Renal

Left kidney- longer renal vein!

uterine artery and ductus deferens
water under the bridge

radiolabeled albumin

inulin

composed of fenestrated cap endothelium- size barier, fused bm with heparan sulfate- neg charge barrier, and epi layer with podocyte foot processes

charge barrier lost
resulting in albuminuria, hypoproteinemia, gen edema, hyperlipidemia

freely filtered, not secreted or reabsorbed
can be used to calc GFR

100 mL/min

approx measure of GFR
slight overestimate bc Cr is moderately secreted by renal tubules

can be estimated using PAH clearance because it is filtered and actively secreted- all PAH entering kidney is excreted

10%

RPF/(1-Hct)

GFR/RPF
nml=20%

GFR x plasma concentration

V times Ux

plasma glucose 160-200 mg/dL
below that, gluc is completely reabsorbed
all transporters are fully saturate at 350 mg/dL

Na dep transporters in prox tubule reabsorb AA by at least 3 distinct carriers with comp inhibition within each group

def of neutral AA (tryptophan) transporter, results in pellagra- diarrhea, dementia, dermatitis

inhibits Na/phosphate cotransport in PCT, causes phosphate excretion
inc Ca/Na exchange in DCT, causes Ca reabsorption

stimulates Na/H exchange, inc Na and H2O reabsorption, permitting contraction alkalosis

Cl reabsorbed at a slower rate than Na in prox 1/3 of PCt, then matches the rate of Na reabsorption distally
relative conc inc before it plateaus

=1
Na reabsorption drives H2O reabsorption, so it nearly matches osm

affects baroreceptor function to limit reflex brachycardia which would normally accompany its pressor effects

from atria in response to inc volume, relaxes vasc smooth muscle via cGMP
causes inc GFR, dec renin

primarily reg osmolarity but also responds to low blood volume- takes precedence

primarily reg blood volume

modified smooth muscle of afferent arteriole
secrete renin in response to low renal bp, low na delivery to DCT, inc beta 1 sympathetic tone

Na sensor, part of DCT
part of JGA

25 OH vit D to 1,25 OH2 vit D by 1 alpha hydroxylase, PTH stimulates this, inc intestinal absorption of ca and phos

can cause acute renal failure by inhib renal prod of prostaglandins, ex PGE2- which vasodilate afferent arterioles to inc GFR

Insulin, beta agonists, alkalosis, hypo osmolarity

insulin def, beta blocker, acidosis, severe exercise, hyperosmolarity, digitalis, cell lysis

resp comp for met acidosis
Pco2=1.5HCO3 + 8 +/- 2

Pco2 inc by 0.7 for every 1 inc in HCO3

MUDPILES
methanol (formic acid), uremia, dka, paraldehyde or phenformin, iron tablets or INH, lctic acidosis, ethylene glycol (oxalic acid), salicylates

diarrhea, glue sniffing, renal tubular acidosis, hyperchloremia

diuretic use, vomitnig, antacid use, hyperaldosteronism

type 1- defect in CD's ability to excrete H+, ass with hypokalemia and risk for ca stones
type 2- defect in PCT bicarb reabsorption, ass with hypokalemia and hypophosphatemic rickets
type 4- hypoaldosteronism, hyperkalemia, dec urine pH due to dec buffering capacity

glomerulonephritis, ischemia, malignant htn

tubulointerstitial inflammation, acute pyelonephritis, transplant rejection

muddy brown
acute tubular necrosis

advanced renal dse/ chronic renal failure

pyuria, no casts

hematuria, no casts

Inflammatory process
when it involves glomeruli, leads to hematuria, RBC casts
ass with azotemia, oliguria, htn, proteinuria

FSGS- focal segmental glomerulosclerosis
MC glomerular dse in HIV pts

due to SLE or MPGN
wire looping of capillaries
subendothelial and sometimes intramembranous IgG based IC with C3 deposition
MCC death in SLE

membranous glomerulonephritis
diffuse cap and GBM thickening
spika and dome appearance on EM with subepi deposits

lipoid nephrosis
nephrotic syndrome
foot process effacement, selective loss of albumin due to GBM polyanion loss
trigger by recent infxn, MC in children, responds to corticosteroids

tram track appearance due to GBM splitting by mesangial ingrowth
subendo ICs with granular IF
ass with HBV, HCV

dense deposits on EM
subendo ICs with granular IF
ass with C3 nephritic factor

nonenzymatic glycosylation of GBM, efferent arterioles
GBM thickining, eosinophilic nodular glomerulosclerosis- Kimmelstiel Wilson lesion

only kidney stone that is radiolUcent

can be caused by hypercalcemia- cancer, inc PTH
ca oxalate crystals can result form ethylene glycol or vit C abuse

from struvite stones- ammonium mg phos
caused by infxn with urease positive bugs- Proteus, Staph, Klebsiella
worsened by alkaluria

originates in renal tubular cells- polygonal clear cells filled with lipids and carbs
hematuria, palp mass, 2ndary polycythemia
invades IVC, spreads hematogenously
ass with VHL, chrom 3p deletion
can secrete ectopic EPO, ACTH, PTHrP, prolactin

Wilms tumor- nephroblastoma, caused by deletion of tumor suppressor gene WT1 on chrom 11p, Aniridia, Genitourinary malformation, mental Retardation

Bladder cancer
Transitional cell ca MC tumor or urinary tract system
ass with Phenacetin, smoking, aniline dyes and cyclophosphamide

acute pyelonephritis
affects cortex, spares glomeruli/vessels
fever, CVA tenderness, NV

eosinophilic casts in tubules
chronic pyelonephritis!
lymphocytes and fibrosis
VUR required for development

MCC of acute renal failure in hospital
granular muddy brown casts
inciting event, maintenance phase- oliguric, 1-3 wks, hyperkalemia, recovery phase- polyruric, hypokalemia
death occurs during initial oliguric phase

ass with dm, acute pyelonephritis, chronic phenacetin use, sickle cell anemia and trait

is reabsorbed for countercurrent multiplication
creatinine is not

dec RBF ex hypotension, dec GFR, na/h20 and urea retained to conserve volume
INC BUN/Cr ratio

ex ATN, patchy necrosis leads to debris obstructing tubule and fluid backflow across necrotic tubule, dec GFR
BUN reabsorption impaired so DEC BUN/Cr ratio

failure of vit D hydroxylation, Ca wasting and phos retention, causes 2ndary hyperparathyroidism, dec intestinal Ca absorption
causes subperiosteal thinning of bones

medullary cysts can lead to fibrosis, inability to conc urine, small kidney, 70% develop stones, poor prog

sulfonamide loop diuretic, inhib Na K Cl pump of thick asc limp of LOH, stim PGE- vasodilate afferent arteriole, inhibited by NSAIDS, Loops Lose Ca
tox ototox, hypokalemia, dehydration, sulfa allergy, interstitial nephritis, gout

Ethacrynic acid- same action as furosemide, can cause hyperuricemia- NEVER use in gout!!!

inhib NaCl reabsorption in early distal tubule
tx htn, chf, hypercalciuria, nephrogenic diabetes insipidus
tox hypokalemic met alk, hyponatremia, hyperGLUC- glycemia, lipidemia, uricemia, calcemia, sulfa allergy

K sparing diuretics, block Na channels in CCT

-pril, red levels of ATII, prevent inactivation of bradykinin, renin release inc due to loss of neg feedback
tx htn, chf, diabetic renal dse
tox cough, angioedema, proteinuria, taste changes, hypotension, fetal renal damage, rash, inc renin, low AT II, hyperkalemia
avoid with bilat renal artery stenosis!!