Carlos Shared "13 Renal" - 89 Picmonics
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13 Renal
Potter Sequence (Syndrome)
- PATHOGENESIS
- Oligohydramnios
- clinical findings
- Limb Deformities
- Facial Anomalies
- Pulmonary Hypoplasia Most Common Cause of Death
- CAUSES
- Autosomal Recessive Polycystic Kidney Disease (ARPKD)
- Posterior Urethral Valves
- Chronic Placental Insufficiency
- Bilateral Renal Agenesis
3 mins
Horseshoe kidney
- Inferior poles of both kidneys fuse abnormally
- As they ascend from pelvis during fetal development, horseshoe kidneys get trapped under inferior mesenteric artery and remain low in the abdomen.
- Kidneys function normally.
- Associations
- Hydronephrosis (eg, ureteropelvic junction obstruction)
- Renal stones
- Infection
- Chromosomal aneuploidy syndromes: Turner syndrome; trisomies 13 (Patau), 18 (Edwards), 21 (Down)
- Rarely renal cancer
- May be seen in patients with Mullerian Agenesis
Urinary Excretory Anatomy
- Characteristics
- Renal Medulla
- Renal Cortex
- Nephron
- Bowman's Capsule
- Glomerulus
- Proximal Tubule
- Loop of Henle
- Distal Tubule
- Collecting Duct
- Ureter
- Urinary Bladder
- Urethra
2 mins
Renal Corpuscle
- Characteristics
- Arterioles
- Glomerulus
- Capillaries
- Fenestrations
- Plasma Solutes and Other Small Molecules Become Ultrafiltrate
- Bowman's Capsule Encapsulates Glomerulus
2 mins
Proximal Tubule
- Characteristics
- Na+ Reabsorbed Via Active Transport
- Water Follows Na+
- Most Of Glucose Reabsorbed
- Most Of Amino Acids Reabsorbed
- Bicarbonate Exchanged For H+
- Drugs and Toxins Excreted
- Filtrate Osmolarity Same As Plasma
- Leads To Loop Of Henle
2 mins
Loop of Henle
- Characteristics
- Descending Limb
- Water Follows Na+
- Medullary Hypertonicity
- Increased Water Reabsorption
- Vasa Recta
- Na+ Reabsorbed Via Active Transport
- Ascending Limb
- Reabsorbs Na+, K+, Cl-
- Decreased Concentration of Filtrate
- Impermeable to Water
- Distal Tubule
2 mins
Distal Tubule
- Characteristics
- Hormonally Regulated
- Aldosterone Causes Na+ Reabsorption
- Na+ Reabsorbed Via Active Transport
- Water follows Na+
- Parathyroid Hormone Causes Ca2+ Reabsorption
- Leads to Collecting Duct
1 min
Collecting Duct
- Characteristics
- Na+ Reabsorption
- Vasopressin Causes Water reabsorption
- Concentrates Filtrate
2 mins
Fanconi Syndrome Characteristics
- Pathophysiology
- Resorption Defect in Proximal Tubule
- Signs and Symptoms
- Hypophosphatemia
- Rickets
- Osteomalacia
- Hypokalemia
- Metabolic Acidosis
- Type 2 Renal Tubular Acidosis
- Treatment
- Treat Underlying Disorder
- Bicarbonate
1 min
Fanconi Syndrome Causes
- Hereditary Causes
- Cystinosis
- Dent's Disease
- Wilson's Disease
- Oculocerebrorenal (Lowe) Syndrome
- Galactosemia
- Hereditary Fructose Intolerance
- Glycogen Storage Diseases
- Tyrosinemia
- Acquired and Medication Causes
- Tenofovir
- Heavy Metals
- Expired Tetracyclines
- Cisplatin
- Gentamycin (Aminoglycosides)
- Valproate Sodium
- Multiple Myeloma
2 mins
Bartter Syndrome
- Reabsorptive defect in thick ascending loop of Henle
- Autosomal recessive
- Affects Na+/K+/2Cl– cotransporter
- Presents similarly to chronic loop diuretic use
- Results in hypokalemia and metabolic alkalosis
- Increased urine calcium
- Increased renin and aldosterone
Gitelman Syndrome
- Reabsorptive defect of NaCl in distal convoluted tubule
- Similar to using lifelong thiazide diuretics
- Autosomal recessive
- Less severe than Bartter syndrome
- Hypomagnesemia
- Hypokalemia, metabolic alkalosis
- Increased renin and aldosterone
- Decreased urine calcium
Liddle Syndrome
- Gain of function mutation - decreased degradation of sodium channels (AD) in collecting tubules
- Increased Na+ reabsorption in collecting tubules (increased activity of epithelial Na+ channel).
- Presents like hyperaldosteronism, but aldosterone is nearly undetectable
- Autosomal dominant
- Hypertension
- Hypokalemia and metabolic alkalosis
- Decreased aldosterone
- Decreased renin
- Treatment: Amiloride or triamterene (spironolactone is not effective)
Syndrome of Apparent Mineralocorticoid Excess
- Hereditary deficiency of 11β-hydroxysteroid dehydrogenase, converts cortisol to cortisone in cells with mineralocorticoid receptors
- Excess cortisol in these cells from enzyme deficiency increase mineralocorticoid receptor activity
- Hypertension
- Hypokalemia and metabolic alkalosis
- Low serum aldosterone levels
- Can acquire disorder from glycyrrhetinic acid (present in licorice), which blocks activity of 11β-hydroxysteroid dehydrogenase
- Treatment
- Corticosteroids (decrease endogenous cortisol production leading to decreased mineralocorticoid receptor activation)
RAAS - Renin-angiotensin-aldosterone system
- Decreased BP (JG cells), decreased Na+ delivery (macula densa cells) and increased sympathetic tone (B1 receptors) stimulate Renin secretion from Kidney
- Liver releases Angiotensinogen
- Renin converts Angiotensinogen to Angiotensin 1
- Lungs and Kidney release ACE
- ACE leads to Bradykinin breakdown and conversion of Angiotensin I to Angiotensin II
- EFFECTS OF ANGIOTENSIN II
- Acts at angiotensin II receptor, type 1 (AT1) on vascular smooth muscle. This leads to vasoconstriction and increase in BP
- Constricts efferent arteriole of glomerulus. This leads to increased FF to preserve renal function (GFR) in low-volume states (ie, when RBF is low).
- Aldosterone is released from adrenal gland. This leads to increase in Na+ channel and Na+/K+ pump insertion in principal cells; enhances K+ and H+ excretion by way of principal cell K+ channels and -intercalated cell H+ ATPases. This creates favorable Na
- ADH (vasopressin) is secreted from posterior pituitary increases aquaporin insertion in principal cells which leads to H2O reabsorption.
- Increased PCT Na+/H+ activity which causes Na+, HCO3 –, and H2O reabsorption (can permit contraction alkalosis.
- Stimulates hypothalamus which mediates thirst
Erythropoietin
- Mechanism
- Stimulates RBC Production
- Indications
- Chronic Renal Failure
- Anemia
- Side Effects
- Increased Risk of Thrombosis
- Pelvic and Limb Pain
- Hypertension
- Considerations
- Do Not Shake
- Monitor Hemoglobin (Hgb) Weekly
- May Accelerate Tumor Progression
2 mins
Vitamin D Mechanism
- 25 OH in the liver
- 1,25 OH in the kidney
- Absorbs Calcium and Phosphorus
42 secs
Potassium shifts
- SHIFTS K+ OUT OF CELL (CAUSING HYPERKALEMIA)
- Digitalis (blocks Na+/K+ ATPase)
- Hyperosmolarity
- Lysis of cells (eg, crush injury, rhabdomyolysis, tumor lysis syndrome)
- Acidosis
- β-blocker
- High blood Sugar (insulin deficiency)
- SHIFTS K+ INTO CELL (CAUSING HYPOKALEMIA)
- Hypo-osmolarity
- Alkalosis
- β-adrenergic agonist (increases Na+/K+ ATPase)
- Insulin (Increases Na+/K+ ATPase)
Hyponatremia
- Assessment
- < 135 mEq Na+
- Nausea and Vomiting
- Decreased LOC
- Confusion / Lethargy
- Seizures
- Priority Interventions
- Assess Airway
- Reduce Diuretic Dosage
- Fluid Excess Hyponatremia
- Mannitol (Osmitrol)
- Fluid Restriction
- Fluid Deficit Hyponatremia
- Hypertonic Solution (3% or 5% NaCl)
2 mins
Hypernatremia
- Assessment
- > 145 mEq/L Na+
- Change in LOC
- Extreme Thirst
- Orthostatic Hypotension
- Dry Flushed Skin
- Muscle Twitching
- Seizures
- Priority Interventions
- Treat and Prevent Dehydration
- Hypotonic Solutions (0.225% or 0.45% NaCl)
- Sodium Restriction
- Diuretics
2 mins
