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Step 1 Renal-First Aid 2017 > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Kidney taken during donor transplantation

A

Left kidney

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2
Q

Reason left kidney taken during donor transplantation

A

Longer renal vein

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3
Q

Vessels used to attached new kidney in transplantation

A

Iliac artery and vein

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4
Q

Structure that may be damaged during ligation of uterine or ovarian vessels

A

Ureters

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5
Q

Consequence of damage to ureters during ligation of uterine or ovarian vessels

A

Obstruction or leakage

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6
Q

Components of glomerular filtration barrier

A

Basement membrane, podocytes, endothelial cells

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7
Q

Cells that detect sodium and stimulate JG cells to secrete renin

A

Macula densa cells

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8
Q

Cells stimulated by macula densa cells to secrete renin

A

JG cells

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9
Q

Location of macula densa cells

A

Inside distal convoluted tubule

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10
Q

Location of JG cells

A

Between distal convoluted tubule and afferent arteriol

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11
Q

Cells that function to clean debris from the glomerulus

A

Mesangial cells

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12
Q

Renal vein drains into what major vessel

A

Inferior vena cava

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13
Q

Major vessel renal arteries branch from

A

Abdominal aorta

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14
Q

Structures ureters pass under

A

Uterine artery or vas deferens

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15
Q

Urine path

A

Pyramids - calyces - renal pelvis - ureter - bladder

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16
Q

Renal blood flow

A

Renal artery - segmental artery - interlobar artery - arcuate artery - interlobular artery - afferent arteriole - glomerulus - efferent arteriole - vasa recta/peritubular capillaries - venous outflow

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17
Q

Total body water percentage

A

60%

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18
Q

Compartment made up of interstitial fluid and plasma

A

Extracellular compartment

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19
Q

Percentage of ECF that makes up interstitial fluid

A

75%

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20
Q

Fraction of total body water that makes up ECF

A

2/3

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21
Q

Percentage of total mass of person that makes up ECF

A

40%

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22
Q

Percentage of total mass of person that makes up ICF

A

20%

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23
Q

Normal hematocrit percentage

A

45%

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24
Q

Formula for calculating HCT %

A

HCT % = 3 x [Hb] in g/dL

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25
Q

Method for measuring plasma volume

A

Radiolabeling albumin

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26
Q

Method for measuring extracellular volume

A

Inulin or mannitol

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27
Q

Formula for measuring ECF volume

A

ECF = grams infused/equilibrium concentration

Can be inulin or mannitol

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28
Q

Fraction of total body water that makes up ICF

A

20%

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29
Q

Responsible for filtration of plasma according to size and charge selectivity

A

Glomerular filtration barrier

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30
Q

Type of collagen found in glomerular filtration barrier

A

Type IV collagen

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31
Q

Layer of glomerular filtration barrier podocytes are found in

A

Epithelial layer

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32
Q

Components of basement membrane

A

Type IV collagen chains and heparan sulfate

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33
Q

Type of endothelium found in glomerular filtration capillaries

A

Fenestrated capillary endothelium

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34
Q

Glomerular filtration charge barrier properties

A

Negative charged glycoproteins prevent positive charge molecule entry

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35
Q

Glomerular filtration barrier structure preventing entry of > 100nm molecules and/or blood cells

A

Fenestrated capillaries

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36
Q

Glomerular filtration barrier structure preventing entry of > 50-60 nm molecules

A

Slit diaphragm

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37
Q

Structures that make up slit diaphragm in glomerular filtration barrier

A

Podocyte foot processes interposed with basement membrane

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38
Q

Volume of plasma from which a substance is completely cleared per unit time

A

Renal clearance (Cx)

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39
Q

If clearance of substance is less than GFR

A

Net tubular reabsorption

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40
Q

If clearance of substance is more than GFR

A

Net tubular secretion

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41
Q

If clearance of substance is equal to GFR

A

No net tubular secretion or reabsorption

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42
Q

Formula for renal clearance

A 
Cx = UxV/Px
Ux = urine concentration of substance X
Px = plasma concentration of substance X
V = urine flow rate (ml/min)
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43
Q

Substance used to calculate GFR because it is freely filtered and is neither reabsorbed or secreted

A

Inulin

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44
Q

What is normal GFR

A

100 ml/min

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45
Q

Substance that is an approximate of GFR

A

Creatinine

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46
Q

Incremental reductions in GFR define what disease

A

Chronic kidney disease

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47
Q

Formula for GFR

A

GFR = U(inulin) x V/P(inulin) = Clearance(inulin)

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48
Q

Substance used to measure effective renal plasma flow

A

para-aminohippuric acid (PAH) clearance

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49
Q

Effective renal plasma flow formula

A

eRPF = U(PAH) x V/P(PAH) = Clearance(PAH)

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50
Q

Formula for renal blood flow

A

RBF = RPF/(1 - Hct)

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51
Q

Formula for calculating plasma from Hct

A

Plasma = 1 - Hct

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52
Q

Measurement that underestimates true renal plasma flow slightly

A

Effective renal plasma flow

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53
Q

Measurement that overestimates GFR

A

Creatinine clearance

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54
Q

Formula for calculating filtration fraction

A

GFR/RPF

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55
Q

What is the normal filtration fraction (%)

A

20%

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56
Q

Formula for calculating filtered load (mg/min)

A

GR x plasma concentration

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57
Q

GFR can be best estimated with what measurement

A

Creatinine clearance

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58
Q

RPF can be best estimated with what measurement

A

PAH clearance

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59
Q

Lipid compounds that dilate afferent arteriole

A

Prostaglandins

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60
Q

Drugs that prevent constriction of efferent arteriole

A

ACE inhibitors

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61
Q

Peptide hormone that preferentially constricts efferent arteriole

A

Angiotensin II

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62
Q

Effect of ACE inhibitor

A

Blocks angiotensin II, increases renin, dilates efferent arteriole

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63
Q

Effects of afferent arteriole constriction

A

Decreased GFR, RPF

No change in FF

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64
Q

Effects of efferent arteriole constriction

A

Increased GFR, FF

Decreased RPF

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65
Q

Effect of increased plasma protein concentration

A

Decreased GFR, FF

No change in RPF

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66
Q

Effect of decreased plasma protein concentration

A

Increased GFR, FF

No change in RPF

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67
Q

Effect of constricting ureter on glomerular dynamics

A

Decreased GFR, FF

No change in RPF

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68
Q

Effect of dehydration on glomerular dynamics

A

Decreased GFR and severe decrease in RPF

Increased FF

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69
Q

Drugs that inhibit prostaglandin synthesis

A

NSAIDs

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70
Q

Glomerular arteriole that is affected by NSAIDs

A

Afferent arteriole

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71
Q

Effect of NSAIDs on glomerular arteriole

A

Vasodilates afferent arteriole

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72
Q

Formula for calculating excretion rate

A

V x [U] of substance

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73
Q

Formula for reabsorption rate

A

Reabsorption rate = filtered - excreted

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74
Q

Formula for secretion rate

A

Secretion rate = excreted - filtered

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75
Q

Formula for calculating fraction of excreted sodium

A

Fe(Na) = P(cr)/U(cr) x U(Na)/P(Na)

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76
Q

Section of renal tubule that reabsorbs glucose

A

Proximal convoluted tubule

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77
Q

Percentage of glucose reabsorption in healthy individual

A

100%

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78
Q

Plasma glucose concentration glucosuria begins

A

200 mg/dL

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79
Q

Rate at which all glucose transporters are saturated

A

375 mg/min

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80
Q

Mechanism of gestational diabetes

A

Decreased ability of PCT to reabsorb glucose

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81
Q

Glucose transporter located in proximal convoluted tubule

A

SGLT2

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82
Q

Drugs that inhibit SGLT2 and permit glucosuria at glucose plasma concentrations < 200 mg/dL

A

Flozin drugs

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83
Q

The region of substance clearance between threshold and glucose transporter saturation

A

Splay

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84
Q

Section of renal tubule that contains brush border

A

Early PCT

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85
Q

Section of renal tubule that generates and secretes NH3

A

Early PCT

86
Q

Hormone that inhibits sodium-phosphate contransport leading to phosphate excretion

A

PTH

87
Q

Peptide hormone that stimulates sodium-H+ transporter leading to increased sodium, water and bicarb reabsorption

A

Angiotensin II

88
Q

Consequence of stimulating sodium-H+ transporter leading to increased sodium, water and bicarb reabsorption

A

Contraction alkalosis

89
Q

Section of renal tubule where 60-80% of sodium is reabsorbed

A

Early PCT

90
Q

Section of renal tubule that is impermeable to sodium

A

Thin descending loop of Henle

91
Q

Function of thin descending loop of Henle

A

Passively reabsorb water, concentrate urine

92
Q

Section of renal tubule that makes urine hypertonic

A

Thin descending loop of Henle

93
Q

Section of renal tubule that is impermeable to water

A

Thick ascending loop of Henle

94
Q

Thick ascending loop of Henle has paracellular transport of what ions

A

Calcium and magnesium

95
Q

Mechanism of paracellular transport of calcium and magnesium in thick ascending loop of Henle

A

Positive lumen potential generated by potassium back leak

96
Q

Section of renal tubule that makes urine less concentrated

A

Thick ascending loop of Henle

97
Q

Drug that inhibits carbonic anhydrase

A

Acetazolamide

98
Q

Side effect of acetazolamide

A

Renal tubular acidosis type II

99
Q

Condition that affects sodium-potassium pump at PCT

A

Hyperkalemia

100
Q

How do potassium and chloride move from tubule to interstitium

A

Diffusion down electrochemical gradient

101
Q

Drugs that act on thick ascending loop of Henle

A

Loop diuretics (furosemide)

102
Q

Amount of sodium reabsorbed at thick ascending loop of Henle

A

10-20%

103
Q

Section of renal tubule that makes urine fully dilute

A

Early DCT

104
Q

Ions absorbed at DCT

A

Sodium and chloride

105
Q

Hormone that increases calcium-sodium exchange leading to calcium reabsorption

A

PTH

106
Q

Amount of sodium reabsorbed in DCT

A

5-10%

107
Q

Drugs that act on DCT

A

Thiazide diuretics

108
Q

Section of renal tubule that is regulated by aldosterone

A

Collecting tubule

109
Q

Effect of ADH binding to V2 receptor

A

Insertion of aquaporins on apical side of principal cell

110
Q

Site of action of potassium sparing diuretics

A

ENaC channel on principal cell

111
Q

Renal tubular defect associated with increased excretion of nearly all amino acids, glucose, bicarb, and phosphate causing renal tubular acidosis

A

Fanconi syndrome

112
Q

Site of action of Fanconi syndrome

A

Proximal renal tubule

113
Q

Type of acidosis caused by Fanconi syndrome

A

Renal tubular acidosis type II

114
Q

Autosomal recessive disorder presenting similar to chronic loop diuretic use

A

Bartter syndrome

115
Q

Site of action of Bartter syndrome

A

Na/K/2Cl cotransporter in thick ascending loop of Henle

116
Q

Findings in Bartter syndrome

A

Causes hypokalemia, metabolic alkalosis with hypercalciuria, hypochloremia, increased renin

117
Q

Components of the juxtaglomerular apparatus

A

Macula densa cells, mesangial cells and JG cells

118
Q

Autosomal recessive disorder presenting similar to being on life-long thiazide diuretics

A

Gitelman syndrome

119
Q

Site of action of Gitelman syndrome

A

Na/Cl cotransporter in DCT

120
Q

Findings in Gitelman syndrome

A

Hypokalemia, hypomagnesemia, metabolic alkalosis, hypocalciuria, hypochloremia

121
Q

Autosomal dominant disorder causing a gain of function mutation presenting like hyperaldosteronism

A

Liddle syndrome

122
Q

Site of action of Liddle syndrome

A

Increased activity of Na channel in collecting duct

123
Q

Findings in Liddle syndrome

A

Hypertension, hypokalemia, metabolic alkalosis

124
Q

Treatment for Liddle syndrome

A

Amiloride

125
Q

Hereditary deficiency of 11-B-hydroxysteroid dehydrogenase leading to excess cortisol levels

A

Syndrome of Apparent Mineralocorticoid Excess (SAME)

126
Q

Findings in Syndrome of Apparent Mineralocorticoid Excess

A

Low aldosterone, hypertension, hypokalemia, metabolic alkalosis

127
Q

Acquired form of Syndrome of Apparent Mineralocorticoid Excess is caused from what

A

Eating licorice - has glycyrrhetinic acid which inhibits 11-B-hydroxysteroid dehydrogenase

128
Q

Treatment for Syndrome of Apparent Mineralocorticoid Excess

A

Corticosteroids

129
Q

Mechanism of exogenous corticosteroids in Syndrome of Apparent Mineralocorticoid Excess

A

Decrease endogenous cortisol production leading to decrease mineralocorticoid receptor activity

130
Q

Function of 11-B-hydroxysteroid dehydrogenase

A

Convert cortisol to cortisone

131
Q

Function of renin

A

Convert angiotensinogen to angiotensin I

132
Q

Function of ACE

A

Convert angiotensin I to angiotensin II and breakdown bradykinin

133
Q

Mechanism of renin release

A

JG cells secrete due to low BP, sympathetic discharge from B1 effect, macula densa cells from low sodium

134
Q

Angiotensin II effects on afferent arteriole

A

Vasoconstrict to raise FF to preserve kidney function in low volume states

135
Q

Angiotensin II effects on posterior pituitary

A

Secrete ADH for aquaporin insertion in principal cells for water reabsorption

136
Q

Angiotensin II effects on vascular smooth muscle

A

Binds ATII receptor causing vasoconstriction and raising BP

137
Q

Angiotensin II effects on hypothalamus

A

Stimulates thirst

138
Q

Angiotensin II effects on PCT

A

Increase Na/H+ activity to increase Na, HCO3, water reabsorption

139
Q

Cells that release atrial natriuretic peptide (ANP)

A

Atrial myocytes in response to increased volume

140
Q

Function of ANP

A

Relaxes smooth muscle via cGMP to increase GFR and decrease renin secretion
Also…
Dilates afferent arteriole, constricts efferent arteriole and promotes natriuresis

141
Q

Function of ADH

A

Regulates osmolarity.

Also responds to low blood volume states

142
Q

Function of aldosterone

A

Regulate ECF volume and Na content.
Also responds to low blood volume states
Increases K excretion during hyperkalemia

143
Q

Mechanism of B-blockers on juxtaglomerular apparatus (JGA)

A

Bind B1-receptors of JGA, decreasing renin which lowers BP

144
Q

Glycoprotein released by interstitial cells in peritubular capillary bed in response to hypoxia

A

Erythropoietin

145
Q

Function of erythropoietin

A

Stimulate RBC proliferation in bone marrow

146
Q

Consequence of low erythropoietin

A

Anemia

147
Q

Active form of vitamin D

A

1,25-(OH)2 Vitamin D3

148
Q

Site of conversion to active form of vitamin D

A

Cells of PCT

149
Q

Enzyme that converts 25-OH vitamin D3 to 1,25-(OH)2 Vitamin D3

A

1a-hydroxylase

150
Q

Hormone that acts with 1a-hydroxylase to convert 25-OH vitamin D3 to 1,25-(OH)2 Vitamin D3

A

PTH

151
Q

NSAID side effect in low renal blood flow states

A

Acute renal failure

152
Q

Effect of prostaglandin on renal vasculature

A

Vasodilates afferent arteriole to increase RBF

153
Q

Direct sympathomimetic secreted by PCT cells which dilates interlobular arteries, afferent and efferent arterioles at low doses and acts as vasoconstrictor at higher doses

A

Dopamine

154
Q

Effect of vasodilatory effects of dopamine on renal vasculature

A

Increase renal blood flow, little to change in GFR

155
Q

Hormone secreted in response to low Ca, 1,25-(OH)2 Vitamin D3 and increased plasma phosphate

A

PTH

156
Q

Effect of PTH

A

Increases Ca reabsorption, phosphate secretion and 1,25-(OH)2 Vitamin D3 production

157
Q

Net effect of atrial natriuretic peptide

A

Water and Na loss

158
Q

Digitalis MOA

A

Blocks Na/K/ATPase shifting K out of cells and H+ into cells

159
Q

Effect of hypo-osmolarity on potassium

A

Hypokalemia

160
Q

Effect of alkalosis on potassium

A

Hypokalemia

161
Q

Effect of B-blockers on potassium

A

Hyperkalemia

162
Q

Effect of insulin on potassium

A

Hypokalemia

163
Q

Effect of hyperosmolarity on potassium

A

Hyperkalemia

164
Q

Insulin MOA in hypokalemia

A

Increases Na/K/ATPase activity shifting K into cells

165
Q

Effect of high blood sugar on potassium

A

Hyperkalemia

166
Q

High blood sugar MOA in hyperkalemia

A

Solvent drag pulls K out of cells

167
Q

Effect of succinylcholine on potassium

A

Hyperkalemia

168
Q

Succinylcholine MOA

A

Increase risk in burns and muscle trauma lysis cells leaking K out of cells

169
Q

Effect of cell lysis on potassium

A

Hyperkalemia - K leaks out of cells

170
Q

Primary disturbance in Bartter syndrome

A

Increased urinary calcium

171
Q

Primary disturbance in Gitelman syndrome

A

Decreased urinary calcium

172
Q

Primary disturbance in Liddle syndrome

A

Decreased aldosterone

173
Q

Primary disturbance in Primary hyperaldosteronism

A

Increased aldosterone

174
Q

Primary disturbance in renin-secreting tumor

A

Increased renin

175
Q

Renal disorder with a primary disturbance of increased urinary Ca and secondary high renin and aldosterone with normal BP

A

Bartter syndrome

176
Q

Renal disorder with a primary disturbance of decreased urinary Ca and secondary high renin and aldosterone, low Mg with normal BP

A

Gitelman syndrome

177
Q

Renal disorder with a primary disturbance of decreased aldosterone and secondary high BP, low renin and aldosterone

A

Liddle syndrome

178
Q

Renal disorder with a normal to high BP, low renin and aldosterone

A

SIADH

179
Q

Renal disorder with a primary disturbance of increased aldosterone and secondary high BP and low renin

A

Primary hyperaldosteronism

180
Q

Renal disorder with a primary disturbance of increased renin and secondary high BP and aldosterone

A

Renin-secreting tumor

181
Q

Metabolic acidosis immediate compensatory response

A

Hyperventilation

182
Q

Plasma changes in metabolic acidosis

A

Primary disturbance - low bicarb

Compensatory - low pH, low PCO2

183
Q

Metabolic alkalosis immediate compensatory response

A

Hypoventilation

184
Q

Plasma changes in metabolic alkalosis

A

Primary disturbance - high bicarb

Compensatory - high pH, high PCO2

185
Q

Respiratory acidosis delayed compensatory response

A

Increased renal bicarb reabsorption

186
Q

Plasma changes in respiratory acidosis

A

Primary disturbance - high PCO2

Compensatory - low pH, high bicarb

187
Q

Plasma changes in respiratory alkalosis

A

Primary disturbance - low PCO2

Compensatory - high pH, low bicarb

188
Q

Henderson-Hasselbalch equation

A

pH = 6.1 + log [HCO3-]/0.03 PCO2

189
Q

How do you determine metabolic acidosis

A

Look at pH, bicarb and PCO2 if all low more likely metabolic acidosis

190
Q

Causes of increased anion gap acidosis

A 
MUDPILES:
Methanol
Uremia
Diabetic ketoacidosis
Propylene glycol
Iron tablets or INH
Lactic acidosis
Ethylene glycol (oxalic acid)
Salicylates (late)
191
Q

Causes of normal anion gap acidosis

A 
HARDASS:
Hyperalimentation
Addison disease
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion
192
Q

Causes of Respiratory acidosis in hypoventilation

A 
Airway obstruction
Acute lung disease
Chronic lung disease
Opioids, sedatives
Weakening of respiratory muscles
193
Q

Formula to calculate anion gap

A

AG = Na - (Cl + HCO3)

194
Q

Causes of respiratory alkalosis in hyperventilation

A 
Hysteria
Hypoxemia (high altitude)
Salicylates (early)
Tumor
Pulmonary embolism
195
Q

Causes of metabolic alkalosis in H+ loss/HCO3- excess

A

Loop diuretics
Vomiting
Antacid use
Hyperaldosteronism

196
Q

Winters formula

A

PCO2 = 1.5 [HCO3] + 8 (+/-) 2

197
Q

A disorder of the renal tubules that leads to normal anion gap metabolic acidosis

A

Renal tubular acidosis

198
Q

Mechanism of hypokalemia in RTA type 1

A

Since H+ not excreted, K+ excreted to luminal charge

199
Q

Findings in RTA type 1

A

Urine pH > 5.5, hypokalemia

200
Q

Causes of RTA type 1

A

Amphotericin B, analgesics, congenital anomalies of urinary tract

201
Q

Mechanism of RTA type 1

A

Inability of a-intercalated cells in collecting duct to excrete H+ and regenerate bicarb

202
Q

Treatment for RTA type 1

A

Oral bicarb

203
Q

Findings in RTA type 2

A

Urine pH < 5.5, hypokalemia

204
Q

Mechanism of hypokalemia in RTA type 2

A

Increased bicarb in lumen leads to negative lumen which pull K+ into lumen increasing excretion

205
Q

Causes of RTA type 2

A

Fanconi syndrome, carbonic anhydrase inhibitors

206
Q

Mechanism of RTA type 2

A

Inability of PCT to reabsorb bicarb

207
Q

What causes acidification of urine in RTA type 2

A

a-intercalated cells in collecting duct acidify urine

208
Q

Other name for RTA type 1

A

Distal renal tubular acidosis

209
Q

Other name for RTA type 2

A

Proximal renal tubular acidosis

210
Q

Mechanism of hyperkalemia in RTA type 4

A

Hypoaldosteronism

211
Q

Mechanism of RTA type 4

A

Hypoaldosteronism causes hyperkalemia decreasing ammonia synthesis in PCT decreasing ammonium excretion

212
Q

Findings in RTA type 4

A

Urine pH < 5.5
Hyperkalemia, hyperchloremia
Hyponatremia

Step 1 Renal-First Aid 2017 (4 decks)

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