PROCESSES

Glomerular capillary to Bowman’s space

What pathway describes the movement of fluid during glomerular filtration?

Tubular lumen to peritubular capillaries

What pathway describes the process of renal reabsorption?

Peritubular capillaries to tubular lumen

What pathway describes the process of renal secretion?

Inulin

What event is used as the gold standard for measuring glomerular filtration because it is filtered only?

Overturning of the transport maximum

What event causes glucose to appear in the urine of patients with diabetic kidney disease?

Size and charge selectivity

What comes after molecules encounter the three-layer glomerular filtration barrier?

Increased GFR

What causes the delivery of NaCl to the macula densa to increase?

Myogenic response

What event involves the stretch of the afferent arteriole leading to reflex constriction to stabilize flow?

Tubuloglomerular feedback

What event involves the macula densa releasing mediators to cause afferent constriction in response to high GFR?

Isosmotic reabsorption

What event describes the proximal tubule process where sodium and water move together?

Splay

What event is the gradual rather than abrupt appearance of glucosuria due to variability among nephrons?

Passive water reabsorption

What causes the tubular fluid to become hyperosmotic in the thin descending limb?

Active NaCl reabsorption via NKCC2

What event causes the dilution of tubular fluid in the thick ascending limb?

Thick ascending limb

What event or segment is known as the major diluting segment of the nephron?

Aldosterone activation

What causes increased Na+ reabsorption and increased K+/H+ secretion in the late distal tubule?

Insertion of AQP2 channels

What event is triggered by high ADH levels during a water deficit?

Low-volume, concentrated urine

What comes after water is reabsorbed osmotically into the hyperosmotic medulla under ADH influence?

RAAS activation

What event is a response to decreased effective circulating volume?

Renin release

What causes the conversion of angiotensinogen to angiotensin I?

ACE activity

What comes after the formation of angiotensin I in the RAAS pathway?

Efferent arteriole constriction

What causes the maintenance of GFR despite low renal perfusion pressure?

Metabolic alkalosis

What causes an increase in distal K+ secretion and subsequent hypokalemia?

Generation of new bicarbonate

What comes after the excretion of one H+ as titratable acid or ammonium?

Type B intercalated cell activity

What event causes the removal of excess bicarbonate from the blood during metabolic alkalosis?

Azotemia

What causes elevated nitrogenous waste products like BUN and creatinine in the blood?

Falls in GFR

What causes the filtration of waste to decrease in azotemia?

Prerenal azotemia

What is the pathophysiology of nitrogenous waste accumulation due to low renal perfusion or heart failure?

Intrinsic renal azotemia

What is the pathophysiology of azotemia caused by acute tubular necrosis or glomerulonephritis?

Postrenal azotemia

What is the pathophysiology of azotemia caused by ureteral stones or prostate obstruction?

Uremic encephalopathy

What causes confusion, dementia-like states, and sleep disturbances in severe uremia?

Decrease in effective GFR or urine flow

What is the common pathophysiology underlying oliguria and anuria?

Complete vascular occlusion

What causes true anuria besides severe bilateral obstruction?

Intense Na+/water reabsorption

What causes a decrease in urine volume during prerenal hypoperfusion?

Glomerular hematuria

What is the pathophysiology of blood in urine presenting with RBC casts and dysmorphic RBCs?

Urologic hematuria

What is the pathophysiology of blood in urine presenting with isomorphic RBCs and clots?

Gelled Tamm-Horsfall protein cylindrical mold

What causes RBCs to become trapped and form RBC casts?

Glomerular proteinuria

What is the pathophysiology of albumin leaking into the filtrate due to loss of barrier selectivity?

Tubular proteinuria

What is the pathophysiology of non-albumin protein excretion due to impaired reabsorption?

Overflow proteinuria

What causes light chains or myoglobin to exceed reabsorptive capacity?

Osmotic diuresis

What causes polyuria in uncontrolled diabetes mellitus?

Water diuresis

What is the pathophysiology of polyuria in diabetes insipidus?

Primary polydipsia

What causes polyuria due to excessive water drinking?

Urinary tract obstruction

What comes after bilateral ureteral stones or a large prostate increases tubular pressure?

Full house pattern

What event on immunofluorescence, showing positive IgG, IgA, IgM, C3, and C1q, indicates lupus?

In situ immune complex deposition

What causes antibodies to react directly with intrinsic or planted antigens in the glomerulus?

Goodpasture syndrome

What causes antibodies to cross-react with both the GBM and alveolar basement membrane?

Granular staining pattern

What event on IF indicates antibodies reacting with planted antigens or circulating complexes?

Circulating immune complex deposition

What causes antigen-antibody complexes formed in the blood to become trapped in the glomeruli?

Mesangiolysis and proliferation

What event is caused by antibodies reacting to mesangial cell antigens?

Foot process effacement

What is the pathophysiology of flattening and fusion of podocytes leading to proteinuria?

Cellular proliferation

What causes the obliteration of the capillary lumen in hypercellularity?

Leukocyte infiltration

What event causes neutrophils to influx and obscure the capillary loops in post-streptococcal GN?

Crescent formation

What event involves the proliferation of parietal epithelial cells and infiltrating leukocytes in Bowman's space?

GBM damage or rupture

What causes fibrin to reach Bowman's space and trigger crescentic responses?

Basement membrane thickening

What event is an EM outcome of immune complex deposition or increased protein synthesis?

Hyalinosis

What is the pathophysiology of plasma proteins accumulating in the glomerulus due to endothelial injury?

Sclerosis

What event is the replacement and deposition of collagenous matrix causing capillary loop collapse?

Post-streptococcal glomerulonephritis

What comes after a streptococcal pharyngeal or skin infection in a child?

Activation and consumption of complement

What causes low serum C3 levels in PSGN?

Granular IgG and C3 deposits

What event on IF characterizes the rock salt appearance of PSGN?

Subepithelial humps

What event on EM shows discrete, amorphous deposits between the epithelium and basal membrane?

RPGN / Crescentic GN

What event is the rapid and progressive loss of renal function with nephritic signs?

Type III RPGN (Pauci-immune)

What event is characterized by little to no immune deposition and the presence of ANCAs?

Wegener granulomatosis

What event presents as a triad of respiratory granulomas, necrotizing vasculitis, and crescentic GN?

Microscopic polyangiitis

What event involves necrotizing vasculitis of arterioles and capillaries with necrotizing GN?

Plasmapheresis

What event is used to remove circulating pathogenic antibodies in Type I RPGN?

Massive proteinuria (>3.5g/day)

What causes hypoalbuminemia and generalized edema in nephrotic syndrome?

C5b-C9 Membrane Attack Complex

What causes capillary wall injury and protein leakage in primary membranous nephropathy?

Subepithelial spike formation

What event is the synthesis of new GBM between immune complex deposits?

M-type phospholipase A2 receptor (PLA2R)

What is the renal autoantigen that causes 60-70% of human membranous nephropathy?

Highly selective proteinuria

What event is characteristic of minimal change disease due to podocyte damage?

TGF-beta stimulation

What causes fibroblasts to deposit collagen in FSGS and idiopathic pulmonary fibrosis?

Loss of functioning nephrons

What causes a cycle of progressive hyperfiltration and hypertrophy?

NPHS1 mutation

What event causes Finnish-type congenital nephrotic syndrome by affecting nephrin?

NPHS2 mutation

What event causes steroid-resistant nephrotic syndrome by affecting podocin?

Collapsing glomerulopathy

What event is the most characteristic renal lesion in HIV-associated nephropathy?

Double-contour or tram-track appearance

What comes after the splitting of the GBM in MPGN Type I?

C3 Nephritic Factor

What event involves an antibody stabilizing alternative pathway C3 convertase?

Lamina densa ribbon-like transformation

What event on EM is the hallmark of Dense Deposit Disease?

High polyanionic charge

What causes proteins to be repelled by the glomerular filtration barrier?

Newborn nephron formation

What event is complete by the 36th to 40th week of gestation?

Hyperfiltration injury

What comes after a child has a significant reduction in the total number of nephrons?

Approximation of adult GFR

What event occurs at 3 years of age in pediatric development?

Preterm birth and perinatal death

What comes after untreated asymptomatic bacteriuria in pregnancy?

Let-down reflex failure

What causes a neonate to have no urine output despite normal kidneys?

Posterior urethral valve

What event is the most common cause of obstructive AKI in male neonates?

Primary nocturnal enuresis

What event describes a child who was never toilet trained and continues to wet the bed?

Secondary nocturnal enuresis

What event describes a child who was toilet trained but started wetting again?

Urate crystals turning pink

What causes pink stains in a newborn’s diaper?

Sudden drop in maternal hormones

What causes pseudomenstruation in female neonates?

Stretching of the renal capsule

What causes flank pain in inflammatory kidney diseases?

Hazing injuries

What causes acute myoglobinuria and tea-colored urine?

Ascorbic acid intake

What causes a false negative dipstick result for hematuria?

Low urine flow and acidic urine

What causes the formation of urinary casts within the tubules?

Renal etiologies

What causes edema to appear first in the periorbital area before spreading to ascites?

Hepatic etiologies

What causes ascites to appear before lower leg edema?

Inappropriate blood pressure cuff size

What causes inaccurate BP determination in children?

BPH

What causes the incidence of UTI in men over 50 to equal that of women?

Phimosis

What causes UTI to be more frequent in males during the neonatal period?

Urinary tract infection

What event typically begins with the ascension of bacteria from the urethra to the bladder?