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194 Cards in this Set
- Front
- Back
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"water under the bridge"
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ureters pass under both uterine artery and ductus deferens
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calculation of total body water?
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60% of total body weight
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calculation of plasma volume?
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1/4 of extracellular fluid, which is 1/3 of total body water
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what fraction of total body water is intracellular?
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2/3 intracellular, 1/3 extracellular
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normal GFR?
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100 mL/min
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function of prostaglandins in kidney?
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paracrine signal; dilate afferent arteriole to increase both GFR and RPF
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at what plasma glucose level do you see glucosuria?
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above 160-200 mg/dL
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Hartnup's disease?
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deficiency of neutral amino acid transporter in kidney; results in pellagra
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what is reabsorbed in early proximal tubule?
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completely resorbes glucose and amino acids
most of bicarb, sodium, chloride, water |
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what is reabsorbed in thick ascending loop of Henle?
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active: sodium, potassium, chloride
indirect/paracellular: magnesium, calcium |
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what is reabsorbed in thin descending loop of Henle?
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passively reabsorbs water
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what is reabsorbed in early distal convoluted tuule?
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sodium and chloride (active reabsorption)
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what is reabsorbed in collecting tubule?
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sodium (in exchange for potassium and H+)
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what is secreted in early proximal tubule?
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ammonia, H+
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what is secreted in thick ascending loop of Henle?
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potassium
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what is secreted in thin descending loop of Henle?
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nothing
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what is secreted in early distal convoluted tubule?
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nothing
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what is secreted in collecting tubule?
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potassium and H+
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what part of nephron is impermeable to water?
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thick ascending loop of Henle
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what part of nephron is impermeable to sodium?
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thin descending loop of Henle
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what stimulates renin release?
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decreased BP (measured by JG cells)
decreased sodium (measured by macula densa) increased sympathetic tone |
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where is angiotensinogen produced?
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liver
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function of renin?
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convert angiotensinogen to angiotensin I
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what converts angiotensin I to angiotensin II?
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ACE (secreted by lungs)
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why do ACE inhibitors cause cough?
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ACE inhibits bradykinin secretion; ACE-I's permit bradykinin production, which is potent vasoconstrictor
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four direct actions of angiotensin II?
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1. ATII receptors on vascular smooth muscle --> vasoconstriction
2. constricts efferent arteriole of glomerulus --> increases FF 3. increases sodium/H+ exchange in proximal tubule (permits contraction alkalosis) 4. stimulates hypothalamus (thirst) |
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two hormones that renin stimulates?
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aldosterone (from adrenal gland)
ADH (from posterior pituitary) |
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actions of aldosterone in kidney?
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1. increases reabsorption of sodium in distal convoluted tubule by inserting sodium channels and sodium/potassium pump
2. enhances potassium and H+ excretion in distal convoluted tubule by upregulating principal cell K+ channels and intercalated cell H+ channels |
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actions of ADH in kidney?
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increases water channel insertion in principal cells, leading to increased water reabsorption
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ANP?
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atrial natriuretic peptide; secreted by atria in response to increased plasma volume; relaxes vascular smooth muscle via cGMP causing decreased production of renin (increased GFR)
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location of JG and MD cells?
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JG cells: afferent arteriole
macula densa: distal convoluted tubule |
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four hormones secreted by kidney?
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1. EPO
2. 1,25-(OH)2 vitamin D 3. renin 4. prostaglandins |
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how do NSAIDs cause acute renal failure?
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inhibit renal production of prostaglandins
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action of ANP on the kidney?
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causes increased glomerular sodium filtration with no compensatory sodium reabsorption in distal nephron (net loss of sodium and volume)
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symptoms of hyponatremia?
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disorientation, stupor, coma
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symptoms of hypocalcemia?
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tetany, neuromuscular irritability
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symptoms of hypokalemia?
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U waves and flattened T waves on EKG; arrhythmias, paralysis
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symptoms of hypomagnesemia?
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arrhythmias, neuromuscular symptoms
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symptoms of hypophosphatemia?
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bone loss, osteomalacia
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symptoms of hypernatremia?
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irritability, delirium, coma
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symptoms of hypercalcemia?
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delirium, renal stones, abdominal pain
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symptoms of hyperkalemia?
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peaked T waves, wide QRS, arrhythmias
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symptoms of hypermagnesemia?
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delirium, decreased DTRs, cardiopulmonary arrest
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symptoms of hyperphosphatemia?
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renal stones, metastatic calcifications
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Winter's formula use?
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respiratory compensation in response to metabolic acidosis
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Winter's formula?
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PCO2 = 1.5(HCO3-) + 8 +/- 2
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Winter's formula estimation?
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PCO2 goes up 0.7 for every 1 mEq/L increase in HCO3-
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MUDPILES?
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(causes of anion gap metabolic acidosis)
Methanol Uremia Diabetic ketoacidosis Paraldehyde or Phenformin Iron tablets or INH Lactic acidosis Ethylene glycol Salicylates |
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acid/base results of aspirin toxicity?
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respiratory alkalosis AND metabolic acidosis (increased gap)
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type 1 RTA?
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distal; defect in collecting tubule's ability to excrete H+
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type 2 RTA?
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proximal; defect in proximal tubule reabsorption of HCO3-
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type 4 RTA?
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hyperkalemic; due to defect in collecting tubule response to aldosterone
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result of type 1 RTA?
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hypokalemia, risk for calcium-containing kidney stones
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result of type 2 RTA?
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hypokalemia, risk for hypophosphatemic rickets
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result of type 4 RTA?
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hyperkalemia, inhibition of ammonium excretion; decreased urine pH (decreased buffering capacity)
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type of RTA associated with decreased urine pH?
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type 4 (due to lack of response to aldosterone)
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type of RTA associated with hypokalemia?
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type 1
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causes of RBC casts?
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glomerulonephritis, ischemia, malignant hypertension
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causes of WBC casts?
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tubulointerstitial inflammation, acute pyelonephritis, transplant rejection
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causes of granular casts?
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("muddy brown")
acute tubular necrosis |
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causes of waxy casts?
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advanced renal disease
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urine protein in nephritic vs. nephrotic syndromes?
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nephrotic > 3.5 g/day
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post-strep kidney failure?
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acute poststreptococcal glomerulonephritis; resolves spontaneously
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microscopy findings in acute poststrep. glomerulonephritis?
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LM: neutrophils, lumpy-bumpy appearance to glomeruli
EM: immune complex humps IF: granular |
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caues of rapidly progressive/crescentic glomerulonephritis?
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50% idiopathic; others caused by goodpastures, wegener's, microscopic polyangiitis
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crescent-moon shape on glomerular microscopy?
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rapidly progressive glomerulonephritis, caused by goodpastures, wegener's, microscopic polyangiitis
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linear immunofluorescence on glomerular microscopy?
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goodpasture syndrome (antibodies to glomerular basement membrane)
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crescentic glomerulonephritis with c-ANCA?
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wegener's granulomatosis
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crescentic glomerulonephritis with p-ANCA?
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microscopic polyangiitis
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wire looping of capillaries?
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diffuse proliferative glomerulonephritis caused by SLE or MPGN
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mesangial immune complex deposits?
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IgA glomerulopathy ("Berger's disease")
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cause of split basement membrane on microscopy?
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Alport's syndrome (mutation in type IV collagen)
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"spike and dome" appearance on electron microscopy?
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membranous glomerulonephritis (a nephROTic syndrome!)
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causes of membranous glomerulonephritis?
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drugs, infections, SLE, solid tumors; most common cause of adult NEPHROTIC syndrome
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histology of SLE nephrotic syndrome?
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membranous glomerulonephritis (spike and dome on EM)
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microscopy findings of minimal change disease?
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foot process effacement on EM
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treatment for minimal change disease?
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corticosteriods
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what causes apple-green birefrinence on microscopy (glomeruli)?
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amyloidosis; associated with chronic conditions like multiple myeloma, TB, RA
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microscopy findings in diabetic glomerulonephropathy?
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thickening of glomerular basement membrane; mesangial expansion; nodular glomerulosclerosis
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segmental sclerosis and hyalinosis on light microscopy?
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focal segmental glomerulosclerosis; causes include HIV, genetics, toxins/drugs, diabetes, chronic pyelo
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GBM splitting caused by mesangial ingrowth giving "tram-track" appearance on EM?
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type I membranoproliferative glomerulonephritis (nephrotic syndrome); associated with HBV, HCV
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causes of type I MPGN?
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HBV, HCV
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radiolucent kidney stones?
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uric acid
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kidney stones caused by ethylene glycol ingestion?
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calcium oxalate
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kidney stones that form staghorn calculi that can be a nidus for UTI?
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ammonium magnesium phosphate (struvite stones)
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UTI specifically associated with phosphate kidney stones?
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klebsiella
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hexagonal kidney stones? Treatment?
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cystine; treat with alkalinization of urine
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cell of origin of renal cell carcinoma?
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renal tubular cells
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environmental factors that increase risk of renal cell carcinoma?
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smoking and obesity; most common in men 50-70 years old
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flank pain, fever, polycythemia?
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renal cell carcinoma (ectopic EPO production)
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renal cell carcinoma mets go where?
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lung and bone
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genetic syndrome associated with renal cell carcinoma?
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von Hippel Lindau; gene deletion in chromosome 3
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nephroblastoma?
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Wilms' tumor; contains embryonic glomerular structures; huge palpable flank mass
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molecular cause of nephroblastoma?
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deletion of tumor suppressor gene WT1 on chromosome 11; WAGR complex (Wilms' tumor, Aniridia, Genitourinary malformation, mental/motor Retardation)
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painless hematuria?
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suggests bladder cancer; transitional cell carcinoma most common
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most common neoplasm of urinary tract system?
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transitional cell carcinoma (can occur in renal calyces, renal pelvis, ureters, bladder)
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exposures related to transitional cell carcinoma?
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Phenacetin
Smoking Anilin dyes Cyclophosphamide |
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eosinophilic casts in renal tubules?
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chronic pyelonephritis
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white cell casts in urine?
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classic for pyelonephritis
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fever, rash, hematuria, and eosinophils in urine?
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drug-induced interstitial nephritis
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muddy brown casts?
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ATN
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timeline of recovery from ATN?
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2-3 weeks if treated; fatal if untreated
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gross hematuria and proteinuria with recent infection or immune stimulus?
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renal papillary necrosis (sloughing of renal papillae)
1. diabetes mellitus 2. acute pyelo 3. chronic acetaminophen use 4. sickle cell anemia |
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BUN/Cr >20?
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prerenal azotemia
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urine osmolality in prerenal azotemia?
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>500
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renal osteodystrophy?
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failure of vitamin D hydroxylation in kidney 2/2 renal failure; causes calcium wasting and phosphate retention -> secondary hyperparathyroidism
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gene mutation associated with ADPKD?
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APKD1 or APKD2; autosomal DOMINANT
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other conditions associated with ADPKD?
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polycystic liver disease, berry aneurysma, mitral valve prolapse
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six classes of diuretics and sites of action?
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1. Acetazolamide (proximal convoluted tubule)
2. osmotic agents (PCT, descending limb, collecting duct) 3. loop agents (thick ascending limb) 4. thiazides (distal convoluted tubule) 5. potassium sparing (distal convoluted tubule) 6. ADH antagonists (collecting duct) |
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MOA of acetazolamide?
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carbonic anhydrase inhibitor; causes sodium bicarb diureses and urinary alkalinization
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MOA of furosemide?
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loop diuretic; inhibits cotrasnport system (Na+, K+, 2Cl-) of thick ascending limb; increases calcium excretion
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MOA of ethacrynic acid?
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loop diuretic (like furosemide) but NOT a sulfonamide
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MOA of hydrochlorothiazide?
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thiazide diuretic; inhibits NaCl reabsorption in early distal tubule and decreases calcium excretion
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HCTZ toxicities?
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hypokalemic metabolic alkalosis
hyponatremia hyperGlycemia hyperLipidemia hyperUriciemia hyperCalcemia |
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four K+ sparing diuretics?
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spironolactone
triamterene amiloride eplerenone |
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MOA of spironolactone?
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potassium sparing diuretic; competitive aldosterone receptor antagonist in cortical collecting tubule
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three ACE inhibitors?
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captopril, enalapril, lisinopril
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MOA of losartan?
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angiotensin II receptor antagonist
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effect of ACE inhibitors on renin concentration?
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increases due to loss of feedback inhibition
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formula to calculate clearance of a substance?
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Cx = (urine conc.) * (urine flow rate) / (plasma conc.)
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best estimate of GFR?
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clearance of creatinine
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best estimate of renal plasma flow?
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clearance of PAH
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calculation of filtration fraction?
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GFR/RPF (normal ~20%)
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urine osmolality <300?
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diabetes insipidus
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loop diuretics can cause metabolic acidosis/alkalosis?
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alkalosis
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FeNa in ATN?
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>2% (unable to reabsorb sodium or concentrate urine)
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type of RTA associated with longstanding diabetes?
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type IV
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what cells secrete renin?
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juxtaglomerular cells
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sodium balance sensing cells in kidney?
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macula densa
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good treatment for UTI caused by Enterobacter cloacae?
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meropenem or imipenem (Enterobacter has developed strong resistance to other beta-lactams)
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other lab abnormalities seen in nephrotic syndrome?
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hypoalbuminemia, hyperlipidemia
*note increased risk of infection due to loss of Ig proteins |
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diuretics that cause metabolic alkalosis?
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loop diuretics and thiazides
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what level of acidemia is an indication for emergent hemodialysis?
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<7.1
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treatment for post-streptococcal glomerulonephritis?
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supportive care
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parasitic infection associated with increased risk of squamous cell carcinoma of the bladder?
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Schistosoma hematobium
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cause of unilateral renal artery stenosis in young woman?
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structural defect of renal artery wall ("fibromuscular dysplasia")
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what antibiotics increase risk of renal toxicity when combined with cephalosporins?
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aminoglycosides (gentamicin, neomycin, tobramycin, etc)
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loss of what property causes proteinuria in minimal change disease?
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loss of negative charge associated with basement membrane foot processes
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loss of what property causes proteinuria in membranous glomerulonephritis?
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loss of size selectivity due to damage to glomerulus
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formula to calculate antion gap?
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Na - (Cl + HCO3)
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normal anion gap?
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8/12/2011
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cuases of oligohydramnios?
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bilateral renal agenesis, chronic uteroplacental insufficiency, posterior urethral valves (in males)
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causes of polyhydramnios?
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esophageal/duodenal atresia; anencephaly
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makes up staghorn calculus?
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struvite (ammonium magnesium sulfate)
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pH of urine that causes precipitation of phostphate?
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alkaline
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primary problem leading to secondary hyperparathyroidism in chonic renal failure?
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ability to excrete phosphate
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developmental cause of hypospadias vs. epispadias?
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hypospadias: due to failure of urethral folds to clsoe
epispadias: due to faulty positioning of genital tubercle |
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effect of furosemide on calcium levels?
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decreased calcium reabsorption (decreased serum calcium levels)
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child with failure to thrive, hypokalemia, metabolic alkalosis, hyperaldosteronism?
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Bartter's syndrome; defect of ion channels in thick ascending loop of Henle
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UTIs that cause alkalinization of urine?
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urease-producing bacteria; Proteus and Klebsiella; predispose to struvite stones
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hormone most directly responsible for BPH?
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dihydrotestosterone (DHT); produced from testosterone by 5alpha-reductase
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red urine after common cold?
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Berger's disease (IgA glomerulopathy)
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electrolyte abnormality that is contraindication for furosemide?
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hypocalcemia
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medication used to prevent tumor lysis syndrome?
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allopurinol (xanthine oxidase inhibitor); spares kidneys from huge purine load
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lab abnormalities seen in tumor lysis syndrome?
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metabolic acidosis, hypocalcemia, hyperphosphatemia
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most common locations of berry aneurysms?
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1. bifurcation of anterior communicating artery
2. posterior communicating artery |
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edema in face, lips, mouth caused by what antihypertensive?
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ACE-inhibitor induced angioedema; due to high levels of bradykinin
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most common glomerular disease in HIV patients?
|
focal segmental glomerulosclerosis (LM shows segmental sclerosis and hyalinosis)
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acid base condition caused by vomiting?
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metabolic alkalosis
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acid base condition caused by diarrhea?
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non-anion-gap metabolic acidosis
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treatment for Conn's syndrome?
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(primary hyperaldosteronism from asldosterone secreting tumor)
treat with surger and/or spironolactone |
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most common type of kidney stones?
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calcium stones (oxalate or phosphate)
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kidney stones most commonly seen in alkaline urine +UTI?
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struvite (ammonium magnesium sulfate)
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remnant of fetal allantois and urachus?
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median umbilical ligament
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remnant of fetal umbilical arteries?
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medial umbilical ligaments
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chromosome associated with Wilm's tumor?
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chromosome 11
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what provides negative charge to glomerular filtration barrier?
|
heparan sulfate coating filtration barrier
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effect of bradykinin on renal blood flow?
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induces vasodilation of arterioles, increasing renal blood flow
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effect of low-dose dopamine on renal blood flow?
|
induces vasodilation of arterioles, increasing renal blood flow
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molecular target of hctz?
|
chloride-binding site of sodium-chloride cotransporter in early distal tubule
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molecular target of loop diuretics?
|
(ie furosemide)
bind to chloride-binding site of sodium-potassium-chloride symporter of thick ascending limb of Henle |
|
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first line therapy for acute, uncomplicated UTI?
|
3 day course of TMP-SMX or ciprofloxacin
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non-gap metabolic acidosis with very low serum potassium?
|
consider type I RTA
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what cells cause type I RTA?
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collecting tubule intercalated cells
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function of intercalated cells (collecting tubule)?
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excrete acid, reabsorb potassium
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function of principal cells (collecting tubule)?
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allow aldosterone-related reabsorption of sodium and ADH-regulated concentration of urine
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effect of aldosterone on potassium balance?
|
increases excretion of potassium by principal cells
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most common cause of non-gap metabolic acidosis?
|
diarrhea
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medications that cuase type IV RTA presentation?
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ACE-inhibitors, trimethoprim, heparin
(all via reducing aldosterone production) |
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why do loop diuretics cause hypocalcemia?
|
inhibit No-K-2Cl cotransporter in thick ascending look; calcium usually passively reabsorbed here via sodium chloride gradient, which is disrupted by loop diuretic
|
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what type of cells mediate acute transplant rejection?
|
cytotoxic T cells (CD8); due to HLA differences
|
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adrenal enzyme deficiency that leads to increased renin production?
|
21-hydroxylase deficiency (decreased aldosterone)
|
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FENa in intrarenal failure?
|
between 2 - 4%
|
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medications that typically cause interstitial nephritis?
|
penicillins (esp. methicillin), cephalosporins, sulfonamides
|
|
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rate determining enzymes in gluconeogenesis?
|
Pyruvate carboxylase
PEP carboxykinase Fructose 1,6-bisphosphatase Glucose-6-phosphatase |
|
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FeNa in prerenal azotemia?
|
<1%
|
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FeNa in post-renal acute kidney injury?
|
>4%
|
|
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MOA of probenecid?
|
competes with uric acid for reabsorption in the kidney
|
|
|
anti-rejection med that inhibits lymphocyte proliferation by blocking production of IL-2 and receptor?
|
cyclosporine
|
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|
MOA and clinical use of cyclosporine?
|
anti-rejection med that inhibits lymphocyte proliferation by blocking production of IL-2 and receptor
|
|
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what is abnormal about sweat in patients with cystic fibrosis?
|
high-chloride, low-bicarb
|
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effect of acidosis/alkalosis on potassium balance?
|
acidosis: causes K+ to shift OUT of cell, causing hyperkalemia
alkalosis: causes K+ to shift INTO cell, causing hypokalemia |
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renal condition associated with old/degraded tetracycline?
|
Fanconi's syndrome; disorder of proximal tubule function resulting in severe loss of protein, glucose, calcium, magnesium
|
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treatment of elevated cystine in urine leading to recurrent cystine stones?
|
alkalization of urine with acetazolamide
|
