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Flashcards in Renal Deck (39):
1

RPF

FF = GFR/RPF
PAH = estimate

2

Filtered load =

FL = GFR * Px

{GFR NOT CLEARANCE!]

3

AA in urine with vs without proline, hydroxyproline, and arginine

With = Fanconi's anemia (NO AA abs in PCT)
without = hartnups (neutral AA only) - pellagra

4

Fanconi anemia s/s and causes

S/s: prox. renal tubular metabolic ACIDosis

Causes: wilsons, tyrosinemia, glycogen storage diseases, expired tetracyclins, tenofovir, multiple myelomas, ischemia, lead poisoning

5

order of renal tubule defects:

fanconi
barters
Gitelman
Liddle - GOF; AD
S.I. mineralocorticoid excess

6

Adrenergic R on JG cells

Beta-1

7

7 effects of Ang-II

Peripheral VC (AT1)
Renal efferent VC
Aldosterone release
ADH release
Thirst
increases PCT Na//H activity (can cause CONTRACTION ALKALOSIS)
Limits reflex bradycardia (via baro-R modulatoin) to maintain BV and BP

8

macula densa pathway: INCREASED NaCl

high NaCl to macula densa (DCT) --> cells swell --> release adenosine -->

1) A1-R: afferent VC

2) A2-R: efferent VD

3) DECREASED JG release of renin

9

protaglandins in the kidney

VD afferent
[block with NSAIDs decreases GFR --> ARF]

10

Hyper vs hypo Mg

HypoMg = tetany, torades, hypokalemia

HyperMg = decreased DTRs, lethargy, hypotension, bradycardia, cardiac arrest, hypocalcemia

11

Normal anion gap (8−12 mEq/L)

HARD-ASS:
Hyperalimentation
Addison disease
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion

12

high anion gap (>12)

MUDPILES:
Methanol (formic acid)
Uremia
Diabetic ketoacidosis
Propylene glycol
Iron tablets or Isoniazid
Lactic acidosis
Ethylene glycol (oxalic acid)
Salicylates (late)

13

Type I renal tubular acidosis (distal)

CD, high urine pH

Alpha-intercalated cant secrete H+ → retain H+ and lose K+
high urine pH + increased bone turnover predisposes to stones

Causes:
amphoteraxcin B, analgesic nephropathy, urinary tract obstructions

14

Proximal/Type 2 renal tubular acidosis

PT, low urine pH

Defective PCT HCO3- absorption @BL → cant resorb Na with it (Na/HCO3 cotransport) → Na gets resorbed at CD, so K+ lost

K+ tries to get resorbed in exchange for H+ @ alpha-intercalated (K//H) → acidifies urine despite metabolic acidosis!

Causes:
Fanconi syndrome, CAH inhibitors (acetazolamide)

15

Hyperkalemic (type 4) renal tubular acidosis

Hypoaldosteronism, hyper K+, low pH urine

No aldosterone → save K+ → can't exchange for H+ out acidemia
High cellular K+ also decreases PCT NH3 synthesis decreasing urine NH4+ levels → acidic urine

Causes:
- hypoaldosteronism (ACE-I, ARB, NSAIDS, DM hyporeninism, adrnal insufficiency, heparin, cyclospirin)
- Aldosterone resistance (K+ sparing diuretics, obstructoin nephropathy, TMP/SMX)

16

granular/muddy brown casts

ATN

17

Waxy casts

ESRD or CRF

18

oval fat bodies

nephrotic syndrome

19

eosinophilic casts

Multiple myelomas (BJP + tammHorsefall)

[eosinoPHIL casts = AIN/TIN; drugs with rash]

20

RBC casts

glomerulonephritis
malignant HTN

21

WBC casts

TIN
acute pyelonephritis
transplant rejection

22

lumpy bumps vs. humps

PSGN - nephritic
lumpy bumpy = IgG, IgM, C3 on GMB and messangium
humps = sub-epi immune complex deposition

23

IgA nephropathy

HSP - nephritic
messangial IgA deposits and proliferation

24

MPGN

nephritic
Type I = subendo = tram tracks = hepB/hepC
Type II = intramembranous = dense deposits = C3 nephritic factor

25

DPGN

nephritic
via SLE (MCCD) or MPGN
wire-loooping capillaries on LM

26

basket-weave

alports
can't see, pee, hear a bee

27

Epidemiology of nephrotic diease

Black/hispanic = FSGS (heroin, sickle, HIV, obesity, IFN, CKD)
MCD = kids 91' or 2' immune stim.)
Membranous nephropathy = white (PLA2-R, HBV, HCV, SLE, solid tumours, NSAIDs, penicillamine)

28

spike and dome

membranous nephropathy - subEPIthelial
capillary and GBM thickening

29

eosinophilic nodular glomerular sclerosis

Kimmelsteil-wilson nodules (diabetic nephropathy)

30

Rx ca-oxalate stones

B6: decreases oxalate production
Citrate: binds Ca++ salts
hydration
thiazides: resorb Ca++

31

Rx RCC

surgery or immunotherapy
[resistant to chemo and radiation]

32

origins: RCC and oncocytoma

RCC = PCT
oncocytoma = CD

33

RF transitional/urothelial CA

Phenacetin (pain med)
Smoking
Aniline dyes (leathers, rubber, textiles)
Cyclophosphamide

34

sterile pyuria with no culture

ghonorrhea or chlamydia (NOT just a UTI)

35

WBC in urine + WBC CASTS!

Acute pyelonephritis
(not just cystitis or UTI b/c of casts)
(cortex, avoids glomeruli/capilaries)

36

throidization of kidney

chronic pyelonephritis

37

Signs of renal failure:

MaD HUNGER
- Metabolic acidosis
- Dyslipidemia (increased TAG)
- Hyperkalemia
- Uremia: encephalopathy, asterixis, platelet dysfunction, pericarditis, functional hypothyroidism
- Na/H2O retention (edema)
- Growth retardation
- EPO failure
- Renal osteodystrophy

38

HTN in ADPKD via

high renin release from giant kidney

39

Medullary cystic disease

inherited
T-I fibrosis --> SHRUNKEN kidneys (seen on US)
can't concentrate urine