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Flashcards in Renal USMLE Deck (167):
1

ureters pass _______ uterine artery and ______ ductus deferens (retroperitoneal)

UNDER,UNDER

mneu: water (ureters) UNDER the bridge (artery, ductus deferens).

2

total body weight is ____% water

60

3

total body water is ___ intracellular fluid

2/3

4

total body water is 1/3 extracellular fluid what portion of this is plasma volume

1/4

5

ICF=

TBW-ECF

6

interstitial volume-

ECF-PV

7

60-40-20 rule (% of body weight)

60% total body water
40% ICF
20% ECF

8

plasma volume can be measured by this

radiolabeled albumin

9

extracellular volume can be measured by this

inulin

10

Cx=

UxV/P=volume of plama from which the substance is cleared completely per unit time

Cx=clearance of X
Ux=urine concentration of X
Px=Plasma concentration of X
V=urine flow rate

11

if Cx < GFR, then there is net tubular ________ of X

resorption

12

if Cx > GFR, then there is net tubular ________ of X

secretion

13

if Cx = GFR, then ___________

no net secretion or reabsorption

14

glomerular filtration barrier is responsible for filtration of plasma according to these 2 factors

size and net charge

15

what is the glomerular filtration barrier composed of

1) fenestrated capillary endothelium (size barrier)
2) Fuse basement membrane with heparan sulfate (negative charge barrier)
3) epithelial layer consisting of podocyte foot processes

16

what barrier of the glomerular filtration barrier is lost in nephrotic syndrome

charge barrier

17

what are some symptoms of nephrotic syndrome

albuminuria, hypoproteinemia, generalized edema, and hyperlipidemia

18

what is used to calculate GFR because it is freely filtered and is neither reabsorbed nor secreted

inulin

19

creatinine clearance is an approximate measure of what

GFR

20

GFR=

U(inulin)xV/P(inulin)=C(inulin)

21

effective renal plasma flow (ERPF can be estimated using _____ because it is both filtered and actively secreted in the proximal tubule. All _____ entering the kidney is excreted.

PAH

22

ERPF=

U(PAH)xV/P(PAH)=C(PAH)

23

RBF=

RPF/1-Hct

24

ERPF underestimates true RPF by how much?

~10%

25

filtration fraction (FF)=

GFR/RPF

26

what effect will afferent arteriole constriction have on
RPF:
GFR:
FF (GFR/RPF):

RPF:↓
GFR:↓
FF (GFR/RPF):NC

27

what effect will efferent arteriole constriction have on
RPF:
GFR:
FF (GFR/RPF):

what effect will afferent arteriole constriction have on
RPF:↓
GFR:↑
FF (GFR/RPF):↑

28

what effect will increased plasma protein concentration have on
RPF:
GFR:
FF (GFR/RPF):

RPF:NC
GFR:↓
FF (GFR/RPF):↓

29

what effect will decreased plasma protein concentration have on
RPF:
GFR:
FF (GFR/RPF):

RPF: NC
GFR: ↑
FF (GFR/RPF):↑

30

what effect will constriction of ureter have on
RPF:
GFR:
FF (GFR/RPF):

RPF: NC
GFR:↓
FF (GFR/RPF):↓

31

free water clearance
C(H2O)=

V-C(osm)

V=urine flow rate

32

glucose at a normal level is completely reabsorbed where

proximal tubula

33

at plasma glucose of _____, glucosuria begins (threshold)

200mg/dL

34

at plasma glucose level of ______, transport mechanism is saturated (Tm)

350 mg/dL

35

amino acid resorption occurs by at least 3 distinct carrier systems, with competitive inhibition within each group. Secondary active transport occurs in the _________ and is saturable.

proximal tubule

36

what effect will decreased plasma protein concentration have on
RPF:
GFR:
FF (GFR/RPF):

RPF: NC
GFR:↑
FF (GFR/RPF):↓

37

what effect will constriction of ureter have on
RPF:
GFR:
FF (GFR/RPF):

RPF: NC
GFR:↓
FF (GFR/RPF):↓

38

free water clearance
C(H2O)=

V-C(osm)

V=urine flow rate

39

glucose at a normal level is completely reabsorbed where

proximal tubula

40

at plasma glucose of _____, glucosuria begins (threshold)

200mg/dL

41

this part of the nephron is called the "workhorse of the nephron"

early proximal convuluted tubule.

42

the early proximal convuluted tubule resorbes all of these 2 things and most of these 3 things

all of glucose and amino acids

most of the bicarb, sodium, and water

43

the early proximal convuluted tubule secretes this which will act as a buffer for secreted H+

ammonia

44

this part of the nephron passively reabsorbs water via medullary hypertonicity (impermeable to sodium)

thin descending loop of Henly

45

this part of the nephron actively reabsorbs Na+, K+, and Cl- and indirectly induces the reabsorption of Mg++ and Ca++. It is impermeable to H2O

Thick ascending loop of Henle

46

the early distal convuluted tubule actively reabsorbs these 2 ions. Here reabsorbion of Ca++ is under the control of PTH

Na+, Cl-

47

the collecting tubules resorb Na_ in exchange for secreting K+ or H+. This is regulated by this hormone

aldosterone

48

in the collecting tubules resorption of water is regulated by this hormone

ADH (vasopressin)

49

osmolarity of medulla can reach ______mOsm

1200

50

this is released by the kidneys upon sensing decreased BP

renin

51

renin cleaves angiotensinogen to this

ATN I (a decapeptide)

52

ATN I is cleaved by this enzyme, primarily in the lung capillaries and elsewehere, to ATN II (an osctapeptide)

Angiotensin-converting enzyme (ACE)

53

what are the actions of angiotensin II

1) potent vasoconstriction
2) release of aldosterone from the adrenal cortex
3) release of ADH from posterior pituitary
4) stimulates hypothalamus to increase thirst

54

what is the overal purpose of ATN II

increase intravascular volume and BP

55

this peptide released from atria may acti as a "check" on the renin-angiotensin system (e.g., in heart failure).

ANP

56

these are modified smooth muscle cells of afferent arteriole

JG cells

57

this is a Na+ sensor and part of the distal convoluted tubule

macula densa

58

JG cells secrete this in resoponse to low renal blood pressure, low Na+ delivery to distal tubule, and increased sympathetic tone

renin

59

what does the juxtaglomerular apparatus (JGA) consist of

JG cells and macula densa

60

when the JG cells secrete renin what does this lead to

increase in ATN II and aldosterone

61

JGA activates the renin-angiotensin system in defence of this

glomular filtration rate

62

juxta means

close by

63

Endocrine fxs of kidney: endothelial cells of peritubular capillaries secrete this in response to hypoxia

erythropoeietin

64

Endocrine fxs of kidney: conversion of 25-OH vit D to ________ by 1alpha-hydroxylase, which is activated by PTH

1,25-(OH)2 vit D

65

Endocrine fxs of kidney: JC cells secrete ____ in response to decrease renal arterial pressure and increase renal sympathetic discharge (B1 effect)

renin

66

Endocrine fxs of kidney: secretion of _________ that vasodilate the afferent arterioles to increase GFR

prostaglandins

67

this common class of drug can cause acute renal failure in high vasoconstrictive states by inhibiting the renal production of prostaglandins, which keep the afferent arterioles vasoldilated to maintain GFR

NSAIDs

68

Hormones acting on the kidney:
This hormone is secreted in response to increased atrial pressure and causes increase GFR and increase Na+ excretion

atrial natriuretic factor (ANF)

69

Hormones acting on the kidney: This hormone is secreted in response to decreased blood volume (via AT II) and increased plasma [K+]. It causes increased Na+ reabsorption, increase K+ secretion, increase H+ secretion

aldosterone

70

Hormones acting on the kidney:
This hormone is secreted in response to low blood volume.

renin

71

where is ATN I converted to ATN II by ACE

lung

72

Hormones acting on the kidney:
This hormone causes efferent arteriole constriction which leads to increase GFR and increase Na+ and HCO3- reabsorption

Angiotensin II

73

Hormones acting on the kidney:
This hormone is secreted in response to increase plasma osmolality and decreased blood volume. It binds to receptors on principal cells, causing increase number of water channels and increased H2O absorption

vasopressin/ADH

74

Hormones acting on the kidney:
This hormone is secreted in response to low plasma [Ca++]. It causes increase [Ca++] reabsorption (DCT), decrease PO4--- reabsorrption (PCT, 1,25 (OH)3 vit D production ->increase Ca_ and PO4--- resorptioon

PTH

75

Acid Base Physiology:
Metabolic acidosis=
pH:
Pco2:
[HCO3-]:
compensatory response:

pH:↓
Pco2:↓
[HCO3-]:↓*
Compensatory response: hyperventilation

76

Acid Base Physiology:
Metabolic alkalosis=
pH:
Pco2:
[HCO3-]:
compensatory response:

pH:↑
Pco2:↑
[HCO3-]:↑*
Compensatory response: hypoventilation

77

Acid Base Physiology:
respiratory alkalosis=
pH:
Pco2:
[HCO3-]:
compensatory response:

pH:↑
Pco2:↓*
[HCO3-]:↓
Compensatory response: renal [HCO3-] reabsorption

78

Acid Base Physiology:
respiratory acidosis=
pH:
Pco2:
[HCO3-]:
compensatory response:

pH:↓
Pco2:↑*
[HCO3-]:↓
Compensatory response: renal [HCO3-] secretion

79

what is the Henderson-Hasselbach equasion

pH=

pKa + log [HCO3-]/0.03 P(co2)

80

acid base compensations: metabolic acidosis

winter's formula:
Pco2=1.5 (HCO3-) + 8 +/- 2

81

acid base compensations: metabolic alkalosis

pco2 ↑ O.7 per
1 HCO3-↑

82

acid base compensations: respiratory acidosis

acute-↑1HCO3- per 10CO2↑

chronic-↑3.5HCO3- per 10CO2↑

83

acid base compensations: respiratory alkalosis

acute-↓2HCO3- per 10CO2↓

chronic-↓5HCO3- per 10CO2↓

84

this syndrome is due to a bilateral renal agenesis which leads to oligohydramnios. This results in limb deformities, facial deformities, and pulmonary hypoplasia

Potter's syndrome

mneu: babies w/ Potter's can't "Pee" inutero

85

what is the embryological malformation which leads to Potters syndrome

malformation of ureteric bud

86

this occurs when the inferior poles of both kidneys fuse.

horseshoe kidney

87

when a horshoe kidney ascends from the pelvis during fetal development the kidneys get trapped under this artery and remain low in the abdomen

inferior mesenteric

88

RBC casts in urine what is your differential

glomerular inflammation (nephritic syndromes), ischemia, or malignant hypertension

89

WBC casts in urine what is your differential

tubulointerstitial dz, acute pylonephritis, glomerular disorders

90

granular casts in urine what is it

acute tubular necrosis

91

waxy casts in urine what is it

advanced renal dz/CRF

92

presence of these indicates that hematuria/pyruia is of renal origin

casts

93

what type of blood cell do you see in the urine with bladder cancer

RBCs

94

what type of blood cell do you see in the urine with acute cystitis

WBCs

95

NephrItic syndrome is characterized by

I=inflammation

96

what signs and symptoms will you see in nephritic syndrome

hematuria, hypertension, oliguria, azoemia

97

give 6 examples of nephritic syndrome

1) acute poststreptococcal glomerulonephritis
2) rapidly progressive (crescentric) glomerulonepritis
3) Good pasture syndrome
4) membranoproliferative glomerulonepritis
5) IgA nephropathy (Berger's dz)
6) Alport's syndrome

98

this nephritic syndrome is most frequently seen in children. It may present with peripheral and periorbital edema. On light microscope the glomeruli may appear enlarged and hypercellular. There is a "lumpy bumpy apprearance. Neutrophils are presence. Elecron microscopy shows subepithelial humps. Immunoflurescent shows a granular pattern. It resolves spontaneously.

Acute postreptococcal glomerulonephritis

99

this nephritic syndrome has many causes it is characterized by a rapid course to renal failure. LM & IF shows crescent moon shape

rapidly progressive (crescentic glomerulonephritis

100

this nephritic syndrome often presents with hemoptysis or hematuria. IF shows a linear pattern and anti-GBM antibodies

Goodpasture's syndrome

101

what type of hypersensitivity is goodpasture's syndrome

type II

102

this nephritic syndrome slowly progresesses to renal failure. EM shows subendothelial humps, "tram track."

membranoproliferative glomerulonephritis

103

this nephritic syndrome is often postinfectious. It is mild and IF and EM show mesangial deposits of IgA

IgA nephropathy (Berger's dz)

104

this nephritic syndrome is a collagin IV mutation. There is a split basement membrane. It is often manifested by nerve deafness and ocular disorders.

Alport's syndrome

105

NephrOtic syndrome is characterized by this

O=protinurea

106

what are the signs and symptoms of nephrotic syndrome

massive protinuria, hypoalbuminemia, peripheral and periorbital edema, hyperlipidemia

107

give 5 causes of nephrotic syndrome

1) membranous glomerulonephritis
2) minimal change dz (lipoid nephrosis)
3) focal segmental glomerular sclerosis
4) diabetic nephropathy
5) SLE

108

this is a common cause of nephrotic syndrome in adults. LM: diffuse capillary and basement membrane thickening. IF: granular pattern. EM: "spike and dome"

membranous glomerulonephritis

109

this is a common cause of nephrotic syndrome in children. LM: normal glomeruli. EM foot process effacement.

It responds well to steroids

minimal change dz (lipoid nephrosis)

110

this type of nephrotic syndrome shows segmental sclerosis and hyalinosis under LM. It causes a more severe dz in HIV pts

Focal segmental glomerular sclerosis

111

this nephrotic syndrome shows Kimmelsteil Wilson "wire loop" lesions and basement membrane thickening in light microscope

diabetic nephropathy

112

this cause of nephrotic syndrome has 5 patterns of renal involvement. LM: in membranous glomerulonephritis pattern, wire-looped lesion with subendothelial deposits

SLE

113

kidney stones can lead to severe complications such as

hydronephrosis and pyelonephritis

114

this is the most common kidney stone (75-85%). They tend to recur.

calcium (calcium oxalate or calcium phosphate)

115

Ca++ kidney stones are radio____

opaque

116

what are some syndromes that can cause calcium kidney stones

Cancer, increase PTH, increase vit D, milk alkali syndrome.

117

this is the 2nd most common kidney stone. It is caused by infection with urease-positive bugs (Proteus vulgaris, staphylococcus, Klebsiella). They can form Staghorn calculi that can be a nidus for UTIs

Ammonium magnesium Phosphate (struvite)

118

Ammonium magnesium Phosphate (struvite) stones are radio_____

opaque

119

this type of kidney stone has a strong associateion with hyperuricemia (e.g., gout). Often seen in dzz with increase cell turnovers, such as leukemia and myeloproliferative disorders

uric acid

120

uric acid stones are radio____

lucent

121

this type of kidney stone is most often secondary to cystinuria

cystine

122

cystine stones are most often secondary to cystinuria and are radio______

faintly radiopaque

123

this is the most common renal malignancy. It is most common in men ages 50-70. There is increased incidence with smoking and obesity. It manifests clinically with hematuria, palpable mass, secondary polycythemia, flank pain, fever, and weight loss.

renal cell carcinoma

124

renal cell carcinoma is associated with this dz and gene deletion

von Hippel-Lindau and gene deletion in chromosome 3

125

renal cell carcinoma originates in renal tubule cells and spreads to the polygonal clear cells. It invades the IVC and spreads thorugh this route

hematogenously.

126

renal cell carcinoma is commonly associated with paraneoplastic syndromes. give some examples.

ectopic EPO, ACTH, PTHrP, and prolactin

127

this is the most common renal malignancy of early childhood (ages 2-4). Presents with huge palpable flank mass, hemihypertrophy.

Wilms tumor

128

Wilms tumor is associated with deletion of this tumor suppressior gene on this chromosome

WT1 on chromosome 11

129

Wilms tumor can be part of WAGR complex. What is this

wilms' tumor
Aniridia
GU malformation,
mental motor retardation

130

this is the most common tumor of urinary tract system (can occur in renal calyces, renal pelvis, ureters, and bladder).

transitional cell caricinoma

131

this is suggestive of bladder cancer

painless hematuria.

132

transitional cell caricinoma is associated with problems in your Pee SACS (mneu). What does this mean

Phenacetin
Smoking
Aniline dyes
Cyclophosphamide
Schistosomiasis

133

pt presents w/ fever and CVA tenderness. What do you suspect?

acute pyelonephritis

134

what part of the kidney does acute pyelonephritis effect

affects cortex w/ relative sparing of glomeruli/vessels.

135

what is pathognomonic for acute pyelonephritis

white cell casts in urine

136

this conditon is characterized by coarse, asymmetric corticomedullary scarring.

chronic pyelonephritis

137

chronic pyelonephritis looks like this tissue histologically

thyroid (thyroidization of kidney)

138

In chronic pyelonephritis, tubules contain ______ casts

eosinophilic

139

this is caused by an acute generalized infarction of the cortices of both kidneys. It is likely due to a combination of vasospasm and DIC. It is associated with obstetric castrophes (e.g., abruptio placentae) and septic shock

Diffuse cortical necrosis

140

this is the most common cause of acute renal failure. It is reversible, but fatal if left untreated. It is associated with renal ischemia (e.g., shock), crush injury (myoglobinuria), toxins. Death most often occurs during the initial oliguric phase. Recovery is in 2-3 weeks.

acute tubular necrosis

141

renal papillary necrosis is associated with four conditions

1) diabetes mellitus
2) acute pyelonephritis
3) chronic phenacetin use
4) sickle cell anemia

142

this is associated with an abrupt decline in renal fx with increased creatinine and BUN over a period of several days

acute renal failure

143

this type of acute renal failure is characterized by decreased RBF (e.g., hypotension) ->decreased GFR. Na+/H2O are retained by the kidney.

Labs:
Urine osmo: >500
Urine Na+: 20

prerenal failure

144

this type of acute renal failure is generally due to acute tubular necrosis or ischemia/toxins. Patchy necrosis leads to debris obstructing tubule and fluid backflow across necrotic tubule -> decreased GFR. Urine has epithelial/granular casts.

Labs:
Urine osmo: 20
Fe(Na): >2%
BUN/Cr ratio:

intrinsic renal failure

145

this type of acute renal failure is due to outflow obstruction (stones, BPH, neoplasia). Develops only with bilateral obstruction
Labs:
Urine osmo: 40
Fe(Na): >4%
BUN/Cr ratio: >15

Postrenal failure

146

acute renal failure is often due to this

hypoxia

147

chronic renal failure is often due to these two chronic dz

htn
dbts

148

renal failure results in a failure to make urine and a failure to excrete this type of waste

nitrogenous

149

this is a clinical sydrome marked by increase BUN and creatinine and associated symptoms

uremia

150

renal failure can result in anemia. why?

failure of erythropoitetin production

151

renal failure can result in renal osteodystrophy. why?

failure of active vit D production

152

renal failure can result in cardiac arrhythmias. why?

hyperkalemia

153

renal failure can result in metabolic acidosis. why?

decreased acid secretion and decrease generation of HCO3-

154

renal failure can result in CHF and pulmonary edema. why?

Na+ and H2O excess

155

what are some other things renal failure can result in?

uremic encephalopathy
chronic pyelonephritis
hypertension

156

low serum Na+ results in

disorientation, stupor, coma

157

high serum Na+ results in

neurologic: irritability, delirium, coma

158

low serum Cl- is often secondary to this

metabolic alkalosis

159

high serum Cl- is often secondary to this

non-anion gap acidosis

160

low serum K+ results in

U waves on ECG, flattened T waves, arrhythmias, paralysis

161

high serum K+ results in

peaked T waves, arrhytmias

162

low serum Ca++ results in

tetany, neuromuscular irritability

163

high serum Ca++ results in

delirium, renal stones, abdominal pain

164

low serum Mg++ results in

neromuscular irritability, arrhythmias

165

high serum Mg++ results in

delirium, decreased DTRs, cardiopulmonary arrest

166

low serum PO4-- results in

low-mineral ion product causes bone loss

167

high serum PO4-- results in

low-mineral ion product causes metastatic calcification, renal stones