Term
| How much do the kidneys weigh? How many cm are they in length? |
|
Definition
135 - 150 grams
10 - 12 cm in length |
|
|
Term
| What are the three layers that surround the kidneys? |
|
Definition
| Renal Capsule, Adipose Capsule and Renal fascia (keeps the kidney in place) |
|
|
Term
| Which nerves help regulate blood flow through the kidneys? |
|
Definition
| Vasomotor nerves from the sympathetic division of the ANS |
|
|
Term
| What is the functional unit of the kidney? |
|
Definition
|
|
Term
| What does the nephron consist of? |
|
Definition
| Renal Corpuscle (Glomerulus and Bowman's Capsule) and renal tubule |
|
|
Term
| What makes up the renal corpuscle? |
|
Definition
| Glomerulus and Bowman's Capsule |
|
|
Term
| What does the renal tubule consist of? (in order) |
|
Definition
| proximal convoluted tubule, loop of henle (descending and ascending), distal convoluted tubule which drains into the collecting duct that is shared by several nephrons |
|
|
Term
| What are the most important ions that the kidneys regulate? |
|
Definition
|
|
Term
| How do the kidneys regulate blood pH? |
|
Definition
| Excreting H+ and conserving HCO3 |
|
|
Term
| What enzyme do the kidneys secrete that helps in BP regulation? How does an increase in renin affect the BP? |
|
Definition
| Renin; Increase in Renin increases BP |
|
|
Term
| What is the relatively stable "normal" osmolality maintained by the kidneys? |
|
Definition
| 300 milliosmoles per liter |
|
|
Term
| What two hormones do the kidneys produce? |
|
Definition
| Calcitriol and Erythropoietin |
|
|
Term
| What is the function of calcitriol? |
|
Definition
| The active form of Vitamin D that helps regulate Ca Homeostasis |
|
|
Term
| What is the function of EPO? |
|
Definition
| Stimulates RBC production |
|
|
Term
| How do the kidneys help regulate the glucose concentration in the blood? |
|
Definition
| Kidneys can use amino acid glutamine in gluconeogenesis, the synthesis of new glucose molecules |
|
|
Term
| What is the origination of ammonia and urea excreted by the kidneys? |
|
Definition
|
|
Term
| What is the origination of bilirubin excreted by the kidneys? |
|
Definition
|
|
Term
| What is the origination of creatine excreted by the kidneys? |
|
Definition
| breakdown of creatine phosphate in muscle fibers |
|
|
Term
| What is the origination of uric acid excreted by the kidneys? |
|
Definition
|
|
Term
| In glomerular filtration describe what primarily moves? |
|
Definition
| water and most solutes leave the blood and move to the glomerular capsule |
|
|
Term
| In Tubular reabsorption describe what primarily moves? |
|
Definition
| 90% of the water and many useful solutes return to the blood |
|
|
Term
| In Tubular secretion describe what primarily moves? |
|
Definition
| secretion of wastes, drugs and excess ions |
|
|
Term
| What accounts for the majority of the make-up of the urine? |
|
Definition
|
|
Term
| What is the normal adult urine volume in a 24 hr period? |
|
Definition
|
|
Term
| What is the average amount of glomerular filtrate in the normal adult? |
|
Definition
|
|
Term
| What are the 3 components of the filtration membrane? |
|
Definition
Glomerular Endothelial Fenestrations (Pores)
Basal Lamina
Slit Membrane of Filtration Slits |
|
|
Term
| What passes through the Glomerular endothelial fenestrations (pores)? |
|
Definition
| allows all proteins and excludes cells, platelets |
|
|
Term
| What is allowed to pass through the Basal lamina? |
|
Definition
| allows small & medium-sized proteins through |
|
|
Term
| What is allowed to pass through the Slit membrane of filtration slits? |
|
Definition
| only allows very small proteins |
|
|
Term
| Which glomerular filtration membrane allows the largest proteins through? |
|
Definition
| Glomerular endothelial fenestrations (pores) |
|
|
Term
| Which glomerular filtration membrane allows the only the smallest proteins through? |
|
Definition
| Slit membrane of filtration slits |
|
|
Term
| What is the normal GBHP (Glomerular Blood Hydrostatic Pressure)? What does it promote? |
|
Definition
| 55mmHg; promotes filtration of water and solutes |
|
|
Term
| What is the normal (CHP) capsular hydrostatic pressure? What does it oppose? |
|
Definition
| 15mmHg; opposes filtration |
|
|
Term
| What is the normal BCOP? What does it opposes? |
|
Definition
| 30 mmHg; opposes filtration |
|
|
Term
| Which two glomerular pressure oppose filtration? |
|
Definition
| CHP (Capsular Hydrostatic Pressure) and BCOP (Blood Colloid Osmotic Pressure) |
|
|
Term
| When all 3 glomerular filtration pressures are considered, what is the net filtration pressure? |
|
Definition
|
|
Term
| What is the term describing the amount of filtrate formed by both kidneys per minute? |
|
Definition
| GFR - Glomerular Filtration Rate |
|
|
Term
|
Definition
|
|
Term
| What are the two main GFR regulation mechanisms? |
|
Definition
Control of blood flow in and out of glomerulus
Control of glomerular surface area |
|
|
Term
| What effect does ADH have on the kidneys? |
|
Definition
| ADH acts on the collecting duct tubules to promote the resorption of free water |
|
|
Term
| Where is ADH released from? |
|
Definition
| released from the posterior pituitary |
|
|
Term
| In what chronic condition is there deficient ADH? |
|
Definition
|
|
Term
| What are the two types of DI? |
|
Definition
Hypothalamic DI
Nephrogenic DI |
|
|
Term
| What are the symptoms of DI? What are they a result of? |
|
Definition
| Polyuria and Polydipsia caused by the kidneys inability to concentrate urine |
|
|
Term
| What chronic conditions is ADH found in excess in the body? |
|
Definition
| SIADH - syndrome of inappropriate ADH |
|
|
Term
| What are the clinical manifestations of SIADH? |
|
Definition
| Hyponatremia, cerebral edema with resultant neurological dysfunction |
|
|
Term
| What evaluations will all pts who are suspected to have renal dz undergo? |
|
Definition
1 - H & P
2 - UA (dipstick and microscopee :)
3 - Assessment of GFR |
|
|
Term
| Where is urea synthesized? What is the origination of urea? |
|
Definition
| synthesized in the liver from the breakdown of protein |
|
|
Term
| What does the concentration of urea and creatinine tell us about the kidney? |
|
Definition
| Urea and Creatinine are excreted principally by glomerular filtration, so the levels of each are determined by the rate of glomerular filtration |
|
|
Term
| What are the normal BUN levels? |
|
Definition
|
|
Term
| In what conditions/diseases would BUN increase? |
|
Definition
Increased in acute and chronic renal failure
urinary obstruction
dehydration
reduced renal perfusion (CHF, hypovolemia)
accelerated catabolism (fever, trauma, GI bleed) |
|
|
Term
| What meds and dietary changes can cause an increase in BUN? |
|
Definition
increased dietary protein
steroids and tetracycline |
|
|
Term
|
Definition
overhydration
increased perfusion (pregnancy and SIADH)
restriction of dietary protein/malnutrition
liver disease |
|
|
Term
| What waste excreted in the urine is a product of protein metabolism? |
|
Definition
|
|
Term
| What waste excreted in the urine is a product of muscle metabolism? |
|
Definition
|
|
Term
| What is the usual means of estimating GFR? |
|
Definition
|
|
Term
| What are the normal values for secretion of Creatinine? |
|
Definition
|
|
Term
| Which meds can cause an increase in Serum Creatinine concentration? |
|
Definition
Cephalosporins - Antibiotic
Cimetidine (Tagamet) - tx for GERD
Probenecid - tx for chronic gout and gouty arthritis
Trimethoprim - UTI med, tx for E.Coli GI infection |
|
|
Term
| What dietary change can cause an increase in Serum Creatinine? |
|
Definition
|
|
Term
| What conditions/diseases can cause an increase in Serum Creatinine? |
|
Definition
acute and chronic renal failure
Urinary tract obstruction
increased muscle mass |
|
|
Term
| What is the normal ratio of BUN/Cr? |
|
Definition
|
|
Term
| What is the MOST important parameter in clinical eval of renal function? |
|
Definition
|
|
Term
| In ESRD what is the best way to measure GFR? |
|
Definition
| Use BOTH BUN and Cr Clearance |
|
|
Term
| What is the "gold standard" for measuring GFR? |
|
Definition
| to use the clearance of injected carbohydrate – inulin (however, this is NOT practical) |
|
|
Term
| What is the normal (adult) value for GFR? |
|
Definition
|
|
Term
| What would a high protein diet or high salt diet cause in GFR? |
|
Definition
|
|
Term
| How does pregnancy affect the GFR? |
|
Definition
| GFR is markedly increased in pregnancy |
|
|
Term
| How does aging affect the GFR? |
|
Definition
|
|
Term
| Which stage of CKD is the GFR >90 and is described as kidney damage, protein in the urine, but normal filtration rate? |
|
Definition
|
|
Term
| Which stage of CKD has a GFR of 60 to 89 and is described as kidney damage, and a mild decrease in filtration rate? |
|
Definition
|
|
Term
| Which stage of CKD has a GFR of 30 - 59 and is described as moderate decrease in filtration rate? |
|
Definition
|
|
Term
| Which stage of CKD has a GFR of 15 - 29 and is described as a severe decline in filtration rate? |
|
Definition
|
|
Term
| Which stage of CKD has a GFR of <15 and is described as kidney failure? |
|
Definition
|
|
Term
| What is the formula for creatinine clearance which considers both serum and plasma? |
|
Definition
| CrCl = (Urine Clearance x Total Body Wt)/ Plasma Clearance |
|
|
Term
| What is the formula for creatinine clearance which considers only serum? |
|
Definition
Cockcroft and Gault Method
C = {(140-age) x Weight in Kg}/Plasma Cr x 72 |
|
|
Term
| Which method of calculating CrCl is the BEST for older or obese pts and also corrects for sex and the AA race? |
|
Definition
|
|
Term
| What calculation is used to estimate the excretion of sodium for pts with suspected acute renal failure? |
|
Definition
| FENa (Fractional Excretion of Sodium) |
|
|
Term
| What should the normal color of urine be? |
|
Definition
|
|
Term
| What is the normal range for specific gravity? |
|
Definition
|
|
Term
| Which type of void is BEST for microscopic evaluation? |
|
Definition
|
|
Term
| Which type of urine sample is best for urinalysis? |
|
Definition
|
|
Term
| What is the best urine test for true quantitative eval and is especially good for total protein? |
|
Definition
|
|
Term
| What does specific gravity correlate well with? |
|
Definition
|
|
Term
| What test data gives important insight into hydration status and concentrating ability of the kidneys? |
|
Definition
|
|
Term
| What is the normal pH range for urine? |
|
Definition
|
|
Term
| What is often the first indication of renal disease? |
|
Definition
|
|
Term
| What type of protein are urine dipsticks MOST sensitive to? |
|
Definition
|
|
Term
| Why would you see an increased Urobilinogen and Bilirubin level on a urine dip sticks? |
|
Definition
| Hemolytic processes or hepatic dz |
|
|
Term
| If a urine dipstick is "positive" for glucose, what is your next step? |
|
Definition
|
|
Term
| Which part of the urine dip stick test is useful to screen for DKA? |
|
Definition
|
|
Term
| What can give you a false pos Urine ketones on a dipstick? |
|
Definition
fasting
post-exercise
Pregnancy |
|
|
Term
| What is a + Nitrite finding on a urine dipstick an indication of? |
|
Definition
|
|
Term
| Which type of bacteria will cause a + Nitrate on a urine dipstick? |
|
Definition
|
|
Term
| What is a + Leukocyte esterase on a urine dipstick analysis suggestive of? Why? |
|
Definition
| Suggestive of bacteria, b/c leukocyte esterase is an enzyme produced by neutrophils which are present with infection |
|
|
Term
| If a urine dipstick is positive for blood, what should your f/u be? |
|
Definition
| Confirm with urine microscopy |
|
|
Term
| Presence of > 5 leukocytes per high power field is considered what? |
|
Definition
|
|
Term
| What are leukocytes found in urine microscopy indicative of? |
|
Definition
| Injury to the urinary tract (can be caused by infection, stones, strictures, neoplasm, GU TB, glomerulonephropathy or interstitial nephritis) |
|
|
Term
| What amount of Erythrocytes found under urine microscopy is considered significant? |
|
Definition
| Presence of > 3 erythrocytes |
|
|
Term
| What do dysmorphic (irregularly shaped) RBCs indicate? |
|
Definition
| Indicative of Glomerulonephritis |
|
|
Term
| What do round/normal RBCs found under urine microscopy indicate? |
|
Definition
| dz along epithelial lining of urinary tract |
|
|
Term
| What type of epithelial cell finding on urine microscopy is indicative of a contaminated specimen? |
|
Definition
| Squamous epithelial cells |
|
|
Term
| What type of epithelial cell finding on urine microscopy may be normal in small amounts, but if found in large amounts may be indicative of neoplasm? |
|
Definition
| Transitional Epithelial Cell |
|
|
Term
| If bacteria is found under microscopic urine exam in an uncontaminated specimen, what is the appropriate f/u? |
|
Definition
|
|
Term
| What is the MC yeast seen in urine? |
|
Definition
|
|
Term
| Under urine microscopy a pear-shape organism with flagella is seen, what condition do you suspect? |
|
Definition
|
|
Term
| What is the MC excreted protein in urine? |
|
Definition
| Tamm-Horsfall mucoprotein |
|
|
Term
| Where are casts found on urine microscopy originally formed? |
|
Definition
| distal tubules and collecting ducts |
|
|
Term
| What is a finding of Tamm-Horsfall mucoprotein on urine microscopy indicative of? |
|
Definition
| Protection against UTI or calcium crystallization |
|
|
Term
| Are hyaline casts specific for renal dz? |
|
Definition
|
|
Term
| When are Hyaline casts seen in urine? |
|
Definition
| Seen in concentrated urine, febrile dz, strenuous exercise, diuretic therapy |
|
|
Term
| What type of med can lead to hyaline casts in the urine? |
|
Definition
|
|
Term
| What urine microscopy finding is CHARACTERISTIC of GN? |
|
Definition
|
|
Term
| If intraparenchymal bleeding is present (as in GN), what will you find on microscopy? |
|
Definition
|
|
Term
| What urine microscopic finding is characteristic of pyelonephritis and useful in distinguishing this d/o from a lower UTI? What other condition can this be found in? |
|
Definition
| White Cell Casts; seen in interstitial nephritis |
|
|
Term
| What condition are tubular cell casts seen in? |
|
Definition
|
|
Term
| Are granular casts usually pathologic? |
|
Definition
|
|
Term
| What conditions can granular casts be seen in? |
|
Definition
| ATN, GN, or tubulointerstitial dz |
|
|
Term
| Which urine microscopic finding is frequently seen in CRF and chronic parenchymal dz? |
|
Definition
|
|
Term
[image]
What is a crystal that resembles an envelope made of and what does its presence indicate? |
|
Definition
Calcium Oxylate Crystals
Indicates kidney stones |
|
|
Term
[image]
Which type of crystals in urine are described as having diamond or barrel-shaped and what condition are they indicative of? |
|
Definition
Uric Acid Crystals
Overproducer of Uric Acid (leading to gout) |
|
|
Term
| Which type of urine crystals look like a box with an X on it? What condition is this finding indicative of? |
|
Definition
| Phosphate crystals; Alkaline urine or UTI |
|
|
Term
| Which renal imaging test can identify thickness and echogenicity of renal cortex, medulla and pyramids and a distended urinary collecting system? |
|
Definition
|
|
Term
| On kidney U/S, what is the normal kidney size? |
|
Definition
|
|
Term
| On renal U/S what does a kidney size of < 9cm in length indicate? |
|
Definition
| Significant irreversible renal dz |
|
|
Term
| On renal U/S what is a "significant" difference btween kidneys defined as? What would a "significant" difference be indicative of? |
|
Definition
Difference of 1.5cm is "significant"
If "significant" difference is seen = unilateral renal dz |
|
|
Term
| Which renal imaging technique is cheap, non-invasive and allows for determining if an obstruction is present, to characterize renal masses and for ADPKD screening? |
|
Definition
|
|
Term
| Which renal imaging technique is used to performed to obtain detailed view of papillary-icaliceal system, assess renal size and shape, detect and localize renal stones, and assess renal function? |
|
Definition
| IVP or Intravenous Urography |
|
|
Term
| When and why is an IVP contraindicated? |
|
Definition
| Contraindicated in pts with increased risk of developing ARF. chronic kidney dz or multiple myeloma, b/c of injection of contrast needed for procedure. |
|
|
Term
| What renal imaging technique is particularly good for dx of medullary sponge kidney and papillary necrosis? |
|
Definition
|
|
Term
| What renal imaging test is BEST for diagnosing renal stones? |
|
Definition
|
|
Term
| What renal imaging test is especially useful for the evaluation of solid or cystic lesions in the kidney or the retroperitoneal space (especially when the U/S findings are suboptimal)? |
|
Definition
|
|
Term
| Which renal imaging technique has a definitive role in staging renal neoplasms and imaging kidneys following trauma? |
|
Definition
|
|
Term
| Which renal imaging technique is a combo of an IVP and abd CT? |
|
Definition
| Computerized Tomography Urogram (CTU) |
|
|
Term
| Which renal imaging technique is useful for hematuria w/up, especially if suspecting renal CA? |
|
Definition
| Computerized Tomography Urogram (CTU) |
|
|
Term
| Which renal imaging technique can easily distinguish renal cortex from medulla? |
|
Definition
|
|
Term
| Which renal imaging can detect loss of corticomedullary function (GN, hydronephrosis, renal vascular occlusion and renal faiure)? |
|
Definition
|
|
Term
| Which renal imaging technique can be used to stage renal cell carcinoma? |
|
Definition
|
|
Term
| Which renal imaging technique is used as a second-line eval for renal masses when a CT w/contrast is contraindicated? |
|
Definition
|
|
Term
| Which renal imaging technique is nearly 100% sensitive and 96-98% specific for the dx of renal artery stenosis? |
|
Definition
|
|
Term
| What is the difference btwn MR Angiography and catheter angiography? |
|
Definition
| MRA is less invasive and less expensive, but images are not quite as clear |
|
|
Term
| What is the preferred method for the eval of urinary reflux? |
|
Definition
| VCUG - Voided Cystourethrography |
|
|
Term
| If a 1 y/o child presents with pelvic discomfort, burning with urination and cloudy urine, what disease should you suspect? What imaging should you use to dx it? How should you treat it and Why? |
|
Definition
Suspect Urinary Reflux
Dx with VCUG (Voided Cystourethrography)
Tx with long-term antibiotics -b/c can lead to permanent scarring |
|
|
Term
Which renal imaging study is described as Catheter inserted into urethra, contrast instilled into bladder
X-rays taken before, during, and after? |
|
Definition
| VCUG -Voided Cystourethrography |
|
|
