Renal Flashcards
Which part of the nephron concentrates urine?
Medulla
What is the course of the ureter?
Under the uterine artery and under the deferens.
What is the 60/40/20 rule?
60% total body water
40% ICF
20% ECF
Goldblatt’e kidney?
Flea-bitten kidney (blown capillaries)
Uremia?
Azotemia + symptoms
Azotemia?
Inc BUN/Cr
Nephritic kidney disease?
Inc size of fenestrations —> vasculitis
Nephrotic kidney disease?
Lose of Basement Membrane charge due to deposition of heparin sulfate —> massive proteinuria and lipiduria
What is seen in RPGN (Rapidly Progressive Glomerulonephritis)?
Crescents
Post-Strep GN?
Subepithelial, IgG/C3/C4 deposition, ASO Ab
Interstitial Nephritis?
Urine eosinophils or eosinophilic casts
Lupus Nephritis?
Subepithelial
MGN (Membranoglomerulonephritis)?
Deposition of “something”
MPGN (Membranoproliferative Glomerulonephritis)?
Tram-tracks (Type II has low C3)
MCD (Minimal Change Disease)?
Kids, fused foot processes, no renal failure, loss of charge barrier
FSGS (Focal Segmental Glomerulosclerosis)?
AA, HIV patients
What are the vasculitis with low C3?
PMS in Salt Lake City
Post-Strep GN MPGN Type II SBE Serum sickness Lupus Cryoglobulinemia
What is the most common cause of kidney stones?
Dehydration
What is the most common type of kidney stones?
Calcium phosphate
What type of kidney stones have coffin-lid crystals?
Triple phosphate
What type of kidney stones have rosette crystals?
Uric acid
What type of kidney stones have hexagonal crystals?
Cystine
What type of kidney stones have envelope or dumbbell shaped crystals?
Oxalate
What disease has Aniridia?
Wilm’s tumor
What disease has Iridocyclitis?
Juvenile rheumatoid arthritis
Phimosis?
Foreskin scarred at penis head (foreskin stuck smooshed up)
Paraphimosis?
Foreskin scarred at penis base (retraction of foreskin —> strangulates penis)
Urge Incontinence?
Urgency leads to complete voiding
Detrusor splasticity —> small bladder volume
Stress Incontinence?
Weak pelvic floor muscles
Estrogen effect
Overflow Incontinence?
Runs down leg but can’t completely empty bladder
What structures have one way valves?
Urethra, ejaculatory duct
What structures have fake sphincters?
Ureters, LES, ileocecal valve
What has WBC casts?
Nephritis
What has WBC casts only?
Pyelonephritis (sepsis)
What has WBC casts + eosinophils?
Interstitial nephritis (allergies)
What has WBC casts + RBC casts?
Glomerulonephritis
What has Fat casts?
Nephrotic syndrome
What has Waxy casts?
Chronic renal failure
What has Tubular casts?
ATN
What has Muddy brown casts?
ATN
What has Hyaline casts?
Normal sloughing
What has Epithelial casts?
Normal sloughing
What has Crescents?
RPGN
How do you measure Afferent renal function?
Creatinine or inulin
How do you measure Efferent renal function?
BUN or PAH
What is the Afferent arteriole’s job?
Filter
What happens if you constrict the Afferent arteriole?
RPF goes down
GFR goes down
FF (GFR/RPF) stays the same
What is the Efferent arteriole’s job?
Secrete
What happens if you constrict the Efferent arteriole?
RPF goes down
GFR goes up
FF (GFR/RPF) goes up
How do you test Afferent arteriole function?
GFR
What is normal GFR?
100 mL/min
How do you test Efferent arteriole function?
RPF
What happens if you increase plasma protein concentration?
RPF stays unchanged
GFR goes down
FF (GFR/RPF) goes down
What happens if you decrease plasma protein concentration?
RPF stays unchanged
GFR goes up
FF (GFR/RPF) goes up
What is pre-renal failure?
Low flow to kidney (BUN:Cr > 20)
What is renal failure?
Damage to glomerulus (BUN:Cr < 20)
What is post-renal failure?
Obstruction (haven’t peed in last 4 days)
What is the job of the proximal tubule?
Reabsorb glucose, amino acids, salt, and bicarb
What is the job of the thin ascending limb?
Reabsorb water
What is the job of the thick ascending limb?
Make the concentration gradient by reabsorbing Na, K, Cl, Mg, Ca without water
What is the job of the early distal tubule?
Concentrate urine by reabsorbing NaCl (hypotonic)
What is the job of the late distal tubule and collecting duct?
Final concentration of urine by reabsorbing water, excretion of acid
What does the macula densa do?
Measures osmolarity
What does the JG apparatus do?
Measures volume
Fanconi’s Syndrome?
Old tetracycline use —> urine phosphates, glucose, amino acids
Bartter’s Syndrome?
Baby with defective triple transporter (low Na, Cl, K with normal BP)
Psychogenic Polydipsia?
No concentrating ability —> cerebral edema
Hepatorenal Syndrome
High urea from liver —> increased activity of glutaminase —> inc NH4+ —> GABA —> kidney stops working
Type I RTA?
Distal renal tubular acidosis
H/K in collecting duct is broken —> high urine pH
(UTI, stones, Li)
Type II RTA?
Proximal RTA: bad CA —> lost all bicarb —> low urine pH
Multiple myeloma
Type III RTA?
RTA I + II —> normal urine pH (5-6)
Type IV RTA?
Infarct of JG —> no renin —> no aldosterone —> high K
DM, NSAIDs, ACEi, heparin
Central Pontine Myelinolysis?
Due to correcting Na faster than 0.5mEq/hr