Renal Physiology Flashcards
Origin of nephron
Metanephric blastema
Origin of collecting duct system
Ureteric bud
Components of nephron
Renal corpuscle (glomerulus+ bowmans capsule) PCT Loop of henle DCT CT
Cells that secrete renin
JG cells
Senses changes in volume and NaCl concentrations
Macula densa
Components of JG Apparatus
JG cells
Macula densa
Mesangial cells
Epithelium of PCT
Simple cuboidal with microvilli for absorption
Epithelium of loop of henle
Ascending limb: Simple squamous
Descending limb: simple cuboidal
Epithelium of DCT
Simple cuboidal
How many % of Cardiac output does kidney receive
25%
Functional unit of kidney
Nephron
Location of JG apparatus
Vascular pole of glomerulus
3 basic processes of kidneys
Glomerular filtration
Tubular reabsorption
Tubular secretion
Cells that secrete EPO
Peritubular capillary cells of kidneys- from interstitial fibroblast and tubular epithelial cells
Action is insertion of aquaporin channel
ADH
Hormone that catalyze in conversion to active vit d form
1 alpha hydroxylase
Enzymes that breakdown bradykinin
ACE
Aminopeptidase P
Carboxypeptidase N
First step in urine formation
Glomerular filtration
What are absorbed by passive diffusion
Water:99%
Na:99.5% (primary active transport)
Urea:50%
Phenol:0%
How is glucose and amino acid reabsorbed
Secondary active transport via sodium gradient
All other steps are passive
Makes urine dilute or concentrated
Medullary countercurrent system- osmotic gradient is controlled by LOH
Permeable to water,not to solute
Descending limb of LOH
Impermeable to water
Permeable to solute
Ascending limb
Ayaw sa agua
Components of glomerular membrane
Fenestrated endothelium of capillary-70nm negatively charged glycoprotein. No protein can pass
Basement membrane
Podocytes
Amount of filtrate formed by both kidneys in a unit time
GFR
Normal GFR
125ml/min
Site of highest renal vascular resistance
Efferent arteriole
What contributes to renal vascular resistance
Interlobular a
Afferrent a
Efferent a
Susbtance with highest clearance, used in renal blood flow measurement
Paraaminohippuric acid
Used to estimate GFR
Inulin- freely filtered but not absorbed nor secreted
Renal threshold for glucose
180mg/dl
Arterial threshold for glucose
200mg/dl
Usual daily UO
720-1440 ml
Oliguria
<400
Cholinomimetix used in post op urinary retention
Bethanecol
DOC for urge incontinence
Oxybutinin-non selective anticholinergic
Causes of cloudy urine
Increased ph
High phosphate
Alkaline urine with ammonia smell
Proteus
Ketone is seen in
DKA
Starvation
Common in pregnancy
Brown muddy cast
Acute tubular necrosis
Average renal blood flow
1100 ml/min for both kidneys
Major pathway for reabsorption of na,cl, water
PCT
Parts impermeable to urea
TAL
DCT
CCD
Group of neuron responsible to maintenance of micturition and defecatory continence and muscular contraction during orgasm
Onufs nucleus
Congenital anomaly sec to ACE inh use during pregnancy
Renal agenesis
MC site of ectopic kidney
Pelvic brim
Gene mutation in ADPKD
PKD1 gene on ch 16-encode for polycystin 1–85%
Pkd2 gene on ch 4
Extrarenal manifestations of ADPKD
Berry aneurysm
Hypertension
MVP
Liver,pancreatic cysts
Aka potter syndrome
ARPKD
Low set ears, parrot beak nose, lung hypoplasia
Potter facie
Multiple cystic dilation of collecting duct and medulla
Medullary sponge kidney
MC type of renal cyst
Simple cyst
Renal cyst with clear fluid and calcium oxate crystals
Dialysis associated cortical/medullary cyst
Type of nephropathy in HSP
Ig A nephropathy
Volume with first urge to void
150 ml
Sense of fullness of bladder
400ml
+ islands of undifferentiated mesenchyme
Cystic renal dysplasia
MC type of renal cell carcinoma
Clear cell carcinoma
Gene mutation in ARPKD
PKHD1 gene encoding for FIBROCYSTIN
Bilateral massive enlargement of kidneys with multiple large cysts
ADPKD
Enlarged kidneys with smooth ext appearance
Spongelike appearance on cross section
Spokes on a wheel pattern
Liver cysts
ARPKD
Hemangioblastoma of cerebellum,brainstem or retina
Cysts of liver,kidney or pancreas
Renal cell cancer
Von hippel lindau
Internists tumor
Renal cell cancer
Triad of RCC
Hematuria
Flank pain
Abd mass
MC manifestation of SLE
Joint pain
Hallmark of lupus nephritis
Deposition of IC
Morphology of Lupus nephritis
Wire loop with granular deposit in sub endothelial membrane
Most common and most severe type of LN
Type 4 diffuse proliferative
New type of lupus nephritis
Type 6 advanced sclerosing
Tx of lupus nephritis
Induction and maintenance phase Mainstay: Steroid: methylprednisolone- induction Prednisone- maintenance Other: Immunosuppressive: Cyclophosphamide Mycophenolate mofetil Azathioprine Calcineurin inhibitor: tacrolimus
A return to a near normal renal function and proteinuria < 30 mg/dl per day
Remission
Sensitive indicator of dm nephropathy
Thickening of GBM
Mx finding in DM nephropathy
Kimmelsteil wilson lesion
Glomerular nodular sclerosis with BM thickening
Kimmelsteil wilson lesion
Causes of ATN
Ischemia
Direct toxic injury
Is atn reversible
Yes
Hallmark of acute pyelonephritis
Patchy interstitial suppurativr inflammation – abscess
Hallmark CM of APN
+ KPS
Complications of APN
Papillary necrosis
Pyonephrosis
Perinephric abscess
Drug assoc with papillary necrosis
Phenacetin
Part of kidney affected in papillary necrosis
Distal tips of pyramids
Antibiotic that can cause interstitial nephritis
Methicillin
Type of nephritis assoc with analgesic nephropathy
Tubulointerstitial nephritis
Renal failure Due to aristolochic acid which increase risk of RCC
Chinese herb nephropathy
MC bone tumor in adult
Multiple myeloma
Mx finding in MM
Bence jones protein combine with tam horsefall protein— cast
MC bone tumor in children
Osteosarcoma
Pt with renal failure and bone pain
Renal osteodystrophy
Nephrosclerosis assoc with malignant hypertension
Malignant nephrosclerosis
Mx of malignant nephrosclerosis
Flea bitten appearance
Onion skinning
Fibrinoid necrosis
Causes of renal artery sclerosis
Atheromatous plaque-70%
Fibromuscular dysplasia
Char by small kidneys with diffuse ischemic atrophy
Renal artery stenosis
Serotypes of GABHS assoc with psgn
Types 1,4,12
Sub epithelial hump/bump electron dense deposits of IC
PSGN
Presence of glomerular crescents in LM due to proliferation of parietal epi cells and infiltration of monocytes and macrophages
RPGN
Anti GBM antibodies
Type 1
goodpasteur syndrome
IC mediated seen in sle and hps
Type 2 rpgn
Anca positive
Assoc with systemic vasculitis
Type 3
wegener granulomatosis
Focal rupture in GBM seen in EM
RPGN
R=rupture
Nephrotic range
> = 3.5 g/day
Massive proteinuria
Hypoalbuminemia
Gen edema
Hyperlipidemia
Nephrotic syndrome
MC diseases causing nephrotic sx
Minimal change
Amyloidosis
Sle
MCC of nephrotic syndrome in adults
Membranous GN
Spike and dome appearance
Membranous gn
Most abundant protein in urine
Tam horsefall protein
Gene mutation in FSGN
NPHS1-nephrin
NPHS2- podocin
MCC of NS in children
Minimal change disease
Pathogenesis of MCD
Cytokine damage of visceral epithelium
LM finding in MCD
Normal
EM finding in MCD
Effacement of podocyte
GN assoc with HIV and heroin
FSGS
Hallmark of FSGS
Epithelial damage prominent in corticomedullary jxn
Tram track/double contour glomerular capillary wall due to duplication of GBM
MPGN
More common type of primary mpgn
Type 1
Also known as dense deposit disease
Type 2 primary mpgn
MC type of GN worldwide
IgA nephropathy/berger disease
Char by deposits of IgA in mesagium
IgA nephropathy
Present as hematuria after a respi infxn
Ig A nephropathy
Hereditary form of gn with nerve deafness
Alport syndrome
Defect in alport syndrome
Type 4 collagen BM
Drugs that cause ischemic nephropathy
Aminoglycoside
Amphotericin B
Contrast dye
Hallmark of ESRD
Chronic GN
MCC of esrd
Rpgn
Fsgn
CM of CGN
3 mos azotemia
Small kidneys
Anemia
Mx of cgn
Thyroidization due to tubular atrophy
Symmetrical contracted kidney
Earliest sign of NS in children
Periorbital edema
Earliest sign of NS in adult
Bipedal edema