Comprehensive Review Flashcards
1
Q
level of left kidney
A
TV11-LV2
2
Q
level of right kidney
A
TV12-LV3
lower because of liver
easier to palpate
3
Q
hormones of kidney?
A
renin
erythropoietin
calcitriol
4
Q
posterior to kidney
A
diaphragm
psoas major
quadratus lumborum
transversus abdominus
5
Q
psoas test
A
pain with extension of thigh
6
Q
anterior to left kidney
A
descending colon spleen pancreas stomach jejunum
7
Q
anterior to right kidney
A
ascending colon
liver
duodenum
8
Q
nephrotosis
A
dropped kidney to pelvis
because lack of fascia/fat
loin to groin pain
9
Q
pararenal fat
A
external to fascia
10
Q
perirenal fat
A
between kidney and fascia
11
Q
perinephric abscess
A
can’t spread contralateral
can spread inferior
12
Q
renal arteries
A
branch of aorta LV1/2
right longer and posterior to IVC
13
Q
renal vein
A
drain to IVC
left longer
14
Q
left renal vein gets drainage from?
A
gonadal
left interior phrenic
left suprarenal
15
Q
renal vein entrapment
A
nutcracker syndrome
left renal vein compressed by aorta and SMA
hematuria, ab pain, left testicular pain
16
Q
constrictions of ureter?
A
renal pelvis/ureteric junction
brim of pelvis
ureter entry to bladder
17
Q
ureter artery?
A
upper 1/3 - renal artery/vein
middle 1/3 - gonadal, aorta, common iliac a/v
lower 1/3 - internal iliac a/v
18
Q
ureter lymph?
A
upper - lumbar
middle - common iliac
lower - common, external, internal iliac
19
Q
muscle in urinary bladder?
A
detrusor
trigone - between orifices
20
Q
trigone muscle?
A
inner - ureteric
outer - detrusor
21
Q
ligaments of bladder?
A
lateral ligament of bladder
puboprostatic
22
Q
cystocele
A
fallen bladder
bc of weakened ligaments
23
Q
male urethra?
A
intramural
prostatic
membranous
penile
24
Q
sphincter urethrae muscle
A
skeletal and smooth muscle
-regulates incontinence
25
female urethra
superior (pelvic) and inferior (perineal)
Skenes gland
26
micturition?
bladder fills - activates stretch receptors
-to spinal cord levels S2, S3, S4 pelvic splanchnic nerves
ascend to micturition center
descend to motor GVE-P of pelvic splanchnic
contract detrusor
relax sphincter urethrae
-sympathetic internal AND somatic external
27
kidney stones?
refer pain to T10-L2
| pain loin to groin
28
kidney autonomic
renal plexus
29
kidney sympathetic
preganglionic - T10-L1
-lesser, least, lumbar splanchnic
postganglionic - aorticorena/renal ganglia - renal plexus
30
kidney parasympathetic
pregang - vagus
| postgang - wall of organ
31
ureter autonomic
renal plexus - upper
| inferior hypogastric - lower
32
ureter sympathetic
pregang - T10-L1
-lesser, least, lumbar splanchnic
postgang - various ganglia
33
ureter parasympathetic
pregang - vagus (upper)
-pelvic splanchnic (lower)
postgang - walls of organs
34
bladder autonomic
inferior hypogastric plexus
35
bladder sympathetic
pregang - T10-L2
-lumbar/sacral splanchnic
postgang - various ganglia
36
bladder parasympathetic
pregang - pelvic splanchnic
postgang - walls of organs
afferent - stretch
37
urinary and repro from what?
intermediate mesoderm
38
pronephros
week 4
| vestigial
39
mesonephros
thoracic/upper lumbar
-to 3 months
tubules to wolffian duct (mesonephric duct)
40
metanephros
permanent kidney
by 3rd month
41
metanephric blastema
becomes nephron
42
uteric duct
from mesonephric duct
| -forms collecting duct, calyces, pelvis, ureter
43
ascent of kidney
week 9
| rotate medially
44
kidney blood supply?
originally common iliac
eventially, renal artery from aorta
45
urorectal septum
splits cloaca
46
urogenital sinus
cranial (vesical) - bladder
-continuous with allantois
middle (pelvic) - urethra in female
-in male - prostatic and membranous
gonadal (phallic) - male penile urethra
47
renal hypoplasia
ureteric bud doesn't branch
-lack nephron differentiation
persistant fetal lobulation
48
renal dysplasia
cystic disease
49
autosomal recessive cystic dx?
CD cyst
50
autosomal dominant cystic dx?
CD and nephron cysts
51
renal agenesis
ureteric bud doesn't form or doesn't differentiate the metanephric blastema
unilateral or bilateral
52
potter
bilateral renal agenesis
53
horseshoe kidney
inferior poles fuse
stuck on IMA
54
ectopic kidney
doesn't ascend
55
wilm's tumor
malignant, before age 5
WT1 mutation
56
duplication of ureter
splitting of ureteric bud
57
ectopic ureter
two ureteric budes form
58
urachal anomalies
allantois persists
59
exstrophy of bladder
ventral lateral body wall defect
bladder exposed
often with episadias
60
exstrophy of cloaca
ventral lateral body wall defect
bladder exposed and rectum exposed
more severe
61
renal lobe
pyramid + cortex
62
collagen in LD?
type 4 globular
63
LRI and LRE?
high laminin and heparan sulfate (a proteoglycan)
64
size barrier?
less than 5200 freely
| greater than 69000 doesn't go
65
charge barrier?
cations easier flow
66
tubules?
acidophilic - mitochondria
67
PCT
cuboidal with dense microvilli
68
PST
shoter cells than PCT
| -in medullary rays
69
LH
simple squamous, thin
70
DST
cuboidal
paler staining
apically placed nuclei
71
DCT
simple cuboidal
-only in cortex
returns to corpuscle of origin
60% shorter than PCT
-influenced by aldosterone
72
aldosterone
in DCT
- reabsorb Na and bicarb
- secrete K, H, ammonia
increases salt reabsorption**
73
JG cells?
secrete renin
74
macula densa
monitor Na+
75
CD
cuboidal than columnar cells
76
ADH
increased water permeability in collecting duct
77
light cells
water release (aquaporins)
78
dark cells
acid base balance
79
alpha cells
H+ secretion
80
beta cells
HCO3- secretion
81
type I in renal interstitium
vasodilator (prostaglandins)
82
leukotrienes
vasoconstrictors
83
renal lobule
bordered by interlobular arteries
medullary ray, labyrinth around ray, renal corpuscle, DCT, PCT
84
artery flow in kidney?
aorta - renal artery - segmental artery - interlobar artery - arcuate artery - interlobular artery - afferent - G cap - efferent -vasa recta OR peritubular cap
85
vein flow in kidney?
vasa recta skips interlobular***
peritubular goes to interlobular**
interlobular - arcuate - interlobar - segmental - renal - IVC
86
outflow tract?
transitional epithelium mucosa with lamina propria
inner long/outer circular muscular
adventitia
87
transitional epithelium
stratified epithelium
- dome surface
- tight junctions
88
ureter
stellate lumen
89
urethra
stellate lumen
high elastin
pseudostratified to stratified squamous
90
transcellular fluid
3rd space
91
high in ECF?
Na Cl HCO3
92
high in ICF?
K Mg PO4 protein
93
tonicity
depends on impermeant solutes
94
ECF and ICF?
isotonic
95
Vd?
```
volume of distribution
-less than 3 only plasma
-14 to plasma and interstitum
40-45 to total body water
over 45 to all tissues
```
96
oncotic pressure
determined by large molecules
97
estimate plasma osmolality?
2x [Na]
or plus glucose/18 and urea/2.8
-with diabetes or renal failure
98
hypoxia?
increased ICF Na
| cell swells
99
body fluid balance?
depends on volume and osmolarity
100
crystalloid
electrolytes that will distribute
101
colloid
large proteins that stay in vasculature
102
causes of edema
altered starling forces
| renal retentno of Na+ and H2O
103
non-pitting edema
swollen cells
| -increaed ICF volume
104
pitting edema
increased interstitial fluid
105
thirst
increased due to ANG II
106
aldosterone
increased due to ANG II
107
salt craving
decreased plasma Na+ response
108
sympathetics in kidney?
increased sodium and water retention
109
isoosmotic contraction/expansion
only change in volume
| diarrhea, vomit, hemorrhage, 0.9% salt
110
hyperosmotic volume contraction
loss of H2O
dehydration, diabetes
111
hyperosmotic volume expansion
gain NaCl
NaCl intake, mannitol infusion
112
hypoosmotic volume contraction
loss NaCl
hypoaldosteronism
adrenal insufficiency
diuresis
113
hypoosmotic volume expansion
gain H2O
```
SIADH
psychogenic polydipsia (drink alot of water)
```
114
volume regulators?
SNS
RAAS
ANP (acts to decrease volume)
115
osmoregulators?
ADH
| thirst
116
BUN/Cr greater than 20
pre-renal
117
filtration fraction
GFR / renal blood flow
118
ANG II
vasoconstriction of efferent arterioles
119
sympathetics
vasoconstriction of afferent arterioles
120
cortex
majority of blood flow
121
endothelin
vasoconstriction
| -released in response to kidney damage
122
increase in RBF and GFR?
bradykinin, prostaglandins, NO
123
renal blood flow
20% of cardiac output
124
sympathetics?
smooth muscle contraction
granular - more renin
more reabsorption
more thirst
125
clearance = ?
U V / P
126
GFR estimate?
inulin clearance
127
cystatin C
also for GFR estimate
128
PAH clearance?
renal plasma flow
129
glomerular slit diaphragm?
CD2AP, CD2, nephrin
130
minimal change density
lose negative change in barrier
131
contraction of glomerular mesangial cells
shortens capillaries
lowers Kf
lowers GFR
132
first half PT
Na reabsorption
| glucose and amino acids as well
133
second half PT
chloride reabsorption
134
thick ascending LOH?
Na/2Cl/K cotransport
| Na/H countertransport
135
intercalated cells
in distal tubule
| -H ATPase secretion
136
principle cells
in distal tubules
-reabsorb Na and secrete K
Na/K ATPase
137
secreted in PT
organic acids/bases, drugs
138
inulin
marker for GFR
| 3:1 ratio
139
TF/P ration
inulin - 3
glucose - 0
PAH - 10 secreted
140
PAH secretion
tertiary active transport
141
weak acids
neutral when protonated
142
weak bases
neutral when deprotonated
143
aspirin overdose
give patient bicarbonate
144
dipstick
sensitive to albumin
145
sulfosalicylic acid
sensitive to all proteins
146
albumin
small size and negative charge
147
ACE inhibitor
no ANG II
