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Renal Flashcards

1
Q

How is plasm volume measured?

A

Radiolabeling albumin

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2
Q

How is extracellular volume measured?

A

Inulin or mannitol

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3
Q

Patient with Addison’s disease experiences what kind of volume shift?

A

Hypoosmotic volume contraction

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4
Q

What cells synthesize renin? Where are they located?

A

Juxtaglomerular smooth muscle cells contained in the afferent arteriole

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5
Q

How are RBCs prevented from filtration in the glomerulus?

A

Fenestrated capillaries

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6
Q

What is the equation for renal clearance?

A

Clearance of substance X = (urine concentration of X * urine flow rate)/plasma concentration of X

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7
Q

If clearance of substance is less than GFR, what does this mean?

A

Net tubular reabsorption of substance

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8
Q

If clearance of a substance is greater than GFR, what does this mean?

A

Net tubular secretion of substance X

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9
Q

What is renal clearance?

A

Volume of plasm cleared of a substance per unit of time

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10
Q

Inulin can be used to measure what?

A

GFR or extracellular volume

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11
Q

How is effective renal plasma flow estimated?

A

Para-aminohippuric acid clearance

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12
Q

How is renal blood flow calculated?

A

Renal plasma flow / (1-Hct)

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13
Q

What affect does probenecid have on penicillin?

A

It increases the half life of penicillin by inhibiting penicillin secretion in the proximal tubule via blocking the PAH transporter

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14
Q

Penicillin is secreted in the kidney by what transporter? Where?

A

Para-aminohippuric acid transporter in proximal tubule

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15
Q

What is the equation for calculating filtration fraction?

A

GFR/RPF

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16
Q

What is a normal filtration fraction?

A

20%

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17
Q

How do you calculate the filtered load?

A

GFR x plasma concentration

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18
Q

How is renal plasma flow estimated?

A

Para-aminohippuric acid

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19
Q

With an increased filtration fraction, what happens to protein concentration in peritubular capillary blood? What affect does this have on the nephron?

A

Increased protein concentration in peritubular capillary blood; which leads to increased reabsorption of water in the proximal tubule

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20
Q

What affects does decreased filtration fraction have on peritubular capillaries and the nephron?

A

Decreased protein concentration in the peritubular capillaries and decreased reabsorption of water in the proximal tubule

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21
Q

In dehydration what happens to GFR, RPF, and FF?

A

Decrease in GFR, large decrease in RPF, and therefore increase in filtration fraction

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22
Q

What affects do prostaglandins have on afferent arteriole? NSAIDs?

A

Vasodilate; NSAIDs cause vasoconstriction, could result in decreased GFR and therefore ischemia to kidney

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23
Q

How is the excretion rate calculated?

A

Urine flow rate x urine concentration of substance

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24
Q

What is the reabsorption rate?

A

Filtered - excreted

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25
What is secretion rate?
Excreted - filtered
26
What is the equation for FENa?
(Plasma creatinine x Urine Na) / (Urine creatinine x Plasma Na)
27
What is seen on light microscopy from a section of the proximal convoluted tubule?
Simple cuboidal epithelium with brush border
28
What is seen on light microscopy from a section of the distal convoluted tubule?
Simple cuboidal epithelium with NO brush border
29
What type of epithelium is seen in the thin descending loop of Henle?
Simple squamous
30
What region of the nephron does PTH act to increase calcium reabsorption?
DCT
31
Where does PTH act in the kidney? What does it do?
Proximal to increase phosphate excretion and DCT to increase calcium reabsorption
32
What is Winter's formula?
Pco2 = 1.5 [HCO3-] + 8 +/- 2
33
What is winters formula used for?
In simple metabolic acidosis, it can be used to calculate predicted resp compensation
34
If measured Pco2 is greater than the predicted Pco2 from winters formula, what is going on?
Concomitant respiratory acidosis
35
If measured PCO2 is less than predicted PCO2, what is going on?
Concomitant respiratory alkalosis
36
What drugs/nephrotoxins can cause Fanconi syndrome?
Ifosfamide, cisplatin, tenofovir, expired tetracyclines, lead poisoning
37
Expired tetracyclines can cause what syndrome?
Fanconi syndrome?
38
What is fanconi syndrome?
Generalized defect in reabsorption in PCT; cannot reabsorb glucose, aa, HCO3, and PO4
39
Fanconi syndrome can result in what acid/base disorder?
Metabolic acidosis - proximal tubular acidosis
40
Barter syndrome is a defect in what transporter?
NKCC2
41
What part of the renal tubule is affected by Bartter syndrome?
Thick ascending limb
42
What is the inheritance pattern of Bartter syndrome?
Autosome recessive
43
How does bartter syndrome present?
Hypokalemia, metabolic alkalosis with hypercalciuria; similar to chronic loop diuretic use
44
What is the inheritance pattern of Gitelman syndrome?
AR
45
What transporter is affected by Gitelman syndrome?
NaCl channel in DCT
46
What labs are seen in Gitelman syndrome?
Hypocalciuria hypomagnesemia, hypokalemia, metabolic alkalosis
47
What is the inheritance pattern of Liddle syndrome?
AD
48
What transporter/channel is affected by Liddle syndrome?
ENaC channel
49
Liddle syndrome results in what types of labs?
Increased Na reabsorption - resulting in HTN; hypokalemia, metabolic alkalosis, decreased aldosterone
50
What enzyme is defective in syndrome of apparent mineralocorticoid excess?
11 beta hydroxysteroid dehydrogenase
51
What is the mechanism of the enzyme 11 beta hydroxysteroid dehydrogenase?
Converts cortisol (active) to cortisone (inactive)
52
How does syndrome of apparent mineralocorticoid present?
Hypertension, hyperkalemia, metabolic alkalosis; low serum aldosterone levels
53
What disorder can be acquired from glycyrrhetinic acid?
Syndrome of apparent mineralocorticoid excess
54
Where is ACE made?
Kidney and lungs
55
What affect does AGII have on the posterior pituitary?
Increases release of ADH
56
What is the mechanism by which ANP vasodilates?
Increases cGMP, relaxing the vascular smooth muscle
57
What affect does ANP have on renin and aldosterone?
Reduces secretion of both renin and aldosterone
58
What is nesiritide?
Recombinant BNP; used for treatment of heart failure
59
What affect does ANP and BNP have on sodium?
Increases its filtration without increasing reabsorption; net effect is loss of both Na and water
60
What increases the secretion of renin?
Low Na sensed by macula densa, low BP sensed by JG cells, and sympathetics acting on beta1 receptors
61
What does the macula densa do?
Senses NaCl; if low - it promotes the secretion of renin from the JG cells
62
Angiotensin II constricts what vasculature?
Efferent arteriole
63
Where in the kidney is dopamine secreted from?
PCT cells
64
What affect does dopamine have on the kidney?
Promotes natriuresis; low doses promotes vasodilation; high doses promotes vasoconstriction
65
What is fenoldopam?
Dopamine receptor agonist - used in hypertensive emergencies
66
How is Epo regulated in the kidney?
Low oxygen states, HIF1alpha is not hydroxylated, and therefore is not degraded, resulting in transcription of erythropoietin
67
Where in the kidney is 1,25-OH D3 formed?
PCT
68
What is the action of 1alpha-hydroxylase?
Converts 25-OH D3 to 1,25-OH D3
69
What is ANP, BNP's effect on the afferent and efferent arteriole?
Constricts efferent arteriole while vasodilating the afferent arteriole, resulting in increased GFR
70
When is PTH secreted?
Decreased serum calcium, increased plasm PO4, or decreased plasm 1,25-OH D3
71
When is aldosterone secreted?
Decreased blood volume (in response to AGII) and increased serum K+
72
Patient with high serum digitalis presents to the ER. What will you see on EKG? Why?
Peaked T waves and wide QRS due to hyperkalemia
73
Patient used way too much of his beta-adrenergic agonist. What effect does this have on K+? What will you likely see on ECG?
Results in hypokalemia (shifts K into cells); U waves and flattened T wave on ECG
74
What affect does low serum calcium have on the ECG?
QT prolongation
75
What are signs and symptoms of low serum calcium?
Prolonged QT interval on ECG, tetany, Chvostek sign (twitching), spasm (Trousseau sign)
76
Patient presents with increased urine frequency, abdominal pain, back pain and anxiety. Additionally, patient states she think she passed a renal stone. What is the likely cause?
Hypercalcemia
77
What are signs and symptoms of high serum calcium?
Abdominal pain, bone pain, renal stones, increased urine frequency, anxiety/altered mental status
78
What is seen on ECG in low serum magnesium states?
Torsades de pointes
79
What additional lab findings do you see with low serum magnesium?
Low serum calcium, low serum potassium
80
What are the signs and symptoms of hypermagnesemia?
Low DTR, lethargy, bradycardia, hypotension, cardiac arrest, hypocalemia
81
What are the signs of increased PO4 in serum?
Renal stones, metastatic calcifications, hypocalcemia
82
What are the results of low serum PO4?
Bone loss, osteomalacia (adults) and rickets (children)
83
What is Conn syndrome?
Primary hyperaldosteronism
84
What affect does salicylates have on acid/base status?
Early - respiratory alkalosis; late - anion gap metabolic acidosis
85
What does HARDASS stand for in acid/base status?
Non-anion gap metabolic acidosis; hyperalimentation, addison disease, RTA, diarrhea, acetazolamide, spironolactone, saline infusion
86
What is type I RTA?
Distal renal tubular acidosis - defect in ability of alpha intercalated cells to secrete H+ and therefore no new HCO3 production, resulting in metabolic acidosis
87
How does renal tubular acidosis present?
Symptoms of volume depletion; normal anion gap (hyperchloremic) metabolic acidosis
88
What drugs cause distal renal tubular acidosis?
(Type I); amphotericin B and lithium
89
What is the urine pH in distal renal tubular acidosis?
>5.5 (because distal tubule is unable to secrete fixed acid)
90
Other than drugs, what else can cause distal renal tubular acidosis?
Congenital - obstruction; autoimmune (Sjogrens), analgesic nephropathy, sickle cell anemia
91
What drugs cause proximal renal tubular acidosis?
(Type 2) - acetazolamide and aminoglycosides
92
What is proximal renal tubular acidosis?
Defect in PCT HCO3 reabsorption
93
What is the urine pH in proximal renal tubular acidosis?
<5.5
94
Distal renal tubular acidosis is associated what electrolyte imbalance?
Hypokalemia
95
Distal renal tubular acidosis results in increased risk for what?
Calcium phosphate kidney stones
96
Proximal renal tubular acidosis is associated with what electrolyte imbalance?
Hypokalemia
97
Proximal renal tubular acidosis increases risk for what?
Hypophosphatemic rickets
98
What is a distinguishing feature of type 4 RTA?
Hyperkalemia (both type I and type II have hypokalemia)
99
What is the cause of type 4 RTA?
Hyperkalemic states - hypoaldosteronism, aldosterone resistance, K+ sparing diuretics, ACE inhibitors and ARBs are examples
100
What drugs can cause type 4 RTA?
Spironolactone, ACEi, ARBs
101
What serotypes of S pyogenes cause PSGN?
M12, M4, M1
102
PSGN is what type of HSR?
Type III
103
Goodpasture syndrome results in rapidly progressive glomerulonephritis. What type of HSR is this?
Type II

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