Comlex: Step Up : Renal

Front 1

order the following from earliest to latest developmental structure:

mesonephros, pronephros, intermediated mesoderm, meta nephros

Back 1

Intermediate mesoderm

Pronephros

Mesonephros

Metanephros

Front 2

This developmental structure forms the UROGENITAL RIDGES on each side of the aorta and gives rise to the NEPHROGENIC CORD

Back 2

Intermediate mesoderm

Front 3

The kidneys develop from what embryological layer?

Back 3

mesoderm

Front 4

this developmental structure forms in the 4th week and regresses quickly. It is non functional

Back 4

pronephros

Front 5

What is the MESONEPHRIC DUCT?

Back 5

comes from mesonephros

is responsible for forming internal sexual structures for males

forms the URETERIC BUD (which forms the *ureter, renal pelvis, calyces, and collecting tubules*)

Front 6

what is the UTERIC BUD?

Back 6

structure that will eventually form the ureter, renal pelvis, calyces, and collecting tubules

Front 7

The metanephros will develop into what?

Back 7

the adult kidney

Front 8

QUICK HIT:

in the adult male, the ureter passes posterior to what structure?

What about in the female?

Back 8

Male: ductus deferens

Female: Uterine artery

Front 9

What does water under the bridge refer to?

Back 9

ureters are posterior to ovarian/testicular artery and uterine artery

Front 10

QUICK HIT:

the entire collecting system arises from the _____. The remainder of the renal system arises from the metanephric mesoderm

Back 10

Ureteric bud

Front 11

QUICK HIT:

____ is a hereditary OR aquired dysfunction of the proximal renal tubules. As a result of impaired glucose, aa's, PO4, and HCO3 reabsorption, it manifests clinically as glycosuria, hyperphosphaturia, aminoaciduria, and acidosis...

Also, from class, what RTA is this associated with? What are the K levels like in this RTA?

Back 11

Fanconi syndrome

Type II RTA (normal K levels)

note: type I (low K), II (normal), IV (high)

Front 12

OPP correlate:

The kidneys are located posterior to the peritoneum and at approximately the level of what?

Back 12

the first lumbar vertebrae

Front 13

what congenital anomaly is associated with:

OLIGOHYDRAMNIOS, PULMONARY HYPOPLASIA, and facial/limb deformities?

Back 13

Bilateral renal agenesis (Potter Syndrome)

Front 14

what congenital anomaly is associated with:

CUTTING WILL PRODUCE ISCHEMIC infarct in area they supply

arise from the aorta

are end arteries

Back 14

Accessory renal arteries

Front 15

QUICK HIT:

The ____ gonadal (testicular or ovarian) vein drains into the ____ renal vein; the ____ gonadal vein drains directly into the IVC

Back 15

left gonadal vein drains into left renal vein

right gonadal vein drains into IVC

Front 16

RBF=

Back 16

RENAL PLASMA FLOW (RPF) / (1-Hematocrit)

Front 17

renal vasculature does what to RBF, to keep it constant?

Back 17

AUTOREGULATES

Front 18

how do you measure RPF?

Back 18

clearance of PAH (para-aminohippuric acid)

note: this measure underestimates by 10%

Front 19

what congenital anomaly is associated with:

enlarged kidneys palpable on newborn exam; death within days to weeks; multiple small and large cysts that are not continuous with the collecting system

Back 19

Congenital polycystic disease

Front 20

what congenital anomaly is associated with:

Inferior poles of kidneys are fused; increased probability of Wilms tumor

Back 20

Horseshoe kidney

Front 21

Normal GFR?

Back 21

90-125

Front 22

what is the ideal measurement for GFR? Why?

Back 22

INULIN

it is FILTERED by the kidney but NOT REABSORBED OR SECRETED

not practical for clinical use

Front 23

What clinically measures GFR? why?

Back 23

CREATININE

it is FILTERED, MINIMALLY SECRETED, and NOT REABSORBED

Front 24

Decreases in GFR does what do BUN and creatinine?

Back 24

increase

Front 25

clearance=

Back 25

(U x V)/ P

U- conc tration of substance in urine

V- urine volume

P-plasma conc of substance

Front 26

what is one major pitfall of using creatinine to measure GFR?

Back 26

MUSCLE MASS

Front 27

a pt with a high muscle mass will have an artificially ____ GFR

Back 27

low

Front 28

GFR=

Back 28

Kf [(PGC - PBS) - (pieGC - pieBS)]

Kf- filtration coefficient of the glomerular capillaries

PGC-hydrostatic pressure exerted by fluid in the glomerular capillary

PBS- hydrostatic pressure exerted by fluid in Bowman's Space. Blockage or constriction of ureters increases this

pieGC- oncotic pressure of glomerular capillary. this value increases along the length of the capillary b/c the protein conc increases as water is forced into bowman's space

pieBS: oncotic pressure in bowman's space; usually zero

so GFR=Kf (PGC-PBC-pieGC)

Front 29

blockage or constriction of ureters does what to PBS? What does this do to GFR?

Back 29

Increases PBS

so decreases GFR according to:

GFR=Kf (PGC-PBC-pieGC)

Front 30

what happens to oncotic pressure of the glomerular capillary as you go down it?

Back 30

it increases b/c protein conc in the capillary increases as water is forced into Bowman's space

Front 31

What percent of body weight is total body water in men and women respectively?

Back 31

Men=60%
Women=50%

Front 32

Of TBW, how much of it is ICF and ECF respectively?

Back 32

ICF: 2/3

ECF: 1/3

Front 33

What can you use to measure ECF? what about ICF?

Back 33

ECF: Inulin, mannitol, sulfate

ICF: TBW-ECF

Front 34

There are 2 components of ECF..what are they and how are they measured?

Back 34

Plasma: 1/4th of ECF; measured by Evan's Blue

Interstitial: 3/4 of ECF; measured by ECF-plasma volume

Front 35

QUICK HIT:

The Tm for glucose is reached at approximately _____ mg/dL. Greater concentrations result in an osmotic diuresis such as that seen in diabetics with hyperglycemia

Back 35

350

Front 36

Filtration fraction=?

Back 36

FF= GFR/RPF

normal is 20%

Front 37

QUICK HIT:

describe the difference between CAPTOPRIL/ENALAPRIL and LOSARTAN

Back 37

CAPTOPRIL/ENALAPRIL:

ACEi; reduce HTN by inhibiting the conversion of Ang I to II, thereby decreasing the release of aldosterone

LOSARTAN:

ARB; prevents angiotension II from interacting with its receptor. This presents Ang II from causing vasoconstriction of efferent arterioles

Front 38

what produces renin? what is it stimulated by?

Back 38

Juxtaglomerular apparatus (JGA)

stimulated by B-sympathetic adrenergics in the kidney and by a fall in pressure of the afferent arteriole

Front 39

____ cleaves angiotension to ANGIOTENSIN I

Back 39

RENIN

Front 40

what cleaves angiotensin I and what do you get?

Back 40

ACE (angiotensin converting enzyme)

ANGIOTENSIN II

Front 41

What are some of the functions of angII?

Back 41

stimulates aldosterone release

stimulates release of ADH

vasoconsticts renal arterioles at low plasma levels

stimulates thirst

stimulates epi and NE from adrenal medulla