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PP Renal Flashcards

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0
Q

What is Goldblatt’s kidney?

A

Flea-bitten kidney (blown capillaries)

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1
Q

Which part of the nephron concentrates urine?

A

Medulla

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2
Q

What is Uremia?

A

Azotemia + symptoms

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3
Q

What is Azotemia?

A

Increase BUN/Cr

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4
Q

What is nephritic kidney disease?

A

Increases size of fenestration => vasculitis
Inflammatory process
When involves glomeruli it leads to: hematuria and RBC cast in urin
A/ w : Azotemia ( BUN/Cr >15), oliguria, hypertension and proteinuria < 3.5

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5
Q

What is nephrotic kidney disease?

A

Lost BM charge due to deposition on heparin sulfate => massive proteinuria > 3.5 , Hyperlipidemia, fatty cast, edema.
A/w: Thromboembolism and increase risk of infection

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6
Q

What is seen in RPGN?

A

LM and EM- crescent-moon shape
Crescent consist of fibrin and plasma protein with glomerular parietal cells, monocytes and macrophages
Several disease processes may result in this pattern including:
- Goodpasture’s syndrome
- Granulomatosis with polyangitis ( Wegener’s)
- Microscopic polyangitis

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7
Q

What is Pot-Strep GN?

A 
LM- "lumpy bumpy" appearance 
EM- Subepithelial immune complex humps
IF- granular appearance due to IgG/IgM/C3/deposition along GBM
Most frecuen in children 
Resolve spontaneously
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8
Q

What is Interstitial Nephritis?

A

Urine eosinophils

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9
Q

What is Lupus Nephritis?

A

Subepithelial

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10
Q

What is Membranous Nephropathy?

A

LM- diffuse capillary and GBM thickening
EM- “spike and dome” appearance with Subepithelial deposits
IF - granular

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11
Q

What is MPGN?

A

Type I - subendothelia IC deposit with granular IF; “Tram-tracks” appearance. A/w HBV, HCV
Type II - intramembranous IC deposit; “dense deposit”. A/w C3 nephritic factor

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12
Q

What is MCD?

A 
LM- normal glomeruli
EM- foot process effacement
MC nephrotic syndrome in Children 
No renal failure 
Loss of charge barrier
Trigger by a recent infection or an immune stimulus
Respond to Corticosteroids
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13
Q

What is FSGS?

A

LM- segmental sclerosis and hyalinosis
EM- effacement of foot process
A/w: HIV infection
MCC of nephrotic syndrome in Adults

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14
Q

What are the vasculitis with low C3?

A 
"PMS in Salt Lake City"
Post-Strep GN
MPGN type II
SBE
Serum sickness
Lupus
Cryolgobulinemia
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15
Q

What’s is the most common cause of kidney stone?

A

Dehydration

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16
Q

What is the most common type of kidney stones?

A

Calcium oxalate

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17
Q

What type of kidney stone have coffin-lid crystals?

A

Triple phosphate

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18
Q

What type of kidney stone have rosette crystals?

A

Uric acid

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19
Q

What type of kidney stone have hexagonal crystals?

A

Cystine

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20
Q

What type of kidney stone have envelope or dumbbell-shaped crystals?

A

Oxalate

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21
Q

What disease has Aniridia?

A

Wilm’s tumor

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22
Q

What disease has Iridocyclitis?

A

Juvenile rheumatoid arthritis

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23
Q

What is phimosis?

A

Foreskin scarred at penis head ( foreskin stuck smooshed up)

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24
What is Parphimosis?
Foreskin scarred at penis base ( retraction of foreskin => strangulated penis)
25
What is Urge incontinence?
Urgency leads to complete voiding ( detrusor spasticity -> small bladder vol)
26
What is Stress incontinence?
Weak pelvic floor muscles (estrogen effect)
27
What is the Overflow incontinence?
Runs down leg but can't complete empty bladder
28
What structure have one way valves?
Urethra | Ejaculatory duct
29
What structures have fake sphincters?
Ureters LES Ileocecal valve
30
What has WBC casts?
Acute Pyelonephritis | Acute Interstitial Nephritis
31
What has WBC cast + eosinophils?
Interstitial nephritis (allergies)
32
What has WBC cast +RBC cast?
Glomerulonephritis
33
What has Fat cast?
Nephrotic syndrome
34
What has Waxy cast?
Chronic renal failure
35
What has Tubular cast?
ATN
36
What has Granular "Muddy brown" casts?
ATN
37
What has Hyaline casts?
Normal sloughing
38
What has Epithelial cast?
Normal sloughing
39
What has Crescents?
RPGN
40
How do you measure afferent renal function?
Creatinine (or insulin)
41
How do you measure efferent renal function?
BUN ( or PAH)
42
What is the afferent arteriole's job?
Filter
43
What is the efferent arteriole's job?
Secrete
44
How to you test the afferent arteriole function?
GFR ( inulin or creatinin)
45
How to you test the efferent arteriole function?
RPF ( PAH)
46
What is pre-renal failure?
Low flow to kidney (BUN:Cr >20)
47
What is renal failure?
Damage glomerulus ( BUN:Cr <20)
48
What is post-renal failure?
Obstruction (haven't peed in last 4 days)
49
What is the job of the proximal tumble?
Reabsorb: glucose, AA, salt and bicarb Isotonic reabsorption Secrets: H
50
What is the job of the thin descending Loop of Henle?
Reabsorbs water | Concentrating segment
51
What is the job of the thick ascending Loop of Henle?
Actively reabsorbing Na, K, Cl, Mg, Ca without water Impermeable to water Makes urine less concentrated Na/K/Cl Symport is inhibit bay loops diuretics
52
What is the job of the early distal tubule?
Actively reabsorbing NaCl Makes urine hypotonic PTH give the signal to reabsorb Ca and excrete Phosphate
53
What is the job of the collecting duct?
Reabsorbs Na by excreting K and H ( regulated by Aldo)
54
What does the macula densa do?
Measures osmolarity | Monitoring Na levels
55
What does the J-G apparatus do?
Measures volume
56
What is Fanconi's syndrome?
Old tetracycline use => urine phosphate, glucose, aa
57
What is Bartter's syndrome?
Baby w/ defective triple transporter (low Na, Cl, K w/ normal BP)
58
What is Psychogenic Polydipsia?
No concentration ability -> cerebral edema
59
What is Hepatorenal syndrome?
High urea from liver -> increase glutaminase -> NH4-> GABA -> kidney stop working
60
What is Type 1 RTA?
Defect in CT ability to excrete H Urine pH> 5.5 A/w hypokalemia Increase risk for Ca phosphate kidney stone
61
What is Type 2 RTA?
Defect in PT HCO3 reabsorption Urine pH < 5.5 A/w hypokalemia
62
What is Type 3 RTA?
RTA I + II -> normal urine pH
63
What is Type 4 RTA?
Hypoaldosteronismo or lack of CT respond to Aldo Hyperkalemia Decrease urine pH
64
What is Central Pontine Myelinolysis?
Due to correcting Na faster than 0.5mEq/hr
65
Whic are the principal structures of the kidney embryology?
Pronefrons Mesonephrons Metanephrons
66
What is the pronephron?
Week 4, then degenerate
67
What are the Mesonephrons?
Function as kidneys in 1st trimester Gives rise to the male genitalia ( Wolfian duct) Give rise to the Uereteric bud = collecting system
68
What is Metanephrons?
Permanent kidney Appear in the 5th week of gestation Need to fuse with the Ureteric Bud to form the kidney
69
Wha structure drive from de Metanephric Mesoderm?
Ascending / Descending Loop of Henle Bowman's Capsule Glomerular tuft
70
The Ureteric Bud gives rise to?
Collecting System
71
What structures compose the Collecting system?
Ureters Pelvis Calyces Collecting duct
72
By which mechanism JG cells release Renin?
Beta adrenergic stimulation Low Na in the DCT ( by macula densa) Low pressure in the afferent arterioles of the Glomerulus
73
Which are the components of the Glomerural Filtration Barrier?
``` Capillary endothelium ( fenestrated) Fused basement membrane with heparin sulfate ( negative charge barrier) Epithelial layer consisting of podocyte foot process ```
74
Under what structures the Ureters pass?
Under Uterine Artery and under Ductus Deferens
75
Renal clearance?
Volume of plasma per unit of time (vol / time) Cx= UxV/Px Cx > GFR = net tubular secretion Cx < GFR = net tubular reabsorption
76
Filtration Fraction?
GFR/ RPF
77
Calculations of reabsorption and secretion rate?
``` Filtered load = (GFR)(Px) Excretion rate = (V)(Ux) Net Excretion Rate = Filtered load - Tubular reabsorption of substance Reabsorption = filtered - excreted Secretion = excreted - filtered ```
78
What is the max serum Glucose [ ] at which glucose can be absorbed by tubules?
350mg/dL
79
What two types of cells compose the CD and the last segment of the DT?
Principals cells -> Na reabsorption, K secretion | Intercalated cells -> K reabsorption, H and HCO3 secretion
79
What are the two type of intercalated cells?
H secreting cells -> Alfa or type A cells | HCO3 secreting cells -> beta or type B cells
80
Which are the functions of Angiotensin II?
Vascular Smooth muscle - vasocontriction -> increase BP Constrict efferent arteriole -> increase FF Release of Aldo -> increase reabsorption of Na and Water Release ADH -> increase water reabsorption Increase PT Na/H activity -> reabsorption of Na, water and HCO3 Stimulate hypothalamus -> thirst
81
What causes K to shift out of cells -> hyperkalemia?
``` Low insulin Beta blocker Acidosis Digoxin Cell lysis ```
82
What causes K to shift into cells -> hypokalemia?
Insulin Beta agonist Alkalosis Cell proliferation
83
Which are the MUDPILES?
``` Methanol Uremia DKA Propylene glycol Iron or INH Lactic acidosis Ethylene glycol Salicylate ```
84
What has RBC cast?
Glomerulonephritis
85
What has bacterial cast?
Pyelonephritis
86
What has epithelia cast?
Renal tubular damage
87
What has Fatty cast "oval fat bodies"?
Nephrotic syndrome
88
White are the Nephrotic Syndrome ?
1. FSGH 2. Membranous Nephropathy 3. MCD 4. Amyloidosis 5. Diabetic Glomerulonephropathy
89
Which are the Nephritic Syndrome?
1. Acute Poststreptococcal Glomerulonephritis 2. RPGN 3. Diffuse proliferative Glomerulonephritis 4. Berger's disease ( IgA Nephropathy) 5. Alport's syndrome
90
What is Amyloidosis?
LM- Congo red stain show Apple-green birefringence under polarized light
91
What is Diabetic Glomerulonephropathy ?
Nonenzymatic glycosylatio (NEG) of GBM -> increase permeability, thickening NEG of efferent arteriole -> increase GFR-> mesangial expansion LM - mesangial expansion
92
What is Diffuse Proliferative Glomerulonephritis?
Due to SLE or MPGN LM- "wire looping" of capillaries EM- Subepithelial and sometimes intramembranous IgG based IC often with C3 deposition IF- granular
93
What is Berger's disease ( IgA Nephropathy)?
Related to Henoch-Schönlein purpura LM- mesangial proliferation EM- mesangial IC deposits IF- IgA-base IC deposit in mesangium
94
What is Alport's syndrome?
Mutation in type IV collagen -> spits BM X-linked Can't see, can't pee, can't hear me

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