renal Flashcards
(168 cards)
1
Q
parts of developing kidny
A
pronephors, degen at 4 weeksmesonephros (interim kdiney)
metanephros (permanent)
2
Q
when does metanephros appear
A
5th week
3
Q
how does glomerulus through to DCT form
A
utereric bud interacts with metanephric mesenchyme which induces differentaiton
4
Q
last part of uro system to canalize
A
ureteropelvic junction MOST COMMON SITE OBSTRUCTION
5
Q
potter sequence etiology
A
anything that causes OLIGOhydramnios
ARPKD, obstructive uropathy (posterior urethral valves), bilateral renal agensis
6
Q
cause of death in potter sequence
A
pulmonary hypoplasia
7
Q
symptoms of potter sequence
A
all compression related POTTER Pulmonary hypoplasia oligohydramnios twisted face twisted skin extremity deformities renal failure in urtero
8
Q
etiology horsehoe kidney
A
abnormal fusion of inferior poles of both kidneys
9
Q
what does the horshoe kidney get stuck under as it ascends from pelvis during dvlpmt
A
IMA
thats why they remain low in abdomen
10
Q
complications of horshoe kidney
A
kidney function NORMAL but
can develop hyronephrosis (uteropelvic junction), renal stones, infection,
11
Q
unilateral renal ageneiss vs multicystic dysplastic kidney
A
unilateral - complete absence of kidney and ureter
multicystic - nonfunctional kidney is just a bunch of cysts and connective tissue
BOTH INVOLVE FAILURE OF URETERIC BUD TO INDUCE DIFFERENTIATION WITH METANEPHRIC MESENCHYME
12
Q
y shaped bifid ureter
A
duplex collecting system
assocaitd with vesicoureteral reflux or ureteral obsrution
13
Q
MCC cause of bladder outlet obstruction in male infants
A
posterior urethral valvues
presents with hydronephrosis
14
Q
ureters travel under what structures
A
female - uterine artery
male - vas deferens
water under bridge
15
Q
renal blood flow from renal artery to venous outflow
A
renal artery segmental artery interlobar artery arcuate artery interlobular artery afferent arteriole glomerulus efferent arteriole vasa recta/peritubular capillaries venous outflow
16
Q
GFR barrier composed of….
A
fenestrated capillary endothelium
basement membrane with type IV collagen
epithelial layer of PODOCYTES
17
Q
which is a better filter fenestrated capillary epithelium or podycyte foot processes
A
podocyte foot processes forms slit diaphragm chich presvents 50-60 nm molecules
fenestrated capillary prevenst greater than 100
18
Q
charge of GFR barier
A
negatively charge glycoproteins (prevent postiive charged molecule entry)
19
Q
where does AT II target on nephron
A
PCT - stimulates Na/H exchange (inrease Na reabsorption, h20, and hc03 reabs) permitting contraction alkalosis
20
Q
how does angiotensin II affect RBF
A
constricts efferent arteriole
21
Q
ANP stimulated by what
A
increases in atrial pressure…will increasee GFR and NA filtration with no reabsorption…Na loss and water loss (brake on RAAAS system)`
22
Q
how is EPO released
A
releasd by intertitial cells in peritubular cap bed in response to hypoxia
23
Q
formula correlating RBF and RPF
A
RBF = RPF/1-Hct
24
Q
every time GFR halves serum creatinine will
A
double (creatinine not a sensitive indicator of kidney function when GFR is normal)
25
which part of nephron is impermeabl to water despite adh
thick ascending loop
26
winters formula
predicted Pco2 =( hco3x1.5) + 8 +/-2
27
what part of nephron is Mg and Ca reabsorbed
Thick ascending loop
28
distal RTA type 1
distal tubule cannot acidify urine (urine ph high) assocaited with hypokalemia
low bicarb
29
assocaited symptoms of distal RTA type 1
alkalinized urine increases risk for calcium phosphae kidney stones
an rickets
30
how to calculate URINE anion gap
Na + K - Cl
31
what is the Cl in urine anion gap a good approx for?
Nh4 (Nh4 leaves with Cl)
32
Urine anion gap in setting of GI acidosis like diarrhea
UAG becomes negative (more chlorine leaving and NH4)
33
Urine anion gap in setting of distal RTA?
since urine can't be acidified, it does not become negative despite acidosis
34
when given ammonia "challenge" (acid load of NH4Cl) what will RTA urine ph be
would still be greater than 5.3
35
negative UAG in acidosis vs psoitive UAG in acidosis
negative UAG = GI acidosis
| postivie UAG - RTA
36
autoimmune disease (srogens or RA) presents with bilateral recurrent kidney stones, with high urine pH, hypokalemia, positive UAG
distal RTA
37
urine pH high or low ins type II proximal RTA
low as it should be
| since DCT can still excrete H+
38
loss of HCO3 resportion in PCT
proximal rta type II
39
why is proximal rta type II assocaited with hypokalemia
low bi carb, low volume, increase in aldosterone, HYPOKALEMIA
40
assocaited with fanconi syndrome
type II proximal RTA
41
hypophosphatemic rickets BUT NO KIDNEY STONES
type II proximal RTA
42
only RTA with hyperkalemia
type 4 RTA
43
dysfuction of aldosterone channels
type 4 rta (distal)
44
dysfunction of distal H/K exchanger
type 1 RTA distal
45
dysfunction of proximal bicarb channels HCO3
type 2 rta
46
noninherited cysts in kidnys
dysplastic kidney
47
inherited defect, BILATERAL enlarged kidneys with cysts in renal cortex AND medulla
Polycystic kidney disease
48
infant PKD
autosomall recessive
| renal failure HTN
49
ARPKD assocaited with what complications
cysts in kidney- so bad you can get oligohydram-> potter
| cysts in LIVER also -> PORTAL HTN -> hepatic fibrosis
50
ADPKD presents what age
young adults
51
mutation ADPKD
APKD1 APKD2, cysts develop GRADUALLY over time
52
why do ADPKD present wiht HTN
can have dysfunctional release of renin
53
CNS complication of ADPKD
berry aneurysm
54
cardiac complication ADPKD
MVP
55
inherited defect ONLY IN MEDULLARY COLLECTING DUCTS
medullary cystic kidney disase (kidneys are SHRUNKEN)
56
shrunken kidneys
medullary cystic kidney disease
57
prerenal Bun:cr ratio and FeNa, urine osm
BunCr>15
FeNa < 1 (tubules still able to resorb Na)
urine osm > 500 (high)
58
key finding ATN
granular "muddy brown " casts in urine
59
Bun cr, FeNa, Urin osm in intrinsic renal
Buncr low
Fe na High
urine osm low
60
part of nephron most suseptible to injury during renal failure
PCT and thick ascending limb
61
agents that can cause nephrotoxic injury
```
aminoglycosies
heavy meatlas
myoglobinuria (crush injiry)
urate (TLS)
radiocontrast!
```
62
how does ATN afect acidase status and potassium status
metabolic acidosis
| hyperkalemia
63
how long can oliguria persist in ATN
2-3 weeks before recovery (tuublar cells are stable cells)
64
drug induced hypersensivitiy reaction of intersitium
acute interstitial nephritis
65
oligura, fever, RASH, hematuria with Eosinophils
aute interstitial neph
66
key finding in urine in AIN
eosinophils
67
drugs tha can induce AIN
```
P's
Pee (diuretics)
Pain free (NSAIDS)
Penicillins
PPi
rifamPin
```
68
long term aspirin use or phenacitin can cause
acute papillary necrosis
69
etiologie renal papillary necrosis
```
SAAD papa with papillary necrosis
Sickle cell
acute pyelo
analgesics (NSAIDS)
DM
```
70
what is lost in nephrotic syndrome
albumin (3.5 day)
gammaglobulin (incrased infxn
anti thrombin III (hypercoag)
also associated with hyperlipidiema and hypercholesterol
71
minimal change assocaited with what cancer
hodgkin lymphoma
72
key findings in minimal change
NORMAL GLOMERULI on Hand E stain
but EFFACEMENT OF FOOT PROCESSES on electron microscopy
NOTHING IMMUNOSTAINS
73
how does hodgkin lymphoma cause amage to kidney
overproduction of CYTOKINEs can efface foot processes
74
nephrotic syndrome with HIV!?!?!
FSGS
75
nephrotic syndrom ein heroin user
FSGS
76
nephrotic syndorme in sickle cell
FSGS
77
key findings in FSGS
look for local sclerosis of SEGMENTS
| effacement of foot processesalso
78
nephrotic syndomr with Hep B/C
membranous nephropathy
79
nephrotic syndrome in SLE patient
membranous nephropathy
80
two hep B renal complications
```
membranoproliferative glomerulonephritis (nephritic)
membranous nephropathy (nephrotic)
```
81
THICKening of membrane on Hand E
membranous nephropathy
82
any time you see "membran" in front of glomerulo it usually due to
imune complex deposition
| so positiev immnofluresent
83
granular IF
membranous nephropathy
84
spike and dome appearance on EM
membranous nephropathy
85
"tram track" appearance
membranoproliferative glomerulonephritis (due to (proliferation of membranes splits )
86
two types of membranoproliferative
1. subendothelial (HBV/HCV)
| 2. basement membrane
87
c3 nephritic factor
type 2 membranoproliferative
88
function of C3 nephritic factor
IgG antibody that stabilizes c3 convertase which will elad to persistent coplement acivaiotn and lowered C3 levels
89
first chagneseen inkdiney in DM
high blood glucose caues nonenzymatic gycosylation of vascular basement ;membrane (vessels more permeable and laeky) resulting in hyaline arteriosclerosis which will increse GFR (backup)causing thickening of mesangial cells
90
key finding in DM glomerfulonephropatyh
```
esoinophilic nodular glomerulsclerosis
MESANGIA EXPAINSION (krimmelsteil wilson lesions
```
91
apple green biferingence in congo stain
systemic amyloidosis
92
where does systemic amyloidosis affectkidney
MESANGIUM
93
nephritic syndrme presents with what
RBC casts
htn and salt retntion
perioberital edema
limited proteinuria
HALL MARK IS GLOMERULAR BLEEDING
94
what bateria can ca;use nephritic snydorme
GABHS (acute post streptococcal glomerulnephritis)
95
virulence factor of GABHS causing nephritic
M protein
96
subepithelial hump on EM, immune complx deposition
acute post strep glomerulnephritis
97
nephritic syndorme that progresses to RENAL FAILURE in weeks to month
rapidly progressing glomeruloneph (crescentic)
98
biopsy in rapidly progressive glomer
creseceent in bowman Space Hand E
99
what makes up "crescent" in crescentic glomerfulnephritis
FIBRIN AND MACROPHAGES
100
```
crescentic glom
LINEAR immunofluoresence (antiboddy to basement membraen)
```
goodpasture syndrome (hematuria and hemoptysis)
101
granular IF pattern
immuncomplex deposition
| PSGN or diffuse proliferative glom
102
MCC disease that damages kidney in SLE
diffuse proliferative glomerulonephritis
103
negative IF neph *pauci immune)
check ANCA
104
patient comes in with hemoptysis, hx of sinus infections hematuria,
Wegner's gran
| c-ANCA
105
how to differentiate goodpastureu and wegner's
wegners - negative IF, nasopharynx involvement
| goodpasture - positive IF (linear IF)
106
microscopic polyangitis vs. churgstrauss
BOTH have p-anca
| but only churg strauss has granulomas, asthma, and eosinophils
107
where does IgA nephropathy deposoit
MESANGIUM
108
EPISODIC HEMATURIA, rbc casts, following mucosal infection i childhood
IgA nephropathy (granular IF) due to immune complexes
109
isoalted hematuria, sensory hearing loss, ocular disturbances
alport syndrome (in a faimily)
110
dysuria, urinary frequency, urgency, suprapubic pain...NO FEVER OR MALAISE
cystitis
111
UTI with alkaline urine and ammonia scent
proteus
112
pyuria with urine culture
urethritis
| chlamydia, neisseria
113
wbc casts
pyelo
114
structural abnoramlity which increses risk UTI
vesiculourethral reflux
115
cortial scarring blunted calyces (thyroidization) thyroid follicles (eosinophilic protenacious material)
chronic pyelo
116
IBD assocaited with which kidney stone
calcium oxalate (decreased absorption of oxlate)
117
how to treat calcium oxalate stones
ca sparin gdiuretic
| thiazide
118
staghorn calculi renal calyces ADULT
ammonium mag phosphate (struvite) coffin) kebseilla or pretus
119
which stones aren't seen on xray
uric acid
120
which stones precipitate in low pH acidic urine
uric acid stones (esp in DCT)
121
staghorn calculi in child
cytinuria (treat by alkalinzing urine)
122
only stone asasociatd with ialkaine urine
ammonioum magneuim phosphate stone
123
cardiac complication uremia
periccarditis
124
where is EPO produced
renal peritubular interstitial cells
125
ESRD chagnes calcium an dphosphate how
hypocalcemia
hyperphosphatemia'
failure of vitD hydroxylation
126
renal osteodystrophy pathogenesis
bad kidney = hypocalcemia = increased PTH = increasd bone turnover
127
acid base ESRD
metabolic acidosis with uremia
128
Esrd kidneys will get bigger or shrink
shrink (increased risk of RCC)
129
angiomyolioma assocaited with what
tuberous sclerosis
130
hematuria PALPABLE MASS and flank pain
RCC
131
paraneoplastic syndromes associated with RCC
EPO - secondary polycythemia
renin- HTN
ACTH - cushings
PTHrp - hypercalcemia
132
testicular complciation RCC
left sided varicocele
133
MCC histologic presentaiotn RCC
```
clear cytoplasm (clear cell carcinoma)
polyganla clear cells
```
134
RCC tumors color and filled with what
yellow illed with lipids
135
risk factor sporadic RCC
SMOKING
136
hereditary syndrome RCC
VHL on chromosome 3p (AD) inactivation of VHL gene (deletion)
137
VHL increased risk of what cancers
RCC and HEMANGIOBLASTOMA
138
RCC likes to spread where
invades IVC to invade lung and bone
| retroperitoneal lymph nodes
139
kidney mass child
wilm's tumor (nephroblastoma)
140
child large unilateral flank mass and HTN
wilms tumor
141
wilms tumor mutation
loss of function of tumor suppressor WT1 WT2 onchormosome 11
142
wilms tumor syndrome
```
WAGR
wilms tumor
aninirida (absence of risi)
genitourinary malformations
Retardation (mental (WT1)
```
143
wilms tumor assocaited with what other genetic syndrome
beckwith wiedemann
144
wilms tumor, macroglossia, organomegaly...HALF OF MUSCLES ON ONE SIDE OF BODY BIGGER THAN OTHER (HEMIHYPERPLASIA)
beckwith wiedemann (WT2 loss of function tumor suppressor)
145
MCC lower urinary tract
transitional cell (urothelial)
146
number oen risk factor TCC
SMOKING
also increased with dye use, pehnacitin
cyclophosphamide
147
painless hematuria
transitional cell carcinoma
148
risk factors of SCC bladder
chronic INFLAMATION
| schistosoma hemaboium
149
middle eastern male presents with painless hematuria
squamous cell carcinoma of bladder from schistosoma haebotulum
150
which diuretic causes acidosis
acetazoalmide (carbonic anhydrase inhibitor) (cannot secrete bicarb) similar to type 2 proximal RTA
151
what part of loop does furosemide, bumetanide, torsemide worke
thick ASCENDING limb
152
which transporter do loop diuretics inhibit
Na K 2 cl cotrasnport
| cannot concentrate urine
153
which diuretics increase excretion of calcium
loop diuretics
154
adverse affects of loop diuretics
```
OHH DAANG
oto toxicicity
hypokalemia
hypomag
dehdyration
allergy *sulfa)
alkalosis
gout
```
155
where to thiazide diuretics target
DCT inhibit Na Cl reabsorption (decreaseing Ca exrcretion ) Ca sparin diuretic
156
diuretics which increase urinary Ca and decrese urinary Ca
increase urinary Ca - loop
| decrease - thiazide
157
adverse effects thiazides
```
hyperGLUC
hypergly
hyperlipid
hyperuriciema
hypercalc
```
158
diuretics to treat hypraldosterone
spironlactone, eplerenon, trimaterine, amiloride
159
target K sparing diurecics
cortical collectin tubule (aldosterone antoagnoists)
160
which diuretics make you acidotic and alkalotic
```
acidotic - ccetoazoamide (cabonic anyhdrase)
potassioum sparking (spirono, amilordie, triamteren, eplenrone)
alkaloti c- loop and thiazide diretics
```
161
teratogenic effect ace inhibitor
fetal malofmraiotn
162
ace inhibitors do what to GFR
constrict efferent ateroiel ACE decreasing egf
| increases renin
163
adverse renal side effect acylovir
crystla nephropathy GIVE WITH AGGRESSIVE IV HYDRATION
164
which di;uretic assocaited with gyneco mastia (antiandorgen effect
sprionolactone
165
causes metalk
vomiting/nasogastric suctioning
thiazie loop diuretics
mineralcorticoid excess (primary hyperaldosteron) saline UNRESPONSIVE (HTN and high urine Cl
166
what to values to evaluate metalk
urinary Cl and volume status
167
why do distal RTA increase risk for ca stones
decerased CITRATE
168
how is digoxin cleared
KIDNEY
