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USMLE > Renal > Flashcards

Renal Flashcards

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USMLE® Step 1 flashcards
1
Q

JG apparatus

A
  • where the distal convoluted tubule meets with the afferent arterioles
  • made up of JG cells in the afferent arterioles - secrete renin
  • macula densa cells in the distal tubule - senses sodium in the distal tubule
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2
Q

JG cells are stimulated to secrete renin by

A
  • beta adrenergic stimulation B1
  • low Na+ in the DCT
  • low pressure in the afferent arterioles
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3
Q

Cortex vs. Medulla

A

Glomeruli are found in the cortex

Nephrons are found in the medulla

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4
Q

Ureters

A

Pass under the uterine artery (females) under the vas deferens (males)

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5
Q

Kidney Embryology

A

526

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6
Q

Causes of Potter Sequence

A
  • ARKPD
  • obstructive uropathy - posterior urethral valves
  • bilateral renal agenesis

REMEMBER TURNER SYNDROME = Horseshoe Kidney

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7
Q

Multi cystic Dysplastic Kidney

A

527

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8
Q

Renal Transplantation

A

Left kidney is usually taken during donor transplantation because it has a longer renal vein

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9
Q

Renal Blood Supply

A

Renal artery –> segmental artery –> inter lobar artery –> inter lobular artery –> arcuate artery

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10
Q

Fluid Compartments

A

Pg 529

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11
Q

Renal Plasma Flow

A
  • blood that goes into the glomeruli and the tubules
  • use PAH to estimate because it is filtered by glomerulus and secreted into the proximal tubule

Pg 530

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12
Q

Filtration Fraction

A

Fraction of blood going to the kidney that is filtered through the glomerulus

Normal = 20%

NSAIDs = constrict the afferent arterioles

  • decreases RBF, GFR
  • no net change for FF

Angiotensin 2 = constricts the efferent arterioles

  • RBF decreases
  • GFR increases
  • FF increases

ACE inhibitors = dilate the efferent arterioles
- FF decreases

Ureter stone obstruction

  • decrease GFR
  • no change of RBF
  • decrease FF

SEE PICTURE

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13
Q

Glucose and Amino acids

A
  • free filter able and all reabsorbed

Glucose

  • normally completely reabsorbed in PCT by Na/glucose transporter
  • at plasma glucose of 200 glucosuria begins (threshold)
  • at 375 all transporters are fully saturated (Tm)
  • Normal pregnancy can decrease the ability of PCT to reabsorbed glucose and amino acids

Amino Acid Clearance

  • Na+ dependent transporters in PCT
  • 3 carrier systems = positive, negative, and neutral
  • deficiency of neutral transporter = Hartnup disease
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14
Q

Psammoma bodies

A
  • Papillary adenocarcinoma of the thyroid
  • serous cyst adenocarcinoma of the ovary
  • meningioma
  • mesothelioma
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15
Q

Proximal Convuluted Tubule

A
  • reabsorbs all glucose and amino acids
  • reabsorbs most HCO3-
  • isotonic reabsorption = water follows

Pg 533!!!!

In Late PCT
= Sodium is being reabsorbed with Chloride

To secrete an anion you use alpha ketoglutarate
To secrete cation you use Na/K+ pump and you bring in H+ into the cell

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16
Q

Loop of Henle

A

Thin descending limb

  • responsible for water reabsorption
  • impermeable to water

Thick Ascending Limb

  • NKCC - inhibited by loop diuretics (Causing an isotonic water excretion)
  • Calcium and magnesium are reabsorbed par acellular
  • impermeable to water
  • makes urine less concentrated as it ascends
17
Q

Early DCT

A
  • activate reabsorption of Na and Cl = inhibited by thiazides
  • Calcium reabsorption occurs here due to PTH
18
Q

Collecting Tubule

A

Principal cells

  • reabsorb Na and water
  • secrete K+
  • ADH acts on the principal cells (lithium inhibits this effect)
  • aldosterone acts on this = reabsorption of Na+ and secretion K+
  • K+ sparing diuretics act here = triamterene and amiloride inhibit epithelial Na+ channels; aldosterone antagonists

Intercalated cells

  • secrete hydrogen or bicarbonate
  • reabsorbs K+
  • alpha cells = secrete H+ ions
  • beta cells = secrete bicarbonate
  • aldosterone acts on this = stimulates secretion of H+ ions
19
Q

Diuretics

A

Pg 554
See Picture

Acute pulmonary edema = loop diuretic
Idiopathic hypercalciuria = thiazide diuretic
Glaucoma = Acetozolamide or mannitol
Edema associated with nephrotic syndrome = loop diuretic
Mannitol = ICP increased
- mild to moderate hypertension = thiazide
Altitude sickness = Acetozolamide

20
Q

ADH

A 
- binds on the principal cells 
SIADH causes
- ectopic ADH production by small cell lung cancer
- pulmonary pathology 
- head trauma
- stroke
- CNS infection 
- drugs = cyclophosphamide
- idiopathic 
- treatment of SIADH = demeclocycline

Diabetes insipidus

  • increased urine volume that is very dilute
  • increased serum osmalality
  • CENTRAL = pituitary
  • Nephrogenic = kidneys unresponsive to ADH ==> can be due to lithium, demeclocycline, hypercalcemia, hereditary mutation of ADH receptor
  • must do water deprivation test to confirm = healthy patient rise in urine osmolarity but in DI there is still a decrease in urine osmolarity
  • Desmopressin challenge = helps you tell if patient has central or Nephrogenic DI

Treatment for Central DI = intra nasal Desmopressin
Treatment for Nephrogenic DI = HCTZ, indomethacin, if lithium induced = amiloride

Lithium uses ENaC to get into collecting tubule = Amiloride blocks this channel

21
Q

Central Pontine myelinolysis

A

Correcting hyponatremia by giving person sodium too quickly

22
Q

Electrolyte Disturbances

A

537

Hyperkalemia
- low insulin
- beta blockers
- acidosis 
- digoxin
- cellular lysis 
- K+ sparing diuretics 
Treatment = beta agonist, IV insulin + dextrose, and bicarbonate

Hypokalemia

  • insulin
  • beta agonists
  • alkalosis
  • loop diuretics and thiazides
  • cell creation/proliferation = cancer
23
Q

Mesonephros

A

forms bowmans capsule, glomerulus, and wolffian duct

the mesonephric ducts ==> ureteric buds –> form the ureters in both sexes and the ejaculatory ducts in males

24
Q

Direction of urine

A

apex of each pyramid –> minor calyx –> major calyx –> renal pelvis –> ureter

25
Q

Dysplastic Kidney

A
  • non inherited congenital malformation of the renal parenchyma that causes cysts and abnormal tissue with cartilage
  • usually unilateral but can be bilateral
    NOT PKD BECAUSE ITS NOT INHERITED
26
Q

Polycystic Kidney Disease

A

Both kidneys I enlarged with cysts in renal cortex and medulla
ARKD
- occurs in infants
- worsening renal failure and hypertension
- newborns may be born with Potter sequence
- associated with congenital hepatic fibrosis and hepatic cysts
ADKD
- occurs in adults
- Hypertension, hematuria, and worsening renal failure
- due to APKD1 or APKD2 gene cysts develop over time
- associated with berry aneurysm, hepatic cysts, and MVP

27
Q

Medullary Cystic Kidney Disease

A

Inherited (autosomal dominant) defect

  • cysts in medullary collecting ducts
  • parenchymal fibrosis results in shrunken kidneys and worsening renal failure
28
Q

Things that cause either an Acidosis/Alkalosis in body

A

Aspirin toxicity

  • early on will directly stimulate the respiratory center in the brain and cause hyperventilation = respiratory alkalosis
  • then later on you can see some metabolic acidosis

Pg 538

29
Q

Renal Tubular Acidosis

A

Pg 539

30
Q

Nephrotic vs. Nephritic Syndrome

A

540-542

GlomeruloNephritis = inflammation of the glomeruli

  • light proteinuria
  • hematuria
  • RBC casts
  • azotemia = serum BUN and creatinine are elevated
  • hypertension
  • decreased urine volume = oliguria

Nephrotic Syndrome

  • hypoalbuminemia
  • edema
  • increased risk of infection = loss of Ig in urine
  • increased risk of thrombosis = loss of antithrombin 3 in urine
  • hyperlipidemia = oncotic pressure decreases stimulates liver to increase lipid production

USMLE (14 decks)

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