Renal Flashcards
In ADPKD, _______ is nonfunctional and what is it’s function?
Polycystin 1, transmembrane glycoprotein important for connective tissue cohesion in cell-cell and cell-ECM interactions
Ethylene glycol can lead to __________ with vacuoles degeneration and ballooning of the _________. You can also see ______ crystals in the tribe
Acute tubular necrosis, proximal tubular cells, oxalate
Chronic kidney disease presents with ______phosphatemia, ________parathyroidism, and ______ calcitriol levels
Hyperphosphatemia, secondary hyperparathyroidism, decreased calcitriol
Chlorthalidone is a _____ diuretic and it can lead to _____kalemia. This explains muscle weakness and cramping
Thiazides, Hypokalemia
______ is a oxidase positive Gram negative rod that is a common cause of UTI with indwelling catheters
Pseudomonas
Para-aminohippuric acid has the lowest concentration in which part of the nephron?
Bowman’s space, it is not reabsorbed by any part of the nephron.
Hypercalcemia in Multiple myeloma is result of ________ induced by tumor cells.
Osteoclasts
PTHrP inc serum Ca by promoting _____ Activity and has NO effect on 1,25 vit D.
Osteoclasts
Diffusion speed across a semipermeable membrane increases with
- Higher molecular concentration gradients
- larger membrane surface areas
- inc solubility of the diffusing substance
Increased levels of both renin and aldosterone are indicative of ________ hyperaldosteronism. Three causes are
Secondary
Renovascular disease (juxtaglomerular cell tumor), malignant hypertension, renin secreting tumors
Imunnofluoresence of post strep glomerulonephritis shows ___, ___, ____
IgG, IgM, C3 in the mesangium and basement membrane
Overflow incontinence is common in diabetics and leads to ________ postvoid residual volume.
Increased
Loop diuretics act at the ______ of the loop of Henle and block the _____ channel
Thick ascending limb, Na/K/Cl
The ureteric bud ultimately gives rise to the ____ system of the the kidney and includes. Failure of this to form leads to ________
Collecting
-collecting tubules and ducts, major and minor calyces, renal pelvis, ureters
Potter sequence
The metanephric blastoderm gives rise to the (5 structures)
Glomeruli Bowman’s space Proximal tubules Loop of henle Distal Convoluted tubules
Filtration fraction equals
GFR/RPF
Net filtration pressure equation
(Pc-Pi)-(Oc-Oi)
Hydrostatic pressures-oncotic pressures
What amino acid needs to be metabolized by the kidney to maximize acid excretion?
Glutamine
This leads to ammonium and bicarbonate
ADH acts in the ____ (part of the kidney). Which part of this does it specifically act on to inc urea and water reabsorption
Collecting ducts, medullary
Spironolactone is a _________ antagonist and acts in what part of the kidney?
aldosterone, cortical collecting duct
thiazide diuretics block _____ reabsorption in what part of the kidney
Na/Cl, distal collecting tubule
acetazolamide blocks ______ in what part of the kidney
carbonic anhydrase, proximal tubule
The urachus is a remnant of the _______ that connects the bladder with the yolk sac during fetal development. Failure of this to separate results in discharge of urine form the umbilicus
allantois
failure of the central part of the urachus to separate leads to a urachal _____
cyst
erythropoeisis stimulating agents treat anemia of _________ but are associated with inc risk of _______ events–> ______ hypertension
chronic disease, thromboembolic, worsening
In absence of ADH tubular fluid is most concentrated in what part of kidney?
junction between descending and ascending loop of henle (BOTTOM of loop of henle)
-highest osmolarity occurs at the bottom of the loop of henle
Glucose is normally filtered at the glomerulus but if something inhibited this, clearance of glucose would be most similar to ______
inulin, which can be approximated as being equal to GFR
acute renal allograft rejection can be _____ or _____ mediated and is seen within ____ after transplant
antibody, cell, 6 months
see inc creatinine, malaise
what type of urinary incontinence is associated with urethral hypermobility or dec urethral sphincter tone
stress incontinence, from coughing or sneezing
what type of urinary incontinence is associated with detrusor hyperactivity
urge, sudden overwhelming urge to urinate
what type of urinary incontinence is associated with impaired detrusor contractility or bladder outlet obstruction
overflow, incomplete emptying and persistent involuntary dribbling
_____ renal allograft rejection manifests months to years after transplantation and presents with worsening ____, ____ creatinine and _______ fibrosis
chronic, HTN, rise in serum, obliterative vascular
A dense interstitial mononuclear infiltrate is characteristic of ______ graft rejection
acute (< 6 months)
Vascular fibrinoid necrosis and neutrophil infiltration of the arterioles, glomeruli, and peritubular capillaries are characteristic of _____ graft rejection
hyperacute (minutes to hours)
Aldosterone antagonists (spironolactone, eplerenone) decrease the secretion of __ and __ by what part of the kidney
K+,H+, collecting tubule
Aldoesterone increases the number of basolateral_____ and apical _____ found on ____ cells in what part of the kidney
Na/K ATPase, sodium, principal, cortical collecting ducts
____1 receptors are located on the jutxtaglomerular cells , which stimulate the release of _____ from sympathetic activation
beta, renin
beta adrenergic antagonists inhibit ____ release in the kidney which leads to a ____ in angiotensin 1/2, and aldosterone levels
renin, decrease
Deposition of ____ in Bowman’s space is an essential pathological step in cresecent formation
fibrin
Acute ureteral obstruction leads to _____ GFR
decreased
Vasopressin causes a ___ receptor mediated ____ in water and urea permeability at the inner medullary collecting duct. You get a resulting ___ in urea absorption (dec renal clearance) that _____ the medullary osmotic gradient
V2, increase, rise, enhances
In pt with extensive smoking history, painless hematuria, polycythemia (elevated hematocrit), renal mass
renal cell carcinoma, most patients asymptomatic and incidental imaging finding
Loss of _______ is responsible for the thrombotic complications of nephrotic syndrome
antithrombin III
The most common cause of fever and fatigue with new onset cardiac murmur is _______. Diffuse prolierative glomerulonephritis secondary to circulating ____________ deposition may lead to renal insufficiency
infective endocarditis, immune complex
What shows up in the urine with early diabetic signs of renal failure? And how does this happen
albumin, normally GBM has negatively charged molecules blocking negatively charged molecules (like albumin) from leaking out but with diabetes there is a progressive loss of this charge
in tumor lysis syndrome, uric acid precipitates at ____ pH and what portion of the nephron has the lowest pH? Also how would you treat tumor lysis
low, distal tubules and collecting ducts, tx with alkalinization and hydration
in metabolic acidosis, urine excretion of which two compounds inc to get rid of excess acid without making the pH too low
NH4+ and H2PO4-(titratable acids)–> inc H+ excretion
since inulin clearance is typically equal to GFR, what is the equation for net excretion rate
(inulin clearance)(plasma concentration of substance)-(tubular reabsorption of substance)
In minimal change disease, loss of _____ charge leads to ______ filtration of these charged proteins. Systemic __ cell dysfunction leads to that leads to podocyte foot fusion
negative, increased, T
Most renal cell carcinomas orginiate from the epithelial cells of the ______ and has cuboidal or polygonal cells with clear abundant cytoplasm. What do you see in the cells?
proximal renal tubules, glycogen and lipid accumulation
Transitional cell carcinomas are responsible for 90% of tumors involving the renal ____
pelvis
Crohn’s disease is associated with a defect in NF-KB which regulates what?
cytokine production, dec so inc chance of bacterial overgrowth and exaggereated response=chronic GI inflammation
Intusseception most commonly occurs at the ______ junction
ileocecal
Opioid analgesics can cause contraction of _________ in the sphincter of Oddi leading to inc pressures in the common bile duct and gallbladder
smooth muscle cells
Most of the K+ filtered by the glomeruli is reabsorbed in the ______ and the _______. The ________ and ______ are the primary sites of K+ concentration in the urine.
proximal tubule and loop of henle, late distal and cortical collecting ducts
tubular fluid means
fluid going through the nephron
Equation for renal plasma flow when you have renal blood flow and hematocrit
RPF=RBF x (1-hematocrit)
Renal artery stenosis leads to significant renal ______ –> ___ GFR and activation of the ______ system. This leads to inc _____ release by modified smooth muscle (juxtaglomerular) cells within the _____________
hypoperfusion, dec, RAAS, renin, afferent arteriole
Benign prostatic hyperplasia can _____ resistance to urine flow in the urethra and lead to incomplete bladder emptying during micturirton–> inc risk for _______
inc, UTI
Flank pain that radiates to groin with a flank mass that develops withina week of pelvic surgery suggests
ureteric obstruction, which can be hydronephrosis
Sx of fever, maculopapular rash, and sx of acute renal fialure (oliguria and inc creatinine) 1-3 weeks after beginning treatment with a beta lactam antibiotic is suggestive of
acute interstital nephritis and the renal interstitum is affected
________ is caused by retrograde urine flow from the bladder to the ureter. The upper and lower poles of kidney appear as _______
vesicouretal reflux, dilated calyces with overlying renal scarring
___________ can present with bilateral hydronephrosis and calcyeal dilation due to _____ of the flow of urine. But it is a malformation of the ________ duct so can only occur in males
posterior urethral valves, obstruction, Wolffian
Another equation for renal blood flow when you have PAH and hematocrit
RBF= (PAH clearance)/ (1-hematocrit)
Carbonic anhydrase inhibitors are used to relieve ________ in glaucoma
intraocular pressure
The graph relationship of serum creatinine and GFR is ______.
nonlinear (a downward half parobola)
What types of casts in the urine do you see in pyelonephritis
white blood cell casts
The proximal tubule _______ reabsorbs glucose and what happens when this is at its max
completely, excreted in urine
Desmopressin binds to V__ receptors which activates __. This then inc ____ which leads to insertion of _______ proteins into the apical membrane of the cortical collecting duct
V2, Gs, cAMP, aquaporin
Non-anion gap metabolic acidosis: HARDASS
Hyperalimentation (IV nutrition), Addison’s disease, Renal tubular acidosis, Diarrhea, Acetazolamide, Spironolactone, Saline Infusion
What two parts of the kidney are most affected by renal tubular acidosis and why? Ischemic injury commonly affects the renal______
straight proximal tubules & thick ascending loop of Henle b/c they participate in the active (ATP consuming) transport of ions and have high O2 demand, medulla
NSAID associated chronic renal injury is characterized by ____________ and ________ necrosis
chronic interstitial nephritis, papillary
Most children 5-12 with PSGN ________ but how are adults affected
recover, poorer prognosis—> complications( inc risk chronic HTN, renal insufficiency)
Most patients with acute tubular necrosis experience _________ and regain renal fucntion
tubular repithelization
-think if suffer from motor accident–>ischemic trauma
Increased urinary _______ prevents formation of kidney stones
citrate, b/c citrate binds free Ca facilitating its excretion
Inc urinary concentrations of which three things inc risk for kidney stones
calcium, uric acid, oxalate
How to findurine flow rate
GFR= (urine inulin concentration x urine flow rate) / plasma inulin concentration
Activation of V1 receptors in vascular smooth muscle by ADH leads to activation of which second messanger system leading to a ____ in total peripheral vascular resistance
Gq, increase
The concentrations of ____,_____,______,______ increase as fluid runs along the proximal tubule, while concentrations of _______,______,_____ decrease
PAH, creatinine, inulin, urea all inc b/c
bicarbonate, amino acids, glucose (all dec b/c mostly reabsorbed)
________ is the most common small cell vasculitis in children. _____ immune complexes deposit in walls. What are 4 key associated sx? When does it typically present?
Henoch Schonlein Purpura, IgA, after a viral infection
-abdominal pain, joint pain, palpable purpura, IgA nephropathy
Enlarged hypercellular glomeruli with deposits of ____ and ____are seen in PSGN
IgG, C3 (levels dec)
Homogenous deposition of eosinophilic hyaline material in the intima and media of small arteries and arterioles characterizes hyaline arteriosclerosis which is seen in?
diabetes
1st stage of acute tubular necrosis (initiation)
ischemic injury precipitated by shock, hemorrhage
2nd stage of tubular necrosis (maintenance)
dec urine output, fluid overload, inc Cr/BUN, hyperkalemia
3rd stage of tubular necrosis (recovery)
gradual inc in urine output leading to high volume diuresis, dec concentrations of K+, Mg++, Ca++, PO4
Stimulation of _______ and _______ receptors inc renal blood flow
dopamine and bradykinin
-aldosterone and alpha receptors cause vasoconstriction
If the pH and CO2 change in opposite directions then it is __________ disturbance
primary respiratory disturbance
if pH and CO2 change in same direction, then it is a ___________ disturbance
primary metabolic
BPH is mediated by what hormone and leads to proliferation of __________ cells in the ________ and _______ zones
DHT, glandular, periurethral and transitional
Treat minimal change disease with?
steroids
prerenal azotemia is from ______ blood flow to the kidneys and the kidneys retain their ________ and get ___ GFR
decreased, concentrating abilities, increased
urine BUN/Cr>20, Osm>500, Frac Na <1%, UNa <20 b/c kidney wants to retain salt to inc blind pressure
intrinsic renal failure impaired the ______ abilities of the kidney and get ___ GFR. See _____ casts
concentrating, dec, muddy brown
urine Osm <350, UNa>40, Frac Na >2%,
post renal azotemia develops from _______. Most common cause is?
obstruction, BPH
IgA nephropathy can occur during or while having cold. When does PSGN present?
2-3 weeks after
In someone with bilateral bruits think _______ disease –> bilateral renal artery ______ which leads to. Which drug do you need to be careful using?
peripheral vascular disease, stenosis, dec perfusion to kidney=dec GFR, ACE inhibitor because they dec GFR
____________ is associated with sub epithelial deposits and no hypercellularity. It is also associated with circulating _____ antibodies to the phospholipase A2 receptor
membranous nephroopathy, IgG4 (PLA2R)
___________ is associated with sub endothelial deposits and IgG.C3 with hepatitis B/C infection. “tram track appearance”
membranoproliferatiive glomerulonephritis type 1
_____________ is mediated by C3 nephritic factor
membranoproliferative glomerulonephritis type 2
CKD leads to ___ GFR which leads to _______ of phosphate–> hypocalcemia
dec, decreased excretion, b/c phosphate binds Ca
can lead to renal osteodystrophy, osteomalacia
CKD can lead to ____kalemia because of
hyperkalemia b/c kidney has dec ability to excrete K+
renal artery stenosis can be from ______ HTN and leads to _____kalemia
resistant, hypokalemia
Goodpasture syndrome shows _____ deposition of IgG. Light microscopy reveals ______ glomerulonephritis
linear, cresenteric
Myeloproliferative disorders can lead to ______ nephropathy secondary to tumor lysis syndrome
urate
-uric acid inc from nucleic acid breakdown
Hyperparathyroidism can also lead to the formation of ______stones
kidney
schistosome ________ leads to bladder cancer
haemeabatoium
recurrent nephrolithiasis in a kid, think __________. How do you treat?
cystinuria, amino acid uria, inc hydration and urinary alkalization
The _________ reabsorb >60% of the water filtered by the glomeruli regardless of the patient’s volume status
proximal tubules
__________ is a complement mediated cell lysis reaction and presents with fever/chills, chest/back pain, hemoglobinuria (brown pee)
acute hemolytic transfusion reaction
-“get an emergency blood transfusion after motor vehicle accident”
In nephrotic syndrome: get inc liver ________ synthesis–> high TGs, dec _____ pressure–> edema, hypovolemia–>inc _______ secretion
lipoprotein, oncotic, aldo/ADH (retain volume)
blood flow to the proximal ureter is from the _______ artery
renal
Renal agenesis can lead to _________
potter sequence
______ can be used to measure ECF volume
inulin
Aspirin toxicity typically develops a respiratory _________ and metabolic ________
respiratory alkalosis, metabolic acidosis
PAH is not reabsorbed by any part of the nephron and tubular concentration is lowest in
bowman’s space
in metabolic acidosis, kidney inc rates of titratable acids (_______) to help excrete more H+ and urine becomes slightly more acidic
H2PO4-, NH3
contraction alkalosis is from loss of _________
extracellular fluid from diuretic use (furosemide)
In SIADH you have _____ volume retention, ____ ANP,, ____ renin, _____ aldosterone
inc volume retention, inc ANP (causes the kidney to inc sodium excretion), dec renin and dec aldosterone from inc volume and leads to inc Na excretion
Dec plasma protein concentration leds to _____ GFR
dec, b/c dec oncotic pressure allows plasma to exit the capillaries which inc filtration fraction and GFR
What diuretic in cystinuria can you give to alkalize the urine
carbonic anhydrase inhibitor
what does aliiskiren block and what drugs is it contraindicated with
renin inhibitor, ACEi and ARBs, because it can lead to severe hypotension and exacerbate hyperkalemia
What is constantly overactive in Liddle syndrome
ENac channels so have inc Na reabsorption with low aldosterone levels
renal oncocytomas arise from what cells
intercalated cells of collecting ducts
renal cell carcinoma arises from what cells
proximal tubule cells of kidney
transitional cell carcinoma arises from what cells
transitional epithelium of urinary collecting system
_______ overdose can present with tinnitus, respiratory alkalosis followed by metabolic acidosis. What can you treat with?
aspirin, bicarbonate to alkalinize the urine and inc aspirin acid excretion
cells in renal cell carcinoma have high amount of _______
glycogen and lipids
In minimal change disease you see ______ filtration of negatively charged plasma proteins
inc
eosinophils in kidney analysis think
drug induced interstitial nephritis that involves the renal intersitium
In mammalian kidney, densely immunostaining protein containing adjacent cells in renal glomerulus are most likely JGA cells that store and secret _______
renin (think of where you are with path slides)
aldosterone leads to inc K losses in urine and would lead to serum ________
alkalosis
The kidney compensates for respiratory alkalosis by preferentially excreting _______ in the urine
bicarbonate –> alkanized urine
kidneys have autoregulatory mechanisms so explain what happens in renal artery stenosis
so dec renal plasma flow–>dec GFR–>afferent arteriolar dilation and efferent arteriolar constriction–>restoring GFR –>inc filtration fraction (FF=GFR/RPF)
Jones methane silver stain for membranous nephropathy will show
thickening of GBM and spikes
Auto recessive PCKD is on chromosome
6
Auto dominant PCKD is on chromosomes
4, 16
calcineurin inhibitors–> renal damage by?
intrarenal vasoconstriction (afferent and efferent constriction)
aminoglycosides damage kidney by
proximal tubular damage
How does acyclovir lead to renal damage
forms crystals in the kidney
hypo________ can lead to rhabdomyolysis
phosphatemia and also hypokalemia
