13 Kidney

q123456's version from 2016-06-02 18:49


Question Answer Column 3
Thiazide diureticsindapamide (KA36-14)
hyper Ca2+
ethacrynic acid
potassium sparing diureticsamiloride


Question Answer
PKD>>>Intracerebral aneurysm>>subarachnoid hemorrhage>>>vasospasm>>weakness of arm and leg.nimodipine
acute renal failureincreases in nitrogens, ions normally excreted by the kidney KA36-20
renal vein thrombosis (RVT) occurs most commonly in?patients with nephrotic syndromeie
>3 g/day protein loss in the urine
nephrotic syndromeurinary protein loss>>>decreased antithrombin III>>>hypercoagulable state excessive>>>renal vein thrombosis>>>left side varicocele, hematuria and flank pain
isolated proteinuria
tubular proteinuriab2 microglobulin, immunoglobulin light chains, AA reabsorbed in the promoximal protein>>>proximal tubular function is disrupted
proteinuria in normal renal functionfunctional proteinuria
orthostatic proteinuria (position: stand)
isolated proteinuria
selective proteinuriaalbumin and transferrin are excreted
antibody to the phospholipase A2 receptoridiopathic membranous nephropathy
joint pain>>>proteinuria?joint pain>>>NSAIDs>>>chronnic interstitial nephritis
polyuria and nocturiatubular dysfunction
nephrotic syndrome-minimal change nephrotic syndromedrop in colloid osmotic pressure in the blood>>>fluid moves into the interstitial tissue>>>edema>>>increased aldosterone>>>retention of sodium and water.Increased
primary mediators of K+ regulationthe principal and a-intercalated cells of the later distal and cortical collecting tubules
* chronic renal insufficiency causes hyperkalemia due to deficient renin production by the damaged kidney
proximal tumule and thick ascending limb of the loop of henle do not regulate K+ excretion in the urine, will reabsorb the majority of filtered K+ in the proximal tubule and loop of henle
loss of HCl
Metabolic alkalosis
low urine Cl-

thiazide or loop diuretic use
metabolic alkalosis
high urine Cl- diuretic therapy (current)>>>low urine Cl- previous thiazide diuretic therapy
volume depletion

conn syndrome
metabolic alkalosis
high urine Cl
juxtaglomerular apparatusjuxtaglomerular apparatus: macula desnsa and juxtaglomerular cells
macula densa cells:distal tubule, Na+ and tubular flow
JG cells: smooth muscle cells of the afferent arteriole, renin
acute salicylate intoxicationstimulate medullary respiratory center>>>hyperventilation>>>loss of CO2>>>Respiratory alkalosis

Section 2

Question Answer
acute interstitial nephritisacute inflammation of the renal interstitium
hypersensitivity reaction
NSAIDS, antibiotics (penicillin, cephalosporins, sulfonamides) and diuretics (furosemide and thiazides)
oliguria, fever and rash
eosinophils seen in the urine
>>>renal papillary necrosis
Acute tubular necrosisischemic or toxic insults
in recovery stage, the renal tubules can not funciton fully>>>a high volume hypotonic urine >>>decreased serum con.c of K, Mg, PO4 and Ca.
vasopressin injection>>>renal clearance of which would be most significantly reduced from baseline after the injection?urea
ADH increases water and urea permeability
urea:40-55% of filtered urea is reabsorbed by the proximal tubule
hypokalemia is the most serious complication of ?Acute tubular necrosis
HE staining: enlarged, nodular sclerosis. GBM Thickens, mesangial matrix increases and proteinuriadiabetic nephropathy
How to calculate excretion rate for substance?excretion rate (RATE=AMOUNT) =total filtration rate-total reabsorption rate=(plasma con.cxGFR)-Tubular reabsorption
clear cell carconomaproximal tubules
full of glycogen and lipid
most commone renal neoplasm
the principal site of uric acid precipitation would be?collecting ducts due to low urine pH
hydronephrosisureters at risk at injury during pelvic surgeries
abdominal pain + hematuria+skin lesion+join painhenoch schonlein purpura
fatigability+constipation+back pain+high serum creatininemultiple myeloma
which area of the nephron is normally impermeable to water regardless of serum vasopressin levels?the ascending limb of the loop of henle is impermeable to water
ADH V2 receptor--------------------
principal cells in the renal collecting ducts
Diabetes insipidus: TOO little ADH. dehydration>>>darrow yannet diagram Kaplan 1-3-25
Diabetic ketoacidosis>>>low pH and low HCO3- (due to form H2CO3 with H+)Increased H2PO4 - decreased HPO4 2-
HPO4 2- + H+>>> H2PO4 -
Secretion in the proximal tubular epithelial cells from the peritubular apillaries and secreted into the tubular fluida carrier enzyme mediated process and is able to be saturated
in the absence of ADH, the tubular fluid is most concentrated atthe junction between the descending and ascending limbs of the loop
renal blood flow x (1-hematocrit)=RBF x(1-hematocrit)renal plasma flow RPF
filtration fraction FFGFR/RFR=GFR/(RBF x (1-hematocrit))
GFR (creatinine clearance) 90-120 ml/min/1.73 m2
(urine urine flow)/plasma con.c
RFR (PAH) (ml)
(urine urine flow)/plasma con.c
if reduce the diameter of renal A by 75%, one week later>>>increased FF. low Na+ reaching to macula desnsa>>>upregulates renin in JG cells>>> elevated angiotensin II>>> constricts efferent artery>>> Low RPF, high GFR>>> elevated FF
renal plasma flow RPFplasma (ml) that perfuses the kidney per unit time
GFRplasma (ml) that filtered from the capillaries into bowman's carpsules per unit time

Section 3

Question Answer
PSGNskin infecton+puffy face+hematuria
Granular deposits of Ig G/M and C3 in the GBM and mesangium.
EM: subepithelial humps
sodium99% of filtered sodium reabsorbed by the proximal
Goodpasture syndromeIF: linear deposits of immunoglobulin along the GBM>>>collagen IV. LIGHT MICROSCOPY: crescents
renal failure(hematuria)+pulmonary hemorrhage(hemoptysis)

alport syndrome: mut in genes of type IV collagen
goodpaste: autoantibody against structures that are usually hidden in the recessive of collagen IV
RPGN1) linear GBM deposits of Ig G/C3. Anti GBM, goodpasture
2) Immune-complex meiated PSGN, SLE, IgA nephropathy (berger disease)
***berger is not buerger's disease: thrombosing vasculitis, smoker
3) no IF presentation anti-ANCA Wegener's
nongonococcal urethritischlamydia trachomatis or ureaplasma urealyticum. chlamydia: lack peptidoglycan, ureaplasma: lack cell wall. treatment: macrolides and tetracyclines
Membranous glomerulopathymost common cause of nephrotic syndrme in adults
edema+proteinuria, most common cause of nephrotic syndrme in adults
the most cost effective initial step for prostate cancerthe digital rectal exam
PSA: recurrences
Embolic phenomena (Left ventricular clots, valvular vegetations, aortic atherosclerotic plaques)stroke, intestinal or foot ischemia and renal infarction
free water clearanceFor example, for an individual with a urine osmolality of 140 mOsm/L, plasma osmolality of 280 mOsm/L, and a urine production of 4 ml/min, the free water clearance is 2 ml/min,
140x4=560, 560/280=2 ml/min

how much water is being lost from the body
Gestational choriocarcinomaproliferation of both cytotrophoblasts and syncytiotrophoblasts
Metastasizes hematogenously
Vaginal bleeding, shortness of breath and hemoptysis
hyperosmotic volume contractionloss of free water exceeds the loss of electrolytes>>>increased osmolarity and decreased volumes in the ICF/ECF spaces
Bladder tumors.painless hematuria.
cystinuriacystine is poorly reabsorbed in the kidney>>>kidney stone/colicky flank pain/hematuria
sodium cyanide-nitroprusside test +
prostate tumorouter glands
Bone metastases>>>osteoblastic, the maker for bone-metastatic prostate carcinoma is alkaline phosphatase
PI3K/AKT signaling,
serum PSA level of 4 ng/mL
Endometriosis>>>infertilityectopic endometrial tissue secretes prostaglandins that interfere with ovulation and tubal function
Acute pyelonephritiswhite blood cell cast
FEVER, HEMATURIA, massive neutrophil infiltration in TUBULAR LUMINA
Gross hemauria in patients with sickle cell diseaserenal papillary necrosis
Erythrocytosis and polycythemia, high hematocritrenal cell carcinoma
69XXXpartial mole
46XXcomplete mole
familial retinoblastomaChromosome 13
Rb tumor suppressor gene mutation
Retinoblastomas in children, sarcomas and osteosarcoma later in life
Benign prostatic hyperplasia (BPH)Dihydrotestosterone (DHT)
most hyperplastic lesions in prostate: inner trasnsition zones
Decidualized endometrium without chorionic villivaginal bleeding, pelvic inflammatory disease
Ectopic pregnancyampulla of the fallopian tube
Atheroembolic disease of the renal arteriescholesterol crystals in arterial lumen
cholesterol containing debris gets pushed from larger arteries and lodges in smaller vessels causing ischemia of the corresponding organs and tissues
Uric acid kidney stonex ray negative, ultrasonogram positive
Primary ciliary dyskinesiakartagener's syndrome
recurrent respiratory infections(impaired mucociliary clearance)
Underscended testesTemperature sensitive>>>seminiferous tubules atrophy>>>depressed sperm count and low inhibin>>>elevated FSH
testicular cancer
Leydig cell and sexual characteristics are normal
the rupture of berry aneurysm mostly occurs at?anterior circulation (anterior communicationg artery)
atherosclerotic aneurysms
most commonly involve the basilar artery
HyperK+ can lead to arrhythmiaa 19 year old woman is brought to ER because of a crush injury that occurred when a bookshelf fell on her abdomen and legs. physical examination shows acute kidney failure (high creatinine, edema, hydrated but oliguric) what is most likely contraindicated in the patient? Spironolactone
acute interstitial nephritisfever, rash and oliguria 1-3 weeks after the initiation of treament a B-lactam antibiotic
bladder wall hypertrophies>>>ureters, renal pelvis and calyces dilate>>>>hydronephrosis>>>the renal parenchyma atrophybenign prostatic hyperplasia (BPH)>>>bladder out flow obstruction>>>increased pressure in the urinary tract
The vesicoureteral junction (UVJ)The VUJ can be recognized as a small convex, bulging-out structure on the mucosal surface of the urinary bladder. The function of the VUJ is to allow unhindered antegrade passage of urine bolus from ureter into the bladder while prevent the reflux of urine into the ureter from the bladder, during both normal bladder filling and voiding.
An anatomic abnormality or an increase in bladder pressure>>>urine retures to the ureterUTI
Urine flows retrograde, or backward, from the bladder into the ureters/kidneys.Vesicoureteral reflux (VUR)