What causes the highly negative charge of the GBM?
Heparin sulfate
What makes up the backbone of the glomerular basement membrane?
Type IV Collagen monomers
What are the three layers to the GBM, starting with the capillaries?
Lamina interna
Lamina densa
Lamina externa
What synthesizes the GBM components?
Podocytes
What two proteins, if mutated, can lead to nephrotic syndrome?
Nephrin and podocin
What cells are indicated in lying down collagen and secrete mediators of inflammation?
Mesangial cells
What two characteristics exclude filtration of albumin?
Size, negative charge
What is the most common kidney disease, with 5% of the US population having this?
Kidney stones
What is oftentimes the root cause of glomerular diseases?
Immune mediation
What is oftentimes the root cause of tubulointerstitial kidney disease?
inflammation, toxic/ischemia
What is azotemia?
Increase in BUN and creatinine.
What is uremia?
Azotemia with clinical symptoms
What are common symptoms of uremia?
Pruritis Anemia gastroenteritis pericarditis peripheral neuropathy
What are the basic distinguishing factors of nephrotic and nephritic syndromes?
Nephritic: Blood in urine
Nephrotic: protein in urine
What are key findings in nephritic syndrome?
Hematuria
Mild proteinuria
HTN
What are key findings in nephrotic syndrome?
Hyperproteinuria (>3.5 gm/day) Hypoalbuminemia Edema Hyperlipidemia Lipiduria
What is the most common cause of acute renal failure?
Acute tubulonecrosis
How will someone with a renal tubular defect present to the clinic?
Polyuria
Nocturia
Electrolyte imbalances
How will someone with acute renal failure present to the clinic?
Oliguria/anuria
Rapid onset azotemia
How will someone present to your clinic with nephrolithiasis?
Renal colic
Hematuria
What equation approximates renal clearance?
Urine concentration x Urine flow / Plasma concentration
What are some causes of a pre-renal increase in BUN?
Increased Urea synthesis (catabolism, lots of protein)
Decreased renal perfusion (Hypotension, CHF, Renal vein thrombosis)
What are renal causes of increased BUN?
Glomerular disease
ATN
Interstitial disease
What are some post renal causes of increased BUN?
Anything with flow obstruction
What are prerenal causes for increased Creatinine?
Increased synthesis (Anabolic roids, car accident, muscle hypertrophy) CHF, Shock
What is the normal ratio of BUN to Creat?
10-20:1
What is the equation for FENa?
(Urine Na x Plasma Cr x 100) / (Urine Cr x Plasma Na)
What does a FENa < 1.0% favor in diagnosis? >2.0%?
1%: Prerenal
2.0: ATN
What is the normal protein make-up of urine?
1/3 albumin
1/3 small globulins
1/3 Tamm-Horsfall protein (secreted by tubule cells)
What can cause a false positive for proteinuria check in a urine dipstick test?
Alkaline urine
Blood in urine
Dilute urine
What is the most common fusion for horseshoe kidneys?
Lower lobe (90%)
What are the key microscopic findings to Cystic Renal Dysplasia?
Undifferentiated mesenchyme/cartilage
Immature collecting ducts
Variable sized cysts lined by flattened epithelium
What is the inheritance pattern of polycystic kidney disease?
Autosomal dominant
What are the most common genes affected in polycystic kidney disease?
PKD 1 and PKD 2
How may someone with polycystic kidney disease present to the clinic?
Pain and hematuria
What other organ is oftentimes affected with cysts in polycystic kidney disease?
Liver
What are two other key pathologies common to patients with Polycystic kidney disease?
Berry aneurisms
Mitral valve prolapse