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Renal Flashcards

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1
Q

What gives rise to the glomerulus-> DCT?

CD-> pelvis?

A

Metanephric mesenchyme = glomerulus

Ureteric bud= CD-> pelvis

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2
Q

Horseshoe kidney is associated with?

A

Turners syndrome

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3
Q

Total body water: ICF vs ECF? How do you measure ECV & plasma volume?
ECF: Plasma vs Interstitial volumes?

A 
ICF= 2/3 
ECF= 1/3 --> INULIN 
Plasma = 1/3 of ECF --> Albumin 
Interstitial = 2/3 ECF
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4
Q

If you give a pt 9L of Hypotonic saline how many enter the plasma? 9L of isotonic saline?

A 
Hypotonic= 3 L into ECF --> 1 L into plasma 
Isotonic = 9L into ECF --> 3 L into Plasma
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5
Q

What is the glomerular basement membrane gives it a negative charge?

A

Heparan Sulfate

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6
Q

Renal Clearance equation?

Cl < GFR vs Cl > GFR?

A 
C= UV/P = Urine [a] x urinve flow rate / plasma [a] 
< = Absorbed 
> = Secreted
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7
Q

What is used to calculate GFR?

GFR equation?

A

Inulin Clearance / Creatinine (slightly secreted)

GFR= U x V / P = Cl of Inulin

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8
Q

What is used to calculate RPF?

RBF calculation?

A

PAH clearance

RBF = RPF / (1-Hct)

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9
Q

Calculate FF? normal FF?

A

FF = GFR / RPF = 20%

Filtered load = GFR x plasma [a]

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10
Q

How do NSAIDs affect RPF + GFR + FF?

A

NSAIDs block PGs = Constriction of Afferent

dec GFR/ dec RPF = FF SAME

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11
Q

How does ACEi affect RPF + GFR + FF ?

A

AngII constricts Efferent = Dilation of Efferent w/ ACEi

dec GFR/ inc RPF = Dec FF

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12
Q

Constriction of Efferent arteriole (FF= GFR/ RPF)?

A 
FF= Inc
GFR = inc
RPF = dec
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13
Q

Increase in plasma protein concentration (FF=GFR/RPF)?

A

FF = dec
GFR = dec (High oncotic pressure)
RPF = NC
**low protein = Inc FF= Inc GFR/ RPF NC

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14
Q

Constriction of ureter affect on FF= GFR/RPF?

A 
FF = dec 
GFR = dec 
RPF = NC
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15
Q

Filtered load calculation? Excretion rate?

A 
FL = GFR x P 
Ex= V x U
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16
Q

Hartnup’s disease?

A

Na dependent AA transporter def in PT

**def in Trp = Niacin def = Pellagra

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17
Q

What part of the tubule does ang II act on?

A

PT = activates Na/ H+ exchanger

** Causes Contraction Alkalosis

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18
Q

The concentration of what substances increase along the PT? highest –> lowest

A

PAH-> Cr–> Inulin -> Urea -> Cl –> K -> Na

  • *Note only PAH & Cr are secreted/ not absorbed W
  • *inulin is Not secreted or absorbed
  • *Na/K/urea/Cl are ALL absorbed But less than H2O so Concentrations Increase
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19
Q

Concentration of what substances dec along PT? Lowest –> highest

A

Glucose (ALL absorbed)
AAs (all absorbed but slower than Glucose)
HCO3
Phosphate
**the Concentration of these substances Dec because they are Reabsorbed Faster than H2O

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20
Q

What stimulates Renin release?

A

B1 agonist
dec Na @ MD
dec BP

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21
Q

Function of ANP?

A

Relax vascular smooth muscle (cGMP)
increase GFR
dec Renin

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22
Q

In response to Hypoxia what releases Epo in the kidney?

A

Interstitial cells in peritubular capillaries

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23
Q

What are some causes of HYPERkalemia?

A 
Digitalis 
Acidosis 
B-antagonists 
Cell lysis 
Hyperosmolarity
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24
Q

Causes of HYPOkalemia?

A

Insulin
Beta agonists (inc Na/K ATPase activity)
Alkalosis
Hypo-osmolarity

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25
U waves and flattened T waves on ECG, arrhythmias, and weakness?
Hypokalemia
26
dec DTR, lethargy, bradycardia, hypotension, Cardiac arrest?
Hyper Mg+
27
Wide QRS and peaked T waves on ECG, weakness and arrhythmias?
Hyperkalemia | Peaked T = High K
28
What things can cause Peaked T waves and Wide QRS?
Digitalis Beta-antagonist Acidosis **HEART BLOCK
29
What things can cause flattened T waves and U wave?
Insulin Alkalosis B-agonists
30
What is the calculation for the predicted respiratory response to metabolic acidosis?
Winters formula = Pco2 = 1.5 (HCO3) + 8 | **HCO3 12 --> Pco2 should= 26
31
What are the causes of anion gap metabolic acidosis?
``` Methanol Uremia DKA Propylene glycol (anti-freeze) Iron or INH Lactic acidosis Ethylene glycol (oxalic acid) Salicylates ```
32
Defect in Distal (CD) tubule H excretion Hypokalemia + urine pH > 5.5 Ca/PO4 stones?
Type 1 RTA (distal)
33
Hypoaldosteroneism or No CD response Hyperkalemia and xammoniagenesis Dec urine pH due to Dec buffers?
Type 4 RTA (Hyperkalemic)
34
Defect in PT HCO3 reabsorption urine pH<5.5 + hypokalemia Hypophosphatemic rickets?
Type 2 RTA (proximal)
35
Waxy casts vs WBC vs RBC casts?
``` Waxy= CRF WBC = pyelonephritis or Transplant rejection RBC= nephritis, ischemia, malignant HTN ```
36
Features of nephrotic syndrome?
Hyperlipidemia Fatty casts ATIII loss = Hypercoagulable state
37
Diffuse GBM thickening due to granular IC deposits ("Spike and dome") associated with HBV, SLE nephrotic?
Membranous
38
Child with recent infection (days ago) and not has puffy eyes. What is seen on biopsy? Rx?
Minimal change= LM= NC EM = Podocyte effacement **STEROIDS
39
Subendothelial IC deposits leading to "tram tracks" due to Mesangial ingrowth?
Type 1 MPGN
40
What is associated with Continuous C3 activation and Very LOW C3 in serum?
Type 2 MPGN (dense deposits dz) | **C3 nephritic factor
41
Associated with HCV? | Intramembranous dense deposits?
HCV= T1 MPGN | dense deposits = T2 MPGN
42
IC deposits: Subepithelial Intramembranous Subendothelial
``` Subepi = Membranous Intramem = T2 MPGN Subendo = T1 MPGN ```
43
Nephritic syndromes?
``` PSGN RPGN DPGN bergers dz Alports ```
44
What is in the "lumpy bumpy" subepithelial deposits?
PSGN = IgM + IgG + C3
45
What is in Crescentic formation?
FIBRIN plasma proteins parietal cells, macs
46
MCC of death in SLE pts?
DPGN= wire loop subendothelial deposits
47
Pt with recent hx of GI/URT infection and now has hematuria and red palpable lesions on buttocks?
Bergers disease = IgA nephropathy * *Henoch-schonlein purpura * *IgA in Mesangium
48
pt with GN, deafness, and visual issues have a defect in?
Type IV collagen (BM) = Alports
49
Pt with recurrent Calcium stones. Rx?
HCTZ or CITRATE
50
What stones form due to High pH by Proteus infection?
Ammonium Mg phosphate = Struvite
51
What is the only stone visible on CT and not X-ray?
Uric acid stone = radiolUcent
52
Form in CD due to dec pH and causes Hexagonal crystal formation in children?
Cysteine stones
53
Renal cell carcinoma descriptions?
PT origination Lipid/ carb accumulation Invades Renal vein--> Lung/bone mets BL in VHL
54
Pt with a mass containing Embryonic glomerular structures, no iris, mental retardation?
WAGR (Wilms, Aniridia, GU malformations, Retardation)
55
What are associated with cancers of renal calyces, pelvis, and bladder?
Transitional cell = Smoking, Aniline dyes, Phenacetin, Cyclophosphamide
56
Pt with fever, CVA tenderness, vomiting, and WBC casts. What part of kidney is affected?
Acute pyelonephritis == CORTEX
57
What is seen with Chronic Pyelonephritis?
Corticomedullary scarring Blunted calyx Eosinophilic casts (Thyroidization of kidney)
58
Thyroidization and Blunted calyces?
Chronic Pyelonephritis
59
Pt with fever, rash, hematuria, CVA tenderness, and eosinophils in urine?
Drug induced Interstitial nephritis
60
Kidneys with "Cirrhosis like" fine cortical granulations due to fibrosis and sclerosis?
HTN nephrosclerosis
61
Pt with DM/SCD/ pyelonephritis/ chronic Phenacetin use with Gross hematuria?
Renal papillary necrosis
62
MCC of acute pyelonephritis and Rx?
``` MCC = VUR + ascending infection Rx = CIPROFLOXACIN ```
63
What are consequences of Renal failure?
``` Anemia (low Retic count) Fibrinous pericarditis (uremia) Encephalopathy Platelet dysfunction Osteodystrophy Dyslipidemia (high TGs) ```
64
What is seen with renal osteodystrophy?
Subperiosteal thinning of bones
65
ADPKD associations?
Berry-aneurysms MVP Benign hepatic cysts
66
Associations with ARPKD?
Congenital Hepatic Fibrosis HTN + Portal HTN Pottter's syndrome if In utero failure
67
Two causes of Shrunken kidneys on US?
``` Adults = CRF Child = medullary cystic disease ```

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