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286 Cards in this Set

  • Front
  • Back
Renal Embroyology:

Pronephros
forekidney
Mesonephros
midkidney-> uteric bud-> collecting duct, calyses, ureters and renal pelvis
Metanephros
hindkidney-> permanent kidney
Urogenital sinus
allantois -.> urachus -> bladder
The Kidney Bean blood flow
Cortex -> medulla -> pyramids -> papillae, callyces, hilum
Kidney Anatomy: where do arteries run with respect to the veins?
Arteries run under the veins due to their high pressure
Where is the Right kidney located?
The right kidney sits at the L2 (lower) due the liver is in the way.
Where is the Right renal artery located?
It runs underneath or posterior to IVC, long course
Where is the Left renal vein located?
It runs anterior to the aorta, long course.
what is its significance of the left renal vein?
the left renal vein runs along the aorta.
so, when there is an aortic aneurysm, the
blood supply to this kidney is affected and
its hurt first.
What is the importance of the Right gonadal vein
Right gonadal vein drains into the IVC (inferior vana cava) therefore it would spread faster if there was metastasis
where does the left gonadal vein drain into?
to the left renal vein
What is the osmolarity of the cortex?
Isotonic (osmolarity is the same as in plasma)
What is the cortex succeptible to?
DIC
What is the osmolarity of the medulla?
hypertonic (concentrates your urine)
What is the medulla succeptible to?
Clots
When do nephrons get longer?
when it is warm to concentrate urine.
Dehydration status: What happens when one has a 5% loss, 10% loss and 15% loss
5%: thirsty
10%: tachycardia
15%: decrease BP/ capillary refill
Rehydration: what is the bolus?
normal saline : 20cc/kg
Rehydration: How do we calculate replacement
Replacement is calculated based on Na:
Measure weight loss 1kg -> 1L
Give 1/2 (minus the bolus) over 8 hours
Give 1/2 over the next 16 hours
Maintenance: how much and what kind of fluid do we use for the following
Adults:
Kids:
Dehydrated adult
Dehydrated kid
Shock
Hyponatremia
Adults: 1/2 normal saline
Kids: 1/4 normal saline
Dehydrated adult: normal saline
Dehydrated kid: 1/2 normal saline
Shock: Lactate ringer's or normal saline (154 mEq salt/L
Hyponatremia: 3% NaCl
How much do I give to the following?
Adult:
Kid <8 y/o:
1st 10kg
2nd 10kg
after that
per hour
Burn deficit:
Adult: 1.5 cc/kg/hr (=urine output)
Kid <8 y/o:
1st 10kg: 100cc/kg/day
2nd 10kg: 50cc/kg/day
after that: 20cc/kg/day
per hour: 4/2/1 cc/kg/day
Burn deficit: 4cc normal saline/kg/% burn ( parkland formula)
What are the values of the survival electrolytes:
NaCI: we need __mEq/ kg/day = ___mEq/3L urine/day= ___mEq/L => use __NS
K: we need ___mEg/ kg/day = ___mEq/3L urine/day= ___ mEq/L =>add ___mEq K/L
NaCl: we need 3 mEq/kg/day = 225 mEq/3L urine/day = 75 mEq/L= > 1/2 NS

K: 1.75mEq/kg/day = 56 mEq/3L urine/day = 20 mEq/l => add 20mEq K/L
Burns: what are the rule of 9's:
head + neck:
chest:
Back:
each arm:
Each leg:
Genitalia;
head + neck: 9%
chest: 18%
Back: 18%
each arm: 9%
Each leg: 18%
Genitalia: 1%
Burn Classification:
1st degree:
2nd degree:
3rd degree:
1st degree: red (epidermis)
2nd degree: blister
3rd degree: painless neuropathy (dermis)
RAA axis: what part of the kidney senses it and what does it senses?
the low volume is sensed by the macula densa
Describe the RAA axis
When the macula densa senses the low volume, it sends a signal to the J-G apparatus to release renin. Renin converts anginotensinogen to ATI the AT I moves to the lungs and is converted to AT II by ACE enzyme. AT II has 4 functions
1) vasoconstriction to increase BP
2) increases thirst
3) releases ADH which absorbs water
4) releases aldosterone which absorbs water and secretes K/H+
What is the average weight in an adult and kid?
adult: 75 kg =165.346 lb
kid: 35 kg = 77.1617 lb
Dialysis: describe hemodialysis and peritoneal dialysis
hemodialysis: forearm AV fistula (done in the hospital)
peritoneal dialysis: peritoneum catheter (done at home)
Burn Tx: and its side effects
Most:
Cartilage:
Eyes:
Most: silver sulfadiazine (leukopenia)
Cartilage: Sulfamylon (acidosis)
Eyes: Triple antibiotic
function of aldosterone
controls volume (Na)
function of ADH
controls water
describe the bradykinin pathway
kininogen ⇢ (kallikrein)⇢ bradykinin ⇢ (ACE)⇢ degraded bradykinin
Bradykinin functions:
⇨dilates veins
⇨proteinuria
⇨cough
Acid base disorders: how is it read
Normal:
1) pH=7.4
2) pCO2 "acid" = 40
3) HCO3 = 24
Note:
⇨if 1 & 2 go in the same direction (ie. increased or decreased) =metabolic
⇨If 2 & 3 go in the same direction = compensated
⇨opposite directions = respiratory or mixed, respectively
Respiratory alkalosis: examples and Tx:
Restrictrive lung Dz
(anxiety, pregnancy, gram - sepsis, PE)
Tx: breath into a bag
Respiratory acidosis: examples Tx:
Obstructive lung Dz (COPD, drugs). Tx: hyperventilation, ⇧FiO₂
metabolic alkalosis: defintion and examples. Tx:
Low volume state (vomiting, diuretics, GI blood loss). Tx. hydration
Metabolic acidosis: definition and examples. Tx:
acid production ( MUDPILES, RTA II, diarrhea).
Tx: bicarbonate if pH < 7.2
oliguria vs anuria
oliguria: < 400 cc/day
anuria: < 100 cc/day
pre-renal failure definition and etiology.
Definition: hypoperfusion to the kidney
1) low volume state (AT II constricts efferent -->⇧BUN,⇩Cr
2) vasculitis
Pre-Renal Failure: BUN/Cr and FeNa
BUN/Cr: >20
FeNa: <1%
pre-renal failure: treatment
fluid bolus (increase flow to the kidney)
Renal problem: definition, examples
damaged glomerulous ie. ATN, SLE, Wegener's, Renal artery stenosis
Renal problem:
what happens to the Cr/RPF levels, BUN
urine osmolarity
Tx
what if you need to give a renal excreting drug/
⇧Cr/⇧RPF (cannot filter)
⇩serum BUN (filter less therefore secrete less), then ⇧(no blood flow).
Urine osmolarity = 300 (near serum osmolarity) -> kidney can't concentrate urine
Tx: Fluid, Diet: low Na/K/PO₄/protein; No renal-excreted meds
Note: if you give a renal excreting drug, make sure to give enough volume.
Post-renal failure: definition
there is an obstruction and has not peed in the last 4 days
Most common cause of post renal failure in newborns
malimplantation of ureter
post-urethral valve obstruction
Most common cause of post renal failure in kids
strictures (UTI's)
Most common cause of post renal failure in adults
scarring (STD's, Nitrofurantoin)
Most common cause of post renal failure in women > 40 y/o
uterine prolapse, cystocele
Most common cause of post renal failure in men > 40 y/o
BPH, nephrolithiasis
Post-renal failure Tx:
catheter to get urine out (have a lot of urine stored in bladder)
ESRD
white powder means that there is urea in sweat
=>pruritis, excoriations.
Patient will also present with pallor and ecchymosis
fake sphincters
ureters, lower esophageal sphincter and ileocecal valve
Urinalysis: color
pus, blood
urinalysis:
Specific Gravity is High: (2)
dehydration, SIADH
urinalysis:
Low pH:
Salicylate O/D
urinalysis:
High pH: (2)
UTI, RTA Type I
urinalysis:
Protein is High
leaky glomeruli
urinalysis:
Glucose is High
DM
urinalysis:
Ketones are High (3)
DKA, starvation, isopropanol toxicity
urinalysis:
High Bilirubin
hemolysis
Urinalysis:
High Urobilinogen (2)
hemolysis or conjugated hyperbilirubinemia
urinalysis:
Nitrite ( + )
Gram (-) bacteria
urinalysis
Nitrite (-):
Enterococcus
urinalysis
Leukocyte Esterase:
WBC's
urinalysis
RBC (3)
stones, tumor, GN
urinalysis
WBC (3)
UTI, prostatitis, vaginitis
urinalysis
Casts:
Kidney dz
urinalysis
Crystals (2)
Kidney stones, Ethylene Glycol toxicity
urinalysis
Squamous Epithelium:
degree of contamination
what is Nephritic syndrome?
increased size of fenestrations=> vasculitis (HTN)
Urine: nephritic syndrome
increase BUN/ Cr
⇩GFR
oliguria, Blood, and WBC casts in the urine
"RPGN":
Rapidly Progressive Glomerulonephritis
Crescent formation=> scars
Post-Strep Glomerulonephritis "PSGN":
presentation
strain
deposits
Ab
Tx
hematuria 2wk after sore throat
• Strain 12
• Subepithelial
• Inflamed glomerulus w/ IgG, C3,C4 deposition
• Anti-streptolysin Ab "ASO" (periorbital swelling)
• Tx: Furosemide (tx symptoms)
what is Interstitial Nephritis and what is it commonly caused by?
urine eosinophils
Caused by Fluoroquinolones
what are vaculitides? (7)
Vasculitidies:
• Wegener's:
• Goodpasture's:
• Henoch-Schonlein Purpura
• Polyarteritis Nodosa
• Subacute Bacterial Endocarditis
• Serum Sickness
• Cryoglobulinemia
Wegener's: antibody and tx
c-ANCA Ab
(Tx: Cyclophosphamide +Prednisone)
Goodpasture's:
ab
presentation
tx
anti-GBM Ab
hematuria+ hemoptysis
(Tx: plasmapheresis)
Subacute Bacterial Endocarditis,
Serum Sickness, Cryoglobulinemia what do they have in common?
they all have ⇩C3.
what is nephrotic syndrome? explain the hyperlipedemia, hypercoagulability, and edema that is seen.
Def: lost BM charge due to deposition on heparin sulfate =>proteinuria and lipiduria
• Edema (due to oncotic forces)
• Liver: makes proteins to compensate (⇧LDL, hypercoagulability, ⇧DVT/renal vein thrombosis)
• Urine: Protein (>3.5g), Lipid (maltese crosses)
• increase Risk Spontaneous Bacterial Peritonitis
Membranous Glomerulonephritis "MGN":
most common in what type of people
associated with what disease?
biopsy?
• Most common in grown-ups
• Hep B
(spike&dome, thick BM)
Membranous Glomerulonephritis "MGN":
what are the common drugs that can cause it? (4)
treatment? (2)
• Penicillamine, Captopril, Mercury, Gold
• Tx: Prednisone, Chlorambucil
which diseases give subepithelial deposits?
Subepithelial:
• SLE
• PSGN
Minimal Change Disease "MCD":
what group of people is it most common in?
describe MCD
Tx
• Most common in children
• Fused foot processes, autoimmune
• Tx: Prednisone (the only curable nephrotic process)
Focal Segmental Glomerulosclerosis "FSG":
who are at risk
⇧Risk in African Americans and HIV patients
Diabetic Nephropathy: describe and Tx
• Glomerulosclerosis
• kimmelstiel-wilson nodules
• Tx: Restrict protein <0.8g/kg
Systemic Lupus Erythematosus "SLE": C3, Ab, deposits and Tx
• ⇩C3, anti-ds DNA
• Subepithelial deposits
• Tx: pulsatile Cyclophosphamide
Membranoproliferative Glomerulonephritis "MPGN": describe and Tx
• ⇩C3, tram tracks"
• Tx: ASA,Dipyramidole
IgA Nephropathy: C3 levels, presentation, associated with what diseases?
• Normal C3
• URI, then hematuria
• Assoc w/ HIV, celiac disease, liver disease
what is total body water and how is it measured?
60% weight (measure w/ D₂O)
what are the components of total body water
>>2/3 intracellular
>>1/ 3 extracellular
what are the two parts of extracellular compartment
o 1/4 plasma
o 3/4 interstitial (plasma - proteins)
what part of total body water decreases with excercise? and how is it measured?
>>1/ 3 extracellular
>>measure w/ inulin)
how is the 1/4 plasma compartment measured?
o 1/4 plasma (measure w/ albumin*)
what compartment does the isotonic saline goes
o 3/4 interstitial (plasma - proteins) ⇦isotonic saline goes
which compartment of the total body water has K+ and Mg2+ in it?
2/3 intracellular compartment
what does the ff mean? -emia and -uria?
-emia: blood
-uria: urine
how is osmolarity approximated?
2 (Na) + Glucose/18 + BUN/3 = 300 Osm/kg
what ions can contribute to the osmolarity
Na(or glucose, mannitol, methanol, ethylene glycol)
what is clearance?
Clearance = FF + secretion - reabsorption
Clearance = excretion (total of all processes)
Secrete= add to the urine (active process)
Reabsorb = subtract from urine
what is FF?
FF= GFR/RPF "ftltration fraction" is how much of the plasma the glomerulus ftlters
what is the job of an afferent arteriole?
Afferent: filtration just uses diffusion)
how is GFR measured in the lab? in real life?
GFR: can measure with inulin lab or.creatinine (physiologic) ⇨ 100% ftltered. In real life Cr is inversely proportional.
what is blood flow per hour
>>RBF to kidney = 20% of CO = 1L/hr
how much is filtered by the glomerulous?
20% of fluid that comes to glomerulus (RBF) is filtered = >200cc/hr
how much fluids should we drink in a day? and why?
RBC are not ftltered (45%) => GFR=125cc/hr => 3L urine per day=> drink 3L H20 per day.to replace
what are the normal values of
BUN, Cr, GFR
Normals:
BUN: 10-20
Cr: 0.6-.2
GFR: 125
what are some ways to calculate the GFR?
>>Cockroft-Gault: (140-age)(weight)/ (72)(serum Cr)
>>MDRD: (age)(serum Cr)(a bunch of numbers)
>>GFR = UV /P "UV peed"
>>(GFR1) (Cr1) = (GFR2) (Cr2)
what does
GFR: mean?
<60
<10
GFR:
<60: Renal failure
<10: End-stage renal disease
calculation of FeNa
FeNa: (Una/Pna)(Pcr/Ucr)
what is the function of efferent arteriole and what does it need to do its job?
secretion (needs transport proteins) =>
what arteriole of the kidney is hurt first in the lower energy state
efferent arteriole
how is secretion measured in the lab? physiologic? how is it calculated/
Can measure with PAH (lab) or BUN (physiologic)
>>RPF1BUN1 = RPF2 BUN2
NSAIDs: effect on arterioles
constricts afferent arterioles
AT -II: effect on arterioles
contricts efferent arterioles
ACE-I:effect on arterioles
dilates efferent arterioles
afferent arteriole: job, measurement and test
Job: ⇧filter
measurement: ⇩creatine, inulin
test: GFR
efferent arteriole: job, measurement and test
Job: ⇧secrete
measurement: ⇩BUN, PAH
test: RPF
what does it mean when there is a small kidney
hypertensive nephropathy
most common cause of secondary hypertension?
renal artery stenosis
what happens during renal artery stenosis?
Increased velocity helps blood get past clot into bad kidney
• Increased pressure on contralateral kidney destroys it => malignant HTN
what test is done for renal artery stenosis? what is considered positive?
Test: captopril renal scan in both renal arteries: 1.5 difference=> stenosis
what is Goldblatt's Kidney
"flea bitten kidney" (blown capillaries). hyperthensive nephropathy
Dx: renal artery stenosis
< 30) y/o:
> 30) y/o
< 30) y/o: fibromuscular Dysplasia
> 30) y/o: Atherosclerosis
treatment of hypertensive nephropathy
Remove contralateral kidney (nephrectomy)
• Remove ipsilaterteral blood clot (atherectomy)
• No ACEI!(dilates efferent arterioles => ⇩blood flow to kidney)
give 5 diseases that can cause big Kidneys?
PCKD
Medullary Cystic/Sponge Kidney
Amyloidosis
DM
Scleroderma
Azotemia:
increase BUN/ Cr
Uremia:
azotemia + sx (bleeding,
pericarditis, encephalopathy)
PCKD: what are its two types and mode of inheritance
PCKD = polycystic kidney disease
• Infantile type (AR):
• Adult type (AD):
PCKD: complications if its the infantile type and unilateral
if unilateral => no problems
PCKD: complications if its the adult type and bilateral
1st sign
what happens to the kidneys? (3)
other presentataions: (3)
o HTN - 1st sign
o Renal failure, azotemia, liver cysts
o Diverticulosis, mitral prolapse, berry aneurysms (post communicating artery)
Medullary Cystic/Sponge Kidney:
presentation and why?
why do they get more stones?
>>"Polyuria, polydipsia (can't concentrate urine b/ c of medulla problem)
>> Low vol state => high pH = > Ca ppt => kidney stones
what would see on a sonogram in Medullary Cystic/Sponge Kidney
bubbles (cystic) or holes (sponge
Amyloidosis:
apple green bifringence with Congo Red stain
:most common cause of ESRD
Diabetes Milliteus
Scleroderma:
tight skin, fibrosis
Proteinuria Dx: Benign, Malignant :
benign (1 + to 2+): increase Protein concentration. gradient (stand, exercise, fever)
malignant (3+ to 4+): Renal problem=> 24-hr urine; measure protein
where are common places where stones gets stuck
Ureter Constrictions: stones get stuck here
• Hilum (especially staghorn calculi)
• Pelvic rim
• Utero-vesicular junction (where ureter enters bladder)
3 causes of painful hematuria
• UTI
• Kidney stone
• Renal infarct
6 causes of painless hematuria
• TB
• Kidney tumor
• Glomerulonephritis
• Prostate disease
• Sickle cell trait
• Acute Intermittent Porphyria- abdominal pain
how do kidney stones present?
when do kidney stones recur?
Backpain radiating to groin due to Dehydration => painful hematuria +colic
Kidney stones: 50% recur in 10 yrs
when do kidney stones reoccur?
Kidney stones: 50% recur in 10 yrs
Coffin-lid
Triple P04
Rosette:
Uric acid
Hexagonal:
Cystine
Envelope:
Oxalate
Calcium Pyrophosphate:
shape
3 common causes
Tx: and how does it do this?
>>amorphous shape
>>Cause: IBD, HyperPTH, Pseudogout
>>Tx: Thiazide diuretics ( decreased Ca concentration in urine)
Triple Phosphate:
aka
crystals
type of stone
>>(MgNH4P04):
>>coffin-lid crystals
>>Stuvite = Staghorn calculus
Triple Phosphate: pathogen
>>Cause: Proteus, Urease (+) Bugs
Triple Phosphate: Tx
Tx: lower urine pH
"lower the coffin"
Uric acid stone shape
Rhombic "rosette" crystals
4 causes of uric acid stones
iatrogenic
disease
drugs (2)
Gout, Chemotherapy (purines => uric acid), HCTZ, Furosemide
treatment for uric acid stones
Tx: raise urine pH (oral bicarbonate or citrate)
"raise: little boy peeing up"
what stone is not seen on x-ray
what test should be done?
Note: not seen on x-ray => do IVP
" U can't see me!": uric acid stones
Cystine: describe crystals
yellow-brown hexagonal crystals
cystine: cause and Tx
Cause: Homocystinuria
Tx: raise urine pH
what is the most common kidney stones and shape?
Calcium Oxalate
envelope or dumbbell shape crystals
what is the cause of oxalate stones and Tx
Cause: Malabsorption => Ca trapped in fat => Ca can't bind oxalate to excrete it.
>>Tx: Thiazide diuretics
most common cause of oxalate crystals in caucasian kids
Cystic Fibrosis
most common cause of oxalate AA kids
celiac sprue
2 other common cause of oxalate
Ethylene Glycol poisoning
High Vit. C ( increase oxalate secretion)
most common cause of oxalate in adults
Crohn's, Vegetarians
Kidney Stone Tx:
< .4cm
>.4-4cm
> 4cm
Septic:
Kidney Stone Tx:
< .4cm: Rehydration, Opiates
>.4-4cm: Lithotripsy (shatter it w/ sound waves) => hematuria
> 4cm: Surgery
Septic: Stent placement to drain pus
how does urinary reflux lead to renal failure?
>>Reflux makes ureters dilate => hydronephrosis =>pyelonephritis => renal failure
where is the ureter located?
Ureter: runs on top of psoas muscle, inferior and behind bladder
Bilateral Hydronephrosis:
dilation of ureters due to urine reflux>
Unilateral Hydronephrosis:
cause
presentation
stones=> colic (pain comes in waves), radiates to groin
what is the residual volume of the bladder?
residual volume= 100cc
how does UTI happen?
how does cranberry juice prevent UTI?
urinary tract has podocytes
Cranberry Juice: prevents bacteria from adhering to bladder
most common viral UTI
Adenovirus
most common bacterial UTI
Bacterial:
1) E. Coli
2) Proteus
3) Klebsiella
4) Enterococcus
treatment for klebsiella UTI
Tx: Bactrim
Urethritis: presentation and pathogen
urethral infection => dysuria alone
(Chlamydia or Gonorrhea)
Cystitis:
define
presentation
tx
bladder infection => frequency, urgency
(Tx: Bactrim or Nitrofurantoin)
Honeymoon cystitis:
Staph saprophyticus from penis head => female UTI
Prostatitis:
cause
presentation
bacteria climbed the urethra to prostate,
uncomfortable in sitting position
Prostatitis: most common pathogen in the young and old, tx
Young: N. gonorrhea,
Old: E. coli
Tx: Bactrim IV or Norfloxacin
Pyelonephritis:
define
cast
presentation
tx
ascending infxn from nephron
=> WBC casts, costovertebral angle tenderness
(Tx: Ceftriaxone)
Balanitis
penis head inflammation
Phimosis:
foreskin scarred at penis head
(foreskin stuck smooshed up)
Paraphimosis:
foreskin scarred at base of penis head
(retraction of foreskin strangulates penis)
Prostatic abscess:
presentation
DRE results
pathogen
repeated UTIs that improve w/ abx
prostate fluctuance
(Staph aureus)
Exstrophy of Bladder:
describe
complication
tx
urachus stuck outside => cancer risk
(Tx: surgery at birth)
Congenital bladder obstruction
posterior urtethral valves close when bladder contracts
drugs that can cause urinary retention:
BPH drugs, Ipratroprium, Quinidine
Hypospadia: define and tx
urinary opening near anus (penis fuses dorsal to ventral, zips up tip to base)
Tx: delay circumcision so the prepuce can be used for reconstruction, repair at 6mo
what part of the urinary system is injured in a Seatbelt Trauma?
superior surface of bladder
Thoracic Aortic Dissection:
3 example presentation
tearing pain, unequal BP/pulses, CXR widened mediastinum
2 types of aortic dissection:
Type A: ascending aorta
Type B: descending aorta
Type A aortic dissection:
location
associations/causes
mngmt.
location: ascending aorta
association: Marfan's, syphilis
management: emergency surgery
Type B aortic dissection:
location
associations/causes
mngmt/tx
location: descending aorta
causes: atherosclerosis in elderly, trauma in young
tx.HTN (Nitroprusside+ Esmolol)
Abdominal Aortic Dissection:
Define
location
etiology
diagnosis
def: ripping pain, pulsating abdominal mass
MC location: 90% occur below left renal artery
MC cause: atherosclerosis
Dx: US or CT (if pt is hypotensive)
Abdominal Aortic Dissection: mngmt:
<4cm, >6cm, emergency treatment
<4cm => control HTN, get CT/MRI/Angiogram
>6cm=> control HTN, surgery
Emergency Tx: Tie aorta off, open heart massage; NO CPR!
what are the 2 types of aneurysm
Types:
o True: all 3 layers
o Pseudo: intima/ media only (Ex: femoral a. catheter injection)
CI for Abdominal Aortic Dissection
why?
No Steriods with Aneurysms
(causes stress demargination of WBCs => thinner walls)
complicaiton of Abdominal Aortic Dissection repair
Repair => emboli => Ant spinal cord infarction => loss of pain/temp/DTR
Urinary Incontinence: management
do cystometry
Urge Incontinence
urgency => complete voiding
"Gotta go right now!"
Urge Incontinence: Tx
1) Urinate frequently to train detrusor
2) oxybutinin
Imipramine
Glycopyrrolate (anti cholinergic)
Tolterodine
Stress Incontinence: define and test performed
weak pelvic floor muscles (estrogen effect), pee when you sneeze
Q-tip test: > 30° change
Stress Incontinence: treatment
1) Kegel exercise
2) Pessary (stick a plastic stopper in to plug it up )
3) Pseudoephedrine (α1-agonist)
4) Kelly plication
One-way valves
• Urethra
• Ejaculatory duct
Overflow Incontinence
persistant dribble, but can't completely empty bladder
Overflow Incontinence: give 2 causes
1) obstruction
2) Detrusor hypotonia
Overflow Incontinence: give 2 Tx of detrusor hypotonia
o Tx: Bethanechol (increase detrusor contractions, muscarinic agonist)
o Tx: intermittent self-catheterization
Overflow Incontinence: detrusor hypotonia is associated with what 2 diseases?
DM, Multiple Sclerosis
Ectopic Ureter:
continuous urine leakage in a child
what is a Casts:
take nephron's shape from PT
WBC casts
Nephritis
WBC casts only=>
Pyelonephritis (sepsis)
WBC + Eosinophils => and tx
Intetstitial nephritis and allergies
Tx: steroids
WBC + RBC casts=>
Glomerulonephritis (hematuria => vasculitis => HTN)
Fat casts:
Nephrotic syndrome
waxy casts:
ESRD
Tubular casts:
ATN
Muddy brown casts:
ATN
Hyaline casts:
Normal sloughing
Epithelial casts:
Normal sloughing
Crescents:
RPGN
FeNa: normal
• Pre-renal
• Renal
• Post
FeNa: 1-10% normal
• Pre-renal < 1%
• Renal > 2%
• Post > 4%
Urine Na= normal
• Pre-renal
• Renal
• Post
UNa= 10-20 normal
• Pre-renal <20 mEq/L
• Renal >20 mEq/L
• Post >40 mEq/L
Proximal Tubule: location, function and what does it secrete?
in cortex (isotonic)
Job: reabsorb glucose, amino acids, salt, bicarb, water
Secrete: H+ (not excrete, keeps circulating)
main reactions in the PTC
Main Rxns:
• H2C03 =>(CA) =>C02 + H20
• Na/Mg/P04/ aa/ glucose/lactate co-transporter
• HC03-/Cl- antiporter
PCT: % of Na, glucose, aa, bicarbonate are reabsorbed
Reabsorb:
• 70% Na
• 70% H20
• filtered HC03-
• 99% glucose
• 90% aa
where is the water reabsorbed
70% H20 (reabsorbed intercellularly - tiny space between cells)
what happens to HCO3- when reabsorbed
filtered HC03- (into plasma) ~ "contraction alkalosis"
transport maximum of glucose
99% glucose (<1.26 = transport maximum)
Fanconi's syndrome
(old tetracycline): urine phosphates, glucose, amino acids=> low energy state
Carbonic Anhydrase Inhibitors:
example
it usage
it has what compound?
>>Acetazolamide
Tx: incr. ICP, acute glaucoma, mountain sickness, pseudotumor cerebri
>> it has sulfur
Thin Descending Limb: function
reabsorbs water
Thick Ascending Limb:
function and describe the urine tonicity:
>>hypotonic
>>make the concentration gradient by reabsorbing Na, K, Cl, Mg, Ca without water
main rxns of thick ascending limb
• 25% Na/K/2Cl co-transporter
• Na/Ca or Na/Mg co-transporter
• Not water-permeable
Bartter's syndrome:
baby w/ defective triple transporter (low Na, Cl, K w/ normal BP)
Psychogenic polydipsia:
no concentrating ability ~> cerebral edema
Post-obstructive diuresis: def and Tx
remove obstruction => medulla feels diluted, can't concentrate
(Tx: replace vol)
Loop Diuretics
kind of acid,
MOA
made up of what compound
looses what ion?
def: weak acid
blocks triple transport system in thick loop of Henle (Na/Cl/K+ and Ca/Mg)
has sulfur
looses Ca
what must be replaced when someone is in loop diuretics?
must replace K+
what kind of compound does loop diuretic compete with
what does it lead to?
competes for uric acid excretion => gout
what are the loop diuretics (4)
Bumetanide
Torsemide
Furosemide
Ethacrynic acid
Furosemide SE and what is it used for?
SE: reversible hearing loss, Stephen Johnson syndrome,
Usage: ciliates lung lymphatics
(use with renal failure and pulmonary edema)
Ethacrynic acid
does not have sulfur
Early Distal Tubule:
Job:
to concentrate urine by reabsorbing NaCl (hypotonic)
Early Distal Tubule:
the three Main Rxns:
• Macula Densa (MD): measures osmolarity and volume
• NaCl co-transporter
• Ca2+ reabsorption (Vit D stimulates Ca ATPase)
what do they measure?
JG:
MD:
JG: measures volume
MD: measures osmolarity
Thiazide Diuretics: kind of acid, has what compound and SE
Thiazide Diuretics:
weak acids, have sulfur
'Hyper GLUC"
HyperGlycemia
HyperLipidemia
High Uric acid
HyperCalcemia
name the Thiazide Diuretics: (4)
Metolazone
Chlorthalidone
indapamide
Hydrochlorothiazide
thiazide diuretic that is used to treat oxalate stones
Hydrochlorothiazide
function of Late DT collecting Duct:
what happens when there is hyperkalemia in the blood?
>>Def: Hyperkalemia (in blood) => acidosis (in cell)
>>Job: final concentration of urine by reabsorbing water, excretion of acid (isotonic)
where is Vit D/Ca-ATPase reabsorbed?
Late DT collecting Duct:
2 types of cell in the Late DT collecting Duct:
Principle cells:
Intercalated cells:
Principle cells: what are the three different channels in it and what steroid or hormone regulates it?
• H20 channels <= ADH
• (lose 90%) K+ channel <=Aldo
• Na channel <= Aldo
Intercalated cells: what are the 2 pump in it and which one is activated by aldosterone?
• H/K. ATPase
• H secretion-ATPase <=Aldo
Hepatorenal syndrome:
high urea from liver increase glutaminase ⇨ NH4 + ⇨ GABA ⇨causes heart to stop pumping ⇨ kidney stops working.
In respiratory acidosis how does the kidney make bicarb in CD?
by Carbonic Anhydrase enzyme,
it makes new bicarb in CD: H2CO3 ⇨ H+ + HCO3·
Glutaminase: breaks Gln ⇨ Glu + NH4 ⇨ NH3 + H+.

when is this active? why?
activated when liver fails.
to make acid from CD
other CD acid sources:
1) H+ ATPases
2) Urea cycle (90% in liver, 10% in CD): NH4 ⇨ NH3 + H+
Spironolactone: MOA, SE, tx
MOA: K+ sparing diuretic, blocks Aldo and p450
SE: gynecomastia, galactorrhea,
tx Conn's and hirsuitism
Triamterene: type of diuretic, MOA and tx for what disease?
K+ sparing diuretic
blocks Na channels directly,
tx: Meninier's
Amiloride
K+ sparing diuretic
blocks Na channels directly, sodium wasting
Renal Tubular Acidosis I:
what happens to serum hydrogen and potassium levels?
serum ⇧H/⇩ K
RTA Type I (distal):
etiology
4 associated syndromes
H /K pump in CD is broken⇨ high urine pH.
(inflammation, autoimmune dz, stones, Li)
RTA Type II (proximal): urine pH
3 associated with what syndromes?
bad Carbonic Anhydrase⇨ lost all bicarb ⇨ low urine pH
(multiple myeloma, Fanconi's, metals)
RTA Type III
I + II ⇨ normal fine pH 5.3
Type IV: RTA
associated with what syndromes
etiology
infarct at the J-G apparatus ⇨ no renin ⇨ no Aldo ⇨ high K
(DM, NSAIDs, ACE-I, Heparin, sickle cell) "HANDS"
J -G apparatus
function
measures volume and secretes renin
PT: what does it absorb? 4
glucose/aa/ bicarb/NaCl
Thin AL:
reabsorbs water
Thick AL:
reabsorbs ions only ⇨ makes concentration gradient
Macula Densa: funciton
measures osmolarity
Early DT: function
reabsorbs NaCl ⇨ starts concentration of urine
Late DT /CD: function
reabsorbs water/ excretes H+ ⇨ final concentration of urine
Anion Gap:
Na - (Cl + HCO3)
normal +9-14mEq/L
High Anion Gap: def and examples
Def: Buffer H+ by losing HC03-
''MUDPILES"
Methanol- turns into formic acid ⇨kills retina
Uremia
DKA
Paraldehycde
INH/ Iron
Lactic acid (Ex: bowel ischemia)
Ethanol/Ethylene Glycol (antifreeze) - turns into glycoxylate => Kidney stones
Salicylates: asa
Low Anion Gap:
Multiple Myeloma
Non-Anion Gap: def (HCO3 and Cl-) and examples
⇩HC03 or⇧ Cl
Diarrhea
Fanconi's
RTA (type II)
Acid ingestion
which one has a longer renal artery?
aorta is on the left and therefore right renal artery is longer
how does thiazide work as a treatment for nephrogenic DI?
thiazide is used as its side effect (making more porins). it stops the Na/K+ pump and therefore holds on to more sodium and the porins help absorb water.
which one has the longest renal vein?
left renal vein is longer because the IVC is on the right. "I am Right"
polyuria and polydipsia DDX
next best step of management.
psychogenic and DI
do water deprivation test first
maximum parkland formula
50% is maximum
70 kg man, 65% burn fluid management
70 x 50%= 2450 x 4cc =9800
4900 first 8 hrs and 4900 next 16 hrs, 2nd day: 4900 and 3rd day give none (massive enuresis)
70 kg man, 65% burn fluid management if the urine out put is 15,20 and 15 an hour.
give more fluids since his urine output should be .5-1.5 cc/hr. 70kg urine output is 35-105/hr. (70 x.5) = 35 and 70 x 1.5 =105
therefore the normal urine output range for this man is 35-105/hr
70 kg man, 65% burn fluid management if the urine out put is 300,250 and 270 an hour. Next best step of management
lower down fluids
70 kg man, 65% burn fluid management if the urine out put is in 48 hours is 50-100 and the third day its 300 and 250. what is the next best step of management?
none, this is the massive eneuresis
management of a dehydrated patient and exception.
Give .9% saline because its isotonic, it fills up the vascular space and eventually go into the cell because cell are hypertonic. If patient was given hypertonic solution, the BP will go up but at the expence of the cells. The only time we give hypertonic solution in a dehydrated patient is when Na <120mg/dl. We give 3% because this person has SIADH and without Na, cells are least likely to depolarize.