Renal Flashcards
What do the trocar and cannula pierce in a suprapubic cystostomy?
Aponeurosis of the abdominal wall muscles, layers of the superficial fascia, transversalis fascia, and extraperitoneal fat
What tumors are associated with VHL?
Renal cell carcinoma, cerebellar hemangioblastomas, pheochromocytomas
What are the clinical features of Fabry disease (alpha galactosidase A deficiency)?
neuropathic pain, hypohidrosis, angiokeratomas, telangiectasias. cerebrovascular and cardiac diseases, renal failure
From what amino acid is ammonium produced in the Kidney?
Renal metabolism of Glutamine. Seen in chronic acidosis
What issue is necessary for acute pyelonephritis?
Some form of vesicoureteral reflux
Where is PAH actively secreted? Reabsorbed?
In the proximal tubule. It is not reabsorbed anywhere
What is an essential pathologic step in the development of glomerular crescents?
Deposition of fibrin in Bowman’s space. Crescents consist of proliferated glomerular parietal cells, monocytes, and macrophages, as well as fibrin
Where are juxtaglomerular cells located?
They are modified smooth muscle cells in the wall of the afferent arteriole
What animal is a reservoir for schistosoma Haematobium?
freshwater snail- infect the water
What is acyclovir induced nephrotoxicity and how can it be avoided?
Acyclovir concentration in the collecting ducts exceeds solubility and causes crystallization, leading to crystalluria and tubular damage.
Prevented with hydration
What are the symptoms of acute hemolytic transfusion reaction
fever and chills, hypotension, dyspnea, chest/back pain, and hemoglobinuria
What can you use to estimate GFR and RPF?
Clearance of creatinine and PAH.
GFR/RPF=FF
Which renal drugs are associated with ototoxicity?
Loop diuretics
What are the symptoms of digoxin toxicity? Why does the dose need to be adjusted in the elderly?
1- visual changes and gastrointestinal disturbances
2- Age-related reduction in renal clearnace
Where are the kidneys normally located in a mature adult?
T12-L3
Discuss the etiology and morphology of hyperacute, acute, and chronic transplant rejection
Hyperacute- preformed Abs against graft–> arterial fibrinoid necrosis, capillary thrombotic occlussion, and gross mottling and cyanosis
Acute- Humoral: C4d, neutrophils, necrotizing vasculitis; Cellular: Lymphocytic infiltrate and endotheliitis
Chronic- vascular wall thickening, luminal narrowing, interstitial fibrosis, and parenchyma atrophy
What happens to the bladder in MS pts with an upper motor neuron lesion?
Spastic bladder- hypertonia. Loss of descending inhibitory control
Besides adding aquaporin channels to the cortical collecting duct, what other action does vasopressin have on the nephrons?
Activates urea transports in the medullary collecting duct to maintain hypertonicity
What is the most common cause of unilateral fetal hydronephrosis?
UPJ issue
What is the most common cause of bilateral fetal hydronephrosis?
posterior urethral valves
What effect do beta blockers have on Renin release?
They block it, because the juxtaglomerular cells which release renin have Beta 1 receptors.
Where in the nephron is most of the water reabsorbed?
Proximal tubule
What is Henoch Schonlein purpura and what are the symptoms?
IgA IMMUNE COMPLEX mediated vasculitis. Presents with palpable purpura, arthralgias, abdominal pain, and hematuria.
What is the most important poor prognostic factor for PSGN?
increased age
What effect does BPH have on the kidneys?
Hydronephrosis- the renal parenchyma becomes scarred and atrophic
What electrolyte changes are noted with the use of foscarnet?
Hypocalcemia (chelating, also reduction of release of PTH) and hypomagnesemia (increased renal wasting). Both of these electrolyte disturbances promote seizures
What is the formula for excretion of substance A?
(GFR/Inulin clearance) x (Plasma Concentration of substance A)
How is FF calculated?
GFR/RPF
What is cystinuria, how does it present, and what tests can be used for diagnosis?
Autosomal recessive disorder affecting the dibasic amino acid (cysteine, ornithine, lysine, and arginine) transporter in the proximal tubule. Presents with cystine stones. Diagnosed if hexagonal crystals are seen in the urine or by sodium-cyanide nitroprusside test (red-purple color change)
Treatment: hydration and urinary alkalinization (acetazolamide)
Describe the stages of ATN
- Initiation: ~36 hours with only slight oliguria
- Maintenance: oliguria, fluid overload, and electrolyte abnormalities. tubular epithelial necrosis, denudation of basement membrane, and necrotic casts. 1-2 weeks
- Recovery: Re-epithelization of tubules, GFR recovers quickly, but epithelium is not fully ready, so can lead to polyuria
What symptoms and labs are suggestive of multiple myeloma?
anemia, bone pain, hypercalcemia (osteolysis by tumor cells), renal insufficiency, elevated proteins, and electrophoresis showing monoclonal immunoglobulin band. The hypercalciuria and light chaincast nephropathy lead to progressive renal failure
What causes urge incontinence in patients with MS?
Spinal cord lesions above the sacral region lead to loss of higher center control of micturition (pons and cerebral cortex) —> detrusor hyperreflexia
