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Y2S1 > Renal System > Flashcards

Renal System Flashcards

1
Q

Where do suprarenal veins drain into? What do they drain?

A

Right drains into IVC, Left drains into Left renal vein.
Suprarenal veins drain the suprarenal glands/adrenal glands.

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2
Q

What is the blood flow in the kidney? (Arteries, capillaries, veins)

A

Mneumonic: Rough Sports Is Always Great Exercise
Renal artery, segmental artery, interlobar artery, arcuate artery, interlobular a, afferent a, glomerular a, capillary, vasa recta (where most secretion takes place), interlobular v, arcuate v, interlobar v, renal v

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3
Q

What arteries, veins, nerves and lymph supply/drain the kidney? Where does pain refer?

A

Arteries: Renal artery:from abdominal aorta R(longer and posterior to IVC)
Veins: Renal veins –L (longer): drains left gonadal, testes, kidney; R: only drains R kidney–gonadal vein drains directly into IVC
Nerves: T12 least splanchnic nerves : pain refers to the lumbar T11-12 and the back
Lymphatics: para-aortic LN –> cisternae chyli

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4
Q

What arteries, veins and nerves supply/drain the Ureters? Where does pain refer?

A

Arteries
Upper: Renal artery
Middle: Aorta, gonadal artery, common iliac
Lower: Internal iliac artery

Nerves:
GVA (SNS afferents) to T11-L2

LN:
Upper: Aortic nodes
Middle: LN associated with common iliac vessels
Lower: LN associated with external and internal iliac vessels

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5
Q

What arteries, veins and nerves supply/drain the adrenal glands?

A

Arteries: Suprarenal arteries
Superior: from inferior phrenic artery
Middle: from abdominal aorta
Inferior: from renal artery

Veins: suprarenal arteries: L drains into left renal vein, R drains into IVC

Nerves: greater splanchnic nerves

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6
Q

What arteries, veins and nerves supply/drain the bladder?

A

Arteries:
superior and inferior vesicle arteries: internal iliac a. and umbilical a

Veins:
Vesicular venous plexus drains to internal iliac veins

Nerves:
Detrusor muscle: PSNS, pelvic splanchnic S2-4
Internal sphincter: SNS hypogastric nerve T11-12, L1-2
External sphincter: Somatic, pudendal nerve S2-4

Lymph:
External and internal iliac LNs

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7
Q

Select which of the following drug combinations is LEAST LIKELY to lead to electrolyte disturbances of
renal origin and lead to cardiovascular complications.
Select one:
a. furosemide and hydrochlorothiazide
b. spironolactone and ramipril
c. hydrochlorothiazide and spironolactone
d. ramipril and losartan

A

C

a/ furosemide=loop diuretic, hypokalemia + hydrochlorothiazide = thiazide hypokalemia
b/ k+ sparing diuretic–hyperkalemia + ACE inhibitor (increases aldosterone and K+) –> hyperkalemia
C: cancels out effect, k+ sparing given together to prevent hypokalemia
d/ ace inhibitor and arb –> K+ reabsorption –> hyperkalemia

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8
Q

Select which of the following does NOT normally appear in the glomerular filtrate.
Select one:
a. Urea
b. Sodium
C. Plasma protein
d. Glucose

A

C
glucose is in filtrate but is reabsorbed and not excreted

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9
Q

Fill in the blanks
1. Macula densa found on ______ arterioles in _____ : low GFR –> rise/fall in [NaCl] signals the release of ______ which vasodilates/vasoconstricts _____ arterioles to ____ GFR.

A

Afferent
DCT
Fall
Prostaglandins
Vasodilates
Afferent
Increase

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10
Q

Fill in the blanks
1. Macula densa found on ______ arterioles in _____ : high GFR –> rise/fall in [NaCl] signals the release of ______ which vasodilates/vasoconstricts _____ arterioles to ____ GFR.

A

afferent, DCT
rise (increased flow past macula densa)
adenosine
vasoconstricts afferent
decrease

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11
Q

What structures does a surgeon need to be especially careful of in hysterectomy (removal of
uterus)?

  1. Pudendal nerve
  2. Inferior epigastric vein
  3. Ureter
  4. Vas deferens
  5. Femoral artery
A

c

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12
Q

Where is ureteric pain referred, and what fibres carry them?
1. Ipsilateral flank only, PSNS afferents
2. Ipsilateral flank only, SNS afferents
3. Loin to groin, PSNS afferents
4. Loin to groin, SNS afferents

A

4

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13
Q

Where renal stones most likely to get trapped in?
1. Minor calyx
2. Major calyx
3. Ureteropelvic junction
4. Where ureter crosses pelvic brim
5. Vesicoureteric junction

A

5

3-5 are all common constrictions of the ureters where stones are likely to be trapped in, but the vesicourteric junction is the most common one

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14
Q

Which is true of vascular supply of suprarenal glands?
1. Right suprarenal vein drains into right renal vein.
2. Left superior suprarenal artery is supplied by the aorta.
3. Right inferior suprarenal artery is supplied by renal artery.
4. Left suprarenal vein drains into splenic vein.

A

3
Suprarenal arteries
Superior: from inferior phrenic artery
Middle: from abdominal aorta
Inferior: from renal artery

Suprarenal vein
Left from left renal vein
Right from IVC

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15
Q

Which of the following about innervation is true?

a. Kidney - Greater splanchnic
b. Adrenal glands - lesser splanchnic
c. Kidney referred pain to T11-T12

A

C

F a. least splanchnic
F b. greater splanchnic
c: correct, least splanchnic T12

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16
Q

True or false? Lateral arcuate ligament overlies the muscle medial to the transversus abdominis
muscle

A

True.

muscle medial to transversus abdominis is the quad. lamborum

17
Q

Are these true/false about the proximal convoluted tubule?

  1. SGLT2 inhibitors work here to inhibit the sodium-phosphate cotransporter
  2. Hydrochlorothiazide works here to inhibit the sodium chloride cotransporter
  3. Acetazolamide works here by upregulating carbonic anhydrase and causing alkaline
    diuresis
  4. Reabsorption here is isotonic
A
  1. SGLT2 inhibitors work here to inhibit the sodium-phosphate cotransporter FALSE,
    sodium glucose linked transporter
  2. Hydrochlorothiazide works here to inhibit the sodium chloride cotransporter FALSE,
    wrong location
  3. Acetazolamide works here by upregulating carbonic anhydrase and causing alkaline
    diuresis FALSE, downregulate
  4. Reabsorption here is isotonic TRUE, water reabsorbed as sodium reabsorbed by
    passive diffusion
18
Q

Where does frusemide work?

A

Loop diuretic: works on the thick ascending limb of the LOH in the nephron –blocks the NKCC cotransporter to decrease Na+ reabsorption

19
Q

T/F Amiloride upregulates the H/K pump of intercalated cells to maintain acid-base homeostasis of the body

A

FALSE, inhibits Na+ channels on principal cells to cause
diuresis

20
Q

T/F V2 aquaporins, signalled by ADH, are inserted on the luminal side of intercalated cells
to increase water reabsorption

A

FALSE, principal cells

21
Q

Alpha intercalated cells are involved when the body is alkalotic and needs to reabsorb acids and secrete bases

A

FALSE
remember that Alpha SECRETES Acid, Beta SECRETES
Base

22
Q

12 year old boy presents to the emergency department with abdominal pain, fruity breath and ketones in urine. What happens to his K+ levels?

A

HYPERKALEMIA in diabetic ketoacidosis (remember
insulin causes potassium to enter cells and therefore decreases potassium levels in
blood!) In DKA, no insulin thus build up of K+

23
Q

Are these statements true/false of renal osteodystrophy?
1. Happens mostly in acute kidney injury
2. High phosphate retention causes hypercalcemia in the early stages
3. Low calcitriol reduces Ca absorption in intestines, worsening osteodystrophy
4. Persistently high PTH in secondary hyperparathyroidism causes hypercalcemia in later
stages

A
  1. Happens mostly in acute kidney injury FALSE, CKD
  2. High phosphate retention causes hypercalcemia in the early stages FALSE,
    hypocalcemia
  3. Low calcitriol reduces Ca absorption in intestines, worsening osteodystrophy TRUE
  4. Persistently high PTH in secondary hyperparathyroidism causes hypercalcemia in later
    stages FALSE, tertiary hyperparathyroidism
24
Q

What are the symptoms of nephrotic syndrome?

A

Abnormal permeability of BM (podocytes) –> proteinuria
HELP
Hypoalbuminuria
Edema
Lipid abnormalities
Proteinura

25
Q

Symptoms of nephritic syndrome?

A

Inflammation of glomerular capillaries
PHAROAH
Proteinura, pruria
Hematuria
Azotemia (high uric acid and nitro waste)
Red blood casts
Oliguria
Anti-strep titres
Hypertension

26
Q

Patient present with headache for several months. She has blood pressure of 200/100 mmHg,
and an ultrasound confirms the cause of her hypertension. Decreased perfusion of which
structure causes renin release that leads to hypertension?
1. Adrenal medulla
2. DCT
3. Afferent arteriole
4. Efferent arteriole
5. Loop of henle
6. PCT

A

3

both 2/3 can cause, but since ultrasound confirms the cause of hypertension: *Cause of her hypertension is renal artery stenosis –> 3 is a better answer

+ jg apparatus releasing renin is in the afferent arteriole –> making it a better answer

27
Q

Nephrolithiasis can cause obstruction of urine and pain. Where is likely for stones to lodge in
the urinary system?
1. Bladder
2. Penile urethra
3. Prostatic urethra
4. Renal calyx
5. Ureter over the iliac vessels

A

5

28
Q

As a result of countercurrent exchange, the fluid in the tubule is most hyperosmotic in the:

  1. Proximal convoluted tubule
  2. Distal convoluted tubule
  3. Ascending limb
  4. Descending limb
  5. Loop of Henle
A

4

Countercurrent multiplication:
Water diffuses out of the descending limb via osmosis –> hyperosmotic at the end of descending limb. Concentration of fluid in lumen is the highest at the tip of LOH (the more inward you go towards medulla). Ascending limb: impermeable to water, actively pumps out ions into interstitium, decreasing osmolarity in tubule (hypoosmotic)

29
Q

Mrs Tan is an 80 year old lady that comes into the GP and is prescribed a carbonic anhydrase
inhibitor. Which of the following mechanisms explain how this drug works?
1. It causes an increased urinary acid excretion
2. It increases bicarbonate reclamation
3. It induces metabolic alkalosis to counter low pH levels
4. It decreases bicarbonate regeneration

A

4

Carbonic anhydrase inhibitors, such as acetazolamide, are drugs that work by inhibiting the activity of the enzyme carbonic anhydrase. This enzyme plays a crucial role in the production of bicarbonate ions (HCO3-) in the kidneys.

Normally, carbonic anhydrase catalyzes the reaction between carbon dioxide (CO2) and water (H2O) to form carbonic acid (H2CO3). Carbonic acid then dissociates into bicarbonate ions (HCO3-) and hydrogen ions (H+). The bicarbonate ions are reabsorbed into the bloodstream, while the hydrogen ions are excreted into the urine.

By inhibiting carbonic anhydrase, carbonic anhydrase inhibitors disrupt this process. As a result, the conversion of carbon dioxide and water into bicarbonate ions and hydrogen ions is reduced. This leads to a decrease in bicarbonate regeneration in the kidneys, as fewer bicarbonate ions are produced.

Since bicarbonate is a major buffer in the body, a decrease in its regeneration leads to a decrease in the availability of bicarbonate to counteract acid in the body. This results in a mild metabolic acidosis, rather than metabolic alkalosis as mentioned in option 3.

30
Q

ADH secretion is increased by all of the following factors except:

  1. Increase in plasma osmolality
  2. Loss of blood
  3. Pain
  4. Vomiting
  5. Alcohol
A

5

1/ activation of osmoreceptors –> increase ADH secretion
2/ decreased blood vol –> ADH inc
3/ pain –> stress response, increased CRH and ACTH –> increase ADH
4/ decreased blood vol
5. is a known diuretic, inhibiting ADH release

31
Q

T/F Damage at the level of sacral spinal cord causes urge incontinence

A

FALSE
(Overflow incontinence)

32
Q

T/F Damage at the level of sacral spinal cord causes stress incontinence

A

TRUE
(pudendal nerve)

33
Q

T/F Damage above sacral spinal cord level causes retention

A

FALSE (urge incontinence)

34
Q

How would renal cell cancer metastasize via a lymphovenous junction?

  1. Via renal artery
  2. Via renal vein
  3. Via arcuate veins
  4. Via interlobular veins
A

2 (Cancer spreads to lymph nodes present in proximity to renal
vein)

35
Q

40yo man presents with hematuria, and sharp sudden colicky pain on lower back that radiates
to his flanks. Noncontrast CT scan shows several stones in both ureters. What is the most
likely cause of this?
1. BPH
2. Large stool in small bowel
3. Hyperparathyroidism
4. Hyperuricemia
5. Staphylococcal infection of the bladder

A

3
*Favours formation of calcium stones, most common type of kidney stone

36
Q

72yo man recently diagnosed with heart disease has sudden onset swelling of face and lips
and mouth. He mentions he was put on medications for hypertension and that sometimes he
gets rashes when taking antibiotics. The accumulation of what substance is likely causing his
symptoms?
1. Bradykinin
2. Histamine
3. Prostacyclin
4. Prostaglandin E2
5. Serotonin

A

1 Bradykinin *ACEi prevent ACE from degrading bradykinin -> accumulation causes angioedema

37
Q

An 85 year old man with a history of lung cancer presents to the GP complaining of bloating
and being unable to pass urine. On further investigations, he is found to have a low plasma
osmolality, low sodium concentration and high urine osmolality. Which of the following
options is most likely causing all of his symptoms?
1. His aldosterone levels are high
2. His reduced salt intake
3. He has an ADH secreting tumour
4. His ADH receptors are not responding

A

3 Given his history of lung cancer, you would be
highly suspicious of an ADH secreting tumour. Low plasma osmolality and high urine
osmolality points to ADH being the problem.

Y2S1 (6 decks)

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