Renal Flashcards
What is the name of the capsule that surrounds the glomerulus?
Bowman’s Capsule
Plasma travels through the ______ arteriole into the glomerulus.
In the glomerulus, plasma then flows through the “leaky basement membrane composed of _______.
Plasma then exits the glomerulus through the _______ arteriole.
Afferent
Podocytes
Efferent
What is the name of the smooth muscle cells that are found “between the cells” in the kidneys which help to regulate blood flow in the glomerulus?
Mesangial Cells
T/F: Capillaries in the glomerulus are sinusoidal
False
They are fenestrated allowing for large amounts of solute-rich fluid to pass through
Are large amounts of protein in the urine normal?
No
JGA is associated with what THREE things in the kidney?
Na+
Renin
Blood Pressure
Podocytes terminate in the foot processes of the basement membrane in the glomerulus.
What is the name of the clefts between those foot process which allow filtrate to enter the capsule?
Filtration Silts
If there was glomerular damage, what may be seen in a patient’s urine?
What processes may lead to this?
Protein
HTN Diabetes Trauma Autoimmune Obstruction
What are the two types of nephrons within the kidney?
Which is most abundant?
Corticol (Most Abundant)
Juxtamedullary
Which nephron in the kidney is involved in urine concentration?
Juxtamedullary
Filtration in the kidney occurs in the ________ which re-absorption and secretion occur in the _______.
Glomerulus
Tubules
Nephrons have two sets of capillaries, glomerular and peritubular.
In which capillary does filtration occur?
Reabsorption?
Filtration: Glomerular
Reabsorption: Peritubular
What is unique about glomerular capillaries in regards to how blood is fed to them and drained from them?
They are the only capillaries in the body that are fed and drained by arterioles
_______ is the movement of fluid out of the tubule and into the peritubular capillary
Reabsorption
_______ is the movement of fluid out of the glomerular capillary and into Bowman’s Capsule
Filtration
________ is movement of fluid out of the peritubular capillary and into the tubule
Secretion
It is important to keep plasma proteins in the plasma during filtration to maintain which force/pressure?
If this is not maintained, what may occur?
Osmotic
If this is not maintained, too much fluid will filter into the filtrate
What ‘forces’ make filtration in the glomerulus go?
What ‘forces’ act against filtration?
GO:
Glomerular Capillary BP
AGAINST:
Bowman’s Pressure (stuff pooling in Bowman’s Space)
Osmotic Force due to protein in plasma
T/F: Polycythemia and Dehydration would lead to an increase in glomerular filtration
False
These would result in slower glomerular filtration
T/F: Tubular reabsorption can be active or passive transport
True
When tubules reach a point when they can no longer reabsorb a certain substance (ex: Glucose), they are said to have reached a _______ _______.
(Hint: This is why untreated diabetic patients have glucose in their urine)
Transport Maximum
What THREE substances are almost 100% reabsorbed daily?
Water
Sodium
Glucose
Tubular Secretion is important for removing excess ___ and controlling the __ of the blood.
Removing Excess K+
Controlling Blood pH
_____ _______ ____ is defined as the quantity of glomerular filtrate formed each minute in the nephrons of both kidneys
Glomerular Filtration Rate (GFR)
What THREE things effect GFR?
- Filtration Surface Available
- Filtration Membrane Permeability/Pressure
- Blood Pressure / Flow into Glomerulus
An increase in blood pressure would lead to a(n) _________ in GFR.
A decrease in blood pressure would lead to a(n) _________ in GFR
Increase
Decrease
Constricting the afferent arteriole would lead to a(n) ______ in GFR
Decrease
Dilation of the efferent arteriole would lead to a(n) _________ in GFR
Decrease
Constriction of the efferent arteriole would lead to a(n) ________ in GFR
Increase
Dilation of the afferent arteriole would lead to a(n) _________ in GFR
Increase
Which electrolyte is important in managing water balance?
Na+
Why do people experience ‘third-spacing’?
More fluid (water) exits the capillaries into interstitial tissues (3rd Space) due to decreases oncotic pressure in the capillaries
Sodium reabsorption is a(n) ______ transport process occurring in all tubular segments except in the ________ limb of the Loop of Henle
Active
Descending
Water is reabsorbed through _______ (a passive process), but is determined by the movement of sodium and the presence of ________ (water channels)
Osmosis
Aquaporins
Should aquaporins be present in the collecting ducts?
No
If there are then Anti-diuretic hormone (ADH) is likely present
Is vasopresson found within the anterior or posterior pituitary
Posterior
You are working out and get dehydrated, so plasma osmolarity _______.
Due to this the posterior pituitary releases ________.
Once this binds to it’s receptor on the basement membrane, there is an increase in ____ which causes phosphorylation of proteins.
This phosphorylation causes ______ to fuse with the luminal membrane.
This process results in more water being ______ from the filtrate.
Increases
Vasopression
cAMP
Aquaporins
Reabsorbed
What is the most abundant cation in the filtrate?
Na+
Filtrate has a high concentration of Na+, so it will ______ transport into the tubular epithelial cells (remember it is moving from high concentrations to lower concentrations).
The above allows for the transport of other solutes into or out of the tubular cells. What are examples of these?
What ‘pump’ then actively transports Na+ into the interstitial fluid? What is being pumped into the cell?
Na+, water, and interstitial solutes are then reabsorbed in the the _______ capillaries
Passively
Into: Glucose
Out of: H+
Na/K ATP pump
K+ into the cell
Peritubular
In regards to osmoreceptors in the hypothalamus….
Lower osmolarity ________ (inhibits/stimulates) the release of vasopresson
Inhibits
In regards to osmoreceptors in the hypothalamus….
Higher osmolarity ________ (inhibits/stimulates) the release of vasopresson
Stimulates
In regards to baroreceptors in the atria/carotids….
Lower blood pressure ________ (inhibits/stimulates) the release of vasopresson
Stimulates
In SIADH, too much ____ is being produced
ADH (Vasopressin)
What Sx are associated with SIADH?
Are you more likely hypertensive or hypotensive?
Hyponatremic or hypernatremic?
Sx:
Irritability
Confusion
Cramping
Hypertensive
Hyponatremic
In Diabetes Insipidus, _______ is not being released.
Vasopressin
What Sx are associated with DI?
Are you more likely hypertensive or hypotensive?
Hyponatremic or hypernatremic?
Sx:
Extreme Thirst
Large, Diluted Urine
Hypotensive
Hypernatremic
Which portion of the loop (ascending/descending) is relatively impermeable to solutes but freely permeable to water?
Which portion of the loop (ascending/descending) is relatively impermeable to water but freely permeable to solutes?
Describe the osmolarity as it travels through the loop.
Descending
Ascending
Osmolarity is around 300 and then travels down the descending loop, at the bottom after it was lost water it becomes ~1400. As it ascends it loses NaCl and returns to 80-100. As it descends again it, it loses water returning the osmolarity to ~1400
____ recycling contributes to the medullary osmotic gradient.
Urea
Which steroid is released in the cortex of the kidney?
Aldosterone
What parts of the nephron does aldosterone work to increase Na+ reabsorption?
Distal Tubule
Collecting Ducts
Which has the FASTER effect, aldosterone or ADH?
ADH
Juxtaglomerular cells line the _______ wall and are ________ (exocrine/endocrine) cells which secrete ______.
Arteriole
Endocrine
Renin
T/F: Juxtaglomerular cells are mechanoreceptors and can release renin when BP gets lower than desired
True
Renin stimulates the release of _________ which causes the release of _______.
Angiotensin
Aldosterone
The macula densa are _________ which detect changes in the _____ content of the filtrate
Chemoreceptors
NaCl
If Na+ is low in the distal tubule (decreased filtration)…..
The macula densa will signal to the JG cells to release more ____ and ________ (increase/decrease) blood flow into the _______ arteriole
Renin
Increase
Afferent
If you had excess aldosterone would you be at risk for hyperkalemia or hypokalemia?
Hypokalemia
What is the name of the hormone made in the hearts atria?
Does it contribute to sodium retention or loss?
Atrial Natriuetic Peptide (ANP)
Sodium Loss
How does ANP contribute to blood volume control?
When the atria distend (as they do when blood volume is high), they make more ANP. Salt gets excreted and plasma volume goes down.
The kidney controls blood pH by regulating the reabsorption/secretion of ___ ions.
H+
Loss of HCO3- through the urine/diarrhea would result in a net ______ (gain/loss) of H+ ions
gain
Within a tubule, H20 and CO2 form _____ and H+.
The _____ then diffuses into the interstitium and into the plasma to control blood ___
The __ ion moves into the tubule lumen and combines with HCO3- to form ___ and ____.
HCO3-
HCO3-
pH
H+
H2O and CO2
If the plasma is too acidic than all the HCO3- gets reabsorbed, and the blood stream will still need more.
Instead of Bicarb, what will the H+ ion bind to in the tubular lumen?
Phosphate
Which area of the kidney is most likely effected by ischemia?
Renal Medulla
Which area of the kidney is commonly effected by autoimmune disorders, HTN, and DM?
Glomerulus
Which area of the kidney is commonly effected by obstructions (ie: clogged by filtrate)?
Tubules
The ureters and bladders are ____-renal structures
The renal artery is a ___-renal structure
Post-renal
Pre-renal
A RAPID increase in BUN and Creatinine would indicate ______ (acute/chronic) renal failure
Acute renal failure
What are causes of pre-renal ARF?
What are causes of intrarenal ARF?
What are causes of post-renal ARF?
Pre-renal:
Hypovolemia
Ischemia
Medications (NSAIDs, ACEi, Diuretics)
Intrarenal:
Vasculitis
Glomerularnephritis
Acute Tubular Necrosis
Post-Renal:
Obstruction
Congenital Abnormalities
Cancer
_____ _____ ______ can occur when blood supply to the kidney is significantly reduced or when tubular flow is occluded.
During this process, tubular cells can die and slough off, which are then excreted in the urine.
Acute Tubular Necrosis
A eGFR of less than 60 for more than 3 months would be classified as what?
Chronic Kidney Disease
What are extra renal manifestations of CKD?
HTN
Fluid Retention
Osteoporosis
What range of GFR qualifies a patient as Stage 1 - 5 CKD
Stage 1: >90
Stage 2: 89 - 60
Stage 3: 59 - 30
Stage 4: 29 - 15
Stage 5: <15
Why may a patient complain of itching as their GFR declines?
Uremia
Resulting in nitrogenous deposits under the skin
Renal blood flow is __-___% of cardiac output.
20-25%
In a 70kg person, the kidneys will filter approximately ___ L of fluid per day
180
________ is a disease of the glomeruli
While, _________ is inflammation of the glomeruli
Glomerularopathy
Glomerulonephritis
A glomerular disease orignating in the kidneys would be considered _________ (primary/secondary) while glomerular disease due to systemic disease would be considered _________ (primary/secondary).
Primary
Secondary
Any combination of the following would be indicative of what……
Hematuria
Proteinuria
HTN
Decline in eGFR
Glomerular Disease
______ Syndrome is characterized by damage that creates thinning of the glomerular basement membrane and pores in the glomerular podocytes
________ Syndrome is characterized by an increased permeability of the capillary walls of the glomerulus
Nephritic Syndrome
Nephrotic Syndrome
What manifestations are seen in nephrotic syndrome?
- > 3.5g of proteinuria
- Low serum proteins
- Peripheral edema
- Hypoalbuminemia
- Increase in cholesterol
- Predisposition to clotting (due to increased blood viscosity)
T/F: In nephrotic syndrome, the glomeruli are affected by inflammation orhyalinization
True
What are the two most common causes of secondary nephrotic syndrome?
- Diabetes (Most Common)
2. HTN
T/F: In nephortic syndrome, the podocytes experience a change in charge, which makes them less permeable to proteins.
False
The charge makes them more permeable to proteins
Would you expect to see oliguria with nephritic or nephrotic syndrome?
Nephritic
What are the FIVE categories of Glomerular disease?
- Acute glomerulonephritis
- Rapidly progressive glomerulonephritis
- Chronic glomerulonephritis
- Nephrotic syndrome
- Asymptomatic urinary abnormalities
______ _________ is the abrupt onset of hematuria and proteinuria with decreased GFR and salt/water retention
Acute Glomerulonephritis
Are patients with acute glomerulonephritis likely to recover full renal function?
Yes
In acute glomerulonephritis, is the glomerulus hypercellular or hypocellular?
Are the capillaries dilated or constricted?
Is filtration slower or faster?
Hypercellular and thickened
Capillaries are constricted and often occluded
Filtration is decreased
A common cause of acute glomerulonephritis is a result of an autoimmune injury initiated by what bacteria?
Group A, Beta-hemolytic streptococcus
How is post-strep glomerulonephritis developed?
Immune system creates antibodies to Group A strep which cross react to a “self” antigen
These immune system compliments and complexes collect with the glomerular capillares and mesangial cells
As a response to this, inflammatroy cells begin to collect in these areas
How soon after a strep infection may signs and symptoms of post-strep GN develop?
7-10 days
Resolves in a few weeks after onset
T/F: Rapidly progressive glomerular nephritis is always autoimmune
True
What is unique about the appearance of rapidly progressing glomerulonephritis on histology?
Crescentric proliferation of epithelial cells in the glomerulus
In rapidly progressing glomerulonephritis, the eGFR will drop by __% within the first 3 months
50%
The presence of anti-glomerular-basement-membrane antibodies (Anti-GBM) would indicate Type __ RPGN.
What is an example of a disease process that causes this?
Type 1
Goodpasture’s
Immune complex deposition would be a cause of Type __ RPGN?
What is an example of a disease process(es) that causes this?
Type 2
Post-strep
SLE
Type __ RPGN does not involve anti-GBM or immune complex deposition, but due to antibodies– often anti-neutrophil-cytoplasm antibodies (ANCA).
What is an example of a disease process that causes this?
Type 3
Wegner’s Granulomatosis
Type 1 RPGN often effects Type ___ collagen in the basement membranes of the kidneys
Type 4
Patients with acute glomerulonephritis who develop chronic renal failure slowly over the next 5-25 years can be defined as having ____ __________.
Chronic Glomerulonephritis
________ glomerulonephritis is one of the most common causes of nephrotic syndrome in adults.
It is autoimmune and progresses slowly with HTN, porteinuria, loss of renal function
Membranous Glomerulonephririts
T/F: In membranous GN, immune complexes serve as an activator which triggers complement to form a membrane attack complex (MAC) on the glomerular epithelial cells
True
______ ______ glomerulonepritis is relatively benign problem with the podocytes that has no known etiology
Minimal Change Glomerulonephritis
What are some triggers of autoimmune glomerulonephritis?
- Infection
- Systemic disease
- Disease originating in the kidneys
- Medications/Drugs
T/F: Secondary GN is the most common cause of renal failure
True
In hypertensive nephropathy, small vessels are damged by the increased pressure creating a accumlation of what in the walls of the arterioles and arteries?
This results in a ____________ (thickening/thinning) of their walls and a _________ (widening/narrowing) of their lumens
Hyaline
Thickening
Narrowing
What are some intrarenal manifestions of hypertensive nephropathy?
- Fibrosis / Scarring
- Ischemia
- Renal Failure
Along with a patient’s history, what UA findings may indicate glomerulonephritis?
How much proteinuria would classify it as nephrotic syndrome?
- Hematuria
- Red Cell Casts
- Lipiduria
- Proteinuria
> 3.5 g in 24 hrs = Neprhotic Syndrome
A urinanalysis showing….
Dysmorphic RBCs, Occasional red cell casts, and mild proteinuria (<1.5g/day)
Without the presence of edema or HTN would be indicative of….
A. Nephoritc Syndrome
B. Diffuse Nephritic Syndrome
C. Focal Nephritic Syndrome
C. Focal Nephritic Syndrome
Classic pattern is asymptomatic proteinuria or hematuria
A urinanalysis showing….
Hematuria
Proteinuria (2.5g/day)
“Full House Casts”
With the presence of edema and HTN would be indicative of….
A. Nephoritc Syndrome
B. Diffuse Nephritic Syndrome
C. Focal Nephritic Syndrome
B. Diffuse Nephritic Syndrome
A urinanalysis showing….
Proteinuria (>3.5g/day)
Lipiduria
Casts (including hyaline casts)
With the presence of edema and HTN would be indicative of….
A. Nephoritc Syndrome
B. Diffuse Nephritic Syndrome
C. Focal Nephritic Syndrome
A. Nephoritc Syndrome
What are common causes of intrinsic obstructive uropathy?
Extrinsic?
Intrinsic:
Calculi
Strictures (Congenital)
Tumors
Clots
Extrinsic:
Pregnancy
Tumors (Prostate, Rectum)
In less than one week of obstructive uropathy, what TWO things may be present?
Hydronephrosis
Hydroureter
How long most obstructive uropathy be present for the distal tubules to show damage?
The proximal tubule?
Glomeruli?
Distal: ~1 week
Proximal: ~2 weeks
Glomeruli: ~4 weeks (after this, cell death would occur)
After 3 months of obstructive uropathy, would it be likely that normal renal function may be returned?
No, it is unlikely
What are the signs and symptoms of obstructive uropathy?
- Flank Pain
- Fever
- Diuresis
- Nausea/Vomiting
- Hematuria
- Glomerular Damage Sx (Edema, Weight Gain)
What UA and labratory findings may be present in a patient with obstructive uropathy?
- Dilute Urine
- Metabolic Acidosis (can no longer secrete H+)
- Hyperkalemia (can’t secrete K+)
- Hyponatremia (Can’t reabsorb Na+)
- Uremia
T/F: Acute Tubular Necrosis (ATN) is the most common cause of AKI
True
T/F: The renal tubules are quite resistant to hypoxic damage
False
They are quite prone to it
How is eGFR decreased due to hypoxic injury to the renal tubules?
What additionally happens as a result of this process?
Hypoxic injury leads to cell death in the tubules.
Tubular debris/filtrate then occludes the tubule.
This results in an increase in the pressure of Bowman’s capsule lowering eGFR
Due to the above, the kidneys are no longer producing vasodilators, which further results in vasoconstriction and exacerbates the cycle.
How would the urine in a patient with ischemic ATN be described?
(Remember this is a result of granular cast debris in the urine)
Muddy Silty Urine
T/F: Nephrotoxic ATN is always a result of exposure to a toxic agent
True
What are some toxic agents that could result in Nephrotoxic ATN?
- Nephrotoxic drugs (Some Abx, Chemo, Contrast Dye)
- Bacterial Toxins
- Increase in Hgb/Myoglobin (Muscle injury/trauma)
- Toxic Substances (Antifreeze, Mercury, Arsenic)
How does Nephrotoxic ATN vary from Ischemic ATN histologically?
In nephrotoxic ATN the tubules are affected more uniformly rather than the patchy appearance of ischemic ATN
Which phase of ATN is indicated by a……
Massive decline in GFR and big bump in BUN and sCr
Initiation phase
Which phase of ATN is indicated by a……
GFR that remains low, a rising BUN and sCr, and the presence of oliguria, uremia, and fluid retention
Maintenance Phase
Which phase of ATN is indicated by a……
Increase in urine volume, decrease in BUN and sCr, and often comes with a “recovery diuresis”
Recovery Phase
In all types of glomerulonephritis the podocyte layer of the glomerulus is disturbed by a loss of _________ (negative/positive) charges leading to increased permeability
Negative
Compliment activation
Podocyte injury
Proteinuria
Loss of negative charges (Hylanization)
Are damages noticed in nephrotic or nephritic syndrome?
Nephrotic Syndrome
Proliferation of macrophages and mesangial cells
Crescentric Proliferating Epithelium
Sclerosis
Fibrosis
Are damages noticed in nephrotic or nephritic syndrome?
Nephritic Syndrome
Hematuria
Oliguria
Azotemia (Itching due to uremia)
HTN
Are all clincally presentations of nephrotic or nephritic syndrome?
Nephritic
What diseases are commonly associated with nephritic syndrome?
- Post-streptoccocal GN
- Goodpasture’s Syndrome
- Wegner’s Granulomatosis
- SLE
- Henoch-Schönlein purpura
Massive Proteinuria
Edema
HLD / Lipiduria
Hypercoaguability
Are all clincally presentations of nephrotic or nephritic syndrome?
Nephrotic Syndrome
T/F: Renal cysts are fairly common, especially with aging
True
______ renal cystic disease is usually a result of ESRD
Where is the most common location for these cysts in the kidney?
Acquired Renal Cystic Disease
These are most commonly found in the Cortex of the kidney
Autosomal _______ Polycystic Kidney Disease presents with early onset, often in infancy, and can lead to ESRD, pulmonary insufficiency, or even death in vitro.
Autosomal Recessive Polycystic Kidney Disease (ARPKD)
(Death occurs in vitro because the Lungs cannot properly develop without the presence of amniotic fluid in utero; amniotic fluid cannot be maintained without functional fetal kidneys)
Where in the kidneys does ARPKD commonly affect?
Tubules
Disease of what organ is almost always present in patients with ARPKD?
Liver
ARPKD results from an abnormal gene on chromosome __
6
Autosomal _______ Polycystic Kidney Disease is more common and shows evidence of progressive renal failure
Autosomal Dominant Polycystic Kidney Disease (ADPKD)
ADPKD results from an abnormal gene on chromosome ___
16
Is it common for patients with ADPKD to have diverticular disease?
Yes
What other organs may become cystic in a patient with ADPKD?
Liver
Spleen
Pancreas
Thyroid
Are vascular abnormalities common in patients with ADPKD?
Yes
1/3rd with have Berry Anuersyms, aortic aneursyms, or MVP
Where are cysts commonly found in the kidney in a patient with ADPKD?
Evenly distributed throughout the medulla and the cortex
What renal tumor is commonly in infants and children?
Nephroblastoma (Wilms tumor)
