Flashcards in Renal Deck (80):
Plasma volume measured by?
Extracellular volume measured by?
Negative charge on glomerular bm?
Heparan sulfate (lost in nephrotic syndrome)
Sodium correction for glucose?
(glucose-100)/100) *1.6= +sodium
Renal plasma flow is best estimated using?
PAH (measures renal plasma flow)
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
Causes of pellagra?
Dec niacin or tryptophan-- why tryptophan? because the body converts tryptophan into niacin
Sodium is absorbed with.......in the early PCT? and ...... in the late PCT?
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)
Part of nephron that is impermeable to water?
Thick ascending limb-- absorbs 10-20%
Difference between thiazide and loop diuretics with regard to calcium?
Thiazides increase calcium
Loops decrease calcium
Tetany and arrhythmia caused by which electrolyte imbalance?
Low serum Magnesium
opioids? alk or acid?
Spironolactone-- acidemia or alkalosis?
Salicylates-- alk or acid?
Loop diuretics-- alk or acid?
Hyperaldosteronism-- alk or acid?
RBC cast ddx?
Glomerulonephritis; ischemia or malignant htn
Tubulointerstitial inflammation; acute pyelonpehritis; transplant rejection
i.e. infection or inflammation
RBC casts may have which protein?
Tamm horsefall protein
Fatty casts (oval fat bodies)
Granular/muddy brown casts?
Acute tubular necrosis
Advanced renal disease/chronic renal failure
Nonspecific-- can be normal finding
Common to see what type of cells in urine?
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
Acute poststrep-- neutrophils in humps
Granular appearance ddx?
Acute strep; diffuse proliferative; membranous
LM wire looping of capillaries?
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
Painless hematuria with no casts for male?
suggests bladder cancer
Transitional cell carcinoma assoc with?
Phenacetin; smoking; aniline dyes; and cyclophosphamide
Lupus nephritis (diffuse progressive)( and membranoproliferative
Where are IgA deposits in kidney?
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
Nothing-- NO immune complexes
Spike and dome?
Membranous-- thick glomerular BM dt immune complexes
Immune complexes eg Membranous, membranoproliferative; Post streptococcul; diffuse proliferative
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
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
enhances Na/K pump--- i.e. secretes K and H
erythropoietin released by
interstitial cells in peritugbular capillary bed in response to hypoxia
wide QRS and peaked T waves
stones bones groans and psychiatric overtones
Electrolye that will cause Decreased DTR in excess?
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)
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
Furosemide effect on afferent arteriole?
stimulates PGE release
toxicity of furosemide
ototoxic; hypokalemic; dehydration; allergy; nephritis; GOUT