Kidney 1

Question 1

where is the upper pole of the kidney?

Answer 1

12th thoracic vertebra

Question 2

where is the lower pole of the kidney?

Answer 2

3rd lumbar vertebra

Question 3

how many vertebral bodies doe a kidney span?

Answer 3

3.5 vertebral bodies

Question 4

renal blood flow gets how much of cardiac output?

Answer 4

20% of CO

Question 5

what is the normal GFR

Answer 5

100-125 ml/min

Question 6

if you have a problem with the renal artery what is compromised?

Answer 6

the entire kidney

Question 7

what nephron as associated w/ maximal ability to concentrate urine?

Answer 7

juxtamedullary nephrons

Question 8

what is the beginning of an individual nephron

Answer 8

glomerulus

Question 9

what region of the glomerulus is nonvascular w/ some contractile components. Sensitive to injury by certain diseases

Answer 9

mesangial region

Question 10

portion of distal convoluted tubule. forms basis for glomerular tubular feedback.

Answer 10

macula densa

Question 11

cells that aren’t inside the glomerulus. Cells aren’t a part of the vascular epithelium

Answer 11

extraglomerular mesangial cells

Question 12

part of epithelial cells that surround the vascular component

Answer 12

food processes (pedicles) of podocytes

Question 13

what type cell is a podocyte?

Answer 13

epithelial cell

Question 14

3 things to remember about the kidney

Answer 14

there are vascular components (dzs due to BVs coming into kidney)
dzs that primarily injury the glomerulus (not necessarily the tubules)
injuries primarily to tubules and interstitium (don’t affect glomerulus)

Question 15

with damage to the glomerulus what will you see on dipstick?

Answer 15

proteinuria

Question 16

with a problem w/ the tubules what would you expect to see?

Answer 16

fluid or electrolyte management

wasting of sodium, glucose, amino acids

Question 17

60-80% of everything that is filtered by the glomerulus is reabsorbed where?

Answer 17

proximal tubule

Question 18

all resabsorptive functions of any of the tubules (proximal, loop of henle, distal, collecting duct) requires what?

Answer 18

energy (primarily glucose)

Question 19

where is bicarbonate reabsorbed?

Answer 19

proximal tubules

Question 20

what else is reabsorbed in the proximal tubule?

Answer 20

Na
glucose
phosphorus

Question 21

where is carbonic anhydrase found?

Answer 21

proximal tubules

diuretic affect this

Question 22

section of nephron where concentration of medullary space happens.

Answer 22

loop of henle

Question 23

what happens in the descending part of the loop of Henle

Answer 23

water goes out, fluid becomes concentrated (1200)

Question 24

what happens in the ascending loop of henle?

Answer 24

transport NaCl out
hypertonic area
sensitive to ischemic loss

Question 25

what happens in the thick part of the ascending loop of henle?

Answer 25

Na, K, and 2 Cl are transported out | back to normal osmole concentration of body

Question 26

where do loop diuretic works?

Answer 26

thick part of ascending loop of Henle

Question 27

what does ADH do in the thick ascending limb?

Answer 27

ADH acts to cause fluid reabsorption

Question 28

where do thiazide diuretic swork?

Answer 28

distal convoluted tubule | block Na/K co-transport system

Question 29

where do you form free water because Na is moved out of luminal cells but the membrane is impermeable to water.

Answer 29

distal convoluted tubule

Question 30

where does aldosterone have a significant effect and causes Na reabsoprtion and K and hydrogen secretion

Answer 30

cortical collecting duct

Question 31

where do the potassium sensitive diuretics act?

Answer 31

cortical collecting duct

Question 32

area where final acidification occurs. Na/K exchange mechanism. fine tuning of acid/base balance occurs.

Answer 32

medullary collecting duct

Question 33

where does the formation of Tamm-Horsfall protein occur? (forms matrix of casts of urine)

Answer 33

distal tubule

Question 34

pressure that is a result of plasma protein in blood

Answer 34

oncotic pressure

Question 35

pressure determined by blood pressure

Answer 35

hydrostatic pressure

Question 36

what is glomerular filtration a function of

Answer 36

surface area permeability hydrostatic/ oncotic pressures

Question 37

what is creatinine production rate?

Answer 37

10-20 mg/kg/ 24 hours

Question 38

how do you figure out 24 hour creatinine production?

Answer 38

15 mg/kg/24 hours x weight in kgs

Question 39

an adequate 24 hour urine collection should have how much protein?

Answer 39

1 gram

Question 40

what's the most creatinine will increase in 24 hours?

Answer 40

2 points

Question 41

what is the formulation for CC?

Answer 41

[(140-age) X LBW] / 72 X Scr (mg/dl)

Question 42

what is LBW for females?

Answer 42

45.5 + (2.3 x each inch from 60 inches)

Question 43

what is LBW for males?

Answer 43

50.0 + (2.3 x each inch from 60 inches)

Question 44

a serum creatinine of -1.0 corresponds to what GFR?

Answer 44

100

Question 45

a serum creatinine of -4.0 corresponds to what GFR?

Answer 45

25

Question 46

a serum creatinine of -8.0 corresponds to what GFR?

Answer 46

12.5

Question 47

when serum creatinine doubles, GFR decreases by what?

Answer 47

50%

Question 48

why can plasma creatinine increase?

Answer 48

increased release from muscles decreased proximal tubular secretion analytical interference (lab erros)

Question 49

what drugs cause decreased proximal tubular secretion

Answer 49

cimetidine triamterene (diuretic) trimethoprim

Question 50

what is the better determinate for renal failure

Answer 50

creatinine

Question 51

what is the normal BUN/ creatinine ratio

Answer 51

20:1

Question 52

what can cause an increased Bun to creatinine ratio

Answer 52

``` effective volume depletion GI bleed early obstructive uropathy catabolic states/ sepesis increased protein intake steroids tetracycline ```

Question 53

what can cause a decreased BUN/Cr ratio (<10:1)

Answer 53

Liver dz low protein rhabdomyolysis

Question 54

what is urine production <50-100 mL/ 24 hours

Answer 54

anuria

Question 55

what is urine production of 100-480 ml/24 hours

Answer 55

oliguria

Question 56

what is urine output of >3 L/ 24 hours

Answer 56

polyuria

Question 57

what is high output state?

Answer 57

0.5-1.0 Liters/hour

Question 58

labs to get with kidney disease

Answer 58

CBC CMP urinalysis urine eosinophils

Question 59

best initial imaging in renal disease

Answer 59

US and doppler (renal blood flow)

Question 60

gives anatomical features and function (secretion of isotopes)

Answer 60

isotopic renogram

Question 61

what is the concern w/ gadolinium?

Answer 61

exacerbating renal failure

Question 62

what does negative urinary sediment means?

Answer 62

water like

Question 63

what does bland urinary sediment mean?

Answer 63

non-diagnostic

Question 64

what does an active urinary sediment mean?

Answer 64

diagnostically suggestive

Question 65

what does an angry urinary sediment mean?

Answer 65

diagnostic implications

Question 66

where do dysmorphic rbcs come from?

Answer 66

injured glomeruli

Question 67

how many WBCs per high powered field have some diagnostic significance

Answer 67

3-5 WBCs

Question 68

if you see a red blood cell cast what does that indicate?

Answer 68

glomerulonephritis

Question 69

what does a WBC cast indicate?

Answer 69

from kidney, they were in tubular fluid pyelonephritis tubular interstitial condition

Question 70

what does a fatty cast indicate?

Answer 70

major lipid disorders | nephrotic syndrome

Question 71

what will a polarized fatty cast look like?

Answer 71

looks like clovers

Question 72

what does a granular cast indicate?

Answer 72

concentrated urine and low flow state

Question 73

what crystals look like a coffin?

Answer 73

phosphate crystals

Question 74

what HIV drug can produce stones and cause obstructive neuropathy

Answer 74

indinavir

Question 75

most frequent cause of hematuria

Answer 75

``` urinary tract infection stones exercise, trauma endometriosis sickle cell polycystic kidney disease cancers BPH intrinsic glomerular dz ```

Question 76

what is glomerular protineuria usually

Answer 76

albumin

Question 77

when does orthrostatic proteinuria go away

Answer 77

at night | but will be >2.0 grams during the day

Question 78

what can cause tubular proteinuria?

Answer 78

microglobulins albumin usually <1.5-2 grams a day

Question 79

whey do you look at the retinas?

Answer 79

window to microvasculature

Question 80

mild albunimuria is associated with what?

Answer 80

increased CV risk

Question 81

what can hyperfiltration due to only having one kidney lead to?

Answer 81

focal glomerular necrosis | proteinuria can get worse

Question 82

do you see dysmorphic RBCs with diabetic disease?

Answer 82

No usually of a vascular origin not an inflammatory origin

Question 83

what can statins cause?

Answer 83

heme positivity on a UA | statins can lead to rhabdomyolysis

Question 84

if you see a 3+ blood on urine but not RBC casts what is the cause?

Answer 84

breakdown of myoglobin