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Physiology > Renal, USMLE > Flashcards

Renal, USMLE Flashcards

1
Q

Embryologic kidney in week 4 AOG

A

Pronephros

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2
Q

Functions as interim kidney for first trimester

A

Mesonephros

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3
Q

Mesonephros also contributes to which organ system

A

Male genital system

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4
Q

Embryologic kidney which is PERMANENT and first appears at 5th week AOG

A

Metanephros

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5
Q

Derived from the caudal end of the metanephros

A

Ureteric bud

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6
Q

Ureteric bud gives rise to (4)

A

1) Ureters
2) Pelvises
3) Calyces
4) Collecting tubules

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7
Q

Ureteric bud is fully canalized at

A

10th week AOG

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8
Q

Aberrant interaction of ureteric bud with this tissue may result in several congenital malformations of the kidney

A

Metanephric mesenchyme

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9
Q

Portion of the ureter that is the last to canalize and is the most common site of obstruction (hydronephrosis in fetus)

A

Ureteropelvic junction

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10
Q

Syndrome of oligohydramnios > fetal compression > limb and facial deformities + pulmonary hypoplasia

A

Potter’s syndrome

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11
Q

Cause of death in Potter’s syndrome

A

Pulmonary hypoplasia

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12
Q

To which structure is the horeshoe kidney trapped

A

IMA

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13
Q

T/F: Horseshoe kidney is dysfunctional

A

F

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14
Q

Syndrome with which horseshoe kidney is associated

A

Turner syndrome

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15
Q

Condition due to abnormal interaction between ureteric bud and metanephric mesenchyme leading to a nonfunctional kidney

A

Multicystic dysplastic kidney

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16
Q

Most common form of multicystic dysplastic kidney

A

Unilateral (asymptomatic)

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17
Q

Which kidney is taken during living donor transplantation

A

Left

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18
Q

Why is the left kidney preferred in living donor transplantation

A

Longer renal vein

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19
Q

Parietal layer of glomerulus

A

Bowman’s capsule

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20
Q

Visceral layer of glomerulus

A

Podocytes

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21
Q

JG cells are found ___

A

At the wall of afferent arteriole

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22
Q

Macula densa is found

A

At the wall of the DCT

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23
Q

Ureters in relation to the uterine artery and ductus deferens (retroperitoneal)

A

Under

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24
Q

Vessels and ureter at the renal hilum

A

Vein, artery, ureter

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25
Q

The glomerular filtration barrier is composed of

A

1) Fenestrated capillary endothelium (size barrier)
2) Fused basement membrane with heparan sulfate (negative charge barrier)
3) Epithelial layer consisting of podocyte foot processes

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26
Q

Hydrostatic pressure in glomerular capillaries

A

60 mmHg

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27
Q

Effect of afferent arteriole constriction on RPF

A

Decreases RPF

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28
Q

Effect of efferent arteriole constriction on RPF

A

Decreases RPF

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29
Q

Effect of ureteral constriction on GFR

A

Decrease GFR

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30
Q

Transporter at the PCT responsible for complete reabsorption of glucose

A

Na-glucose cotransport (SGLT-2)

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31
Q

Increase vs Decrease: Effect of pregnancy on reabsorption of glucose and aa at the PCT

A

Decrease

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32
Q

Transporter responsible for reabsorption of aa from PCT

A

Na-dependent transporters

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33
Q

Deficiency of neutral amino acid transporter at the PCT

A

Hartnup’s disease

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34
Q

AA wasted in Hartnup’s disease

A

Tryptophan

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35
Q

Hartnup’s disease is associated with this nutrient deficiency state

A

Pellagra

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36
Q

Hormone acting on PCT to increase phosphate excretion by inhibiting Na/phosphate cotransport

A

PTH

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37
Q

Hormone acting on PCT to increase Na, H2O, and HCO3 reabsorption by stimulating Na/H exchanger

A

ATII

38
Q

Transport mechanism by which water is reabsorbed from the thin descending LOH

A

Passive diffusion via medullary hypertonicity

39
Q

Transport mechanism by which Mg and Ca are reabsorbed in the thick ascending LOH

A

Paracellular transport via (+) lumen potential generated by K backleak

40
Q

Means by which PTH increases Calcium reabsorption in the kidneys

A

Increases activity of Na/Ca exchanger in the early DCT

41
Q

How aldosterone exerts its mineralocorticoid effect on kidneys

A

Insertion of Na channel in luminal side of principal cell

42
Q

How ADH exerts its effect on kidneys (receptor; action)

A

Acts at V2 receptor>insertion of aquaporin H2O channels on luminal side of principal cell

43
Q

Effects of ATII

A

1) Vascular smooth muscle constriction via AT1 receptors
2) Efferent arteriole constriction
3) Increase absorption of Na, HCO3 and water from PCT
4) Production of aldosterone by adrenals
5) Stimulates thirst via hypothalamus

44
Q

Tubuloglomerular feedback fails once SBP falls below

A

80mmHg

45
Q

Stimulus for release of ANP

A

Increased atrial pressure

46
Q

Shift K out of cells causing hyperkalemia (6)

A

DO Insulin LAb

1) Digitalis
2) Hyperosmolarity
3) Insulin deficiency
4) Lysis of cells
5) Acidosis
6) b-adrenergic antagonist

47
Q

How insulin and b-adrenergic agonists cause K shift into cells

A

Stimulation of Na-K ATPase pump

48
Q

ECG changes in hypokalemia

A

1) U waves

2) Flattened T waves

49
Q

Shift K into cells causing hypokalemia (4)

A

1) Hypoosmolarity
2) Insulin
3) Alkalosis
4) b-adrenergic agonist

50
Q

Hypocalcemia vs hypercalcemia: Tetany

A

Hypocalcemia

51
Q

Hypocalcemia vs hypercalcemia: Seizures

A

Hypocalcemia

52
Q

Symptoms of hypercalcemia (4)

A

1) Stones
2) Bones
3) Groans
4) Psychiatric overtones

53
Q

Hypomagnesemia vs hypermagnesemia: Tetany

A

Hypomagnesemia

54
Q

Hypomagnesemia vs hypermagnesemia: Decrease DTR

A

Hypomagnesemia

55
Q

Hypomagnesemia vs hypermagnesemia: Bradycardia

A

Hypomagnesemia

56
Q

Hypomagnesemia vs hypermagnesemia: Hypotension

A

Hypomagnesemia

57
Q

Predicted respiratory compensation can be calculated using

A

Winter’s formula

58
Q

Winter’s formula

A

PCO2 = 1.5 (HCO3) + 8 +/-2

59
Q

Normal anion gap

A

8-12 mEq/L

60
Q

Type 1 vs Type 2 RTA: Distal

A

Type 1

61
Q

Type 1 vs Type 2 RTA: Defect in COLLECTING TUBULE’s ability to EXCRETE H+

A

Type 1

62
Q

Type 1 vs Type 2 RTA: Defect in PCT’s ability to REABSORB HCO3

A

Type 2

63
Q

Type 1 vs Type 2 RTA: Risk for calcium phosphate formation in kidney

A

Type 1

64
Q

Type 1 vs Type 2 RTA: Rickets

A

Type 2

65
Q

Type 1 vs Type 2 RTA: Urine pH >5.5

A

Type 1

66
Q

Type 1 vs Type 2 RTA: Urine pH less than 5.5

A

Type 2

67
Q

Pathophy of Type 4 RTA

A

Lack of collecting tubule response to aldosterone resulting in hyperkalemia

68
Q

Hyperkalemia in Type 4 RTA results in impaired

A

Ammoniagenesis in PT, decreasing buffering capacity, decreasing urine pH

69
Q

RBC casts are seen in (3)

A

1) GN
2) Ischemia
3) Malignant HTN

70
Q

WBC casts are seen in

A

1) Tubulointerstitial inflamm
2) Acute pyelonephritis
3) Transplant rejection

71
Q

Casts seen in ATN

A

Granular/muddy casts

72
Q

Casts seen in advanced renal disease/chronic renal failure

A

Waxy casts

73
Q

Glomerular disorders with hypercellular glomeruli

A

Proliferative

74
Q

Glomerular disorders with thickening of GBM

A

Membranous

75
Q

Nephritic syndromes (4)

A

1) APGN
2) RPGN
3) Berger’s IgA glomerulonephropathy
4) Alport syndrome

76
Q

Both nephritic and nephrotic (2)

A

1) Diffuse proliferative GN

2) MPGN

77
Q

In nephrotic syndrome, risk of infection is increased due to

A

Loss of Igs in urine

78
Q

Segmental sclerosis and hyalinosis on LM

A

FSGS

79
Q

Effacement of foot processes similar to MCD on EM

A

FSGS

80
Q

Normal glomeruli on LM

A

MCD

81
Q

Type of proteins lost in MCD

A

Albumin, not globulins

82
Q

Congo red stain shows apple-green birefringence under polarized light

A

Amyloidosis

83
Q

MPGN type with tram-track appearance

A

I

84
Q

MPGN type with dense deposits

A

II

85
Q

Type I MPGN is associated with what infections (2)

A

1) HBV

2) HCV

86
Q

Type II MPGN is associated with what factor

A

C3 nephritic factor

87
Q

Pathophysiology of DM nephropathy

A

Non-enzymatic glycosylation of GBM increasing permeability and thickening

88
Q

Kimmelsteil-Wilson lesion can be seen on LM as

A

Eosinophilic nodular glomerulosclerosis

89
Q

Lumpy-bumpy appearance of APGN is seen under

A

LM

90
Q

Subepithelial humps of APGN is seen under

A

EM

Physiology (15 decks)

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