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195 Cards in this Set
- Front
- Back
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What is the allantois? What does it become?
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Fetal structure that connects bladder to yolk sac -> turns into urachus (through umbilicus)
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A baby is losing urine through it's umbilicus. What's going on?
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Patent uracus -> remnant of allantois, which connected bladder to yolk sac during fetal development.
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A persistent yolk stalk leads to what in neonatal life?
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GI - umbilicus attachments. Meckels, cyst, etc (persistent viteline duct)
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What do the paramesonephric ducts fuse to form??
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The uteran tubes, uterus, cervix and upper 1/3 of the vagina
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What do the mesonephric ducts go on to form and males and females?
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Women: Gartner's ducts. Men: wolfian ducts -> male genitalia
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Incomplete fusion of what in the male forms hypospadias?
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Urethral folds
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Hydogcoele and indirect inguinal hernia form when what fails to obliterate?
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Processus vaginalis
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What embryonic structure gives rise to the collecting system of the kidneys (collecting ducts, minor and major calyces, renal pelvis, ureters)?
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Ureteric bud
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What embryonic structure gives rise to the glomerulus through collecting tubule)?
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Metanephric mesoderm
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What hormones make the uterus NOT develop in males?
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Mullerian inhibitory factor (MIF) (causes regression of paramesonephric ducts)
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The embryonic testes secrete what 2 hormones?
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MIF (regression of female parts) and testosterone (development of genetalia)
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What is epispadius? What causes it?
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Hypospadius but dorsal. Caused by malpositioning of genital tubercle
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What is Potter syndrome?
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Oligohydraminos -> compression of fetus with resulting limb and facial deformities, lung hypoplasia
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What is the most common cause of fetal hydronephrosis? Why?
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Uretopelvic junction obstruction - this is the last part of the ureteric bud to canalize
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Ureteric bud is usually fully canalized by what gestational week?
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10
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What happens to RPF, GFR and FF at moderate and severe efferent artiolar constriction?
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Moderate: Decreased RBF, Incresed GFR (from increased hydrostatic pressure) and increased FF. Severe: Further decreased RBF, decresed GFR (from buildup of plasma oncotic pressure from slow blood flow) increased FF.
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5 things that cause nephrotic syndrome and 2 things that cause nephrotic and nephritic?
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FSGS, membranous nephropathy, minimal change dz, amyloidosis, diabetic glomerulonephropathy. Both: Diffuse proliferative glomerulonephritis, membranoproliferative glomerulonephritis
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4 things that cause nephritc syndrome and 2 things that cause both?
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Acute PSGN, RPGN, Berger's IgA nephropathy, Alport syndrome
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What part of the kidney does ANP work on? What is its effect on GFR and Na+ reabsoprtion?
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ANP relaxes afferent and constricts effernt arteriole, also decreases renin, causing an increase in GFR with no compensatory increase in Na+ reabsorption, leading to overall loss of Na+ and H2O.
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Does drug induced lupus frequently involve the kideny?
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Nope! (ie, procainamide induced)
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Pathogenesis of diabetic nephropathy?
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Increased ANP secretion 2/2 hyperglycemia -> increased GFR. Then get morphological changes in kidney to compensate -> increased mesangial matrix and thickened basement membrane -> nodular glomerulosclerosis
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"eosinophillic glomerulosclerosis" (Kimmelstiel Wilson lesions) what kidney problem?
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Diabetic nephropathy!
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"Diffuse glomerular hypercellularity 2/2 increased mesangial cell proliferation and leaukocyte infiltration" "lumpy bumpy" what GN?
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PSGN
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What tirggers minimal change dz?
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Recent infeciton or immune rxn (allergic rxn ex: bees)
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What GN is associated with HIV infection, heroin abuse, and obesity?
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FSGS
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"Segmental sclerosis and hyalinosis" what GN?
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FSGS
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What are the 3 embryonic kidney stages?
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Pronephros, mesonephros, metanephros
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During the ascent of the horseshoe kidney, what blood vessel catches it?
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IMA
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What 3 cells is the JG apartaus composed of?
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Macula densa cells, JG cells, extraglomerular mesangial cells
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What kind of cells are JG cells and where are they located?
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Modified smooth muscle cells located in the walls of afferent arterioles.
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What do the JG cells respond to (3) and what do they do in response?
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Respond to: decreased renal blood pressure, decreased NaCl delivery to distal tubule (sensed by MD cells) and increased sympathetic tone
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Where are the macula densa cells located? What do they do?
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Located in distal tubule. Monitor osmolity (amount of NaCl) and amount of urine and transmit info to JG cells.
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What cells become hypertrophied when renal blood flow is decreased?
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JG cells! 2/2 RAAS stimulation from low blood volume.
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At what plasma glucose concentration does glucosuria begin? At what concentration are renal transporters full saturated?
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Beings at 160, fully saturated at 350.
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In what state do you get glucosuria at lower plasma concentrations than normal?
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Pregnancy!
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What's up with PAH clearance from the kidney? What can it be used to estimate?
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PAH is almost completely secreted (so anything not filtered is secreted into the tubules from the efferent blood anyway). Thus can be used to estimate RBF
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What's up with inulin clearance from the kideny? What can it thus be used to estimate?
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Not secreted or reabosrbed - thus can be used to measure GFR.
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What % of sodium is normally reabsorbed by the kidney?
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~99%
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Approximately what % of urea is normally reabsorbed by the kidney?
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~40-50%. Stable at a constant GFR.
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Can you sometimes see respiratory failure in DKA?
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Yes! Watch for it
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What neurotransmittor is released on the adrenal medulla?
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Ach! (a preganglionic neuron)
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What two parts of the kideny are most damaged in ischemic ATN?
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Proximal tubule and thick ascending loop (in outer medulla, which has low blood supply, and also both have transport that requires ATP)
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How do you calculate RPF frmo RBF?
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(1-hct)(RBF)
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Where in the nephron does aldosterone act?
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Collecting ducts
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What effect does aldosterone have on K+ and H+ in the collecting ducts? In what cell types?
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Aldosterone increases secretion of K from the principle cells and H from the intercalcated cells of the collecting tubules
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What is the primary stimulus for aldosterone secretion?
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Decreased blood volume
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What is the primary stimulus for ADH secretion? What factor takes precedence if 2 diff things are competing?
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Increased blood osmolarity (and secondarily blood volume). HOWEVER, low blood volume takes precendence over osmolarity if the 2 compete
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In a water deprivation state, what part of the nephron contains the most dilute urine?
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Distal convoluted tubule (impermeable to water, only solute are being reabsorbed, diluting urine)
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What is the osmolality of the urine in the proximal convoluted tubule?
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Isotonic = ~290
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What kind of drug is bumetanide?
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Loop diuretic! (bumex)
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How does manniotl work?
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Extracts fluid from interstitial space into lumen, then causes diuresis.
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What is a possible toxicity of mannitol?
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Pulmonary edema! Due to too much fluid being pulled intravascularly at once - worsened with prexisiting CHF.
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EM: "subepithelial immune complex humps"?
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PSGN
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"Diffuse capillary and GBM thickening" on LM, what GN?
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Membranous GN
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EM: "Spike and dome appearance with subepithelial deposits". What GN?
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Membranous GN
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EM: "Foot process effacement" What GN?
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Minimal change dz
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"Selective loss of albumin, not globumins, 2/2 GBM polyanion loss" What GN?
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Minimal change dz
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LM: "Congo red stains shows apple-green birefringence under polarized light" What GN?
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Amyloidosis
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LM: "Tram track appearance due to GBM splitting" what GN? (2)
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Membranoproliferative GN and Alports
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LM: "Intramembranous IC deposits" "dense deposits" what GN?
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Membranoproliferative GN
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What GN is associated with HBV and HCV?
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Membranoproliferative GN
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"Non enzymatic glycosylation of GBM and efferent arterioles" what GN?
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Diabetic GN
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IF: "granular appearance due to IgG, IgM and C3 deposition along GBM and mesangium"
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PSGN
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"linear immunofrluorescence" what GN?
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Goodpasteurs
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What type of GN is Goodpasteurs?
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Rapidly progressing GN (crescentic)
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EM: "GBM disruptions and fibrin deposition" What GN?
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RPGN (crescentic)
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LM: "wire looping of capilaries" what GN?
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Diffuse proliferative glomerulonephritis
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What 2 things cause diffuse proliferative GN?
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SLE and MPGN
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MoA lithium-induced DI? Reversible?
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Blocks action of ADH in collecting tubules. Reversible with discontinuation of the drug
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What 3 things cause crescentic GN?
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Goodpastures, Wegeners, microscopic polyangitis
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What renally active drug causes ototoxicity and deafness? When is it more likely to occur?
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Loop diuretics! More likely at higher doses, rapid IV administration or when used with other ototoxic agents.
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What is triamterene?
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A K sparing diuretic
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Sprinolactone, eplerenone, triamterene and amiloride are all K sparing diuretics. How are their MoAs different?
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Spironolactone and eplerenone are aldosterone receptor antagonists. Triamterene and amiloride blocking Na+ channels. All work in CCT.
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Why do you become hypercoagulable during nephrotic syndrome?
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2/2 loss of ATIII.
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Nephrotic syndrome with sudden onset of L sided flank pain, hematuria and left varicocele - suspect what?
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L renal vein thrombosis 2/2 hypercoagulabilty from nephrotic syndrome
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What rib overlies the left kidney?
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12th
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What ribs overlie the splee?
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9-11th
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"Cystic dilations of the medullary collecting ducts" What condition? What does it predispose to?
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Medullary sponge kidney. Common benign congenital disorder. Predisposes to kideny stones, NOT chronic renal failure.
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What 2 immunosuprpessants work by blocking T cell differentiation. Mechanism?
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Cyclosporin and tacrolimus. Calcineurin inhibitiors -> blocks production of IL-2, which is responsible for T cell differentiation
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What class of renally acting drug has a side effect profile including somnolence and paresthesias?
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Carbonic anhydrase inhibitors
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What kidney d/o is characterized by multiple cysts of different sizes and abscence of a normal pelvocalceal system? Are defects present at birth? Cause?
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Multicystic kidney dysplasia. Defects present at birth. 2/2 abnormal interaction between ureteric bud and metanephric mesenchyme
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Can ADPKD be picked up on newborn US?
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Nope! Cysts too small at birth to be seen on US.
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What are the 2 main extrarenal symptoms of ADPKD?
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Liver cysts and brain aneurysms
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Is RAAS up, down or normal in nephrotic syndrome?
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Upregulated. Movement of fluid into interstitium from lumen -> decresed apparent circulating volume seen by kidenys -> RAAS!
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In what 2 forms is excess H+ removed in the urine during DKA?
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Free H+ and titratable acids (H2PO4- and NH4+)
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How do you calculate RPF from PAH clearance?
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([Urine PAH] x urine flow rate)/[plasma PAH]
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How do carbonic anhydrase inhibitors affect HCO3 in the proximal tubule?
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Block reabsorption, so INCREASE amount EXCRETED in urine
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Where in the kidney is the primary site of osmotic diuretic action?
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Descending loop of henle (where only water is usually be reabsorbed). Also a little action in proximal tubule as well.
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What diuertic is indicated in the treatment of calcium kidney stones? What other med?
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HCTZ! Increases calcium reabsorption so decreases urinary calcium. Also citrate
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What effect does acute ureteral obstruction have on GFR, RPF and FF?
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RPF stays the same, GFR and FF decreases 2/2 increased hydrostatic pressure in bowman's space (interstitium) from backwards buildup.
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What is it called when your kidneys recover from ATN?
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Re-epithelialization
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Is glucose secreted or reabsorbed in the kidney?
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Reabsorbed!
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Is creatinine secreted, reabsorbed or neither in the kideny?
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Secreted! (Thus Cr clearance slightly overestimates GFR)
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Do you see RBC casts with bladder cancer or kidney stones?
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Nope! Just hematuria.
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Amphotericin B causes what 2 electrolyte abnormalities 2/2 renal toxcity?
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HypoMg and hypoK (can cause cardiac arrythmias)
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What is foscarnet used for? Electrolyte side effects?
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To treat CMV retinitis in HIV patients. Can cause hypocalcemia (chelates calcium) and hypomag 2/2 renal effects.
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Let's just be clear: loop and thiazides have what effect on potassium?
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DECREASE SERUM POTASSIUM.
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Effect of ACE inhibitors on potassium?
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Increase serum potassium 2/2 decreased aldosterone
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Are there such things as renin-secreting tumors?
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Yes.
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What effect do Loops have on PGs? What does this result in?
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Cause increased PGs, resulting in more afferent arteriolar dilation -> greater GFR and delivery of drug!
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What is nesiritide?
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A BNP analog
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What 2 things stay at approximately the same concentration throughout the proximal tubule?
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Na and K (as well as fluid osmolarity)
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What 3 substances significantly increase in concentration through the proximal tubule? Why?
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PAH, Creatinine, Inulin - not reabsorbed at all! (In fact, Cr and PAH are secreted!)
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What 2 things increase slightly in concentration in the proximal tubule, but not as much as PAH/Cr/Inulin?
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Urea and Cl
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What 2 substances decreases slightly in concentration in the PT, but not as much as glucose and AAs?
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Bicarb and inorganic phosphate!
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What 2 things decrease in concentration MASSIVELY in the proximal tubule?
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Glucose and AAs
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What is the most common type of RCC? What does it look like histologically? What cell type does ir originate from?
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Clear cell carcinoma. Rounded or plygonal cells with abundant clear cytoplasm. Proximal tubule cells.
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What are calcium and phosphate levels in ESRD? Why?
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Low Ca (lower activated vit D) and high phosphate (from kidney not excreting it as well). Secondary hyperpara does not make up for calcium - it stays low!
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What does the hypocalcemia of ESRD cause?
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Renal osteodystrophy
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Effect of uremia on thyroid hormones?
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Decreases peripheral conversion of T4 to T3 -> functional hypothyroidism
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What is the most important prognostic factor in poststrep GN?
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Age! Kids almost all recover completely, adults not as much.
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Do you use steroids to treat poststrep GN?
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Nope!
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Tx of minimal change dz?
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Steroids!
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What happens to RPF, GFR and FF in severe hypovolemia?
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RPF and GFR both fall, but 2/2 RAAS effernent arteriole constriction, RPF falls more -> FF actually increses.
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What is the eventual outcome of ADPKD?
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ESRD
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What parts of the nephron have the lowest pH?
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Distal tubules and collecting ducts
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Where in the nephron are uric acid crystals most likely to form?
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Distal tubules and collecting ducts because they are the most acidic, and uric acid crystals precipitate in acid!
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For what 2 kinds of kidney stones do you treat with alkalinization of the urine?
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Uric acid and cystine (precipitate in acidic environment)
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Which is oliguric and which is polyuric - maintenance or recoery phase of ATN?
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Maintenance (middle phase) = oliguric. Recovery = ployuric.
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What happens to fluid status and potassium levels during the maintenance vs recovery phases of ATN?
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Maintenance - 2/2 oliguria, hypervolemia and hyperkalemia. Recovery - 2/2 polyuria, become dehydrated and hypokalemic (also low Mg, Phos and Ca due to slowly recovering tubular function)
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What occupational exposures predispose you to bladder cancer? (5)
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Rubber, plastics, textiles, leather, aromatic amine-containing dyes
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What area of the nephron is impermeable to water?
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Ascending loop of henle
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Timing difference with IgA nephropathy and PSGN with regards to prior illness?
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IgA - a few days. PSGN - 2 weeks
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Most common GN associated with solid tumors?
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Membranous GN
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Circulating IgG4 Abs to the phospholipase A2 receptor (a protein on podocytes) is associated with what GN?
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Membranous nephropathy
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Antibodies to the alph-3- chain of collagen Type IV cause what condition?
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Goodpastures
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Do you see RBC casts with nephritic and nephrotic syndrome?
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Nope, just nephritic!
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Where in the nephron is urine most concentrated in the abscence vs presence of ADH?
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Presence: end of collecting ducts. Absence: junction of descending and ascending loop of henle
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Renal function in MCD?
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Normal!
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Why do thiazides cause hypercalcemia?
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In the DCT (where they act) there is a basolateral (serum side) Na/Ca exchagner. If decreased Na+ is absorbed into cell from urine, gradient is for more Na+ to move into cell from serum, and thus more Ca to be exchanged into serum.
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MoA acyclovir nephrotoxicity? How can you prevent?
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When concentration exceeds solubility, get acyclovir crystals that muck things up. Pretreat with AGRESSIVE IV HYDRATION
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What are the epithelial cells of the glomerulus?
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Podocytes!
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Which is more size selective, endothelial, epothelial or GBM of the glomerulus?
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GBM and epithelium - both VERY size selective.
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By what process is PAH secreted from the proximal tubule. What does this imply about excretion rate?
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Carrier protein mediated - secretion can be maxed out at a certain level (though filtration at the glomerulus will never be)
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Are excretion and secretion the same thing?
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No! Excretion is filtration + secretion.
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What is the main site of potassium excretion regulation in the nephron?
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CCT.
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Is potassium reabsorbed in the PCT and the loop of henle?
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Yes!
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Which parts of the collecting duct do aldosterone and ADH work at, respectively?
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Aldosterone = cortical. ADH = medullary
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What 3 factors is the diffusion of a molecule across a membrane directly proportional to? What 2 factors are inversely proportional?
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Directly: the concentration difference across the membrane, the surface area of the membrane, and the solubility of the molecule. Inverse: membrane thickness, molecular weight
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How do you calculate the filtration rate of a random substance from the plasma?
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GFR x plasma concentration
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GFR is approximately equal to clearance of what?
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Inulin!
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"spike and dome" appearance. What GN?
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Membranous GN.
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MoA OKT3?
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Is an antibody against CD-3, which is expressed on T lymphocytes. Useful in acute organ rejection.
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Main renal pathophysiologic abnormality in chronic NSAID use?
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Chronic interstitial nephritis and papillary necrosis
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Renal biopsy showing ballooning and vacuolar degeneration + oxalte crystals -> caused by what?
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Ethylene glycol poisening!
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In addition to water, what substance's reabsorption is increased by ADH? Where?
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Urea! In the medullary collecting duct.
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What kind of casts are seen in myeloma kidney?
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Eosinophillic casts composed of Bence-Jones protein.
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What section of the nephron absorbs the most fluid in normal vs dehydrated states?
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Regardless of fluid status, the proximal tubule absorbs the greatest part of fluid, passively with resorption of solutes
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As people age, their renal clearance decreases, yet Cr usually stays about the same. Why? What does this mean for drug dosing?
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Because muscle mass also decreases. It means that even though Cr is normally, drugs should still be renally dosed for a lower clearance
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How is dig excreted?
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Renally, essentially unchanged from how was ingested
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What fraction of total body water is extracellular? What fraction of that is plasma vs interstitial?
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1/3 of TBW is extracellular. 1/4 of that is plasma (3/4 = interstitial). Therefore, 1/12 of TBW is plasma.
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What is a normal filtration fraction?
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0.2
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PAH clearance is an estimate of what?
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RPF
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Effect of afferent arteriolar constriction on RPF, GFR and FF?
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Decreased RPF and GFR, so FF stays the same
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Transporters that resorb AAs are dependent on what?
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Na+!
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What 2 places in the nephron does PTH work? What does it do in each place?
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Proximal tubule -> inhibits Na/Phosphate cotransport, leading to phosphate excretion. DCT: Increased Na/Ca exchanger, leading to calcium absorption
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What is the action of ATII at the proximal tubule?
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Stimulates NA/H exchange, leading to increased NA, H2O and HCO3 absoprtion -> contraction alkalosis
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What cells in the kidney release EPO. In response to what?
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Interstitial cells. In response to hypoxia
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What cell do the vit D conversion?
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Proximal tubule cells
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What is Type 1 RTA? What type of stone does it predispose to? Associated with what K derrangement?
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"Distal". Impairment in excretion of H+ in collecting duct. Assoc with hypokalemia. Calcium phosphate stone (2/2 increased pH)
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What is the pathophys of Type 2 RTA? Potassium derrangement?
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Proxiaml tubule HCO3 reabsorption fail. Hypokalemia
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Where is ammonia secreted in the nephron? Why?
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In proximal tubule to buffer secreted acid.
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Pathophys of type 4 RTA?
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Decreased aldosterone or CCT lack of response to aldosterone. Results in hyperkalemia, which impairs ammoniagenesis in the proximal tubule, decreasing buffering capacity in in the PT and decreased urinary pH
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When do you see "oval fat bodies"?
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All causes of nephrotic syndrome (fatty casts)
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When do you see waxy casts?
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Advanced renal disease/chronic renal failure
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What kind of kidney stone CANT you see on xray?
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Uric acid
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What kind of calcium stone predominates in basic vs acidic pHs?
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Basic - phosphate. Acidic = oxalate
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What kind of kidney stone forms hexagonal crystals?
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Cystine stones
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What 3 paraneoplastic hormones are secreted with RCC?
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EPO, ACTH, PTHrP
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Can you normally treat RCC with conventional chemo and radiation?
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Nope, resistant. Treat with resection.
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What is ethacrynic acid?
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Loop diuretic - use in patiens with sulfa allergy who cant take lasix
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What two diuretics cause acidemia?
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CA inhibitors and K sparing diuretics (2/2 hyperkalemia and aldosterone blockade leading to decreased H+ secretion)
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EM: "subepithelial immune complex humps"?
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PSGN
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Diffuse capillary and GBM thickening on LM, what GN?
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Membranous GN
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EM: "Spike and dome appearance with subepithelial deposits". What GN?
|
Membranous GN
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EM: "Foot process effacement" What GN?
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Minimal change dz
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Selective loss of albumin, not globumins, 2/2 GBM polyanion loss What GN?
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Minimal change dz
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LM: "Congo red stains shows apple-green birefringence under polarized light" What GN?
|
Amyloidosis
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LM: "Tram track appearance due to GBM splitting" what GN? (2)
|
Membranoproliferative GN and Alports
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LM: "Intramembranous IC deposits" "dense deposits" what GN?
|
Membranoproliferative GN
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What GN is associated with HBV and HCV?
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Membranoproliferative GN
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Non enzymatic glycosylation of GBM and efferent arterioles what GN?
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Diabetic GN
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IF: "granular appearance due to IgG, IgM and C3 deposition along GBM and mesangium"
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PSGN
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linear immunofrluorescence what GN?
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Goodpasteurs
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What type of GN is Goodpasteurs?
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Rapidly progressing GN (crescentic)
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EM: "GBM disruptions and fibrin deposition" What GN?
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RPGN - Goodpasteurs
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LM: "wire looping of capilaries" what GN?
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Diffuse proliferative glomerulonephritis
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What 2 things cause diffuse proliferative GN?
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SLE and MPGN
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eosinophillic glomerulosclerosis (Kimmelstiel Wilson lesions) what kidney problem?
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Diabetic nephropathy!
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Diffuse glomerular hypercellularity 2/2 increased mesangial cell proliferation and leaukocyte infiltration "lumpy bumpy" what GN?
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PSGN
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What tirggers minimal change dz?
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Recent infeciton or immune rxn (allergic rxn ex: bees)
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What GN is associated with HIV infection, heroin abuse, and obesity?
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FSGS
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Segmental sclerosis and hyalinosis what GN?
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FSGS
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What GN is related to HSP?
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Berger's dz (IgA nephropathy)
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Mutation in type IV collagen messing up GBM. What GN?
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Alports
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