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Renal

Instructions:

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. What 3 things stimulate the release of renin - and Where is it released from
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

2. What effect does ANP have on GFR
NC - dec - dec
Invades IVC and spreads hematogenously
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Inc

3. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
White cell casts
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Dec - dec - NC

4. How is plasma volume measured
Solute is reabsorbed more quickly than water
Macula densa and JG cells
Renal in origin
Radiolabelled albumin

5. What is generated and secreted in the proximal tubule
Under and under
Metabolic acidosis
Ammonia - buffer for secreted H+
To defend GFR

6. diffuse
All glomeruli
Inulin
Size
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection

7. What is the ddx for metabolic alkalosis with compensation
Diuretics - vomiting - antacid - hyperaldosteronism
Phenacetin - smoking - aniline dyes - cyclophosphamide
Solute is reabsorbed more quickly than water
Diarrhea - glue - RTA - hyperchloremia

8. How is chlorid reabsorbed in the proximal tubule
2 ways - base exchanger and between epithelial cells
Kids - peripheral and periorbital edema - resolves spontaneously
Na
Thickening of glomerular BM

9. Which cells sense decreases in Na delivery
Macula densa
Nephrotic syndrome
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Metabolic acidosis

10. waxy casts ddx
Modified smooth muscle of afferent arteriole - secrete renin
Advanced renal dz - CRF
Growth retardation and developmental delay
NC - dec - dec

11. When is glucose reabsorbed and with What transporter
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Proximal tubule - na/glucose co transporter

12. What is the algorithim for acidosis/alkalosis
Hypokalemia - risk for Ca containing kidney stones
PH - then PC02
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Simple cysts

13. What does aldosterone do in the collecting tubule
Insertion of Na channel on luminal side
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
V x Urine concentration

14. What is the effect of AT II on the posterior pituitary
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Rxn from angiotensinogen to angiontensin I
Size and charge
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

15. What do you see on LM for focal segmental glomerulosclerosis
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Segmental sclerosis and hylanosis
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
HIV

16. What are the effects of AT II on vascular smooth muscle
Involves only glomeruli
Vasocxn - inc BP
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

17. What is the cutoff of proteinuria in nephritic syndrome
<3.5 g /day
LM - nl glomeruli - EM - foot process effacement
Solute is reabsorbed less quickly than water or net secretion of substance
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

18. hyaline casts ddx
Inc - dec - dec
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Nonspecific

19. What is the formula for renal blood flow
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
RPF/(1- Hct)
Von hippel laundau and gene deletion in chromosome 3
Diabetic glomerulonephropathy

20. What are the associations with RTA type 1
No
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Under and under
Hypokalemia - risk for Ca containing kidney stones

21. What is the ddx for a metabolic acidosis with an inc anion gap
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Wilms tumor (ages 2-4)
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Hydronephrosis and pyelonephritis

22. What is the 3rd most common kidney stone and What causes it
Macula densa
Inc plasma osm - dec blood volume
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell

23. What is the prognosis of RPGN
Poor - days to weeks
1alpha hydroxylase - PTH stimulates it
Solute is reabsorbed more quickly than water
Proximal tubule - na/glucose co transporter

24. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
White cell casts
Hypervent - early high altitude - aspirin ingestion early
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Nephrotic syndrome

25. What happens in the collecting tubules
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Reabsorb Na in exchange for secreting K and H
60% total body water - 40% ICF - 20% ECF
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

26. What are the effects of AT II on the adrenal gland
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
160-200 - 350
Solute is reabsorbed less quickly than water or net secretion of substance
Diuretics - vomiting - antacid - hyperaldosteronism

27. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
Advanced renal dz - CRF
Failure of EPO
Inc in concentration - not amout - due to water reabsorption
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

28. What are the main complications of kidney stones
Dec - inc - inc
Inc Ca/Na exchange to inc Ca reabsoprtion
ANP
Hydronephrosis and pyelonephritis

29. When is TF/P = 1
Inc - inc - inc
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Solute and water are reabsorbed at the same rate
Size and charge

30. What circumstances causes ADH secretion
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Chronic pyelonephritis
Inc plasma osm - dec blood volume
Thromboembolism and inc risk of infection

31. What is the effect of PTH on the proximal tubule
UTI or acute gastroenteritis
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Inhibits Na/phosphate cotransport leading to phosphate excretion

32. Who commonly gets acute post strep GN
It has a longer renal vein
Renal in origin
Kids - peripheral and periorbital edema - resolves spontaneously
160-200 - 350

33. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Diuretics - vomiting - antacid - hyperaldosteronism
Diarrhea - glue - RTA - hyperchloremia
Anion gap = na - (Cl + bicarb)
Becomes concentrated and hypertonic

34. What does thyroidization of the kidney result in
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Under and under
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Eosinphilic casts in tubules

35. What is winter's formula and when do you use it
NC - inc - inc
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
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
No

36. What is the pathway from the efferent arteriorle to the renal v
Becomes concentrated and hypertonic
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Vasa recta - interlobular v - interlobar v - renal v
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

37. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
GFR/RPF
JG cells
Acute pyelonephritis

38. What is the compensatory response in respiratory alkalosis
RTA type 4 (hyperkalemic)
Dec renal bicarb reabsorption - delayed
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

39. In what disease in FSGS the most common glomerular disease
Macula densa and JG cells
HIV
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock

40. Under what circumstances is aldosterone secreted
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
All glomeruli
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

41. What are the main causes of membranous GN
Under and under
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Acute pyelonephritis
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

42. In who is RCC most comon
Men 50 to 70 - inc incidence with smoking and obesity
Hypervent - early high altitude - aspirin ingestion early
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Eosinphilic casts in tubules

43. The fenestrated capillary endothelium constitutes what portion of the barrier
Rxn from angiotensinogen to angiontensin I
Size
White cell casts
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

44. Congo - red stain - apple green birefringence
Freely filtered and neither absorbed or secreted
Solute is reabsorbed less quickly than water or net secretion of substance
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Amyloidosis

45. By what percentage does EPRF underestimage true RPF
Macula densa and JG cells
Inc GFR and mesangial expansion
By 10%
Principal cells and intercalated cells

46. Where is potassium conc. Highest? Intra or extra
Small kidney - poor prognosis
Freely filtered and neither absorbed or secreted
Intra = HIKIN!
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

47. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Dec - dec - dec
Na
Amyloidosis
Carbonic anhydrase

48. Who often has diffuse proliferative GN
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Makes urine less concentrated - impermeable to H20
Radiolabelled albumin
Under and under

49. What are the two kinds of cells in the collecting tubules
Principal cells and intercalated cells
Needs to be bilateral
Antifreeze - ethyelene glycol or vit C abuse
Hypokalemia - risk for Ca containing kidney stones

50. What happens to tubular inulin along the proximal tubule and why
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Inc in concentration - not amout - due to water reabsorption
Hypovent - immediate
Chronic pyelonephritis