Renal Flashcards
give 4 points for a ideal GFR marker
appear at a constant state
be freely absorbed at glomerulus
not be absorbed at by the renal tubule and not secreted by the renal tubule
not undergo extra renal elimination
how is urea produced
as a result of protein breakdown in the liver
restrictions of creatinine
steep fall in GFR may only lead to a small rise in Cr
overestimates if muscle mass is low
underestimates if muscle mass is high
what are the two types of proteinuria and describe them
overflow - protein being produced elsewhere (myeloma)
glomerular - produced in kidneys (albuminuria)
urine sodium levels in intrinsic renal failure compared to pre renal failure
higher in intrinsic than pre renal
how long and wide are kidneys
10-12cm
5-6cm wide
what are kidneys covered with
thin but strong capsule of dense collagen fibres
what are the thin loops of henle lined with
what is the thick ascending limb lined with
what are the collecting ducts lined with
squamous
simple cuboidal cells with abundant mitochondria
simple cubiodal/columnar epithelium
difference between proximal tubule and distal convolution tubule
PCT has a brush border
what is the distal convoluted tubule lined with
simple cuboidal
what are medullary rays
lines of CDs heading from cortex down to the medulla
What are the ducts of bellini
part of the CDs seen in longitudinal sections
What does uroepithlium line - what kind of epithelium and how many layers
the urinary tract
stratified
3-6 layers
uroepthelial cells at the luminal surface - describe them
umbrella cells - domed
thick and impermeable
inflexible
variable in thickness
what is under the uroepithelium and how does this differ between the distal and proximal ureter
lamina propria (connective tissue) smooth muscle - distal ureter has more smooth muscle compared to the proximal ureter
how long is the female urethra and how does its lining change
3-5 cm
TE to squamous stratified
how long is the male urethra and how does its lining change
prostatic urethra 3-4cm TE
membranous 1cm stratified columnar
penile 15cm stratified columnar to stratified squamous
what are tubuloalveolar glands lined with in the prostate and what do they secrete
simple columnar secreting epithelium with fibromusclular storm secrete half of seminal fluid volume
what are penile concretions
increase with age
what micro organism does not give a positive nitrite test
enterococcus sp.
how does trimethoprim (PO) work
is it safe in pregnancy
inhibit folic acid synthesis
safe but avoid in first trimester
why is nitrofurantoin (PO) only used in lower UTIs
is it safe in pregnancy
only reaches effective concentrations in the bladder
avoid in late pregnancy (causes neonatal haemolysis), breast feeding and children under 3 months
what does Gentamicin not treat and what are its risks
enterococci
renal failure, CN8 nerve damage
what is pivmecillinam (PO)
what does this have activity against
esterified version of mecillinam
ESBLs
Tenvocilin (IV) has activity against what
what can this be used instead of
ESBLs
used instead of gent in patients with poor renal function
not as good as gent
should a biopsy be done on small scarred kidneys and why
no
only show scarred tissue
what acid base problem can be caused by fucked up kidneys and why
how compensate?
met acidosis
kidneys secrete acid
resp compensation - blow off co2
causes of large kidneys
causes of palpable kidneys
PCK, myeloma, DM
PCK
what can uraemia lead to
pericarditis - saddle shape ST elevation on ECG
give the pathogenesis of GN
humeral (AB mediated)
T cell mediated
inflam cells, complement
over all immune mediated
cause of minimal change GN
FCS GN
membranous GN
IgA GN
idiopathic. NSAIDs, IL-13
idiopathic. HIV
idiopathic. hep B. SLE. gold/penicillamine
idiopathic. HSP
process behind FCS GN
defect in CD2AP slit pore proteins
increase in SUPAR
treatment of membranous GN
steroids/alkylating agents/B cell monoclonal ABs
what are raised red/blue lesions on the skin and what disease are they associated with
angiokeratomas
anderson fabrys
give 3 features of medullary cystic kidney
abnormal renal tubules
autosomal dom
cortex and medulla shrink
give 2 features of medullary sponge kidney
sporadic inheritance
cysts have calculi
common medullary origin. white nodules
fibroma
hello nodules
adenoma
can become large and have an affect on renal function.
angiofibrolipoma
produce rennin leading to secondary hypertension
JGT
central scar on XR. dx only after nephrectomy
oncocytoma
the 3 HLAs in transplantation
HLAA, HLAB, HLADR
two types of amyloid and which is deposited first
AL first
AA second
what leads to fertile cervical mucous
estrogen
what does oestrogen do in terms of LH, prolactin and FSH
inhibits FSH and prolactin
stimulates secretion of LH
where does progesterone come from
what does it do in terms of LH
what does it lead to
what kind of an affect does it have on temp and muscles
CL
inhibits
infertile cervical mucous
thermogenic, relaxes smooth muscles
give the peaks of the hormones in ovulation
oestrogen, lh and fsh - ovulation
oestrogen and progesterone
