First Aid-Renal

Front 1

the ureters pass under the ____ and the _______

Back 1

-uterine arteries and the ductus deferens (retroperitoneal)

Front 2

what % of body weight is water?
-how much of it is intracell fluid?

Back 2

-60% and 40% of it is intracell fluid

Front 3

what is the extracell fluid made of?

Back 3

-1/4 plasma volume 5%
and the other 15% is interstitial volume

Front 4

what is the glomerular filtration barrier made of?

Back 4

fenestrated capillary endothelium, fused BM with heparin sulfate (negative charged barrier), and epithelial layer consisting of podocyte foot processes

Front 5

when is the cahrge barrier lost?

Back 5

nephrOtic syndrome, so you get albuminuria, hypopoteinemia, gen edema and hyperlipidemia

Front 6

what do you use to measure GFR?

Back 6

inulin, creatinine

Front 7

what do you use to measure RPF?

Back 7

PAH (underestimates RPF by 10%)

Front 8

how do you get renal blood flow?

Back 8

RBF= RPF/1-Hct

Front 9

what effects the afferent arteriole?

Back 9

prostaglandins dilate the afferent arteriole
-inc RPF, and inc GFR so FF is constant
-NSAIDS inhibit this dilation

Front 10

what effects the efferent arteriole?

Back 10

angiotensin II constricts the efferent arteriole
-dec RPF adn inc GFR so FF increases
-ACE inhib work here

Front 11

proximal tubule

Back 11

-reabsorbs all the gluc and aa and most of the bicarb, Na and water
- secretes ammonia which buffers the secreted H+

Front 12

thin decending loop of Henle

Back 12

passively absorbs water due to medullary hypertonicity

Front 13

thick ascending loop of Henle

Back 13

actively reabsorbs Na K 2Cl and indirectly Ca and Mg++

Front 14

early distal convoluted tubule

Back 14

Na and Cl reabsorption and Ca reabsorption is under the control of PTH

Front 15

collecting tubules

Back 15

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

Front 16

actions of angiotensin II

Back 16

vasoconstrict
release aldosterone from the adrenal cortex
release ADH from the post pituitary
stim the hypothal. to inc thirst

Front 17

what is the check on the renin-ang system

Back 17

ANP, like in heart failure can cuase the renin to decrease and GFR to increase

Front 18

what do the JG cells do and where are they located?

Back 18

they secrete renin in response to dec blood pressure and dec Na to the distal tubule, and inc symp tone

Front 19

what is part of the JGA?

Back 19

the JG cells and the macula densa which is the Na sensing region of the dist conv tubule

Front 20

what are the four kidney endocrine functions?

Back 20

-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

Front 21

what does ANF do?

Back 21

causes GFR to increase and Na to be excreted

Front 22

ang II causes inc reabsorb of what?

Back 22

na and bicarb

Front 23

ADH is secreted in response to ________

Back 23

increased plasma osmolarity and decreased blood volume

Front 24

ADH causes what cells to increase the number of H20 channels?

Back 24

principal cells

Front 25

what causes resp acidosis?

Back 25

hypoventilation
-airway obstruction
acute lung disease
chronic lung disease
opiods narcotics and sedatives
weakening of resp mm

Front 26

what causes metabolic acidosis?

Back 26

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)

Front 27

what causes resp alkalosis?

Back 27

hyperventilating, aspirin (early ingestion)

Front 28

metabolic alkalosis?

Back 28

diuretic use, vomiting, antacid use and hyperaldosteronism

Front 29

what is potters syndrome?

Back 29

bilateral renal agensis, caused by oligohydramnious.
-limb and facial deformities, pulmonary hypoplasia
-caused by malformation of the ureteric bud

Front 30

the ureteric bud gives rise to what?

Back 30

the collecting duct system: minor and major calyces and renal pelvis

Front 31

the metanephric mesoderm gives rise to what?

Back 31

loops of henle, bowmans capsule and glomerular tuft

Front 32

a horseshoe kidney is located where and under what vessel?

Back 32

under the inf mesenteric aa and in the abdomen

Front 33

what are the five types of casts that you see in urine?

Back 33

RBC, WBC, granular, waxy and hyaline

Front 34

what are RBC casts from?

Back 34

glom inflamm (nephritic syndromes), ischemia and malig HTN

-bladder cancer

Front 35

what are WBC casts from?

Back 35

tubulointerstitial disease, acute pyelonephritis, glomerular disorders

-acute cystitis

Front 36

what are granular casts from?

Back 36

acute tubular necrosis and epithelial casts are also present

Front 37

what are waxy casts from?

Back 37

CRF or advanced renal disease

Front 38

what are hyaline casts from?

Back 38

non specific

Front 39

what do all these casts mean?

Back 39

that the hematuria/ pyuria is of renal origin

Front 40

acute post strep GNItis?

Back 40

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

Front 41

Rapidly progressive (crescentic) GNItis?

Back 41

cresent moon shape- # of crescents indicate prognosis
-rapid course to renal failure

Front 42

Goodpastures syndrome?

Back 42

-Nephritic
-anti BM Ig's with hemoptysis and hematuria

Front 43

Membranoproliferative GNItis?

Back 43

SUBENDOTHELIAL HUMPS, "tram tracking"
-slowly progess to renal failure

Front 44

IgA nephropathy, Berger's disease?

Back 44

mesangial deposits of IgA
-mild disease often post infectious

Front 45

Alports syndrome?

Back 45

split BM, collagen type IV mutation, nerve deafness and ocular disorders

Front 46

what is associated with all Nephritic syndromes?

Back 46

hematuria and HTN, oliguria and azotemia
-Inflammation

Front 47

what is associated with all nephrotic syndromes?

Back 47

massive proteinuria (frothy urine), hypoalbuminemia, periph and periorbital edema, hyperlipidemia

Front 48

Membranous glomerulonephritis?

Back 48

-nephrotic
-diffuse capillary and BM thickening, granular pattern, spike and dome
-MC cause of adult nephrOtic syndrome

Front 49

minimal change disease?

Back 49

normal glomeruli on LM and foot process effacement
-MC cause of childhood nephrOtic syndrome
-resp well to steroids

Front 50

Focal segmental glomerular sclerosis?

Back 50

segmental sclerosis and hyalinosis, more sever in HIV pts

Front 51

Diabetic nephropathy?

Back 51

Kimmestiel-Wilson wire loops, BM thickening

Front 52

SLE?

Back 52

5 patterns of involvement, in membranous glomerulonephritis- wire loop lesions with subepithelial deposits

Front 53

Amyloidosis?

Back 53

congo red stain and apple green bifringence
-assoc with multiple myeloma, chronic conditions, TB and RA