Renal Disease Prt.2

Question 1

•Each nephron processes ~_____ of filtrate daily with____% reabsorption

Answer 1

180L

99%

Question 2

•Tubular system performs (3)

Answer 2

reabsorption, secretion, and concentration

Question 3

•The____ is the functional unit of the kidney with distinct segments

Answer 3

nephron

Question 4

Key Tubular Segments and Functions

Answer 4

Proximal tubule
LOH
Distal tubule
Collecting duct

Question 5

Proximal Tubule
1. Reabsorbs 65-80% of filtered (3)
2. Handles virtually all (2) reabsorption
3. Reabsorbs 80-90% of (1)

Answer 5

sodium, chloride, water

glucose and amino acid

bicarbonate

Question 6

1. Establishes concentration gradient
2. Impermeable to water in ascending limb

Answer 6

Loop of Henle

Question 7

•Fine-tunes electrolyte balance
• Regulated by hormones (PTH, aldosterone)

Answer 7

Distal Tubule

Question 8

• Water reabsorption (ADH-controlled)
• Final acid-base regulation
• Potassium secretion

Answer 8

Collecting Duct

Question 9

Pathophysiological Patterns

•_______: Failure to reabsorb filtered substances
•_______: Failure to secrete substances
•_______: Disrupted water handling

Answer 9

Wasting Syndromes

Retention Syndromes

Concentration/Dilution Defects

Question 10

Clinical Manifestations
• Polyuria/polydipsia
•Electrolyte abnormalities
•Acid-base disturbances
•Growth issues in children
• Nephrolithiasis/nephrocalcinosis

Answer 10

Tubular Disorders

Question 11

Tubular disorders

Diagnostic Approach (4)

Answer 11

• Urinalysis (pH, specific gravity, glucose, protein)
•Serum electrolytes and acid-base status
•Specialized functional testing
• Imaging and genetic studies when indicated

Question 12

Proximal Tubular Disorders (5)

Answer 12

Fanconi Syndrome
Renal Glucosuria
Cystinuria
RTA T2
Hartnup Disease

Question 13

Loop of Henle Disorders (2)

Answer 13

Bartter Syndrome
Medullary Sponge Kidney

Question 14

Distal Tubular Disorders (2)

Answer 14

RTA T1
Gitelman Syndrome

Question 15

Collecting Duct Disorders (2)

Answer 15

Nephrogenic DI
RTA T4

Question 16

Proximal Tubular Disorders

•Pathophysiology: Generalized proximal tubular dysfunction

Answer 16

Fanconi Syndrome

Question 17

Proximal Tubular Disorders

•Clinical Features: Polyuria, polydipsia, dehydration, growth retardation

• Laboratory Findings:
• Glucosuria with normal blood glucose
• Aminoaciduria
• Phosphaturia and hypophosphatemia
• Bicarbonaturia and metabolic acidosis
• Low-molecular-weight proteinuria

Answer 17

Fanconi Syndrome

Question 18

Proximal Tubular Disorders

•Pathophysiology: Isolated defect in glucose reabsorption

Answer 18

Renal Glucosuria

Question 19

Proximal Tubular Disorders

•Clinical Features: Often asymptomatic
• Laboratory Findings:
• Glucosuria with normal blood glucose
•No other tubular abnormalities

Answer 19

Renal Glucosuria

Question 20

Proximal Tubular Disorders

•Pathophysiology: Defective transport of dibasic amino acids

Answer 20

Cystinuria

Question 21

Proximal Tubular Disorders

•Clinical Features: Recurrent kidney stones

Answer 21

Cystinuria

Question 22

Proximal Tubular Disorders

Cystinuria

• Laboratory Findings:
Increased urinary excretion of (4)

•Characteristic____ crystals in urine

•Positive______test

Answer 22

cystine, ernithine, lysine, and arginine

hexagonal

cyanide-nitroprusside test

Question 23

Proximal Tubular Disorders

•Pathophysiology: Defective bicarbonate reabsorption

Answer 23

Renal Tubular Acidosis Type 2 (Proximal RTA)

Question 24

Proximal Tubular Disorders

•Clinical Features: Growth failure, rickets, osteomalacia

• Laboratory Findings:
•Hyperchloremic metabolic acidosis
• Urine pH < 5.5 during acidosis
•Bicarbonaturia
• Hypokalemia

Answer 24

Renal Tubular Acidosis Type 2 (Proximal RTA)

Question 25

Proximal Tubular Disorders •Pathophysiology: Defective ***neutral amino acid transport***

Answer 25

Hartnup Disease

Question 26

Proximal Tubular Disorders •Clinical Features: ***Pellagra-like rash, cerebellar ataxia*** • Laboratory Findings: • Increased urinary excretion of neutral amino acids •Normal serum amino acid levels

Answer 26

Hartnup Disease

Question 27

Hartnup Disease •Clinical Features:

Answer 27

Pellagra-like rash cerebellar ataxia

Question 28

RTA T2 •Clinical Features:

Answer 28

Growth failure, rickets, osteomalacia

Question 29

Cystinuria •Clinical Features:

Answer 29

Recurrent kidney stones

Question 30

Fanconi syndrome •Clinical Features:

Answer 30

Polyuria, polydipsia, dehydration, growth retardation

Question 31

Loop of Henle Disorders • Pathophysiology: Defect in ***sodium-potassium-chloride cotransporter***

Answer 31

Bartter Syndrome

Question 32

Loop of Henle Disorders •Clinical Features: Growth retardation, muscle weakness, polyuria • Laboratory Findings: • Hypokalemic metabolic alkalosis •Hypochloremia •Normal blood pressure •Elevated renin and aldosterone • Hypercalciuria

Answer 32

Bartter Syndrome

Question 33

Loop of Henle Disorders • Pathophysiology: Cystic dilation of collecting ducts in renal pyramids

Answer 33

Medullary Sponge Kidney

Question 34

Loop of Henle Disorders •Clinical Features: Nephrolithiasis, hematuria, UTIs • Laboratory Findings: •Nephrocalcinosis • Hypercalciuria •Microscopic hematuria •Sterile pyuria

Answer 34

Medullary Sponge Kidney

Question 35

Bartter syndrome •Clinical Features:

Answer 35

Growth retardation, muscle weakness, polyuria

Question 36

Medullary sponge kidney •Clinical Features:

Answer 36

Nephrolithiasis, hematuria, UTIs

Question 37

Distal Tubular Disorders •Clinical Features: Growth failure, rickets, nephrocalcinosis • Laboratory Findings: •Hyperchloremic metabolic acidosis • Urine pH > 5.5 despite acidosis •Hypercalciuria •Hypokalemia •Nephrocalcinosis

Answer 37

Renal Tubular Acidosis Type 1 (Distal RTA)

Question 38

Distal Tubular Disorders •Pathophysiology: ***Inability to secrete hydrogen ions***

Answer 38

Renal Tubular Acidosis Type 1 (Distal RTA)

Question 39

Distal Tubular Disorders •Clinical Features: Muscle weakness, fatigue, tetany • Laboratory Findings: • Hypokalemic metabolic alkalosis •Hypomagnesemia •Hypocalciuria •Normal blood pressure

Answer 39

Gitelman Syndrome

Question 40

Distal Tubular Disorders •Pathophysiology: Defect in ***thiazide-sensitive sodium-chloride cotransporter***

Answer 40

Gitelman Syndrome

Question 41

Collecting Duct Disorders •Clinical Features: Polyuria, polydipsia, dehydration • Laboratory Findings: •Dilute urine (specific gravity < 1.005) • Hypernatremia •No response to desmopressin •Normal or elevated ADH levels

Answer 41

Nephrogenic Diabetes Insipidus

Question 42

Collecting Duct Disorders •Pathophysiology: Resistance to antidiuretic hormone (ADH)

Answer 42

Nephrogenic Diabetes Insipidus

Question 43

Collecting Duct Disorders •Clinical Features: Muscle weakness, cardiac arrhythmias • Laboratory Findings: •Hyperkalemia •Mild hyperchloremic metabolic acidosis •Urine pH < 5.5 •Low or normal aldosterone levels •Associated with diabetic nephropathy or interstitial nephritis

Answer 43

Renal Tubular Acidosis Type 4 (Hyperkalemic RTA)

Question 44

Collecting Duct Disorders • Pathophysiology: Aldosterone deficiency or resistance

Answer 44

Renal Tubular Acidosis Type 4 (Hyperkalemic RTA)