Renal DIT Flashcards
3 parts of the embryological kidney
Which gives rise to the ureteric bud?
Which gives rise to the audlut kidney
Pronephros Mesonephros -caudal end -> ureteric bud Metanephros -adult kidney
Ureteric bud arises from? Gives rise to (4)
arises from the caudal end of the mesonephros -> induces metanephric mesenchyme to induce into nephrons and form glomerluli
the bud -> renal calyx, ureters, collection duct, pelvis
Most common site of obstruction in a fetus
ureteropelvic junction -> last to canalize
What does the mesenephros give rise to? (2)
ureteric bud (caudal end)
male genital system (in males)
Potters syndrome presents as?
Due to
Due to oligohydraminos (classically renal a genesis; also ARPKD and posterior urethral valves)
POTTER
Pulmonary hypoplasia Oligohydraminos Twisted face Twisted skin Extremities malfunction Renal agenesis
Horseshoe kidney is associated w/
turners syndrome
Renin is released from what cell under what 3 conditions
Released from Juxtaglomerular cells (next to the afferent artery) in response to
Low afferent BP (JG cells sense)
Low Na concentration in efferent arteriorl (Macula densa sense)
Beta 1 stimulation
Glomeruli filtration barrier is made of (3)
fenestrated endothelium
negatively charged basement membrane
podocytes (viseral layer)
Ureters course in relation to major anatomy?
Retroperitoneal or paritoneal?
retroparitoneal course
Ureters flow under the the uterine arteries in females and vas defer ins in males
% of the body that is water
-EC vs IC
W/in EC
–plasma vs intertitial
60% of the body is water
-1/3 extra cell and 2/3 intracellular
1/4 of extracellular fluid is plasma
3/4 extracellular fluid is interstitial
Renal clearance formula
UV/P
U- urine concent
V - urine flow rate
P - plasma concentration
Clearnance and relation to GFR
Cl< GFR = absorbtion
Cl> GFR = excretion
Cl =GFR = no ∆ ~ inulin
GFR calculation and estimation
calculate using inulin and the Clearance formula
[U(urine concent inulin) V] / (Plasma concent of inulin)
Can estimate w/ creatine which slightly over estimates GFR w/ mild secretion
Normal GFR =
100 mL/min
Effective renal plasma flow concept and formula
Effective renal plasma flow is ALL of the blood flow through the kidney, not just what is measured with clearance
Use PAH (para aminohiipuric acid) to calculate due to active secretion AND filtration at the proximal tubule
RPF~ Cl formula = clearance of PAH
[U (PAH) x V] / P (PAH)
Filtration Fraction formula and concept
filtration fraction is a comparisons of how much is being filtered at a given time compared to total flow
FF = GFR/RPF (or renal plasma flow)
normally 20%
Filtered load formula
GFR x plasma concentration
Excretion rate in renal?
U x V
the top part of the clearance formula ( flow rate x conncentration in the urine)
Prostaglandins and effect on the filtration
dialate afferent arteriole
- Increase GFR
- Increase RPF
- No ∆ in FF
NSAIDs effect on glomeruli filtration
blocks prostaglandins afferent dialation ->
Decrease GFR
Decrease in RPF
-No ∆ in FF
angiotension II role of on glomeruli filtration
preferentially constricts the efferent arteriole
Increases GFR
Decrease in RPF
-> Increase in FF
ACE inhibitors and role on glomeruli filtration
blocks angiotensions II preferential constricion on the efferent arteriole
Decreases GFR
Increases RPR
Decreases FF
explains why creatine increases w/ ACE inhibitors
Ureter stone and effect on glomerlui filtration
blocks the flow downstream -> back pressure
Decreases GFR
No change in RPF
Decrease in FF
Increase in plasma globulin and effect on glomeruli filtration
increase osmotic pressure w/in the blood vessel
Decreases GFR
No change in RPF
Decrease in FF
Glucose clearance minimized due to?
- point of saturation
Na/Glucose cotransporters in the proximal tubule reabsorb ALL glucose up to 160 mg/dL; then have some spill in the urine
Transporters saturated at 350 mg/dL
AA clearance and reabsorbtion
3 cotransporters that use Na absorb : acidic, basic and neutral AA in the proximal tubule
Neutral AA reabsorbtion dysfunciton = Hartnup’s disease
- Tryptophan deficiency -> niacin deficiency -> pellagra
Hartnup’s disease
deficiency in neutral AA/Na co-transporter in the kidney -> excessive loss of reabsorption of tryptophan
Can’t make Niacin (B3) -> pellagra
- diarrhea
- dermatitis
- dementia
- death
Pellegra can be due deficiency of what in the kidney
Presents as?(4)
neutral AA/Na co-transporter (no tryptophan -> B3/niacin)
-Hartnup’s disease
Dementia
Dermatitis
Diarrhea
Death
Part of the nephron responsible for collection of 2/3 of fluids and electrolytes
proximal
First half Proximal tubule collects? (6)
Bicarb (converted -> H2O and CO2 in lumen -> cell and converted back to bicarb)
glucose AA inorganic phosphate lactate electrolytes (isotonically, meaning water follows)
2nd half of proximal tubule collects?
Cl
Where does organic anions and cations get excreted in the nephron?
Due to?
in the proximal tubule
-alpha ketoglutarate gradient set up by Na/K atpase drives out organic anions into the lumen
organic cations are excreted by the electrochemical gradient set up with 3 Na out for every 2 in ATPase
- H is reabsorbed w/ lose of cation
thin ascending loop responsible for
reabsorbing water
impermeable to Na
Thick ascending loop responsible for (2)
actively reabsorbing Na/K/2Cl
->induces Mg and Ca to pass pericellular
Impermeable to water -> dilutes urine
Early distal tubule is responsible for (2)
Na/Cl actively being reabsorbed
Responding to PTH by placing Ca/Na exchangers on the basolateral side to reabsorb Ca
Impermeable to H2O
PTH has 3 functions w/ Ca(3)
Induces Ca reabsorption from bone
Stimulates Vitamin D conversion in the kidney by activating 1 hydroxylase
Places Na/Ca exchanges to reabsorb Ca in the kidney
2 types of cells in the collecting duct and their respectful roles
principle cells -responds to Aldosterone - ENaC and EK channels ADH -V2 and aquaporins
intercalcalated cells
- A cell (alpha) -> secrete H
- B cell (beta) - > secrete HCO3
Aldosterone acts where and has what function (3)
acts on the principle cell in the collecting duct to place Na channels to reabsorb Na and have H2O follow.
-Also places K channels which is thus lost to the lumen
In the alpha intercalated cell -> excretion of H
Epleronone and Spironolactone block
ADH/vasopressin act where and has what function
acts in the collecting duct on V2 and leads to the placement of aquaporins in the lumen to reabsorb water
Interfered w/ by lithium
Uses of mannitol
Drug overdose
elevated intracranial pressure
shock
glaucoma (acute angle closure)
What electrolyte is slightly elevated w/ the use of mannitol
Na in the serum due to the loss of free water
Glaucoma diuretics
Mannitol - acute closed angle
Acetazolamide - chronic
How does acetazolamide help in altitude sickness?
Blocks carbonic anhydrase in the lumen of the kidney thus leading to excretion instead of reabsorption in proximal tubule
Toxicity associated w. acetazolamide use
hyperchloremic metabolic acidosis
do not use w/ any hypokalemia, hyponatremic or hyper chorolate
Uses of acetazolamide
glaucoma- chronic
urinary alkalization
metabolic alkalosis -> piss away excess bicarb
altitude sickness
Dieuretics to stay away from if sulfa allergy(3)
acetazolamide
Loops
-furosimide
hydrochorothizide
Use ethacrynic acid
Need to use a loop but the patient is allergic to sulfa drugs use
ethacrynic acid
Which diuretics lose Ca and which retain
Loops lose Ca (may exacerbate a kidney stone problem)
Thiazides retain ( maybe use in idiopathic hypercalciuria)
Toxicity w/ loop diuretics(6)
be wary combing w/ what drug class
Ototoxic and nephrotoxic
-aminoglycosides
hypokalemia
dehydration
allergy
gout
Thiazide toxicity (7)
hypokalemic metabolic alkalosis hyponatremia hyperglycemia hyperlipidemia hyperuicemia -> gout hypercalcemia -allergy - sulfa
Drugs used to increased morbidity and mortality in CHF patients (3)
Beta blockers
K sparing dieuretics
ACE inhib/ARBs
Hydrocholorthiazides ex (4)
hydrocholothiazide
chlorothiazide
chorthalidone
metolazone
K sparing dieuretics (4)
SEAT
Spiranolactone
Epleronone
Amiloride
Triamterene
may used in combination w/ Loops or thiazides to retain some K
Toxicity of K sparing diuretics (2)
Hyperkalemia -> arrhythmia
Antiandrogen -> gynectomastia in men / menstural problems in females
diuretics causing acidosis(2)
carbonic anhydrase inhibitor (acetazolamide)
K sparing (spares H excretion as well in the intercalated A cell)
diuretics causing alkalosis (2)
loops and thiazides
the loss of Cl leads to less bicarb being excreted and
anemia in a pateint due to renal failure
lack of erythropoeitin
enzyme in kidney that converts Vit D into its most active form
1 alpha hydroxylase
unregulated by PTH
what does the kidney secrete to vasodialate afferent arterioles to increase GFR
prostaglandins
NSAIDs can precipitate acute renal failure
ANPs action on the kidney
causes increase in GFR and Na filtration w/ no compensatory Na reabsorption in the distal tubule
opposite of aldosterone
SIADH can be caused (5)
Ectopic ADH - small cell lung CA CNS disorder/head truama/ infection Pulmonary disease Drugs - cyclosporine Idiopathic
Presentation of SIADH(3)
Rx?
excessive water retention
hyponatremia w/ continued Na excretion
-low aldosterone due to hypercolemia (net Na loss)
urine osmolarity is low
Need to correct low Na very slowly (central pontine myelinolysis)
Rx -Demeclocycline, flid restricion, conivaptana nd tolvaptan
Central Diabetes insepitis causes (3) and presentation
pituitary tumor
trauma
surgery
intense thirst and polyuria - increased serum osmolarity, low specific gravity of urine (very dilute)
partial - some ADH
complete - No ADH
responds to desmopressin
Nephrogenic diabetes insepitis causes(4) and presentation
hereditary
secondary to hypercalcemia
lithium *
demeclocylcine
intense thirst and polyuria - increased serum osmolarity, low specific gravity of urine (very dilute);
Does not respond to desmopressin