MF2 RENAL Flashcards
(50 cards)
Which kidney is higher
left
Describe the vasculature of the kidney
renal artery → segmental arteries → interlobar artery → arcuate artery → cortical radiate arteries → afferent arterioles → glomerular capillaries → efferent arterioles → peritubular capillaries and/or vasa recta → interlobar veins → arcuate veins → interlobar veins → segmental veins → renal vein
Risk factors of upper UTI
- Female
- Sexual intercourse
- Indwelling catheter
- Diabetes mellitus
- Urinary tract obstruction
- Vesicoureteral reflux: primary congenital defect, bladder outlet obstruction)
Risk factors of lower UTI
- Sexual intercourse
- Female
- Post-menopause (decreased estrogen)
- Foley catheter
- Hyperglycemia
- Impaired bladder emptying
- Poor hygiene
Symptoms and Urinalysis for UTIs
SYMPTOMS
- Lower
> Dysuria
> Increased frequency
> Increased urgency
> Suprapubic pain
- Upper
> Fever
> Chills
> Flank pain (costovertebral engle)
- Kids
> Delirium
> Fatigue
> Incontinence
- Elderly
> Irritable
> Malodorous
> Fever even in lower
URINALYSIS
- WBCs
- Leukocyte esterase
- Nitrates
- Hematuria
Radiology for UTI diagnoses
- Renal ultrasound: can be used with kids with kidney malformation that can lead to UTI
- Bladder Ultrasound
- Voiding (VCUG) cystourethrogram: radiocontrast on fluoroscopy to watch urination
> Vesicoureteral reflux
Types of Kidney Stones
Nephrolithiasis: solutes in urine precipitate out and crytallize
- Calcium stones: calcium oxalate (80%) or phosphate
- Uric acid: lose too much fluid, high protein diet, diabetes, metabolic syndrome
- Struvite: magnesium ammonium phosphate → upper UTI
- Cysteine stones: rare disorder → cystinuria
Xanthogranulomatous peylonephritis: infected kidney stone causes chronic obstruction → infection and increased pressure
Kidney stones treatment
- Shockwave lithotripsy
- Medications
> a-blockers/CCB
> NSAIDs/opiates
Receptors in bladder and urethra
- B3 on bladder wall: binds NE; relax bladder
- M3 on bladder wall: binds acetylcholine; contract detrusor
- Stretch receptors on bladder wall: detect rugae expansion
- a1 on internal sphincter: binds NE; closes sphincter
- N1 on external sphincter: binds Ach; closes sphincter
Nephrotic syndrome (subtypes, causes)
Massive proteinuria, hypoalbuminemia, hyperlipidemia, edema
- Increased permeability through damaged glomerular basement membrane
- PRIMARY (intrinsic kidney disease)
> Membranous glomerulonephritis: white adults,
thickened basement membrane from auto-Abs
- HBV, SLE, solid tumors (lung, breast, GI)
> Minimal change glomerulonephritis: children; if adult
check hematological malignancy;
- NSAIDs
***PERIORBITAL EDEMA IN KIDS
> Focal segmental glomerulosclerosis:
- African ancestry, obese, HIV, scaring/sclerosis of
glomerulus - SECONDARY (systemic disease, congenital)
> Nodular Glomerulosclerosis
- DM: hyperglycemia → glycation → thickened
basement membrane → hypertrophy, scarring,
thickening
- Amyloidosis: nodular deposits
> Focal segmental glomerulosclerosis: podocytes
- Inherited, heroin
> Membranoproliferative GN
- HCV, malaria, SLE, leukemia, lymphoma, shunt
neprhitis
Factors affecting GFR
- Pressure out
> Glomerular hydrostatic pressure: out capillaries - Pressure in
> Colloid pressure: by plasma proteins pulling water
> Scapular hydrostatic pressure: fluid backup - KF
> Surface area of glomeruli
> Permeability of glomeruli
Diagnosing Nephrotic syndrome
- Urinalysis
> 3+ or 4+ proteinuria (dipstick) - Blood test
> Hypoalbuminuria
> Hyperlipidemia
> HIV, Hep C (FSG)
> Autoantibodies (membranous)
> Cancer - Physical exam
> Edema - Renal biopsy
Nephrotic syndrome treatment
- Corticosteroids: immune suppression
> Prednisone - Diuretics: loo diuretics for edema
> Furosemide
Nephron - Proximal Convoluted Tubule
- 3NA/2K pump, water follows
- NaCl channel
- Amino acids
- SGLT2 transporter (glucose)
> Jiardiance is an inhibitor; used for diabetes, HTN - HCO3 reabsorb, Na & H antiporter
> Acetazolamide inhibits → Na/H2O excretion, acidosis
> Impaired = type II renal tubular acidosis
Nephron - Loop Henle
- Aquaporin I: water pump
> Mannitol increases gradient → more reabsorption - Na/K/2Cl cotransporter
> Loop diuretics inhibit (furosemide)
> Barters type I syndrome - ROMK: K pump
> Barter’s type III - IC-KB: Cl pump
> Barter’s type II
Nephron - Distal Convoluted Tubule
- NaCl pump
> Thiazide diuretics inhibit (increased Ca absorb)
> Gitleman’s syndrome - 3Na/2K pump, water follows
- Ca channel
> Hypercalcemia: cancer if admitted, hyperparathyroidism
if outpatient
> PTH activates this channel - Na pump
> Aldosterone activates (activated by ACE) - K pump
> Aldosterone activates (activated by ACE)
-3Na/2K pump, water follows
> Aldosterone activates (activated by ACE)
**K sparing diuretics inhibit aldosterone (receptor agonist)
> Spironolactone
**Type IV renal tubular acidosis inhibits aldosterone
Nephron - Collecting system
- Intercalated A cells: secrete H
> Inhibition is type IV renal tubular acidosis - Intercalated A cells: reabsorb H
- Aquaporin II: pump water
> Activated by ADH (activated by increased plasma
osmolarity, decreased blood volume)
> Activated in SIADH (urine concentrated, euvolemic; small
cell lung cancer)
> Inhibited by chronic lithium (bipolar meds, diabetes
insipidus; urine dilute, inappropriate)
Barter’s Syndrome
- Loop of Henle issue → acts like loop diuretic
- Infants
- Increased renin
- Increased aldosterone
- Decreased Na, K, Cl
- Increased HCO3 → alkalosis
Gitleman’s sydrome
- NaCl pump issue in DCT → acts like thiazide diuretic
- Teenage
- Alkalosis
- Hypokalemia
- Decreased Mg
- Often asymptomatic; muscle weakness, fatigue, dizziness, vertigo, plyuria, nocturia
Hypernatremia and Hyponatremia
**Disorders of water balance
HYPERNATREMIA
- Decreased volume
> Dehydrated (less urination) or diabetes insipidus
(increased urination)
- Increased volume
> Excessive IV or hyperaldosteroneisma
- SYMPTOMS: tired, weak, altered mental status, seizures
***cerebral edema
HYPONATREMIA
- Hyperosmolar
> Hyperglycemia
- Iso-osmolar
> Lab error
> Multiple myeloma
- Hypo-osmolar
> Hypervolemic: CHF, cirrhosis, nephrotic syndrome
> Euvolemic: SIADH, Addison’s, hypothyroid, adrenal
insufficiency
> Hypovolemic: renal or GI fluid loss
- SYMPTOMS: neurological predominate (headache, nausea, malaise, lethargy, weakness, muscle cramps, anorexia, disorientation)
***cerebral demyelenation syndrome (“locked in”)
Hyperkalemia vs Hypokalemia
HYPERKALEMIA
- Increased intake
> IV
- Transcellular shift
> Cell injury
> Metabolic acidosis
> Tumor lysis
- Decreased loss
> Decreased GFR, hypoaldosterone
- SYMPTOMS: muscle weakness, arrhythmias, paralysis, nausea, palpitations, muscle stiffness
> ECG changes and cardiotoxicity (peaked & narrow T, loss
P, long PR, wide QRS, AV block)
HYPOKALEMIA
- SYMPTOMS: usually asymptomatic; muscle cramps, arrhythmias, fatigue, myalgia, constipation
- Decreased intake
> Anorexia
> Alcoholism
- Transcellular shift
> Alkalemia, insulin, hyperaldosterone
- Increased loss
> Renal: loop diuretics/Bartter’s, thiazide/Gittleman’s
> GI: vomiting (increase pH), diarrhea (decrease pH)
Hypertension
ESSENTIAL (95%)
- Increased sympathetic NS activity
> Obesity (high catecholamines)
> High stress (high cortisol)
- Increased renin release
> Diabetes
> Obesity
- Increased Na retention (“low renin HTN”)
> African American
- Increased age (decreased compliance, increased TPR)
SECONDARY (5%)
- Renal
> Vascular: fibromuscular dysplagia, renal artery stenosis
> Parenchyma: diabetic nephropathy, glomerulonephritis,
polycystic kidney disease
- Cardiac
> Coarctation of aorta (diff BPs upper vs lower)
- Lungs
> obstructive sleep apnea
- Neuro (ICP)
> Cushings triad: high BP, low HR, irregular respiration
- Drugs
> Sympathomimetics (cocaine, NMDA, PCP,
amphetamines, ADHD meds)
> Estrogen contraceptives (estrogen increased liver AII)
> NSAIDs (inhibit COX2 → constrict afferent → low GFR)
- Pregnancy
> Preeclampsia: >20wks, HTN, proteinuria
> Eclampsia: >20wks, HTN, proteinuria, seizures
- Endocrine
> Adrenal
- Cortisol → Cushing’s syndrome
- Aldosterone → hyperaldosterone → high Na → BV
- Norepinephrine → pheochromocytoma
> Thyroid
- Hypothyroid
- Hyperthyroid
- Hyperparathyroid → increased Ca → vasoconstriction
HTN medications
- ACEi: avoid in asthma, african american, pregnant, renal arterial sclerosis
- ARBS
- Dihydropiridine CCBs: good in low renin HTN
- Thiazide diuretics
- B-blockers: careful in COPD, asthma
- Aldosterone antagonists (K sparing diuretics)
- Alpha 1 blockers/ alpha 2
HTN meds in pregnancy
- Hydralizine: vasodilator
- Methyl-dopa: alpha-2 agonist
- Lavetalol: beta blocker
- Nifidipine: Ca channel blocker
