Renal For Quiz 1 Flashcards
Hyponatremia and hypernatremia show problems with what process?
Free water handling
What is the typical renal response to hypernatremia (Dehydration)
ADH secretion causing free water retention and hyperosmolar urine.
Match the cause with the hyponatremia type:
Hypovolemic———-Excess serum protein
Euvolemic————-Diuretics and volume loss
Hypervolemic———Inappropriate ADH
Hypo - Diuretics
Eu - inappropriate ADH
Hyper - excess protein (from Cirrhosis, nephrotic syndrome, etc)
When do you correct for hyponatremia? What can happen if you correct too fast?
Acute hyponatremia with neurological dysfunction. If corrected too fast, permanent neurological damage can occur
What pH shifts can lead to hypo and hyper kalemia
Acidosis leads to hypernatremia, alkalosis leads to hyponatremia
How is hyperkalemia treated?
Calcium Gluconate to correct EKG changes. Then correction with insulin or k+ binding resin
What ekg changes can be found with hypokalemia?
Prolonged QTc
How do you calculate anion gap?
Na - (Bicarbonate + Cl)
Embryology: What forms the collecting tubules of the kidney?
The uretic bud
Embryology: What forms the nephron?
Metanephric blastema
What lines perinephric fat?
Gerota’s fascia
How can you differentiate proximal and distal tubules histologically?
Proximal tubules have microvilli, so you can see the lumen better in distal
What is the GFR cutoff for end stage renal disease?
GFR < 5%
What is the difference between nephrotic and nephrotic syndromes?
Nephritic: Hematuria, mild proteinuria, and HTN
Nephrotic: Major proteinuria, hypoalbuminemia (protein wasting), edema, hyperlipidemia, and lipiduria
In Acute renal failure, what are lab values and urinary habits you will see?
Oliguria or Andrea, as well as azotemia (increased BUN and Creatinine)
What are some causes of acute renal failure?
Obstruction of the urinary ducts or decreased perfusion (due to hypovolemia, sepsis, etc) or intrinsic diseases of the kidney
What are some causes of acute kidney injury?
Ischemia and toxic substances
What gross anatomical changes accompany Acute kidney injury?
Enlarged kidney, darker medulla, and pale cortex
What are casts in the urine?
Anything that packs into the nephron and can later be passed in the urine. In AKI, this is Tamm-Horsfalll protein (a urinary glycoprotein)
What are some histological changes in the initiation phase of AKI?
Loss of brush borders, edema of proximal tubules, dilation of distal tubules, ragged endothelium, and leukocytes in the vasa recta
What are the progression of phases of AKI and how long does each last
Initiation - few hours - days
Maintenance - around 1 week (66% mortality)
Recovery - around 2 weeks (33% mortality)
What are some toxic causes of AKI?
Aminoglycosides Ethylene Glycol (antifreeze) NSAIDs ACE inhibitors Pb and Hg IV contrast
What is the histological difference between ischemic and nephrotoxic acute kidney injury?
Ischemic has basement membrane involvement (tubulorrhexis), whereas nephrotoxic is often limited to only necrosis of the proximal tubule
What are the most common bacterial causes of pyelonephritis?
Same microbes as lower UTI (esp. E.coli)
What is the most common cause of chronic pyelonephritis?
Chronic reflux from the bladder to the ureter (associated with shorter inter-wall path of ureter through the bladder)
What organ can a kidney look like histologically if the patient has chronic kidney infection?
Thyroid (thyroidization)
Which chronic kidney infection causing bacteria can cause xanthogranulomatous pyelonephritis, which can look like a renal cell carcinoma?
Proteus
Which cause of chronic pyelonephritis often leads to non-polar scar formation?
Urinary tract obstruction
