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53 Cards in this Set

  • Front
  • Back
the ureters pass under the ____ and the _______
-uterine arteries and the ductus deferens (retroperitoneal)
what % of body weight is water?
-how much of it is intracell fluid?
-60% and 40% of it is intracell fluid
what is the extracell fluid made of?
-1/4 plasma volume 5%
and the other 15% is interstitial volume
what is the glomerular filtration barrier made of?
fenestrated capillary endothelium, fused BM with heparin sulfate (negative charged barrier), and epithelial layer consisting of podocyte foot processes
when is the cahrge barrier lost?
nephrOtic syndrome, so you get albuminuria, hypopoteinemia, gen edema and hyperlipidemia
what do you use to measure GFR?
inulin, creatinine
what do you use to measure RPF?
PAH (underestimates RPF by 10%)
how do you get renal blood flow?
RBF= RPF/1-Hct
what effects the afferent arteriole?
prostaglandins dilate the afferent arteriole
-inc RPF, and inc GFR so FF is constant
-NSAIDS inhibit this dilation
what effects the efferent arteriole?
angiotensin II constricts the efferent arteriole
-dec RPF adn inc GFR so FF increases
-ACE inhib work here
proximal tubule
-reabsorbs all the gluc and aa and most of the bicarb, Na and water
- secretes ammonia which buffers the secreted H+
thin decending loop of Henle
passively absorbs water due to medullary hypertonicity
thick ascending loop of Henle
actively reabsorbs Na K 2Cl and indirectly Ca and Mg++
early distal convoluted tubule
Na and Cl reabsorption and Ca reabsorption is under the control of PTH
collecting tubules
reabsorb Na in exchange for K and H (reg by aldosterone), reabsorbtion of water is regulated by ADH
-medullary osmolarity can reach 1200mOsm/L H20
actions of angiotensin II
vasoconstrict
release aldosterone from the adrenal cortex
release ADH from the post pituitary
stim the hypothal. to inc thirst
what is the check on the renin-ang system
ANP, like in heart failure can cuase the renin to decrease and GFR to increase
what do the JG cells do and where are they located?
they secrete renin in response to dec blood pressure and dec Na to the distal tubule, and inc symp tone
what is part of the JGA?
the JG cells and the macula densa which is the Na sensing region of the dist conv tubule
what are the four kidney endocrine functions?
-endothel cells of the peritubular capillaries secrete erythropoietin in response to hypoxia
-conversion of vit D to its active 1,25 form by 1 alpha hydroxylase, which is activ by PTH
-Jg cells secrete renin (due to dec Na and increased B1 discharge)
-secrete PGE to dilate afferent arteriole
what does ANF do?
causes GFR to increase and Na to be excreted
ang II causes inc reabsorb of what?
na and bicarb
ADH is secreted in response to ________
increased plasma osmolarity and decreased blood volume
ADH causes what cells to increase the number of H20 channels?
principal cells
what causes resp acidosis?
hypoventilation
-airway obstruction
acute lung disease
chronic lung disease
opiods narcotics and sedatives
weakening of resp mm
what causes metabolic acidosis?
normal anion gap- diarrhea, glue sniffing, renal tubular acidosis, hyperchloremia

-increased anion gap:
MUD PILES
methanol, uremia, diab ketoacidosis. paraldehyde, phenformin, iron tablets or INH, lactic acidosis, ethylene glycol, salicylates (chronic)
what causes resp alkalosis?
hyperventilating, aspirin (early ingestion)
metabolic alkalosis?
diuretic use, vomiting, antacid use and hyperaldosteronism
what is potters syndrome?
bilateral renal agensis, caused by oligohydramnious.
-limb and facial deformities, pulmonary hypoplasia
-caused by malformation of the ureteric bud
the ureteric bud gives rise to what?
the collecting duct system: minor and major calyces and renal pelvis
the metanephric mesoderm gives rise to what?
loops of henle, bowmans capsule and glomerular tuft
a horseshoe kidney is located where and under what vessel?
under the inf mesenteric aa and in the abdomen
what are the five types of casts that you see in urine?
RBC, WBC, granular, waxy and hyaline
what are RBC casts from?
glom inflamm (nephritic syndromes), ischemia and malig HTN

-bladder cancer
what are WBC casts from?
tubulointerstitial disease, acute pyelonephritis, glomerular disorders

-acute cystitis
what are granular casts from?
acute tubular necrosis and epithelial casts are also present
what are waxy casts from?
CRF or advanced renal disease
what are hyaline casts from?
non specific
what do all these casts mean?
that the hematuria/ pyuria is of renal origin
acute post strep GNItis?
enlarged hypercellular glomeruli with neutrophils and a "lumpy bumpy" appearance- granular on IF
-SUBEPITHELIAL HUMPS

-90% of kids spon resolve and only 60% of adults
Rapidly progressive (crescentic) GNItis?
cresent moon shape- # of crescents indicate prognosis
-rapid course to renal failure
Goodpastures syndrome?
-Nephritic
-anti BM Ig's with hemoptysis and hematuria
Membranoproliferative GNItis?
SUBENDOTHELIAL HUMPS, "tram tracking"
-slowly progess to renal failure
IgA nephropathy, Berger's disease?
mesangial deposits of IgA
-mild disease often post infectious
Alports syndrome?
split BM, collagen type IV mutation, nerve deafness and ocular disorders
what is associated with all Nephritic syndromes?
hematuria and HTN, oliguria and azotemia
-Inflammation
what is associated with all nephrotic syndromes?
massive proteinuria (frothy urine), hypoalbuminemia, periph and periorbital edema, hyperlipidemia
Membranous glomerulonephritis?
-nephrotic
-diffuse capillary and BM thickening, granular pattern, spike and dome
-MC cause of adult nephrOtic syndrome
minimal change disease?
normal glomeruli on LM and foot process effacement
-MC cause of childhood nephrOtic syndrome
-resp well to steroids
Focal segmental glomerular sclerosis?
segmental sclerosis and hyalinosis, more sever in HIV pts
Diabetic nephropathy?
Kimmestiel-Wilson wire loops, BM thickening
SLE?
5 patterns of involvement, in membranous glomerulonephritis- wire loop lesions with subepithelial deposits
Amyloidosis?
congo red stain and apple green bifringence
-assoc with multiple myeloma, chronic conditions, TB and RA