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renal Flashcards

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0
Q

Mesonephros

A

functions as interim kidney for 1st trimester;lateral contribution to male genital system

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1
Q

Pronephros

A

wk 4, then degenerates

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2
Q

Metanphros

A

permanent, first appears in 5th week of gestation, nephrogenesis continues through 32-36 wk of gestation

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3
Q

ureteric bud

A

from caudal end of mesonephros
ureter, pelvises, calyces, and collecting ducts,
fully canalized by 10th week

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4
Q

metanephric mesenchyme

A

ureteric bud interacts with this tissue;

interaction induces differentiation and formation of glomerulus through to distal convoluted tubule

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5
Q

Aberrant interaction between these 2 tissues may result ?

A

Aberrant interaction between these 2 tissues may result in several congenital malformation of the kidney

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6
Q

ureteropelvic junction

A

last to canalize
most common sit of obstruction
hydronephrosis

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7
Q

failure of urachus to close result in?

A

urine through the umbilical

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8
Q

allantoic duct give rises to

A

urachus medial umbilical ligament

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9
Q

potter’s syndrome

A

oligohydramnios

compression of the fetus–>limb deformities, facial deformitis, pulmonary hypoplasia, cause of death

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10
Q

horse shoe kidney

A

inferior pole of both kidneys fuse
ascend from pelvis during fetal development trapped under IMA
remind low in pelvis
associated with Turner syndrome

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11
Q

multicystic dysplastic kidney

A

abnormal interaction between ureteric bud and metanephric mesenchyme
nonfunctional kidney consisting of cysts and connective tissue
unilateral is generally symptomatic with compensatory hypertrophy of contralateral kidney
prenatally via ultrasound

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12
Q

juxtaglomerular cell

A

beta1-nonadrenergic input,decrease renal blood pressure, decrease Na to distal tubule
secretes renin

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13
Q

macula densa

A

decrease Na in distal convoluted tubule

increase beta1,ADH

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14
Q

ureters course

A

under uterine artery

under ductus deferens

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15
Q

extracellular fluid?

A

1/3 of all water

20% of total body weight

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16
Q

intracellular water

A

2/3 of water

40% of all weight

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17
Q

plasma volume

A

1/4 of EC

5% of total weight

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18
Q

intersititial volume

A

3/4 of EC

15% of total weight

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19
Q

Glomerular filtration barrier

A

fenestrated capillary endo, size barrier
GBM with heparan sulfate, -charged
Epi layer of podoctye foot processes

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20
Q

what is used to calculate GFR

A

inulin

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21
Q

what is used to calculate ERPF

A

PAH clearance
100% of PAH entering the kidney will be excreted
20% from Bowman space and 80% from secretion

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22
Q

filtration fraction=

A

GFR/RPF

20% normal

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23
Q

filtered load=

A

GFR*plasma concentration

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24
GFR=
Ui*V/Pi
25
ERPF
effective renal plasma flow =Up*V/Pp=C(PAH) RBF=ERPF(1-Hct)
26
afferent arteriole constriction-->
decrease in RPF decrease in GFR FF-- happen in NSAID
27
efferent arte riole constriction
decrease RPF increase GFR increase FF happen in ACEI
28
increase plasma protein concentration
NC in RPF decrease in GFR decrease in FF
29
decrease protein concentration
NC in RPF increase GFR increase FF
30
constriction of ureter
NC in RPF decrease in GFR decrease in FF
31
pregnancy on glucose and AA?
decrease reabsorption of glu and AA | caused by increase GFR
32
Hartnap's disease
AA clearance is by sodium dependent transporter in the proximal tubule deficiency in neutral AA transporter result in pellagra
33
TM system | transporter max system
all organic go by this ex. glu except urea!!!!!more water more urea
34
transporters on proximal tubule include
``` Na/Glu,symport Na/H, antiport Na/K, symport Cl/Base, antiport almost all reabsorbed: Glu, AA, HCO3, Na, Cl, Phosph, water secretes ammonia, buffer for H ```
35
what substance works on proximal tubule
PTH: inhibits Na/ phosphate cotransport-->phosph secretion ATII:Na/H exchange-->increase Na and H2O and HCO3 reaborption Vit D activiton
36
thin descending loop function?
passively reabsorb water via medullary hypertonicity, impermeable to sodium concentrating segment make sure urine hypertonic
37
greatest osm is at?
tip of loop and end of collecting duct
38
thick ascending function
reabsorbs Na, K, Cl, indirectly induces the paracellular reabsorption of Mg, Ca through lumen potential generated by K back leak impermeable to H2O Na/K/Cl cotransport
39
early distal convoluted tubule
reabsorbs Na, Cl make urine hypotonic Na/Cl cotransport PTH work here to increase Ca/Na exchange to increase Ca absorption
40
lowest osm is in?
the early distal convoluted tubule
41
collecting tubules function
reabsorption of Na inexchange for secreting K and H Na in and K out H2O in Aldosterone:insertion of Na channel on luminal side ADH:V2 receptor, insertion of aquaporin H2O channels on luminal side
42
What absorbs slower than Water and what absorbs faster?
slower:Urea and Cl Faster: Glu, HCO3, Pi, AA
43
ADH primarily regulates?
osmo
44
Aldosterone regulates
blood volume
45
kidney endocrine?
erythropoietin: intersitial cells in peritubular capillary bed Vit D:proximal tubule converts 25OH Vit D-->Vit D Renin: JG cell to decrease pressure and increase beta1 PG: for vasodilation in afferent A to increase GFR
46
ANP works on?
increase atrial pressure-->secrete by atrial myocytes increase GFR increase Na secretion vaso dilation -->Na loss in volume loss and Bp decrease
47
PTH works on
proximal tubule: Pi decrease absorption | early collecting duct: Ca increase absorption
48
AT II
``` proximal tubule efferent arteriole constrction increase GFR and increase FF compensatory Na reabsorption -->preservation of renal function in a low volume state ```
49
Aldosterone
collecting duct inresponse to decrease blood volume and increase plasm K causes increase Na reabsorption, decrease K secretion, increase H secretion
50
ADH
collecting duct in response to increase plasma osm and decrease blood volume bind to receptor on principal cells increase water channel and increase water reabsorption.
51
K shifts out of cell?
``` DO Insulin Lab Digitalis hyperOsm insulin deficiency Lysis of cell Acidosis Beta antagonist ```
52
shift K into cells
hypo Osmo Insulin(increase Na K ATpase) Alkalosis Beta agonist
53
increase and decrease K result in? EKG
increase: wide QRS and peaked T waves on ECG decrease: U waves and flatten T waves
54
type 1 tubular acidosis
collecting tubule, Na for H and K, but cannot excrete H pH>5.5 urine hypokelamina increase risk for Ca phosphate kidney stone by increase urine pH and bone resortion
55
type II RTA
Defect in proximal tuble hCO3 reabsorption Faniconi's syndrome urine<5.5 hypokalemia increase risk for hypophosphatemic rickets
56
type 4 RTA
hypoaldosterone lack of collecting tubule response to aldosterone hyper K impairs ammoniagenesis in proximal tubule decrease buffering capacity decrease urine pH
57
Respiratory Acidosis
``` pCO2>40mmHg, pH<7.4 Hypoventilation airway obstruction chronic lung disease opioid weakening of muscle ```
58
metabolic acidosis | increase anion gap
``` ph< MUDPILES Methanol, Propylene glycol, Ethylene glycol Uremia, iron tablet or INH,Salicylates Diabetic acidosis, Lactic acidosis ```
59
Metabolic acidosis | normal anion gap, 8-12
``` HARD ASS Hyperalimentation,Saline infusion Addison's disease Renal tubular acidosis Diarrhea Acetazolamide, Spironolactone ```
60
Respiratory Alkalosis
Hyperventilation early high altitude Salicylate, early, stimulate respiratory center-->hyper
61
Metabolic alkalosis
LAVA low urine Cl: vomiting, prior diuretics,hydrochorothiazide,antacid use high urine Cl: hypovolemia :current diuretic use, bartter&Gitelman syndrome hypervolemia: hyperAldosteronism
62
RBC casts
Glomerulonephritis ischemia malignant hypertension Bladder cancer,kidney stone-->hematuria but no cast
63
WBC casts
Tubulointersitial inflammation acute pyelonephritis, transplant rejection acute cystitis-->pyruria, no casts
64
fatty casts | oval fat bodies
nephrotic syndrome
65
Granular casts | muddy brown
cute tubular necrosis
66
Hyaline casts
Nonspecific | normal finding
67
Focal segmental glomerulosclerosis
LM-segmental sclerosis and hyalinosis EM-effacement of foot process similar to minimal change disease most common nephrotic syndrome in adult associate with hIV, heroin, obesity, IFN treatment, Chronic kidney disease
68
Membranous nephropathy
LM: diffuse capillary and GBM thickening EM:spike and dome appearance with subepithelial deposits IF-granular SLE's nephrotic presentation 2nd most sommon causes of primary nephrotic syndrome in adult Drug, SLE, solid tumor
69
Minimal change disease | lipoid nephrosis
LM: normal glomeruli EM:foot process effacement selective loss of albumin, not globulin, caused by GBM polyanion loss may be triggered by infection or immune stimulus most common in children respond to corticosteroid
70
Amyloidosis
LM: congo red stain shows apple green birefringence under polarized light. Associated with chronic condition
71
Membrano-proliferative glomerulonephritis | MPGN
Type1-subendothelial IC deposits with granular IF, tram-track on GBM due to splitting caused by mesangial ingrowth Type2-intramembranous IC deposits, dense deposits Can also present as nephritic syndrome Type I: associated with HBV, HCV Type II: associated with C3 nephritic factor
72
Diabetic glomerulonephropathy
Nonenzymatic glycosylation (NEG) of GBM--> increase permeability, thickening NEG of efferent arterioles-->increase GFR-->mesangial expansion LM-mesangial espansion, GBM thickening, eosinophilic nodular glomerulosclerosis
73
Kmmelstiel-Wilson lesion
eosinophilic nodular glomerulosclerosis
74
Armani-Ebstein lesion
tubular pathy
75
Acute poststrep glomerulonephritis
LM: glomeruli enlarged and hypersellular, etrophils, lump-bumpy EM: subepithelial immune complex humps IF:granular appearance due to IgG IgM and C3 deposition along GBM and mesangium
76
Rapidly progressive glomerulonephritis | crescentic
LM and IF- crescent-moon shape, crescents consist of fibrin ad plasma proteins, C3b, with parietal cells, monocytes and macrophages Goodpasture's syndrome Granulomatosis with polyangitis, Wegener's microscopic olyangiitis, Churg-Strauss
77
Diffuse-proliferative glomerulonephritis | DPGN
Due to SLE or MPGN LM-wire looping capillaries EM-subendothelial and sometimes intramembranous IgG-based ICs often with C3 deposition IF-granular
78
berger's disease | IgA nephropathy
Henoch-Schonlein purpura LM-mesangial peoliferation EM-mesangial IC deposits IF-IgA-based IC deposits in mesangium
79
Alport syndrome
``` mutation in type IV collage-->spilt basement membrane X-linked Glomerulonephritis deafness less common with eye problem ```
80
kidney stone that precipitates at increase pH
calcium phosphate | ammonium
81
precipitate at a decrease pH, stone
calcium oxalate uric acid cystine
82
X-ray radiopaque stone
calcium ammonium cystine
83
radiolucent stone
uric acid stone
84
ethylene glycerol or Vit C abuse
Calcium oxalate stone
85
infection of Proteus and staphycoccus, Klebisella
ammonium magneium stone urease positive bugs CHuck hate PUNKSS
86
hexagonal crystals
cystine
87
diagnosis of cystine in the urine
cystine+cynide-->cysteine+nitroprusside-->purple discoloration
88
renal cell CA
von hippel-lindau, gene deletion chrom 3 polygonal clear cell filled with lipid and carbohydrate from proximal tubule cells incidence increase with smoking and obesity 2andary polycythemia, invade renal vein and IVC and to lung and bone paraneoplasic syndrome
89
Wilm's tumor
most common in child 2-4yrs embryonic glomerular structure. presents with huge palpable flank mass and/or hematuria delection of tumor suppressor gene WT1 on Chrom 11 Beckwith-Wiedemann sydrome, WT-2: organmegaly... WAGR: wilm, aniridia, genitourinary malformation, mental retardation
90
Beckwith-Wiedemann sydrome
``` WT-2 HEMIHYPERTROPHY macroglodssia organmegaly neonatal increase Glu ```
91
Transitional cell CA
most common tumor painless hematuria no cast assoicated with phenacetin, smoking, aniline dyes, cyclophosphamide
92
oncocytoma
oncocyte: wpi cell/ large eosinophile-->round blue benign tumor
93
renal papillary adenoma
from renal tubule
94
angiomyolipoma
hamartomas | tuberous sclerosis
95
pyelonephritis acute
affect cortwx with relative sparing of gloeruli and vessels present with fever costovertabral anagle tenderness nausea and vomitinghite cell casts E. coli ascending from urethra
96
chronic pyelonephritis
the sesult of recurrent episoodes of acute pyelonephritis predisposition of infection such as vesicoureral reflux or chronic obstructing kidney stone coarse, asymmetric corticomedullary scarring, blunted calyx. Tubules can contain eosinophlic casts, thyroidization of kidney
97
Drug induced intersitial nephritis
Acute intersititial renal inflammation pyuria, "eosinophils", azotemia hapten drug 1-2wks after the drug, months after NSAID
98
diffuse cortical necrosis
acute generalized cortical infarction of both kidneys likely due to combination of vaso spasm and DIC ob and septic shock
99
Acute tubular necrosis stages
lnciting event maintenance phase-oliguric lasts 1-3 wks, risk of hyperkalemia recovery phase, polyuric, BUN and serum creatinine fall, risk of hypokalemia
100
renal papillary necrosis
``` sloughing of renal papillae gross hematouria and proteinuria DM, acute pyelonephritis, Chronic phenacetin use sickle cell anemia ```
101
prerenal azotemia
bun/crea>20 urine osm>500 urine Nadecrease GFR
102
intrinsic renal failure
BUN/creadecrease GFR
103
postrenal azotemia
outflow obstruction bilateral obstruction BUN/Cr>15 urine<350
104
renal failure consequence
increase Na, K, H, Urea, TG decrease Hb renal osteodystrophy
105
renal osteodystrophy
failure of vitamin D hydroxylation hypo Ca hyperphosphatemia-->2nd hyperPTH
106
ADPKD
AD, PKD1/PKD2 berry aneurysm mitral valve prolapse, benign hepatic cyst
107
ARPKD | infantile polycystic kidney disease
AR | potter's syndrome
108
medullary cystic disease
``` tubulointerstitial fibrosis progressive renal insufficiency with inability to concentrate urine visualized, shrunken kidneys on ultrasound poor prognosis ```
109
bilateral renal infarction
aortic dissection classically present with sharp and tearing pain radiating to the back location of pain more as dissection progress progress distally involve major artery from aorta occluded renal artery
110
renal artery stenosis
``` fibromuscular dysplasia in young female (medial thickening) or AS in old ppl increase ald, 2ndary hyperald increase renin, increase Na, increase BP decreased K angiography: strings of pearls ```
111
benign nephrosclerosis
focal ischemia of parenchyma medial intimal thickening-->hyaline deposition in arterioles risk factor!!!: DM and hypertension malignant HTN: frinold necrosis, onion skin lesion
112
thrombotic microangiopathies
hemolytic anemia thrombocytopenia renal failure fibrinold stain show PLT-fibrin(RED)
113
hemolytic uremic syndrome
E Coli, shiga like toxin | microangiopathic hemolytic anemia
114
thrombotic thrombocytopenia purpura
aDAMTS-13-->cleaves vWF abnormal PLT activation aggregation neurologic changes more common
115
sickle cell nephropathy
hematuria polyuria papillary necrosis, obstruction of vessel

Pathology (11 decks)

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