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Renal

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Answer 50 questions in 15 minutes.
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1. membranous
1alpha hydroxylase - PTH stimulates it
Thickening of glomerular BM
20 percent
Eosinphilic casts in tubules

2. Defect in proximal tubule HCO3 reabsorption
RTA type 2 (proximal)
NC - inc - inc
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Thromboembolism and inc risk of infection

3. net tubular secretion of x
Thickening of glomerular BM
Cx>GFR
Inc - inc - inc
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

4. What is lost in nephrotic syndrome resulting what urine and serum changes
Segmental sclerosis and hylanosis
NC - inc - inc
Insertion of Na channel on luminal side
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

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

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6. What is the henderson hasselbalch equation
Intra = HIKIN!
Diarrhea - glue - RTA - hyperchloremia
NKCC
PH = pKa + log bicarb/0.03PCO2

7. What are the main complications of kidney stones
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Solute and water are reabsorbed at the same rate
Hydronephrosis and pyelonephritis
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

8. waxy casts ddx
Kids - peripheral and periorbital edema - resolves spontaneously
Thickening of glomerular BM
Advanced renal dz - CRF
Bladder cancer

9. Subendothelial immune complexes with granular IF
Freely filtered and neither absorbed or secreted
Membranoproliferative glomerulonephritis
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Nonspecific

10. What is the purpose of the JGA
To defend GFR
Intra = HIKIN!
Triglycerides
Bladder cancer

11. What do patients die from ADPKD
Most of the bicarb - sodium - chloride - and water
Complications of chronic kidney disease or HTN
Inc GFR and mesangial expansion
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

12. Under what circumstances is aldosterone secreted
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Staghorn calculi - worsened by alkaluria
160-200 - 350
20 percent

13. What is winter's formula and when do you use it
Cx<GFR
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
CHF - pulmonary edema - HTN
Na

14. What change (lack of) is common in children with renal failure
Freely filtered and neither absorbed or secreted
Inulin
Rxn from angiotensinogen to angiontensin I
Growth retardation and developmental delay

15. In what clinical context does Berger's disease often present
UTI or acute gastroenteritis
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
ANP
Liver

16. What serum changes cause a secretion in PTH
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Ammonia - buffer for secreted H+
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
160-200 - 350

17. What is the most common renal malignancy of early childhood
Wilms tumor (ages 2-4)
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Phenacetin - smoking - aniline dyes - cyclophosphamide

18. When is TF/P <1
Inc in concentration - not amout - due to water reabsorption
Solute is reabsorbed more quickly than water
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Vasocxn - inc BP

19. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Dec - dec - NC
Dec renal bicarb reabsorption - delayed
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Involves glomeruli and other organs

20. How can NSAIDs cause acute renal failure
Dec - dec - NC
Radiolabelled albumin
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Solute and water are reabsorbed at the same rate

21. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
GFR x plasma concentration
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Medullary cystic disease
Principal cells and intercalated cells

22. inc in creatinine and BUN over a period of several days
Segmental sclerosis and hylanosis
Stimulates thirst
Beta 1
Acute renal failure

23. What substance is secreted in response increase atrial pressure
ANP
Corticosteroids
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
20 percent

24. What dyslipidemia is most common in renal failure
<3.5 g /day
JG cells
Triglycerides
Inc in concentration - not amout - due to water reabsorption

25. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
EPO - endothelial cells of peritubular capillaries
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Dec renal bicarb reabsorption - delayed
Inc in Ca and PO4 absoprtion from the gut

26. What is the BUN/Cr ratio in prerenal azotemia and why?
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Dialysis cysts
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Small kidney - poor prognosis

27. In what disease in FSGS the most common glomerular disease
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Phenacetin - smoking - aniline dyes - cyclophosphamide
EPO - endothelial cells of peritubular capillaries
HIV

28. What effect does efferent arteriole cxn have on RPF - GFR and FF
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
V x Urine concentration
Hypervent - early high altitude - aspirin ingestion early
Dec - inc - inc

29. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
It has a longer renal vein
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Hypokalemia and hypophosphatemic rickets

30. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Chronic pyelonephritis
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
<3.5 g /day
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

31. What does ADH do in the collecting tubule
Dec - dec - NC
Antifreeze - ethyelene glycol or vit C abuse
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Complications of chronic kidney disease or HTN

32. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Staghorn calculi - worsened by alkaluria
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

33. RBC casts - ddx
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Na reabsorption drives H20 reabsorption
PH - then PC02

34. secondary glomerular dz
Dec - inc - dec
Staghorn calculi - worsened by alkaluria
Involves glomeruli and other organs
Nonspecific

35. What is hartnup's disease
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Radiopaque

36. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Complications of chronic kidney disease or HTN
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Failure of EPO
NC - inc - inc

37. What are the associations with RTA type 1
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Advanced renal dz - CRF
Hypokalemia - risk for Ca containing kidney stones
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

38. WBC casts - ddx
Involves only glomeruli
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
LM - nl glomeruli - EM - foot process effacement
Vasocxn - inc BP

39. What does NEG lead to in the efferent arterioles
60% total body water - 40% ICF - 20% ECF
Inc GFR and mesangial expansion
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
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

40. What is the pathway from the efferent arteriorle to the renal v
Small kidney - poor prognosis
Few glomeruli
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Vasa recta - interlobular v - interlobar v - renal v

41. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
Poor - days to weeks
160-200 - 350
Few glomeruli
Inc - dec - dec

42. What is the net effect of ANP
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Macula densa and JG cells
Na and volume loss
It has a longer renal vein

43. What is the ddx for metabolic alkalosis with compensation
Diuretics - vomiting - antacid - hyperaldosteronism
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

44. What therapy does miminal change respond to...
Corticosteroids
NC - dec - dec
Principal cells and intercalated cells
All glomeruli

45. In renal failure - what happens to potassium
Antifreeze - ethyelene glycol or vit C abuse
Cx<GFR
Inc Ca/Na exchange to inc Ca reabsoprtion
Hyperkalemia

46. how does this present in adults and What is the pattern of inheritence
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Ammonia - buffer for secreted H+
Staghorn calculi - worsened by alkaluria
Inc GFR and mesangial expansion

47. What is the effect of AT II on efferent arterioles
Type II - C3 nephritic factor
Contrict leading to inc FF - preserver renal GFR in low volume states
Size and charge
Wilms tumor (ages 2-4)

48. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Negative charge
It has a longer renal vein
CHF - pulmonary edema - HTN

49. What do you see on LM for focal segmental glomerulosclerosis
Segmental sclerosis and hylanosis
Inc renal bicarb resabsoprtion - delayed
RTA type 1 (distal)
Renal in origin

50. What is the second most common kidney stone
Filtered - secreted
Macula densa and JG cells
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

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Renal

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