CHAPTER: Renal Flashcards Preview

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Flashcards in CHAPTER: Renal Deck (65):
1

The kidney develops in 3 nephros parts - name each part and its role

1st = PRO-nephros - degenerates by wk 4
2nd = MESO-nephros - 1st trimester kidney
3rd = META-nephros - permanent kidney that has 2 parts: uretric bud (from bottom of meso duct) + metanephric mesenchyme

2

What adult structures arise from the :
Meso-nephros
Uretric bud
Metanephric mesenchyme

Meso = male vas deferans
Metanephric mesenchyme = glomerulus -> DCT
Uretric bud = (everything else) ureter, renal pelvis + calyces, CDs

3

What is causing fetal hydronephrosis if it is:
1. Obstructive + unilat
2. Non-ob + unilat
3. Bilateral in a boy

1. Kink in ureto-pelvic jxn - makes sense since the junction is the last part of the system to become hollow
2. Incomplete CLOSURE of the vesicouretral jxn
3. Posterior urethral valves -> may also cause Potter sequence

4

No uretric bud means....

No kidney = agenesis aka the primordial tissue was never even there

5

What are you thinking if a baby has unilat vs bilat cystic kidney on US

Unilat = multicystic dysplastic kidney (NOT inherited)
Ureteral bud is there - kidney exists
But doesn't cause metanephric mesenchyme to differentiate - no glom -> DCT
Kidney is not fxnal - mass of cystic CT
Bilat = AR PCKD (can cause Potter's)

6

If a kid presents with recurrent UTIs due to asynchronous muscle contractions + vesicoureteral reflux - what deformation are you thinking?

Duplex collecting system
2 pelvises -> 2 ureters -> 2 diff insertions into bladder
There was an early separation of the ureteric bud

7

Which kidney do you use for transplant and why?

L kidney b/c longer renal vein (has to cross over aorta)

8

Walk through renal BF from renal art -> afferent art

Lobe - arch - LOB
Renal art
Segmental art
Interlobar art
Arcuate art
Interlobular art
Afferent art

9

SAD PUCKER for retroperitoneal organs

Supra-renal (adrenals)
Aorta + IVC
Duodenum pts 2-4
Pancreas except top 1/3
Ureters (water under bridge)
Colon - ascending + descending
Kidneys
Esophagus - lower 2/3
Rectum

10

The ureter has 3 sources of blood supply - name them. What dermatomes does kidney pain localize to?

Top 1/3 = renal art
Middle 1/3 = middle iliac + gonadal art
Lower 1/3 = int iliac
T10/11 dermatomes = CVA tenderness (T10 = belly button)

11

2 things you can measure with inulin

GFR - 100% filtered, no secretion or absorption
ECF (also mannitol) = 1/3 of TBW

12

Where do NSAIDs affect the kidney

PGs dilate the AFFERENT arteriole, so NSAIDs cause constriction
PGs secreted from kidney, work paracrine
X PGs -> ↓RPF -> ↓GFR
No change to FF = GFR/RPF

13

Fanconi syndrome

Many causes defective PCT
1. Metabolic acidosis - can't reabsorb bicarb
2. ↑U AA, glucose, bicarb, P

14

Bartter syndrome

X Na/K/2Cl - AR
Looks like chronic loop diuretic use:
1. Metabolic alkalosis
2. HypoK (duh)
3. ↑U Ca (duh)

15

Gitelman syndrome

X NaCl @ DCT - AR
Looks like chronic thiazide use (metabolic alkalosis)
↓U Ca (duh)

16

Liddle syndrome - present, inheritance, treat

Presents as HTN w/ ↓aldo - weird!
GOF of ENAC - AD
+ Amiloride

17

Syndrome of apparent mineralcorticoid excess - inheritance + treat

X 11 beta OH deH
Can't inactivate cortisol -> will cross react to bind aldo R (looks like excess aldo @ CD but really ↑cortisol)
Presents as HTN w/ ↓Pk + metabolic acidosis (excess aldo)
+ CS - exog CS ↓prod of endog CS

18

What food can cause acquired SAME (↑cortisol)

BLACK licorice

19

What type of RTA causes basic urine w/ hypoK? Name drug that can cause this?

T1 RTA (normal gap metabolic acidosis)
Alpha int cells @ CD won't secrete H+
Means you hold H, waste K (hypoK)
↑Risk Ca stones (basic urine) + ↑bone turnover
AMPHO B

20

What type of RTA causes acid urine w/ hypoK? 1 disease cause vs 1 drug cause

T2 RTA (normal gap metabolic acidosis)
X HCO3 reabsorbed @ PCT
But urine gets acidified by alpha int cells @ CD
Idk why hypoK
1. Fanconi = defective PCT
2. CA Is

21

What type of RTA causes acidic urine w/ hyperK?

T3 RTA (normal gap metabolic acidosis)
Hypoaldo
Waste Na, hold K -> hyperK ↓NH3 syn @ PCT -> ↓NH4 excretion = acid urine

22

MUDPILES = gap metabolic acidosis (K+Na - Cl+HCO3)

Methanol
Uremia
DKA
Propylene glycol
Iron tab or INH
Lactic acidosis
Ethylene glycol --> oxalic acid
Salicylates

23

HARD ASS = non-gap metabolic acidosis

Hyperalimentation = feeding tube
Addison disease
RTA
Diarrhea
Acetazolamide (T2 RTA)
Spironolactone
Saline infusion

24

Signs of hyper vs hypo Mg

Hypo: torsades, tetany (no just hypoCa), hypoK
Hyper: ↓DTR, ↓HR + BP, ↓Ca, cardiac arrest

25

Why might chronic NSAID use cause renal pap necrosis?

X PGs -> constrict afferent arteriole
Chronically ↓renal BF states = ischemia = renal pap necrosis

26

Where in the kidney is dopamine made - what is its effects at high vs low doses?

PCT - goal = naturesis
↓dose = dilates interLOBULAR, afferent + efferent = ↑RBF
↑dose = vasoconstrict

27

Where does PTH ↑Ca reabsorb vs ↑P excrete

DCT reabsorb Ca
Trash P at PCT

28

How does ANP/BNP cause natriuresis

↑cGMP -> relax SM -> dilate A art + constrict E art
↑GFR = ↑Na filtered w/o ↑Na reabsorption
This is how diuretics are limited in effectiveness

29

What is the JGA - what 2 cells make it up?

JG cells = SM @ afferent art
Macular densa = Cl sensor @ DCT
Apparatus secretes renin

30

Casts seen in ESRD

Waxy

31

Nephritic syndromes are characterized by immune complexes. What cell mediated the damage to the glomerulus in these diseases?

C5a attracts neutrophils

32

Lumpy bump IF + subEPI humps

Post strep GN

33

SLE presentation of nephritic vs nephrotic

Phritic = diffuse prolif GN ask IC deposit
Phrotic = mebranous

34

Wire looping capillaries LM + sub-endo IC on EM + granular IM

Diffuse proliferative GN

35

Basket weave EM w/ splitting of the BM

Alport - X dominant

36

Hep B/C infection w/ tram track LM, granular IF, GBM splitting

Type 1 membranoprolif GN - sub-endo
Tram track - membranous

37

Excess C3 nephritic factor stabilizes C3 convertase and causes what GN

Type 2 membranoprolif GN - intramembranous deposits, overall tram track on LM (membranous

38

Frothy urine means what casts

Fat - think nephrotic

39

What type of cancer might cause MCD

Hodgkins - RS secreting cytokines effaces foot processes

40

HIV + sickle cell pts presenting with nephrotic syndrome - which one

FSGS

41

LM tram track, granular IF, spike + dome EM

Membranous nephropathy
Spike + dome is sub-epi

42

2 non-enzymatic glycosylation changes to the glomerulus in diabetes // why give ACE Is to diabetic patients

@ GBM @ diffuse thickening
@ efferent art -> narrow lumen -> ↑GFR -> mesangial expansion
Give ACE to counteract AGT 2 constrict at efferent ↓GFR and minimize mesang prolif

43

Describe why nephrotic syndromes are a hyper-coag with ↑infection risk

Hypercoag - lost AT3 in urine
Lose Ig in urine = ↑infections

44

Which 3 stones form in acid urine - what does each look like

Ca oxalate - envelope or dumbell
Uric acid - (duh basic would neutralize) diamond or rosette
Cystine - cystinuria AR - hexagonal
Defective reabsorb COLA - cyteine, orthinine, lysine, arginine

45

Hydronephrosis if untreated causes atrophy of what 2 parts of the kidney

cortex + medulla

46

RCC
Originates from what cells
Histo of cells
Color of tumor
RF
Mets via and to
Treat

From PCT
Clear cell RCC = filled with fat
Therefore gold/yellow color
SMOKING + obesity
Carcinoma that mes via blood - renal vein -> lung + bone, impt to know b/c commonly see the met 1st
Aldesleukin = IL 2 to ↑NK
RESISTANT to chemo + radiation

47

Renal oncocytoma - histo, cell arise from, gross

From CD
Eosinophilic cells
Central scar on gross

48

3 ways a Wilm's tumor can present depending on WT1 vs WT 2 mutation

WT1: WAGR = Wilms, no iris, GU malform, mental retard
WT1: Wilms, male pseudohermaphroditism
WT2: Wilms, big tongue, organomeg, hemihypertrophy

49

4 RF for urothelial/transitional cell bladder cancer + 2 types

Smoking, analine dyes, cyclophosphamide (+mensa)
Flat = early p53 mut, starts high grade
Papillary = low -> high grade
Ex of field effect tumor - multifocal + likely to recur

50

Detursor muscle instability leads to

Urgency incontinence = any vol in bladder causes urge to void immediately + leak
+ AntiM = oxybutynin
Vs detrusor underactivity = overflow incontinence

51

3 causes of bladder adenocarcinoma

1. @dome due to urachal remnant
2. Cystitis grandularis = chronic inflam (cystitis) causes columnar metaplasia (glandularis)
3. Extrophy = congenital malformation a tthe bottom of the ant ab + bladder walls (born with bladder outside belly)

52

Sterile pyuria indicates what cause of UTI (- culture, + WBC)

Neisseria or chlamydia - treat for both!

53

Imaging of acute pyelo

@ cortex - striated parenchymal enhancement
Aka light up the outside of kidney

54

Where does the kidney normally scar with chronic vesicouretral reflux?

Upper + lower poles

55

2 changes to the kidney with chronic pyelo

Cortico/med scarring + blunted calyx
"Thyroidization of kidney" - eos casts

56

2 major causes of diffuse cortical necrosis

DIC + vasospasm

57

2 major imaging findings for renal osteodystrophy

Subperiosteal thinning
Tissue calcifications

58

Why is BUN/Cr ration ↑ w/ pre-renal azotemia/AKI

Pre-renal means kidney think being under-perfused
↓GFR -> RAAS -> ↑Na reabsorb -> H2O follows -> BUN follows
Goal = reabsorb to gain vol

59

Ethylene glycol poisoning cause what 2 things

Gap metabolic acidosis + Ca oxalate crystals

60

Ps that cause acute interstitial nephritis

Drugs that produce haptans -> eosinophils in urine is pathoneumo
Pee = diuretics
Pain free - NSAIDs
Penicillin + cephalosporins (vs aminoG cause ATN)
PPIs
RifamPin

61

3 stages of ATN

Inciting event
Maintenance = ↓urine - metabolic acidosis + ↑K + uremia
Recovery = tons of urine, risk of hypoK

62

4 causes of renal pap necrosis

Sick cell
Acute pyelo
NSAIDs
Diabetes

63

Heart problem in AD PCKD - what parts of the kidney does AR vs AD PCKD affect

Mitral valve prolapse
AD - cortex + medulla
AR = babies = CD
Both HUGE cystic kidneys

64

If you have cysts in the medulla only of the kidney how will the kidney as a whole look?

Shrunken - medullary cystic kidney disease

65

Simple vs complex renal cysts on US

Simple: filled with fluid
Complex - septated, enhanced, solid components, bad b/c ↑RCC risk