Carlos Shared "13 Renal" - 88 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
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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
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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
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2 mins
Renal Corpuscle
Characteristics
Arterioles
Glomerulus
Capillaries
Fenestrations
Plasma Solutes and Other Small Molecules Become Ultrafiltrate
Bowman's Capsule Encapsulates Glomerulus
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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
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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
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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
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1 min
Collecting Duct
Characteristics
Na+ Reabsorption via Passive Transport
Vasopressin Causes Water reabsorption
Concentrates Filtrate
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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
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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
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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
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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
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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)
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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
ŽHypertension
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 decreasedŽ mineralocorticoid receptor activation)
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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
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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
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2 mins
Vitamin D Mechanism
25 OH in the liver
1,25 OH in the kidney
Absorbs Calcium and Phosphorus
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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)
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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)
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2 mins
Hypernatremia
Assessment
> 145 mEq/L Na+
Change in LOC
Extreme Thirst
Orthostatic Hypotension
Dry Flushed Skin
Muscle Twitching
Seizures
Priority Interventions
Prevent Dehydration
Hypotonic Solutions (0.225% or 0.45% NaCl)
Sodium Restriction
Diuretics
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2 mins

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