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Renal

First Aid: Renal

QuestionAnswer
This structure passes under the uterine artery and under the ductus deferens (retroperitoneally) Ureters
What percentage of total body weight is total body water, ICF, and ECF? 60/40/20 rule; 60% TBW, 40% ICF, 20% ECF (which is 1/4th plasma volume, 3/4ths interstitial volume)
What is the equation for renal clearance? C=UV/P
What does it mean if renal clearance is greater then GFR? What does it mean if it is less then GFR? If renal clearance is greater than GFR then there is net secretion; if less than GFR then there is net reabsorption
What substance is used to calculate GFR? inulin (creatinine clearance is an approximate measure, but 10-15% is secreted so not as accurate as inulin)
What substance is used to calculate effective renal plasma flow (ERPF)? PAH is used as it is both filtered and actively secreted
This substance dilates afferent arteriole leading to increased GFR and RPF. prostaglandins; inhibited by NSAIDs
This substance constricts efferent arteriole leading to increased GFR and decreased RPF resulting in an increased filtered fraction. Angiotensin II; inhibited by ACEi's
What is the equation for free water clearance? CH2O=V-Cosm; Cosm=Uosm*V/Posm
What is the Tm of glucose transport? 350 mg/dL, but glucosuria begins at 200 mg/dL
Where is glucose reabsorbed in the nephron? It is absorbed in the proximal tubule via cotransport with sodium; a basolateral Na/K ATPase restores the intracellular sodium balance
How is bicarb reabsorbed in the proximal tubule? Sodium/hydrogen exchanger pumps hydrogen into the lumen so that it can combine with bicarb via CA in the lumen and be reabsorbed as water and CO2; in the cell CA splits it back to hydrogen (exchanged for sodium) and bicarb is pumped into interstitium
How is potassium reabsorbed in the thick ascending limb? Na/K/2Cl cotransporter; this is the site of action for loop diuretics (furosemide) and the reason they cause increase potassium loss; sodium is then pumped into interstitium via Na/K ATPase
How is chloride reabsorbed in the distal convoluted tubule? Na/Cl cotransport; sodium is then pumped into interstitium via Na/K ATPase
Where does PTH act to increase calcium reabsorption? Distal convoluted tubule
On what cells does aldosterone act to increase Na reabsorption? In the collecting tubules; principal cells (where Na is reabsorbed in exchange for K) and intercalated cells (where Na is reabsorbed in exchange for H)
What causes renin release from JGA? Decreased Na return (can be caused by decreased BP, decreased renal blood flow, etc), also secreted in response to increased sympathetic tone
What are the actions of angiotensin II? Potent vasoconstriction (especially efferent arteriole), increase in proximal tubule Na reabsorption, release of aldosterone, release of ADH, stimulation of hypothalamus (thirst)
What is the action of ANP? released by atria in response to increased atrial pressure, decreases renin and increases GFR
In metabolic acidosis bicarb would be increased or decreased? Decreased, as its buffering action would cause it to combine with hydrogen to form CO2 and water
In metabolic alkalosis bicarb would be increased or decreased? Increased, as water and CO2 would be split to generate H+ to offset alkalosis
What are common causes of anion gap metabolic acidosis? MUDPILES; methanol, uremia, diabetic ketoacidosis, paraldehyde, intoxication (iron or isoniazid), lactic acidosis, ethylene glycol, salicylates
What are common causes of normal anion gap metabolic acidosis? diarrhea, renal tubular acidosis, hyperchloremia (decreased bicarb reabsorption to maintain neutrality, not total picture but helps me remember)
What are common causes of metabolic alkalosis? vomiting, diuretic use, antacid use, and hyperaldosteronism (Na/H exchange in intercalated cells)
What is Potter's syndrome? bilateral renal agenesis resulting in oligohydramnios--> pulmonary hypoplasia and limb and facial abnormalities
Horseshoe kidneys get trapped under what artery when ascending from the pelvis? Inferior mesenteric artery
What are common causes of RBC casts? Glomerular inflammation (nephritic syndrome), ischemia, or malignant hypertension
What are common causes of WBC casts? acute pyelonephritis, tubulointerstitial disease, glomerular disorders
What are causes of waxy casts? advanced renal disease, chronic renal failure
What condition is associated with granular casts? acute tubular necrosis
Lumpy bumpy appearance on LM, subepithelial humps on EM, what is expected on IF? granular pattern; acute poststrep glomerulonephritis
Crescent moon shape on LM and IF is associated with this syndrome. Rapidly progressive (crescentic) glomerulonephritis; rapid progression to renal failure (prognosis in number of crescents)
In Goodpasture's syndrome, what pattern is seen on IF? Linear staining pattern of basement membrane; anti-GBM antibodies
Subendothelial humps on EM with "tram track" appearance of basement membrane is seen in what disorder? Membranoproliferative glomerulonephritis; slow progression to renal failure
IgA deposits in mesangium are seen on IF and EM in this disorder. Berger's disease (IgA nephropathy, often postinfectious)
A split glomerular basement membrane is seen in this disorder, often associated with nerve deafness and ocular disorders. Alport's syndrome; collagen IV mutation
Non-diabetic patient with diffuse capillary and basement membrane thickening, what can be expected on EM? "spike and dome" appearance; membranous glomerulonephritis
EM shows foot process effacement in this disease. Minimal change disease
Segmental sclerosis and hyalinosis is seen on LM in this disease. Focal segmental glomerular sclerosis
IF congo red stain, apple green birefringence Amyloidosis
This type of kidney stone is secondary to urease positive buts (proteus, staph, klebsiella). ammonium magnesium phosphate (struvite)
This renal malignancy is associateed with von Hippel-Lindau disease and gene deletion in chromosome 3. Renal cell carcinoma; originates in renal tubule cells, may produce secondary polycythemia
What is von Hippel-Lindau disease? Autosomal dominant condition where hemangioblastomas are found in cerebellum, retina, and spinal chord; associated with renal cell carcinoma and pheochromocytoma
Deletion of the WT1 gene on what chromosome leads to Wilm's tumor? chromosome 11; can be part of WAGR (Wilms tumor, Aniridia (colorless eye), Gonadoblastoma, mental Retardation)
Thyroidization of the kidney is seen in this disease. Chronic pyelonephritis
Acute pyelonephritis affects what part of the kidney? The cortex
This common cause of renal failure is associated with renal ischemia (shock), crush injury (myoglobinuria), and some intoxications. Acute tubular necrosis; granular casts often seen
Renal papillary necrosis is seen in what diseases? DM, acute pyelonephritis, and sickle cell anemia
What is the cause of prerenal ARF? decreased renal blood flow (hypotension) leading to decreased GFR and Na/H20 retention; BUN/Cr ratio is often greater than 20
What is the cause o intrinsic renal ARF? generally due to ATN or ischemia/toxins with debris obstructing tubule and fluid backflow; BUN/Cr ratio is often less than 15
What is Fanconi syndrome? defect in proximal tubule transport of amino acids, phosphate, uric acid, protein, and electrolytes.
Osmotic diuretic which acts by keeping water in the lumen. Mannitol
What is the mechanism of action of acetazolamide? carbonic anhydrase inhibitor --> bicarb reabsorption drives the Na/H exchanger in the proximal tubule --> NaHCO3 excreted; causes acidosis
Na/K/2Cl cotransport inhibitor. Furosemide; acts in ascending limb
This diuretic inhibits NaCl reabsorption in early distal tubule. Hydrochlorthiazide
This diuretic is a competitive aldosterone receptor antagonist. Spironolactone, triamteren, amiloride
What is the contraindication of ACE inhibitors? Bilateral renal artery stenosis
Created by: rahjohnson