Renal Flashcards

1
Q

Anatomy of the kidneys

A

Located between T12 and L3
Three surrounding layers - renal fascia, adipose tissue and renal capsule
Retroperitoneal
R kidney sits lower because of liver

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2
Q

Blood flow through kidneys

A

Aorta ➡️ L/R renal artery ➡️ segmental artery ➡️ interlobar artery ➡️ arcuate artery ➡️ cortical radiate arteries ➡️ afferent arteriole ➡️ glomerular capillaries ➡️ efferent arteriole ➡️ peritubilar capillaries ➡️ cortical radiate veins ➡️ arcuate vein ➡️ interlobar vein ➡️ L/R renal vein ➡️ IVC

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3
Q

Cells of the juxtomedullary complex

A

Macula densa cells

  • Are on the distal convoluted tubule
  • Sense low Na and Cl
  • Signal juxtoglomerullar cells

Juxtoglomerullar cells

  • found next to afferent arteriole
  • Sense low BP
  • Release renin

Extraglomerular mesangial cell
- Regulate interaction between macula densa cells and juxtoglomerullar cells

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4
Q

Functions of renin

A

Increases Na reabsorption
Vasoconstriction
Increases BP

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5
Q

IgA nephropathy pathophysiology

A
  • Formation of abnormal IgA antibodies with lack of glycosylated amino acids. - - These accumulate and form immune complexes with IgG antibodies which get deposited in the glomerular membrane of Bowman’s capsule.
  • Causes a type III hypersensitivity reaction (occurs at site of deposition, not formation)
  • Activation of inflammatory cytokines and macrophages in area causes damage of glomerular membrane
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6
Q

IgA nephropathy symptoms

A
  • Most common nephropathy in the world
  • Occurs mostly in children
  • Following an acute mucosal infection (GI/URTI)
  • Gross or microscopic haematuria
  • Type of nephritic syndrome
  • Repeated glomerular insult results in renal failure
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7
Q

IgA nephropathy signs

A
  • Light microscopy: mesangial proliferation
  • Electron microscopy: Immune complex deposition in glomerulus
  • Immunofluorescense: IgA deposition
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8
Q

IgA nephropathy treatment

A
  • only recommended when proteinuria > 0.5g, abnormal BP or abnormal eGFR
  • Lifestyle changes for BP control
  • Antihypertensives - ACE inhibitors: also reduce proteinuria, can also use ARBs
  • Corticosteroids: consider in patients who have persistent proteinuria despite ACEi/ARB use
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9
Q

Henoch-Schonlein Purpura (HSP) and IgA nephropathy

A
  • Similar findings on light microscopy, electron microscopy and immunofluorescence: IgA immune complex deposition
  • In HSP, deposition occurs widespread in body, but in IgA nephropathy deposition occurs only in kidneys
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