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Flashcards in Renal Deck (90):
1

What happens to : Pronephros, Mesonephros, Metanephros

Pronephros: degenerates at week 4
Mesonephros: degerates and creates ureteric bud (ureter, pelvises, calyces, collecting duct) and male genital sytem
Metanephros: kidney

2

Most common site of fetal renal obstruction

ureteropelvic junction

3

What is Potters sequence/syndrome?

oligohydramnios -> compression of fetus -> limb deformities, facial deformities, and pulmonary hypoplasia

4

What etiology of Potters?

babies can't Pee (potters). ARPKD, posterior urethral valves, renal agenesis

5

What is horseshoe kidney?

bottom of kidneys fuse while in pelvis. when they ascend from the pelvis they get stuck on the inferior mesenteric artery but work just fine.

6

What is horseshoe kidney associated with?

turners syndrome (a single x chromosome)

7

What causes multicystic dysplastic kidney ?

abnormal interaction between ureteric bud and metanephric mesenchyme

8

Ureters course

water under the bridge. ureters under uterine artery/ductus deferens. all retroperitoneal

9

inulin

tells you GFR cause it is filtered out but not secreted or resorbed at all

10

Glomerulous filter components

fenestrated capillary endothelium (size), heparan sulfate basement membrane (negative charge barrier), epithelial podocyte foot processes

11

PAH

both filtered out and entirely secreted so it measures total glomerulous flow rate

12

normal filtration fraction

20%

13

effect of prostaglandins on filtratin

(paracrine) dialate afferent ateriole -> more RPF and GFR but FF static

14

effect of Angiotensin II on filtration

constricts efferent arteriole. decrease RPF, increase GFR and FF

15

where and how is glucose resporbed? exceptions?

Na cotransport in PCT 100%. uncontrolled diabetes and normal pregnancy

16

nephrogenic cause of pellagra and symptoms

deficient sodium-tryptophan transporter -> low W -> cant make niacin -> dermatitis, diarrhea, disturbed (mental)

17

PTH effect on nephron

inhibit na/phosphate coreuptake in PCT, enhance calcium/sodium coreuptake in DCT

18

AT II effect on PCT

stimulates Na/H antiport -> acidify urine, more CO2/bicarb uptake, Na uptake, water uptake

19

loop diuretics hit?

triporter (Na/K/2Cl) of Thick ascending loop

20

What does aldosterone modulate in nephron?

Aldosterone inserts mineralocorticoid Na-channel on lumin of collecting duct. Na goes in exchanged for H and K.

21

what does ADH do to the nephron?

inserts aquaporin in collecting tubule

22

describe renin-angiotensin-aldosteron system

(liver) angiotensinogen --(renin/kidney)--> angiotensin I --(ACE/kidney/lung)--> Angiotensin II --> Aldosterone release (adrenal) and ADH (posterior pituitary)

23

effects of Angiotensin II

vasoconstriction (up BP), constrict efferent arteriole, Aldosterone release from adrenal, ADH release from posterior pituitary, PCT Na/H antiport (absorb Na/bicarb/water), stimulate thirst, limits reflex bradycardia

24

what inhibits bradykinin?

ACE

25

what upregulates renin?

low BP (JG cells), low sodium (macula densa), high sympathetic tone

26

ANP

released from atria due to high volume to relax smooth mucles via cGMP and increase GFR and lower renin. No compensatory Na reabsoption

27

Juxtaglumerulous cells

afferent arteriole release renin

28

macula densa cells

distal convoluted tube sense NaCl

29

kidney effects RBCs by

EPO

30

kidney processing of vitamin D

converts 2,5-oh vit D ---(1alpha-hydroxylase)--> 1,2,5 oh which is active form. parathyroid hormone activates

31

What shifts K out of cells?

DO Insulin LAB(eta): digitalis, hyperOsmolarity, Insulin deficency, Lysis of cells, Acidosis, Beta adrenergic antagonist

32

Serum Na high/low symptoms

low: nausea, malaise, stupor, coma.
high: irritability, stupor, coma

33

Serum K high/low symptoms

low: U waves on ECG, flattened T waves, arrhythmias, muscle weakness
high: wide qrs, peaked T waves, arrhythmias, muscle weakness

34

Serum Ca high/low symptoms

low: tetany, seizures
high: Stones, bones (pain), groans (ab pain), psyc overtones (anxiety, odd)

35

Serum Mg high/low symptoms

low: tetany, arrhythmias
high: decreased reflexes, lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia

36

Serum Phosphate high/low

low: bone loss, osteomalacia
high: renal stones, metastatic calcifications, hypocalcemia

37

Metabolic acidosis labs

pH low, pCO2 low, HCO3 low (hyperventalation response immediate)

38

Metabolic alkalosis

pH high, pCO2 high, HCO3 high (hypoventalation response immediate)

39

Respiratory acidosis

pH low, pCO2 high, HCO3 high (bicarb renal retention delayed)

40

Respiratory alkalosis

pH high, pCO2 low, HCO3 low (renal response)

41

What is anion gap and what is abnormal?

Anion gap = Na - (Cl+HCO3). normal is 8-12

42

anion gap metabolic acidosis etiology

MUDPILES: Methanol, Uremia, Diabetic Keto, Propylene glycol, Iron tablets, Lactic acidosis, Ethylene glycol, Salicylates

43

non-anion gap metabolic acidosis etiology

HARD ASS: Hyperalimentation, Addisons Disease, Renal tubular acidosis, Diarrhea, Acetazolamide, Spironolactone, Saline infusion

44

Renal tubular acidosis type 1

distal: collecting duct can't excrete H. hypokalemia. calcium phosphate kidney stones. urine pH > 5.5

45

Renal tubular acidosis type 2

proximal: PCT cant reabsorb HCO3. Seen in fanconi syndrome. urine pH

46

Renal tubular acidosis type 4

hyperkalemic: hypoaldosterone or response of collecting tubule -> can't secrete K. high K = can't release ammonia to buffer -> acidic pee

47

casts in urine

means is from the kidney

48

rbc casts

glomerulonephritis, ischemia, malignant hypertension

49

wbc casts

tubulointerstitial inflammation, acute pyelonephritis, transplant rejection

50

fatty casts "oval fat bodies"

nephrotic

51

granular casts "muddy brown"

acute tubular necrosis

52

waxy casts

advanced renal disease/kidney failure

53

hyaline casts

nonspecific, even normal

54

Focal segmental glomerulosclerosis. type, LM, EM

#1 nephrotic. LM: segmental sclerosis/hyalinosis. EM: foot process effacement (same as minimal change).

55

Focal segmental glomerulosclerosis associations

HIV, heroin, massive obesity, interferon

56

Membranos nephropathy type, LM, EM, IF

#2 Nephrotic. LM: diffuse capillary and GBM thickening. EM: "spike and dome" subendothelial deposits. IF: granular. This is SLE nephrotic (also idopathic or drug-induced)

57

Minimal Change disease

Children Nephrotic. LM: normal. EM: foot process effacement. Loss of albumin not globulins cause GBM anions gone.

58

Amyloidosis nephropathy

Nephrotic LM: congo red shws apple-green birefringence. associated with chronic conditions.

59

Membranoproliferative glomerulonephritis

Nephrotic/Nephritic.
Type I: subendothelial immunocomplex deposits. granular IF "tram-track". associated HBV, HCV

Type II: intramembranous IC "dense deposits". Associated C3 nephritic factor

60

Diabetic glomerulonephropathy

Nephrotic. Nonenzymatic glycosylation of GBM and efferent arteriole. LM: mesangial expansion/gbm thickening/glomerulous eosinophilic nodules (Kimmelstel-wilson)

61

Acute poststreptococcal glomerulonephritis: LM, EM, IF, epidemiology

Nephritic. LM: large gloms, neutrophils, "lumpy-bumpy". EM: subepithelial IC. IF: granular. seen in kids w/ periorbital edema, dark urine.

62

Rapidly progressive glomerulonephritis causes

Nephritic or Nephrotic. Goodpastures, wegeners, microscopic polyangiitis

63

goodpastures hypersensitiveity type, IF, antibody targets

type II, kidney and lung basement menbrane antibodies, linear IF

64

Wegeners vs microscopic polyangitits

Both RPGN. Wegeners (c-ANCA) vs Microscopic Poly Angitis (p-ANCA)

65

Bergers Disease

IgA nephritic syndrome. Purpura, URI, GI-itis. LM: mesangial proliferation. EM: mesangial IC. IF: IgA IC deposites

66

Alports

Nephritic. Mutation in type IV collagen(x linked) -> BM splitting. Nephritis/deafness/eye problems

67

Kidney stone types

calcium, ammonium/magnesium phosphate, uric acid, cystine

68

which kidney stones are opaque vs lucent

opaque: calcium, ammonium magnesium phsphate, cystine
lucent: uric acid

69

vitamin c cause what kinda stones

calcium

70

ethelene glycol (anti freeze) stones type

calcium

71

urease-positive bugs cause what kinda stones?

ammonium

72

staghorn calculi stones?

ammonia stones. serve as plateform for uti

73

#1 renal cancer?

Renal cell carcinoma

74

genetic association with renal cell carcinoma?

Chrom 3 deletion (VHL syndrome)

75

renal cell carcinoma presentating symp

hematuria, mass, pain. paraneoplastic syndrome cause EPO (polycythemia), ACTH, PTHrp. often presents with mets cause retroperotoneal

76

renal cell carcinoma histology and age group

PCT cells: polygonal, lots of lipids (clear). Men 50-70 with smoking and obesity

77

renal cell carcinoma treatment

resection, resistant to chemo and radio

78

Wilms tumor (nephroblastoma)

childhood renal cancer. embryonic glomeruli. due to deletion of WT1 gene on Ch 11.

79

WAGR complex (brandon your a warg!)

Wilms tumor, aniridia (no iris), genitourinary malformation, retardation

80

Transitional cell carcinoma

urinary tract cancer. painless bloody pee.
Pee SAC: Phenacetin, Smoking, Aniline dyes, Cyclophosphamide

81

thyroidization of the kidney

chronic pyelonephritis

82

Drug induced interstitial nephritis

occurs a week or two later with eosinophile urine, azotemia.

83

diffuse cortical necrosis

bilateral widespread infarction. associated with obstetric catastrophes (abruptio placentae)

84

Azotemia

High urine bun and low serum creatinine

85

Prerenal azotemia
Urine osmolality
Urine Na
FeNa
Serum bun/creatinine

Urine osmolality > 500 (normal)
Urine Na 20% (high)

Kidney is working to conserve volume

86

Intrinsic renal failure
Urine osmolality
Urine Na
FeNa
Serum bun/creatinine

BUN is high cause kidneys are fucked
Urine osmolality 40 (normal)
FeNa >2% (high)
Serum bun/creatinine

87

Posterrenal azotemia

BUN is high cause cant excrete

88

renal osteodystrophy

can't make activated vitamin D, hypocalemia, and hyperphosphatemia so bones thin. also has secondary compensatory hyperparathyroidism

89

ADPKD

cysts destroy kidney. PKD1 or PKD2 genes. Associations: berry aneurysms, mitral valve prolapse, benign hepatic cysts

90

ARPKD

infantile, recessive. hepatic fibrosis, potters sequence