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Flashcards in Renal Deck (133):
1

Aldosterone

Na reabsorbed, K+ and H+ excreted

2

PAH

Freely filtered and also secreted by a carrier protein-mediated process
- Secretion can be saturated at high blood concentration

3

Renal Papillary Necrosis

Associated with ischemia --> gross hematuria and proteinuria
- Sickle Cell (disease and trait)
- Diabetes
- Acute pyelonephritis
- Chronic phenacetin

4

Removal of one Kidney: GFR changes

Immediate decrease in GFR by 50%, will increase to about 80% after several weeks

5

Focal Segmental Glomerulosclerosis (FSGS)

HIV associated nephrotic syndrome; glomerular capillary wall collapse
- foot process effacement (similar to minimal change)
- black and hispanics
- HIV, Heroin, Sickle cell, IFN treatment
- inconsistent steroid response

6

Nephrotic Syndromes

FSGS, Membranous, minimal change, diabetic glomerulonephropathy, amyloidosis

7

Nephritic Syndromes

PSGN, RPGN, IgA glom., Alport

8

Both Nephritic and Nephrotic

Diffuse proliferative (aw/ SLE) and Membranoproliferative

9

Along Proximal Tubule: Increases and Decreases in Concentration

- Increases concentration: PAH, creatinine, inulin, and urea (Water reabsorbed so more concentrated)
- Decreases concentration: bicarb, glucose, and amino acids (These are reabsorbed)

10

Pelvic Surgery Risk

Ureters at risk during pelvic surgeries (may be ligated) → hydronephrosis

11

Blood Supply to Proximal 1/3 of Ureter

Branches of the Renal Artery (superior vesicular artery does the rest of the ureter)

12

Cystinuria

From defective amino acid transport (decreased reabsorption of cysteine from urine); COLA
- Hexagonal Crystals

13

Kidney Stones: Calcium Oxalate

MC
X-box shape (envelope) or Dumbell

14

Kidney Stones: Calcium phosphate

Alkaline pH
X-box shape (envelope) or Dumbell

15

Kidney Stones: Magnesium ammonium phosphate (struvite)

Coffin Shape
Alkaline pH
- aw/ Urease + bugs (proteus, Staph, Klebsiella)
- Staghorn may act as UTI nidus

16

Kidney Stones: Uric Acid

Rhomboid or rosettes
- aw/ gout, or leukemia (high cell turnover)

17

Kidney Stones: Cysteine

Hexagonal
- MC in children
- can form from staghorn calculi
- Sodium nitroprusside test +

18

UTI w/ +leukocyte esterase and nitrite

E. faecalis or S. saprophyticus
- Most enterobacteriaceae (Gm- enteric rods): +nitrite

19

Tx for UTI/Pyelonephritis w/ E. Coli

Ciprofloxacin

20

HUS

- HUS: microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury
(Diarrhea associated)

21

Henoch Schonlein Purpura

- systemic vasculitis caused by IgA Complex deposition that will also be seen with arthralgias and acute glomerulonephritis
- Small vessel leukocytoclastic angiitis in children
- aw abdominal pain and often palpable skin lesions; may have glomerulonephritis

22

IgA Nephropathy vs PSGN

IgA is seen after a few days (IgA deposits), PSGN is after a few weeks

23

Renal Cell Carcinoma (RCC)

Clear Cell Carcinoma (MC subtype) from epithelial cells of proximal tubule

24

Nephron Segment w/ Highest Osmolarity

Bottom of loop of Henle
- Absorb water in descending loop (impermeable to solutes) → concentrates
- Absorb NaCl in ascending loop (impermeable to water) dilutes

25

Acyclovir: Renal Side Effect

Obstructive crystalline nephropathy and acute renal failure if not adequately hydrated

26

Wilm's Tumor:

Chr 11
MC renal malignancy in children (age 2-4)
Huge flank mass containing embryonic glomerular structures
aw/ WAGR, Denys-Drash, Beckwith-Wiedemann

27

Hydronephrosis

Ureteropelvic junction MC site of obstruction

28

Tx for Nonobstructive Urinary Retention (atonic bladder)

Cholinergic Agent

29

Only radiolucent stones (visible)

Uric Acid Stones

30

Diabetic Neuropathy: Detrusor

Overflow Incontinence due to impaired detrusor contractility
- TCAs can be used for diabetic peripheral neuropathy but will have anticholinergic effect

31

Cisplatin: Renal Side effect

Nephrotoxicity that can be prevented with amifostine

32

Ethylene glycol or methanol poisoning Antidote

Fomepizole

33

RPGN (rapidly progressive crescenteric glomerulonepritis)

- ANCA associated
- Also called Pauci Immune GN due to lack of Ig or C3 deposits
- Crescents (fibrin and protein) on light microscopy
- Goodpastures (anti-GBM, linear IF), Wegeners, or Microscopic polyangiitis)

34

In the true pelvis, ureter is anterolateral to _________

Internal iliac artery (uterine artery is medial)

35

Drug-Induced Acute Interstitial Nephritis (AIN)

1-3 weeks after drug (fever, rash, oliguria); eosinophilia
and azotemia
- diuretics, penicillin derivatives, sulfonamides, rifampin
- may occur months later w/ NSAIDs

36

Loop Diuretics Effect on Prostglandins

Loop diuretics also stimulate prostaglandin release → increased RBF and GFR → enhanced drug delivery

37

Formation of Stones Prevented w/:

Citrate and high fluid intake

38

Stress Incontinence

MC after age 45, due to loss of pelvic floor support and incompetent urethral sphincter (innervated by S3, S4)
- Increased abdominal pressure (cough, sneeze, etc) can cause brief involuntary urine loss

39

Urge Incontinence

- detrusor overactivity, sudden urge to urinate

40

Overflow Incontinence

- involuntary, continuous leakage, full bladder
- Due to impaired detrusor contractility (diabetic neuropathy)
- Bladder outlet obstruction (tumor blocking urethra)

41

Membranous Nephropathy has Antibodies to:

Phospholipase A2

42

Pauci Immune (Type 3 RPGN)

- no Ig or complement deposits, but it is still crescenteric
- ANCA antibodies
- Often aw/ Wegeners

43

Modified Smooth Muscle Cells in the Afferent Arteriole

Renin synthesizing JG (juxtaglomerular) cells
- can hypertrophy/hyperplasia w/ chronic renal hypoperfusion

44

Ureteric Bud (Metanephric Diverticulum)

Collecting duct system (collecting ducts and tube, major and minor calyces, renal pelvis, and ureters)

45

Metanephric Mesoderm

glomeruli, Bowman's space, proximal tubules, loop of Henle, and distal convoluted tubule

46

Mesonephros

Wolffian ducts, ductus deferens, epididymis

47

Acetazolamide

Carbonic anhydrase inhibitor that acts on Proximal tubule
- increased excretion of HCO3 (so alkaline urine), may develop metabolic acidosis

48

ATN: Maintenance Stage

Decreased urine output, fluid overload, high BUN and creatinine, HYPERkalemia

49

ATN: Recovery Phase

Gradual increase in urine output --> high volume diuresis
- Decreased K, Mg, PO4, and Ca
(HYPOkalemia)

50

Causes of Oligohydramnios: (3)

ARPKD, Posterior urethral valves, or bilateral renal agensis

51

Renal Artery

Renal --> segmental --> lobar --> interlobar --> arcuate --> interlobular

52

Isotonic Fluid Loss

Hemorrhage, Diarrhea, and Vomiting

53

Hypotonic Fluid Loss

Dehydration, Alcoholism, and DI

54

ICF Volume Changes

Inverse to Osmolarity

55

Radiolabeled Albumin measures:

Plasma Volume

56

Inulin measures:

Extracellular Volume

57

RPF =

RBF(1-Hct)

58

FF =

GFR/RPF (normal is 20%)

59

Afferent Arteriole

Dilated by prostaglandins (inhibited by NSAIDs)

60

Efferent Arteriole

Constricted by Ang II (inhibited bye ACEi and ARBs)

61

Ammonia In Nephron

Secreted in Proximal Tubule

62

Urine is Concentrated in:

Thin Descending Loop and Collecting Duct (depending on ADH)

63

Urine is Diluted in:

Thick Ascending Tubule and Distal Convoluted Tubule

64

Urea Secreted in:

Thin ascending tubule

65

Fanconi Syndrome

Reabsorption problem in proximal tubule
Increased excretion of all amino acids, glucose, HCO3, and PO4
- may cause metabolic acidosis

66

Bartter Syndrome

Na/K/2Cl transporter inhibited
- hypokalemia, metabolic alkalosis, and hypercalciuria
(similar to loop diuretics)

67

Gitelman Syndrome

NaCl transporter defect in distal tubule
- hypokalemia, metabolic alkalosis, NO hypercalciuria
(similar to thiazide diuretics)

68

Liddle Syndrome

Overactive/constitutive ENac Channel (too much Na reabsorption)
- hypertension, hypokalemia, metabolic alkalosis
- low aldosterone
Tx: amiloride or triamterene

69

Proximal Tubule absorbs (below the line)

HCO3, Glucose, and Amino Acids

70

Relative Concentrations along Proximal Tubule

> 1 is solute reabsorbed much slower than water
= 1 is solute and water are reabsorbed at the same rate
> 1 is solute is reabsorbed more quickly than water

71

Low Serum Mg2+ causes:

Tetany and Torsades de Pointes
(more Ca released from SR)

72

Winter's Formula

PCO2 = 1.5 [HCO3] + 8 (+/- 2)

73

Anion Gap with Metabolic Acidosis

MUDPILES
Methanol, Uremia, DKA, Propylene Glycol, Iron tablets or INH, Lactic acidosis, Ethylene Glycol. Salicylates (late)

74

Metabolic Acidosis w/out anion gap

HARDASS
Hyperalimentaion, Addisons, Renal tubular acidosis, Diarrhea, Acetazolamide, Spironolactone, Saline infusion

75

Salicylates

Early Respiratory Alkalosis
Later Metabolic Acidosis
pH will be low/acidic to normal

76

Waxy Casts

Chronic renal failure

77

Muddy brown casts

ATN

78

Fatty Casts (oval bodies)

Nephrotic syndrome

79

Pyuria, without casts

Acute cystitis

80

Hematuria, without casts

Bladder cancer or Kidney stones

81

Membranous Nephropathy

- GBM thickening
- Spike and dome
- Caucasian (MC)
- aw/ Phospholipase A2 antibody
- SLE, NSAIDs, penicillamine, HBV, HCV, solid tumors
- Poor steroid response

82

Minimal Change Disease

- Glomeruli normal, foot process effacement
- Children after recent infection
- aw/ Hodgkins
- Great response to steroids
- Selective albuminuria

83

Membranoproliferative Glomerulonephritis (2 types) (MPGN)

- Hypercellular and thickened GBM
I: subendothelial deposits, tram track (GBM splitting)
- HBV, HCV
II: intramembranous complex deposits (dense deposits)
- Low C3

84

Diabetic Glomerulonephropathy

- thick GBM w/ non-enzymatic glycosylation
- Kimmelsteil wilson nodules (mesangial expansion)

85

Acute Post-streptococcal Glomerulonephritis (PSGN)

- enlarged and hypercellular
- Starry sky, lumpy bumpy ( IgG, IgM, and C3 deposition)
Type III Hypersensitivity
- low C3
- Subepithelial humps on EM
- Few weeks after GAS infection (of skin or pharynx)
- Increased anti-DNase B
- cola colored urine and facial edema

86

Diffuse Proliferative Glomerulonephritis (DPGN)

- wire looping (chicken wire) capillaries, subendothelial deposits
- SLE or MPGN (MC cause of death in SLE)

87

IgA Nephropathy (Berger)

- mesangial proliferation and deposits (of IgA)
- aw/ Honoch Schonlein purpura
- aw/ URI or acute gastroenteritis

88

Alport Syndrome

- X-linked mutation in type IV collagen
- Deafness and eye problems
- Glomerulonephritis that will almost always become ESRD

89

Stones that form in Alkaline Environment

Calcium Phosphate and Ammonium Magnesium Phosphate (struvite)

90

Radiolucent Kidney Stones

Uric Acid
- not visible on xray (can see on ultrasound)

91

Calcium Stones caused by:

Hypercalciuria (normocalcemia), ethylene glycol ingestion, Vit C abuse, or Crohns

92

Sodium nitroprusside test +

Cystine Stones

93

Staghorn Caliculi

Ammonium magnesium phosphate (struvite): adults
Cystine: children

94

RCC treatment

Resistant to chemo and radiation
- must resect

95

Renal oncocytoma

Benign epithelial tumor (well circumscribed)
- yellow brown central stellate scarring
- Large eosinophilic cells

96

RCC: Paraneoplastic

EPO, ACTH, and PTHrP

97

Transitional Cell Carcinoma: Causes

Phenacetin, Smoking, Aniline Dyes, and Cyclophosphamide
(also rubber, plastic, textile manufacturing)

98

Squamous Cell Carcinoma of Bladder: Causes

Chronic irritation
Schistosoma haematobium, chronic cystitis or nephrolithiasis, smoking

99

Wilm's Tumor: WAGR syndrome

- WAGR syndrome:
wilms tumor, aniridia, genital abnormalities, motore retardation (WT1 deletion)

100

Wilm's Tumor: Denys-Drash Syndrome

- Denys-Drash Syndrome:
wilms tumor, renal disease, male pseudohermaphroditism (WT1 mutation)

101

Wilm's Tumor: Beckwith-Wiedmann Syndrome

- Beckwith-Wiedemann syndrome:
wilms tumor, neonatal hypoglycemia, muscle hemihypertrophy, organomegaly of tongue (WT2 mutation, IGF2 specifically)

102

Thyroidization of Kidney

Eosinophilic casts resembling thyroid tissue
Chronic/recurrent pyelonephritis

103

ATN by Nephrotoxic Drugs

aminoglycosides (MC), radiocontrast agents, lead, cisplatin, Crush injury

104

Diffuse Cortical Necrosis of kidney

Vasospasm, DIC
(aw/ obstetric problems like abruptio placentae, or septic shock)

105

Prerenal Azotemia

Increased Na reabsorption
Increased BUN/Creatinine

106

Intrinsic Renal Failure

MC due to ATN
Impaired reabsorption of Na and BUN
Decreased BUN/Creatinine

107

Postrenal Azotemia

Outflow obstruction ( only if bilateral)
Less reabsorption of Na
Mild increase in BUN/Creatinine

108

Uremia: abnormal bleeding

Impaired platelet aggregation/adhesion due to uremic metabolites --> increased bleeding time only
(PT, PTT, platelet count are all normal)

109

Renal Osteodystrophy

Can hydroxylate Vit D so low Ca and high PO4 causing secondary hyperparathyroidism --> thinning of bones

110

Associations with ADPKD

Berry aneurysms
MVP
Hepatic cysts

111

Associations with ARPKD

Hepatic fibrosis
Portal hypertension
Potter Syndrome

112

Medullary Cystic Disease

Inherited tubulointerstitial fibrosis (AD)
Can't concentrate urine
Medullary cysts and shrunken kidney

113

Simple vs Complex Cysts

Simple: in outer cortex, filled with ultrafiltrate, MC, usually asymptomatic
Complex: have septated or solid component (removed because risk of RCC

114

Loop Diuretic for patients allergic to sulfa:

Ethacrynic Acid
- can cause hyperuricemia
- side effects similar to loop diuretics

115

Thiazide: Side effects

- Block NaCl symporter in distal tubule
Hyperglycemia
Hypercalcemia
Hyperuricemia
Hyperlipidemia
Hyponatremia and Hypokalemia
Metabolic Alkalosis

116

Spironolactone: Side Effects

Gynecomastia, antiandrogen effects

117

K+ Sparing Diuretics

Aldosterone Antagonists: spironolactone and eplerenone
ENac inhibitors: triamterene and amiloride
- all can cause hyperkalemia --> arrhythmia

118

MC cause of Fetal Hydronephrosis

Inadequate recanalization of ureteropelvic junction
(antenatal hydronephrosis is by vesicoureteral junction)

119

Lowest pH in nephron

Distal Tubule and Collecting Duct
(where stones will obstruct)

120

Increased risk of Varicocele or Hypercoagulation w/ Nephrotic Syndrome

Antithrombin and anticoagulant factors get lost in the urine leading to an overall state of hypercoagulability

121

Hyaline arteriolosclerosis of Renal Arteries

Nonmalignant HTN or Diabetes

122

Euvolemic Hyponatremia

SIADH
- appropriately concentrated urine, low serum sodium and osmolality but normal fluid volume due to compensation by ANP/BNP

123

Densely immunostaining protein containing cells near glomerulus:

JG cells w/ renin inside

124

Tamm-Horsfall Glycoprotein

can accumulate in lumen to make hyaline casts in prerenal azotemia

125

Causes of Central DI (5)

Pituitary tumor/resection, head trauma, brain tumor/infiltrative lesion, brain metastases

126

Causes of Nephrogenic DI (4)

Drugs (lithium, amphoteicin B, ciplastin, gentamicin)
Hypercalcemia
Hypokalemia
Postobstructive Diuresis

127

Xanthogranulomatous Pyelonephritis

Rare form of chronic pyelonephritis
- especially aw/ Proteus infection
- Tumor-like growth, upper urinary tract infection, and lipid-laden foamy macrophages (make this neither acute pyelo nor cancer)

128

Schistosomiasis

Schistosomiasis - particularly endemic in Africa
aw/ chronic cystitis
- Calcifications of the bladder wall (pathognomonic)
- Chronic infection is associated with an increased risk of squamous cell carcinoma of the bladder

129

NSAIDs can cause:

Acute Interstitial Nephritis
Membranous Nephropathy
Papillary Necrosis

130

Rhabdomyolysis

- Extreme exercise followed by renal failure
- Dark urine (without actual blood in it) is due to myoglobinuria, which can cause a false positive urine dipstick.

131

Loop Diuretic Effects on Nephron

- inhibits Na/K/2Cl symporter in thick ascending
- decreases water absorption in the descending loop
- decreases osmolarity of medullary interstitium

132

Renal Failure and Toe Gangrene following an invasive vascular procedure

Atheroembolic renal disease
- cholesterol emboli obstructing renal arterioles

133

Unilateral Renal Artery Stenosis

Usually a cause of secondary hypertension
- kidney affected by stenosis often gets atrophied due to oxygen and nutrient deprivation