Renal Embriology/ A&P High Yield Flashcards by Erin Allmer

What functions as an interim kidney for the 1st trimester?

Mesonephros

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When does the metanephros begin to develop?

5th week of gestation

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What does the ureteric bud give rise to?

Ureter, pelvises, calyces, collecting ducts

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What results in congenital malformation of the kidney?

abberent interaction between the uteric buds and metanephric mesenchyme

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What renal condition can cause Pooter sequence/ oligohydramnios?

ADPKD, renal agenesis, and obstructive and obstructive uropathy

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“inferior poles of both kidneys fuse and get trapped under the IMA”

Horeshoe kidney

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What chromosomal disorders are horseshoe kidney related to?

Edwards
Down
Patau
Turner

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“bifurcation of ureteric bud before it enters metanephric blastema that leads to a Y shaped ureter”

Duplex collecting system

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What congenital renal conditions leads to increased risk of RCC?

Renal agenesis

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Which kidney is typically taken during a kidney transplant? Why?

The Left kidney due to its longer renal vein

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Are ureters retro or intraperitoneal?

Retro

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Does the ureter pass over or under the uterine artery and ductus deferens?

under (water under the bridge)

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Where in the bladder are ureteral orifices?

Near the trigone of the bladder

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The uterine vessels are in which ligament?

Cardinal ligament

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How many liters is total body water (TBW) in a 70L person?

42L (60

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How many liters in the ECF and ICF?

ECF (20%)= 14L

ICF (40%)= 28L

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What is the volume of plasma volume?

3.5 L (25% of ECF)

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What is the volume of interstitial volume?

10.5 (75% of ECF)

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What 3 factors make up the glomerular filtration barrier?

Fenestrated capillary endotheium

Fused basement membrane with heparin sulfate

Epithelial layer consisting of poducyte foot processes

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What is the equation for renal clearance?

Cx= UxV/ Px

Cx= clearance of X
Ux= urine concentration of x
Px= plasma concentration of x
V= urine flow rate

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How is GFR calculated?

GFR= clearance of inulin

Cin= UinV/ Pin

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What lab value is an approximate measure of GFR?

Creatinine clearance

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How is renal plasma flow calculated?

RPF= UpahV/ Pah

The clearance of PAH!

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How is RBF calculated?

RBF= RPF/ (1- Hct)

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How is PAH used to estimate RPF?

Because it is both filtered and secreted in the PCT--> near 100% clearance

How is filtration fraction calculated?

FF= GFR/ RPF

What is normal FF?

20%

What substance dilates afferent arterioles?

Prostaglandins

What preferentially constricts efferent arterioles?

Angiotensin II

Does the following increase or decrease GFR, RPF, and FF: Afferent arteriole constrictoin

GFR: decrease RPF: decrease FF: --

Does the following increase or decrease GFR, RPF, and FF: Efferent arteriole constriction

GFR: increase RPF: decrease FF: Increase

Does the following increase or decrease GFR, RPF, and FF: Increased plasma protein concentration

GFR: decreased RPF: -- FF: decreased

Does the following increase or decrease GFR, RPF, and FF: decreased plasma protein concentration

GFR: increased RFP: -- FF: increased

Does the following increase or decrease GFR, RPF, and FF: Constriction of ureter

GFR: decreased RPF: -- FF: decreased

What is the equation for filtered load?

Filtered= GFR X Px

What is the equation for excretion rate?

Excretion rate= V X Ux

How and where is glucose reabsorbed?

Via Na/ glucose cotransport in the PCT

At what glucose concentration are the renal glucose transporters saturated?

Approximately 375 mg/dL

What is hartnup disease?

deficiency of neutral amino acid transporters in the PCT and enterocytes

What is the inheritance pattern of Hartnup disease?

Autosomal dominant

What are the symptoms of Hartnup disease?

Pellagra like (because decreased tryptophan conversion to niacin)

What transporter does Angiotensin II work on? What results from this interation?

Works on Na+/ H+ antiport (H+ enters the urine) Leads to contraction alkalosis

Where is NH3 generated and secreted within the nephron?

PCT

Which segment of the nephron is impermiable to Na?

tDL of henle

Is the tubular fluid hypertonic or hypothonic in the tDL?

It is Hypertonic because it is impermeable to water yet it allows for H2O reab

Which segment of the nephron makes urine less concentrated?

TAL

Where are Na/K/2Cl transporters found?

TAL

Where does paracellular Mg and Ca reaborption occur?

TAL

Where does PTH work in the Nephron?

1- inhibits Na/ PO4 cotransport in the PCT 2- increases Ca/ Na exchange in the DT

What type of transporter do thiazide diuretics work on?

Na/ Cl

In the CT, Na is reabsorbed in exchange for...

K+ and H+

How does aldosterone exert its effects?

Induces protein synthesis leading to increased Na/K pump activitry and K+ loss as well as increasing H/ ATPase activity leading to ucreased HCO3/ Cl- activity

"increased excretion of nearly all amino acids, glucose, HCO3, and PO4 that can result in metabolic acidosis)

Fanconi syndrome (generalized reabsorptive defect in PCT)

"defective Na/K/2Cl transporter in the TAL that has AR inheritance"

Bartter syndrome

What are the electrolye and metabolic changes seen in Bartter syndrome?

Hypokalemia, metabolic alkalosis, and hypercalciuria

"resorptive defect of NaCl in DCT with AR inheritance"

Gitelman syndrome

"AD gain of function mutation leading to increased Na reab in the CT"

Liddle syndrome

What 3 factors can lead to increased renin secretion?

Decreased BP (JG cells) Decreased Na+ delivery (macula densa cells) Increased sympathetic tone (beta 1 receptors)

What is the main function of ADH?

regulates osmolarity

What is the main function of aldosterone?

primarily regulates ECF volume and Na content

Through what mechanism does ANP/ BNP work?

relaxes vascular smooth muscle via cGMP--> increased GFR--> decreased renin

How do beta 1 blocers decrease renin release?

Via inhibition of Beta 1 receptors of the JGA cells

What cells repease EPO?

Peritubular cells

Where is 1 alpha hydroxlase found?

In PCT cells

What cells secrete renin?

JG cells

What 2 factors promote the secretion of aldosterone?

Increased plasma K and decreased blood volume

Name 6 factors that lead to Shift of K out of the cell (hyperkalemia)?

Digitalis Hyperosmolarity Lysis of cells Acidosis beta blocker high blood sugar

Name 4 factors that cause the shift of K into the cell (hypokalemia)?

Hypoosmolarity Alkalosis beta adrenergic agonist insulin

Name the electrolyte abnormality: U wave

HYPOkalemia

Name the electrolyte abnormality: flattened T wave

HYPOkalemia

Name the electrolyte abnormality: Wide QRS and peaked T wave

HYPERkalemia

Name the electrolyte abnormality: TdP

Hypomagnesium

Name the electrolyte abnormality: Bones, groans, psychiatric overtones, stones

HYPERcalemia

What are the levels of the pH, Pco2 and HCO3 in the folling acid base problem: Metabolic acidosis

pH: decreased Pco2: decreased HCO3: decreased

What is the compensation for metabolic acidosis?

Hyperventilation

What are the levels of the pH, Pco2 and HCO3 in the folling acid base problem: Metabolic alkalosis

pH: increased Pco2: increased HCO2: increased

What is the compensation for metabolic alkalosis?

Hypoventilation

What are the levels of the pH, Pco2 and HCO3 in the folling acid base problem: respiratory acidosis

pH: decreased Pco2: increased HCO3: decreased

What is the compensation for respiratory acidosis?

increased real HCO3 reabsorption

What are the levels of the pH, Pco2 and HCO3 in the folling acid base problem: respiratory alkalosis

pH: increased Pco2: decreased HCO3: increased

What is the compensation for respiratory alkalosis?

decreased renal HCO3 reabsorption

What is winter's formula? What is it used for?

Pco2= 1.5 (HCO3) + 8 +/- 2 It is used to see if there is compensation

What can cause anion gap metabolic acidosis?

MUDPILES: ``` Methanol Uremia Diabetic ketoacidosis propylene glycol Iron tables or isoniazid lactic acudosis ethylene glycol salicylates ```

What causes normal non gap metabolic acidosis?

HARD-ASS ``` Hyperalimentation Addison disease Renal Tubular Acidosis Diarrhea Acetazolamide Spironolactone Saline infusion ```