Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Metabolic - Urology > Y2 Kidney Revision > Flashcards

Y2 Kidney Revision Flashcards

(91 cards)

Start Studying
1
Q

What is atrial natriuretic peptide?

A

Secreted by the atria in repsonse to stretch

Decreases renin production and promotes sodium and water excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does frothy urine idicate?

A

Protein in the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does brown/red urine indicate?

A

Rhadbomyolysis - muscle break down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What would the presence of nitrites in the urine indicate?

A

Bacterial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Discuss autosomal dominant polycystic kidney disease

A

PKD1 (chromosome 16) mutation - affects people aged 30-40

PKD2 (chromosome 4) mutation - affects people 70+

PKD1 is more severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the glomerulus?

A

Tuft of capillaries within Bowmanns capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the renal corpuscle?

A

Bowmans capsule + glomerulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is nephroptosis?

A

Kidney drop - often due to fat loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is hydronephrosis?

A

Swelling of the kidney due to urine buildup

Most commonly due to kidey stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Discuss the two types of nephrons

A

1) Cortical: 85%
- Short loop, efferent supplies peritubular capillaries, renal corpuscle in the cortex
2) Juxtamedullary: 15%
- Long loop, efferent supplies vasa recta, renal corpuscle closer to medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What should glomerular filtration be?

A

90-120 ml/min

180L plasma/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the cellular layers of the filtration membrane of the glomerulus?

A
  1. Fenestrated endothelium: blocks RBCs
  2. Glomerular basement membrane: blocks plasma proteins
  3. Podocytes: blocks macromolecules
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is renal clearance?

A

How quickly a substane is removed from the kidney and excreted in the urine

Clearance = concentration of substance in urine x flow rate/ concentration of substance in plasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should the clearance of createnine be?

A

140ml/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is inulin?

A

Used to measure GFR accurately - it is freely filtered and not absorbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Discuss comparison of filtration of a substance to that of inulin

A

Cx (calculated clearance of substance)/ Clearance of inulin

= 1: substance is freely filtered

= <1: substance is absorbed

= >1: freely filtered and secreted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Where do the kidneys sit?

A

T12 - L3 vertebrae

Partially protected by ribs 11&12

Retroperitoneal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are macula densa cells?

A

Chemoreceptors in the DCT

Detect NaCl

Low NaCl = low BP - macula densa cells cause afferent arteriole to dilate and increase the hydrostatic pressure in the glomerulus

MD cells cause granular cells to secrete renin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are juxtaglomerular cells?

A

Secrete renin to increase Na reabsorption

Receive signals from macula densa cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Discuss peritubular capillaries and the vasa recta

A

Peritubular capilaries surround DCT and PCT

Vasa recta surrounds the loop of Henle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is mannitol?

A

Osmotic diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is acetazolemide?

A

Carbonic anhydrase inhibutor - diuretic

Reduces Na/H+ exchange so more Na in filtrate and more water loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is furosemide?

A

Loop diuretic

NKCC2 inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do thiazide diuretics work?

A

Blocks Na/Cl transporter in the DCT and causes more potassium excretion because more Na reaches the collecting duct

In the collecting duct, Na is absorbed in exchange for the secretion of K+

*amiloride blocks this exchanger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Discuss K+ sparing diuretics
Amiloride: blocks Na+/ K+ exchanger in collecting duct - means less Na+ is absorbed and therefore less K+ is excreted Spirololactone: blocks the aldosterone receptor, the activation of the aldosterone receptor normally causes more Na/K channels to be placed in the membrane
26
How does anti diuretic hormone work?
AKA vasopressin, secreted by **posterior** pituitary - Causes more AQP2 to be place in collecting duct membrane and promotes water uptake
27
Where is the majority of Na+ reabsorbed?
PCT
28
What is true of the thick ascending limb?
It is impermeable to water Large simple squamous epithelial cells
29
Discuss countercurrent multiplication of the kidney
Descending limb: permeable to water, impermeable to ions water flows into interstitium Think ascending limb: impermeable to water, ions move into interstitium because of water loss from descending limb - Ultimately we lose water and ions to the interstitium and therefore end up with a more concentrated urine
30
What is the epithelia of the DCT?
Cuboidal cells, no microvilli
31
Discuss the transporters of the DCT
1. Basolateral Na/K exchanger - Na absorbed into blood and K secreted 2. Apical Na/Cl co-transporter 3. Apical Ca2+ transporter \*Ca2+ and Mg+ reabsorption is thought to occur passively
32
Discuss HCO3- reabsorption in the kidney
**PCT:** Na is absorbed in exchange for H+ secretion H+ and HCO3- combine in lumen to form carbonic acid Carbonic acid then converts into water and CO2 CO2 enters the cell from the lumen and combines with water to become H+ and HCO3- HCO3- can then be absorbed along with Na+ **DCT:** same as above but HCO3- reabsorption requires Cl- instead of Na+
33
Where does most acid-base balance occur?
PCT
34
What is the role of type B intercalated cells?
Express a chloride-bicarbonate exchanger, pendrin, at their apical membrane and express H+-ATPase at their basolateral membrane Essentially they secrete HCO3- and reabsorb H+
35
What is the role of type a intercalated cells?
Acid secretion - damage to these cells causes distal renal tubular acidosis
36
What are the renal tubule buffers?
Phosphate (HPO4-) + H+ = H2PO4 Glutamine breakdown = Ammonia (NH3) + H+ = NH4 (ammonium) \*stop the urine being too acidic
37
What could cause metabolic acidosis?
- Diabetes: ketone bodies - Too much protein in diet - Diarrhoea - Antifreeze - Aspirin
38
What could cause metabolic alkalosis?
- Vomiting - Too many rennies - Too much fruit - Thiazide and loop diuretics - K+ and H+ loss - Loss of function of type B intercalated cells (spit out bases) - Hyperfunction of type A intercalated cells (spit out acid)
39
Where is arterial blood usually taken from for blood gases?
Radial
40
What is the normal level of HCO3-?
22-26mEq
41
What is the normal range of CO2?
34-45mmHg
42
What is the key intracellular and plasma buffer?
Hb - forms HHb when combined with H+
43
Discuss buffering in the body
* 52% of the buffering capacity is in cells * 5% is in RBCs * 43% of the buffering capacity is in the extracellular space * of which 40% by bicarbonate buffer, 1% by proteins and 1% by phosphate buffer system
44
What could cause a respiratory alkalosis?
Depression of respiratory centres by narcotics - Restrictive lung disease - Paralysis of respiratory muscles
45
Where are the majoirty of drug components secreted in the kidney?
PCT
46
Discuss the role of urine pH in drug excretion
Acidic urine: alklaine drug more readily ionised and therefore more easily excreted Alkaline urine: acidic drug more easily excreted
47
What would be given in the case of an aspirin overdose?
Sodium bicarbonate - makes urine more alkaline and promotes loss of salicylic acid (aspirin metabolite)
48
Which drug has a 25x increased half life in renal failure?
Aminoglycosides (30s inhibitors) - Can also cause ototoxicity
49
Which diuretics are associated with gout
Thiazides - promote uptake of urea
50
What does nosocomial mean?
Originating in hospital
51
What is the most common UTI causing bacteria?
E.Coli UPEC \*E.Coli 0157 causes intestinal disease
52
What pathogen rarely causes UTIs?
M.Tuberculosis
53
Discuss E.Coli UPEC
Uropathogenic E.Coli - Type 1 fimbriae bind to mannose residues on host cells - Type P frimbriae adhere to urinary tract cells and prevent phagocytosis
54
What are the risks of UTIs in pregnancy?
- Low birth weight - Prematurity
55
What is pyelonephritis?
Kidney inflammation usually due to infection
56
Uncomplicated vs. Complicated UTI
Uncomplicated: not pregnant, no evidence of kidney spread, normal urinary system, normal pathogen Complicated: opposite of above
57
Name a commonly used antibacterial for UTIs
Trimethoprim: stops DHF - THF, prevents folate production and inhibits DNA
58
What is nitrofurantoin?
Used to treat UTIs Inhibits the synthesis of DNA, RNA, protein and cell wall synthesis - ineffective for kidney infection - highly stable against resistant bacteria due to number of MOA
59
How would UTIs be treated in children?
Lower: amoxicillin, trimethoprim Upper: Co-amoxiclav (combination consisting of amoxicillin, a β-lactam antibiotic, and potassium clavulanate, a β-lactamase inhibitor)
60
Which drugs are commonly used for pyelonephritis?
Co-amoxiclav and ciproflaxin Sometimes trimethoprim
61
How is chronic kidney disease defined?
Structural damage GFR \<60mL/min/1.73m2 for 3 months
62
How is acute kidney disease defined?
Creatinine \>26mmol/L Urine \<0.5mL/Kg/day
63
Discuss causes of renal failure
Pre renal: HF, hypovolemia Renal: Tubular necrosis, trauma, sepsis Post renal: bladder obstuction, stones
64
Discuss stages of kidney disease
Per GFR Stage 1 \>90 Stage 2 \<90 Stage 3 \<60 Stage 4 \<30 Stage 5 \<15 or dialysis
65
What is nephrotic syndrome?
Protein loss due to dysfunction of podocytes Causes frothy urine and oedema **Adults: Focal segmental glomerulosclerosis** In children: most common cause is **minimal change disease** - so called because the damage is so small it cant be seen using a microscope
66
What are the consequences of nephrotic syndrome?
- Oedema - Hypoalbuminemia - Proteinuria - Hyperlipidemia - Hypercoaguability
67
What is Berger's disease?
Nephritic disease: IgA neuropathy * Hematuria (gross, frank, microscopic) * Oedema in hands and feet * Cola- or tea-colored urine
68
What is nephritic syndrome?
Immune cmplexes build up and elecit an immune response that damages the filtration membrane - Loss of RBCs - Proteinuria - Oliguria - Hypertension Henloch-Schonlein and Goodpasture's
69
What is Goodpasture's syndrome?
Immune system attacks the basement membrane in kidney and allows blood through into the urine
70
What is the first sign of kidney damage?
Oliguria
71
What is used to treat BPH?
Finasteride - 5a reductase inhibitor, prevents DHT production from testosterone
72
What is tamulosin?
Alpha 1a blocker, relaxes muscle fibres in prostate and bladder neck and allows for easier micturition
73
Discuss renal cell cancer
- Clear cell (most common - treated with surgical resection) AKA renal adenocarcinoma - Papillary types 1&2 - Chromophobe (similar appearance to clear cell but cells are larger) - Oncocytic - Collecting duct: rare, seen in young adults, aggressive
74
Discuss bladder cancer
- Transitional cell (most common) - SCC - Adenocarcinoma - 7th most common in UK
75
What is the blood supply to the bladder?
Superior and inferior vesical arteries, which arise directly or indirectly from the internal iliac artery
76
Which nerve supplies the external urethral sphincter?
Pundendal
77
Discuss micturition
Pelvic nerve: parasympathetic, ACh release, causes contraction of detrusor muscle Pudendal nerve: parasympathetic, ACh release, contraction of external urethral sphincter Hypogastric nerve: sympathetic, noradrenaline release, relaxes detrusor and contracts internal spincter
78
What is the difference between nicotinic and muscarinic receptors?
Both are ACh receptors Nicotinic: ionotropic All are excitatory Muscarinic: GPCRs
79
Discuss the three layers of the bladder
Outer: adventitial connective tissue Middle: smooth muscle detrusor) Inner: Transitional epithelium
80
What is acute urinary retention?
Painful inability to void with relief following catheterisation \>800mL
81
Discuss drug interactions with spironolactone
ACE inhibitors: dangerous hyperkalemia because ACE inhibitors also increase potassium retention - Since aldosterone is responsible for increasing the excretion of potassium, ACE inhibitors can cause retention of potassium Aspirin: defecreases spironolactone effectiveness
82
Which drugs increase GFR?
Afferent dilators: Atrial natriuretic peptide, prostaglandins Efferent constrictors: angiotensin II and ANP (by blocking affect of noradrenaline)
83
How do NSAIDs affect the kidney?
Contrict the afferent arteriole and therefore reduce GFR
84
Why are ACEi and ARB contraindicated in renal artery stenosis?
Renal artery stenosis = GFR low ACEi and ARB = dilate efferent arteriole and decrease GFR even further
85
What would be the result of a dilated efferent arteriole?
GFR would decrease because blood can easily flow out via the efferent
86
What would happen to the GFR if the efferent arteriole was constricted?
GFR would increase
87
What are the consequences of renal artery stenosis?
Stenosis causes hypoperfusion of kidney Kidney senses low BP and release renin Renin causes increase BP systemically but this can't get past the renal stenosis and thus more renin is released etc etc Causes hypertension
88
What affect does noradrenaline have on GFR?
Increases GFR by constricting the efferent arteriole
89
Discuss causes of nephritic syndrome in adults and children
Children: Haemolytic uraemic syndrome Henloch-Scholein purpura Post-streptococcal GN Adults: Goodpasture's, ANCA associated vasculitis, lupus (SLE)
90
What is ANCA associated vasculitis?
(ANCA)-associated vasculitis (AAV) is a group of diseases (granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis), characterized by destruction and inflammation of small vessels
91
Discuss various causes of nephritic disease
Immune complex trapping: Systemic lupus erythematosus In situ antigen: Goodpasture's - circulating anti-glomerular basement membrane antibody Post infectious: bacterial antigen sits in the membrane

Metabolic - Urology (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions