HDS Renal/Endo Week 1 Pathology

Acute Kidney Injury, Chronic Kidney Disease, Glomerular Diseases, HTN, Hypo/Hyperkalemia, Hypo/Hypernatremia, Intro to Nephrology, Renal Vascular Disease, Tuberointerstitial Diseases of the Kidney, Urinalysis/Renal Lab Dx, Urinary Tract Pathology

The functional units of the kidney are ____, which consist of a ____ and a ____

nephrons; glomerulus; renal tubule

The kidney is ____peritoneal

retro

The right kidney is typically ____ than the left kidney

lower

The ____ kidney has a shorter renal vein

right

The ____ kidney is taken during donor transplantation because it has a longer renal vein

left

Blood enters the kidney via a ____, which branches into ____

renal artery; segmental arteries

Segmental arteries of the kidney further branch into ____

interlobar arteries

Interlobar arteries of the kidney further branch into ____

arcuate arteries

Arcuate arteries of the kidney further branch into ____

interlobular arteries

The interlobular arteries of the kidney divide into the ____

afferent arterioles

Blood enters the glomerular capillaries via the ____

afferent arterioles

Blood exits the glomerular capillaries via the ____

efferent arterioles

Blood from the efferent arterioles is delivered to the ____ capillaries

peritubular

The juxtaglomerular apparatus consists of ____ cells, ____ cells, and the ____

mesangial; JG; macular densa

The kidneys receive approximately ____% of the cardiac output

20

On average, total body water (TBW) is ____% of body weight

60

On average, ____ fluid is ____% of body weight

intracellular; 40

On average, ____ fluid is ____% of body weight

extracellular; 20

Extracellular fluid comprises ____ of total body water

one-third

Extracellular fluid is divided into ____ (75% of ECF) and ____ (25% of ECF)

interstitial fluid; plasma

Intracellular fluid comprises ____ of total body water

two-thirds

The major cation of extracellular fluid is ____

Na+

The major cations of intracellular fluid are ____ and ____

K+; Mg2+

The major anions of extracellular fluid are ____ and ____

Cl-; HCO3- (bicarbonate)

Fluid exits the glomerular capillaries and enters Bowman's space via the process of ____

filtration

The sum of filtration, secretion, and reabsorption is ____

excretion

Fluid exits peritubular capillaries and enters PCT cells via the process of ____

secretion

Fluid exits PCT cells and enters the peritubular capillaries via the process of ____

reabsorption

The ____ is the ratio of the Na+ excreted/ Na+ filtered

fractional excretion of sodium (FENa)

Acidemia is characterized by arterial pH < ____

7.35

Alkalemia is characterized by arterial pH > ____

7.45

Which acid-base disturbance is caused by increased HCO3-?

metabolic alkalosis

Which acid-base disturbance is caused by decreased HCO3-?

metabolic acidosis

In response to ____ Na+ delivery, the macula densa cells of the kidney cause increased renin release

decreased

In response to increased Na+ intake (and ECF volume), there is ____ renin-angiotensin-aldosterone activity

decreased

In response to ____ blood pressure, the JG cells of the kidney cause increased renin release

decreased

In response to increased Na+ delivery, the macula densa causes decreased renin release, which ultimately relaxes the ____ arterioles

efferent

____ is a hormone synthesized in the kidneys in response to hypoxia

Erythropoietin (EPO)

In the kidney, 25-hydroxycholecalciferol may be hydroxylated by ____ to produce ____; this compound is chemically ____

1α-hydroxylase; 1,25-dihydroxycholecalciferol; active

In chronic renal failure, decreased production of the active form of vitamin ____ by the kidney contributes to decreased ionized Ca2+

D (1,25-dihydroxycholecalciferol)

In chronic renal failure, the combination of elevated PTH and decreased 1,25-(OH)2D3 produces ____, in which there is increased bone resorption and osteomalacia

renal osteodystrophy

What bone pathology is associated with chronic renal failure?

renal osteodystrophy

Acute pyelonephritis may present with ____ pain due to sensitization of the nerves of the kidney capsule (CVA tenderness on physical exam)

flank

____ is the primary abnormality in prerenal disease

Reduced renal perfusion

____ is due to obstruction of the urinary tract downstream from the kidney (e.g. stones, BPH, neoplasia)

Postrenal azotemia

Does postrenal azotemia occur with unilateral or bilateral obstruction?

bilateral

____ is generally due to acute tubular necrosis or ischemia/toxins

Intrarenal azotemia

Intrarenal azotemia is less commonly due to acute ____ or acute ____

glomerulonephritis; interstitial nephritis

Nephritic syndrome is a group of glomerular disorders characterized by glomerular ____ and ____

inflammation; bleeding

Nephritic syndrome is characterized by limited ____-uria < 3.5 g/day

protein

How does nephritic syndrome affect urine output?

decreased

Nephritic syndrome is associated with ____ BUN and creatinine

increased

Nephritic syndrome is associated with ____ with consequent periorbital edema and ____

salt retention; hypertension

Nephritic syndrome may lead to hematuria and ____ casts in the urine

RBC

Nephrotic syndrome results in ____, which increases risk of infection

hypogammaglobulinemia

Nephrotic syndrome causes a ____ due to loss of ____

hypercoaguable state; antithrombin III

Nephrotic syndrome is associated with ____lipidemia and ____cholesterolemia

hyper; hyper

Nephrotic syndrome results in ____, which manifests as ____

hypoalbuminemia; pitting edema

Acute tubular necrosis caused by ____ is due to toxic substances

nephrotoxicity

What is the most common cause of acute renal failure in hospitalized patients?

acute tubular necrosis

Acute tubular necrosis is caused by ____ or ____ injury

ischemic; nephrotoxic

Acute tubular necrosis caused by ____ is due to decreased renal blood flow

ischemia

Which movement disorder presents as "flapping" motion upon extension of the wrists?

asterixis

Uremia, a consequence of renal failure, may cause ____ with ____

encephalopathy; asterixis

What renal pathology is associated with eosinophils in the urine?

acute interstitial nephritis

____ cells in a urine specimen are widely thought to be associated with bacterial contamination

Squamous epithelial

____ casts are a key finding of nephritic syndrome

RBC

____ casts will be seen in acute interstitial nephritis or pyelonephritis

WBC

____ is associated with granular "muddy brown" casts in the urine

Acute tubular necrosis

Incremental reductions in ____ define the stages of chronic kidney disease

GFR

In addition to inulin, ____ clearance may also be used to estimate GFR

creatinine

What is the normal serum BUN:creatinine ratio?

15:1

In prerenal azotemia, the BUN:creatinine ratio is ____ than 15

greater

In prerenal azotemia, there is an ____ in the ratio of BUN/creatinine to more than 20

increase

A ____ is commonly performed percutaneously with ultrasound guidance and is often used in the diagnosis of glomerulonephritis

renal biopsy

Treatment of renal failure involves ____ or ____

dialysis; renal transplant

____ is also known as acute renal failure

Acute kidney injury

____ was previously known as chronic renal failure

Chronic kidney disease

____ is used for patients on dialysis or have a history of renal transplantation

End stage renal disease (ESRD)

Azotemia typically refers to an increase in serum ____ and ____

BUN; creatinine

____ is a symptomatic clinical syndrome marked by increased nitrogenous waste products in the blood (azotemia)

Uremia

Urothelium is 6-7 cell layers thick when not distended, two cells thick when distended; surface layer known as ____

umbrella cells

In females, the ureters pass ____ the uterine artery

under

In males, the ureters pass ____ the vas deferens

under

The renal pelvis and ureters are ____peritoneal

retro

Ureters enter the bladder ____, which acts as a valve

obliquely

The ureter is described as having three anatomic sites of narrowing at which kidney stones typically become lodged: (1) the ____ junction (2) ____ (crossing iliac vessels) (3) the ____ junction

ureteropelvis; pelvic brim; ureterovesical

____ is backward urine flow from the bladder to the kidneys

Vesicoureteral reflux

Tissue membrane remnant obstructing urethral outflow in male children is called ____

posterior urethral valve

What is the most common site of obstruction (hydronephrosis) in the fetal kidney?

ureteropelvic junction

What condition results when there is formation of two ureteric buds on one side?

duplex collecting system (ureteral duplication)

Duplex collecting system is associated with increased risk for ____

urinary tract infections

Duplex collecting system is strongly associated with ____

vesicoureteral reflux

____ is the distention or dilation of the renal pelvis and calyces

Hydronephrosis

Hydronephrosis is usually caused by urinary tract ____

obstruction

Hydronephrosis may lead to the compression and possible ____ of the renal cortex and medulla

atrophy

A ____ presents as urine discharge from the umbilicus

patent urachus

What is the most common type of kidney stone (80%)?

calcium stone

Which type of calcium kidney stone (calcium-oxalate or calcium-phosphate) is more common?

calcium oxalate

The second most common type of kidney stone (15%) is an ____ stone, also known as struvite

ammonium magnesium phosphate