Test your basic knowledge |

Renal

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Answer 50 questions in 15 minutes.
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1. When is TF/P ratio > 1
Dialysis cysts
Size
Solute is reabsorbed less quickly than water or net secretion of substance
Rxn from angiotensinogen to angiontensin I

2. membranous
Eosinphilic casts in tubules
Macula densa and JG cells
Thickening of glomerular BM
Needs to be bilateral

3. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
160-200 - 350
Advanced renal dz - CRF
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Solute is reabsorbed more quickly than water

4. By what percentage does EPRF underestimage true RPF
Dec - inc - dec
Inc renal bicarb resabsoprtion - delayed
By 10%
Huge palpable flank mass and hematuria

5. What do casts indicated about hematuria/pyuria
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Renal in origin
It has a longer renal vein

6. in TCC - What does painelss hematuria suggest
60% total body water - 40% ICF - 20% ECF
Kids - peripheral and periorbital edema - resolves spontaneously
V x Urine concentration
Bladder cancer

7. What happens in the thin descending loop of henle
Chronic conditions - multiple myeloma - TB - RA
Solute and water are reabsorbed at the same rate
Filtered - secreted
Passively reabsorbs water via medullary hypertonicity

8. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Cx>GFR
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Filtered - secreted

9. What 3 things stimulate the release of renin - and Where is it released from
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Stimulates thirst
Diuretics - vomiting - antacid - hyperaldosteronism
NC - inc - inc

10. What is the compensatory response in metabolic acidosis
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Invades IVC and spreads hematogenously
Hypervent - immediate
EPO - endothelial cells of peritubular capillaries

11. What is the ddx for a respiratory alkalosis
Reabsorb Na in exchange for secreting K and H
Solute and water are reabsorbed at the same rate
Na reabsorption drives H20 reabsorption
Hypervent - early high altitude - aspirin ingestion early

12. 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
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
White cell casts
UTI or acute gastroenteritis

13. What does renin do
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Few glomeruli
Staghorn calculi - worsened by alkaluria
Rxn from angiotensinogen to angiontensin I

14. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
ADPKD
Inc Ca/Na exchange to inc Ca reabsoprtion
Acute pyelonephritis
Phenacetin - smoking - aniline dyes - cyclophosphamide

15. What is the effect of AT II on the hypothalamus
Stimulates thirst
Becomes concentrated and hypertonic
Contrict leading to inc FF - preserver renal GFR in low volume states
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

16. What is the compensatory response in respiratory alkalosis
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Vasa recta - interlobular v - interlobar v - renal v
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Dec renal bicarb reabsorption - delayed

17. The fenestrated capillary endothelium constitutes what portion of the barrier
Amyloidosis
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Size

18. What does LM - EM - IF show in diffuse proliferative GN
Modified smooth muscle of afferent arteriole - secrete renin
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
2 ways - base exchanger and between epithelial cells
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

19. What is the LM for diabetic glomerulonephropathy
EPO - endothelial cells of peritubular capillaries
Segmental sclerosis and hylanosis
Hypervent - immediate
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

20. What is ADPKD also associated with
Corticosteroids
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Solute is reabsorbed less quickly than water or net secretion of substance

21. What is the formula for clearance of a substance per unit time
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Inc in Ca and PO4 absoprtion from the gut
Hyperkalemia
Corticosteroids

22. What are the effects of AT II on vascular smooth muscle
LM - nl glomeruli - EM - foot process effacement
<3.5 g /day
Diarrhea - glue - RTA - hyperchloremia
Vasocxn - inc BP

23. In what clinical context does Berger's disease often present
Staghorn calculi - worsened by alkaluria
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
1alpha hydroxylase - PTH stimulates it
UTI or acute gastroenteritis

24. What are the effects of AT II on the adrenal gland
Na
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Chronic conditions - multiple myeloma - TB - RA
Dialysis cysts

25. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
Nonspecific
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Insertion of Na channel on luminal side

26. What does US show with medullary cystic disease
Thickening of glomerular BM
Small kidney - poor prognosis
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

27. 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
Reabsorb Na in exchange for secreting K and H
Inc plasma osm - dec blood volume
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

28. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Nephrotic syndrome
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
2 ways - base exchanger and between epithelial cells
Dialysis cysts

29. What is the algorithim for acidosis/alkalosis
Na reabsorption drives H20 reabsorption
PH - then PC02
Vasocxn - inc BP
Beta 1

30. What is the effect of PTH on the proximal tubule
Acute renal failure
Inhibits Na/phosphate cotransport leading to phosphate excretion
Under and under
RTA type 1 (distal)

31. granular - muddy brown casts - ddx
Hypervent - early high altitude - aspirin ingestion early
Acute tubular necrosis
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Most of the bicarb - sodium - chloride - and water

32. What are the associations with RTA type 2
Involves only glomeruli
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Nonspecific
Hypokalemia and hypophosphatemic rickets

33. How are amino acids reabsorbed
Renal artery - interlobar a - interlobular a
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Renal tubular cells - polygonal clear cells
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

34. What can cause oxalate crystals
Failure of EPO
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Antifreeze - ethyelene glycol or vit C abuse
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

35. Where is angiotensinogen made
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Angio I to angio II and inhibits bradykinin
Liver
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

36. Congo - red stain - apple green birefringence
Angio I to angio II and inhibits bradykinin
Amyloidosis
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Acute renal failure

37. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Macula densa
Under and under
UTI or acute gastroenteritis
Carbonic anhydrase

38. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Renal tubular cells - polygonal clear cells
Acute - ATN - or chronic - HTN - DM
NKCC
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

39. How do struvite stones appear on xray
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Phenacetin - smoking - aniline dyes - cyclophosphamide
All glomeruli
Radiopaque

40. inc in creatinine and BUN over a period of several days
Excreted - filtered
Acute renal failure
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

41. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Growth retardation and developmental delay
Inc - inc - inc
Most of the bicarb - sodium - chloride - and water
Advanced renal dz - CRF

42. How do calcium stones appear on x ray
Ammonia - buffer for secreted H+
Radiopaque
Passively reabsorbs water via medullary hypertonicity
Podocytes foot processes

43. coarse - asymmetric - corticomedullary scarring and blunted calyx
Liver
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Acute tubular necrosis
Chronic pyelonephritis

44. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
RPF/(1- Hct)
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Nephritic syndrome
60% total body water - 40% ICF - 20% ECF

45. What needs to happen for postrenal obstruction to creat ARF
<3.5 g /day
Intra = HIKIN!
Needs to be bilateral
Triglycerides

46. hypoaldosteronism or lack of collecting tubule response to aldosteron
Needs to be bilateral
Acute tubular necrosis
Wilms tumor (ages 2-4)
RTA type 4 (hyperkalemic)

47. What is the BUN/Cr ratio in prerenal azotemia and why?
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Crescent - moon shape
Inc renal bicarb resabsoprtion - delayed
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

48. Why can inulin be used to calculate GFR?
Dec - dec - NC
Wilms tumor (ages 2-4)
Freely filtered and neither absorbed or secreted
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

49. Why can PAH be used to measure ERPF
Solute is reabsorbed less quickly than water or net secretion of substance
By 10%
Passively reabsorbs water via medullary hypertonicity
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

50. What is the 3rd most common kidney stone and What causes it
Antifreeze - ethyelene glycol or vit C abuse
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Acute renal failure
Staghorn calculi - worsened by alkaluria

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Renal

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