rev Flashcards
which artery is associated with horse shoe kidneys?
inferior mesenteric artery - gets caught on ascent
commonest congenital abnormality
lymphatics for testes
lumbar lymph nodes around aorta
histological difference between PCT + DCT epithelium
both cuboidal epithelium BUT
PCT = thick brush border = microvilli (large surface area)
DCT = no microvillia
what do juxtaglomerular cells secrete?
renin
juxtaglomerular cells = granular
3 components of juxtaglomerular apparatus
mucula densa = sense NaCl conc
juxtaglomerulat cells
mesangial cells
where actually is the juxtaglomerular apparatus?
specialised region where DCT passes adjacent to vascular pole of the SAME renal corpuscle
histology of collecting ducts
simpler columnar
histology of collecting ducts
simpler columnar
histology of urine conducting system
transitional epithelium - urothelium
cells on luminal suface = umbrella cell (facet) - thick, provides IMpermeable barrier
below is lamina propria = smooth muscle
how much of cardiac volume does the kidneys receive?
20% = 1 litre
gain of NaCl effect on fluid compartments
gain NaCl = increase ECF + decrease ICF
(GID)
loss = opposite
how much of the plasma entering glomerulus is filtered/leaves through efferent arteriole?
20% entering glomerulus is filtered
80% enters then leaves via efferent arteriole
what is the charge of the basement membrane?
negatively charged
endothelium -> basement membrane -> podocytes
RBC barrier -> plasma protein barrier (PPB) -> PPB
which forces act against net filtration pressure?
bowmans capsule HYDROstatic = 15mmHg
capillary ONCOTIC = 30
net filtration pressure
10mmhg
(55+0)-(15+30) = 10
affect of nictotine + alcohol on ADH release
nicotine stimulates ADH release
alcohol inhibits ADH release
what conditions may present with resp acidosis?
(CO2 retention)
COPD, asthma, airway restriction
what conditions may present with metabolic acidosis?
excess H+
sepsis, lactic acidosis, DKA
what conditions may present with metabolic alkalosis?
(net loss of H or gain in HCO3)
vomiting, diuretics, hyperaldosteronism, hypokalaemia
target saturations in COPD patient
88-92%
monitor ABG closely
reduced anion gap causes
myeloma
hypoalbuminaemia
raised anion gap causes
alcohol, kentones, Uraemia, DKA**
Isoniazid, Lactic acidosis
Ethylene glycol, Salicylate poisoning
how does CKD cause secondary hyperparathyroidism? management ?
vit D os hydroxylated in kidney (impaired in CKD)
–> leads to reduced calcium absorption + 2nd hyperpara
in advanced CKD - serum phosphate rises, also increased PTH
Mx = alfacalcidiol, phosphate + phosphate binders
foot process fusion on electromicroscopy
minimal change GN
complete remission with steroids
glomerular crescents on biopsy
rapidly progressive GN
positive congo red staining showing apple green befringence under polarised light
amyloidosis
proteus UTIs
associated with formation of stones, foul smelling, burnt chocolate?
pseudomonas aeruginosatreatment
ciprofloxacin - resistant to most others
–> is a Cdiff risk drug
gram neg bacillus - not a coliform
which causative organisms of UTIs do NOT give a positive test?
enterococcus
where does spironolactone act? side effects?
aldosterone antagonist that acts on CORTICAL COLLECTING DUCTS
SE = hyperkalaemia + gynacomastia
what brain abnormality can acute severe hyponatraemia cause?
cerebral oedema
thiazides inhibit dilution in DCT
What is measured to obtain renal plasma flow?
para-amino hipuric acid (PAH)
Renal plasma flow = (amount of PAH in urine per unit time) / (difference in PAH concentration in the renal artery or vein)
Normal value = 660ml/min
where is the greatest amount of sodium reabsorbed?
proximal CT - due to Na/k ATPase action
-> msot filtered water is absorbed here too (osmosis)
activity of zona glomerulosa in dehydrated state
increased (release aldosterone)
increased activation of RAAS
secretion levels of ADH in dehydrated state
increased secretion - increase water reabsorption in collecting duct
drugs which can cause hypokalaemia
thiazide diuretics
loop diuretics
acetazolamide
salbutamol (treatment of hyperkal)
drugs which can cause hyperkalaemia
ACEi, ARBs spironolactone heparin ciclosporin amiloride K supplements
Excessive production of which hormone in the adrenal can lead to hyper-androgenic effects such as hirsutism, deepening of the voice and increased libido? where is it produced?
dehydroepiandrosterone (DHEA)
–> zona reticularis
(androgen hormone that can be converted into the more biologically active testosterone)
losartan drug type
ARB - stop in AKI
what are the complication of diabetes neuropathy due to?
enzymatic glycosylation of the basement membrane
AFP + HCG levels in seminomas
normal
usually raised in teratomas + yolk sac tumours
most common renal carcinoma in kids
Wilms tumour
acetazolamide prescribed for glucoma has what affect on the kidney?
mild diuretic effect through inhibition of carbonic anyhydrase
-> reduces reabsorption of sodium + therfore water in PCT
staghorn calculi
composed of struvite
urease producing bacteria - proteus
(assoc with recurrent/chronic infections)
where in the GI tract is the majority of water absorbed?
jejunum
difference between loop + thiazide diuretics
both SE of hypokalaemia + hyponatraemia(diuretic excess)
loop = increases Ca EXCRETION, may precipitate renal calculi formation
thiazide = increases Ca resorption, used to control calculi formation
