Renal Flashcards
1
Q
pronephros exists
A
until week 4
2
Q
mesonephros
A
interim kidney for first trimester
3
Q
metanephros
A
permanent
appears in 5th week
4
Q
Where is the ureteric bud derived from?
What does it become?
A
caudal end of mesonephric duct
ureter, pelvises, calyces, collecting ducts
5
Q
when is the ureteric bud fully developed?
A
week 10
6
Q
what forms the glomeruli –> distal converluted tubule?
A
metanephric mesenchyme
7
Q
what is the last area of the kidney to canalise?
A
ureteropelvic junction
8
Q
most common site of hydronephrosis in fetus
A
ureteropelvic junction
9
Q
Potter syndrome caused by
A
Oligohydrimonas
10
Q
What are the signs of potter syndrome?
A
Pulmonary hypoplasia Oligohydramnios Twistsed face Twisted skin Extremity deformity Renal failure in utero
11
Q
Where does a horseshoe kidney get trapped?
A
inferior mesenteric artery
12
Q
associations with horseshoe kidney
A
hydronephrosis, renal stones, infection, chromosomal aneuploidy syndromes, renal cancer
13
Q
unilateral renal agenesis
A
ureteric bud fails to develop - absense of kidney and ureter
14
Q
multicystic dysplastic kidney
A
ureteric bud doesn’t differentiate metanephric mesenchyme
non-function kidney with cysts and connective tissue
15
Q
duplex collecting system associated with
A
vesicoureteral reflux, urethral obstruction, UTIs
16
Q
Left kidney
A
Higher, and has longer renal vein
17
Q
renal blood flow
A
renal artery –> segmental artery –> interlobar –> arcuate –> interlobular –> afferent –> glomerulus –> efferent –> vasarecta/peritubular capillaries –> venous outflow
18
Q
interstitial fluide =
A
75% extracellular volume
19
Q
water weight rule
A
60-40-20
60% water
40% ICF
20% ECF
20
Q
how can you measure plasma volume?
A
radiolabel albumin
21
Q
how can you measure extracellular volume?
A
inulin/ mannitol
22
Q
What is normal blood Osm?
A
285-295 mOsm/kg H2O
23
Q
what are the three layers of the glomerulus?
A
capillary endothelium basement membrane epithelial layer (podocytes)
24
Q
what does the basement membrane contain?
A
heperan sulfate
25
what is special about the basement membrane?
negatively charged
26
renal clearance =
(urine concentration x urine flow rate)/
| plasma concentration
27
If clearance is less than GFR
net tubular reabsorption of substance
28
what can be used to measure GFR?
inulin clearance
29
GFR =
(urine concentration x urine flow rate)/
| plasma concentration
30
how does Createnine clearance estimate GFR and why?
overestimate
| moderately secreted by renal tubules
31
effective renal plasma flow can be estimated using
para-aminohippuric acid (PAH) clearance
32
renal blood flow =
RPF/ (1-Hct)
| 1-Hct = plasma
33
how does eRPF measure against the true value?
slightly underestimates
34
Filtration fraction =
GFR/RPF
35
what is the normal filtration fraction?
20%
36
what is the filtered load?
GFR x plasma concentration
37
effect of prostaglandins on kidney
dilate afferent arteriole
38
Net filtration pressure =
(P-gc + Pi-bs) - (P-bs + Pi-gc)
39
what preferentially constricts the efferent arteriole?
AT II
40
what does constricting the efferent arteriole do?
decreases RPF, increases GFR, increases FF
41
how does ureter constriction affect GFR?
decreases it
42
Where is glucose reabsorbed?
proximal converluted tubule
43
what is the level of renal glucose to see glucosuria?
200 mg/dL
44
When is Tm for glucose transporters?
375 mg/min
45
Thin descending loop
water only
46
what is reabsorbed and secreted in the proximal converluted tubule?
reabsorbed - glucose, a.a, HCO3, Na, Cl, PO4, K, H2O, uric acid
secreted NH3
47
purpose of NH3 in urine
buffer for H+
48
What does PTH do in the kidney and where does it act?
```
inhibits Na/PO4 cotransport
PO4 excretion
increases Ca/Na exchange
Ca reabsorbtion
proximal converluted tubule, distal converluted tubule
```
49
What does ATII do in the kidney and where does it act?
stimulates Na/H, increases Na, H2O and HCO3- reabsorbtion
| proximal converluted tubule
50
What is reabsorbed in the thick ascending loop?
Na, K, Cl
| IMPERMEABLE to water
51
what is reabsorbed in the distal converluted tubule?
Na, Cl
52
What is the exchanger for sodium in the collecting duct?
Na/K orH
53
what is the regulation of the collecting duct?
aldosterone increases ENaC
secretes K+
H secretion from lumen negativety
54
How does ADH work?
inserts aquaporin
55
Fanconi syndrome
| what does it cause?
proximal tubule - excretes substrates
| proximal renal tubular acidosis
56
what can cause Fanconi syndrome?
```
Leave When It Gets Too Metabolic
lead poisoning
wilson's disease
ischemia
glycogen storage disease
tyrosinemia
multiple myeloma
```
57
what drugs can cause Fanconi syndrome?
```
Thats the TICET
Tenofovir
Ifosfamide
Cisplatin
Expired Tetracyclines
```
58
resorptive defect in thick ascending loop of Henle
Bartter syndrome (AR)
59
What is affected in Bartter syndrome?
Na/K/2Cl
60
What will Bartter syndrome look like?
chronic loop diuretic use
61
metabolic changes seen in Bartter's
hypokalemia, metabolic acidosis, hypercalcuria
62
Gitelman syndrome
NaCl resorptive defect in distal converluted tubule
63
what will Gitelman syndrome look like?
lifelong use of thiazides
64
metabolic changes in Gitelman's
hypokalaemia, hypomagnesia, metabolic acidosis, hypocalciuria
65
Liddle syndrome
increased Na reabsorption in collecting tubules
66
condition presenting like hyperaldosteronism, but low aldosterone
Liddle syndrome
67
htn, hypokalemia, metabolic acidosis, low aldosterone
Liddle syndrome
68
Rx Liddle syndrome
Amiloride
69
low aldosterone, htn, hypokalemia, metabolic acidosis, deficiency in 11B-hydroxysteroid dehydrogenase
syndrome of apparent mineralocorticoid excess
70
11B-hydroxysteroid dehydrogenase deficiency Rx
corticosteroids (decreases endogenous production and receptor activation)
71
what breaks down ACE?
Bradykinin
72
Renin is linked to what receptor? and responds to what?
B1
| decreased renal arterial pressure
73
role of ATII
limits reflex bradycardia, maintains blood volume and pressure
74
function of ATII
vasoconstriction, constricts efferent arteriole of glomerulus, stimulates ADH, Na, HCO3, H2O reabsorption in proximale tube, stimulates thirst
75
function of AMP
relaxes s.m via cGMP, dilates afferent arteriole, constricts efferent arteriole
76
purpose of ADH
regulates Osm
77
action of aldosterone
increases Na channel reabsorbtion
| enhances K and H secretion
78
what cells are found in the juxtaglomerular apparatus?
mesangial cells
79
what is the macula dense?
NaCl sensor in distal tubule
80
what releases erythropoeitin?
interstitial cells in peritubular capillary bed
81
what cells are used in calcium metabolism?
PCT cells
82
what do PCT cells do?
convert 25-OH D3 --> 1,25-(OH)2 D3
83
what is secreted by PCT cells?
dopamine
84
what effect does dopamine have on the kidney?
promotes naturesis, dilates arteries, increases RBF
| in high doses it is a vasoconstrictor
85
Drugs causing hyperkalaemia
```
DO LABS
Digitalis
hyperOsmolarity
Lysis
Acidosis
B blockers
Sugar (high)
```
86
Drugs causing hypokalaemia
```
opposite of hyperkalaemia:
DO LABS
Digitalis
hyperOsmolarity
Lysis
Acidosis
B blockers
Sugar (high)
```
87
nausea, malaise, stupor, coma, seizure
hyponatremia
88
irritable, stupor, coma
hypernatremia
89
muscle cramps, spasm, weakness, U waves, flat T waves, arrhythmia
hypokalemia
90
muscle weakness, arrhythmia, wide QRS, peaked T waves
hyperkalemia
91
tetany, seizure, long QT, twitching, spasm
hypocalcemia
92
hypercalcemia
stones, bones, groans, thrones, psychiatric moans
93
tetany, torsades de pointes, hypokalemia
hypomagnesia
94
lethargy, bradycardia, hOtn, cardiac arrest, hypocalcemia, low tendon reflexes
hypermagnesia
95
Henderson-Hasselbalch equation
pH = 6.1 + log ([HCO3]/0.03 PCO2)
96
how to calculate predicted respiratory compensation in metabolic acidosis
PCO2 = 1.5[HCO3-] + 8 +- 2
97
If measured PCO2 is more than predicted PCO2
respiratory acidosis on top of metabolic acidosis
98
causes of metabolic alkalosis
loop diuretics, vomiting, antacid use, hyperaldosteronism
99
respiratory alkalosis causes
hysteria, hypoxemia, salicylates, tumour, PE
100
increased anion gap metabolic acidosis
```
MUDPILES
Methanol
Uremia
DKA
Propylene glycol
Iron tablets
Lactic acidosis
Ethylene glycol
Salicylates
```
101
Normal anion gap metabolic acidosis
```
HARDASS
Hyperalimentation - diarrhoea
Addison's
Renal tubular acidosis
Diarrhoea
Acetazolamide
Spironolactone
Saline infusion
```
102
renal tubular acidosis type 1 and 2
distal
| proximal
103
distan renal tubular acidosis urine
urine pH >5.5
104
what happens in distal renal tubular acidosis?
alpha intercalated cells can't secrete H+
| no new HCO3- is generated
105
what is renal tubular acidosis associated with?
hypokalemia
106
what causes distal renal tubular acidosis?
ABC
Analgesic nephropathy
amphotericin B toxicity
Congenital abnormalities
107
what happens in proximal renal tubular acidosis?
defect in PCT HCO3 reabsorption
108
what is the urine like in proximal renal tubular acidosis?
pH <5.5
109
what causes proximal renal tubular acidosis?
Fanconi syndrome, carbonic anhydrase inhibitors
110
what does proximal renal tubular acidosis increase the risk of?
hypophosphatemic rickets
111
urine pH <5.5, hyperkalemia
hyperkalaemic renal tubular acidosis
112
what happens in hyperkalaemic renal tubular acidosis?
hyperaldosteronism
decrease NH3 synthesis in proximal tubule
decreased NH4+ secretion
113
causes of hyperkalemic renal tubular acidosis
decreased/resistance to aldosterone
114
what causes a decrease in aldosterone?
```
HCA DAAN
heparin
cyclosporine
adrenal insufficiency
diabetic hyporeninism
ACE inhibitors
ARBs
NSAIDs
```
115
what causes aldosterone resistance?
K sparing diuretics, nephropathy from obstruction, TMP/SMX
116
casts in urine
glomerular or renal tubular origin
117
RBC casts
glomerulonephritis, malignant htn
118
WBC casts
tubulointerstitial inflammation, acute pyelonephritis, transplant rejection
119
Fatty casts
nephrotic syndrome
120
granular casts
acute tubular necrosis
121
waxy casts
end stage renal disease
122
hyaline casts
can be normal
123
focal segmental glomerulosclerosis
<50% glomeruli
124
membranoproplferative glomerulonephritis
hypercellular glomeruli
125
thickening of glomerular basement membrane
membranous nephropathy
126
primary disease of kidney impacting glomeruli
minimal change disease
127
proteinuria, hypoalbuminemia, edema
nephrotic syndrome
128
what causes nephrotic syndrome?
podocyte disruption
129
causes of nephritis syndrome
```
focal segmental glomerulosclerosis
minimal change disease
membranous nephropathy
amyloidosis
diabetic
```
130
causes of nephritic syndrome
IgA, Alport syndrome, rapidly progressive glomerulonephritis, post strep, goodpastures, wegner's
131
Berger disease
IgA nephropathy
132
what causes nephritic syndrome?
GMB disruption
133
htn, raised Cr, oliguria, hematuria
nephritic syndrome
134
nephritic-nephrotic picture
diffuse proliferative glomerulonephritis
| membranoproliferative glomerulonephritis
135
starry sky nephritic syndrome
acute poststrep
136
what is deposited in acute poststrep glomerulonephritis?
IgG, IgM, C3
137
what type of hypersensitivity is acute poststrep glomerulonephritis?
III
138
coke coloured urine, edema, htn
acute poststrep glomerulonephritis
139
crescent moon shape on microscopy
rapidly progressive glomerulonephritis
140
what are the crescents made out of?
fibrin, plasma proteins, glomerular parietal cells, monocytes, mpgs
141
Goodpastures
antibodies to GBM
| type II hypersensitivity
142
immune association with rapidly progressive glomerulonephritis
PR2-ANCA/c-ANCA
| MPO-ANCA/p-ANCA
143
granular, C3 deposition, wire looping of capillaries
diffuse proliferative glomerulonephritis
144
SLE kidneys
diffuse proliferative glomerulonephritis
145
Alport syndrome
IV collagen mutation
| can't see, can't pee, can't hear a bee
146
kidney disease linked with Hepatitis B/C
membrano-proliferative glomeruloephritis
147
tram-track PAS stain
membranoproliferative glomerulonephritis
148
EM effacement of foot processes
minimal change disease
149
Rx minimal change disease
steroids
150
most common cause of nephrotic syndrome in African Americans and hispanics
focal segmental glomerulosclerosis
151
conditions resulting in focal segmental glomerulosclerosis
HIV, sickle cell, heroin abuse, obesity, interferon Rx, CKD from congenital malformation
152
segmental sclerosis and hyalinosis, potential immune deposits, effacment of foot processes
focal segmental glomerulosclerosis
153
most common cause of primary nephrotic syndrome in caucasian adults
membranous nephropathy
154
capillary an GBM thickening, granular, immune complex deposition
spike and dome
membranous nephropathy
155
what is a primary cause of membranous nephropathy?
phospholipase A2 receptor antibodies
156
what are secondary causes of membranous nephropathy?
NSAIDs, penicillamine, HB/CV, SLE, solid tumours
157
congo red stain shows apple-green birefringence under polarised light
amyloidosis
158
where do you get amyloid deposits?
mesangium
159
mesangial expansion, GBM thickening, eosinophilic nodular
diabeic glomerulonephritis
160
Kimmelstiel-Wilson lesions
eosinophilic nodular glomerulosclerosis
161
envelope shaped urine crystals
calcium oxalate stones
162
most common kidney stones
calcium oxalate
163
hypocitrateuria
decreased urine pH
164
Rx hypocitrateuria
thiazides, citrate, low sodium diet
165
wedge shaped prism crystals
calcium phosphate
166
Rx Ca phosphate stones
thiazides
167
coffin lid crystals
ammonium magnesium phosphate
168
stones from urase positive organisms
ammonium magnesium phosphate
169
urease positive organisms
proteus mirabilis, staph saphrophyticus, kelbsiella
170
what is the likely cause of a staghorm calculi?
ammonium magnesium phosphate
171
rhomboid/rosette crystals
uric acid
172
RF for uric acid stones
| Rx
low urine volume, arid climates, acidic pH, gout
| alkalisation of urine, allopurinol
173
hexagonal crystals
cystine stones
174
sodium cyanide nitroprusside positive
cystine stones
175
what causes cystine stones?
| Rx
can't reabsorb cystine in proximal tubule
or ornithine, lysine or arginine
COLA
low sodium, alkalinisation of urine, chelating agents
176
hydronephrosis
distension/dilation of the renal pelvis
177
most common renal malignancy
renal cell carcinoma
178
where does renal cell carcinoma originate?
PCT cells --> polygonal clear cells
179
golden yellow cells in PCT mean, because
renal cell carcinoma
| high lipid content
180
spread of renal cell carcinoma
hemetogenous through renal vein and IVC
181
Rx renal cell carcinoma
aldesleukin, resection
182
gene deletion of chr. 3
renal cell carcinoma
183
renal oncocytoma
benign epithelial tumour from collecting ducts
184
large eosinophilic cells with lots of mt
| no perinuclear clearing
renal oncocytoma
185
Wilms tumour
nephroblastoma
186
Wilms tumour genetics
WT1 or 2 gene on chr.11
187
WT1 causes
Wilms tumour, aniridia, genitourinary malformation, mental retardation
188
Denys-Drash
Wilms tumour, early onset nephrotic syndrome, male pseudohermaphroditism, WT1 mutation
189
Beckwith-Wiedemann
wilms tumour, macroglossia, organomegaly, hemihyertrophy, WT2 mutation
190
RF transitional cell carcinoma
phenacetin
smoking
aniline dyes
cyclophosphamide
191
RF squamous cell carcinoma of bladder
schistosoma haematobium, chronic cystitis, smoking, chronic nephrolithiasis
192
squamous cell carcinoma of bladder caused by
chronic irriration of bladder
193
urge incontinance Rx
oxybutanin (antimuscarinic)
194
causes of UTI
E coli
Staph saphrophyticus (sexually active young women)
kelbsiella
p. mirabilis
195
urine smells like ammonia
proteus mirabilis
196
striated parenchymal enhancement
acute pyelonephritis
197
RF acute pyelonephritis
UTI, catheter, vesicoureteral reflux, DM, pregnancy
198
complications of acute pyelonephritis
chronic, renal papillary necrosis, perinephric abscess
199
asymmetric corticomedullary scarring, blunted calyx
chronic pyelonephritis
200
thyrodization of kidney
eosinophili casts
| chronic pyelonephritis
201
xanthogranulomatous pyelonephritis
granulomatous tissue containing foamy mpgs
202
diffuse cortical necrosis
cortical infarction of both kidneys
| vasospasm + DIC
203
renal osteodystrophy
failure of vitamin D hydroxylation due to CKD
204
which AKI has the highest urine Osm?
pre-renal
| means urine is concentrated
205
AKI with high urine Na
renal or post renal
206
effects of high BUN
nausea, anorexia, pericarditis, asterixis, encephalopathy, plt dysfunction
207
causes of acute interstitial nephritis
diuretics, penicillin, PPIs, sulfonamides, rifampicin, NSAIDs, Sjogren's syndrome, SLE, sarcoidosis, mycoplasma
208
causes of acute tubular necrosis
| risks
ischemic - decreased renal blood flow
nephrotoxic - toxic substances, crush injury, hemoglobinurea
risks - hyperkalaemia followed by hypokalaemia in recovery
209
nephrotoxic substances
aminoglycosides, radiocontrast, lead, cisplatin
210
gross hematuria and proteinuria and recent infection
renal papillary necrosis
211
RF renal papillary necrosis
sickle cell, acute pyelonephritis, analgesics, DM
212
PKD1
| PKD2
85% chr.16
| 15% chr.4
213
cystic dilation of collecting ducts, seen in infants
| Rx
AR PKD
| ACE inhibitors or ARBs
214
what is associated with AR PKD?
congenital hepatic fibrosis
215
medullary cyctic disease
tubulointerstitial fibrosis, can't concentrate urine, shrunken kidneys
216
simple renal cyst
ultrafiltrate
217
complex renal cyst
septated, enhanced, solid components
218
mannitol
use
s.e.
osmotic diuretic PCT
drug overdose, elevated ICP
pulmonary edema, dehydration
219
acetazolamide
use
s.e.
NaHCO3 diuresis
glauoma, urinary alkalinization, metabolic alkalosis, pseudotumour cerebri
proximal renal tubular acidosis, parasthesias, NH3 toxicity, sulfa allergy
220
Mechanism loop diuretics
| use
inhibit Na/K/2Cl in thick ascending limb
stimulate PGE release
edema, htn, hypercalcemia
221
what inhibits loop diuretics?
| don't give loop diuretics to
NSAIDs
| OP - you loose Ca
222
s.e. loop diuretics
```
OH DANG
ototoxicity
hypokalaemia
dehydration
allergy
metabolic alkalosis
nephritis
gout
```
223
ethacrynic acid
| s.e.
nonsulfonamide loop diuretic
| ototoxic
224
thiazides mechanism
use
s.e.
inhibit NaCl reabsorption in DCT, decrease Ca excretion
htn, HF, hypercalciuria, nephrogenic diabetes insipidus, OP
hypokalemic metabolic alkalosis, hyponatremia, hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia, sulfa allergy
225
K sparing diuretics
use
s.e.
spironolactone, amiloride
hyperaldosteronism, K depletion, HF, hepatic ascites, nephrogenic DI
hyperkalaemia, endocrine effects from spironolactone (gynecomastia, antiandrogen)
226
mechanism spironolactone
competitive aldosterone receptor antagonist
227
mechanism amiloride/ triamterene
block Na channels in collecting duct
228
diuretics increasing urinary NaCl
all of them
229
diuretics causing acidemia
carbonic anhydrase inhibitors
230
diuretics causing alkalemia
loop, thiazide
231
use ACE inhibitors
| s.e.
htn, HF, proteinuria, diabetic nephropathy
| cough, angioedema, teratogenic, decrease GFR, hyperkalemia, hOtn
232
difference between ACE inhibitors and ARBs
ARBs do not increase bradykinin
233
use ARBs
| s.e.
htn, HF, priteinuria, diabetic nephropathy
| hyperkalemia, decrease GFR, hOtn, teratogen
234
aliskiren
renin inhibitor
235
use aliskiren
| s.e.
htn
| hyperkalaemia, decrease GFR, hOtn, don't use in combination with other htn drugs
