Renal Flashcards
What is POTTER sequence?
Can’t pee in utero- oligohydramnios
- pulmonary hypoplasia
- oligohydramnios
- twisted face
- twisted skin
- extremity defects
- renal failure
- low set ears and retrognathia, flattened nose
What affects the metanephric mesenchymal differentiation?
interaction with the ureteric bud
-if you get this you can get multicystic dysplastic kidney, usually unilateral and nonfunctional, but if bilateral then you get POTTER sequence
what is a duplex collecting system?
the ureteric bud bifuricates befor it interacts with the metanephric blastema
-higher risk UTIs and reflux
what does the ureter go over and under anatomically?
goes under the gonadal arteriesm over the common iliac artery then under the uterine artery
-gyne procedures can damage the ureter
how do you calculate the clearance of a substance?
Cx=UxV/Px, if CxGFR, then net secretion and if they are equal then theres no reabsorption or secretion
what is the normal GFR?
100ml/min, can calculate with Uinulin because not absorption or secreted
effective renal plasma flow calculation?
is estimated by PAH, because 100% should be excreted
how do you estimate the filtration fraction?
GFR/RPF, normal FF 20%
what do prostaglandins and angiotensin 2 due to the afferent and efferent arterioles?
prostaglandins dilate afferent arteriole
angiotensin 2 constricts the efferent arteriole
fractional excretion of sodium?
UNa x V (flow)/GFR xPNa
What is Fanconi syndrome?
PCT reabsorption issue, so excretion HCO3, glucose, PO4, can get osteopenia, metabolic acidosis, hypophosphatemia
What is Bartter syndrome?
affects thick ascending loop of henle,- Na/K/2Cl pump- looks like chronic use of loop diuretics so you can get metabolic alkalosis, hyperca, hypoK
Gitelman syndrome?
DCT, looks like chronic thiazide diuretic use- get metabolic alkalosis, hypoCa, hypoMg, hypoK
Liddle syndrome?
in the collecting duct
- gain of function mutation
- only one thats AD
- you get increased activity of Na channel (more absorption of Na)
- metabolic alkalosis, hypoK, hypertension, low aldosterone
- it looks like primary hypoaldosteronism, but the aldosterone is undetectable
Syndrome of apparent mineralocorticoid excess
hereditary deficiency in 11B-hydroxysteroid dehydrogenase
- too much cortisol , increased mineralocorticoid activity
- metabolic alkalosis, hypoK, hypertension
- actually have low aldosterone because cortisol is trying to be aldosterone
- tx with K sparing diuretic and steroids, exogenous steroids will dec endogenous secretion
What are ANP and BNP?
ANP-atria
BNP-ventricles
-secreted when high volume, relax vascular smooth muscle so inc GFR and decrease renin, dilate afferent and constrict efferent
where is 25OH vit d converted to 1,25 OH vit d?
PCT by 1-alpha hydroxylase (PTH increases 1 alpha hydroxylase)
What is winters formula?
predicted respiratory compensation
PCo2=1.5 (HCO3) + 8 +/-2
What are causes of non-anion gap metabolic acidosis?
HARDASS-hyperailmentation, addisons disease, renal tubular acidosis, diarrhea, acetozolamide, spironolactone and saline infusion
Whats the difference between type 1 and type 4 distal renal tubular acidosis?
type 1- alpha intercalated cell dysfunction, pH>5.5, because can’t secrete H, hypokalemia
type 4- hypoaldosteronism-ph urine <5.5 b/c secreting H to compensate, hyperkalemia
What is the maltese cross sign?
oval fatty casts- nephrotic syndrome
what causes nephrotic syndrome?
- Membranous nephropathy
- Minimal change disease
- Diabetic nephropathy
- Focal segmental glomerulosclerosis
- amyloidosis
what causes nephritic syndrome?
- Post strep glomerulonephritis
- IgA nephropathy
- MPGN
- Alports
what type of hypersensitivity reaction is post strep glomerulonephritis?
type 3
what type of hypersensitivity reaction is goodpastures?
type 2- plasmapheresis
-get crescentic moon shape on LM-fibrin and plasma proteins
What is Beckwith-Wiedemann syndrome associated with?
Wilms tumour (nephroblastoma), macroglossia, organomegaly, hemihyperplasia (WT2 mutation-tumour suppressor genes)
