Renal Flashcards by elliot sultanik

Plasma volume measured by?

Albumin

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Extracellular volume measured by?

Inulin

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Negative charge on glomerular bm?

Heparan sulfate (lost in nephrotic syndrome)

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Sodium correction for glucose?

(glucose-100)/100) *1.6= +sodium

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Filtration fraction?

GFR/RPF

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Normal FF?

20%

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Renal plasma flow is best estimated using?

PAH (measures renal plasma flow)

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Deficiency in neutral amino acid (tryptophan) transporter?

Hartnup’s disease– results in pellagra

Should never see amino acids in urine– amino acids are absorbed by sodium dependent transporters in proximal tubule

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Causes of pellagra?

Dec niacin or tryptophan– why tryptophan? because the body converts tryptophan into niacin

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Sodium is absorbed with…….in the early PCT? and …… in the late PCT?

Bicarb

Cl-

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Describe AII and contraction alkalosis?

AII acts on the PCT to absorb Na– which in turn secretes H+– Bicarb is absorbed when H+ is secreted–>metabolic alkalosis (i.e. contraction alkalosis)

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Part of nephron that is impermeable to water?

Thick ascending limb– absorbs 10-20%

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Difference between thiazide and loop diuretics with regard to calcium?

Thiazides increase calcium

Loops decrease calcium

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Tetany and arrhythmia caused by which electrolyte imbalance?

Low serum Magnesium

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opioids? alk or acid?

Respiratory acidosis

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Spironolactone– acidemia or alkalosis?

Metabolic acidosis

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Salicylates– alk or acid?

Respiratory alkalosis

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Loop diuretics– alk or acid?

Metabolic alkalosis

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Hyperaldosteronism– alk or acid?

Metabolic alkalosis

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RBC cast ddx?

Glomerulonephritis; ischemia or malignant htn

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WBC casts?

Tubulointerstitial inflammation; acute pyelonpehritis; transplant rejection

i.e. infection or inflammation

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RBC casts may have which protein?

Tamm horsefall protein

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Fatty casts (oval fat bodies)

Nephrotic syndrome

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Granular/muddy brown casts?

Acute tubular necrosis

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Waxy casts?

Advanced renal disease/chronic renal failure

Hyaline casts?

Nonspecific-- can be normal finding

Common to see what type of cells in urine?

Epithelial cells

Pt. presents with proteinuria, fatty casts and edema-- what would you expect on blood labs?

Hypoaggamablobulinemia and hyperlipidemia and hypoalbuminemia Increased risk of infection due to hypoagammaglobulinemia

MCC of nephrotic syndrome in adults?

Focal segmental glomerulosclerosis-- no immune complexes

EM shows effacement of foot processes; poor response to steroids?

Focal segmental glomerulosclerosis

Spike and dome appearance with subepithelial deposits of IgG and C3? causes?

Membranous nephropathy (nephrotic) Granular on IF Drugs, infection, sle, idiopathic

Foot process effacement; loss of albumin but not globulins?

Minimal change disease-- usually follows infection. Responds well to corticosteroids Dec IgG and inc IgM

DDX of amyloidosis?

Multiple myeloma; TB; RA

Subendothelial IC deposits with granular IF; tramtrack appearance due to splitting of mesangial ingrowth? What is this associated with?

Membranoproliferative glomerulonephritis type 1-- associated with HBV and HCV

Intramembranous IC deposits; dense deposits; dec C3?

Membranoproliferative glomerulonephritis type 2

Resorptive defect in PCT assoc with increased excretion of all amino acids?

Fanconi-- metabolic acidosis

Resorptive defect in TAL?

Barterr syndrome--hypokalemia; met alkalosis and hypercalceuria

Subepithelial humps?

Acute poststrep-- neutrophils in humps

Granular appearance ddx?

Acute strep; diffuse proliferative; membranous

LM wire looping of capillaries?

Diffuse proliferative

Staghorn caliculi?

Ammonium magnesium phosphate aka struvite crystals

Radiolucent crystals on xray?

Uric acid-- lemon drop shape

Lemon drop shape crystals?

Uric acid-- seen with diseases of high cell turnover

Hexagonal crystals?

Cystine

Painless hematuria with no casts for male?

suggests bladder cancer

Transitional cell carcinoma assoc with?

Pee SAC | Phenacetin; smoking; aniline dyes; and cyclophosphamide

Subendothelial humps?

Lupus nephritis (diffuse progressive)( and membranoproliferative

Where are IgA deposits in kidney?

Mesangium

Brown granular casts-- dead epithelial cells?

Acute tubular necrosis

Rash, fever, kidney disease?

Acute interstitial nephritis-- inflammatory infiltrate-- eosinophils in urine, may lead to papillary necrosis

Fatty casts?

Nephrotic syndrome

FSGS-- IF?

Nothing-- NO immune complexes

Spike and dome?

Membranous-- thick glomerular BM dt immune complexes

Granular IF?

Immune complexes eg Membranous, membranoproliferative; Post streptococcul; diffuse proliferative

Tram tracks?

Membranoproliferative

What do you see in nephritic syndrome (glomerulus?)

Hypercellular inflamed glomerulus

Difference between Wegeners and Good pastures?

Nasopharynx involvement in Wegeners and no IF because no immune complexes

Pathology of chronic pyelonephritis?

Cortical scarring and blunted calyces

Pyuria with negative urine cultures?

urithritis dt chlamydia and neisseria

Contraction alkalosis

ATII stimulates Na/H exchange-->inc Na and HCO3

PTH acts proximally and distally-- what does it do in each instance?

Proximally it inhibits Na/phosphate | Distally it enhances Ca/Na exchange-->Ca reabsorption

Distal tubule is impermeable to urea

FREEBIE

principal cells

enhances Na/K pump--- i.e. secretes K and H

erythropoietin released by

interstitial cells in peritugbular capillary bed in response to hypoxia

Low K?

WEAKNESS

High K?

wide QRS and peaked T waves

stones bones groans and psychiatric overtones

HYPERCALCEMIA

Electrolye that will cause Decreased DTR in excess?

Magnesium

Renal tubular acidosis are associated with

Hypokalemia except 4 which causes hyperkalemia dt decreased aldosterone or lack of response to aldosterone Remember: type 2 has decreased urine despite being a tubular acidosis

Eosinophilic nodular glomerulosclerosis

kimmelstiel wilson lesions

Upper respiratory tract infection; IgA deposition; gastroenteritis

henoch schonlein or bergers disease

treatment for calcium stones

HCTZ and CITRATES

RCC spread to?

lung and bone

common bugs of pyelonephritis?

Enterobacter faecalis; kleb; ecoli

eosinophilic casts (thyroidization of kidney)

chronic pyelonephritis

3 stages of ATN

1) inciting event 2) Maintenance phase-- oliguric 1-3 weeks; risk of hyperkalemia 3) Recovery phase-- polyuric, bun and creatinine fall; risk of hypokalemia

Used to treat pseudotumor cerebri

acetazolamide

Furosemide effect on afferent arteriole?

stimulates PGE release

toxicity of furosemide

OH DANG | ototoxic; hypokalemic; dehydration; allergy; nephritis; GOUT

Side effects of Ace inhibitors

CATCHH | cough, angioedema, Teratogen, Creatinine increase; HYPERkalemia; hypotension

Renal Flashcards

(80 cards)