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Block 10 Kidney

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klau253's version from 2017-06-03 16:37

Section

Assessment of proteinuria
Question Answer
For screening purposealbumin:creat ratio
For monitoring purposeProtein:creat ratio
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Polycystic kidney disease
Question Answer
Geneticauto dom, polycystin gene
ADPKD130-40s onset
ADPKD270s onset
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Main site of electrolyte reabsorption
Question Answer
Na+, Ca2+, phosphate,HCO3-PCT
Mg2+thick ascending loop
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Vasopressin
Question Answer
secreted frompost pit
acts onmedullary collecting duct
MoAacts on V2 receptors to lead to an increase in AQP2
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Aldosterone
Question Answer
MoAincrease renal outer medullary K+ channel, increase ENaC, increase Na+/K+ ATPase --> K+ losing and Na+ retaining
trigger bylow BP, low renal flow, hyperK+
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Question Answer
P-aminohippurate(PAH)measurement of renal plasma blood flow
Inulingold standard to measure GFR
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Renal K+ regulation
Question Answer
What drives an increase in intracellular K+hypokalemia, hypertonicity, exercise, acidemia
What drives the oppositehyperkalemia, insulin, beta-2 adrenergic, alkalemia
K+ excretion mainly viakidney, then colon
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Juxtaglomerulus apparatus
Question Answer
3 cell typesgranular, macula densa, extraglomerular mesangial
Functionsecrete renin
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Question Answer
Renal vascular resistance is offered byinterlobular arteries, afferent and efferent arterioles
which offers max resistanceefferent
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GFR regulation

 

Increase GFR
Question Answer
Aff. Art. DilationNO, prostaglandin, low dose dopamine, kinin
Eff. Art. constrictionlow dose ang II
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Decrease GFR
Question Answer
Aff. Art. constrictionendothelin, NE, high dose ang II
Eff. Art. dilatationACEI
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Common causes of nephrotic syndrome
Question Answer
Primary causesminimal change disease (mostly in child), focal segmental glomerulosclerosis, membranous nephropathy
Secondary causes, >50% of cases in adultDN, SLE, amyloidosis, chronic viral infection, CA
Most common causes in childrenminimal change disease, focal segmental glomerulosclerosis
Most common causes in adultsmembranous glomerulonephritis, IgA nephropathy, DN, SLE, Amyloidosis
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Causes of nephritic syndrome
Question Answer
ChildrenHaemolytic Uraemic Syndrome, Henoch-Schonlein Purpura, Post-streptococcal glomerulonephritis
Adultsgoodpasture's, ANCA-associated vasculitis, SLE, primary or secondary mesangiocapillary GN
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Causes of AKI
Question Answer
Pre-renalshock, blood flow obstruction (atherosclerosis)
Intra-renalGN, DN, pyelonephritis, drug-induced interstitial nephritis, HTN, vasculitis
Post-renalObstruction: BPH, malignancy, kidney stone
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Question Answer
Causes of met acidosisincrease in metabolic acid (DKA, lactic acidosis), loss of base in lower gut (diarrhoea), decreased ability to excrete acid (renal tubular acidosis)
Causes of resp acidosisfailure of pulmonary ventilation
Causes of met alkalosisvomiting gastric juice/ingestion of alkali(antacid)
Causes of resp alkalosispanic attack, anxiety, hypoxia due to high altitude, pons damage, fever
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Congenital urology conditions
Question Answer
Weigert-Meyer Rule of duplex uretersupper renal moiety often obstructs, inserts medial and distally inferior to the lower pole moiety ureter. Lower renal moiety often refluxes, inserts lateral and superior to upper renal moiety ureter
Bladder Exstrophyprotrusion of bladder thru the abdominal wall
Vesicoureteric refluxinsufficient oblique tunneling at distal ureter inserting the bladder
Patent Urachusconnection between umbilical cord and bladder
Post. urethral valveobstructive membrane at post. urethra of male
Epispadiasurethra opening located in upper penis
Hypospadiasurethra opening in abnormal location
Penile Chordaepenis curves up/downward
Phimosisforeskin of penis cannot be pulled back past glans
Cryptorchidismundescended testes can affect spermatogenesis,and can have CA
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UTI
Question Answer
Urethritisusually viral and self limiting
Reiter's syndromearthritis + urethritis + conjunctivitis
Pyelonephritisclinical triad:Fever, raised WCC, renal angle pain
Epididymo-orchitisinflammation of epididymis and testicles, caused by E.coli/Gonorrhoea/Chlamydia/mumps
Schistomatosiscauses scarring and calcification in bladder and seminal vesicles
urinary TBvia haematogenous spread
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Inflammation
Question Answer
Chemical cystitisketamine, BCG vaccine, mitomycin
radiation cystitisradiotx
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Urethral/uretheral Stricture
Question Answer
causesinfection, trauma, neoplastic infiltration, extrinsic compression
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Stones/urolithiasis
Question Answer
RFmale, dehydration, dietary components, genetics
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Cancer
Question Answer
kidneyrenal cell carcinoma
Bladder/ureter/renal pelvisTransitional cell carcinoma, SCC, Adencarcioma
prostateadenocarcinoma
Testiclesseminomas (40-45%), non-seminomas (teratoma, embryonal carcinoma, choriocarcinoma, yok sac tumors), RF(undescended testes)
PenileSCC, RF(HPV)
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Question Answer
Acute urinary retentionpainful inability to void, relieved after catheterisation, volumes of 500-800cc
Detrusor failurevoiding difficulty along with incontinence, results from prostate obstruction/urethral stricture/
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Incontinence
Question Answer
stressinsufficient strength of bladder closure, common in younger women
Urgehigh bladder pressure, common in older women
Mixedcommon in older women
overflowbladder that is overfull and overflow
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Organiusms that cause UTI
Question Answer
commonest bacteria causeuropathogenic E. Coli, proteus mirabilis
Adenovirushaemorrhagic cystitis
BK and JC virusasso/ with infection in graft after renal transplant
Parasitic causeschistosoma haematobium
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Host defence against UTI
Question Answer
secreted factorssecretory IgA, lactoferrin
mucosal defenceglucoseaminoglycan
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E.coli (UPEC) virulence factor
Question Answer
Type 1 fimbriaebinds to mannose on host, asso/ with cystitis
Type P fimbriaebinds to glycolipid on host, asso/ with pyelonephritis
Capsuleformed by K antigen, resist phagocytosis, asso/ with pyelonephritis
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Proteus mirabilis virulence factor
Question Answer
produces ureaseincreases urine pH to favour the production of struvite
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False negative results in urinalysis
Question Answer
Nitriteinfections caused by non-nitrate reducing bacteria, low # of bacteria, pt taking vit C
Leukocyte esterasept taking antibx such as cefalexin, high levels of glucose in urine
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