea, malaise, stupor, coma.
high: irritability, stupor, coma

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33
Q

Serum K high/low symptoms

A

low: U waves on ECG, flattened T waves, arrhythmias, muscle weakness
high: wide qrs, peaked T waves, arrhythmias, muscle weakness

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34
Q

Serum Ca high/low symptoms

A

low: tetany, seizures
high: Stones, bones (pain), groans (ab pain), psyc overtones (anxiety, odd)

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35
Q

Serum Mg high/low symptoms

A

low: tetany, arrhythmias
high: decreased reflexes, lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia

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36
Q

Serum Phosphate high/low

A

low: bone loss, osteomalacia
high: renal stones, metastatic calcifications, hypocalcemia

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37
Q

Metabolic acidosis labs

A

pH low, pCO2 low, HCO3 low (hyperventalation response immediate)

38
Q

Metabolic alkalosis

A

pH high, pCO2 high, HCO3 high (hypoventalation response immediate)

39
Q

Respiratory acidosis

A

pH low, pCO2 high, HCO3 high (bicarb renal retention delayed)

40
Q

Respiratory alkalosis

A

pH high, pCO2 low, HCO3 low (renal response)

41
Q

What is anion gap and what is abnormal?

A

Anion gap = Na - (Cl+HCO3). normal is 8-12

42
Q

anion gap metabolic acidosis etiology

A

MUDPILES: Methanol, Uremia, Diabetic Keto, Propylene glycol, Iron tablets, Lactic acidosis, Ethylene glycol, Salicylates

43
Q

non-anion gap metabolic acidosis etiology

A

HARD ASS: Hyperalimentation, Addisons Disease, Renal tubular acidosis, Diarrhea, Acetazolamide, Spironolactone, Saline infusion

44
Q

Renal tubular acidosis type 1

A

distal: collecting duct can’t excrete H. hypokalemia. calcium phosphate kidney stones. urine pH > 5.5

45
Q

Renal tubular acidosis type 2

A

proximal: PCT cant reabsorb HCO3. Seen in fanconi syndrome. urine pH

46
Q

Renal tubular acidosis type 4

A

hyperkalemic: hypoaldosterone or response of collecting tubule -> can’t secrete K. high K = can’t release ammonia to buffer -> acidic pee

47
Q

casts in urine

A

means is from the kidney

48
Q

rbc casts

A

glomerulonephritis, ischemia, malignant hypertension

49
Q

wbc casts

A

tubulointerstitial inflammation, acute pyelonephritis, transplant rejection

50
Q

fatty casts “oval fat bodies”

51
Q

granular casts “muddy brown”

A

acute tubular necrosis

52
Q

waxy casts

A

advanced renal disease/kidney failure

53
Q

hyaline casts

A

nonspecific, even normal

54
Q

Focal segmental glomerulosclerosis. type, LM, EM

A

1 nephrotic. LM: segmental sclerosis/hyalinosis. EM: foot process effacement (same as minimal change).

55
Q

Focal segmental glomerulosclerosis associations

A

HIV, heroin, massive obesity, interferon

56
Q

Membranos nephropathy type, LM, EM, IF

A

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
Q

Minimal Change disease

A

Children Nephrotic. LM: normal. EM: foot process effacement. Loss of albumin not globulins cause GBM anions gone.

58
Q

Amyloidosis nephropathy

A

Nephrotic LM: congo red shws apple-green birefringence. associated with chronic conditions.

59
Q

Membranoproliferative glomerulonephritis

A

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
Q

Diabetic glomerulonephropathy

A

Nephrotic. Nonenzymatic glycosylation of GBM and efferent arteriole. LM: mesangial expansion/gbm thickening/glomerulous eosinophilic nodules (Kimmelstel-wilson)

61
Q

Acute poststreptococcal glomerulonephritis: LM, EM, IF, epidemiology

A

Nephritic. LM: large gloms, neutrophils, “lumpy-bumpy”. EM: subepithelial IC. IF: granular. seen in kids w/ periorbital edema, dark urine.

62
Q

Rapidly progressive glomerulonephritis causes

A

Nephritic or Nephrotic. Goodpastures, wegeners, microscopic polyangiitis

63
Q

goodpastures hypersensitiveity type, IF, antibody targets

A

type II, kidney and lung basement menbrane antibodies, linear IF

64
Q

Wegeners vs microscopic polyangitits

A

Both RPGN. Wegeners (c-ANCA) vs Microscopic Poly Angitis (p-ANCA)

65
Q

Bergers Disease

A

IgA nephritic syndrome. Purpura, URI, GI-itis. LM: mesangial proliferation. EM: mesangial IC. IF: IgA IC deposites

66
Q

Alports

A

Nephritic. Mutation in type IV collagen(x linked) -> BM splitting. Nephritis/deafness/eye problems

67
Q

Kidney stone types

A

calcium, ammonium/magnesium phosphate, uric acid, cystine

68
Q

which kidney stones are opaque vs lucent

A

opaque: calcium, ammonium magnesium phsphate, cystine
lucent: uric acid

69
Q

vitamin c cause what kinda stones

70
Q

ethelene glycol (anti freeze) stones type

71
Q

urease-positive bugs cause what kinda stones?

72
Q

staghorn calculi stones?

A

ammonia stones. serve as plateform for uti

73
Q

1 renal cancer?

A

Renal cell carcinoma

74
Q

genetic association with renal cell carcinoma?

A

Chrom 3 deletion (VHL syndrome)

75
Q

renal cell carcinoma presentating symp

A

hematuria, mass, pain. paraneoplastic syndrome cause EPO (polycythemia), ACTH, PTHrp. often presents with mets cause retroperotoneal

76
Q

renal cell carcinoma histology and age group

A

PCT cells: polygonal, lots of lipids (clear). Men 50-70 with smoking and obesity

77
Q

renal cell carcinoma treatment

A

resection, resistant to chemo and radio

78
Q

Wilms tumor (nephroblastoma)

A

childhood renal cancer. embryonic glomeruli. due to deletion of WT1 gene on Ch 11.

79
Q

WAGR complex (brandon your a warg!)

A

Wilms tumor, aniridia (no iris), genitourinary malformation, retardation

80
Q

Transitional cell carcinoma

A

urinary tract cancer. painless bloody pee.

Pee SAC: Phenacetin, Smoking, Aniline dyes, Cyclophosphamide

81
Q

thyroidization of the kidney

A

chronic pyelonephritis

82
Q

Drug induced interstitial nephritis

A

occurs a week or two later with eosinophile urine, azotemia.

83
Q

diffuse cortical necrosis

A

bilateral widespread infarction. associated with obstetric catastrophes (abruptio placentae)

84
Q

Azotemia

A

High urine bun and low serum creatinine

85
Q 
Prerenal azotemia 
Urine osmolality
Urine Na
FeNa
Serum bun/creatinine
A

Urine osmolality > 500 (normal)
Urine Na 20% (high)

Kidney is working to conserve volume

86
Q 
Intrinsic renal failure 
Urine osmolality
Urine Na
FeNa
Serum bun/creatinine
A

BUN is high cause kidneys are fucked
Urine osmolality 40 (normal)
FeNa >2% (high)
Serum bun/creatinine

87
Q

Posterrenal azotemia

A

BUN is high cause cant excrete

88
Q

renal osteodystrophy

A

can’t make activated vitamin D, hypocalemia, and hyperphosphatemia so bones thin. also has secondary compensatory hyperparathyroidism

89
Q

ADPKD

A

cysts destroy kidney. PKD1 or PKD2 genes. Associations: berry aneurysms, mitral valve prolapse, benign hepatic cysts

90
Q

ARPKD

A

infantile, recessive. hepatic fibrosis, potters sequence

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