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First Aid Diseases > Renal > Flashcards

Renal Flashcards

1
Q

Where is the macula densa? JG cells?

A

Macula densa are cells w/in DCT

JG cells are modified SmM of aff art, make connection w/ DCT and macula densa

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2
Q

Body water is where?

A

60-40-20 (% of body wt)

60% TBW, 40% ICF, 20% ECF (1/4 pl vol, 3/4 interstitial vol)

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3
Q

Clearance =

A

vol of pl from which the substance is cleared per unit time:
C [ml/min] = [U] x V / [P]

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4
Q

GFR =

- Cr over or underest’s GFR?

A

use inulin:
GFR = CL(inulin) = UV/P, where U is the urine conc of inulin, P is the pl conc of inulin, and V is the urine flow rate
- slightly overest’s bc is secreted

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5
Q

ERPF =
RBF =

Is ERPF really RPF?

A

use PAH for est’d renal pl flow bc all PAH that enters kidneys is excreted:
ERPF = UV/P = CL of PAH
- RBF = RPF / (1-Hct)
- no, ERPF underest’s true RPF by about 10%

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6
Q

FF =
nl is?
Filtered load =

A

FF = GFR/RPF, nl is 20%

Filtered load = GFR x pl conc

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7
Q

What effect do PGEs and ATII have on FF?

A

PGEs don’t affect FF bc they incr RPF -> incr’d GFR

ATII incr’s FF bc decr RPF -> incr’d GFR

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8
Q

What effect do NSAIDs and ACEIs have on FF?

A

NSAIDs constric aff art (prevent dilation) -> decr’d RPF and GFR -> no change in FF
ACEIs dilate eff art (prevent constriction) -> incr’d RPF and decr’d GFR -> decr’d FF

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9
Q

Filtered load =
Excretion rate =
How to calc reab’n? secretion?

A

GFR x [P]x
V x [U]x
Reab’n = filtered - excreted
Secretion = excreted - filtered

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10
Q

Pl glc reab’n threshold?
Glc reab’n sat’n max at?
- What happens in nl preg?

A

~160 -> glucosuria
350 -> all transporters fully sat’d (Tm)
- Reduced reab’n of glc -> glucosuria and aminoaciduria (also not ab’d as well)

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11
Q

Hartnup’s dz =

A

defic in neutral AA (Tryptophan) transporter -> pellegra

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12
Q

ATII’s affect on kidneys?

PTHs 2 affects on kidneys?

A
  • PT: stim’s Na/H exchange -> reab’n of Na, water, bicarb -> contrac alkalosis
  • PT: inhib’s Na/phos cotrans -> phos excretion; and DCT: stim’s Ca/Na exchange -> incr’d Ca reab’n
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13
Q

What 3 things stim renin release from kidney?

A

Decr’d BP (sensed by JG cells)
Decr’d Na deliv (sensed by MD cells)
Incr’d symp tone (on b1 Rs)

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14
Q

Why don’t you get reflex brady w/ incr’d BP from ATII?

A

ATII also affects baroR func -> limits reflex brady

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15
Q

ADH reg’s?

Aldos reg’s?

A

ADH reg’s osmol’s (except w/ low bl vol then incr’s water reab’n to save vol)
Aldos reg’s bl vol

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16
Q

EPO is made by?

Act’d VitD is made where?

A
  • Interstitial cells in the peritubular capillaries

- In the PT cells by 1a-hydroxylase

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17
Q

3 things that stim PTH release?

A

Decr’d pl Ca
Incr’d pl PO4(3-)
Decr’d pl 1,25-(OH)2 VitD

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18
Q

Insulin defic -> what effect on K?

Thus incr’d insulin does what?

A

Causes hyperK bc decr’d act’n of Na/K pump

- Incr’d INsulin shifts K INto cells (hyopK)

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19
Q

HyperK shows what on EKG?
HypoCa causes?
HypoMg causes?

A
  • wide QRS and peaked T waves, arrhythmias
  • tetany, seizures
  • tetany, arrhythmias
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20
Q

Winter’s formula =

- use for?

A

PCO2 = 1.5(bicarb) + 8 +/-2
to determine what PCO2 should be w/ simple metab acidosis (determine if resp compensation is adequate of it there is a mixed acid-base d/o)

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21
Q

AG =

- check when?

A

AG = Na - Cl - HCO3-

check w/ metab acidosis to see if it’s gap or non-gap acidosis

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22
Q

Causes of gap metabolic acidosis?

A 
MUDPILES
Methanol (formic acid)
Uremia
DKA
Propylene glycol
Iron tab's or INH
Lactic acidosis
Ethylene glycol (oxalic acid)
Salicylates (late)
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23
Q

Causes of non-gap metab acidosis?

A 
HARD-ASS
Hyperalimentation
Addison's dz (decr'd aldos)
RTA
D
Acetazolamide
Spironolactone
Saline infusion
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24
Q

Salicylate poisoning causes what change in bl pH first? then later?

A

Early: rep alkalosis bc stim’s resp center -> hypervent
Late: metab acidosis bc of acid

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25
Q

4 causes of metab alkalosis?

A 
V
loop diuretics (incr'd Na to DCT, and incr'd H+ out)
antacid use (less H+)
hyperaldos (incr'd H+ out)
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26
Q

Type I RTA has incr’d risk of?

A

Ca phosphate kidney stones bc of alk urine pH and bone resorption

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27
Q

Type II RTA has incr’d risk of?

- May see this RTA w/?

A

Hypophosphatemic rickets

- Fanconi’s synd

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28
Q

Nephrotic synd sx?

6 nephrotic synd’s are?

A

proteinuria >3.5g/d, frothy urine from incr’d albinuria, hyperlipidemia, fatty casts, edema, incr’d coag state (decr’d ATIII), incr’d risk of infec (loss of Igs)
- Membranous nephropathy, MPGN (also a GN synd), MCD -> FSGS, Amyloidosis, Diabetic nephropathy

29
Q

Fat Hispanic/AfAm w/ HIV, does heroin, on IFN trtmt and has effacement of foot processes -> what renal synd?

A

FSGS

30
Q

Spike and dome appearance on EM, has SLE and a tumor, and is a Caucasian adult -> what renal synd?

A

Membranous nephropathy

31
Q

Kid w/ recent cold -> what renal synd?

A

MCD (aka lipoid nephrosis) can progress to FSGS), cytokines from infec (or R-S cells in HL), KO podocytes)

32
Q

Chronic conditions like MM, TB, RA -> what renal synd?

A

Amyloidosis

33
Q

C3 nephritic factor -> what renal synd?

A

Type II MPGN (intramem IC deposits)

- is autoAb that stabilized C3 convertase -> incr’d act’n of C’: C3->C3a+C5a -> decr’s C3 in circ

34
Q

HBV/HCV -> what renal synd?

A

Type I MPGN (subendo IC deposits)

35
Q

Mesangial expansion w/ pink nodular glomerulosclerosis -> what renal synd?

A

Diabetic nephropathy w/ Kimmelstiel-Wilson lesions

36
Q

Nephritic synd has what sx?

- 5 ex’s of it?

A

Inflamm process -> hematuria, RBC casts in urine, azotemia, oliguria, HTN and proteinuria <3.5g/d
- Acute post-strep GN, RPGN (crescents), DPGN, IgA nephropathy, Alport synd

37
Q

Lumpy-bumpy appearance on LM in person w/ recent cold -> what renal synd?

A

Acute post-streptococcal GN (from Strep w/ M pr VF), w/ subepi IC deposition (granular on EM)

38
Q

Crescents in ? renal dz, are made of?

A

RPGN

Crescents are made of fibrin and Mphage (inflamm debris)

39
Q

c-ANCA renal dz?

p-ANCA renal dz?

A 
Granulomatosis w/ polyangiitis (Wegener's)
Microscopic polyangiitis (also Churg-Strauss)
40
Q

Granular IF and SLE -> what renal synd?

A

DPGN, subendo and sometimes intramem IgG ICs often w/ C3 deposition

41
Q

Mesangial IC deposits -> what renal synd?

- presents why?

A 
IgA nephropathy (Berger's dz)
- mucosal infec -> incr'd IgA made
42
Q

Deaf, renal problems and eye problems = what synd?

A

Alport synd

43
Q

Ca (oxalate/phosphate) stones:

  • see on XR?
  • trtmt?
A

Yes, radiopaque

Thiazides and citrate

44
Q

Staghorn calculi is made of?

- due to infec w/ what?

A

Ammonium magnesium phosphate stone

- Urease (+) bac: Proteus, Staph, Klebsiella

45
Q

What is the only kidney stone that you can’t see on XR?

- trtmt?

A

Uric acid stone, from gout or conditions w/ high cell turnover (leukemia)
- KHCO3 to alkalize urine and hydration

46
Q

Staghorn hexagonal stone in a kid is what?

A

Cystine stone, assoc’d w/ Cystinuria (genetic decr’d reab’n of Cys)

47
Q

RCC is assoc’d w/ what gene deletion?

- assoc’d w/ what paraneoplastic synd’s?

A

VHL gene on chr3

- EPO, ACTH, PTHrP, renin

48
Q

VHL dz =

A

RCC + hemangioblastoma of Ce

49
Q

Wilm’s tumor is made up of cells from?

A

Embryonic glom struc’s (blasthema cells)

50
Q

WAGR complex =

A

Wilms’ tumor
Aniridia
GU malformation
Retarded

51
Q

Beckwith-Wiedmann synd =

A

Wilms’ tumor
Neonatal hypoGlc
M. hemihypertrophy
Organomegaly (tongue)

52
Q

Painless hematuria w/ no casts ->

A 
Bladder ca (transitional cell ca)
- often multifocal and will recur due to field damage of entire bladder epithelium
53
Q

What is assoc’d w/ problems in your Pee SAC (aka bladder)?

A

Phenacetin
Smoking
Aniline dyes (hair dyes)
Cyclophosphamide

54
Q

White cell casts in urine =

- 3 causes?

A

Pylonephritis (E.coli, Klebsiella, Enterococcus)

55
Q

Tubules w/ Eo’ic casts (aka thyroidization of kidney) is caused by?

A

Chronic pyelonephritis (coarse asymm corticomedullary scarring, blunted calyx)

56
Q

4 causes of drug-induced AIN (acute interstitial nephritis)?
Presents when?

A

Diuretics, Pn’s, sulfonamides, rifampin

- 1-2wks after drug use, or mo’s after starting NSAIDs

57
Q

Granular muddy brown casts =

A

ATN (renal ischemia from shock/sepsis, crush injury w/ myoglobinuria, drugs, toxins (usu PT)

58
Q

Can get renal papillary necrosis from recent infec or imm stimulus, inc’ing (4)?

A

DM, acute pyelo, chronic phenacetin (acetaminophen) use, SCA/trait

59
Q

FeNa is <one, with high urine osmolarity

A

Prerenal azotemia bc kidneys are working fine to conc urine and reab Na

60
Q

FeNa is >two w/ urine osmol <15

A

Intrinsic renal azotemia bc kidneys aren’t working to conc urine nor to reab Na nor to reab BUN

61
Q

FeNa >two w/ urine osmols 15

A

Postrenalazotemia bc kidneys have back P on them so can’t conc urine nor reab Na very well, but can reab BUN bc back P pushes BUN into bl

62
Q 
In renal failure:
K is?
pH is?
Coagulable?
Lipids are?
A

HyperK (can’t excrete K+)
Metab acidosis (can’t excrete org acids)
No, bc plt dysfunc from uremia
Off, esp have high TGs

63
Q

Low Ca causing renal osteodystrophy is from what 2 causes?

A

1) low VitD (can’t be act’d in kidneys) -> low Ca reab’n from gut
2) high phos binds Ca, decr’ing free Ca

64
Q

3 things assoc’d w/ ADPKD?

What is assoc’d w/ ARPKD?

A

Berry aneurysms
MV prolapse
Hepatic cysts
- hepatic cysts -> congenital hep fibrosis causing portal HTN

65
Q

Cysts in renal cortex + small kidneys =

A

Medullary cystic disease

66
Q

Which diuretics cause acidemia? which cause alkalemia?

A

Acidemia: CA inhib’s, K+ sparing aldos blockers
Alkalemia: Thiazides and loop diuretics (incr K loss -> incr’d exchange for H+)

67
Q

Which diuretic causing hypocalcemia?

Which causes hypercalcemia?

A

Loop diuretics

Thiazides (can cause Ca renal stones)

68
Q
  • Urine pH 5.5, hypokalemia
  • Urine pH <5.5, hyperkalemia
    Which RTA
A
  • Type 2 RTA (prox, decr’d HCO3- reab’n, hypoK bc binds HCO3-)
  • Type 1 RTA (distal, no H+ secretion)
  • Type 4 RTA (no aldos, less NH3 buffer made in PT so less buffering capacity and low urine pH; can be due to decr’d renin from destruc of JGA)

First Aid Diseases (16 decks)

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