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Test your basic knowledge |
Renal
Start Test
Study First
Subject
:
health-sciences
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
ANP
Carbonic anhydrase
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
2. What dyslipidemia is most common in renal failure
Triglycerides
Needs to be bilateral
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Diabetic glomerulonephropathy
3. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
No
Stimulates thirst
Acute pyelonephritis
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
4. How is plasma volume measured
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Radiolabelled albumin
Hypovent - immediate
Men 50 to 70 - inc incidence with smoking and obesity
5. Which cells sense decreases in Na delivery
Complications of chronic kidney disease or HTN
Macula densa
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Inc renal calcium reabsorption and dec renal phosphate reabsoprtion - BUT also stimulates the prox tub cells to make 1 -25 (OH)2 vit D which inc intestinal absorption of both Ca and PO4
6. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Segmental sclerosis and hylanosis
Nephrotic syndrome
Na
Bladder cancer
7. In renal failure - what happens to potassium
Radiolabelled albumin
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Cx>GFR
Hyperkalemia
8. What change (lack of) is common in children with renal failure
Growth retardation and developmental delay
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Under and under
9. What effect does cxn of the ureter have on RPF - GFR and FF
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
NC - dec - dec
Acute tubular necrosis
Beta 1
10. What do patients die from ADPKD
RPF/(1- Hct)
Macula densa
Complications of chronic kidney disease or HTN
Hyperceullular glomeruli
11. coarse - asymmetric - corticomedullary scarring and blunted calyx
Rxn from angiotensinogen to angiontensin I
Chronic pyelonephritis
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Macula densa
12. Where is potassium conc. Highest? Intra or extra
Vasa recta - interlobular v - interlobar v - renal v
Intra = HIKIN!
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Stimulates thirst
13. Why can inulin be used to calculate GFR?
Inc - dec - dec
Freely filtered and neither absorbed or secreted
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
NKCC
14. WBC casts - ddx
RTA type 4 (hyperkalemic)
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Inc plasma osm - dec blood volume
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
15. What is the effect of AT II on the hypothalamus
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Dec - dec - NC
Hydronephrosis and pyelonephritis
Stimulates thirst
16. What is the compensatory response in respiratory acidosis
Under and under
Modified smooth muscle of afferent arteriole - secrete renin
By 10%
Inc renal bicarb resabsoprtion - delayed
17. What is the effect of AT II on the posterior pituitary
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Size and charge
Passively reabsorbs water via medullary hypertonicity
18. inc in creatinine and BUN over a period of several days
Acute renal failure
Inhibits Na/phosphate cotransport leading to phosphate excretion
1/4 plasma - and 3/4 interstitial volume
Simple cysts
19. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Insertion of Na channel on luminal side
Inc plasma osm - dec blood volume
Transitional cell carcinoma
Needs to be bilateral
20. TCC is associated with problems in your Pee SAC - ??
Hyperceullular glomeruli
Failure of EPO
Phenacetin - smoking - aniline dyes - cyclophosphamide
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
21. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Hydronephrosis and pyelonephritis
Dec - inc - dec
Negative charge
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
22. What is the effect of aldosterone in principal cells
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Dec - dec - dec
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
23. Who commonly gets acute post strep GN
RTA type 2 (proximal)
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Kids - peripheral and periorbital edema - resolves spontaneously
24. Which cells sense decreases in BP
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
ADPKD
JG cells
Small kidney - poor prognosis
25. Subendothelial immune complexes with granular IF
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Hypervent - early high altitude - aspirin ingestion early
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Membranoproliferative glomerulonephritis
26. What two cells make up the JGA
Macula densa and JG cells
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Carbonic anhydrase
Hyperceullular glomeruli
27. What are the two forms of renal failure and What are examples of each
Acute renal failure
60% total body water - 40% ICF - 20% ECF
Acute - ATN - or chronic - HTN - DM
Polycystic liver disease - berry aneurysms - mitral valve prolapse
28. In renal failure What are the consquence sof Na/H20 retention
Advanced renal dz - CRF
CHF - pulmonary edema - HTN
Acute - ATN - or chronic - HTN - DM
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
29. What is the net effect of PTH
Negative charge
Insertion of Na channel on luminal side
Inc in Ca and PO4 absoprtion from the gut
Polycystic liver disease - berry aneurysms - mitral valve prolapse
30. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Needs to be bilateral
Na
31. What are the associations with RTA type 2
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
HIV
GFR/RPF
Hypokalemia and hypophosphatemic rickets
32. What are the effects of AT II on the adrenal gland
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Solute is reabsorbed less quickly than water or net secretion of substance
Inc - inc - inc
33. RBC casts - ddx
Staghorn calculi - worsened by alkaluria
RPF/(1- Hct)
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
By 10%
34. What are the effects of AT II on vascular smooth muscle
Simple cysts
Vasocxn - inc BP
JG cells
All glomeruli
35. proliferative
Hyperceullular glomeruli
EPO - endothelial cells of peritubular capillaries
Hydronephrosis and pyelonephritis
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
36. What are the effects of PTH hormone on the kidney
Inc - inc - inc
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Inc renal calcium reabsorption and dec renal phosphate reabsoprtion - BUT also stimulates the prox tub cells to make 1 -25 (OH)2 vit D which inc intestinal absorption of both Ca and PO4
Acute tubular necrosis
37. What are the 3 transporters of the intercalated cells
Involves glomeruli and other organs
Eosinphilic casts in tubules
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
38. What is the algorithim for acidosis/alkalosis
Chronic pyelonephritis
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
PH - then PC02
<3.5 g /day
39. do you see casts in bladder cancer - kidney stones with hematuria
Antifreeze - ethyelene glycol or vit C abuse
Dec - inc - inc
Beta 1
No
40. How do calcium stones appear on x ray
Dec - dec - NC
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Radiopaque
Solute is reabsorbed less quickly than water or net secretion of substance
41. What does US show with medullary cystic disease
Small kidney - poor prognosis
Membranoproliferative glomerulonephritis
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Inc
42. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Size
Becomes concentrated and hypertonic
Freely filtered and neither absorbed or secreted
43. In a metabolic acidosis What additional calculation is necessary and How do you make it
Triglycerides
Inc
RTA type 4 (hyperkalemic)
Anion gap = na - (Cl + bicarb)
44. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
1alpha hydroxylase - PTH stimulates it
Podocytes foot processes
Men 50 to 70 - inc incidence with smoking and obesity
Hypokalemia and hypophosphatemic rickets
45. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Inc GFR and mesangial expansion
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
46. waxy casts ddx
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Advanced renal dz - CRF
Renal tubular cells - polygonal clear cells
White cell casts
47. What is the formula for the filtered load
Complications of chronic kidney disease or HTN
PH - then PC02
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
GFR x plasma concentration
48. What effect does afferent arteriole cxn have on RPF - GFR and FF
Diarrhea - glue - RTA - hyperchloremia
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
GFR/RPF
Dec - dec - NC
49. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Inc GFR and mesangial expansion
Vasa recta - interlobular v - interlobar v - renal v
Thickening of glomerular BM
Diarrhea - glue - RTA - hyperchloremia
50. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Medullary cystic disease