kidney embryo - 3 phases and final fate
pronephros - degenerates
mesonephros - interim kidney in 1st TM > male genital system
metanephros - permanent, becomes kidneys
Potter’s syndrome - causes and effects
caused by ARPKD, post urethral valve, bilat renal agenesis
results in oligohydramnios > compression of fetus > limb deformities, facial deformity, pulmonary hypoplasia (can cause death)
horseshoe kidney assoc w/
Turner syndrome
relationship of ureters to uterine artery / ductus deferens
“water under the bridge” - ureters go under both structures
what makes the charge barrier in the glomerular filtration barrier?
heparan sulfate in the BM
clearance formula
C = U*V/P
normal filtration fraction
20%
at what glucose level does glucosuria begin, and at what level do the transporters reach there maximum?
160 mg/dl it begins, at 350 mg/dl its at Tm
Hartnup’s disease
def of neutral AA transporter results in pellagra
3 stimuli for renin release
dec BP (JG cells) dec Na delivery (macula densa cells) inc sympathetic tone (beta 1 receptors)
what cells secrete renin
juxtaglomerular cells
6 things that shift K out of cells / cause hyperkalemia
digitalis hyperosmolarity insulin def lysis of cells acidosis beta adrenergic antagonist
U waves on ECG
hypoK
peaked T waves on ECG
hyperK
Henderson Hasselbach Eqn
pH = 6.1 + log (bicarb/(0.03PCO2))
Winter’s formula
predicts resp compensation for primary metab acid/base disturbance
PCO2 = 1.5bicarb + 8 +/- 2
type 1 RTA
distal - defect in CD’s excretion of H. assoc w/ hypoK and inc risk of Ca kidney stones and bone resorption
type 2 RTA
proximal - defect in PCT bicarb reabs. assoc w/ hypoK and inc risk for hypophosphatemic rickets. does not respond to tx w/ bicarb
type 4 RTA
hypoaldosteronism / reduced response to aldosterone. causes hyperK > impairs ammoniagenesis in PCT > acidosis
granular muddy brown casts in urine
ATN
fatty casts “ oval fat bodies” in urine
nephrotic syndrome
2 MCC nephrotic synd in adults
1 - focal segmental glomerulosclerosis
2 - membranous nephropathy
causes of focal segmental glomerulosclerosis
HIV, heroin, obesity, interferon, CKD due to congenital absence or surgical removal
EM kidney biopsy - “spike and dome” w/ subepithelial deposits
membranous nephropathy
causes of membranous nephropathy
idiopathic, drugs, infxns, SLE, solid tumors
MCC nephrotic synd in kids
minimal change dz
membranoproliferative glomerulonephritis is assoc w/
HBV, HCV
“tram track” appearance
membranoproliferative glomerulonephritis
Kimmelstiel Wilson lesions
diabetic glomerulonephropathy
“lumpy bumpy” glomeruli
acute post strep glomerulonephritis
conditions that can cause crescentic glomerulonephritis
Goodpasture’s
Wegener’s (granulomatosis w/ polyangiitis)
microscopic polyangiitis
MCC death in SLE
diffuse proliferative glomerulonephritis
“wire looping” of capillaries in glomeruli
diffuse proliferative glomerulonephritis
Berger’s dz (IgA nephropathy) - related to what condition, what appearance on LM
Henoch-Schonlein purpura
mesangial proliferation
high pH vs low pH calcium kidney stones
high pH > Ca phos
low pH > Ca oxalate
hexagonal crystals (kidney stone type)
cystine stone
clear cell RCC originates from what cell
proximal tubule cell
genetic cause of RCC
gene deletion on chromosome 3 (can be sporadic or part of von Hippel Lindau)
paraneoplastic synd assoc w/ RCC
ectopic EPO, ACTH, PTHrp
Wilm’s tumor assoc w/ (2 things)
Beckwith-Wiedemann synd WAGR complex (Wilm's, Aniridia, Genitourinary malformation, mental Retardation)
MC tumor of urinary tract system
transitional cell CA (urothelial tumor)
diffuse cortical necrosis - causes
vasospasm and DIC - occurs after obstetric catastrophes and septic shock
MCC intrinsic renal failure
ATN
phases of ATN
inciting event
maintenance phase - oliguric for 1-3 wks, risk of hyperK
recovery phase - polyuric, BUN and Cr fall, risk of hypoK
renal papillary necrosis is assoc w/
DM
acute pyelonephritis
chronic phenacetin use
sickle cell anemia and trait
dec BUN/Cr ratio
intrinsic renal failure
renal osteodystrophy
failure of vit D hydroxylation > hypoCa and hyperPhos > 2ndary hyperPTH > subperiosteal thinning of bones
assoc conditions w/ ADPKD
berry aneurysms, mitral valve prolapse, benign hepatic cysts
effect of loop diuretics and thiazides on Ca
loops inc Ca excretion
thiazides dec Ca excretion
tox of furosemide
OH DANG ototox hypoK dehydration allergy (sulfa) nephritis (interstitial) gout
non-sulfa drug version of furosemide
ethacrynic acid
tox of thiazides
hypokalemic metab alkalosis
hyponatremia
sulfa allergy
hyperGLUC (glycemia, lipidemia, uricemia, calcemia)
ACEi tox
CATCHH cough angioedema teratogen (renal abnlties) Cr increase (dec GFR) hyperK hypoTN