Renal Flashcards by Niamh Fitzpatrick

What happens in the proximal tubule?

regulation of pH

100% of filtered glucose and amino acids are reabsorbed.

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Which part of the loop of Henle is water-impearmeable?

ascending

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What is secreted in the distal tubule?

Potassium

Hydrogen

Urea

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Which cells make up the juxtaglomerular apparatus?

granular

macula densa

mesangial cells

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Where are macula densa cells found?

distal convoluted tubule

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Which cell detects NaCl?

macula densa

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Which cells secrete renin?

granular cells

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What do potassium-sparing diuretics do?

inhibit na reabsorption and K excretion

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What do loop diuretics do?

NKCC2 transporter

(na, k, cl)

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What do thiazide diuretics do?

Inhibit NaCl co-transporter in the distal convoluted tubule

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What is GFR?

rate at which protein-free plasma is filtered into the bowmans capsule per unit of time

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Normal GFR

125ml

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which factors are taken into account when looking at GFR

CAGE - serum creatinine - age - gender - ethnicity

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If muscle mass is high, is GFR over or underestimated?

underestimates

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What is the main determinant of GFR?

glomerular capillary blood pressure

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GFR is equal to

Kf x NFP (filtration coeffienct x net filtration pressure)

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What does filtration coefficient mean?

how holey the membrane is

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Net filtration pressure equation

BPgc + COPbc opposition: HPbc + COPgc

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Formation of interstitial fluid

(Pc-Pi) - (Piep - piel) (capillary pressure - interstitial fluid pressure) - (capillary oncotic pressure - interstitial fluid oncotic pressure) inc oedema if inc pc or decrease piep

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Constriction of which arteriole causes an increase in glomerular filtration?

efferent

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How does vasoconstriction at afferent arteriole affect GFR?

decrease

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Plasma clearance

([x]urine x Vu) / [X]plasma

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Rate of filtration

conc in plasma x GFR

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Rate of excretion

conc in urine x urine vol

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Rate of reabsorption

rate of filtration - rate of excretion

Rate of secretion

rate of excretion - rate of filtration

Reabsorbed substance

GFR\> clearance

Secreted substance

clearance\> GFR

Neither absorbed nor secreted substance

clearance = GFR

Where does the bulk of solute and water reabsorption occur?

proximal tubules

Calculate anion gap

(Na+ + K+) - (Cl- + HCO-3)

normal anion gap

10-18

action of spirinolactone

aldosterone antagonist

Diagnose BPH

TRUS (transrectal ultra sound guided) biopsy

Treat BPH

alpha blocker eg tamsulosin 5 alpha reductase eg finestride

Treat proteinuria and hypertension

ACE-inhibitor (-prils)

Investigate polycystic kidney disease

renal ultrasound

Nephrotic syndrome

proteinuria\>3g/day Hypoalbuminaemia Oedema (periorbital) hypercholesterolaemia normal renal function

How is nephrotic syndrome treated?

steroids

Nephritic syndrome

AKI oliguria oedema/fluid retention hypertension haematuria (+/- proteinuria)

How is nephritic syndrome treated?

ACEi

What imaging is used in lower renal tract?

cystography

What imaging is used in upper renal tract?

renal US( \<50) CT urography (\>50)

What imaging is used for renal colic?

non-contrast CT KUB

What investigations are done in scrotal swelling?

ultrasound

What investigations are done in renal or urinary tract trauma?

CT: renal, ureteric contrast cystography: bladder

most common renal cancer in a) children b) adults

a) nephroblastoma b) renal cell carcinoma

What mets are seen with renal cell carcinoma?

canon ball mets in the lungs - also liver, brain and bones

Investigate and treat renal cell carcinoma

triple phase contrast CT radical nephrectomy or radioablation - mets are radioand chemo resistant

What tumour is associated with tuberous sclerosis?

angiomyolipoma

Which type of HPV is associated with mouth ulcers?

1-4

Which type of HPV is associated with genital cancer?

16-18

Which benign renal tumour can cause secondary hypertension?

juxta glomerular cell tumour - secretes renin

Where do most transitional cell carcinomas occur in the bladder?

trigone ---\> ureteric obstruction

How is TCC of the bladder investigated?

cystoscopy with biopsy (diagnose) CT urogram (staging)

How is TCC of the bladder treated?

stage 1 --\> transurethral resection invasive --\> radical cystectomy

What do prostate cancers tend to be ?

multifocal adenomas

What type of mets are seen with prostate cancer?

osteosclerotic

How do you treat prostate cancer?

if old + low risk --\> active surveillance if young --\> radical prostatectomy or radiotherapy hormonal drugs eg LRHR agonists, anti-androgens

What is the most common type of testicular tumour?

seminoma

Give testicular tumour markers: a) seminomas b) teratomas with yolk sac elements c) highly malignant teratomas with trophoblastic tissue

a) placental ALP b)AFP c)bhCG

Describe a seminoma

potato looking - very radiosensitive

Which UTI bacteria a) forms calculi? b) is resistant to most antibiotics? c) is seen with women of child bearing age? d) catheterised? e) no +ve nitrates

a) proteus sp. b) enterococcus faecium c) staph. saphrophyticus d) pseudomonas e) enterococcus spp.

Kass' criteria for UTI in women of child-bearing age

10^4 organisms/ml = possible, needs repeat more than 10^5 = probable

Give examples of non-proliferative GN

minimal change focal segemental membranous

Give examples of proliferative GN

IgA nephropathy Membranous proliferative Rapid progressive (vasculitis or goodpasture's) Post-infection

renal failure after a fall

myoglobulinuria causing acute tubular necrosis

what is trousseau's sign?

spasm of fingers during BP due to hypocalcaemia

What happens to a) phosphate b) vitamin D in CKD?

a) rises (sometimes need phosphate binders as not removed effectively by dialysis) b) activation is reduced

In which disease are anti-GBM antibodies seen?

Goodpasture's disease

haemoptysis + renal failure

Goodpasture's

When do you see a) p-ANCA b) c-ANCA

a) microscopic polyangitis b) GPA

How is Alport's disease inherited?

x-linked

deafness + renal failure

Alport's

Which drug stabilises the cardiac membrane in hyperkalaemia?

calcium gluconate

In hyperkalaemia what does combined insulin/dextrose infusion do?

shifts potassium from extracellular to intracellular fluid compartment in the short-term

How does IgA nephropathy present?

young male macroscopic haematuria overlap with times of infection

What triad is seen in haemolytic uraemic syndrome?

* acute renal failure * microangiopathic haemolytic anaemia * thrombocytopenia

What does nebulised salbutamol do in hyperkalaemia?

Shifts potassium from extracellular to intracellular fluid compartment in the short-term

how does renal cell carcinoma present?

haematuria, loin pain, abdominal mass

Older patient with painless, visible haematuria

transitional cell carcinoma of the bladder

rash after diarrhoea

Haemolytic uraemic syndrome

Markers of nephritic syndrome

proteinuria haematuria oliguria hypertension.

renal screening in diabetic patients

albumin:creatinine ratio (ACR) in an early morning specimen

What are muddy brown casts suggestive of ?

acute tubular necrosis

Which renal disease is caused by hypertension?

renal artery stenosis