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170 Cards in this Set
- Front
- Back
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a 3-year old boy presents with facial edema, malaise, and proteinuria. What does he have, how do you treat?
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Steroids, he has Minimal Change Disease
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Woman presents with UTI positive for Proteus Vulgaris; what kind of kidney stone is she at risk for?
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Struvite stone (ammonium magnesium phosphate)
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Patient describes a 2-year history of acetaminophen use. What are they at risk for?
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Renal papillary necrosis
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Xray shows massively enlarged bilateral kidneys. What is the diagnosis?
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Adult polycystic kidney disease
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A person taking enalapril complains of constant coughing. What is a good replacement drug?
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Losartan - it is not an ACE inhibitor, it is an ARB
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A person with CHF needs diuretic therapy, but is allergic to sulfa drugs. What is a good choice?
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Ethacrynic acid
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A person has horseshoe kidney disease. What artery keeps it low in the abdomen?
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Inferior mesenteric artery
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A person presents with hypertension, hypokalemia, metabolic acidosis, and low renin. What do they have, how do you treat?
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They have Conn's syndrome. Too much aldosterone. Treat with spironolactone.
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How much of the body is water by weight?
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60%
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how much of the body is made of intracellular water?
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40%
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How much of the body is made of extracellular water?
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20%
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What fraction of extracellular fluid is plasma, and what fraction is interstitial?
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1/4 plasma
3/4 interstitial |
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What is the formula for renal clearance?
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UV/P
U=urine concentration of x V=urine flow rate P=plasma concentration of x |
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What does "clearance" mean, in normal english words?
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Clearance is the volume of plasma from which a substance is 100% cleared per unit time (volume/time)
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If the clearance of x is less than the GFR, then what can you say about reabsorption/secretion?
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If clearance of x is LESS than GFR, then there is net reabsorption of x in the tubules
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If the clearance of x is more than the GFR, then what can you say about reabsorption/secretion?
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If clearance of x is MORE than GFR, then there is net secretion of x in the tubules
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If clearance of a substance is equal to GFR, then what can be said for reabsorption/secretion of x?
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If clearance of x equals the GFR, then there is no net secretion or reabsorption of x
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How do you measure GFR?
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GFR=clearance of inulin, which is freely filtered and neither reabsorbed nor secreted. You can also use creatinine
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What are the 3 components of the filtration barrier?
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1) fenestrated capillary wall (size barrier)
2) basement membrane (charge barrier) 3) epithelial podocytes |
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What disease process occurs when the filtration barrier is lost?
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nephrotic syndrome
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What are the general symptoms of nephrotic syndrome?
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albuminuria, hypoproteinemia, generalized edema, hyperlipidemia
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Effective Renal Plasma Flow (ERPF) is calculated how?
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It is the clearance of PAH: UV/P.
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How do you calculate Renal Blood Flow (RBF)?
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(Renal plasma flow)/(1 - hematocrit)
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What is the formula for the Filtration Fraction?
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glomerular filtration rate divided by the renal plasma flow
(GFR/RPF) |
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What is the formula for the Filtered Load?
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GFR x plasma concentration (for whatever it is you are measuring)
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What do prostaglandins do to the glomerulus?
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dilate the afferent artery. increase GFR, increase RPF, filtered fraction stays the same
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What do NSAIDS do to the glomerulus?
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inhibit prostaglandin synthesis, so the afferent arteriole constricts
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What does angiotensin II do to the glomerulus?
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constricts the efferent arteriole, so GFR goes up, RPF goes down, and the filtration fraction goes up
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What do ACE inhibitors do to the glomerulus?
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inhibit angiotensin II, so the efferect arteriole dilates
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What is the formula for free water clearance?
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V - (UV/P), where:
V=urine flow rate U=urine osmoles P=plasma osmoles |
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How does ADH affect free water clearance?
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ADH present: clearance < 0
ADH absent: clearance > 0 if clearance =0, you have isotonic urine |
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How does the kidney handle glucose?
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at normal levels, glucose is completely reabsorbed in the proximal tubule
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How does the kidney handle amino acids?
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active transport reabsorbs protein in the proximal tubule
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What does the proximal tubule secrete?
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Ammonia
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What does the proximal tubule absorb?
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all glucose, all protein, most of the sodium, bicarb, and water
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What does the thin, descending loop of henle absorb?
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Water. impermeable to sodium. Concentrates the urine.
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What does the thick ascending loop of Henle absorb?
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Na+, K+, Cl-, Mg++, Ca++. impermeable to water. dilutes the urine.
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What does the distal tubule absorb?
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Na+, Cl-, and sometimes Ca++ (when PTH is present)
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Where does PTH act, and what does it do?
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PTH acts in the distal tubule to increase absorption of Ca++
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What does the collecting tubule absorb?
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K+ or H+ (when aldosterone is present)
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What does the distal tubule secrete?
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Nothing
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Where does aldosterone act and what does it do?
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Aldo acts in the collecting duct to increase the absorption of Na+ in exchange for secreting K+ and H+
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What does the collecting duct absorb?
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Na+ (when aldosterone is present)
water (when vasopressin is present) |
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Where does vasopressin act and what does it do?
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Vasopressin acts in the collecting duct to increase the absorption of water
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where does renin come from, and what stimulates it?
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endothelial cells in the juxtaglomerular apparatus sense low BP (in the kidney) and then secrete renin
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Where does angiotensinogen come from?
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The liver
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Where does angiotenin I come from?
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Renin cleaving angiotensinogen
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Where does angiotensin II come from?
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ACE in the lungs converts angiotensin I to angiotensin II
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Where does aldosterone come from, and what stimulates it?
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Angiotensin II stimulates the adrenal cortex to secrete aldosterone
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What are the 4 actions of angiotensin II?
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1) vasoconstriction
2) aldosterone release 3) ADH (vasopressin) release 4) stimulates hypothalamus to increase thirst |
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Where is ANP released, and what hormone does it inhibit?
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ANP is released from the atria of the heart in response to high blood pressure, and it inhibits the release of renin
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What two structures make up the juxtaglomerular apparatus?
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the JG cells in the afferent arteriole and the macular densa (part of distal tubule)
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What does the macula densa do, and why?
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senses Na+ in the distal tubule. If low, it stimulates the JG cells to secrete renin
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What 3 things can cause the JG cells to secrete renin?
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low renal blood pressure, low sodium in the macula densa, and increased sympathetic tone
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Where does erythropoetin come from, and what leads to its secretion?
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Epo is made in the endothelial cells of the peritubular capillaries in response to hypoxia
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What does the kidney do to vitamin D?
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converts 25-OH D to 1,25-OH D, the active form, when stimulated by PTH
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How do NSAIDS cause renal failure?
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cause vasoconstriction of the afferent arterioles, leading to decreased GFR
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Which 5 hormones act on the kidney?
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1) ANP
2) PTH 3) aldosterone 4) angtiotensin II 5) vasopressin |
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What does ANP do to the kidney?
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causes increased GFR and increased sodium excretion
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What does PTH do to the kidney?
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Causes increased Ca++ absorption in the distal tubule and increased production of 1,25-OH vit D.
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What does aldosterone do to the kidney?
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causes increased Na+ absorption in the collecting duct, and increased K+ and Na+ secretion
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What does angiotensin II do to the kidney?
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increased GFR and increased Na+ absorption by constricting the efferent arteriole
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What does vasopressin do to the kidney?
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increased water absorption in the collecting duct by increasing aquaporins in the cell membranes
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What direction do pH, pCO2, and [HCO3] go in a metabolic acidosis?
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pH - down
PCO2 - down [HCO#] - down |
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What direction do pH, pCO2, and [HCO3] go in a metabolic alkalosis?
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pH - up
pCO2 - up [HCO3] - up |
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What direction do pH, pCO2, and [HCO3] go in a respiratory acidosis?
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pH - down
pCO2 - up [HCO3] - up |
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What direction do pH, pCO2, and [HCO3] go in a respiratory alkalosis?
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pH - up
pCO2 - down [HCO3] - down |
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How does your body compensate for a metabolic acidosis?
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hyperventilate to blow off excess CO2
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How does your body compensate for a metabolic alkalosis?
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hypoventilate to increase blood CO2
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How does your body compensate for a respiratory acidosis?
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Kidneys reabsorb more bicarb to neutralize the acid
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How does your body compensate for a respiratory alkalosis?
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Kidneys secrete more bicarb to make the blood more acidic
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What is the normal pH of plasma?
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7.4
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What is the formula for the anion gap?
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Na+ - (Cl- + HCO3)
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What are the 8 causes of an increase anion gap?
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MUDPILES: methanol, uremia, diabeticketoacidosis, phenformin, ironoverload, lacticacidosis, ethyleneglycol, salicylates
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A person has metabolic acidosis with a normal anion gap. What are the 4 causes?
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diarrhea, glue sniffing, renal tubular acidosis, hyperchloremia
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What are common causes of respiratory acidosis?
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hypoventilation due to: obstruction, lung disease, opiods/narcotics, weak diaphragm
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What are common causes of respiratory alkalosis?
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hyperventilation due to: stress, high altitude, aspirin ingestion
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What are common causes of metabolic alkalosis?
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diuretic use, vomiting, antacid use, hyperaldosteronism
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What happens in renal tubule acidosis type 1?
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defect in H+ pump, you fail to acidify your urine
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What happens in renal tubule acidosis type 2?
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Your kidneys secrete too much bicarb
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What happens in renal tubule acidosis type 4?
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hyperaldosteronism -> hypokalemia -> inhibits ammonia secretion
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What's the formula for diagnosing a metabolic acidosis?
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if pCO2=1.5x(HCO3)+8, plus or minus 2, then it's a metabolic acidosis
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What's the formula for diagnosing a metabolic alkalosis?
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if the pCO2 goes up 0.7 for every 1 HCO3 (above normal), then it's a metabolic alkalosis
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What's the formula for diagnosing acute respiratory acidosis?
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if the bicarb goes up 1 for every 10 pCO2 up, it's acute respiratory acidosis
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What's the formula for diagnosing chronic respiratory acidosis?
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if the bicarb goes up 3.5 for every 10 pCO2 up, it's chronic respiratory acidosis
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What's the formula for diagnosing acute respiratory alkalosis?
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if the bicarb goes down 2 for every 10pCO2 down, it's acute respiratory alkalosis
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What's the formula for diagnosing chronic respiratory alkalosis?
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if the bicarb goes down 5 for every 10 pCO2 down, then it's chronic respiratory alkalosis
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What do you call the disorder where the kidneys don't form at all in the fetus?
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Potter's syndrome
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What are some symptoms of Potter's syndrome?
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oligohydramnios leading to facial deformities, limb deformities, pulmonary hypoplasia
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What are the symptoms of horseshoe kidney?
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None. The kidneys function normally.
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What do RBC casts in the urine suggest?
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glomerular inflammation (nephritic syndrome), ischemia, malignant hypertension
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What do WBC casts in the urine suggest?
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tubulointerstitial disease, acute pyelonephritis, glomerular disorders
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What do muddy brown, granular casts in the urine suggest?
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acute tubular necrosis
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What do hyaline casts in the urine represent?
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Anything. It's non-specific
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What sort of urinary casts will you see in a person with bladder cancer?
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None, but you will see free RBCs. Casts only appear when the kidneys are involved
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What sort of urinary casts will you see in a person with acute cystitis?
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None, but you will see free WBCs. Casts only appear when the kidneys are involved.
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What are common symptoms of Nephritic Syndrome?
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hematuria, hypertension, oliguria, azotemia
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What are common symptoms of Nephrotic syndrome?
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proteinuria, hypoalbuminemia, peripheral edema, hyperlipidemia
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What are the 6 most common causes of Nephritic syndrome?
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Acute poststreptococcal glomerulonephritis, membranoproliferative glomerulonephritis, cresentic glomerulonephritis, Goodpasture's syndrome, IgA nephropathy, Alport's syndrome
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What are the 6 most common causes of Nephrotic syndrome?
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membranous glomerulonephritis, minimal change disease, focal segmental glomerular sclerosis, diabetic nephropathy, lupus, amyloidosis
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What is Acute Poststreptococcal Glomerulonephritis?
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Nephritic - enlarged hypercellular glomeruli, lots of neutrophils. Affects children
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What is Membranoproliferative Glomerulonephritis?
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Nephritic: "tram track" and subendothelial humps on microscopy. Slowly progresses to renal failure
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What is Cresentic Glomerulonephritis?
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Nephritic: crescent-shaped scar tissue obliterates glomerulus
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What is Goodpasture's syndrome?
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Nephritic: linear, smooth layer of antibodies attack the basement membrane. Also affects lungs
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What is IgA Nephropathy?
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Nephritic: also called Berger's Disease. IgA attacks mesangial cells. not serious.
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What is Alport's syndrome?
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Nephritic. Collagen IV mutation. Split basement membrane. Also affects eyes and ears.
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What is Membranous Glomerulonephritis?
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Nephrotic. thickening of capillaries and basement membrane. More common in adults
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What is Minimal Change Disease?
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Nephrotic. normal glomeruli, damaged foot processes on podocytes. Common in kids.
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What is Focal Segmental glomerular sclerosis?
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Nephrotic. Scarring and hyalinosis in glomerulus. More severe in HIV patients
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What is Diabetic Nephropathy?
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Nephrotic. Basement membrance thickening. Oval acellular nodules
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How does Lupus affect the Kidney?
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Nephrotic. scarring and thickening of capillaries and basement membrane
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How does Amyloidosis affect the kidney?
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Nephrotic. Congo-red stain, apple-green birefringence. Associated with RA, TB, multiple myeloma
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What are the 4 types of kidney stones?
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1) calcium
2) struvite (ammonia-Mg-phosphate 3) Uric acid 4) cystine |
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What predisposes to calcium kidney stones?
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hypercalcemia due to cancer, PTH, too much vitamin D, or milk-alkali syndrome. These tend to recur
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What predisposes to struvite kidney stones?
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infection with urease-positive bugs. Can form staghorn stones
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What predisposes to uric acid kidney stones?
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Gout, hyperuricemia. Can't see these on Xray or CT
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What predisposes to cystine kidney stones?
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Cystinuria. These are hexagon-shaped
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What is the most common kidney malignancy in adults?
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Renal cell carcinoma
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What gene is associated with renal cell carcinoma?
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von-Hippel Lindau, and deletions on chromosome 3
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What are the symptoms of renal cell carcinoma?
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hematuria, flank pain, fever, weight loss, polycythemia, palpable mass
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What is the most common kidney malignancy in children?
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Wilm's tumor
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What is the genetic basis for a Wilm's tumor?
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deletion of tumor-suppressor gene WT1 on chromosome 11
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What other 3 things commonly accompany a Wilm's tumor?
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aniridia, genitourinary malformations, and mental/motor retardation
(WAGR) |
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How does a Wilm's Tumor present?
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Huge, palpable mass on only one side. Contains embryonic kidney structures.
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What kind of cancer can present anywhere along the urinary tract?
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Transitional cell carcinoma
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What 4 things are associated with transitional cell carcinoma?
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Phenacetin, Smoking, Aniline dyes, and Cyclophosphamide
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A person has fever, costovertebral tenderness, white cell casts in urine, normal glomeruli and vessels but inflammed cortex. What do they have?
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acute pyelonephritis
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What happens as acute pyelonephritis turns into chronic pyelonephritis?
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coarse, assymetric scarring of the cortex and medulla, blunted calyx, eosinophils in the WBC casts
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What can cause diffuse cortical necrosis?
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infarction of both kidneys due to vasospasm, DIC, septic shock, and pregnancy issues
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What drugs can cause Drug-Induced Interstitial Nephritis, and ow do they do it?
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penicillins, NSAIDS, diuretics can all act as haptens that induce hypersensitivity
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What are the symptoms of Drug-Induced Interstitial Nephritis?
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fever, rash, eosinophilia, hematuria 2 weeks after you take the drug
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What are 3 common causes of Acute Tubular Necrosis?
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trauma, shock, toxins
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What is the most common cause of acute renal failure?
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Acute tubular necrosis
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What happens during Acute Tubular Necrosis?
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cells lose polarity, epithelial cells detach, muddy-brown casts, necrosis
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What 4 things can cause Renal Papillary Necrosis?
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1) Diabetes Mellitus
2) Acute pyelonephritis 3) acetominophen use 4) sickel cell anemia |
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Acute renal failure can be categorized according to where the problem is. These categories are:
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Pre-renal
Intra-renal Post-renal |
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What is the cause of post-renal acute renal failure?
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bilateral outflow obstruction, due to stones, tumors, or benign prostatic hypertrophy
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What are causes of pre-renal acute renal failure?
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decreased renal blood flow (hypotension) leading to decreased GFR. sodium and urea retained by the kidney.
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What are some causes of intra-renal acute renal failure?
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Usually due to acute tubular necrosis or ischemia/toxins, or the nephritic/nephrotic syndromes
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Which two parameters mark uremia?
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Increased BUN and increased serum creatinine
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In normal english, how would you describe uremia?
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failure of the kidneys to make urine or excrete nitrogenous waste
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Name 9 consequences of uremia
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anemia, low Vit D, hyperkalemia, metabolic acidosis, encephalopathy, CHF, edema, pyelonephritis, hypertension
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Why does uremia cause anemia?
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damaged kidney can't make erythropoeitin, so you have less RBCs being made
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Why does uremia cause CHF and edema?
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You can't make urine, you get hypervolemic, so the vessels leak and the heart can't handle all the extra volume
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What is Fanconi's syndrome?
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failure of the proximal tubule to absorb glucose, amino acids, ions, and uric acid.
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What are some complications of Fanconi's syndrome?
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rickets, osteomalacia, hypokalemia, metabolic acidosis
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Which gene is associated with adult polycystic kidney disease?
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APKD1, and the mutation is autosomal dominant
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How does adult polycystic kidney disease present?
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flank pain, hematuria, hypertension, UTI's, progressive renal failure
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What are the symptoms of low Na+ in the plasma?
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disorientation, coma, stupor
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What are the symptoms of high Na+ in the plasma?
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irritability, delirium, coma
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What are the symptoms of low K+ in the plasma?
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U waves and flat T waves on EKG, arrythmias, paralysis
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What are the symptoms of high K+ in the plasma?
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peaked T waves and wide QRS on EKG, arrythmias
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What are the symptoms of low Ca++ in the plasma?
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tetany, neuromuscular irritability
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What are the symptoms of high Ca++ in the plasma?
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Delirium, kidney stones, abdominal pain
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How does Mannitol work as a diuretic?
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In the proximal tubule, it osmotically draws water into the lumen
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What are some toxicities of Mannitol as a diuretic?
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It can cause pulmonary edema, dehydration. Contraindicated in CHF
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How does Acetazolamide work?
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inhibits carbonic anhydrase, so you excrete all your bicarb in the proximal tubule It's a diuretic
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What are some toxicities of acetazolamide?
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acidosis, neuropathy, ammonia toxicity, Sulfa allergy
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What are some toxicities of furosemide?
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ototoxic, hypokalemia, dehydration, nephritis, gout, Sulfa allergy
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What does furosemide do?
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Loop diuretic that inhibits ion transport in the ascending loop of Henle. Destroys concentration gradient in the medulla
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How does ethcrynic acid work?
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Same as furosemide, but no Sulfa allergy or gout sensitivity
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How do the thiazides work?
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Inhibits NaCl absorption in the distal tubule. Water follows salt, so you excrete more water.
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What are some thiazide toxicities?
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hypokalemia, hyponatremia, hyper- -glycemia, -lipidemia, -uricemia, -calcemia. Sulfa allergy.
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What are the 4 potassium-sparing diuretics?
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spironolactone, triamterene, amiloride, eplerenone
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How do spironolactone and eplerenone work?
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diuretics that block aldosterone receptors in the collecting tubule. Cause sodium excretion
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How do triamterene and amiloride work?
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diuretics that physically block sodium channels in the collecting tubule. cause sodium excretion
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Which diuretics cause increased urine calcium?
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furosemide, ethacrynic acid
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Which diuretics cause decreased urine calcium?
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thiazides
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which diuretics cause increased urine potassium?
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all of them except the K+-sparing ones: spironolactone, triamterene, amiloride, eplerenone
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Which diuretics can cause sulfa allergies?
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furosemide, thiazides, acetazolamide
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