Renal
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| Estimated Renal Plasma Flow | = [urine PAH] x Flow rate = PAH clearance (Underestimates RPF by 10%)
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| Renal Blood Flow | = Renal Plasma Flow / (1-Hct)
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| Filtration Fraction | = GFR / RPF
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| Filtered Load | = GFR x plasma concentration
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| Angiotensin II | Vasoconstriction (but not the afferent arteriole), Pressure Natriuresis (PCT Na absorption), Aldosterone & ADH release, thirst. Antagonized by ANP. Synthesized in liver.
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| Glucosuria | Begins at 200mg/mL. Transport saturated @ 350mg/dL
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| Proximal Convoluted Tubule | All Glucose, Protein, MOST Bicarb, Na, H20. Iso-osmotic
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| Thin Descending Loop of Henle | Passive H20 absorption & urea excretion -> urine hypertonic
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| Thick ascending Loop of Henle | NKCC pump (Where furosemide acts) actively reabsorbs salts, indirectly absorbs Mg & Ca. Impermeable to urea, H20 -> urine hypotonic
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| Distal Convoluted Tubule | Na/Cl co-transporter (where Thiazides act). ENaC sodium reabsorption. PTH-mediated Ca reabsorption. Impermeable to urea (maintains at least some osmolarity to the hypotonic urine).
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| Collecting Tubules | Aldosterone-mediated Na reabsorption for K. ADH mediated H20 & little urea reabsorption
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| PTH in the Kidney | Increases PTC calcium absorption, decreases DCT PO4 absorption. Alpha1 hydroxylase expression to produce 1,25 (OH)2 Vitamin D.
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| Anion Gap Metabolic Acidosis Etiology | PCO2<40. MUDPILES: Methanol, Uremia, DKA, Paraldehyde, Phenformin, Iron, INH, Lactic acidosis, Ethylene glycol, Salicylates
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| Non Anion Gap Metabolic Acidosis Etiology (8-12) | PCO2<40. Diarrhea, Glue Sniffing, hyperchloremia, Renal tubular acidosis (Type 1: H pump defect, Type 2: renal bicarb loss, Type 4: Hyperaldo-> HyperK -> No ammonia excretion)
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| Respiratory Acidosis Etiology | Hypoventilation (primary lung problem). PCO2 > 40
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| Respiratory Alkalosis Etiology | PCO2<40. Early aspirin ingestion, Hyperventilation.
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| Metabolic Alkalosis Etiology | PCO2>40. Diuretics, Vomiting, antacids, Hyperaldosteronism.
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| Metabolic Acidosis Formula | 1.5(HCO3) + (6 to 10) = PCO2 (WINTER’S FORMULA)
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| Metabolic Alkalosis Formula | .7(HCO3 increase above 40) = PCO2 increase
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| Respiratory Alkalosis Formula | Acute: .2(PCO2 decrease) = HCO3 drop CHRONIC: .5(PCO2 decrease)= HCO3 drop
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| Respiratory Acidosis Formula | Acute: .1(PCO2 elevation) = HCO3 increase Chronic: .35(PCO2 Elevation) = HCO3 increase
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| Nephritic Syndromes | Type III Hypersensitivities (-Godpastures). Sx: Hematuria, HTN, Oliguria, Azotemia. Acute Post-Strep Glomerulonephritis, Membranoproliferative G., Rapidly Progressive/Crescentic G., Goodpasture’s, Berger’s/IgA Nephropathy, Alport’s.
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| Enlarged/hypercellular glomeruli, neutrophilic infiltrate. EM: Supepithelial humps. IF: Granular | Acute Post-streptococcal Glomerulonephritis. Pediatric. Peripheral/periorbital edema. Self-resolves
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| Subendothelial Humps, Tram tracking (Mesangial cell consume Dense deposits & lay down new BM | Membranoproliferative Glomerulonephritis. Slowly progressive to renal failure.
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| Crescent-Moon Shape LM & IF | Rapidly progressive glomerulonephritis. Rapidly progresses to renal failure.
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| Linear IF. IgA mesangial deposits | Berger’s Disease/ IgA Nephropathy. Mild, Post-infx. Recurrent hematuria.
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| Linear Immunofluorescence, Anti-GBM antibodies | Goodpasture’s Syndrome (Type II hypersensitivity). Hemoptysis, hematuria.
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| Split basement membrane | Alport’s Syndrome. Collagen Type IV mutation. Deafness, ocular disorders.
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| Nephrotic Syndromes | Proteinuria. Frothy urine, hypoalbuminemia, peripheral & Periorbital edema, hyperlipidemia. Membranous Glomerulonephritis, Minimal Change Disease, Focal Segmental Glomerular Sclerosis (FSGS), Diabetic Nephropathy, SLE, Amyloidosis.
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| Diffuse capillary & BM thickening, granular immunofluorescence, spike & dome EM | Membranous Glomerulonephritis. #1 in adults
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| Normal glomeruli & foot process effacement | Minimal Change Disease #1 Pediatric. Tx: steroids
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| Segmental sclerosis & hyalinosis | Focal Segmental Glomerular Sclerosis. HIV
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| K-W Nodules, BM thickening | Diabetic Nephropathy
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| Diffuse capillary & BM thickening. Wire-loop leisions w/ subepithelial deposits | SLE Nephropathy. 5 patterns.
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| Amyloid Deposits (Congo red +, Apple green) | Amyloidosis: MM, TB, RA, chronic conditions.
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| Renal Cell Carcinoma | Polycythemia, palpable mass, hematuria, flank pain. Associated w/ VHL (ch3), Smoking, obesity, 50-70yos. Paraneoplastic: EPO, ACTH, PTHrP, Prolactin
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| Wilm’s Tumor | #1 Pediatric. Embryonic structures. WT1 deletion (Ch11). May be part of WAGR: Wilms, Anirida (no iris), GU malformation, MR
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| Transitional Cell Carcinoma | #1 of Urinary tract. Painless hematuria. Associated w/Phenacetin, Smoking, Aniline dyes, Cyclophosphamide.
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| Pyelonephritis | WBC casts pathognomonic. Affects cortex. Fever, CVA tenderness. Corticomedullary scaring, blunted calyx.
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| Diffuse Cortical Necrosis | Abruptio Placentae, Septic shock -> DIC & Vasospasm -> Bilateral renal cortex infarction
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| Drug-Induced interstitial Nephritis | Penicillins, NSAIDs, Diuretic-Hypersensitivity -> Interstitial Inflammation -> Systemic signs + Hematuria 2wks post-administration
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| Acute Tubular Necrosis | #1 ARF. Ischemia/shock, Trauma, Toxins -> epithelial detachment, necrosis -> muddy brown casts. Death in early oliguric phase, recovery in 2-3 wks.
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| Renal Papillary Necrosis | DM, Acute Pyelonephritis, Chronic Phenacetin use(ie-tylenol), Sickle Cell Anemia -> Hypoxic injury to medulla-> necrosis.
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| PRERENAL Acute Renal Failure | High Osmolarity (>500), BUN/Cr Ratio (>20), low Na (10)& FeNa (1%) (Hypotension -> low RBF)
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| INTRINSIC Acute Renal Failure | Low Osmolarity (<350), Moderate Na (20)& FeNa (2%), Low BUN/Cr (ATN, Ischemia, Toxins) Epithelial & Muddy Brown Casts.
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| POSTRENAL Acute Renal Failure | Low Osmolarity (<350), high Na(40), FeNa (4%), Moderate BUN/Cr (>15). BPH, Stones, Neoplasia.
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| Chronic Renal Failure | HTN, Diabetes Induced
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| Renal Failure Consequences | Uremia & uremic encephalopathy. Anemia (no EPO), Renal Osteodystrophy (no VD), Hyperkalemia, Metabolic Acidosis (no excretion w/ typical high-acid diet), Na & H20 Excess (CHF & PE), Chronic Pyelonephritis, HTN
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| Fanconi’s Syndrome | Proximal Tubule LOF -> No resorption of AAs, Glucose, PO4, Uric Acid, electrolytes. Consequences: Rickets, Osteomalacia, Hypokalemia, metabolic acidosis.
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| Dialysis Cysts | Cortex & medulla. Due to Chronic Dialysis
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| Simple Cysts | Cortex. Benign.
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| Medullary Cystic Disease | Medullary. Small kidney. Poor prognosis
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| Medullary Sponge Disease | Collecting ducts. Good prognosis.
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| Hyper & Hyponatremia Sx | HypoNa: Disoriented, stuporous, coma. HyperNa: Irritable, Delirious, coma
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| High & Low Cl Etiologies | Low Cl: Metabolic alkalosis, HypoK, Hypovolemia, High aldo. HIGH Cl: Non-Anion Gap Acidosis
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| Hyper & HypoKalmeia Sx | HypoK: U waves, flat T waves, Arrhythmias, paralysis. HyperK; Peaked T waves, wide QRS, arrhythmias
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| Hyper & HypoCalcemia Sx | HypoCa: Tetany, Neuromuscular irritability. HyperCa: Delirium, Renal Stones, Abdominal pain, +/-Calcuria
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| Hyper & HypoMagnesmia Sx | HypoMg: Neuromuscular irritability, arrhythmias. HyperMg: Delirium, weak DTRs, cardiac arrest
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| Hyper & HypoPhosphatemia Sx | HypoPO4: Bone loss, osteomalacia HyperPO4: Metastatic calcification, renal stones
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| Mannitol | Mech: Osmotic diuresis. USE: Shock, drug OD, reduce ICP, IOccularP. SE: PE, dehydration, CI’d in anuria, CHF
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| Acetazolamide | Mech: Carbonic anhydrase inhibitor, excreting HCO3. USE: Glaucoma, alkalinize urine, metabolic alkalosis, altitude sickness. SE: HyperCl metabolic acidosis, neuropathy, NH3 toxicity, Sulfa allergy
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| Furosemide & Ethacrynic Acid | Mech: NKCC blocker, preventing urine concentration. USE: Edematous states, HTN, HyperCa. SE: Ototoxicity, HypoK, sulfa allergy, interstitial nephritis, gout.
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| HCTZ | Mech: NaCl blocker in DCT. USE: HTN, CHF, HyperCa tx, Nephrogenic DI. SE: HypoK Metabolic Alkalosis, hypoNa; HyperGLUC: Glycemia, Lipidemia, Uricemia, Calcemia. Sulfa allergy
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| Spironolactone | Spironolactone, Triamterene, Amiloride. Mech: Spiro: Aldosterone Receptor Blocker; Triam & Amil: CCT ENaC Blockers. Use: Hyperaldosteronism, HypoKalemia tx, CHF. SE: HyperK. Spironolactone: Gynecomastia, antiandrogenic.
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| ACE Inhibitors | Capto, Elana,Lisino-pril. Use: HTN, CHF, Diabetic renal disease. SE: CAPTOPRIL: Cough, Angioedema, Proteinuria, Taste change, hypotension, Pregnancy problems (fetal renal damage), Rash, Increased renin, Low angII + HyperK. CI’d in Renal Artery Stenosis
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| Losartan | Angiotensin II Receptor Antagonist. Use: Same as ACE Inhibitors when patient has bradykinin-induced cough.
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| Henderson Hasselbach Equation | pH= pKa + log [HCO3]/.03PCO2
Describes acid-base response
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| Cause of Hyperkalemia & Hypokalemia | HyperK: Low insulin, aldosterone, sympathetic tone, acidosis, digitalis, hyperosmolarity. HypoK: High insulin, aldosterone or sympathetic tone, alkalosis, hypoosmolarity.
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| Anion gap | Na - (Cl + HCO3)= anion gap
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