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233 Cards in this Set
- Front
- Back
ureters pass under ___ or ___
|
uterine a.
vas deferens |
|
___ of total bodyweight is water
|
60%
|
|
2 compartments of total body water
|
ICF
ECF |
|
ICF is ___ of total body water
|
2/3
|
|
2 parts of ECF
|
interstitial fluid
plasma |
|
interstitial fluid is ___ of ECF
|
3/4
|
|
plasma volume is measured via ___ (2)
|
radiolabeled albumin
evans blue |
|
ECF is measured via ___ (2)
|
inulin
mannitol |
|
negative charge of glomerular BM is from ___
this is lost in ___ |
heparan sulfate
nephrotic syndrome |
|
formula for clearance of substance X
|
C_x = U_xV/P_x
where C_x = clearance of x, U_x = urinary concentration of x, V = urine flow rate, P_x = plasma concentration of x |
|
if C_x < GFR, then ___
|
x is reabsorbed
|
|
if C_x > GFR, then ___
|
x is secreted
|
|
because ____, ____ (2) can estimate GFR
|
they are neither reabsorbed nor secreted
inulin clearance creatinine clearance (slightly secreted though) |
|
starling forces equation for GFR
|
GFR = K_f[(P_GC - P_BS) - (Pi_GC - Pi_BS)]
|
|
renal plasma flow may be estimated by ___
this is because ___ |
CL_PAH
it is primarily secreted and only slightly filtered |
|
RPF in terms of RBF
|
RPF = RBF(1-HCT)
|
|
estimated RPF (from PAH) over/underestimates RPF
|
underestimates
|
|
definition of filtration fraction (FF)
normal value of FF |
FF = GFR/RPF
20% |
|
Ang II works on ___ arteriole
effect is ___ effect is blocked by ___ |
efferent
constriction ACEI or ARB |
|
PGs work on ___ arteriole
effect is ___ effect is blocked by ___ |
afferent
dilation NSAIDs |
|
afferent arteriole constriction does
___ to RPF ___ to GFR ___ to FF |
lowers
lowers no change |
|
efferent arteriole constriction does
___ to RPF ___ to GFR ___ to FF |
lowers
raises raises |
|
plasma protein concentration increase does
___ to RPF ___ to GFR ___ to FF |
no change
lowers lowers |
|
ureter constriction does
___ to RPF ___ to GFR ___ to FF |
no change
lowers lowers |
|
definition of free water clearance
|
C_H2O = V - C_osm
where V = urine flow rate, C_osm = clearance of osmoles = U_osmV/P_osm i.e. C_H2O = V(1 - U_osm/P_osm) |
|
when ADH is present, C_H2O is ___
otherwise, it's ___ |
<0
>0 |
|
quantity of x excreted in terms of GFR (filtered load)
|
filtered load = (GFR)(P_x)
|
|
2 related measures of urinary transit of substance x
|
filtered load
excretion rate |
|
filtered load is product of ___ (2)
|
GFR
P_x |
|
excretion rate is product of ___ (2)
|
V
U_x |
|
(excretion rate)_x = (filtered load)_x if ___
|
x is neither reabsorbed nor filtered
|
|
glucosuria occurs at plasma glucose levels above ___ mg%
|
160
|
|
___ happens above plasma glucose of 350mg%
|
saturation of Glc transporters
|
|
2 disease resulting from deficient PT AA transporters
|
Hartnup
cystinuria |
|
descending limb of LOH is ___ for water
ascending limb is ___ |
permeable (water efflux from urine)
impermeable (electrolyte efflux) |
|
5 substances with secretion > reabsorption
on plot of [TF]/[P] vs. distance along PT, this is represented as ___ |
PAH
inulin creatinine urea Cl- slope > 1 |
|
4 substances with reabsorption > secretion
|
Glc
AAs HCO3- P_i |
|
2 parts of juxtaglomerular apparatus
|
JG cells
macula densa |
|
JG cells are ___ cells in ___
|
smooth muscle
afferent arteriole |
|
macula densa cells are ___ cells in ___
|
epithelial
early DCT |
|
renin is secreted by ___
in response to ___ (3) |
JG cells
hypoTN reduced Na+ at macula densa NE (beta_1 R) |
|
renin acts via ___
|
converting angiotensinogen -> Ang I
|
|
EPO is made by ___ cells of ___
|
endothelial
peritubular capillaries |
|
2nd hydroxylation of D3 is done by ___ cells
enzyme is ___ it is induced by ___ |
proximal tubule
1alpha hydroxylase PTH |
|
3 physiologic states which cause K+ shift OUT of cell
|
acidosis
severe exercise hyperosmolarity |
|
2 drugs which cause K+ shift OUT of cell
mechanism of both is ___ |
beta blocker
digoxin Na+/K+ ATPase inhibition |
|
acidosis causes hyperkalemia because ___
|
H+/K+ exchanger swaps extracellular H+ for intracellular K+
|
|
2 drugs which cause K+ shift INTO cell
mechanism is ___ |
insulin
beta agonists Na+/K+ ATPase activation |
|
2 kinds of acidosis
|
respiratory
metabolic |
|
2 defining lab values for respiratory acidosis
|
pH<7.4
PCO2>40 mmHg |
|
2 defining lab values for metabolic acidosis
|
pH<7.4
PCO2<40 mmHg |
|
2 kinds of metabolic acidosis
|
anion gap high
anion gap normal |
|
anion gap definition
|
AG = Na+ - (Cl- + HCO3-)
|
|
anion gap is comprised of ___ (4)
|
anionic protein
P_i citrate sulfate |
|
elevated anion gap metabolic acidisis means ___ (2)
|
HCO3- was lost
the unmeasured anions have increased to take its place |
|
non-elevated anion gap metabolic acidosis means ___ (2)
|
HCO3- was lost
Cl- has increased to take its place |
|
4 causes of non-anion gap metabolic acidosis
|
diarrhea
glue sniffing RTA hyperchloremia |
|
normal anion gap
|
8-12 mEq/L
|
|
2 kinds of alkalosis
|
metabolic
respiratory |
|
2 lab values for metabolic alkalosis
|
pH>7.4
PCO2>40 mmHg |
|
2 required lab values for respiratory alkalosis
|
pH>7.4
PCO2<40 mmHg |
|
4 causes of metabolic alkalosis
|
diuretics
vomiting antacids hyperaldosteronism |
|
2 causes of respiratory alkalosis
|
hyperventilation
aspirin intoxication (early) |
|
3 types of RTA
|
1
2 4 |
|
type 1 RTA is caused by ___ in ___
|
deficient H+ excretion
collecting tubule |
|
type 1 RTA is associated with ___ (2)
|
hypokalemia
Ca2+ stones |
|
type 2 RTA is caused by ___ in ___
|
deficient HCO3- reabsorption
proximal tubule |
|
type 2 RTA is associated with ___ (2)
|
hypokalemia
hypophasphatemic rickets |
|
type 4 RTA is caused by ___ (2)
|
hypoaldosteronism
aldosterone insensitivity |
|
type 4 RTA is associated with ___
|
hyperkalemia
|
|
hyperkalemia in type 4 RTA causes ___ in PT
this causes ___ |
reduced NH3 excretion
aciduria |
|
dd of RBC casts (3)
|
GN
ischemia malignant HTN |
|
dd of WBC casts (3)
|
tubulointerstitial inflammation
acute pyelonephritis transplant rejection |
|
cause of granular casts
|
ATN
|
|
cause of waxy casts
|
RF (main chronic)
|
|
presence of casts means urinary complaint is ___
|
of renal origin
|
|
3 kinds of causes of RPGN
|
anti-GBM disease
immune complex vasculitis pauci-immune vasculitis |
|
___ causes anti-GBM RPGN
|
Goodpasture's disease
|
|
5 immune complex causes of RPGN
of these ___ (2) also cause plain GN |
essential cryoglobulinemic
HSP cutaneous leukocytoclastic SLE PAN HSP SLE |
|
GN causes ___ (2) in urine
|
hematuria
RBC casts |
|
GN causes ___ (4) derangements of renal function
|
azotemia
oliguria HTN proteinuria |
|
proteinuria in GN is ___
|
<3.5g/day
|
|
post-strep GN has ___ (2) on LM,
___ on EM, and ___ on IF |
hypercellular glomeruli (proliferative)
neutrophilic infiltrate subepithelial deposits lumpy-bumpy pattern |
|
post-strep GN happens mostly in ___
end-point is ___ causative strep species is ___ |
kids
spontaneous resolution S. pyogenes |
|
immune complexes in post-strep GN consist of ___ (3)
|
IgG
IgM C3 |
|
2 lab values for post-strep GN
|
high ASO
low C3 |
|
4 components of RPGN cresents
|
glomerular parietal epitheilum
fibrin plasma protein MQs |
|
fibrin, plasma protein and MQs of RPGN crescents are located in ___
|
urinary (Bowman's) space
|
|
2 causes of diffuse proliferative GN
|
SLE
MPGN |
|
diffuse proliferative GN has ___ on EM, and
___ on IF |
subendothelial deposits
lumpy-bumpy pattern |
|
diffuse proliferative GN represents WHO class ___ SLE renal disease
|
4
|
|
class I SLE renal disease
|
no changes
|
|
class II SLE renal disease
|
mesangial GN
|
|
class III SLE renal disease
|
focal proliferative GN
|
|
class V SLE renal disease
|
diffuse membranous GN
|
|
most common form of SLE renal disease
|
class IV
|
|
on LM, DPGN has ___ aka ___
on EM it has ___ on IF it has ___ |
capillary wall thickening
wire looping subendothelial deposits lumpy bumpy pattern |
|
IgA nephropathy GN has ___ on LM
it commonly occurs after ___ (2) |
mesangial IC deposits
URI gastroeneteritis |
|
___ is the MCC of nephrotic syndrome in adults
it is caused by ___ (4) |
diffuse membranous GN (DMGN)
SLE (class V) drugs infections solid tumors |
|
on LM, DMGN has ___ (2)
on EM it has ___ |
capillary wall thickening
GBM thickening subepithelial deposits |
|
DMGN subepithelial deposits have ___ appearance
|
spike and dome
|
|
___ is MCC of nephrotic syndrome in kids
|
minimal change disease (MCD)
|
|
on LM, MCD has ___
on EM it has ___ |
minimal change
foot process effacement |
|
MCD patients lose ___ but not ___
|
albumin
globulins |
|
MCD tx
|
CS
|
|
most common glomerular disease in HIV patients
|
FSGS
|
|
T/F: FSGS is usually secondary to systemic disease
|
false: usually idiopathic
|
|
idiopathic FSGS is more common in ___ (2 ethnicities)
|
hispanic
black |
|
___% of FSGS reach end-stage disease within 10 years
|
50
|
|
in FSGS, IF identifies ___ (2) deposits. these are not ___s.
|
IgM
C3 ICs |
|
in FSGS, ____ is visible on EM in non-sclerotic areas
|
foot-process effacement
|
|
idiopathic FSGS is caused by defect in ___. for example, ____ (3 proteins).
|
filtration slit
nephrin podocin alpha-actinin |
|
in membranous nephropathy complement causes capillary damage directly via ___ and indirectly via ____ from ____ (2)
|
MAC
MAC-triggered ROS and protease release epithelial cells mesangial cells |
|
2 kinds of MPGN are ___. ___ is much more common than the other.
|
immune complex MPGN
dense deposit disease immune complex MPGN |
|
in both kinds of MPGN, ____ cells try to phagocytose ____, after which they ___.
in response ____ cells secrete more ____, which causes loss of ____. |
mesangial
subendothelial deposits proliferate endothelial GBM capillary lumen |
|
deposits in IC MPGN are ___ (4)
|
IgG
C3 C4 C1 |
|
deposits in dense deposit disease are ___ (2)
|
C3
properdin |
|
in MPGN serum C3 is high/low
|
low
|
|
amyloidosis deposits accumulate in ___ (2)
|
mesangium
subendothelium |
|
3 GBM changes in DM
|
thickening
more collagen IV less proteoglycans |
|
___ is a useful early test in DM
|
microalbuminuria
|
|
2 DM risk factors for DM nephropathy
|
uncontrolled DM
HTN |
|
___ are essential drugs for arresting DM nephropathy
|
ACEIs
|
|
all DM has ___. this is caused by ___.
some patients progress to ___ and others to ___. |
diffuse GBM thickening
non-enzymatic glycation diffuse GS nodular GS |
|
nodular GS has ____ surrounded by ___. nodular GS is aka ___
|
PAS + nodules
dilated capillaries Kimmelstiel-Wilson disease |
|
microalbuminuria is ____/day
macroproteinuria is ___/day |
>30mg
>300mg |
|
in addition to GS, ____ (2) are DM associated nephropathies
|
hyaline arteriolosclerosis
pyelonephritis |
|
exposure to ___ such as in ___ (occupation) is a risk factor for Goodpasture
|
volatile hydrocarbons
gasoline workers |
|
3 problems in Alport's syndrome
|
nephritis
deafness ophthalmic disorders |
|
2 inheritance patterns for Alport's. the more common is ___.
|
XLR
AR XLR |
|
Alport's is caused by mutations in ___.
|
collagen IV
|
|
Alport's appears as ___ on EM
|
lamellation of GBM
|
|
in nephrotic syndrome ANP is high/low
|
low
|
|
2 complications of nephrotic syndrome
|
infection
thrombosis |
|
infection in nephrotic syndrome is because of ___
thrombosis in nephrotic syndrome is because of ___ |
loss of Igs
loss of anticoagulants |
|
IgA nephropathy is aka ___. it is caused by accumulation of ___ (2) in ___. this activates ___.
|
Berger's disease
IgA C3 mesangium alternate complement pathway |
|
IgA nephropathy may appear via LM as ___ (3)
|
normal
focal GN mesangial cell proliferation |
|
IgA nephropathy is associated with ___ (2).
|
celiac
liver disease |
|
IgA nephropathy is a mild/severe disease.
|
mild
|
|
T/F: in MCD renal function is normal.
|
true
|
|
MCD is occasionally associated with ___ and rarely with ___ (3)
|
nephrin deficiency
HLy NSAIDs atopy |
|
3 systemic diseases causing nephrotic syndrome
|
SLE
amyloidosis DM |
|
2 complications of kidney stones
|
hydronephrosis
pyelonephritis |
|
___ is most common kind of kidney stone
|
Ca2+
|
|
2 kinds of Ca2+ kidney stone
|
Ca2+ oxalate
Ca2+ phosphate |
|
Ca2+ stones are radio-___
|
opaque
|
|
Ca2+ stone crystal shape
|
rectangular with X
|
|
4 causes of Ca2+ stones
|
hyper-PTH
hypervitaminosis D cancer milk-alkali syndrome |
|
2 causes of Ca2+ oxalate crystals
|
ethylene glycol poisoning (antifreeze)
vitamin C abuse |
|
2nd most common kidney stone
|
struvite (15%)
|
|
struvite is either ___ or ___
|
NH4MgSO4
NH4Mg(PO3)3 |
|
struvite stones can cause ___
|
staghorn calculi
|
|
staghorn calculi can cause ___
|
UTI
|
|
struvite stones are radio-___
|
opaque
|
|
struvite stones are caused by ___
|
urease + bacteria
|
|
5 urease + bugs
|
Proteus vulgaris
Klebsiella HP Ureaplasma Staph |
|
struvite crystal shape
|
rectangular
|
|
3rd most common kidney stone
|
urate (5%)
|
|
urate crystals are associated with ___ (2)
|
leukemia
MPD (high cell turnorver rate) |
|
urate crystals are radio-___
|
lucent
|
|
4th most common kidney stone
|
cystine (1%)
|
|
main cause of cystine stones
|
cystinuria
|
|
cystine crystals shape
|
hexagonal
|
|
cystine crystals can cause ___
|
staghorn calculi
|
|
cystine crystals are radio-___
|
opaque (faintly)
|
|
4 ectopic hormones associated with RCC
|
EPO
ACTH PTHrP PRL |
|
RCC is associated with ___
|
VHL
|
|
___ is most common renal malignancy in kids
|
Wilms'
|
|
Wilms' tumor contains ___
|
embryonic glomeruli
|
|
growth disorder associated with Wilms' tumor
|
hemihypertrophy
|
|
___ on chromosome ___ is a gene linked to Wilms' tumor
it is a ___ gene |
WT1
11 tumor-suppressor |
|
complex including Wilms' tumor
|
Wilms' tumor
Aniridia Genitourinary malformation mental-motor Retardation (WAGR) |
|
symptom suggestive of transitional cell ca
|
painless hematuria
|
|
TCC is associated with ___ (4)
|
Phenacetin (analgesic)
Smoking Aniline dyes CTX (Pee SAC) |
|
pyelonephritis primarily affects ___ of kidney
|
cortex
|
|
pyelonephritis has ___ casts in ___
this is called ___ |
eosinophilic
tubules thyroidization |
|
2 causes of diffuse cortical necrosis
|
obstetric catastrophe
septic shock |
|
2 mechanisms of diffuse cortical necrosis
|
DIC
vasospasm |
|
___ is reversible but requires ___ to prevent death
|
ATN
supportive dialysis |
|
ATN is associated with ___ (3)
|
shock
crush injury (myoglobinuria) toxins |
|
ATN has ___ phase followed by ___ occurring at ___
|
oliguric
recovery 2--3 weeks |
|
death from ATN occurs in ___ phase
|
oliguric
|
|
prerenal azotemia is caused by ___
|
reduced RBF
|
|
postrenal azotemia is caused by ___
|
BILATERAL outflow obstruction
|
|
prerenal ARF has
___ urine osmolality ___ urine Na+ ___ FENa and ___ BUN/Cr ratio |
high (>500)
low (<10) <1% >20 |
|
renal ARF has
___ urine osmolality ___ urine Na+ ___ FENa and ___ BUN/Cr ratio |
low (<350)
high (>20) >2% <15 |
|
postrenal ARF has
___ urine osmolality ___ urine Na+ ___ FeNa and ___ BUN/Cr ratio |
low (<350)
very high (>40) >4% >15 |
|
electrolyte disorder in RF
|
hyperkalemia
|
|
acid-base disorder in RF
|
metabolic acidosis
|
|
uremia syndrome includes ___ (5)
|
nausea
pericaditis encephalopathy platelet dysfunction asterixis |
|
skeletal disorder in RF
cause is ___ |
renal osteodystrophy
deficient 1,25-OHD |
|
metabolic disorder in RF
|
dyslipidemia (hyper-TAG)
|
|
Fanconi's syndrome is deficient ___ in ___
|
metabolite transport
PT |
|
4 metabolites lost in Fanconi's syndrome
|
Glc
AAs phosphate uric acid |
|
2 kinds of Fanconi's syndrome
|
congenital
acquired |
|
3 kinds of causes of Fanconi's
|
Wilson's
glycogen storage disease drugs |
|
2 drugs causing Fanconi's
|
cisplatin
expired tetracycline |
|
simple renal cysts are located in ___
they are benign/symptomatic |
cortex
benign |
|
medullary renal cysts pw ___ (2)
prognosis is good/bad |
concentrating defect
small kidney on US bad |
|
4 sx of hyponatremia
|
disorientation
stupor coma seizure |
|
3 sx of hypernatremia
|
irritability
delirium coma |
|
hypochloremia is associated with ___ (4)
|
metabolic alkalosis
hyperaldosteronism hypokalemia hypovolemia |
|
hyperchloremia is associated wtih ___
|
non-anion gap metabolic acidosis
|
|
2 sx of hypokalemia
|
paralysis
arrhythmia |
|
2 EKG signs of hypokalemia
|
U wave
flattened T wave |
|
U wave is ___
it has same polarity as ___ it is caused by ___ |
small deflection after T wave
T wave septal repolarization |
|
T/F: u wave is pathological
|
false: present in 50% of normal EKG
|
|
sx of hyperkalemia
|
arrhythmia
|
|
2 EKG signs of hyperkalemia
|
peaked T wave
wide QRS |
|
2 sx of hypocalcemia
|
tetany
neuromuscular irritability |
|
T/F: hypercalcemia can occur without hypercalciuria
|
true
|
|
2 sx of hypomagnesemia
|
neuromuscular irritability
arrhythmia |
|
3 sx of hypermagnesemia
|
delirium
decreased DTRs cardiopulmonary arrest |
|
2 sx of hypophosphatemia
|
bone loss
osteomalacia |
|
2 sx of hyperphosphatemia
|
kidney stones
metastatic calcification |
|
4 indications for mannitol
|
high ICP
high intraocular pressure drug OD shock |
|
2 mannitol SEs
|
pulmonary edema
dehydration |
|
mannitol is contraindicated in ___ (2)
|
CHF
anuria |
|
acetazolamide mechanism
|
CA inhibition
|
|
CA does ___
|
H2O + CO2 <--> H2CO3
|
|
in PT, filtered ___ combines with secreted ___ to make ___
|
HCO3-
H+ H2CO3 |
|
normally, CA facilitates ___
therefore, inhibition causes ___ this causes ___ |
HCO3- reabsorption
HCO3- excretion metabolic acidosis |
|
6 indications for acetazolamide
|
open angle glaucoma
pseudotumor cerebri cystinuria altitude sickness metabolic alkalosis dural ectasia |
|
furosemide causes increased ___ excretion
|
Ca2+
|
|
6 furosemide SEs
|
Ototoxicity
Hypokalemia Dehydration Allergy (sulfa) Nephritis (interstitial) Gout |
|
___ is a non-sulfonamide loop diuretic
it can be used in the presence of ___ |
ethacrynic acid
gout |
|
4 indications for thiazide
|
HTN
CHF idiopathic hypercalciuria nephrogenic DI |
|
7 thiazide SEs
|
hypokalemic metabolic alkalosis
hyponatremia hyperGlycemia hyperLipidemia hyperUricemia hyperCalcemia sulfa allergy |
|
triamterene acts at same channel as ___
|
amiloride
|
|
___ diuretics cause acidemia
___ (2) cause alkalemia |
acetazolamide
loop diuretics thiazide |
|
___ diuretics cause hypercalciuria
___ cause hypocalciuria |
loop diuretics
thiazide |
|
10 ACEI SEs
|
Cough
Angioedema Proteinuria Taste changes hypOtension Pregnancy problems Rash Increased renin Lower Ang II hyperkalemia |
|
ACEIs are contraindicated in ___
because ___ |
bilateral renal artery stenosis
they lower GFR |