Term
| What is the course of the ureters? |
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Definition
UNDER the uterine artery and UNDER the ductus deferens
Water under the bridge (artery, ductus) |
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Term
| What portion of total body weight is water? |
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Definition
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Term
| What creates the negative charge barrier of the glomerulus? When is this charge barrier lost? |
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Definition
Heparan sulfate
Lost in nephrotic syndrome |
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Term
| What things dilate the afferent arteriole? What things constrict the efferent arteriole? |
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Definition
Dilate afferent = prostaglandins
Constrict efferent = ATII
So NSAIDs act on the afferent and ACEi's act on the efferent to decrease GFR |
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Term
| At what glucose concentration does glucosuria occur? |
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Definition
350 mg/dL
transporters are fully saturated |
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Term
| What is Hartnup's disease? |
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Definition
deficiency of the neutral amino acid transporter that results in lack of reabsorption (mostly trptophan)
Causes pellagra (niacin syn from Trp) |
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Term
| What substances are reabsorbed in the proximal tubule? |
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Definition
Na, PO4, amino acids, glucose, lactate
H+ get secreted, also NH3 which buffers H+ |
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Term
| What does Angiotensin II do to the proximal tubule? |
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Definition
| Stimulates Na/H+ exchange causing Na and H2O reabs. Results in contraction alkalosis!! |
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Term
| Where do Mg and Ca get reabs? How do they affect each other? |
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Definition
thick ascending loop of henle
Hypercalcemia will cause increased Mg excretion, and vice versa (they are symported so an increase in one in the blood will lead to a decrease in the reabs of the other) |
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Term
| How can furosemide affect Ca excretion? |
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Definition
Can increase Ca excretion if fluid is replaced
B/c blocking the Na/K/2Cl transporter, so there is no gradient for Ca to be reabs |
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Term
| How does contraction alkalosis occur? |
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Definition
Volume contraction stimulates the action of ATII, causing Na/H exchange in the prox tubule (to increased BP), this results in increased H+ excretion and HCO3- reabs
(Think of the carbonic anhydrase stuff!) |
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Term
| Where does PTH act on the nephron? |
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Definition
Prox tubule: stim's Na reabs and PO4 excretion
DCT: stim's increased Ca/Na exchange (on basolateral surface), resulting in increased Na into cell and Ca into the blood)
Thiazides increase Ca reabs b/c block the Na/Cl transporter, which will reflexively stim the Na/Ca transporter on the other side (less Na reabs means more Na can move into the cell on the other side) |
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Term
| What affect does furosemide and thiazides have on Ca reabs? |
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Definition
Furosemide causes increased Ca excretion by blocking the transporter and decreasing the gradient for Ca reabs
Thiazides block the Na/Cl transporter, allowing increased Na into the cell (basolateral) which allows Ca movement into the blood |
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Term
| What is the effect of aldosterone of the collecting duct? |
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Definition
| inserts Na channels on the luminal side allowing Na reabs (can cause hypokalemia!) |
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Term
| What part of the nephron is the primary regulator of K+ levels? |
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Definition
| Cortical collecting duct via H/K ATPase (intercalated cell) |
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Term
| What are the primary responsibilities of the principle cells and intercalated cells of the collecting ducts? |
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Definition
Principle cells = Na/H2O reabs, K secretion
Intercalated cells: secrete H+ and reabs K by H/K ATPase |
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Term
| How much filtered urea is reabsorbed? |
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Definition
~50%
In the proximal tubule
Urea excretion varies w/ urine flow rate |
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Term
| What substances are mostly excreted by the nephron? (TF/P > 1) |
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Definition
PAH, Inulin, Creatinine, Urea, Cl
K and Na are mostly completely followed by water so TF/P~1 |
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Term
| What substances are mostly reabsorbed by the nephron? (TF/P<1) |
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Definition
| Glucose, Amino acids, bicarb, phosphate |
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Term
| What are the actions of ANP on the kidney? |
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Definition
Released from atria in response to increased volume
Relaxes vascular smooth muscle via cGMP, causing increased GFR and decreased renin |
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Term
| Does ATII cause reflex bradycardia? |
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Definition
No, it limits it
So can maintain BP |
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Term
| ADH is primarily regulated by what? When does this change? |
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Definition
regulated by osmolarity
But low volume states take precedence (can have low osmolarity, but if low volume will still activate ADH) |
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Term
| What are the main effects of angiotensin II? |
|
Definition
vasocontriction
Efferent arteriole constriction = increased FF to preserve GFR in low volume states
Increased Na channel, Na/K pump insertion on principal cells (enhances K and H excretion)
Causes ADH secretion
Increased prox tubule Na/H activity (H2O abs + contraction alkalosis)
Stimulates hypothalamus --> thirst |
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Term
| How does PTH act on vit D activation? |
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Definition
| Stimulates 1-hydrox in kidney |
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Term
| What endocrine hormones does the kidney produce? |
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Definition
EPO
Active vit D
Renin
Prostaglandins (vasodilates afferent arterioles to increase GFR) |
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Term
| What are the differences in the actions of ANP vs ATII? |
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Definition
ANP causes increased GFR but NO compensatory Na reabs in DCT (relaxes all vasculature)
ATII also causes increased GFR but WITH compensatory Na reabs in PCT and DCT (relaxes afferent and constr efferent, so increases GFR and FF) |
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Term
| What things cause hyperkalemia? |
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Definition
Insulin def (decreased Na/K ATPase, don't want to reabs glucose!)
beta-adrenergic antagonists (decreased Na/K ATPase, THINK they are decreasing BP!)
Acidosis (increased K/H exchanger, H out K in)
Hyperosmolarity
Digitalis
Cell lysis |
|
|
Term
|
Definition
Insulin (wants to increase glucose abs w/ Na!)
beta-adrenergic Agonists (increase BP, so increase Na reabs)
Alkalosis (want to reabs H, so must secrete K)
Hypo-osmolarity (want to reabs Na, so excrete K) |
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Term
| What are the findings associated with hypokalemia and hyperkalemia? |
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Definition
Hypo = U waves on ECG, flattened T waves (less repol), arrhythmias, paralysis (too lg of a gradient, cell hyperpolarized)
Hyper = peaked T waves, wide QRS, arrhythmias |
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Term
| What are the findings w/ low serum Mg and high serum Mg? |
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Definition
Low = neuromuscular irritability, arrhythmias
High = delirium, decreased DTRs, cardiopulmonary arrest |
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Term
| What are the causes of respiratory acidosis? |
|
Definition
Hyperventilation
Aspirin ingestion (early) |
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Term
| What are the causes of metabolic alkalosis? |
|
Definition
Diuretic use
Vomiting
Antacid use
Hyperaldosteronism |
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Term
| What are the causes of increased anion gap metabolic acidosis? |
|
Definition
MUDPILES
Methanol, Uremia, Diabetic ketoacidosis, Paraldyhyde/Phenformin, Iron tablets/INH, Lactic acidosis, Ethylene glycol, Salicylates |
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Term
| What are the causes of normal anion gap acidosis? |
|
Definition
Diarrhea
Glue sniffing
Renal tubular acidosis
Hyperchloremia |
|
|
Term
| What are the causes of respiratory acidosis? |
|
Definition
|
|
Term
| What are the different types of renal tubular acidosis? |
|
Definition
Type I = defect in collecting tubule's ability to excrete H+ Assoc w/ hypokalemia and risk of Ca-containing kidney stones
Type 2 (proximal) = defect in PCT bicarb reabs. Assoc w/ hypokalemia and hypophosphatemic rickets
Type 4 (hyperkalemic) = hypoaldosteronism or lack of response to aldosterone. Inh of ammonium excretion in prox tubule |
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Term
| What are the different types of casts in urine? |
|
Definition
RBC = glomerulonephritis, ischemia or malignant HTN
WBC = tubulointerstitial inflamm, acute pyelo and transplant rejection
Granular casts "muddy brown" = acute tubular necrosis
Waxy casts = advanced renal disease
Hyaline casts = nonspecific |
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Term
| What are the different nephritic syndromes? |
|
Definition
Acute Poststreptococcal Glomerulonephritis
Rapidly progressive glomerulonephritis
Diffuse Proliferative Glomerulonephritis
Berger's disease (IGA Glomerulopathy)
Alport's Syndrome |
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Term
| What are the causes of RPGN? |
|
Definition
Goodpasture's
Wegener's Granulomatosis (c-ANCA)
Microscopic Polyangiitis (p-ANCA) |
|
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Term
| What are the causes of Diffuse Proliferative GLomerulonephritis? |
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Definition
| SLE or mesangial proliferative GN |
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Term
| In general, what are the 3 types of RPGN? |
|
Definition
1) Anti-GBM (Goodpasture's)
2) Immune-complex mediated granular IF (post-strep, IgA, Henoch-Schonlein)
3) Pauci immune (no Ig or complement deposits) = ANCA positive (wegener's and microscopic polyangiitis) |
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Term
| What are the different forms of Nephrotic syndrome? |
|
Definition
Membranous Glomerulonephritis - GM thickening
Minimal Change Disease (GBM polyanion loss)
Amyloidosis
Diabetic GLomerulonephropathy (nodular glomerulosclerosis)
FSGS
Membrano-proliferative GN |
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Term
| What are the causes of membranous glomerulonephritis? |
|
Definition
Drugs (gold salts), infection (HBV, syphilis, malaria), SLE, solid tumors
Subepithelial deposits |
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|
Term
| What nephron syndromes result in subepithelial vs subendothelial deposits? |
|
Definition
Subepithelial = Post-strep GN, membranous glomerulonephritis (nephrotic sx)
Subendothelial = Diffuse prliferative GN (SLE), Membrano-proliferative GN |
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|
Term
| What are mesangial deposits associated with? |
|
Definition
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|
Term
| What are the different types of kidney stones? |
|
Definition
| Calcium oxalate/Ca-phosphate, Ammonium Magnesium Phosphate, Uric acid (radiolucent), Cystine |
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Term
| What kidney stones do you treat by alkalyzing the urine? Which is worsened by doing this? |
|
Definition
Uric acid and cystine
Ammonium Mg Phosphate stones are worsened by alkaline urine |
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|
Term
| What paraneoplastic syndromes is renal cell carcinoma associated with? |
|
Definition
EPO, ACTH, PTHrP and prolactin
Assoc w/ von Hippel-Lindau |
|
|
Term
| What are the things associated with Wilm's tumor? |
|
Definition
WAGR
Wilms' tumor, Aniridia, Genitourinary malformation, and mental-motor Retardation |
|
|
Term
| What drugs are associated with Drug-induced interstitial nephritis? |
|
Definition
Pyuria and azotemia
Diuretics, NSAIDs, penicillins, sulfonamides, rifampin
Act as haptens, induce hypersensitivity |
|
|
Term
| What is acute tubular necrosis associated with? |
|
Definition
Renal ischemia, crush injury (myoglobinuria) and toxins
Granular "muddy brown" casts |
|
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Term
| What things are associated with Renal Papillary necrosis? |
|
Definition
Diabetes mellitus
ACute pyelonephritis
Chronic phenacetin use (tylenol)
Sickle Cell anemia |
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|
Term
| What are the causes of acute renal failure? |
|
Definition
Prerenal azotemia - due to decreased RBF (decreased GFR)
Intrinsic renal - ATN/ischemia, causes decreased GFR, BUN reabs is impaired
Postrenal - outflow obstruction |
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Term
| What are the differences in BUN/Cr in the different types of acute renal failure? |
|
Definition
Prerenal: BUN/Cr is >20
Renal: BUN/Cr is <15 (can't reabs urea)
Postrenal: BUN/Cr is >15 |
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Term
| What are the consequences of renal failure? |
|
Definition
Na/H20 retention
Hyperkalemia
Uremia
Anemia
renal osteodystrophy (increased PTH, decreased Ca, increased PO4, decreased Vit D)
Dyslipidemia
Growth retard and dev delay |
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Term
| What can ARPKD in utero lead to? |
|
Definition
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