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Renal

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 do struvite stones appear on xray
Radiopaque
Dec - dec - dec
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

2. Where does renal cell carcinoma originate and What do the cells look like
Negative charge
RPF/(1- Hct)
Renal tubular cells - polygonal clear cells
Macula densa and JG cells

3. What happens when PTH is secreted
ADPKD
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

4. What cells create the epithelial layer of the glomerular filtration barrier
NC - inc - inc
Podocytes foot processes
20 percent
Hyperkalemia

5. inc in creatinine and BUN over a period of several days
Acute renal failure
Corticosteroids
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

6. Defect in proximal tubule HCO3 reabsorption
PH = pKa + log bicarb/0.03PCO2
Dec - inc - inc
RTA type 2 (proximal)
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

7. What is the LM for diabetic glomerulonephropathy
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Nephritic syndrome
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Inc in Ca and PO4 absoprtion from the gut

8. What are the main complications of kidney stones
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Hydronephrosis and pyelonephritis
Freely filtered and neither absorbed or secreted
Nephritic syndrome

9. What effect does dec plasma protein concentration have on RPF - GFR - and FF
NC - inc - inc
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Beta 1

10. What does LM - EM - IF show in diffuse proliferative GN
Inhibits Na/phosphate cotransport leading to phosphate excretion
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
PH = pKa + log bicarb/0.03PCO2
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

11. Focal
Hyperkalemia
Few glomeruli
Inc GFR and mesangial expansion
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

12. Who often has diffuse proliferative GN
RTA type 4 (hyperkalemic)
Acute renal failure
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Diuretics - vomiting - antacid - hyperaldosteronism

13. What are the associations with nephrotic syndrome
Thromboembolism and inc risk of infection
60% total body water - 40% ICF - 20% ECF
Negative charge
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

14. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Intra = HIKIN!
Beta 1
<3.5 g /day
Nonspecific

15. What is the pathway to the afferent arteriole
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Renal artery - interlobar a - interlobular a
Failure of EPO
Angio I to angio II and inhibits bradykinin

16. Where is angiotensinogen made
Liver
Ectopic EPO - ACTH - PTHrP - prolactin
LM - nl glomeruli - EM - foot process effacement
Inc in Ca and PO4 absoprtion from the gut

17. in TCC - What does painelss hematuria suggest
Antifreeze - ethyelene glycol or vit C abuse
Chronic conditions - multiple myeloma - TB - RA
Chronic pyelonephritis
Bladder cancer

18. What does US show with medullary cystic disease
JG cells
Small kidney - poor prognosis
Makes urine less concentrated - impermeable to H20
Renal in origin

19. in acute post strep GN - What do you see on LM - EM and IF

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20. What is the genetic etiology of wilms tumor and What is WAGR complex
Na and volume loss
LM - nl glomeruli - EM - foot process effacement
Renal artery - interlobar a - interlobular a
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

21. nonenzymatic glycosylation of GBM - inc permeability and thickening
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Diabetic glomerulonephropathy
Hyperceullular glomeruli
Staghorn calculi - worsened by alkaluria

22. With what genetic tumor syndrome is RCC associated
Solute is reabsorbed less quickly than water or net secretion of substance
Reabsorb Na in exchange for secreting K and H
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Von hippel laundau and gene deletion in chromosome 3

23. What is the ddx for a respiratory alkalosis
Hypervent - early high altitude - aspirin ingestion early
White cell casts
Growth retardation and developmental delay
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

24. 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
Small kidney - poor prognosis
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

25. Where is ACE made and What are 2 of its fxns
Inc - inc - inc
Angio I to angio II and inhibits bradykinin
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
JG cells

26. Congo - red stain - apple green birefringence
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Na
Amyloidosis
Acute tubular necrosis

27. How does RCC manifest clinically
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Small kidney - poor prognosis

28. Why is there anemia in renal failure
Segmental sclerosis and hylanosis
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
LM - nl glomeruli - EM - foot process effacement
Failure of EPO

29. Bergers' disease - which antibody and What do you see on LM and IF
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
1alpha hydroxylase - PTH stimulates it
Hydronephrosis and pyelonephritis
60% total body water - 40% ICF - 20% ECF

30. What is the effect of PTH on the proximal tubule
Inhibits Na/phosphate cotransport leading to phosphate excretion
Involves only glomeruli
Crescent - moon shape
Stimulates thirst

31. What is the formula for renal blood flow
RPF/(1- Hct)
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Diarrhea - glue - RTA - hyperchloremia

32. What is renal osteodystrophy
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Rxn from angiotensinogen to angiontensin I
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

33. What is the BUN/Cr ratio in prerenal azotemia and why?
Inhibits Na/phosphate cotransport leading to phosphate excretion
Intra = HIKIN!
Simple cysts
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

34. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Hyperkalemia
Acts on V2 receptors leading to insertion of aquaporins on luminal side
160-200 - 350

35. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
Nephritic syndrome
Dialysis cysts
CHF - pulmonary edema - HTN
Cx = GFR

36. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Dec - inc - dec
Eosinphilic casts in tubules
Poor - days to weeks
Inc - inc - inc

37. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Bladder cancer
Membranoproliferative glomerulonephritis

38. net tubular secretion of x
Transitional cell carcinoma
Cx>GFR
Most of the bicarb - sodium - chloride - and water
<3.5 g /day

39. How What does the glomerular filtration barrier distinguish by
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Liver
Nephrotic syndrome
Size and charge

40. What do casts indicated about hematuria/pyuria
Radiopaque
Hyperkalemia
PH - then PC02
Renal in origin

41. Why can PAH be used to measure ERPF
Failure of EPO
EPO - endothelial cells of peritubular capillaries
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
PH = pKa + log bicarb/0.03PCO2

42. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Dec - inc - dec
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Negative charge
Macula densa

43. How does Wilms tumor present
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Huge palpable flank mass and hematuria
Chronic pyelonephritis
Renal in origin

44. By what percentage does EPRF underestimage true RPF
Corticosteroids
By 10%
Simple cysts
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell

45. What happens to urine in the ascending limb
PH - then PC02
Acute - ATN - or chronic - HTN - DM
Hyperkalemia
Makes urine less concentrated - impermeable to H20

46. waxy casts ddx
ADPKD
Thickening of glomerular BM
Advanced renal dz - CRF
Vasa recta - interlobular v - interlobar v - renal v

47. What is lost in nephrotic syndrome resulting what urine and serum changes
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Dec renal bicarb reabsorption - delayed
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

48. do you see casts in bladder cancer - kidney stones with hematuria
Vasocxn - inc BP
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Renal in origin
No

49. What are the associations with RTA type 1
Hypokalemia - risk for Ca containing kidney stones
Hypokalemia and hypophosphatemic rickets
Kids - peripheral and periorbital edema - resolves spontaneously
Radiopaque

50. What effect does inc plasma protein concentration have on RPF - GFR - and FF
Na
NC - dec - dec
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Filtered - secreted