Renal smart book Flashcards by Trevor Johnson

Where is the lowest osmolarity in the nephron?

its the Distal convoluted tubule

ADH works here

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What are the stages of Acute Tubular Necrosis? ATN

1- ischemia/toxic phase:

2- maintenence:

oliguria, tubular necrosis, denudation of basement membrane,

3: Recovery: re-epithelization of tubules

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What are the depositions found along the GBM after post streptococcal glomerulonephritis?

IgM, IgG, C3

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whats the fuck up of urinary incontinence when you pee when you sneeze or cough or laugh

Urethral sphincter dysfunction

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where is the majority of water absorbed throughout the nephron?

the Proximal Convoluted tubule (60%)

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What are the possible side effects caused at each stage of Acute Tubular necrosis

1- ishemia/toxic: decrease blood flow

2- maintence: Hyperkalemia, acidosis

3-hypokalemia

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what do you give to prevent side effects of Aciclovir

(intersitial nephritis/crystal formation)

Shit ton of water

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Which nephrotic syndrome do you think of when you see these lesions?

Diabetic Glomerulonephropathy

those are Kimmelstiel-wilson lesions

-eosinophil nodular sclerosis

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What are the different transplant rejection reactions?

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for metabolic alkalosis what findings do you use to diagnose the acid base abnormality?

urine chloride and serum volume

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what two side effects are EPO stimulators assocaited with

Thromboembolic events and HTN

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how does forscarnet work? what are the side effects?

it chelates calcium and promotes Mg wasting

it can lead to hypocalcemia and hypomagnesia

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what are the three types of rapidly progressive (crescentic) glomerulonephritis?

1- good pastures - Anti GBM: Linear IF filled with igG and c3. type 2 hypersensitivity along with alveolar basement membrane

2- Granulomatosis with polyangiitis (wegeners); c anca / no igG or c3

3- microscopic polyangiitis - p ance

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what causes cysteinuria?

what test do you run?

Defective amino acid transport in PCT

decreased reabsorption of cystein (and others) from urine COLA

sodium nitroprusside test

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what are the ways to increase rate of dialysis removal of a drug OD

increase surface area, temp, pore size

decrease membrane thickness

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whats the mutation for Renal cell carcinoma? RCC

RCC= 3p = VHL

(3 letters)

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Chronic renal hypoperfusion will cause hypertrophy and hyperplasia of which cells in the kidney?

Juxtaglomerular cells

which are modified smooth muscle cells of the afferent arteriole

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Post strep glomerulonephritis is worst for what age group?

Adults

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what are the best ways to prevent UTIs from catheters?

avoiding unnecesary caths, use sterile techniques, and removing it asap

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whats the treatment for Diabetic ketoacidosis (DKA)

Insulin and saline

increases serum bicarb,

decr glucose (duh), osmolality, and potassium

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bence jones highly eosinophilic casts in urine

Multiple myeloma

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whats the most common site of fetal hydronephrosis due to obstruction?

narrowing or kinging at the uteropelvic junction

(where the ureters join the kidney)

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what part of the kidney does the uteric bud ultimately give rise to ?

what about the metanephric blastema?

the collecting ducts, major/minor calyces, renal pelvis, ureters

__________

glomeruli, bowmans space, PCT, loop, DCT

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where does the ureter lie in reference to the gonadal artery and veins, and the internal illiac?

water under the bridge, but anterior to the internal illiac

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How would Renal cell Carcinoma present?

painless hematuria, flank pain, abdominal mass incr. hematocrit due to release of EPO from the tumor

what is PAH a measure of?

renal plasma flow RPF it gets freely **filtered** and **secreted** back into the blood butttt at increased PAH concentrations the tubule's **carrier transport** gets **saturated** so the extraction ratio goes down

renal scarring on **upper and lower poles**, HTN at younger age?

**Vesicouretal reflux** when the ureters enter the bladder at a perpendicular angle as opposed to oblique. when the bladder fills it normally closes the flap that the oblique angle creates. but with perpindicular angle there is no flap can lead to **infections** **dilated/blunted calyx & cortical scarring**

How is PAH a measure of Renal Plasma Flow (RPF)

PAH enters the nephron primarily through **secretion** with only a little bit of filtration so you increase RPF you increase PAH secretion vice versa

Kidney transplant that causes problems **a week** later

acute transplant rejection **HOST T cells** attack the *graft MHC antigens*

a person gets a kidney stone (calcium oxalate most common) what is his serum and urine calcium levles

Serum: Normocalcemia Pee: Hypercaliuria the serum gets regulated by vit d and pth and all that shit

a guy has been working at a rubber factory for 30 yrs. and he has slowly increasingly red urine. what should you think?

Transitional cell carcinoma of the bladder Factory workers have high occupational hazards for bladder cancer

equation for **Renal Plasma Flow**. when youre only given *renal blood flow and hematocrit*

RPF= RBF x (1-Hct)

which substances are found deposited in Rapidly progressive GN

Fibrin/macrophages with goodpastures: igG/C3 with Wegeners or micro polyangiitis: c/p anca

what are the clinical presentation of **Acute interstitial nephritis** what can cause this?

Fever, **RASH**, hematuria **Eosinophils** in urine!!! P's: Pee (diuretics), penicilin, pain free (nsaids), PPI, rifamPin

why does **spironolactone** cause anti androgen side effects? what are the effects?

it acts as an **androgen receptor antagonist** which inhibits *testosterone* synthesis **gynecomastia**, decr. libido, impotence

what are the lab findings of HUS

thrombocytopenia (decr. platelets) Microangiopathic hemolytic anemia MAHA (microthrombi in small vessels) acute kidney injury

Renal transplat patient that comes in **months-years** later. what type of rejection is this?

Chronic rejection due to **vascular wall thickening** **interstitial fibrosis/ parenychma atrophy**

which casts are seen in pyleonephritis?

White blood cell CASTS

how would cells look on biopsy of **Renal cell carcinoma?**

its a **clear cell carcinoma** -accumulation of lipids and carbs

which diuretics are the best and most potent for rapid relief of HTN

Loop diuretics cmon son

what are some factors predisposing to Calcium oxaloate stones? what are they shapped like?

hypercalciuria (high pee calcium) hyPOcitraturia (low pee Citrate) - acidic Pee shaped like X-s

tell me about HSP clinical presentation

affects younger kids after an upper respiratory infection. the body forms Ig**A** antibodies that get deposited in vessesl causing **vasculitis** abominal pain, rash on **lower legs and buttocks**, *joint pain,* hematuria

porster fractured rib levels left 9-11

1-6: **visceral pluera** 9-11: **spleen** 12: **Kidney**

**episodic** recurrant Hematuria that follows some type of u**pper respiratory infe**ction **DAYS** after

Ig**A nephropathy** Burgers Dz - **mesangial** proliferation

whats antiphospholipid syndrome?

you have antiphospholipd antibodies that cause **hypercoaguable** state as **thromboemobli/recurrent pregnancy lost** false positive on **VDRL/RPR** (syphillis test) prolonged PTT associated with **Lupus**

best way to test for early signs of diabetic nephropathy

albumin mesangial expansion

*phospholipase A receptor antibody* that messes with the podocytes. which nephropathy?

Membranous nephropathy ## Footnote **Spike/dome**

what precipitates uric acid in the nephron and which part?

low ph (acidic) in the collecting duct

_fyi_ in metabolic acidosis the nephron compensates by reabsorbing all bicarb (to helpd neutralize) and pee out H+ and NH4 and H2PO2

what arteries supply the ureter

renal artery - proximal ureter gonadal artery - middle ureter internal illiac - distal ureter

immunosuppresant drugs

what renal problem can cause a vericocle

Renal Vein thrombosis **RVT** caused by nephrotic syndrome due to loss of antithrombin 3 **ATIII** Hypercoagable state

what are the main losses in nephrotic syndrome?

Albumin (edema) immunoglobulin (infection) ATIII (hypercoag/RVT)

what is Renal osteodystrophy? what causes it?

Renal osteodystrophy caused by end stage renal disease decr in (Vit D hydroxylation) =\> decr. serum calcium incr in serum phosphate

how do you calculate clearance?

Clearnce= (Urine concentration x flow rate) / plasma concentraiont

_fyi_ hypotension leads to decr. **RPF** which leads to decr. **GFR**

what are things associated with renal papillary necrosis

Sickle Cell Pyelnephritis Analgesics Diabetes mellitus SPAD

when would ADPKD present?

youre totally fine at infancy cysts start up **later in life**

end stage renal dz what are the calcium/phosphate/pth levels?

TTP-HUS

platelet activation (lack of ADAMST13) in arterioles and capallaries diffuse **microvascular thrombosis** **maha** w/ shiistocytes **thrombocytopenia**