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143 Cards in this Set

  • Front
  • Back
clearance of any substance = ?
urinary excretion/plasma concentration
what does the clearance of PAH equal?
effective renal plasma flow (unless the secreting mechanism is saturated)
what kind of diuretics are contraindicated in renal failure?
potassium sparing - exacerbates elevated serum potassium & hyperkalemia can lead to arrhythmia
tubular fluid with lowest osmolarity is found where?
macula densa
how is interstitial fluid volume related to inulin space?
inulin space approximates ECF volume, so interstitial fluid volume = inulin space - plasma volume
what percent of total body weight is total body water?
what proportion of total body water is ECF and ICF?
1/3 ECF and 2/3 ICF
what percent of ECF is plasma volume? interstitial volume?
1/4 plasma volume and 3/4 insterstitial volume
how is plasma volume measured?
radiolabeled albumin
how is extracellular volume measured?
formula for clearance?
C=UV/P = [urine] x urine flow rate/[plasma]
what forms the size barrier of the glomerulus?
fenestrated capillary endothelium
what formes the negative charge barrier of the glomerulus?
fused basement membrane with heparan sulfate
what is lost in nephrotic syndrome?
charge barrier - resulting in albuminuria, hypoproteinemia, generalized edema, and hyperlipidemia
what substance is used to calculate GFR?
creatinine clearance is an approximate measure of what?
what does renal blood flow equal?
renal plasma flow/1-Hct
effective renal plasma flow underestimates true renal plasma flow by how much?
about 10%
filtration fraction = ?
what arteriole does AT II act on?
preferentially constricts efferent arteriole - decreases RPF, increases GFR, so FF increases
what dilates the afferent arteriole? what effect does this have?
prostaglandins - increases RPF, GFR so FF remains constant
afferent arteriole constriction has what effect?
decreases RPF & GFR - FF remains constant
efferent arteriole constriction has what effect?
decreases RPF, increases GFR, so FF increases
increased plasma protein concentration has what effect on GFR?
decreases GFR, (RPF stays same so FF decreases)
decreased plasma protein concentration has what effect on GFR?
increases GFR (RPF stays same, so FF increases)
constriction of ureter has what effect on GFR?
decreases it (also decreases FF)
free water clearance = ?
urine flow rate - clearance(osm)
at what plasma glucose level does glucosuria begin? at what level does the transport mechanism become saturated?
200; 350
the osmolarity of the medulla can reach what level?
1200 mOsm
on what type of cells does aldosterone act?
principal cells of collecting ducts - activates Na+/K+ pump; intercalated cells - stimulates H+ secretion
portion of the nephron that reabsorbs all of the glucose & AAs, and most of the bicarbonate, sodium, and water; secretes ammonia, which acts as a buffer for H+
early proximal convoluted tubule
portion of the nephron that passively reabsorbs water via medullary hypertonicity
thin descending limb
portion of the nephron that contains the NKCC and indirectly induces the absorption of Mg2+ and Ca2+; impermeable to water
thick ascending limb
location of the nephron in which calcium reabsorption is under the control of PTH?
early distal convoluted tubule
actions of the early distal convoluted tubule?
actively reabsorbs Na+, Cl-; reabsorbs calcium under PTH control
portion of the nephron that reabsorbs sodium in exchange for secreting potassium or H+? what regulates this?
collecting tubules; aldosterone
reabsorption of water in this portion of the nephron is under control of ADH (vasopressin)
collecting tubules
actions of angiotensin II?
1. potent vasoconstriction 2. release aldosterone from adrenal cortex, 3. release ADH from post pit 4. stimulate hypothalmus to increase thirst 5 increase intravascular volume and BP
what may be released from atria as a check on the RAA system, e.g. in CHF?
what cells secrete renin?
juxtaglomerular cells - in response to decreased renal BP, decreased Na+ delivery to distal tubule, and increased sympathetic tone
how can NSAIDs cause acute renal failure in high vasoconstrictive states?
by inhibiting the renal production of prostaglandins, which keep the afferent arterioles vasodilated to maintain GFR
where does ADH bind? what is the result?
binds to receptors on principal cells, causing an increase in the number of water channels/aquaporins and increased H2O reabsorption
what is ANF secreted in response to? what does it do?
secreted in response to increased atrial pressure, causes increased GFR and increased Na+ excretion
what effect does aldosterone have?
secreted in response to decreased blood volume (via AT II) and increased plasma K+ - causes increased Na+ reabsorption and increased K+ and H+ secretion
angiotensin II causes increased absorption of what?
Na+ and HCO3-
primary disturbance in metabolic acidosis?
decreased HCO3- (causes hyperventilation/ decreased PCO2)
primary disturbance in metablic alkalosis?
increased HCO3- (causes hypoventilation/ increased PCO2)
primary disturbance in respiratory acidosis?
increased PCO2 (causes increased renal HCO3- absorption)
primary disturbance in respiratory alkalosis?
decreased PCO2 (causes decreased renal HCO3- absorption)
acidosis with PCO2 >40?
respiratory acidosis
acidosis with PCO2 <40?
metabolic acidosis with compensation
alkalosis with PCO2 <40?
respiratory alkalosis
alkalosis with PCO2 >40?
metabolic alkalosis with compensation
causes of respiratory acidosis?
hypoventilation - airway obstruction, acute/chronic lung disease, opiods, narcotics, sedatives, weakening of respiratory muscles
causes of anion gap metabolic acidosis?
MUD PILES: methanol, uremia, diabetic ketoacidosis, paraldehyde or phenformin, iron tablets or inh, lactic acidosis, ethylene glycol, salicilates
causes of non-anion gap metabolic acidosis?
diarrhea, glue sniffing, renal tubular acidosis, hyperchloremia
how do you calculate ion gap?
Na+ - (Cl- + HCO3-)
causes of respiratory alkalosis?
hperventilation, aspirin ingestion (early)
causes of metabolic alkalosis?
vomiting, diuretic use, antacid use, hyperaldosteronism
Winter's formula?
PCO2 = 1.5(HCO3-) + 8 +/-2
type of metabolic disturbance commonly seen in cardiopulmonary arrest?
mixed acidosis
ureter crosses anterior to the origin of what artery to enter the pelvis?
external iliac
ovoid, PAS-positive hyaline masses
Kimmelstiel-Wilson nodule - most specific lesion of diabetic glomerulosclerosis
nephrotic syndrome in IV drug user or HIV nephropathy
focal segmental glomerulosclerosis
renal pathology associated with DIC?
diffuse cortical necrosis
Potter's syndrome?
bilateral renal agenesis - oligohydraminos, limb & facial deformities,pulmonary hypoplasia
cause of Potter's syndrome?
malformation of ureteric bud
why do kidneys stay low in abdomen in horseshoe kidney?
get trapped under IMA
RBC casts in urine
glomerular inflammation (nephritic syndromes), ischemia, or malignant hypertension
WBC casts in urine
tubulointerstitial disease, acute pyelonephritis, glomerular disorders
granular casts in urine
acute tubular necrosis
waxy casts in urine
advanced renal disease/CRF
hyaline casts in urine
LM: glomeruli enlarged and hypercellular, neutrophils, lumpy-bumpy; EM: subepithelial humps; IF: granular pattern
acute postreptococcal glomerulonephritis
LM and IF: crescent moon shape
rapidly progressive (crescentic) glomerulonephritis
finding on immunofluorescence in Goodpasture's?
linear pattern
IF and EM findings in Berger's disease?
mesangial IgA deposits
split basement membrane
Alport's syndrome
mutation in Alport's? characteristic findings?
collagen IV; nerve deafness and ocular disorders
hematuria, hypertension, oliguria, azotemia
nephritic syndrome
findings in nephrotic syndrome
massive proteinuria, hypoalbuminemia, peripheral and periorbital edema, hyperlipidemia
LM: diffuse capillary and BM thickening; IF: granular pattern; EM: spike and dome
membranous glomerulonephritis
findings in minimal change disease/lipoid nephrosis?
LM: normal glomeruli; EM: foot process effacement
LM: segmental sclerosis and hyalinosis
focal segmental glomerular sclerosis - most severe disease in HIV patients
findings in diabetic nephropathy
LM: Kimmelstiel-Wilson 'wire loop' lesions, basement membrane thickening
findings in membranous glomeruloneprhitis in SLE
wire-loop lesion with subendothelial deposits
most common type of kidney stones?
calciium oxalate, calcium phosphate, or both
second most common type of kidney stone; can form staghorn calculi that can be nidus for UTIs
ammonium magnesium phosphate (struvite)
infection with what type of organism leads to struvite kidney stones?
urease-positive bugs - proteus vlugaris, staph, klebsiella
kidney stones often seen as a result of diseases with increased cell turnover, such as leukemia and myeloproliferative disorders
uric acid
types of radiolucent kidney stones?
uric acid and cystine
gene association with renal cell carcinoma?
deletion of VHL gene on chromosome 3
where does renal cell carcinoma originate?
renal tubule cells (polygonal clear cells)
renal cell carcinoma is associated with what syndromes?
paraneoplastic (ectopic EPO, ACTH, PTHrP, and prolactin)
gene association with Wilm's tumor?
deletion of tumor suppressor WT1 on chromosome 11
WAGR complex?
Wilm's tumor, Aniridia, genitourinary malformation, and mental-motor retardation
most common tumor of the urinary tract system?
transitional cell carcinoma
transitional cell carcinoma is associated with what?
phenacetin, smoking, analine dyes, and cyclophosphamide
white cell casts in urine are pathognomonic for what?
acute pyelonephritis
chronic pyelonephritis?
coarse, asymmetric corticomedullary scarring; tubules can contain eosinophilic casts (thyroidization of the kidney)
most common cause of acute renal failure?
acute tubular necrosis
what is acute tubular necrosis associated with?
renal ischemia (e.g. shock), crush injury (myoglobinuria), toxins
when does death most often occur in ATN?
during initial oliguric stage
what is renal papillary necrosis associated with?
diabetes, acute pyelonephritis, chronic phenacitin use
what is uremia?
clinical syndrome marked by increased BUN and creatinine and associated symptoms
metabolic disturbance seen in renal failure?
metabolic acidosis due to decreased acid secretion and decreased HCO3- generation
low serum chloride concentration is secodary to what?
metabolic alkalosis
high serum chloride concentration is secondary to what?
non-anion gap acidosis
most common cause of nephrotic syndrome in adults?
membranous glomerulonephritis
how does renal cell carcinoma typically present?
as a mass or hematuria
loop diuretic indicated for the treatment of edema associated with CHF, cirrhosis, and renal disease?
two principal causes of rapidly progressive glomerulonephritis?
anti-glomerular basement membrane and primary systemic vasculitis
drugs implicated in the pathogenesis of acute interstitial nephritis?
NSAIDs, beta-lactam antibiotics (cepalothin & methicillin), sulfonamides, diuretics (furosemide and thiazides), phenytoin, cimetidine, methyldopa
EM: subendothelial humps, tram-track
membranoproliferative glomerulonephritis
when is mannitol contraindicated?
anuria, CHF
clinical use of mannitol?
shock, drug overdose, decrease intracranial/intraocular pressure
how does mannitol work?
increases tubular fluid osmolarity, producing increased urine flow
mechanism of acetazolamide?
carbonic anhydrase inhibitor - causes self-limited NaHCO3 diuresis and reduction in total body HCO3- stores
where does acetazolamide act?
proximal convoluted tubule
toxicity of acetazolamide?
hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy
clinical use of acetazolamide?
glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness
mechanism of furosemide?
sulfonamide loop diuretic - inhibits NKCC of thick ascending limb; abolishes hypertonicity of medulla, preventing concentration of urine
what effect does furosemide have on calcium excretion?
increases it - Loops Lose calcium
clinical use of furosemide?
edematous states (CHF, cirrhosis, nephrotic syndrome, pulmonary edema), hypertension, hypercalcemia
toxicity of furosimide?
ototoxicity, hypokalemia, dehydration, allergy (sulfa), nephritis (interstitial), gout
drug for diuresis in patients allergic to sulfa drugs?
ethacrynic acid
diuretic that can be used in hyperuricemia, acute gout?
ethacrynic acid
mechanism of hydrochlorothiazide?
inhibits NaCl reabsorption in distal convoluted tubule, reducing diluting capacity of the nephron, decreases calcium excretion
clinical use of hydrochlorothiazide?
hypertension, CHF, idiopathic hypercalciuiria, nephrogenic diabetes insipidus
diuretic used in nephrogenic diabetes insipidus?
toxicity of hydrochlorothiazide?
hypokalemic metabolic alkalosis, hyponatremia, hyperGlycemia, hyperLipidemia, hyperUricemia, and hyperCalcemia and sulfa allergy
what are the potassium sparing diuretics?
Spironolactone, Triamterene, Amiloride, eplercone
mechanism of spironolactone?
competitive aldosterone receptor antagonist in cortical collecting tubule
how do triamterene and amiloride act?
cortical collecting tubule - block Na+ channels
clinical use of K+ sparing diuretics?
hyperaldosteronism, K+ depletion, CHF
toxicity of K+ sparing diuretics?
hyperkalemia, endocrine effects (e.g. spironolactone causes gynecomastia, antiandrogen effects)
diuretics causing acidosis?
carbonic anhydrase inhibitors, K+ sparing diuretics
diuretics causing alkalosis?
loop diuretics, thiazides
diuretic that increases urine calcium?
loop diuretics
diuretics that decrease urine calcium?
name 3 ACE inhibitors
captopril, enlapril, lisinopril
mechanism of Losartan?
AT II receptor antagonist - not ACE inhibitor and so doesn't cause cough
toxicity of ACE inhibitors?
cough, angioedema, proteinuria, taste changes, hypOtension, pregnancy problems (fetal renal damage), rash, increased renin, lower angiotensin II; hyperkalemia