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Spring 2016 - CVPR > Renal > Flashcards

Renal Flashcards

1
Q

What is the main physiological function of the kidneys?

A

Maintenance of the composition and volume of extracellular fluid

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2
Q

What is extracellular fluid?

A

Fluid outside cells, but on the serosal side of epithelial tissues

So, bladder urine, GI tract fluid, and lung fluid are not ECF

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3
Q

How much extracelular fluid do we have? What are the 2 main compartments?

A

15 L

12L interstitial fluid
3 L Plasma

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4
Q

How do we maintain homeostasis of stuff in the extracellular fluid?

A

Through urine production

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5
Q

What are the 2 capillary beds of the kidneys?

A

Glomerular

Peritubular

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6
Q

What is glomerular filtration?

A

Filtration of plasma into the tubule.

Allows water and solutes in, but retains larger colloids

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7
Q

What is the filtration fraction? What is its normal value?

A

Amount of renal plasma flow filtered at the glomerulus.

20% of renal blood flow

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8
Q

What induces the kidneys to secrete renin? (3)

A

Activation of renal beta-sympathetic nerves

Stimulation of renal baroreceptors by decreased arteriolar pressure

Activation of macula densa chemoreceptor by reduced delivery of NaCl to the distal rubule

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9
Q

Which cells in the kidney secrete renin? Where are they? What structure are they part of?

A

Granular cells, in the afferent arteriole going to the glomerulus

Juxtaglomerular apparatus

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10
Q

The molecular sieving process of the glomerulus is also called _______________

A

Ultrafiltration

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11
Q

What is filterability a function of?

A

Molecular size

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12
Q

What are the 3 filters of the glomerulus?

A

Fenestrated epithelium

Basal lamina

Podocytes

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13
Q

What is the charge of the basal lamina?

A

Negative, so negatively charged things don’t get through

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14
Q

Mathematical description for GFR

A

GFR = dP/R = KdP = K(Pgc-Pt-Pigc)

Pressures of glomerular capillary, tubule, colloid osmotic pressure)

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15
Q

What are 2 forces that oppose glomerular filtration?

A

Tubule diameter -> backpressure = Pt

Colloid osmotic force

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16
Q

What is the net filtration pressure?

A

Sum of glomerular capillary, tubule, colloid osmotic pressures

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17
Q

What do mesangial cells do? (3)

A

Secrete matrix continuous with basal lamina

Do some macrophage-like things (make cytokines, etc)

Unclear role in contraction of glomerular capillary loops

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18
Q

Is glomerular capillary pressure dependent on mean arterial pressure?

A

No. It is very tightly autoregulated

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19
Q

What is the glomerular response to chronic hypotension?

A

Both the afferent and efferent arterioles constrict

This decreases flow through the glomerulus (so it can go to other organs) but sort of maintains Pgc (glomerular capillary pressure)

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20
Q

3 baroreceptors that affect glomerular arterioles

A

Baroreceptors in main arteries -> sympathetic response

External baroreceptors -> antiogensin II constricts

Intrarenal baroreceptors -> RAAS

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21
Q

Where are renal interstitial cells located? What do they do?

A

Located in kidney medulla between renal pyramids

Make renal prostaglandins

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22
Q

When are renal prostaglandins produced? What do they do?

A

Secreted in response to angiotensin II

Dilate renal arterioles -> maintain adequate renal blood flow, maintain GFR. This blunts effects of hypovolemic mechanisms so the kidney doesn’t get ischemic

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23
Q

Compare autoregulation and hypovolemic response:

Responds to
Purpose
Arterioles involved
Mechanism of arteriolar changes
Location of mechanism
A

mrr

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24
Q

What do the minor calyxes do? Major calyx?

A

Drain renal pyramids

Drain minor calyxes

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25
What do the medullary pyramids contain?
Nephrons and collecting ducts
26
What is the path of the renal arteries to veins?
Renal artery -> anterior and posterior segments -> interlobar (between medullary pyramids) -> arcuate arteries (parallel to outer capsule) -> interlobular -> afferent arterioles -> glomerular capillary -> efferent arterioles -> vasa recta ? -> peritubular capillary -> interlobular veins -> arcuate veins -> interlobar veins -> renal vein
27
What part of the kidney are renal corpuscles located in?
Cortex
28
What part of the kidney are renal tubules in?
Medulla
29
What kind of epithelium is in the proximal tubule?
Cuboidal with brush border
30
What does the proximal tubule transport?
Na/K ATPase for pumping sodium out of the basolateral side
31
What is the epithelium like in the thin loop of Henle?
Simple squamous
32
What is the epithelium like in the thick loop of Henle?
Cuboidal
33
What is the epithelium like in the distal tubule?
Cuboidal
34
Where do aldosterone and antidiuretic hormone act in the kidney?
Distal tubule
35
What two hormones act on the distal tubule?
Aldosterone | Antidiuretic hormone
36
The distal convoluted tubule is physically connected to the region near the vascular pole through the _______
Macula densa
37
Where are the Lacis cells located?
Between macula densa and mesangial cells
38
What is another name for antidiuretic hormone?
Vasopressin
39
What is the major osmotic substance in the ECF?
Sodium
40
Where are the osmoreceptors?
Supraoptic nucleus of the hypothalamus
41
What makes antidiuretic hormone?
Hypothalamus (specifically, the supraoptic nucleus) OR maybe the pituitary
42
Mental states with increased risk of suicide
Hopelessness Helplessness Impulsivity
43
Are all patients who kill themselves depressed?
No
44
How do you protect against suicide in schizophrenia?
Clozapine
45
What CSF substance is associated with an increased risk of violence and suicide?
5-HIAA (hydroxyindoleacetic acid)
46
What are 2 groups of people who are at high risk of completing suicide?
Single male who lives alone | Chronic physical illness
47
7 psychiatric illnesses that predispose to suicide
``` Depression Schizophrenia Bipolar mood disorder Drug or alcohol problems Cognitive disorder Anorexia nervosa Personality disorder with axis I co-morbidity ```
48
When is risk of suicide highest in renal disease? What does this mean?
First 3 months of dialysis | Suicide is prompted by failure to cope with stress rather than declining health status
49
5 errors made in the evalulation of psychiatric patients
Not corroborating story with family/friends Not reviewing old records Not seeking consultation Avoiding specific questions about guns, plans, fantasies, etc Ignoring risk enhancing factors
50
How much fluid is in the intracellular compartment? What are the 2 parts?
27L Noncirciulating cell volume = 24L Blood cells = 3L
51
What are the insensible water losses?
Respiration, skin | The ones you can't sense I guess
52
How much of the cardiac output do kidneys recieve?
25%
53
Why do filtration and reabsorption rates >> excetion rates?
Rapid removal of waste products | Precise and rapid volume/composition control of ECF
54
What important calcium-related substance does the renal system make?
Calcitriol
55
What is the rate-limiting step of the RAAS?
Renin
56
What happens to net filtration pressure as we move along the tubule?
It decreases and eventually reaches equilibrium This is because Pi gc increases and Pgc-Pt decreases
57
What 2 things make up K, the resistance term in GFR = dP*K?
Hydraulic conductivity Surface area K = pA
58
What 2 things determine filtration fraction?
FF = GFR/RPF RPF = renal plasma fraction
59
Which arteriole does angiotensin II act on?
Both, but mostly the efferent (away) one
60
How do NSAIDS affect the kidneys?
They block prostaglandins, vasoconstricting the afferent arteriole
61
How do ACEIs and ARBs affect the kidneys?
They block angiotensin II, increasing renal blood flow but decreasing GFR
62
What is the pH of the urine of carnivores and herbivoes?
Carnivores - acidic | Herbivore - alkaline
63
What are the 2 sides of the epithelial cells in the renal tubules?
Apical - faces lumen | Basolateral - faces serosa (interstitium and capillaries)
64
What side are microvilli on?
Apical
65
How many ions/molecules does a facilitated diffusion carrier take?
At least 2 (why not 1?)
66
What side is the Na/K ATPase on? Which directions does it transport?
Basolateral | 3 Na out, 2K in
67
What are the jobs of the nephron segments?
Proximal convoluted tubule - bulk reabsorption Loop of Henle - urine dilution Distal convoluted tubule - tine-tuning Na balance Collecting duct - fine-tuning K, acid, water ballance
68
10 things the proximal tubule cell does
Bulk reabsorption of: Na, water, glucose, amino acids, calcium, phosphate, citrate H+ secretion/HCO3 absorption Organic anions secretion Macromolecule absorption
69
Is the thick ascending limb permeable to water?
No
70
What 3 things are reabsorbed in the thick ascending limb?
Na (trans-Na/K/2Cl cotransporter and paracellular) Ca (paracellular) Mg (paracellular)
71
What 3 things are reabsorbed in the distal convoluted tubule?
Na (Na/Cl cotransporter) Ca Mg
72
Where do thiazide diuretics act?
Distal convoluted tubule NaCl cotransporter
73
2 types of cells in the collecting duct
``` Principal cells Intercalated cells (alpha, beta) ```
74
What do principal cells do (3)?
Fine tune Na (ENaC), K (ROMK/Maxi), water (aquaporin) reabsorption in the collecting duct
75
What do alpha intercalated cells do?
H+ secretion HCO3- synthesis K+ absorption
76
What do beta intercalated cells do?
HCO3- secretion | CL- absorption
77
What does aldosterone do to the principal cells in the collecting duct?
Increases Na+ transporters so Na+ goes into the blood
78
What does vasopressin do the collecting duct?
Allows it to be permeable to water via aquaporins
79
How does tubular function depend on flow?
Higher velocity - less time for interaction with transporters -> less absorption Reduced flow rate increases absorption
80
How do receptors for ECF volume work?
Stretch
81
4 effects ofsympathetic activity on the kidney
Vasoconstriction Renin release Decreased RBF/GFR Increased renal reabsorption of NaCl
82
Where is aldosterone made?
Adrenal gland
83
What does vasopressin do?
Induces expression of aquaporins on collecting duct cells so water can escape out of the urine
84
8 non-osmotic stimuli for vasopressin
``` Low effective arterial blood volume Endocrine disorder Pain Nausea CNS disorders Pulmonary disorders Drugs Meds ```
85
What are the normal values for PO2 PCO2 and HCO3
94 +-8 38 +-2 24 +-2
86
What defines acute kidney injury?
Rapid reduction in glomerular filtration rate manifested by a rise in plasma creatinine and urea concentration
87
What state does acute kidney injury result in?
Reduced clearance of nitrogenous waste products -> azotemia
88
What are 3 problems that can cause acute kidney injury?
Pre-renal azotemia - decreased GFR from decreased renal plasma flow or renal perfusion pressure Post-renal azotemia or obstructive nephropathy - decreased GFR due to obstruction of urine flow Intrinsic renal disease - decreased GFR from direct injury to the kidneys
89
What is oliguria? | What is anuria?
Decreased urine (
90
What is the most common cause of an abrupt decrease in GFR in a hospitalized patient?
Prerenal azotemia
91
What are 2 hypervolemic states that can cause pre-renal azotemia?
Congestive heart failure Cirrhosis These diseases are characterzed by low effective arterial blood volume and reduced renal perfusion
92
4 types of kidney diseases that cause acute kidney injury
Vascular (cholesterol emboli, renal vein thrombosis) Glomerular (acute glomerulonephritis, hemolytic uremic syndrome) Interstitial (acute interstitial nephritis, infection, myeloma kidney) Tubular (ischemic or nephrotoxic acute tubular necrosis)
93
Where in the nephron do urinary casts usually form
Distal convoluted tubule
94
2 common causes of death in patients with acute tubular necrosis
Infections | GI bleed
95
What is the primary protein in the slit diaphragm of pedicels?
Nephrin
96
Why should we care about microalbuminuria?
Suggestive of early glomerular damage | We look for it in diabetics to predict diabetic nephropathy
97
What is nephrotic syndrome? | What is nephritic symdrome?
Nephrotic - protein leak through glomerular capillary wall Nephritic - glomerular injury
98
5 things altered in nephrotic syndrome
``` Protineuria Hypoalbuminemia Edema Hyperlipidemia Lipiduria ```
99
What are the 2 mechanisms by which edema occurs in nephrotic syndrome?
Decreased serum albumin | Defect in sodium excretion -> volume expansion
100
Why is there hyperlipidemia and increased risk for thrombosis in nephrotic syndrome?
The liver tries to make more albumen and it also makes more of all proteins, including lipoproteins and clotting factors
101
6 things altered in nephritic syndrome
``` Microhematuria (sometimes casts) Leukocyturia Proteinuria Decreased GFR Hypertension Edema ```
102
3 genes most commonly mutated in hereditary glomerular disease
Nephrin Podocin WT-1
103
How do you treat hereditary glomerular disease?
ACEI Renal transplantation eventually Steroids don't work
104
What is the mechanism of minimal change disease?
A circulating permeability factor acts directly on the podocyte, disrupting the permeability barier so proteinuria occurs
105
What molecule is expressed with minimal change disease?
CD80
106
What is the treatment for minimal change disease?
Steroids
107
What genetic polymorphism is more common in focal segmental glomerulosclerosis?
APOL1
108
What is membranous nephropathy?
Deposition of immune complexes in subepithelial space - glomerular basement membrane looks thickened
109
What is the antigen n membranous nephropathy?
Something on the podocyte, usually PLA2
110
What is the histologic pattern in membranoproliferative glomerulonephritis?
Mesangial proliferation Thickening of glomerular basement membrane C3 and IgG deposits
111
Membranoproliferative flomerulonephritis type 1 is associated with what infection?
Hepatitis C
112
What 2 diseases exhibit pulmonary-renal syndrome?
Goodpasture's | ANCA-associated vasculitis
113
Crescents are ssociated with what disease process?
Rapidly progressing glomerulonephritis
114
Where are crescents? What 2 cells types are they made of?
Bowman's capsule | Macrophages and parietal epithelial cells
115
Which infection is most common before post-infectious glomerulonephritis?
Group A strep (GAS)
116
In IgA nephropathy, wheredoes IgA usually deposit?
Mesangium
117
What is the mechanism of IgA nephropathy?
IgAs have abnormal sugars and are not cleared as easily, resulting in circulating complexes
118
What is the systemic disease that results in IgA nephropathy?
Henoch-Schonlein purpura
119
What is a pauci-immune renal vasculitis
Small vessel vasculities of the kidneys without evidence of immune complex deposition
120
What autoantibody is often present in pauci-immune renal vasculitis?
ANCA
121
What are the 2 most common antigens for ANCA?
Myeloperoxidase | PR-3
122
Cryoglobulins are most frequently associated with ________ infection
Hepatitis C
123
What do maltese crosses and oval fat bodies refer to?
The refractile pattern of lipiduria
124
3 complications of nephrotic syndrome
Hypercoagulability Increased infections Less vitamin D
125
3 things in general management of nephrotic syndrome
Low-salt diet Diuretics Blood pressure control
126
What is the main pathologic change in minimal change disease? What imaging modality is used to see it?
Elecron microscopy shows foot process fusion (but really foot processes are disrupted and proteinuria occurs)
127
What are 3 diseases associated with focal segmental glomerulosclerosis?
HIV associated nephropathy Sickle cell Obesity
128
What toxin can lead to membranous nephropathy?
Mercury
129
What is abnormal in membranoproliferative glomerulonephritis type II?
Low C3 and C4 via the alternative complement pathway
130
Are adjacent podocyte feet from the same cell or different cells?
Different! They alternate
131
5 clinical syndromes of glomerular disease
Asymptomatic hematuria/proteinuria Acute nephritic syndrome (hematuria/protinuria + ARF) Rapidly progressive nephritic syndrome Nephrotic syndrome (massive proteinuria, hypoalbuminemia, edema) Chronic renal failure
132
What are the 6 'nephritic' diseases?
Benign familial hematuria (thin basement membrane disease) Alport's disease IgA nephropathy Postinfectious glomerulonephritis Focal necrotizing/crescentif glomerulonephritis Lupus glomerulonephritis
133
What is mutated in both thin basement membrane disease and Alport's disease?
Collagen IV
134
What is the triad of Alport's disease?
Nephritis Deafness Ocular lesions
135
What is the inheritance pattern of Alport's disease
X-linked | I presume recessive
136
What population does Henoch-Schonlein Purpura most commonly occur in?
137
A starry sky immunoflourescence pattern occurs in which disease?
Postinfecious glomerulonephritis
138
What is the difference between membranous disease and membranoproliferative disease (both 1 and II)
Immune aggregates between the basement membrane and the podocyte Immune aggregates in the basement membrane I - antibodies II - complement
139
3 types of IF staining in focal segmental necrotizing and crescentic glomerulonephritis
Linear - basement membrane itself is the antigen (Goodpasture's, anti-GBM) Granular - immune complex-mediated (IgA, SLE, endocarditis, etc) No staining - pauci-immune (vasculites)
140
What is the difference between Goodpasture's and anti-glomerulobasement membrane disease?
Renal limited: AGBM | Renal + lung: Goodpasture's
141
What Ig is anti-GBM and Goodpasture's?
IgG
142
What are the 6 renal lupus classifications?
``` I: No or minimal changes II: Mesangial glomerulitis III: Focal, segmental glomerulonephritis IV: Diffuse glomerulonephritis V: membranous nephropathy VI: Renal failure ```
143
2 mechanisms of hyperfiltration injury
Circulating factors | Mechanical stress
144
What 4 things are associated with membranous glomerulopathy 15% of the time?
Bugs - infections Drugs - rheumatoid meds Tumors Rheum - SLE
145
What is the mechanism for membranoproliferative glomerulonephritis?
Subendothelial deposits cause injury to the endothelial cell | It retracts and puts a new layer of basement membrane between the deposit and itself
146
Is renal amyloidosis hypo or hypercellular?
Hypocellular - amyloid deposits wipe out the glomerulus and deposit in vessels
147
What does amyloidosis look like on EM?
Spilled spaghetti
148
What 2 kidney lesions does diabetes cause?
Hyaline arteriolar disease | Diabetic glomerulosclerosis
149
What happens in diabetic glomerulosclerosis?
Expansion of the mesangium Basement membrane thickening Mesangial lysis (they make so much basement membrane they kill themselves)
150
Wat is the gross appearance of the kidney in hypertensive renal disease?
Finely granular surface fromscarred glomeruli
151
What happens to the kidney in hypertensive renal disease (2)?
Medial and intimal thickening | yaline deposition
152
What happens in malignant/accelerated hypertensive renal disease?
Renal vasculature injury - > fibrinoid necrosis, hyperplastic arteriolitis (ok inflammation) - > increased renin - > viscious cycle
153
What is uremia?
Dysregulation of stuff when there is severe loss of all renal functions
154
3 other things that get fucked up when your kidney is really fucked
Erythropoietin -> anemia Renin -> hypertension Vitamin D -> osteomalacia
155
Within what time frame must urinalysis be done in?
2 hours of collection | Or refrigerated if longer (but less than 24 hours)
156
What can cause a false positive on a urinalysis glucose screen? A false negative?
Jar is left open | Vitamin C
157
What does nitrite in the urine mean?
Gram negative bacteria
158
What do hyaline casts indicate?
They are normal
159
Hypo and hypernatremia refer to the concentration of sodium where?
In the serum NOT total body
160
Urine can be _____ times more concentrated than plasma
4
161
What 2 things does ADH/vasopressin do?
Increase renal water reabsorption Vasoconstriction
162
What is hte most common electrolyte disturbance in hospitalized patients?
Hyponatremia
163
What is a common mechanism of hyponatremia? What are 2 ways this can occur?
Elevated serum osmolality from a solute other than sodium Hyperglycemia Mannitol/glycerol administration
164
2 conditions that cause isotonic hyponatremia
Lab artifact: Hyperlipidemia Hyperproteinemia (like multiple myeloma)
165
Explain lab artifact isotonic hyponatremia
Plasma osmolality is normal but there is less water content *because of hyperlipiedmia or hyperproteinemia) It is a laboratory artifact of flame photometry and a sodium-sensitive electrode will yield a normal value
166
Deficiency in what hormone causes hypovolemic hyponatremia? What about euvolemic hyponatremia?
Mineralocorticoid Glucocorticoid
167
4 causes of hypervolemic hyponatremia
Congestive heart filaure Hepatic cirrhosis Nephrotic syndrome Advanced chronic or acute renal failure
168
What is serum osmolality like in hypernatremia?
It is always increased
169
What is diabetes insipidus?
Excessive thurst and excretion of lots of dilute urine. Reuction of fluid intake does not concentrate urine
170
What are the 2 kinds of diabetes insipidus?
Central - ADH/vasopressin is not made Nephrogenic - insensitiity to ADH/vasopressin
171
Equation for amount of water needed to treat someone with hypernatremia
0.6*body weight in kg * [actualNa/desiredNa-1]
172
What is effective arterial blood volume?
Volume of blood detected by volume sensors in the arteries
173
What are the 4 categories of volume sensors?
Low-pressure baroreceptors - veins High-pressure baroreceptors - carotid and aortic body Intrarenal sensors Hepatic and CNS sensors
174
What is the end product of the RAAAS?
Aldosterone
175
4 substances that decrease sodium reabsorption
Natriuretic peptides Prostaglandins Bradykinin Dopamine
176
4 substances that increase sodium reabsorption
Angiotensin II Aldosterone Catecholamines Vasopressin/ADH
177
What does sympathetic stimulation do to natriuresis?
Increases sodium reabsorption
178
What are 3 ways Na gets reabsorbed in the distal colvoluted tubule?
1. Na channels 2. NaCal cotransporter 3. Na/H antiporter These are all on the luminal side
179
How does sodium get into the principal cells of the cortical collecting duct?
Na enters and is exchanged for K
180
What is Bartter's syndrome? Where in the kidney is the defect?
A mutation in the Na/K/2Cl cotransporter in the thick ascending loop of Henle? ``` Hypokalemia Hypomagnesemia Metabolic alkalosis High renin High aldosterone Increased calcium excretion Normal blood pressure ```
181
What is Gitelman's syndrome? Where in the kidney is the defect?
A mutation in the Na/Cl cotransporter in the distal tubule Hypokalemia Hypomagnesemia Metabolic alkalosis Reduced excretion of calcium
182
4 serum changes in stats of volume contraction
Increased BUN:plasma creatine ratio (>15) Metabolic alkalosis if upper GI fluid loss Metabolic acidosis if lower GI loss Increased hematocrit and serum albumin
183
6 diseases of nephrotic syndrome
Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy Membranoproliferative nephropathy Diabetes mellitus Systemic amyloidosis
184
What are 3 changes in cirrhosis that cause underfilling of the arterial circulation?
Hepatic and portal hypertension Aplanchnic vasodilation Hypoalbuminemia
185
How does acetazolamide work?
Blocks carbonic anhydrase -> bicarb wasting -> metabolic acidosis and some diuretic action Works in the proximal tubule
186
How do loop diuretics work?
Inhibit Na/K/2Cl cotransporter in thick ascending limb
187
How do thiazide diuretics work?
Inhibit the Na/Cl transporter Blocking sodium entry In distal convoluted tubule
188
How do triamterene and amiloride diuretics work?
Sodium channel blockers in collecting duct
189
How does spironolactone work?
Inhibits aldosterone
190
What are 2 direct sodium channel blocker diuretics?
Triamterene | Amiloride
191
How do the osmotic thresholds for thirs and ADH compare?
The threshold for thirst is a little higher (a few mOsm/kg)
192
2 states that increase ADH. Which is stronger?
Hyperosmolality Hypovolemia Hypovolemia overrides if osmolality and volume are opposing
193
3 causes of hypovolemic hyponatremia
Hemorrhage (due to rehydration without adequate Na intake) Plasma volume and extracellular fluid losses Decreased aldosterone as in addison's disease
194
3 causes of hypervolemic hyponatremia
CHF Cirrhosis (both these cause release of ADH due to reduced effective blood volume) Severe renal failure (the kidneys can't excrete water)
195
Which type of diuretic impairs dilution and are a frequent cause of hyponatremia, particularly in the elderly?
Thiazides
196
3 treatments for hypervolemic hyponatremia
``` Water and salt restriction (giving salt is a frequent mistake but it worsens the edema!) Loop diuretics (but not thiazides, which can worsen) Inotropes if CHF ```
197
What is the underlying cause of symptoms of hyponatremia? What are some of them (8)?
Cerebral edema Anorexia, nausea, vomiting Weakness, lethargy, confusion Seizures, death
198
If hyponatremia is chronic or uf unkonown duration, you slow correction to avoid what?
Central pontine myelinosis (osmotic demyelenation syndrome)
199
3 things in treatment of euvolemic hyponatremia
Seizures -> hypertonic saline Asymptomatic -> water restriction and correction of underlying disorder ADH/vasopressin antagonists
200
How does hypernatremia develop since we have a strong thirst reflex?
When patients don't ave access to water | CNS problem that impairs thirst
201
What are 2 things that can be mutated in congenital nephrogenic diabetes insipidus?
``` AVP receptor (X-linked recessive) Aquaporin 2 (autosomal R or D) ```
202
How do you treat nephrogenic diabetes insipidus?
Vasopressin receptor antagonsts like tolvaptan
203
What is the cause of gestational diabetes insipidus?
Release of vasopressinase from the placenta during the second half of pregnancy
204
What is the job of the high-pressure baroreceptors?
Maintain mean arterial pressure by normalizing ECF volume
205
What is glomerulo-tubular balance?
Changes in GFR induce a proportional change in the rate of proximal tubular sodium reabsorption Part of renal autoregulation
206
Where is most of the glomerular filtrate reabsorbed?
Proximal tubule
207
How is the sodium gradient maintained in the proximal tubule? (so that sodium will go into the cell)
Na/K ATPase at the basolateral membrane puts sodium into the blood
208
What does post-infectoius glomerulonephritis look like under imaging? (light, IF
Light microscopy - hypercellular, inflamed glomeruli IF - granular EM - large, subepithelial lump
209
What are the 3 types of rapidly progressing glomerulonephritis?
They describe the immunoflourescence patterns Linear - antibodies against the glomerular basement membrane Granular - immune complex deposition Pauci-immune - ANCA-positive vasculitis
210
What is seen on urinalysis in acute tubular necrosis?
Brown granular casts These were once the tubular cells
211
3 endogenous substances that affect internal K balance
Insulin Catecholamines (NE, epi) Aldosterone (maybe and if so its role is small)
212
What channel does K use to get out of the cells in the ascending limb of the loop of henle?
ROMK
213
Since aldosterone and cortisol bind to the mineralocorticoid receptor on cells in theascending limb of the loop of henle, how do we reduce the effects of cortisol?
Enzyme 11BOH-SDH turns cortisol into cortisone so it can't bind
214
What can cause a spirous low serum K? High serum K?
High WBC count | High platelet count
215
How does hypomagnesia result in hypokalemia?
Mg prevents the K+ channel in the renal rubule from releasing potassium Without Mg, renal K+ wasting occurs
216
Are men or women more likely to have hypertension?
Their risks are equal
217
Is systolic or diastolic blood pressure a more important cardiovascular disease risk factor in people over 50?
Systolic
218
What is the Guyton hypothesis of essential hypertension? (6)
Primary defect in renal sodium excretion from lower perfusion pressure - > increased plasma volume - > increased cardiac output - > overperfusion of organs - > autoregulatory increased in systemic vascular resistance - > increased blood pressure
219
What is the cellular model of essential hypertension? (6)
In vascular smooth muscle cells - > Na/K ATPase inhibitor - > increased intracellular Na - > Na/Ca exchanger doesn't work (it puts Na in and calcium out) - > SMC contracts - > increase in systemic vascular resistance - > increase in blood pressure
220
What is the most important thing to do in hypertension management?
Stop smoking
221
How do we define hypertension?
The level of blood pressure at which the benefits of therapy outweigh the risks
222
How do you calculate mean arterial pressure?
(2*DBP + SBP)/3
223
What are 3 proposed mechanisms of impaired natriuresis (the kidney excretes less Na than it should)
1. Having less nephron mass -> decreased exretory ability 2. Increased RAAS and sympathetic input -> more proximal tubular Na reabsorption 3. Increased vascular resistance -> reduced renal blood flow
224
What turns angiogensin I into angiotensin II?
ACE (angiotensin converting enzyme)
225
What are 2 causes of renal artery stenosis? What are typical patient populaitons for each?
Fibromuscular dysplasia 50 years old and smokers and men
226
2 clinical features that suggest primary hyperaldosteroneism
Hypokalemic metabolic alkalosis | Resistant hypertension
227
What is the mineralocorticoid escape mechanism?
A mysterious mechanism where in hyperaldosteronism, sodium retention and edema don't occur
228
What is pheochromocytoma?
A benign tumor of the adrenal medulla that makes catecholamines
229
What is a hypertensive crisis?
Acute management of elevated blood pressure plays a decisive role in outcome
230
Why is determining if hypertensive neuroretinopathy is present important?
If present, it signifies a systemic hypertensive vasculopathy (with fibinoid necrosis and obliterative arteriopathy)
231
What are the 2 findings that caracterize malignant hypertension?
Elevation of blood pressure | Widespread acute arteriolar injury
232
What is the most characteristic feature of malignant hypertension? What causes it?
Cotton-wool spots on the fundoscopic exam From ischemic infarction of retinal nerve fiber bundles From proliferation of vascular endothelium -> occlusion
233
What is goal blood pressure in patients with diabetes or chronic kidney disease?
234
What drug class reduces hypertension by decreasing cardiac output and total peripheral resistance? Just CO? Just TPR?
Non-dihydropyridine calcium channel blockers (verapamil) Beta blockers Dihydropyridine calcium channel blockers (amlodipine)
235
What drug classes reduces hypertension by decreasing cardiac output and total peripheral resistance?
Non-dihydropyridine calcium channel blockers
236
Where is most of the body's potassium?
Intracellular fluid
237
What are 2 situations when K+ moves from intracellular fluid to the extracellular fluid?
Acidemia | Hyperosmolality
238
How does insulin react to K+?
Their levels are proportional and dependent boht ways Increased insulin moves K+ into cells
239
How do beta-2 agonists affect K+?
Put K+ into cells
240
How does exercise affect K+
Muscle inury - > leakage of K+ into extracellular fluid - > hyperkalemia Athletes redistribute K+ into the muscles -> hypokalemia
241
Which way does Na/K ATPase go?
3 Na out | 2 Na in
242
Where in the kidney do disorders of renal K+ handling occur?
Collecting duct Either addition or reabsorption)
243
Is adaptation to changes in Na or K intake faster?
Na
244
What is pH?
-log[H+]
245
What is the body's normal pH range?
7.35-7.45
246
What is ammonia trapping?
NH3 diffuses into the lumen Binds H+ It becomes NH+, which can't get back through the membrane of the tubule
247
What size molecule does not pass through the glomerular filter?
60,000 daltons
248
What prevents red blood cells from getting into Bowman's space?
Fenestrated epithelium (the holes are too small)
249
Where is the Na/K/2Cl cotransporter?
The thick ascending limb of Henle
250
Where does ammonioagenesis occur?
Proximal tubule cells
251
When is bicarbonate synthesized?
When there is no HCO3- in the tubular lumen
252
What is the formulat for net acid excretion?
NH4+ excretion + titratable acid excretion - HCO3- excretion
253
What is winter's formula?
Expected CO2 = 1.5*bicarb + 8 +-2 TO see if appropriately respiratory compensaiton
254
How do you tell if pH is being metabolically or respiratorily compensated for?
Compensation is the same way as the pH Cause is the opposite way
255
Where does mannitol work? | How does it work?
Proximal tubule | It is an osmotic diuretic
256
5 adverse effects of loop diuretics
``` Decreased K Decreased Mg Decreased hypocalcemia Gout attack Metabolic alkalosis ```
257
When do you use ethacrynic acid?
When you want loop diuretic effects that aren't sulfa drugs
258
Where do loop diuretics work? | How do they work?
They inhibit the Na/K/2Cl cotransporter
259
Where do thiazide diuretics work? | How do they work?
Distal tubule | Inhibit Na/Cl cotransporter
260
What are 2 ways thiazide diuretics reduce hypertension?
Decrease plasma colume | Decrease cardiac output
261
Thiazides can cause hyper_______ and hyper_______
Hypercalcemia | Hyperglycemia (in people with impaired glucose tolerance)
262
How does chronic kidney disease alter thiazide diuretic response?
Thiazides become less effecteive because less drug reaches the site of action You need a more effacious one at GFR
263
How do potassium sparing diuretics work?
Bind to the aldosterone-dependent Na/K exchange site and prevent aldosterone from reabsorbing
264
How do thiazides and loop diuretics affect uric acid?
They increase them
265
Is there cross-reaction between sulfonamide antibiotics and diuretics?
No
266
4 side effects of ACE inhibitors
Cough (from bradykinin not being broken down) Hyperkalemia Transient rise in serum creatinine Angioedema
267
3 side effects of ARBs
Hyperkalemia Transient rise in serum creatinine Angioedema
268
Which calcium channel do CCBs block? What does this accomplish?
L-type Arterial vasodilation -> decreased peripheral vascular resistance
269
What are the 2 classes of calcium channel blockers? What is the difference in their effects?
Dihydropyridines - peripheral and cardiac vasodilators Non-dihydropyridines - cardiac stuff (negative inotropic activity)
270
Non-dihydropyridines inhibit what enzyme? Dihydropyridines inhibit what enzyme?
CYP450 3A4. CYP450 is an isoenzyme of 3A4, whatever that means
271
How do hydralazine and minoxidil work?
Increase intracellular cGMP - > relaxaiton of arterial smooth muscle - > decreased systemic pressure and contractility
272
What is the suffix for alpha-1 receptor blockers?
-azosin Terazosin Doxazosin Prazosin
273
How do alpha-1 receptor blockers work? What are they used for?
Peipheral postsynaptic blockade - > decrease in arterial tone - > relaxes smooth muscle of bladder neck They are used for BPH
274
What are 2 alpha-2 receptor agonists we care about?
Clonidine | Methyldopa
275
How does bone act as a buffer?
In acidosis, osteoblasts are suppressed and osteoclasts are stimulated
276
Do we ingest/make an exces of acid or base?
Acid
277
How does the kidney transport hydrogen into the urine?
Sodium-hydrogen exchanger
278
What are the 2 main buffers in the urine?
``` TItratable acids (complexing of a hydrogen ion toa filtered acid anion) Ammonia ```
279
How does hyper/hypokalmeia affect ECF pH?
Hypokalemia -> alkalosis Low K+ causes H+ shif into cells Increased H+ in tubule cells means more is excreted High K+ causes H+ to be inappropriately retained in the ECF
280
What is the bicarb equation?
H+ + HCO3- H2CO3 H2O + CO2
281
That is the expected increase in bicarbonate in respiratory acidosis in acute and chronic settings?
Acute: dHCO2- increases by 1 mEq/L for every 10 mmHg increase in PCO2 Chronic: dHCO3 increases by 4 mEq/L for every 10 mm increase in PCO2
282
What are the 2 steps of metabolic alkalosis?
``` Generation Miaintenance (always the kidney's fault) ```
283
In what case do you give hypertonic saline?
Seizures
284
Why does ADH cause hyponatremia?
It causes reabsorption of water, not sodium
285
Which diuretic can cause hyponatremia?
Thiazides
286
What causes euvolemic hyponatremia?
Syndrome of inappropriate ADH secretion
287
When do you give D5W?
For volume expansion in cases of low blood sugar or high sodium
288
What does insulin do to potassium?
Shifts it intracellularly
289
What does increased blood pH do to potassium?
Shifts potassium extracellularly Because of the K/H exchanger
290
IN what state are peaked T waves seen on an EKG?
Hypokalmia
291
What does beta2 input do to potassium?
Shifts it intracellularly
292
What is the effect of increased tubular flow on potassium secretion?
Increased tubular flow makes secretion easier (so, more) because the fluid goes away
293
What is contraction alkalosis?
Loss of chloride-rich fluid
294
How does chloride afect blood pH?
Chloride depletion results in resporption of bicarbonate by the kidney Thus, it maintains metabolic alkalosis
295
How does aldosterone contribute to alkalosis?
It induces H+ ATPase activity
296
What are 2 causes of chloride-resistant metabolic alkalosis
Hyperaldosteronism | Cushing's syndrome
297
Equation for the expected increase in CO2 in metabolic alkalosis
dCO2 = (0.25 to 1.0)*HCO3
298
How do you treat chloride-responsive acidosis and chloride-resistant alkalosis?
NaCl infusion or KCl Block mineralocorticoid effect with spironolactone or amiloride
299
How do you calculate a urine anion gap? What does it mean?
Na+K - Cl Negative -> ammonia production in kidney is occuring Positive -> renal ammonia production impaired an a renal tubular acidosis is present
300
Is acetazolamide a sulfa drug?
Yes
301
What is the results of inhbiting the Na/K/2Cl transporter with loop diureteics?
Medulary intersitium decreases tonicity -> inhibition or reabsorption of water
302
Can you use loop diuretics on edema caused by calcium channel blockers?
No | Only cardiovascular, renal, or hepatic disease
303
3 adverse effects of spironolactone
Hyperkalemia Gynecomastia Amenorrhea Eplerenone also does 1 and 3
304
What are 2 sodium-channel blocker diuretics we care about?
Triamterene | Amiloride
305
What is the suffix for ARBs?
-sartan Angiotensin II receptor blockers
306
What is the mechanism of action of calcium channel blockers?
L-type channel block - > less intracellular calcium in muscles - > inhibition of intracellular phosphodiesterase - > increased GMP - > inhibition of vascular SMC contractility and cardiac conduction
307
What is the difference in target between dihydropyridines and nondihydropyridines?
Dihydropyridines are selective for L-type Ca channels in blood vessels Non-dihydropyridines bind equally to cardiac and vascular L-type Ca channels
308
What are 2 direct vasodilators we care about?
Hydralazine | Minoxidil
309
How doe smnoxidil work?
Potassium chanel opener | -> hyperpolarizaiton of cell membranes
310
How does hydralazine work?
Alters calcium metabolism messing up the contractility somehow of the vasculature
311
What suffix is for alpha-1 blockers?
-zosin
312
How does clonidine work?
Stimulates alpha-2 adrenergic receptors Decreases peripheral vascular resistance Inhibits norepinephrine
313
What is the difference between hypertensive urgency and emergency?
Urgency - severe elevation | Emergency - BP >180/120 with organ dysfunction
314
How does sodium nitroprusside work?
Nitric oxide donor Activates guanyl cyclase -> myosin dephosphorylatin -> VSMC relaxation
315
Which hypertension drug is light-sensitive and requires reconstitution in a vial?
Sodium nitroprusside
316
What is the definition of chronic kidney disease?
A permanent reduction in GFR
317
6 causes of chronic kidney disease
``` Diabetic nephropathy Hypertensive nephrosclerosis/renal vascular disease Glomerulonephritis Polycystic kidney disease Interstitial nephritis Obstruction ```
318
In chronic kidney disease, wthe rise of what 2 substances occurs to maintain balance?
FGF-23 | Parathyroid hormone
319
What is the most important factor in decreasing the progression of kidney disease?
Blood pressure control
320
When is dialysis initiated?
When the risks of uremic complications exceed the risks of dialysis
321
What are the 3 ways heodialysis can be sceduled?
3 times per week Short daily Nocturnal
322
What are the 3 typical locations for arteriovenous shunts for hemodialysis?
Radiocephalic Brachiocephalic Brachiobasilic
323
Where does a dialysis catheter go?
Inernal jugular (so it's a port I think)
324
3 limittions of dialysis
Uremia may not improve all the way Difficult to remove enough volume to achieve euvolemia Hperphosphatemia can ocure
325
What is warm and cold ischemia for a kidney transplant?
Warm - time from cardiac death/clamping in doner Cold - time from cold perfusion to recipient anastomosis (24-36 hours)
326
What are the 2 pathways of T cell activation in transplant rejection?
Direct: Recipient T cells recognize intact donor HLA antiens on donor APCs Indirect: recipient T cells recognize donor HLA antigen fragments on host APCs. This is the 'normal' mechanism of activation
327
What happens to CD4 Th cells when actiated?
They differentiate nto various subtypes depending on the stimulus and environment
328
Which 3 cytokines do TH1 cells make?
IFN-Y TNF-a IL-2
329
Is Th1 or Th2 the dominant immune response in acute allograft rejection?
Th1
330
Which cells is HLA class 1 on? HLA class II?
HLA/MHC 1 - all cells HLA/MHC 2 - APCs
331
What are the 2 modes of transplant rejection?
Cellular (T-cell) Antibody (B cell)
332
What are the 2 types of cellular kidney transplant rejection?
Tubulitis -> Banff class I Vasculitis -> Banff class II
333
3 criteria to determine if antibody-mediated kidney rejection is occuring
peritubular capillary C4d staining Graft damage Donor specific antibodies
334
2 1st degree agents 2 second degree agents 3rd degree agents For immunosuppression to limit immune graft damage
Calcineurin inhibitors cyclosporine, tacrolimus Proliferation inhibitors MMF, sirolimus Prednisone
335
How do NSAIDS work?
They block cyclooxegenase 1 and 2, resulting in lack of prostaglandin and thromboxane production
336
Which beta-blocker do we like to use in chronic kidney disease?
Metroprolol because its half-life is not prolonged
337
4 drug classes that can causehyperkalemia in chronic kidney disease
POtassium-sparing diuretics ACE inhibitors ARBs Digoxin
338
6 things to give for hyperkalemia if EKG cheanges are present and their 3 different categories
To antagonize cardiac conduction abnormalities: Calcium gluconate Sodium bicarbonate To shift K+ Intracellularly: Glucose + insulin Albuterol nebs (super hoigh doses) To remove K+ from the body: K exchange resin Hemodialysis
339
How does Kayexalate K+ exchange resin work?
Binds K+ in exchange for Na+ in the gut
340
How does Patiromer/Veltassa K+ exchange resin work?
Exchanges Ca++ sorbitol for K+ in the gut
341
What are the 5 stages of chronic kidney disease?
``` 1 - kidney damage, normal GFR 2 - kidney damage, mild GFR decrease 3 - moderate 4 -severe 5 - kidney failure ``` They all have GFR requirements
342
Wt which CKD stage do you need to renally dose drugs?
3-5
343
How do you deal with diuretic resistance in CKD?
Synergistically combine diuretics that act at different sites of the nephron
344
How does serum phosphate affect serum calcium leels?
They are inversely proportional | High phosphate -> lowers calcium
345
What is the trade-off hypothesis in chronic kidney disease?
kidney failure - > phosphorus is retained - > calcium is lowered - > parathyroid release - > excretino of phosphate and restoration of calcium levels Eventually the renal tubules can no longer respond, bone disease occurs, and sytemic toxicity may happen
346
How does the kidney compensate for hydrogen ions in CKD?
Increase in NH4+
347
What are 4 reasons why anemia occurs in CKD?
Decreased erythropoietin Shortened RBC lifespan, possibly due to a uremic toxin Blood loss, possibly due to abnormal coagulation Marrow fibrosis
348
What are 3 reasons why hypertension occurs in CKD?
Expansino of extracellular fluid volume (reduce ability to excrete sodium) Incresed RAAS Autonomic dysfunction and baroreceptors are insensitive
349
What is the number one thing to do to reduce CKD progression?
Treatment of hypertension with ACEIs or ARBs
350
What is a disadvantage of a catheter vs arteriovenous fistula/graft? An advantage?
Disadvantage - infection, mostly Staph | Advantage is ready immediately vs. weeks
351
Peritoneal dialysate has a lot of _____ to provide a high oncotic pressure
Dextrose
352
Why doesn't the unterovesice junction have a valve?
The ureter goes into the bladder at an angle and this works
353
What are radio-paque stones made out of? Semiopaque? Not radiopaque (soo radiolucent?)
Radiopaque - calciu oxalate and phosphate Semiopaque - magnesium ammonium phosphate Other - uric acid, cystine
354
5 risk factors for kidney stones
Hypercalcemia Increased uric acid Low pH Decreased volume Bacteria
355
5 consequences of urinary tract obstruction
Hyeronephrosis, hydroureter Infection Chronic obstructive pyelonephritis Renal failure Hypertension
356
What are the 2 parts of the female intrinsic urinary sphincter?
Bladder neck muscle fibers | Mid-urethral complex
357
What are the 3 parts of the male intrinsic urinary sphincter?
Bladder neck circular muscle fibers | Smooth muscle of prostate and membranous urethra
358
What are the effects of parasympathetic (1) and sympathetic action (2) on the bladder?
PS: detrusor contraction S: inhibition of detrusor, increased tension in smooth muscle of bladder neck and proximal urethra
359
What nerves are the somatic innervation of the bladder?
S2-S4
360
Which 3 parts of the brain provide input to micturition?
Cortex (inhibitory) | Cerebellum and brainstm (facilitatory)
361
What are the 5 steps of bladder emptying?
Storage Emptying/voiding/micturition1. increase in bladder wall tension 2. Afferent input overcomes inhibitory signal 3. Pudendal nerve activity stops, external sphincter/pelvic floor relaxes, detrusor neurons discharge 4. Proximal urethra opens 5. BLadder contracts
362
What do hyperactive deep tendon reflexes suggest? Hypoactive deep tendon reflexes?
Hyper - upper motor nuerons are fucked Hypo - lower motor neurons are fucked
363
What drug class do you use to manage overactive bladder?
Antimuscarinic agents They inhibit involuntary bladder contractions and increase bladder capacity
364
4 side effects of antichoenergic therapy
Dry mouth Constipation Blurred vision Drowsiness
365
Do drugs for urinary incontinence affect the afferent or efferent nerves?
Efferent
366
What is the goal of medical management of stress urinary incontinence? What are the 2 drug classes?
Goal is to increas bladder outlet resistance Alpha agonists Estrogen
367
What is the most common cause of pediatric hydronephrosis?
Uteropelvic junction obstruction
368
What is the most common renal abnormality?
Ureteral duplication
369
What is a ureterocele? Why is it a problem?
A cystic dilation of the part of the ureter that is within the bladder (intravesical part) Can be obstructive or cause reflux
370
Where does the urachus go?
From the dome of the fetal blader to the allantois of the umbilical cord It forms the median umbilical ligament after birth
371
What causes posterior urethral valves?
There are not supposed to be valsces there They are from abnormal insertion of mesonephric duct on the cloaca before it divides into the urogenital sinus and anorectal canal
372
What is hypospadias? What is epispiadias?
Hypospadias is when the orifice of penile urethra is somewhere along the ventral aspect of the penis (the part facing forward when penis is erect) Epispadias is when it is on It is from abnormal fusion of urogenital folds from androgen insufficiency
373
What is chordee?
A fibrous band on the penis, causing it to curve
374
What is exstrophy?
Exposure of the bladder mucosa b/c abdominal wall is absent
375
What causes an exstrophy-epispadias complex?
Failure of separation of the primitive cloaca by the urorectal septum
376
What are the 5 parts of Potter sequence?
``` Renal agenesis Small amt of amniotic fluid Squished face Amnion nodosum Pulmonay hyupoplasia ```
377
What causes amnion nodosum? Why is ist bad?
Nodules of squamous cells on amniotic membrane b/c the baby sheds them. Over time this erodes the surface of the amnion
378
What is the cause of death in renal agenesis?
Respiratory insufficiency (Potter sequence)
379
What causes prune belly/Eagle-Barrett syndrome?
Atrophy of anterior abdominal muscles due to megalocystis
380
Which kidney is less likely to form?
The left one is more comonly absent
381
What is renal ectopia? What are 2 complications?
When the kidney is not in the right place May result in ureteral obstruction or discoid shape
382
Where are kidneys usually fused in horseshoe kidney? What is the most common complication?
They are usually fused at the lower pole Increased incidence of urolithiasis
383
Which type of polycystic kidney disease presents earlier?
Autosomal recessive
384
What is the most common cause of renal cysts?
Dialysis
385
What other 5 organs can autosomal dominant polycystic kidney disease affect?
``` Hepatic cysts Mitral valve prolapse Diverticulosis Cerebral aneurisms (berry aneurisms) Pancreatic cysts ```
386
Where are the cysts in autosomal dominant PKD? Where are they in ARPKD?
AD - entire nephron | AR - collecting tubules
387
What happens to the liver in autosomal recessive polycystic kidney disease?
Portal hypertension from bile duct proliferation and periportal fibrosis
388
What causes multicystic dysplastic kidney?
Abnormal induction of metanephric blastema by uretal bud
389
What happens to a multicystic dysplastic kidney after birth?
If is nonfunctional, asymptomatic, and will involute over time
390
What is tubule cuffing on histology associated with?
Multicystic dysplastic kidney
391
What are 3 pediatric kidney tumors?
Congenital mesoblastic nephroma | Wilms tumor
392
What are the 3 components of a Wilms tumor?
Blastemal (small round blue cells) Epithelial (tubules) Stromal (fibroblastic)
393
What is associated with worse prognosis in Wilms tumor? Describe. Why is this bad?
Anaplasia These are large, hyperchromatic cells with weird mitotic figures It means these tumors are less chemosensitive
394
What is the stage of a bilateral Wilms tumor?
V (even though most cancers only go up to stage IV)
395
4 components of Beckwith-Weidemann syndrome
Wilms tumor GIgantism Macroglossia Abdominal wall defects
396
4 components of WAGR syndrome
Wilms tumor Aniridia (no iris) Genitourinary malformation mental Retardation
397
Which kidney is used for transplant?
Left because the renal vein is longer
398
Where do the renal vein and artery anastomosed to in a kidney transplant? Which side does the kidney go on?
External iliac vein and artery, usually on the right side
399
Which MHC do CD8+ cells respond to?
i
400
Which MHC do CD4+ cells respond to?
II
401
Which MHC/HLA is on all nucleated cells?
Cllass I
402
What are the 4 steps of T cell receptor activation?
Increased intracellular Ca2+ activates calmodulin - > Calmodulin binds/activates calcineurin - > calcineurin dephosphorylates nuclear transcription factor NFAT - >NFAT induces cytokine transcription in the nucleus (IL-2)
403
What are the 3 steps of T cell proliferation after activation?
IL-2 and IL-15 activate JAK/STAT pathway - > mTOR pathway - >Nucleotide synthesis and cell cycle activation leading to clonal expansion
404
What are the 3 classifications of kidney donors?
Standard Donation after cardiac death Extended criteria
405
What are 2 inhibitors of T cell proliferation?
``` Myocphenolate mofetil mTOR inhibitors (siroliumus, everolimus) ```
406
What does the urinary tract consti of?
Real pelvis Ureter Bladder
407
What are the 2 routes of infection for a UTI?
Hematogenous | Ascending
408
What is the most common cause of ascending UTI?
E. COli
409
What do “O” antigens mean?
They make certain E. coli strains more resistant
410
What are the 3 kidneys in the embryo? What are the time points associated with each?
Pronephros (4 weeks) Mesonephros (4 weeks-2 months) Metanephros - 5 weeks - maturity)
411
All 3 kidney stages develop from the ________ within the ________
Nephrogenic cord | Urogenital ridge
412
What are the little bits of emryological kidneys within each somite called?
Nephrotomes
413
What is the joining of the nephrotomes called?
Mesonephric duct
414
The mesonephric duct is also called the _____
Wolffian duct
415
What does the mesonephric duct/Wolffian duct become?
Epididymus | Vas deferens
416
The paramesonephric duct is also called the ______
Mullarian duct
417
What does the paramesonephric duct/Mullerian duct become?
Oviducts and uterus parts
418
The Mullerian duct is also called the ______
Paramesonephric duct
419
Whe wolffian duct is also called the _______
Mesonephric duct
420
The ______ surrounds the ureteric bud
Metanephric blastema
421
What 4 things does the metanephric blastema become?
Ureter Renal pelvis Major calyces Minor calyces
422
3 benign tumors of the kidney
Renal papillary adenoma Angiomyolipoma Oncocytoma
423
3 cell types in clear cell renal cell carcinoma
Clear Granular Spindle
424
What genetic disease is associated with Clear cell renal cell carcinoma?
Von Hippel-Lindau disease
425
What are the 4 renal cell carcinomas?
Clear cell Chromophobe Collecting duct Familial
426
4 exposers that increase risk of transitional urinary tract cancers
Smoking acrylamide Schistosoma haematobium Radiation
427
What is medullary sponge kidney?
A congenital disorder where cystic dilation of collecting tubules occurs
428
Autosomal dominant PDK is due to a defect in which protein? What is autosomal recessive PDK due to?
Polycystin | Fibrocystin
429
What is nephrophthisis-medullary cystic kidney disease complex?
A heritable disease where medullary cells die
430
In kidney failure how does an increased in volume of distribution affect drug plasma concentration? A decreased volume of distribution?
They both increase plasma concentration | So, renal dosing usually means reduce med
431
What 2 drugs dilate the affsorium Naerent arteriole? Which drug constricts it?
Dopamine, caffeine | NSAIDS
432
What 2 drugs constrict the efferent arteriole?
ACEIs, ARBs
433
How do you calculate FENa?
urinary Na * plasma creatinine/(plasma Na*urinary creatinine)
434
What can cause peaked T waves?
Hyperkalemia
435
What electrolyte imbalance can lead to rhabdomyolysis?
Hypokalemia
436
What is the equation for renal clearance?
Urine concentration * urine flow/plasma concentration
437
What does angiotensin II doe to the glomerulus? What results does this have?
It vasoconstricts the afferent and efferent arterioles (but mostly the efferent) This results in decreased GFR
438
What does the macula densa respond to?
Changes in NaCl delivery
439
Which hormone inserts aquaporins?
Aldosterone
440
Is the response to ADH or aldosterone faster?
ADH, since it prompts vesicle fusion and aldosterone goes all the way to the nucleus to induce transrption of Na+ channels and pumps
441
Is BUN/creatinine reabsorbed/secreted?
BUN is reabsorbed and creatinine is secreted
442
How long after infection does post-infectious glomerulonephritis occur?
2-3 weeks
443
What is the treatment for post-infectious glomerulonephritis?
Supportive
444
What is a bad complication of PIGN in adults?
Can become RPGN
445
What characterizes rapidly progressive glomerulonephritis?
Crescents in bowman's space on H&E This is fibrin and macrophages
446
How do you differentiate types of post-infectious glomerulonephritis
Immunoflourescence
447
Which disease results in thinning and splitting of the glomerular basement membrane?
Alport syndrome
448
What part of the kidney is renal cell carcinoma from?
Kidney tubules
449
What is the classic symptomatic triad in renal cell carcinoma?
Hematuria Palpable mass Flank pain
450
Where does the uteric bud branch from?
The mesonephric duct
451
How many people in the US have hypertension?
50-60 million
452
What does the Furnman criteria apply to?
Clear cell carcinoma
453
What is the fate of the ureteric bud? The metanephric blastema?
``` Urinary tract (urethra to tubules) Kidney ```

Spring 2016 - CVPR (4 decks)

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