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Flashcards in Renal Deck (104):
1

Kidney artery tree

Renal, segmental, interlobar, arcuate, interlobular

2

12th rib fracture lacerates what structure?

Kidney

3

Ureteric bud derivatives

Collecting system, including collecting tubules and ducts, major/minor calyces, renal pelvic, and ureters

4

Metanephric mesoderm/blastema derivatives

Glomeruli, Bowman's space, proximal tubules, loop of Henle, and distal convulted tubulues

5

Post-streptococcal GN: histo

Subepithelial humps (electron-dense deposits on epithelial side of GM), composed of IC made up of IgG, IgM, C3

6

Crescentic GN: histo

Prominent fibrin deposition

7

Renal cancer RF

Tobacco smoke, obesity, HTN

8

Bladder cancer RF

Tobacco smoke, occupational exposure to rubber, textiles, leather

9

Renal angiomyolipoma

Benigh tumor comporised of blood vessels, smooth muscles, and fat; bilateral renal angiomyolipomas are associated with tuberous sclerosis (AD)

10

Uric acid crystallization occurs in what structure, and is prevented by what?

Collecting duct (2/2 low urine PH); thus, give hydration and urine alkalinization to prevent

11

GFR is estimated by calculating the clearance of what substance?

Inulin

12

PAH

Freely filtered at glomerulus, and secreted into the urine at the proximal tubule (thus, excretion > filtered load)

13

Calcineurin

Protein phosphatase that, once activated, dephosphorylates NFAT and allows the latter to bind the IL-2. IL-2 stimulates growth and differentiation of T-cells. Inhibit with cyclosporine or tacrolimus.

14

Oxybutynin

Antimuscarinic agent used for urge incontinence

15

Post-op urinary retention rx

Bethanechol (muscarinic agonist)

16

GRE and creatinine relationship

If GFR normal, relatively large decreases will only result in small increases in Cr. If GFR is significantly decreased, small decreases will produce relatively large increases in Cr. Every time GFR is halved, Cr doubles.

17

Left and right renal vein differences

Left renal vein drains the left suprarenal vein (obstruction causes varicocele) and the left gonadal vein

18

Amphotericin B MOA, SE

Binds to ergosterol in fungal cell membranes to form holes; Nephrotoxicity causing severe hypokalemia and hypomagnesemia

19

Sudden onset of abdominal/flank pain, hematuria, L-sided varicocele

Renal vein thrombosis

20

Furosemide MOA

inhibit Na-K-2Cl symporter @ loop of Henle, causing increased Na, Cl, fluid excretion; and stimulate prostaglandin release (NSAIDs will thus blunt diuretic effect)

21

UTI pathogenesis

Suppression of endogenous flora, colonization of distal uretrha by pathogenic gram-negative rods, and attachment of such pathogens to bladder mucosa

22

What is necessary for development of acute pyelonephritis?

Anatomic or functional vesicoureteral reflux

23

PT: what substrates increase in concentration?

PAH, creatinine, inulin, urea

24

PT: what substrates do not change in concentration?

Na, K

25

PT: what substrates decrease in concentration?

Bicarb, glucose, AA

26

Furosemide SE

Hypokalemia, hypomagnesemia, hypocalcemia; ototoxicity

27

Clear cell carcinoma

Renal tubular cells; histo: rounded/polygonal cells with abundant clear cytolasm with high glycogen or lipid content

28

Visual impairment of HIV pt; rx, SE?

CMV-induced retinitis; ganciclovir, foscarnet; foscarnet SE: hypocalcemia (chelates with Ca), hypomagnesemia (nephrogenic wasting)

29

Calcium stone prevention

Ample fluid intact, high-normal calcium intake, low-protein diet, low-sodium diet

30

Calcium stones with hyperoxaluria

Vitamin B6 (decreases endogenous oxalate production)

31

ACE SE

first-dose hypotension (esp with pts with hyponatremia, hypovolemia 2/2 existing diuretics, low baseline BP, high renin/aldosterone lvels, renal impairment and heart failure)

32

The majority of water reabsorption occurs where?

Proximal convoluted tubule

33

Goodpastures: LM, IF

Glomerular crescent formation; linear deposits of IgG and C3 along glomerular BM

34

Membranous glomerulopathy: LM, IF

Diffuse capillary wall thickening; granular deposits of IgG/C3 along glomular BM

35

Alport syndrome pw, EM

Nephritis, deafness; BM splitting

36

MPGN: EM, IF, LM

EM: BM splitting, granular deposits, lobular appearance with proliferating mesnagial cells and increased mesangial matrix

37

Mannitol MOA, SE

Osmotic diuresis, agent to lower intracranial pressure; pulmonary edema 2/2 reactionary volume expansion

38

Renal osteodystrophy MOA

ESRD-related retention of phosphate and decreased synthesis of calcitriol causes hypocalcemia, secondary hyperparathyroidism and renal osteodystrophy

39

Renal cell carcinoma gene mutation

VHL deletion on C3p (mostly sporadic)

40

MOA of hypocalcemia in renal failure

Decreased calcitriol leads to decreased Ca, phosphate absorption from intestine and kidneys; decreased urinary excretion of phosphate leads to elevated serum phosphate, and this phosphate binds with Ca and reduces serum Ca; Thus, low serum calcium and high phosphate

41

Calcium oxalate crystals in urine: appearance, significance

Folded envelopes on microscopy; ethylene glycol ingestion (AG acidosis, osmolar gap)

42

Urachus

Remnant of allantois that connects bladder with yolk sac during fetal development; failure of urachus to obliterate leads to urine discharge from the umbilicus

43

ATN most likely to occur in what areas of the nephron

Tubular epithelial cells in proximal tubules and the thick ascending limb of Henle's loop; muddy brown casts are pathognomonic for ATN

44

Finasteride and terazosin different timeline of action

Finasteride: 6-12 months; terazosin: days-weeks

45

Angiotensin II: two negative feedback systems on RAS

Stimulates juxtaglomerular cells to inhibit renin release; and elevates BP/Na to decrease renin reliease via intrarenal baroreceptors and macula densa

46

K flow throughout nephron

Most resorbed by the proximal tubule and loop of Henle; K depletion stimulates alpha-IC cells to reabsorb extra K via H/K ATPase; high K leads principal cells to secrete K

47

Proximal 1/3 of ureter receives its blood supply from what artery?

Renal artery

48

Drug-induced interstitial nephritis: presentation

Fever, maculopapular rash, and oliguria 1-3 weeks after starting treatment with beta lactam, NSAD, sulfonamides, rifampin, diuretics; peripheral eosinophilia and eisinophiluria are important clues

49

AD polycystic kidney disease

pw HTN, flank pain, gross hematuria, UTI, kidney stones; Numerous kidney and liver cysts seen by the 3rd or 4th decade help make diagnosis; most common hereditary cause of renal failure (age 70)

50

Nephrotic syndrome pw, difference between highly/poorly selective proteinuria

Massive proteinuria (>3.5 gm/day), hypoalbuminemia, generalized edema, hyperlipidemia, lipiduria; highly selective (minimal change dz with low molecular weight proteins, such as albumin and transferrin)

51

Most common cause of fetal hydronephrosis

Inadequate recanalization of the ureteropelvic junction

52

Most common cause of calcium kidney stone disease

Idiopathic hypercalciuria with normal serum calcium levels

53

Hyperoxaluria

Diet high in oxalate (chocolate, nuts, spinach), low calcium diets, CD/intestinal malabsorption

54

Hyperuricosuria

High protein diet

55

Hyperuricemia and hyperuricosuria

Myeloproliferative disorder or tumor lysis syndrome; typically stimulates calcium oxalate formation (uric acid stone less common)

56

Metabolic acidosis: kidney correction MOA

1. Increased bicarb reabsorption at the proximal tubule (via carbonic anhydrase action in the lumen); 2. Increased H secretion throughout nephron (Na/H antiporter in proximal nephron, H-ATPase, H/K ATPase in alpha-IC cells; 3. Increased acid buffer execretion (NH3 (more important, at proximal tubule) and HPO4)

57

GFR, RPF, FF

Renal plasma flow is the amount of plasma delivered to the kidney per unit of time, esimated by PAH; GFR depends on hydrostatic/oncotic pressures and is calculated separately

58

Cystinuria

AR Inborn defect of the transporter for cystine, ornithine, aginine, lysine; pw nephrolithiasis that presents with renal colic in 2/3rd decades, with UA showing hexagonal cystine crystals

59

Horseshoe kidney

Isthmus lies posterior to the IMA

60

Renal cell carcinoma

Arise from epithelial cells of the proximal renal tubules; grossly, golden yellow mass and light microscopic exam, cells with abundant clear cytoplasm and eccentric nuclei

61

ARB MOA

Block AT-1 receptor and inhibit ATII, resulting in arterial vasodilation and decreased aldosterone secretion

62

PSGN

1. enlarged, hypercellular glomeruli on light microscopy; 2. "lumpy-bumpy" granular deposits of IgG and C on IF; 3. electron-dense deposits on the epithelial side of basal membrane

63

Spironolactone similar to what molecule

Steroids, so can cause gynecomastia, decreased libido, impotence

64

Bladder outflow obstruction leads to what?

Reflux nephropathy, hydronephrosis, renal interstial atrophy and scarring

65

ADH effect on urea reabsorption

Increases passive urea transporters in the inner medullary collecting duct, allowing highly concentrated urea to diffuse down its gradient into the medullary interstitum and further into the thin loop of Henle (contributing to osmotic gradient)

66

Clearance

(Urine concentration/plasma concentration) X urine flow rate)

67

RBF two ways of calculating

(Renal artery pressure - renal vein pressure)/renal vascular resistance; (PAH clearance)/(1-hct)

68

Membranous glomerulopathy

Mostly idiopathic; but can be a.w. malignant tumors, infections (Hep B, C), meds; light microscopy shows diffuse increased thickness of the BM (without increased cellularity), "spike and dome" appearance on silver stain; IF shows granular deposits

69

Total filtration rate of substance A

Inulin clearance x plasma concentration of substance A

70

IgA nephropathy

pw painless hematuria 2-3 days after URI; IF: Prominent IgA deposits in the mesangium; EM: electron dense material in mesangium

71

Henoch-Schonlein disease

Purpuric lesions on extensor surfaces; GI (ab pain, intestinal bleeding, intussusception; IgA nephropathy

72

Salicylate poisoning

Acute respiratory alkalosis followed by metabolic acidosis

73

NSAID associated chronic renal injury

Papillary necrosis and chronic interstitial nephritis with mild/no glomerular and vascular abnormalities

74

Cystinuria pw, rx

Recurrent stone formation at young age; hexagonal cystine crystals on UA; sodium cyanide-nitroprusside test detects cystine's sulfhydryl groups

75

Acute rejection of transplants: rx

Anti-CD3 antibodies (muromonab) that inhibit t-lymphocytes

76

MM nephropathy

Bence jones proteins precipitate with Tamm Horsfall protein and form eosinophilic casts (not eosinophil cell casts) that compress tubular epithelium and obstruct tubular lumens and impede renal function; LM: numerous large, glassy eosinophilic casts in tubular lumen

77

Determinants of diffusion across semipermeable membrane directly proportional with, and inversely proportional with

concentration difference across membrane, total surface area, solubility of substance; membrane thickness and molecular weight of the molecule

78

ATN clinical course

Initiation; maintenance (oliguria for 1-2 weeks, granular casts, flattening/necrosis of tubular epithelial cells): recovery: re-epithelization of tubules (polyuria, normalizatin of GFR)

79

Long-standing nonmalignant HTN or DM pw

Homogenous deposition of eosinophilic hyalin material in the intima and media of small arteries and arterioles characterizes hyaline arteriolosclerosis

80

Malignant HTN

hyperplastic arteriolosclerosis (homogenous, onion-like concentric thickening of the arteriole wall)

81

Important prognostic factor in PSGN

Age (95 percent of children, 60 percent of adults recover completely)

82

Idiopathic membranous nephropathy a.w.

Circulating IgG4 antibodies to phospholipase A2, leading to IC deposition in glomerulonephritis

83

Minimal change disease

Immune dysregulation and overproduction of a specific cytokine that directly damages podocytes, leading to effacement and fusion of food processes; selective loss of albumin in the urine (but not other serum proteins)

84

Glaucoma pw

Severe unilateral eye pain and ipsilateral HA with severe nausea and "halo" around objects

85

Kidney stones: calcium oxalate or calcium phosphate

70-80%, radiopaque, colorless octahedron

86

Struvite (magnesium ammonium sulfate or triple phosphate)

15%, radiopaque, rectangular prism ("coffin lids"); associated with urease-forming UTI organisms (proteus), "staghorn" calculi,

87

Uric acid

Radiolucent; yellow/red-brown, diamond or rombus

88

Cystine

Flat, yellow, hexagonal;

89

Pelvic surgery risks

Ureter ligation and hydronephrosis

90

Anatomy: ureter course

Cross over the common/external iliac vessels and under the gonadal vessels (and uterine vessels in females); anterolateral to the internal iliac vessels and medial to the ovarian vessels

91

Digoxin toxocity in elderly patients

Reduce dose 2/2 age-related renal insufficiency (even with normal creatinine)

92

ANCA-associated RPGN

Pw with renal failure, pulmonary symptoms, upper respiratory symptoms (Granulomatous polyangitis); crescents on light microscopy; absence of Ig or C3 deposits

93

ATN: initiate stage

Ischemic injury to tubules precipitated by hemorrhage, acute MI, sepsis, surgery

94

ATN: maintenacne

Decreased output, fluid overload, increasing creatinine/BUN, hyperkalemia

95

ATN: Recovery

Gradual increase in urine output leading to high-volume diuresis. Electrolyte abnormalities, including decreased K, Mg, PO4, Ca 2/2 decreased tubular function

96

WBC cast formation

WBC precipitated by Tamm-Horsfall protein secreted by tubular epithelial cells; when accompanied by systemic symptoms, means acute pyelonephritis; if no urinary symptoms, could be acute interstitial nephritis

97

Muscarinic receptors: M1

Gq, Brain, memory formatoin/cognitive functioning, confusion

98

Muscarinic receptors: M2

Gi, heart, decreased HR and decreased ionotrophy; increased HR and contractility

99

Muscarinic receptors: M3

G1: Lung (bronchoconstriction), bladder (detrusor contraction), eyes (miosis, accomodation), GI (increased peristalsis, increased salivary and gastric secretions), skin (increased sweat production)

100

Diabetic nephropathy MOA

Glomerula hyperfiltration and increased in mesangial matrix/thickening of GBM; affects the glomeruli and the arterioles; nodular glomerulosclerosis (i.e. KW nodules), diffuse glomerulosclerosis, and hyaline arteriolosclerosis

101

Nephritic vs nephrotic

Former: HTN, mild proteinuria (3.5 g/day), lipiduria, absence of RBC casts in the urine, normal renal function

102

Crescent formation

Glomerula parieta cells, monocytes, macrophages, fibrin; eventually become sclerotic, disrupting glomerular function and causing irreversible renal injury

103

Hemolytic uremic syndrome MOA

Shiga toxins from E Coli O157:H7 or Shigella injure the endothelium of preglomerular arterioles and glomerular capillaries, leading to platelet activation (thrombocytopenia) and formation of microthrombi (microangiopathic hemolytic anemia). Dmg to renal vasculature results in AKI

104

Papillary necrosis etiologies

SCD or trait, DM, analgesic nephropathy, severe obstructive pyelonephritis; acute colicky flank pain, gross hematuria, passage of tissue fragments in urine