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FA complete Review

At which week does the pronephros degenerates? 4th Week
What are the roles of the Mesonephros? Functions as: 1. Interim kidney for the 1st trimester 2. Later contributes to male genitalia system
Which embryological state of the kidney is the permanent kidney? Metanephros
At which week does the metanephros appear? Week 5
What is the average time of neurogenesis in the developing embryo? 32-36 weeks
What structures are derived by the Ureteric bud? Ureter, pelvises, calyces, collecting ducts
By which which is the Ureteric bud supposed to be fully canalized? Week 10
What is another term used for metanephric mesenchyme? Metanephric blastema
What is the result from the interaction of the ureteric bud and the metanephric mesenchyme? Differentiation and formation of glomerulus through to distal convoluted tubule (DCT)
Aberrant interaction of the Ureteric bud and Metanephric mesenchyme lead to: Congenital kidney malformations, such as, Renal agenesis, multicystic dysplastic kidney
What embryological area or tissue is the last to be canalized? Ureteropelvic junction
What area of the embryological kidney is the MC to be obstructed? Ureteropelvic junction
Obstruction of the Ureteropelvic junction is diagnosed with US, and is called ___________________. Hydronephrosis
What conditions are associated with the Potter sequence? Pulmonary hypoplasia Oligohydramnios (trigger) Twisted face Twisted skin Extremity defects Renal failure in utero
What is the MCC of death in Potter sequence? Pulmonary hypoplasia
Potter sequence is associated with Oligo- or Polyhydramnios? Oligohydramnios
What are the facial abnormalities seen in Potter sequence? Low-set ears, retrognathia, and flattened nose
What causes the pulmonary hypoplasia in Potter sequence? Compression of chest and lack of amniotic fluid aspiration into fetal lungs
What are some common causes of Potter sequence? ARPKD, obstructive uropathy (posterior urethral valves), bilateral renal agenesis, chronic placental insufficiency,
What is the common obstructive uropathy that leads to development of Potter sequence? Posterior urethral valve obstruction
What is "Horseshoe kidney"? Inferior poles of both kidneys fuse abnormally
What artery "traps" the normal ascend of the kidneys of the Horseshoe kidney? Inferior Mesenteric Artery
What conditions are associated with Horseshoe kidney? Hydronephrosis, renal stones, infection, chromosomal aneuploidy syndromes, and rarely renal cancer.
What chromosomal aneuploidy syndromes are associated with Horseshoe kidney? Turner syndrome; trisomies 13, 18, and 21.
What are two common presentations of Congenital solitary functioning kidney? Unilateral renal agenesis and Multicystic dysplastic kidney.
Which condition is seen with complete absence of a kidney and ureter? Unilateral Renal agenesis
What is the cause of Unilateral Renal agenesis? Ureteric bud fails to develop and induce differentiation of metanephric mesenchyme
What condition is seen when the ureteric bud fails to develop and induce differentiation of metanephric mesenchyme? Unilateral renal agenesis
Which condition is seen when the ureteric bud only fails to differentiate the metanephric mesenchyme? Multicystic dysplastic kidney
What condition is seen with an non-functional kidney consisting of cysts and connective tissue? Multicystic dysplastic kidney
What is the consequence of bilateral Multicystic dysplastic kidney? Potter sequence
What is Duplex Collecting system? Bifurcation of ureteric bud before it enters the metanephric blastema creates a Y-shaped bifid ureter.
What are the main associated conditions with Duplex Collecting System? Vesicoureteral reflux and/or ureteral obstruction, and increase risk for UTIs.
What are (embryologically) the Posterior urethral valves? Membrane remnant in the posterior urethra in males
Persistence of the Posterior urethral valves leads to : Obstruction
What signs can identify prenatally the presence of Posterior urethral valves obstruction? Hydronephrosis and dilated or thick-walled bladder on US.
What is the MCC of bladder outlet obstruction in male infants? Posterior urethral valves obstruction
Which kidney is used for donor transplantation? Left kidney
Why is the Left kidney preferably used for donor transplantation? It has a longer renal vein
Renal blood flow path. What structure follow the flow after the afferent arteriole? Glomerulus
Renal blood flow path. Glomerulus ---> Efferent arterioles -----> ______________. Vasa recta/peritubular capillaries --> venous outflow
The Juxtaglomerular cells are located between which two nephrogenic structures? Distal convoluted tubule and the Afferent arteriole
Which cells line up the luminal face of the basement membrane of the glomerulus? Podocytes
The podocytes form the ________ layer of the glomerular basement membrane. Visceral
In a normal cross-section view of a kidney, which vessel is represented above the other, the renal vein or renal artery? Renal artery
From which structure do ureters arise form? Renal pelvis
Course of the ureters. Initiate at the renal pelvis then --> Travel under the gonadal arteries --> over common iliac artery --> under uterine artery/vas deferens (retroperitoneal)
Ureters travel over which vascular structure? Common iliac artery
Which iliac artery is associated with the course path of the ureters? Common iliac artery
The ureters travel or course under two different arterial structures, which are? First under the gonadal arteries, and lagter under the Uterine artery
What retroperitoneal structure is traveled under by the Ureters? Vas deferens
What kind of surgical procedures may cause damage to the ureters? Gynecologic procedures
What are the 3 main locations of construction of the ureters? 1. Ureteropelvic junction 2. Pelvic inlet 3. Ureterovesical junction
Which female structure is described in the course of the ureters in the retroperitoneal area? Uterine artery
What protein level or amount can be used to measure the plasma volume? Albumin
The amount of inulin or mannitol can be measured to calculate which body volume? Extracellular volume
Normal Osmolality range 285-295 mOsm/kg H2O
What is the main component of ICF? K+, Mg2+, organic phosphates
The ECF is mainly composed of: Na+, Cl-, HCO3-, and albumin
What is the principal function or responsibility of GFR? Filtration of plasma according to size and charge selectivity
What is the composition of the Glomerular filtration barrier? 1. Fenestrated capillary endothelium 2. Basement membrane with type IV collagen chains and heparan sulfate. 3. Epithelial layer consisting of podocyte foot processes
How is the Glomerular filtration membrane charge? Negatively
What is the symbol representing Renal clearance? Cx
What is the equation used to calculate renal clearance? (Ux V) = ---------- Px
What is Ux? Urine concentration of X
What is Px? Plasma concentration of X
What is represented by V in the equation for renal clearance? Urine flow rate
If the Renal clearance is less than GFR ===> Net tubular REABSORPTION of X
If the Cx is greater of GFR ===> Net tubular SECRETION of X
What does it mean to be "freely filtered"? Substance is neither reabsorbed nor secreted
Inulin clearance can be used to calculate===> Glomerular filtration rate (GFR)
What value can be used to measure the GFR? Inulin clearance
What is the normal GFR? 100 mL/min
What is the equation of GFR? (U inulin x V) = ------------------- (P inulin)
What measured value slightly overestimates GFR? Creatinine clearance
Why is there a slight overestimation of the GFR when measured with Creatine clearance? Moderately secreted by renal tubules
What is described by incremental reduction in GFR? Define the stages of chronic kidney disease
PAH clearance can be used to estimate __________________. Effective renal plasma flow (eRPF)
What is the equation for RBF? (RPF) = -------------- (1 - Hct.)
TBV x (1-Hct) = Plasma volume
What is the normal FF? 20%
FF = GFR =---------- RPF
What kind of drugs inhibit the afferent renal arteriole? NSAIDS
The use of NSAIDS causes ____________________ of the ____________ arteriole. Vasoconstriction ; Afferent
What medication types cause a dilation of the afferent arteriole? Prostaglandins
Angiotensin II preferential ___________ ___________ arteriole. Constricts efferent
What is the effect in the efferent arteriole of an ACE inhibitor? Vasodilation
In reference to renal filtration what does the mnemonic PDA stands for? Prostaglandins Dilate Afferent arteriole
In reference to renal filtration, what does the mnemonic ACE stands for? Angiotensin II Constricts Efferent arteriole
In simple words, what is meant by a substance been secreted? Going from the vasa recta/ or Peritubular arteriole into the renal glomerular tubule system
If a substance goes from the lumen of the PCT into the vasa recta, is its said it has been ___________________. Reabsorbed
Any substance is considered FILTERED if goes from: The Bowman space into the PCT
What is the main effect in glomerular dynamic in case of dehydration? Severely decrease in RPF
What action can cause a decrease in both glomerular dynamics, GFR and RPF, but no changes in FF? Afferent arteriole constriction
Increase in plasma protein concentration causes what kind of changes in glomerular dynamics? Decrease in GFR and FF, but no changes in RPF
How is RPF affected in cases of changes of plasma protein concentration? Unaffected
What causes the greatest change or decrease in RPF? Dehydration
What action is the only one that keeps the FF unaffected? Afferent arteriole constriction
The constriction of the efferent arteriole due to angiotensin II, causes the following glomerular dynamic changes: Increase in GFR and FF, and a decrease in RPF
Where is glucose completely reabsorbed in the renal system? Proximal convoluted tubule (PCT)
What mechanism in the PCT is used to reabsorb glucose? Na+/glucose cotransporter
In adults, at what value of plasma glucose, starts the evidence of glucosuria? 200 mg/dL
At what value or point are all transporters in charge of glucose reabsorption at PCT fully saturated? 375 mg/min
What condition, causes to lower the threshold of glucosuria? Anything that raises Filtration
What kind of drugs are intended or used to lower the threshold of glucose and have glycosuria at levels lower than 200 mg/dL? Sodium-glucose cotransporter (SGLT2) inhibitors
What is the "Splay phenomenon"? Tm for glucose is reached gradually rather than sharply due to the heterogeneity of nephrons
How is the "slay" in glucose reabsorption graph represented? Portion f of titration curve between threshold and Tm.
Which part of the nephron reabsorbs most of the Na+? Early PCT
Which substances are completely reabsorbed in the PCT? Glucose and Amino Acids
Where do most of K+, Cl-, phosphate, bicarbonate, Na+, water and uric acid reabsorption occur in the nephron? Early PCT
Which are two common hormones and/or proteins that act on the PCT? PTH and AT II.
What is the role of PTH in the PCT? Inhibition of the Na+/phosphate cotransport, which eventually leads to Phosphate excretion
What is the role or function of AT II in the early PCT? Stimulation of Na+/H+ exchange, which leads to Increased reabsorption of Sodium, water, and bicarbonate.
What is the result of the increased reabsorption of Na+, water, and bicarbonate in the PCT due to AT II? Contraction alkalosis
What compound is generated and secreted in the PCT ? NH3
What is the role or function of NH3 generation and secretion in the PCT? Enables the kidney to secrete more H+.
What is the physiologic role of the Thin descending loop of Henle? Passively reabsorbs water via medullary hypertonicity
Which part of the nephron makes urine hypertonic? Thin descending loop of Henle
What area of the loop of Henle is known as the concentrating segment? Thin descending loop of Henle
The Thin descending loop of Henle is impermeable to: Na+
Which part of the loop of Henle is impermeable to water? Thick ascending loop
What is directly reabsorb by the Thick ascending loop of Henle? Na+, K+, and Cl-
What is indirectly reabsorbed in the Thick ascending loop of Henle? Mg2+ and Ca2+
Urine becomes _______ concentrated as it ascends the Thick loop of Henle. Less
What causes the indirect paracellular reabsorption of Mg2+ and Ca2+ in the Thick ascending loop of Henle? K+ backleak
Which part of the nephron has hypotonic urine? Early DCT
What ions or electrolytes are reabsorbed in the early DCT? Na+ and Calcium
The DCT is impermeable to _____________. Water
How does PTH work on the DCT? Increase the Ca2+/Na+ exchange ----> Ca2+ reabsorption
What is the physiologic role of the Collecting tubules of the Nephron? Reabsorbs Na+ in exchange for secreting K+ and H+
What mineralocorticoid regulates the reabsorption of Na+ in the Collecting tubules of the Nephron? Aldosterone
Which are the two types of cells in which Aldosterone act upon in the Collecting tubes of the Nephron? Principal cells and a-intercalated cells
What is the result of Aldosterone interacting with the Principal cells in the Collecting tubes? Increase: apical K+ conductance, Na/K pump, epithelial Na channel activity, leading to lumen negativity, which then results in K+ secretion.
What is happens as Aldosterone interacts with a-intercalated cells of the Collecting tubule? The lumen negativity leads to Increase in H+ ATPase activity, leading to H+ secretion, which then results in an increase in bicarbonate/Cl- exchanger activity.
ADH interacts the _____ receptor of the Collecting tubules. V2
What is the result of ADH interaction at the Collecting tubule's V2 receptors? Insertion of aquaporin H2O channels on the apical side.
What is the renal tubular defect seen at the PCT? Fanconi syndrome
What is the renal tubular defect in the Thick ascending loop of Henle? Bartter syndrome
Which part of the nephron has a renal tubular defect in Gitelman syndrome? PCT
Which are the two known renal tubular defects of the Collecting tubules of the Nephron? Liddle syndrome and Syndrome of Apparent Mineralocorticoid Excess.
What is the defect in nephron seen in Fanconi syndrome? Generalized reabsorption defect in PCT, which leads to increased excretion of amino acids, glucose, bicarbonate and phosphate, among other substances reabsorbed in the PCT.
What are the electrolyte effects seen in Fanconi syndrome? Metabolic acidosis (proximal RTA), hypophosphatemia, and osteopenia.
Which drugs are associated to the development of Fanconi syndrome? Ifosfamide, cisplatin, and expired tetracyclines
Which renal tubular defect presents similar fashion as chronic use of loop diuretics? Bartter syndrome
What is the main defect in Bartter syndrome? Resorptive defect in thick ascending loop of Henle, that mainly affects the Na+/K+/2Cl- cotransporter.
Defective Na+/K+/2Cl- cotransporter. Diagnosis? Bartter syndrome
What electrolyte imbalances are seen with Bartter syndrome? Metabolic alkalosis, hypokalemia, and hypercalciuria.
Fanconi syndrome develops metabolic ________________, while Bartter syndrome is classically seen with metabolic ____________. Fanconi ---- acidosis Bartter ------ alkalosis
Which three renal tubular syndromes are AR inheritance? Bartter, Gitelman, and SAME
What renal tubular defect is due to reabsorption defect of NaCl in DCT? Gitelman syndrome
Which of the renal tubular defects is the only one seen with developing metabolic acidosis? Fanconi syndrome
Presents similarly to lifelong thiazide diuretic use. Dx? Gitelman syndrome
What is a key electrolyte imbalance seen in Gitelman syndrome? Hypomagnesemia, and hypocalciuria
Which syndrome is more severe, Bartter or Gitelman syndrome? Bartter syndrome
Which renal tubular defect presents similar to hyperaldosteronism, but with aldosterone almost undetectable? Liddle syndrome
What is the cause of Liddle syndrome? Gain of function mutation --> Increase activity of Na+ channel -----> Increase Na+ reabsorption in collecting tubules
Metabolic alkalosis, low serum K+, hypertension, and low/undetectable aldosterone. Most likely diagnosis? Liddle syndrome
What is the MC treatment of Liddle syndrome? Amiloride
What enzyme deficiency is related to SAME? 11B- hydroxysteroid dehydrogenase
What is the role of 11B-hydroxysteroid dehydrogenase in cells with mineralocorticoid receptors? Conversion of cortisol into cortisone
In cases of SAME, the deficiency of 11B-hydroxysteroid dehydrogenase, leads to: Excess cortisol ---> Increased mineralocorticoid receptor activity
What is the main treatment for SAME? K-sparing diuretics or corticosteroids
What is the purpose of using K+-sparing diuretics in the treatment of SAME? Decrease mineralocorticoid effects
What common substance is often indicated with the highest value of secretion and concentration along the PCT? PAH
Which common substance has a very low depiction in the Relative concentrations along PCT curve? Glucose and amino acids (glucose the lowest)
Why do Tubular inulin concentration increases along the length of the PCT? As result of water reabsorption
If the [TF/P] > 1, it means: Solute is secreted and water is reabsorbed less quickly than the solute.
What is the action of Aldosterone on a-intercalated cells? Promote H+ secretion due to increased activity of H+ ATPase
Which two substances act on the Principal cells of the the collecting tubules? Aldosterone and ADH
What is the result of aldosterone interaction with the Principal cells? Sodium reabsorption and K+ secretion due to increase K+conductance, Na/K ATPase activity, and ENaC activity.
Which cells secrete Renin? JG cells
Why do JG cells secrete Renin? In response to: 1. decreased renal perfusion pressure, 2. Increase renal sympathetic discharge (B1 effect), and , 3. Decreased NaCl delivery to macula densa cells
Which kind of receptors detect a decrease in renal perfusion pressure? Renal Baroreceptors in the Afferent arteriole
What is the main function or role of AT II? Maintain blood pressure and blood volume
Which common endogenous enzyme limits reflex bradycardia, in cases of using a pressors in a patient? AT II
Which substances serve as "check" on renin-angiotensin-aldosterone system? ANP and BNP
What are the actions resulting of ANP and BNP activity? Dilates afferent arteriole, Constricts efferent arteriole, Promotes Natriueresis
ANP causes ___________ in afferent arteriole. Dilation
BNP and ANP cause the efferent arteriole to ________________. Constrict
Which endogenous cardiac protein is secreted in order to promote natriuresis? ANP (from atria) and BNP (from ventricles)
What substance primarily regulates ECF and Na+ content? Aldosterone
What is the role of Renin in Angiotensin pathway? Converts Angiotensinogen into Angiotensin I
Which organs can secrete ACE? Lungs and Kidneys
What is the Juxtaglomerular apparatus? Consists of mesangial cells, JG cells, and the macula densa.
What is the role of the JGA (Juxtaglomerular apparatus)? Maintains GFR via renin-angiotensin-aldosterone system.
What is the Macula densa, and where is it located? NaCl sensor, located at distal end of loop of Henle
What happens when the Macula densa senses a decrease in NaCl delivery to the DCT? Increase renin release, which cause efferent arteriole vasoconstriction ==> Increased GFR.
What kind of antiarrhythmics can cause inhibition of B1-receptors of the JGA causing a decrease renin release? B-blockers
What cells release Erythropoietin? Interstitial cells in peritubular capillary bed
EPO is release as a response to ___________________. Hypoxia
RBC proliferation in bone marrow is stimulated by? Erythropoietin
How is the PCT involved in vitamin D metabolism? Converts 25-OH vitamin D3 to 1, 25-(OH)2 vitamin D3
What is the name of 1, 25-(OH)2 vitamin D3? Calcitriol, active form
What is the enzyme used to convert Vitamin D3 into its active form in the PCT? 1a-hydroxylase
What hormone catalyzes the action of 1a-hydroxylase? PTH
What is the role of Dopamine by PCT cells? Promotion of natriuresis
Dopamine in low doses causes _________________ in arterioles. Vasodilation
High doses of dopamine causes __________, contrary to low doses. Vasoconstriction
What conditions cause hypokalemia due to shifts of K+ into cells? Hypo-osmolarity, alkalosis, B-adrenergic agonist, Insulin
Shifts K+ out of the cell causes --> Hyperkalemia
What are some conditions that cause hyperkalemia by K+ shifts out of the cell? Digitalis, Hyperosmolarity, Lysis of cells, Acidosis, B-blockers, high blood sugar, and Succinylcholine.
What are clinical presentation of Low Na+ concentration? Nausea and malaise, stupor, coma, seizures
How is hypernatremia is clinically presented? Irritability, stupor, coma
What EKG changes are seen with hypokalemia? U waves and flattened T waves
Hypokalemia is seen clinically with? Arrhythmias, muscle cramps, spasm, weakness
What EKG changes are seen with high serum concentration of Potassium? Wide QRS and peaked T waves
How is hypocalcemia clinically presented? Tetany, seizures, QT prolongation, twitching (Chvostek sign), spasm (Trousseau sign).
(+) Chvostek and Trousseau signs are presented with _____________. Hypocalcemia
What are some signs of low serum Mg2+ concentration? Tetany, torsades de pointes, hypokalemia, and hypocalcemia
A person with elevated serum levels of Mg2+? Decreased DTRs, lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia
Low phosphate in blood is seen with: Osteomalacia (adults) and Rickets (children)
What is the most significant change in Conn syndrome? Elevated aldosterone
What renal disorders have most significantly low aldosterone levels? Liddle syndrome, and SAME
What is the main electrolyte clue and/or change in Bartter syndrome? Increased urine calcium
What is the compensatory response form Metabolic acidosis? Hyperventilation
A patient with Metabolic alkalosis is immediately compensated? Hypoventilation
What electrolyte change is most important in Metabolic acidosis/alkalosis? Bicarbonate
Increase in [HCO3-] creates metabolic________________. Alkalosis
Increased renal [HCO3-] reabsorpton is compensatory of: Respiratory acidosis
A change in partial carbon dioxide (PCO2), will cause a respiratory or metabolic change? Respiratory
What are the common causes of Respiratory Acidosis? Airway obstruction, Acute lung disease, Chronic lung disease, Opioids, sedatives, weakening of respiratory muscles.
If a condition makes respiration difficult or weak, the patient is likely to develop: Respiratory acidosis
The loss of H+ or the excess of bicarbonate lead to ---> Metabolic alkalosis
What are some causes of Metabolic alkalosis? Loop diuretics, Vomiting, Antacid use, and Hyperaldosteronism
What conditions are associated Respiratory alkalosis? Anxiety/ panic attack, Hypoxemia, Salicylates, tumor, and pulmonary embolism.
Normal anion gap metabolic acidosis is caused by: Hyperalimentation, Addison disease, Renal tubular acidosis, Diarrhea, Acetazolamide, Spironolactone, Saline infusion.
Increase anion gap metabolic acidosis is a caused by: Methanol, Uremia, Diabetic ketoacidosis, Propylene glycol, Iron tablets, INH, Lactic acidosis, Ethylene glycol, and salicylate (late)
What is the main defect of Renal Tubular acidosis type I? Inability of a-intercalated cells to secrete H+ ----> no new bicarbonate is generated leading to ---> metabolic acidosis
What is the urine pH in RTA type I? > 5.5
What are some common causes of RTA I? Amphotericin B toxicity, analgesic nephropathy, congenital anomalies of urinary tract, and autoimmune diseases such as SLE.
Distal renal tubular acidosis type I is associated with: - Increased risk for calcium phosphate kidney stones
Why is there an increase risk of Ca-phosphate kidney stones in RTA I patients? Increase urine pH and Increased bone turnover
What type of electrolyte disorder is caused by all types of RTA? Normal anion gap (hypochloremic) metabolic acidosis
What is the pH of RTA II and RTA IV? < 5.5
What is the main defect in Proximal RTA II? Defective PCT bicarbonate reabsorption --> Increase excretion of bicarbonate in urine ----> metabolic acidosis
What are some causes of Proximal RTA II? Fanconi syndrome, multiple myeloma, carbonic anhydrase inhibitors
What is an associated risk of Proximal RTA II? Hypophosphatemic rickets in Fanconi syndrome
Hyperkalemic Tubular acidosis main defect is: Hypoaldosteronism or aldosterone resistance; hyperkalemia ---> decreased NH3 synthesis in PCT ------> decreased NH4+ excretion
What is the level (high or low) of K+ in Distal RTA and Proximal RTA II? Low serum K+ levels
Which type of RTA is the only one seen with Hyperkalemia? Type IV
What are the main two categories that cause RTA IV? 1. decreased aldosterone production 2. Aldosterone resistance
Examples of conditions that may decrease the production of aldosterone? Diabetic hyporeninism, ACE inhibitors, ARBs, NSAIDs, heparin, cyclosporine, adrenal insufficiency
What are examples that demonstrate aldosterone resistance? K+-sparing diuretics nephropathy due to obstruction, TMP-SMX use.
What does the presence of cast indicate? Hematuria /pyuria is of glomerular or renal tubular origin
What conditions show RBC casts? Glomerulonephritis and hypertensive emergency
In which conditions can we find WBC casts? Tubulointerstitial inflammation, acute pyelonephritis, and transplant rejection
Fatty casts are also known as: Oval fat bodies
What conditions have the presence of Fatty casts? Nephrotic syndrome
What is an associated sign of Fatty casts? "Maltese cross" sign
What kind of casts are found in Acute tubular necrosis (ATN)? Granular ("muddy brown") casts
Waxy casts are seen with: End-stage renal disease/ chronic renal failure
A patient with a long stand Hx of CKD, most likely will present with what kind of casts in the urine? Waxy casts
Which kind of casts may be considered a normal finding in urine analysis? Hyaline casts
It is defined as focal is the ________ of glomerulus is damaged or involved. < 50%
What term or nomenclature is used to describe a condition in which more than 50% of the glomeruli is involved? Diffuse
What are examples of Secondary glomerular diseases? SLE and Diabetic nephropathy.
Which are the 2 Nephritic-Nephrotic syndromes? 1. Diffuse proliferative glomerulonephritis 2. Membranoproliferative glomerulonephritis
What amount of protein per day must be lost in order to be consider a nephrotic syndrome? >3.5 g/ day
What kind of damage is the main cause of Nephrotic syndrome pathologies? Podocyte disruption which lead to charge barrier impaired.
What are the common Nephrotic syndrome diseases? 1. Focal segmental glomerulosclerosis 2. Minimal change disease 3. Membranous nephropathy 4. Amyloidosis 5. Diabetic glomerulonephropathy
What are the most common Nephritic syndrome examples? 1. Acute poststreptococcal glomerulonephritis 2. Rapidly progressive glomerulonephritis 3. Iga nephropathy (Berger disease) 4. Alport syndrome 5. Membranoproliferative glomerulonephritis
What kind of glomerular diseases are due to GBM disruption? Nephritic syndromes
What are key characteristics of all Nephritic syndrome? Hypertension, Increased BUN and Creatine, oliguria, hematuria, RBC casts in urine.
Which are the key characteristics of Nephrotic syndrome? Massive proteinuria with hypoalbuminemia, resulting edema, hyperlipidaemia, and frothy urine with fatty casts.
What are state is associated with Nephrotic syndrome pathology? Hypercoagulable state due to antithrombin (AT) III loss in urine and increase risk of infection.
What is the MCC of nephrotic syndrome in children? Minimal change disease
What are some common triggers for MCD? Recent infection, immunization, immune stimulus.
What kind of treatment has excellent response to Primary MCD? Corticosteroids
What is the EM of MCD? Effacement of podocyte foot processes
How is the glomeruli in MCD under LM? Normal glomeruli
What is the most common cause of nephrotic syndrome African-Americans and Hispanics? Focal segmental glomerulosclerosis
Focal segmental glomerulosclerosis is often secondary to: HIV infection, sickle cell disease, heroin abuse, massive obesity, interferon treatment, or congenital malformations
Inconsistent response to corticosteroids in Focal segmental glomerulosclerosis leads to: Chronic kidney disease
What is the LM description of FS glomerulosclerosis? Segmental sclerosis and hyalinosis
IF in Focal Segmental glomerulosclerosis? Negative but may (+) for nonspecific focal deposits of IgM, C3, and C1.
Membranous nephropathy is can be primary due to: - Antibodies to phospholipase A2 receptor
What are secondary causes of Membranous nephropathy? Drugs such as NSAIDs, penicillamine, gold, or Infections such as HBV, HCV, syphilis, and other SLE and solid tumors
What nephrotic syndrome has LM described as diffuse capillary and GBM thickening? Membranous nephropathy
IF in Membranous nephropathy is? granular due to IC deposition
EM described as "spike and dome" appearance of subepithelial deposits. Dx? Membranous nephropathy
Another name of Membranous nephropathy? Membranous glomerulonephritis
How does Membranous nephropathy respond to corticosteroids? Poorly
What is the LM description of Amyloidosis? Congo red stain shows apple-green birefringence under polarized light due to amyloid deposition in the mesangium.
What is the most involved organ in Amyloidosis? Kidney
What is the MCC of End-stage Renal Disease (ESRD) in the United States? Diabetic glomerulonephropathy
What is the result of hyperglycemia in Diabetic glomerulonephropathy? Nonenzymatic glycation of tissue protein ---> Mesangial expansion; GBM thickening and increased permeability
What is seen in the LM of Diabetic glomerulonephropathy? Mesangial expansion, GBM thickening, eosinophilic nodular glomerulosclerosis
What is the WBC seen in Diabetic glomerulonephropathy? Eosinophils
What are the Kimmelstiel -Wilson lesions? Eosinophilic nodular glomerulosclerosis seen in Diabetic glomerulonephropathy
Nephritic syndrome is considered an ________________________ process. Inflammatory
What structure needs to be involved in nephritic syndromes in order to present with hematuria and RBC casts in urine? Glomeruli
Nephritic syndromes are associated with what clinical features? Azotemia, oliguria, hypertension, proteinuria, hypercellular/inflamed glomeruli on biopsy.
What type of nephritic syndrome is most common seen children? Acute poststreptococcal glomerulonephritis
Common cause/Hx for Acute PSGN? 2-4 weeks after group A streptococcal infection of pharynx or skin
What kind of bacteria is involved in PSGN? Group A Streptococcus
PSGN is an type ______ hypersensitivity reaction. III
What are the clinical features of PSGN? Peripheral and periorbital edema, cola-colored urine, and HTN
What are common lab results for a patient with PSGN? (+) strep titers/ serologies, and decreased complement levels (C3) due to consumption
What is the LM of PSGN? Glomeruli enlarged and hypercellular
"starry sky" granular appearance ("lumpy-bumpy") due to IgG, IGgM, and C3 deposition along GBM and mesangium. Describes? IF findings of PSGN
PSGN EM description is: Subepithelial immune complex humps
Which nephritic syndrome is related to the shape "crescentic"? Rapidly Progressive glomerulonephritis
What is the main LM description of RPGN? Crescent moon shape
What is the composition of crescents seen in RPGN? Fibrin and plasma proteins (C3b) with glomerular parietal cells, monocytes, and macrophages
The different disease process that lead to RPGN are differentiated by what type of pattern? IF pattern
What type of IF pattern is seen in RPGN due to Goodpasture syndrome? Linear IF due to antibodies to GBM and alveolar basement membrane.
What is the treatment for Goodpasture syndrome? Plasmapheresis
What are some key characteristics of Goodpasture syndrome? Hematuria/ hemoptysis; type III hypersensitivity reaction
RPGN due to Granulomatosis with polyangiitis has what kind of IF pattern? Negative IF/ Pauci-immune (no Ig/C3 deposition)
LM- "wire looping" of capillaries Diffuse proliferative glomerulonephritis
Diffuse proliferative glomerulonephritis often presents as: Nephrotic and Nephritic syndrome concurrently
What is the IF pattern seen in Diffuse proliferative glomerulonephritis? Granular
Which nephritic syndrome is described with EM of subendothelial and sometimes intramembranous IgG-based ICs often with C3 deposition? Diffuse proliferative glomerulonephritis
Another name for IgA nephropathy? Berger disease
Episodic hematuria that occurs concurrently with respiratory of GI tract infections? IgA nephropathy
What renal pathology is highly associated with HSP? IgA nephropathy
Which Nephritic syndrome IF, EM,and LM is related to mesangium description? IgA nephropathy
IgA-based IC deposits in mesangium, describes? IF findings in Berger disease
Mutation type IV collagen. Dx? Alport syndrome
What is the result of mutation type IV collagen in Alport syndrome? Thinning and splitting of glomerular basement membrane.
What is the most common type of inheritance of Alport syndrome? X-linked dominant
What are the clinical features seen with Alport syndrome? Eye problems (retinopathy, lens dislocation), glomerulonephritis, sensironurularl deafness
What is the classical description of Alport syndrome EM view? "Basket-weave"
What type of hearing loss or deafness is developed in Alport syndrome? Sensorineural deafness
What are common infections that develop Type 1 Membranoproliferative glomerulonephritis? Hepatitis B or C infection
IF of Type 1 Membranoproliferative glomerulonephritis? Subendothelial IC deposits with granular IF
What nephritic factor is associated with Type 2 Membranoproliferative glomerulonephritis? C3
What is the role of C3 nephritic factor? IgG antibody that stabilized C3 convertase ---> persistent complement activation ---> decrease C3 levels
The IgG antibody stabilization of C3 convertase is due to what specific factor activity? C3 nephritic factor
What is another name for the Intramembranous deposits seen in type 2 membranoproliferative glomerulonephritis? Dense deposit disease
What some characteristics that both, type 1 and 2 membranoproliferative glomerulonephritis present? GBM splitting --> "tram-track" appearance on H&E and PAS stains
What are stains often mentioned or used to depict the mesangial ingrowth of membranoproliferative glomerulonephritis? H&E and PAS
What are serious complication of Kidney stones? Hydronephrosis and Pyelonephritis
What is the typical clinical presentation of kidney stones in patient? Unilateral flank tenderness, colicky pain radiating to groin, and hematuria
What is the MC kidney stone presentation? Calcium oxalate stone in patient with hypercalciuria and normocalcemia
What is the MC urine Calcium level seen in a patient with a kidney stone? Elevated Calcium urine level
What is the serum level MC seen in a patient with an Calcium-oxalate kidney stone? Normal calcium level
What are the two types of Calcium kidney stones? Calcium oxalate (hypocitraturia) and Calcium phosphate
What is the description of the Urine crystal of Calcium oxalate kidney stone? Shaped like envelope or dumbell
Enveloped or dumbbell shaped kidney stone? Calcium oxalate
Hypocitraturia is associated with: Calcium oxalate nephrolithiasis due to decreased urine pH.
What are the most common type of Calcium kidney stones Calcium oxalate
What are some common causes of development of Calcium oxalate kidney stones? Ethylene glycol (antifreeze) ingestion, vitamin C abuse, hypocitraturia, and malabsorption (Crohn's disease).
What type of IBS syndrome is often associated with Calcium oxalate kidney stone formation? Crohn disease
What is the MC treatment for all Calcium kidney stones? Thiazides and low-sodium diet
What are the CT and X-ray findings of Calcium stones? Radiopaque
Increased pH can precipitate which kind of Calcium stone? Calcium phosphate
An decreased in pH value (acidosis) is commonly related precipitation of which calcium kidney stone? Calcium oxalate
Which is the "basic"/"alkalotic" precipitated calcium kidney stone? Calcium phosphate
Which are the two types of kidney stones that precipitate with an increase (alkalotic change) in pH? Calcium phosphate and Ammonium-Magnesium-Phosphate stones
What is the shape of struvite stones? Coffin lid
What is another name for ammonium magnesium phosphate kidney stones? Struvite
What kind of organisms (bugs) cause Struvite formation? Urease (+)
What are some organisms that are urease (+)? Proteus mirabilis, Staphylococcus saprophyticus, and Klebsiella
How do urease (+) organisms cause struvite formation? Urease (+) busgs hydrolyse urea into ammonia -->Urine alkalization
Staghorn calculi refers to? Ammonia Magnesium Phosphate renal stones
What is the treatment for Struvite calculi? Treat underlying infection and surgical removal of calculi
Rhomboid or rosettes urine crystal indicate? Uric acid stone
What are the CT/and X-ray findings of Struvite? Radiopaque
A ________ in pH leads to Uric acid renal stone formation. Decrease
Which two, non-calcium, renal stones require acidic environments in order to precipitate? Uric acid and Cystine stones
What are some strong diseases and conditions that lead to Uric acid renal stone formation? 1. Hyperuricemia (gout) 2. Disease with increased cell turnover (Leukemia)
Patient with podagra, may develop more readily what kind of renal calculi? Uric acid stone
What is the treatment indicated for Uric acid kidney stone? - Alkalinization of urine, and, - Allopurinol
What is the description of Uric Acid stone under X-ray image? Radiolucent
Which type of renal calculi is minimally visible in CT scan? Uric acid stone
Cysteine kidney stone is in what shape? Hexagonal
What type of renal stone is seen with a (+) Sodium Cyanide nitroprusside test? Cystine
What is the treatment of Cystine stones? Low-sodium diet, alkalinization of urine, and chelating agents if refractory
Defects that cause a an serum increase in cysteine levels are often associated with what kind of renal stones? Cystine
What is a common AR defect that can cause cystinuria, and eventually cystine stones? Cystine-reabsorbing PCT transporter losses function
What are 4 common amino acids seen with defective cysteine-reabsorption PCT reabsorption function? COLA: Cysteine, Ornithine, Lysine, and Arginine
What is plasmapheresis? Process in which liquid part of blood, the plasma, is separated from the red blood cells.
Why is plasmapheresis used in Goodpasture syndrome as treatment? The plasma of the blood contains the antibodies that affect the immune system, thus, separating the plasma allow for removal of autoantibodies in GPS.
What is hydronephrosis? Distension/dilation of renal pelvis and calyces
What are the main causes of Hydronephrosis? 1. Urinary tract obstruction 2. Retroperitoneal fibrosis 3. Vesicoureteral reflux
What are some common UT obstructions that cause hydronephrosis? Renal stones, severe BPH, congenital obstructions, cervical cancer, and injury to ureter
Where does dilation occur in hydronephrosis? Proximal to site of pathology
What conditions of hydronephrosis may lead to an increase in serum creatine? 1. Bilateral obstruction or, 2. Obstructed solitary kidney
What are some possible complications of untreated hydronephrosis? Compression and atrophy of renal cortex and medulla
What is the most common primary renal malignancy? Renal cell carcinoma
Polygonal clear cells filled with accumulated lipids and carbohydrate. Often golden-yellow due to increased lipid contedn. MC malgnanc? Renal cell carcinoma
Where does RCC originates in the nephron? PCT
What could be serious complication is RCC invades the LEFT renal vein? Varicocele
What is the first and second vascular structures that RCC invades in its path to lung and bone metastasis? First the renal vein and then the IVC.
What is the common clinical picture of RCC patient? Manifest with hematuria, palpable masses, secondary polycythemia, flank pain, fever and weight loss
What type of renal malignancy is resistant to chemotherapy and radiation therapy? Renal cell carcinoma
What is a common medication in the treatment of RCC once it cause a disseminated condition? Aldesleukin
What are some risk factors or conditions for RCC development? 1. Age -- 50-70 years old 2. Smoking 3. Obesity
What type of renal cancer is associated with Paraneoplastic syndromes? Renal cell carcinoma
What are some associated paraneoplastic syndromes in RCC? PTHrP, Ectopic EPO, ACTH, and Renin
What is a common AD condition associates with Renal cell carcinoma? von Hippel-Lindau syndrome
vHL disease is associated with which chromosome gene deletion? Chromosome 3
Renal oncocytoma? Benign epithelial cell tumor arising from collecting ducts.
Where in the nephron does a renal oncocytoma most likely arises from? Collecting ducts
What is a common histologic description of Renal oncocytoma? Large eosinophilic cells with abundant mitochondria without perinuclear clearing
What is a more common name for Nephroblastoma? Wilms tumor
What is the most common child (2-4 years old) renal malignancy? Wilms tumor
What malignancy is due to a "loss of function" mutations of tumor suppressor genes WT1 and WT2 on chromosome 11? Wilms tumor
WT1 and WT2 are both: Tumor suppressor genes
What are the 3 most common syndromes in which Wilms tumor may be a part of? 1. WAGR complex 2. Denys-Drash syndrome 3. Beckwith-Wiedemann syndrome
What are the common components of WAGR complex? Wilms tumor, Aniridia, Genitourinary malformations, mental retardation/intellectual disability
What is aniridia? Absence of iris
What is Denys-Drash syndrome? Condition in which Wilms tumor often seen, along with Diffuse mesangial sclerosis (early nephrotic syndrome), and dysgenesis of gonads
WAGR complex is usually due to a _______ of ______ gene. Deletion of WT1 gene
What syndrome is often seen with a WT1 mutation? Denys-Drash syndrome
What Wilms tumor-related syndrome arises from WT2 mutation? Beckwith-Wiedemann syndrome
Wilms tumor, macroglossia, organomegaly, and hemihyperplasia. Dx? Beckwith-Wiedemann syndrome
What is another name for Transitional cell carcinoma? Urothelial carcinoma
What is the MC tumor of the urinary tract system? Transitional cell carcinoma
Where in the urinary tract system can TCC can occur? Renal calyces, renal pelvis, ureters, and bladder
What is common and key clinical sign of TCC? Painless hematuria with no casts
What are associated problems with Transitional cell carcinoma (TCC)? Phenacetin, Smoking, Aniline dyes, and Cyclophosphamide
Aniline dyes are often associated with the development of which kind of renal cancer? Transitional cell carcinoma
What is the pathogenesis of the development of Squamous cell carcinoma of the bladder? Chronic irritation of urinary bladder --> squamous metaplasia --> dysplasia and squamous cell carcinoma
What are some associated risk factors or Squamous cell carcinoma of the bladder? 1. Schistosoma haematobium infection (Middle East) 2. Chronic cystitis, smoking, chronic nephrolithiasis
Squamous cell carcinoma of the bladder presents with _____________ hematuria. Painless
What specie of Schistosoma is associated with the development of Squamous cell carcinoma of the Bladder? Haematobium
What is the cause for Stress incontinence? 1. Urethral hypermobility, or, 2. Intrinsic sphincteric deficiency
What is the treatment for Stress incontinence? 1. Pelvic floor muscle strengthening (Kegel) exercises 2. Weight loss 3. Pessaries
Outlet incompetence describes more closely what type Urinary incontinence? Stress
What type of urinary incontinence is seen with leak with increased intra-abdominal pressure? Stress
What are some actions that can cause sudden increase in intra abdominal pressure and cause urine involuntary leakage? Sneezing, cough, lifintn
What are some associated risk factors of Stress Urinary incontinence? Obesity, vaginal delivery, prostate surgery
A positive bladder test. Dx? Stress urinary incontinence
Urgency incontince is due to: Overactive bladder --> leak with urge to void immediately
Detrussor instability is cause of what type of urinary incontince? Urgency
UTI are often associated with ________ incontinence. UTI
What kind of drugs are often used to treat urgency urinary incontinence? Antimuscarinics (oxybutynin)
Patient on Oxybutynin. Suspect dx? Urgency incontinence
What urinary incontinence is due to to detrusor underactivity and/or outlet obstruction? Overflow incontinence
Incomplete emptying --> leak with overfilling, describes what type of urine incontinence? Overflow
What are some conditions associated with overflow incontinence? -Polyuria (diabetes), Bladder outlet obstruction (BPH), neurogenic bladder (MS)
What is the treatment for overflow incontinence? Catheterization and relive obstruction
What type of drugs can be used to treat the overflow incontinence in a patient with severe BPH? Beta blockers
Urinary tract infection is often referred as: Acute bacterial cystitis
What is UTI? Inflammation o f urinary bladder
How is UTI clinically presented? Suprapubic pain, dysuria, urinary frequency, urgency. Usually no systemic symptoms.
What are the most common risk factors for developing UTI? 1. Female gender (short urethra), 2. Sexual intercourse ("honeymoon cystitis") 3. Indwelling catheter 4. DM 5. Impaired bladder emptying.
What is the most common organism to cause an UTI? E. coli
What is the second most common UTI-causing organism in a young sexually active women? Staphylococcus saprophyticus
What UTI-causing organisms produces ammonia scent in urine? Proteus mirabilis
What lab findings in UA indicate UTI infection due to gram negative organisms? (+) Nitrites
What does Sterile pyuria and (-) urine cultures suggest as causing organism of an UTI? N. gonorrhea or Chlamydia trachomatis
What is (+) result indicates UTI (E.coli)infection? Leukocytes esterase
Why do women have higher risk of acquiring UTI? Due to shorter urethra than men
When does Acute pyelonephritis occur? As neutrophils infiltrate renal interstitium
What part of the urinary system is affected by pyelonephritis? Affects the cortex with relative sparing of glomerular/ vessels
What is the typical description of flank pain in pyelonephritis? Costovertebral angle tenderness
What are the two main causes of acute pyelonephritis? Ascending UTI (E. coli MC), and Hematogenous spread to kidney
What are some featured finding in the UA of a acute pyelonephritis patient? WBCs in urine and +/- WBC casts
What are common risk factors for Acute pyelonephritis? Indwelling catheter, urinary tract obstruction, vesicoureteral reflux, DM, and pregnancy.
What are some concerning complications of acute pyelonephritis? Chronic pyelonephritis, renal papillary necrosis, perinephric abscess, urosepsis.
What two conditions are most commonly present in order to develop chronic pyelonephritis? Vesicoureteral reflux and chronically obstructed kidney stones
What renal pathology is often referred with the description of "Thyroidization of kidney"? Chronic pyelonephritis
What is the thyroidization of kidney? Tubules can eosinophilic casts resembling thyroid tissue
What is Xanthogranulomatous pyelonephritis? Uncommon chronic destructive granulomatous process of the renal parenchyma;
What do the orange nodules in Xanthogranulomatous pyelonephritis may mimic? Tumor nodules
What type of infection is associated with development of Xanthogranulomatous pyelonephritis? Proteus infection
How is Acute Kidney injury defined? Abrupt decline in renal function as measured by increased creatine and increased BUN or by oliguria/anuria
What are the main 3 types of Acute Kidney injury? 1. Prerenal azotemia 2. Intrinsic renal failure 3. Postrenal azotemia
What is kind of Acute Renal injury is due to decreased RBF, such as hypotension? Prerenal azotemia
Why is the BUN:Cr ratio elevated in Prerenal azotemia? Urea is reabsorbed and not Creatine
What is the most common cause of Intrinsic renal failure? Acute Tubular necrosis from ischemia or toxins
What less common causes of Intrinsic renal failure? RPGN, Hemolytic uremic syndrome, or acute interstitial nephritis
What causes a decrease in GFR in a ATN patient with patchy necrosis? Debris obstructing tubule and flud black low across necrotic tubule
What type of urine cast asr found in ATN? Epithelial/granular casts
How is the BUN:Cr ratio of Intrinsic renal failure? Decreased
A BUN:Cr less than 15 indicates: Intrinsic renal failure
Prerenal azotemia has a BUN:Cr Greater than 20
What is the FE Na of Prerenal azotemia? <1%
FE NA > 2% is seen with: Intrinsic renal failure
Postrenal and Intrinsic renal failure have a Urine osmolality of: < 350
What is the common Urine osmolality value of Prerenal azotemia? > 500
What are some causes of Postrenal azotemia? Stones, BPH, neoplasia, congenital anomalies
What are the 2 forms of renal failure? 1. Acute (ATN) 2. Chronic (HTN, DM, congenital anomalies)
What is the definition of Renal failure? Decline in renal filtration can lead to excess retained nitrogenous waste products and electrolyte imbalances
What are the consequences of Renal failure? Metabolic Acidosis Dyslipidemia Hyperkalemia Uremia Na/water retention Growth retardation and developmental delay Erythropoietin failure Renal osteodystophy
What are the characteristics of Uremia due to renal failure? Nause, anorexia, Pericarditis, Asterixis, Encephalopathy, and platelet dysfunction.
What is azotemia? Abnormal condition due to abnormally high nitrogenous compounds in the blood.
Renal osteodystrophy is most commonly associated with which PTH condition? Secondary hyperparathyroidism
What is a common result of the bones in Renal Osteodystrophy? Thinning of the bones
Another term/name used for Acute Interstitial nephritis? Tubulointerstitial nephritis
Acute interstitial renal inflammation is: Acute interstitial nephritis
Acute interstitial nephritis is often due to: Administration of drugs that act as haptens, inducing hypersensitive.
What are some common drugs associated with the development of Acute Interstitial Nephritis? Diuretics, penicillins, proton pump inhibitors, sulfonamides, rifampin, NSAIDs
Pyuria with eosinophils and azotemia after administration of a new drug? Acute interstitial nephritis
What is the MCC of Acute Kidney injury in hospitalized patients? Acute Tubular Necrosis
What is the key finding in ATN? Granular ("muddy brown") casts
What are the most common Ischemic causes of ATN? Secondary to decreased RBF: - Hypotension, shock, sepsis, hemorrhage, HF
What re the most vulnerable areas of the nephron int ischemic injury in ATN? PCT and thick ascending loop of Henle
ATN secondary to nephrotoxic substances is seen with: Aminoglycosides, radiocontrast agents, lead, cisplatin, ethylene glycol, crush injury (myoglobinuria), hemoglobinuria
What part of nephron most susceptible to ischemic injury causing ATN? Proximal tubules
Acute generalized cortical infarction of both kidneys. Dx? Diffuse cortical necrosis
What is the MCC of Diffuse cortical necrosis? Combination of vasospasm an DIC
What are some association of Diffuse cortical necrosis? Obstetric catastrophes, and septic shock
Sloughing of necrotic renal papillae--> gross hematuria and proteinuria. Dx? Renal papillary necrosis
What conditions and drugs are closely associated to Renal Papillary Necrosis? Sickle cell disease or trait, acute pyelonephritis, NSAIDs, and Diabetes mellitus
What gene is the most common to cause ADPKD? PKD1 on chromosome 16
What is the most common causes of death in ADPKD? CKD or Hypertension caused by increased renin production
What are some common associations of ADPKD? Berry aneurysms, MVP, benign hepatic cysts, diverticulosis.
At what point should ADPKD is treated with ACE inhibitors and ARBs? If hypertension or proteinuria develops
Numerous cysts in cortex and medulla causing bilateral enlarged kidneys ultimately destroy kidney parenchyma. Dx? ADPKD
What gene mutation is accountable for only 15% of cases of ADPKD? PKD2 gene mutation in on chromosome 4
Cystic dilation of collecting ducts. Dx? ARPKD
Autosomal recessive polycystic kidney disease s most associated with ____________. Children
What is an important associative condition with ARPKD? Congenital hepatic fibrosis
What are some concerns beyond neonatal period in cases of ARPKD? Systemic HTN, progressive renal insufficiency, and portal hypertension form congenital hepatic fibrosis
What is another name for AD tubulointerstitial kidney disease? Medullary cystic kidney disease
What is Autosomal dominant tubulointerstitial kidney disease? Inherited disease causing tubulointerstitial fibrosis and prefessive renal insufficiency with inability to concentrate urine.
What part of the nephron does Mannitol acts on? PCT and Thin descending loop of Henle
Where in the nephron des Acetazolamide works? PCT
Loop diuretics work in the __________________________________. Thick ascending loop of Henle
Thiazide diuretics work on the _____________ of the nephron DCT
Which part of the nephron has K+sparing diuretics exert their action? Cortical part of the Collecting duct
What is the mechanism of action of Mannitol? Osmotic diuretic. Increased tubular fluid osmolarity --> increase urine flow, and decreases intranial/intraocular pressure
What the clinical use of Mannitol? Drug OD, elevated intracranial or intraocular pressures
What are some significant side effects of Mannitol? Pulmonary edema, dehydration, hypo-or hypernatremia.
What is the most significant adverse effect of Mannitol? Pulmonary edema
Carbonic anhydrase inhibitor diuretic? Acetazolamide
What is the mechanism of action of Acetazolamide? Carbonic anhydrase inhibitor. Cause self limited NaHCO3 diuresis and decrease total body HCO3- stonres
What are the most common clinical uses of Acetazolamide? Glaucoma, metabolic alkalosis, altitude sickness, pseudotumor cerebri. Alkalinizes urine
Which diuretic is commonly used to treat altitude sickness? Acetazolamide
Common diuretic used to alkalinizes urine Acetazolamide
Which diuretic can be used in the treatment of glaucoma? Acetazolamide
What are the associated adverse effects of Acetazolamide? Proximal RTA, paraesthesias, NH3 toxicity, sulfa allergy, and hypokalemia.
What type of renal stone is often precipitated in excess Acetazolamide therapy? Calcium phosphate stone formation due to high pH
Which are common Sulfonamide Loop diuretics? Furosemide, Bumetanide, and torsemide
What is the mechanism of action of Furosemide? Inhibit cotransport system (Na/K/2Cl) of thick ascending limb of loop of Henle.
What is the result in the mechanism of action of Loop diuretics? Abolish hypertonicity of medulla, preventing concentration of urine
What is release by the use of Loop diuretics? PGE which has an vasodilatory effect on the afferent arteriole
Loops lose _____. Ca2+
What diuretic promotes the excretion of Calcium ion? Loop diuretics
What is the non-sulfonamide loop diuretic? Ethacrynic acid
What edematous states are commonly treated with Loop diuretics? HF, cirrhosis, nephrotic syndrome, pulmonary edema
What are minor uses for Loop diuretics? Hypertension and Hypercalcemia
What are the most significant side effects of loop diuretics? Ototoxicity, hypokalemia, hypomagnesemia, dehydration, allergy (sulfa), metabolic Alkalosis, Nephritis (interstitial), and Gout
What is the difference in adverse effects between Furosemide and Ethacrynic acid? Ethacrynic acid is more ototoxic
What are common Thiazide diuretics? Hydrochlorothiazide, Chlorthalidone, and Metolazone
Which diuretics work by inhibiting NaCl reabsorption in early DCT leading to decreasing diluting capacity of the nephron? Thiazide diuretics
Which diuretics decrease Ca2+ excretion? Thiazide diuretics
What are some common uses for thiazides? Hypertension, HF, idiopathic hypercalciuria, nephrogenic diabetes insipidus, osteoporosis
What are some adverse effects of thiazide diuretic use? - Hypokalemic metabolic alkalosis - Hyponatremia - Hyperglycemia - Hyperlipidemia - Hyperuricemia - Hypercalcemia -Sulfa allergy
What are the most common Potassium-sparing diuretics? Spironolactone, Eplerenone, Amiloride, and Triamterene
Which two Potassium-sparing diuretics are competitive aldosterone receptor antagonists in the cortical tubule? Spironolactone and Eplerenone
What is the mode of action of Triamterene and Amiloride? Block Na+ channels at the cortical collecting tubule
What are some uses of all K+-sparing diuretics? Hyperaldosteronism, K+ depletion, HF, and antiandrogen
What is an exclusive use for amiloride? Nephrogenic DI
What is an exclusive Spironolactone clinical use? Hepatic ascites
What side effect of potassium-sparing diuretics can lead to arrhythmias? Hyperkalemia
What are the endocrine effects seen with the toxic use of Spironolactone? Gynecomastia and antiandrogen effects
A man with enlarging breast and HF, is probably taking which common diuretic? Spironolactone
Which diuretics cause an increase in urine NaCl? All diuretics
An increase in urine NaCl by diuretics, it may lead to: Decrease in serum NaCl
Which two kind of diuretics are especially significant for raising the level of urine K+? Loop and thiazide diuretics
Which diuretics cause an increase in urine Ca2+? Loop diuretics
Which diuretics cause a decrease in urine Ca2+? Thiazide diuretics
Which diuretics cause alkalemia? Loops and thiazides
Acidemia is caused by ___________________________. Carbonic anhydrase inhibitors.
What are common ACE inhibitors? Captopril, enalapril, lisinopril, and ramipril
What is the common suffix of ACE inhibitors --pril
What action is prevented by ACE-inhibitors at the efferent arteriole? Constriction
The levels of _____ are decreased with ACE-inhibitors and consequently it leads to a _______ ___________. AT II are decreased ----> decreased GFR
What enzyme is produced in response to the decrease GFR caused by Captopril? Increase in Renin
ACE inhibition has which secondary effect? Inactivation of bradykinin (potent vasodilator)
A diabetic patient with Hx of HTN should be placed on ___________ to prevent diabetic nephropathy. ACE inhibitors
What are some clinical uses for ACE inhibitors? Hypertension, HF, proteinuria, and diabetic nephropathy
How does ACE inhibitors are recommended in patients with diabetic nephropathy? Decrease intraglomerular pressure, slowing GBM thickening
Which adverse effects of ACE inhibitors are both due to incrased levels of Bradykinin? Cough and Angioedema
What are the teratogenic effects of ACE inhibitors? Fetal renal malformations
What are all adverse effects of ACE inhibitors? Cough, Angioedema, Teratogen, increased Creatine (decrease GFR), Hyperkalemia, and hypotension
ACE inhibitor toxicity is seen with low or high levels of serum K+? High
What is the main difference between ARB and ACE inhibitor toxicity? ARBs do not increase levels of bradykinin
What type of medication selectively block binding of ATII to AT1 receptor? ARBs
What is Aliskiren? Direct renin inhibitor
What is a common direct renin inhibitor? Aliskiren
What is prevented or blocked by Aliskiren? Conversion of Angiotensinogen into AT I
What is the MC use for Aliskiren? Hypertension
What are some adverse effects associated with Aliskiren? Hyperkalemia, decreased GFR, angioedema; contraindicated in pregnant women, and those on ACE-inhibitors and/or ARBs.
What is the most commonly referred ARB? Losartan
Created by: rakomi