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Anderson Nephrology Flashcards

1
Q

drug induced pathologies with kidney papilli

A

papilli are at the apex of the renal pyramids

cause necrosis and then they get blocked and urine can’t get out

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2
Q

what does a nephron consist of

A

glomerulus and collecting ducts and tubules

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3
Q

which type of nephrons have loop of henle?

A

juxtamedullary nephrons (not cortical)

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4
Q

efferent tubules

A

take blood away from glomerulus

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5
Q

what did pericapillary system/vasa recta come from?

A

efferent tubules

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6
Q

what are afferent and efferent arterioles sensitive to?

A

afferent: epinephrine
- constriction of afferent arteriole leads to decreased filtration (GFR decreases)
efferent: angiotensin-2
- constriction of efferent leads to increased pressure in glomerulus

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7
Q

hemorrhage leads to what in kidney

A

glomerulus shuts down (increased EPI constricts afferent arteriole) and GFR decreases to conserve fluids

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8
Q

what does macula densa do?

A

senses sodium potassium and it is at the end of the tubule before the collecting duct

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9
Q

renal clearance

A

amount of plasma that gets completely cleared

if substance is completely removed from plasma while passing through the kidneys, then clearance equals plasma flow.

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10
Q

most common cause of hyperosmolarity

A

dehydration

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11
Q

hyperosmolarity results in

A

hypothalamus releases ADH and increases thirst

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12
Q

low blood volume results in

A

baroreceptors (sympathetic NS) and macula densa activate sympathetic NS and release renin from JGA (volume regulation)

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13
Q

how much sodium goes back into the blood in the first two mm of proximal tubule and how?
how much in thick ascending loop of henle?
distal tubule?

A

67% (2/3) glucose, AAs, PO4 cotransporter and via Na/H exchange.

25% Na K Cl tritransporter

8% Na-Cl cotransporter

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14
Q

what is reabsorbed in proximal tubule?

A

67% Na and H2O

all glucose, HCO3, and amino acids

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15
Q

How much K is reabsorbed in proximal tubule?

distal loop of Henle

distal tubule

A

67% with Na and H2O

20% via Na K Cl tritransporter

either reabsorbed or secreted depending on dietary intake of K

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16
Q

What is interesting about K excretion in distal tubule?

A

if hyperkalemia, nephron can regulate and can pump K from blood to urine in distal tubule
- will see excess K in urine if hyperkalemic

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17
Q

what part of the nephron is water impermeable and generates the osmotic gradient?

A

Loop of Henle

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18
Q

what is job of macula densa?
Low GFR =
what is response to low GFR?

A

sense Na and Cl levels
increased Na/Cl
increase filtration rate by angiotenin 2 and constriction of efferent arteriole

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19
Q

what makes angiotensinogen?

A

liver

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20
Q

what converts angiotensinogen to angiotensin 1?

A

renin

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21
Q

ACE enzyme comes from where and what does it do?

A

Comes from lungs and converts angiotensin 1 to angiotensin 2.

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22
Q

what are 2 actions of angiotensin 2?

A

constricts efferent arterioles and increases GFR

promotes release of aldosterone from adrenal cortex (zona glomerulosa)

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23
Q

what does aldosterone do?

A

acts on distal tubules and forces reabsorption of Na and H2O and excrete K

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24
Q

aldosterone affect

A

Na increases and K decreases in blood

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25
Q

oxidative deamination

reductive amination

A

amino acid to alpha keto acid (removing N)

alpha keto acid to amino acid form (adding N)

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26
Q

what are ALT and AST enzymes dependent on?

A

vit B6

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27
Q

what do transamination reactions do?

A

removes amino group from amino acid, leaving behind it’s alpha keto acid
free amino group is transferred to a waiting alpha keto acid to form a new amino acid

28
Q

urea cycle occurs where?

what does it do?

A

liver

gets rid of free CO2 and NH4

29
Q

what happens if there is excess CO2 and NH4?

A

toxic encephalopathy

30
Q

what part of urea cycle happens in mitochondria?

what part happens in the cytosol?

A

mitochondria: induction phase, ornithine is made with carbamoyl phosphate synthase, NH4 and CO2 and pumped out as citruline.

31
Q

what enzyme hides CO2 and HH4 in mitochondria during urea cycle?

A

carbamoyl phosphate synthase phosphorylates N and C groups and puts them in a package that can encounter ornithine.
ornithine decarboxylase dephospharylates N and C onto ornithine

32
Q

What happens to citruline when it gets outside of mitochondria in the urea cycle?

A

goes through many transamination reactions until it forms arginine

33
Q

what does arginine do when it is acted on by arginase?

A

urea is made with left over portion of NH4 and CO2

34
Q

what is happening in cytosol portion of urea cycle?

A

citruline undergoes various transamination reactions to form urea and ornithine residue restarts the whole cycle

35
Q

backdoor for N residues?

A

amino shuttle that doesn’t use urea
oxidative deamination takes off N group and it is shuttled out of kidney with glutamine and then it finds H ions in urine and you pee out ammonia

36
Q

acute glomerulonephritis is caused by what?

A

strep
derm, ortho joint, kidney/heart symptoms can happen after non-treated strep and this points towards post-strep glomerulonephritis

37
Q

IgA nephropathy/Berger’s

A

increased IgA in response to viruses, bacteria (GI and lungs)
end up with hematuria, proteinuria, and chronic glomerulnephritis due to too much IgA

38
Q

Henoch Schonlein Purpura

A

in children

respiratory illness prodrome, high IgA = sore joints, get leaky kidney, and get purpura

39
Q

Goodpasture’s

A

rapid GN with auto-antibodies to basement membrane

young men who smoke

40
Q

nephrotic syndrome

A

proteinuria, edema, hypoalbuminemia, hyperlipidemia, lipiduria
foamy urine

41
Q

pyelonephritis

A

infection in kidneys (renal pelvis)
ascending fecal flora due to blockage (pregnancy, BPH)
medical emergency

42
Q

hydronephrosis

A

swollen ureter or renal pelvis due to obstruction (stone)

43
Q

what type of stones show up on X-ray?

A

Ca oxalate

44
Q

uric acid calculi is secondary to?

A

gout

45
Q

cystitis vs interstitial cystitis?

A

cystitis due to local flora (e. coli)

interstitial cycstitis: autoimmune attack on inner lining of bladder (punctate hemorrhages)

46
Q

adenocarinoma/hypernephroma

A

painless hematuria

cigarette smokers

47
Q

Wilm’s Tumor

A

common primary renal tumor in kids

large abdominal mass, painless hematuria

48
Q

what do kidneys secrete?

A

EPO to increase RBC production in bone marrow

49
Q

What do kindeys do?

A 
filter blood
secrete EPO
volume regulation
vit D activation
gluconeogenesis in starving state
50
Q

where are the kidneys located?

A

in retroperitoneal space

  • deep to 12th rib
  • r is lower due to liver
51
Q

blood supply to kidney

A

aorta -> renal artery ->

52
Q

what do kidneys secrete?

A

EPO to increase RBC production in bone marrow

53
Q

What do kindeys do?

A 
filter blood
secrete EPO
volume regulation
vit D activation
gluconeogenesis in starving state
54
Q

where are the kidneys located?

A

in retroperitoneal space

  • deep to 12th rib
  • r is lower due to liver
55
Q

blood supply to kidney

A

aorta -> renal artery -> segmental -> interlobar -> arcuate -> interlobar -> affarent -> efferent -> vasa recta -> renal vein goes into inferior vena cava

56
Q

innervation of kidney

A

sympathetic via splenic n

57
Q

what does kidney arise from?

A

mesoderm -> urogenital ridge -> ovaries and tests and nephrogenic cord -> holonephros -> pronephros, metanrphros, mesonephros

58
Q

what do the pronephros, metanephros, and mesonephros turn into?

A

pronephros: regress
mesonephros: wolfian duct -> bladder and vas deferens, seminal vessicles, ejaculatory duct, epididmis
metanephros: from mesonephros: renal ureters, pelvis, calyces, collecting ducts

59
Q

what forms the renal pelvis, calyces, collecting ducts?

A

metanephros via uretic bud

60
Q

what gives rise to ovaries?

A

malarian duct via mesoderm and urogenital ridge

61
Q

what gives rise to testes?

A

wolfian duct via mesonephros

62
Q

what is blood glucose measure for diabetics?

A

over 160-200g/dL

63
Q

what does collecting duct do?

A

ADH released from post pit to conserve water by increasing aquaporins
H2O reabsorption to concentrate urine

64
Q

What hormone is released in distal convoluted tubule?

A

PTH reabsorbs Ca from filtrate into blood

65
Q

What hormone is released into proximal convoluted tubule?

A

PTH secretes phosphate into filtrate = secretion

66
Q

capillary endothelium
basement membrane
slit diaphragm in basement membrane

A
  • fenestrated so that only certain sizes can get through
  • charged heparin sulfate groups inhibit large molecules/proteins
  • podocyte feet last catch

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