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Renal

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1. What is the most common renal malignancy of early childhood
Inhibits Na/phosphate cotransport leading to phosphate excretion
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Wilms tumor (ages 2-4)
2 ways - base exchanger and between epithelial cells

2. What is generated and secreted in the proximal tubule
Ammonia - buffer for secreted H+
<3.5 g /day
Diuretics - vomiting - antacid - hyperaldosteronism
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

3. in acute cystitis with pyuria - do you see casts
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Inc in concentration - not amout - due to water reabsorption
Membranoproliferative glomerulonephritis
No

4. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Excreted - filtered
Diarrhea - glue - RTA - hyperchloremia
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

5. What is the compensatory response in metabolic alkalosis
Excreted - filtered
Hypovent - immediate
No
Hypervent - immediate

6. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Most of the bicarb - sodium - chloride - and water
Wilms tumor (ages 2-4)
Thickening of glomerular BM
Needs to be bilateral

7. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Contrict leading to inc FF - preserver renal GFR in low volume states
Medullary cystic disease
White cell casts
Crescent - moon shape

8. How is chlorid reabsorbed in the proximal tubule
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
GFR/RPF
Hypovent - immediate
2 ways - base exchanger and between epithelial cells

9. What does NEG lead to in the efferent arterioles
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Segmental sclerosis and hylanosis
Inc GFR and mesangial expansion
Chronic conditions - multiple myeloma - TB - RA

10. What is hartnup's disease
Poor - days to weeks
Macula densa
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Huge palpable flank mass and hematuria

11. What are the associations with RTA type 2
No
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Hypokalemia and hypophosphatemic rickets
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

12. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
Nephritic syndrome
60% total body water - 40% ICF - 20% ECF
2 ways - base exchanger and between epithelial cells
Acute renal failure

13. granular - muddy brown casts - ddx
Small kidney - poor prognosis
Acute tubular necrosis
Inc in Ca and PO4 absoprtion from the gut
20 percent

14. Defect in collecting ducts ability to excrete H+
NC - dec - dec
RTA type 1 (distal)
Nephritic syndrome
Nonspecific

15. What effect does ANP have on Na in the kidney
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Radiolabelled albumin
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb

16. How does RCC spread
Invades IVC and spreads hematogenously
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
PH - then PC02

17. What does the crescent moon shape consist of in RPGN
Principal cells and intercalated cells
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

18. What effect does inc plasma protein concentration have on RPF - GFR - and FF
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
GFR/RPF
NC - dec - dec
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

19. What is renal osteodystrophy
Diarrhea - glue - RTA - hyperchloremia
Acute pyelonephritis
Inc GFR and mesangial expansion
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

20. What happens to pH - PCO2 and bicarb in metabolic acidosis
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Dec - dec - dec
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection

21. What are the main complications of kidney stones
Dec - inc - dec
Hydronephrosis and pyelonephritis
LM - nl glomeruli - EM - foot process effacement
Invades IVC and spreads hematogenously

22. What happens when PTH is secreted
Intra = HIKIN!
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Wilms tumor (ages 2-4)
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

23. Bergers' disease - which antibody and What do you see on LM and IF
Advanced renal dz - CRF
By 10%
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Dialysis cysts

24. tram track appearance on EM - typ - path - and associated dz
Hypokalemia - risk for Ca containing kidney stones
Hydronephrosis and pyelonephritis
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
ADPKD

25. In renal failure What acid - base disturbance is most likely
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Inc Ca/Na exchange to inc Ca reabsoprtion
NKCC
Metabolic acidosis

26. What is the effect of AT II on the posterior pituitary
Dec - inc - dec
Amyloidosis
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

27. how does this present in adults and What is the pattern of inheritence
Acute renal failure
Medullary cystic disease
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Angio I to angio II and inhibits bradykinin

28. What are JG cells and what substance do they secrete
Modified smooth muscle of afferent arteriole - secrete renin
60% total body water - 40% ICF - 20% ECF
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Phenacetin - smoking - aniline dyes - cyclophosphamide

29. membranous
Thickening of glomerular BM
Acute pyelonephritis
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

30. What is the formula for reabsorption
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Dec renal bicarb reabsorption - delayed
Medullary cystic disease
Filtered - secreted

31. What is the second most common kidney stone
Modified smooth muscle of afferent arteriole - secrete renin
Renal artery - interlobar a - interlobular a
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
NKCC

32. Why can inulin be used to calculate GFR?
Beta 1
Vasa recta - interlobular v - interlobar v - renal v
Size and charge
Freely filtered and neither absorbed or secreted

33. proliferative
Thromboembolism and inc risk of infection
Hyperceullular glomeruli
Acute pyelonephritis
Bladder cancer

34. What does renin do
Rxn from angiotensinogen to angiontensin I
Nephritic syndrome
Hypokalemia and hypophosphatemic rickets
Amyloidosis

35. How What does the glomerular filtration barrier distinguish by
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Size and charge
Needs to be bilateral
Chronic conditions - multiple myeloma - TB - RA

36. What do you see on LM for focal segmental glomerulosclerosis
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Segmental sclerosis and hylanosis
Principal cells and intercalated cells
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

37. What is the ddx for metabolic alkalosis with compensation
Diuretics - vomiting - antacid - hyperaldosteronism
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Type II - C3 nephritic factor
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell

38. hypoaldosteronism or lack of collecting tubule response to aldosteron
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
RTA type 4 (hyperkalemic)
To defend GFR
No

39. What is the BUN/Cr ratio in instrinsic renal ARF and why
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Vasa recta - interlobular v - interlobar v - renal v
Dec - inc - dec
Dec - inc - inc

40. When is TF/P ratio > 1
Solute is reabsorbed less quickly than water or net secretion of substance
V x Urine concentration
Hypervent - immediate
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

41. Congo - red stain - apple green birefringence
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Na and volume loss
Becomes concentrated and hypertonic
Amyloidosis

42. What are the main causes of membranous GN
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Antifreeze - ethyelene glycol or vit C abuse
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Cx<GFR

43. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Inc - dec - dec
Advanced renal dz - CRF
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

44. TCC is associated with problems in your Pee SAC - ??
Involves glomeruli and other organs
CHF - pulmonary edema - HTN
Inc GFR and mesangial expansion
Phenacetin - smoking - aniline dyes - cyclophosphamide

45. What happens to urine in the ascending limb
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Makes urine less concentrated - impermeable to H20
Medullary cystic disease
Inc Ca/Na exchange to inc Ca reabsoprtion

46. What does thyroidization of the kidney result in
Beta 1
PH = pKa + log bicarb/0.03PCO2
Dec renal bicarb reabsorption - delayed
Eosinphilic casts in tubules

47. What do you see on LM and IF with rapidly progressive GN
Inc plasma osm - dec blood volume
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Crescent - moon shape
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

48. In what disease in FSGS the most common glomerular disease
By 10%
Size
HIV
No

49. What are the effects of AT II on the adrenal gland
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Proximal tubule - na/glucose co transporter
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
To defend GFR

50. 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
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Diabetic glomerulonephropathy
Chronic conditions - multiple myeloma - TB - RA

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Renal

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