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Renal

Instructions:

Answer 50 questions in 15 minutes.
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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. How is plasma volume measured
White cell casts
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Small kidney - poor prognosis
Radiolabelled albumin

2. primary glomerular dz
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Size
Bladder cancer
Involves only glomeruli

3. What happens to urine in the ascending limb
ADPKD
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Makes urine less concentrated - impermeable to H20

4. What is the least common kidney stone - What causes it and How do you treat it
All glomeruli
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Acute renal failure
Principal cells and intercalated cells

5. What is the formula for renal blood flow
Carbonic anhydrase
RPF/(1- Hct)
Under and under
No

6. What is the compensatory response in metabolic acidosis
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Antifreeze - ethyelene glycol or vit C abuse
Triglycerides
Hypervent - immediate

7. no net secretion or reabsorption of x
Stimulates thirst
RTA type 1 (distal)
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Cx = GFR

8. What are the main complications of kidney stones
Hydronephrosis and pyelonephritis
Segmental sclerosis and hylanosis
Antifreeze - ethyelene glycol or vit C abuse
Macula densa and JG cells

9. What effect does ANP have on Na in the kidney
Renal tubular cells - polygonal clear cells
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

10. What is the henderson hasselbalch equation
Dec - dec - NC
Inc Ca/Na exchange to inc Ca reabsoprtion
CHF - pulmonary edema - HTN
PH = pKa + log bicarb/0.03PCO2

11. Who commonly gets acute post strep GN
Hypervent - early high altitude - aspirin ingestion early
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Kids - peripheral and periorbital edema - resolves spontaneously

12. What is the effect of PTH on the proximal tubule
Anion gap = na - (Cl + bicarb)
Inhibits Na/phosphate cotransport leading to phosphate excretion
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
White cell casts

13. What happens to pH - PCO2 and bicarb in metabolic acidosis
Cx<GFR
Dec - dec - dec
Hydronephrosis and pyelonephritis
Makes urine less concentrated - impermeable to H20

14. hyaline casts ddx
Nonspecific
Dec renal bicarb reabsorption - delayed
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Macula densa

15. What can cause oxalate crystals
Antifreeze - ethyelene glycol or vit C abuse
Dec renal bicarb reabsorption - delayed
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Segmental sclerosis and hylanosis

16. What is the BUN/Cr ratio in prerenal azotemia and why?
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
No
Bladder cancer

17. hypoaldosteronism or lack of collecting tubule response to aldosteron
RTA type 4 (hyperkalemic)
Acute pyelonephritis
Excreted - filtered
Thromboembolism and inc risk of infection

18. WBC casts - ddx
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
<3.5 g /day
Inc - dec - dec

19. In renal failure What acid - base disturbance is most likely
Involves glomeruli and other organs
Nephrotic syndrome
Metabolic acidosis
Type II - C3 nephritic factor

20. In who is RCC most comon
Crescent - moon shape
Men 50 to 70 - inc incidence with smoking and obesity
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

21. What is the effect of AT II on the posterior pituitary
Macula densa and JG cells
Type II - C3 nephritic factor
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
By 10%

22. What is winter's formula and when do you use it
Acute - ATN - or chronic - HTN - DM
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Inc renal bicarb resabsoprtion - delayed
Complications of chronic kidney disease or HTN

23. What is generated and secreted in the proximal tubule
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Na reabsorption drives H20 reabsorption
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Ammonia - buffer for secreted H+

24. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Failure of EPO
PH - then PC02
NKCC

25. In renal failure - what happens to potassium
All glomeruli
Needs to be bilateral
Hyperkalemia
Passively reabsorbs water via medullary hypertonicity

26. What is the ddx for a metabolic acidosis with an inc anion gap
NC - dec - dec
1/4 plasma - and 3/4 interstitial volume
Chronic conditions - multiple myeloma - TB - RA
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

27. how does this present in adults and What is the pattern of inheritence
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Inc in concentration - not amout - due to water reabsorption
Wilms tumor (ages 2-4)
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

28. What is the effect of aldosterone in principal cells
LM - nl glomeruli - EM - foot process effacement
Na and volume loss
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Negative charge

29. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
V x Urine concentration
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

30. What is hartnup's disease
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Renal artery - interlobar a - interlobular a
UTI or acute gastroenteritis
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

31. What circumstances causes ADH secretion
Failure of EPO
UTI or acute gastroenteritis
Rxn from angiotensinogen to angiontensin I
Inc plasma osm - dec blood volume

32. In renal failure with uremia - What are the 5 aspects of uremia
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Amyloidosis
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia

33. What is the effect of AT II on the hypothalamus
Stimulates thirst
Diabetic glomerulonephropathy
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Nephrotic syndrome

34. What happens in the thin descending loop of henle
Passively reabsorbs water via medullary hypertonicity
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Solute is reabsorbed more quickly than water
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

35. cortical and medullary cysts resulting from long standing dialysis
Vasa recta - interlobular v - interlobar v - renal v
Failure of EPO
Dialysis cysts
1alpha hydroxylase - PTH stimulates it

36. What are the associations with nephrotic syndrome
Corticosteroids
Thromboembolism and inc risk of infection
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

37. In renal failure What are the consquence sof Na/H20 retention
Reabsorb Na in exchange for secreting K and H
CHF - pulmonary edema - HTN
Simple cysts
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

38. What do casts indicated about hematuria/pyuria
Inc
Inc in concentration - not amout - due to water reabsorption
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Renal in origin

39. proliferative
Hyperceullular glomeruli
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Type II - C3 nephritic factor
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

40. How do struvite stones appear on xray
Negative charge
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Radiopaque

41. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Inc in concentration - not amout - due to water reabsorption
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Segmental sclerosis and hylanosis

42. What are the effects of AT II on the adrenal gland
Eosinphilic casts in tubules
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Phenacetin - smoking - aniline dyes - cyclophosphamide
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

43. What is amyloidosis associated with
Chronic conditions - multiple myeloma - TB - RA
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Acute - ATN - or chronic - HTN - DM
Phenacetin - smoking - aniline dyes - cyclophosphamide

44. RBC casts - ddx
NC - dec - dec
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
No
Inc renal bicarb resabsoprtion - delayed

45. What effect does cxn of the ureter have on RPF - GFR and FF
Stimulates thirst
Huge palpable flank mass and hematuria
NC - dec - dec
Modified smooth muscle of afferent arteriole - secrete renin

46. What effect does ANP have on GFR
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
ANP
Intra = HIKIN!
Inc

47. in acute cystitis with pyuria - do you see casts
Corticosteroids
No
RTA type 4 (hyperkalemic)
Na reabsorption drives H20 reabsorption

48. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
RPF/(1- Hct)
Dec - dec - dec
Inc - inc - inc

49. Congo - red stain - apple green birefringence
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
All glomeruli
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Amyloidosis

50. How do the ureters course in relation to the uterine artery and ductus deferens
Hypervent - immediate
1alpha hydroxylase - PTH stimulates it
Under and under
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity