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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. When is TF/P = 1
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Solute and water are reabsorbed at the same rate
Radiopaque

2. What two cells make up the JGA
Acute tubular necrosis
Hydronephrosis and pyelonephritis
Macula densa and JG cells
CHF - pulmonary edema - HTN

3. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
NKCC
Segmental sclerosis and hylanosis
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Simple cysts

4. What do you see on LM for focal segmental glomerulosclerosis
Ectopic EPO - ACTH - PTHrP - prolactin
NC - dec - dec
Segmental sclerosis and hylanosis
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

5. How do the ureters course in relation to the uterine artery and ductus deferens
Wilms tumor (ages 2-4)
Under and under
Diuretics - vomiting - antacid - hyperaldosteronism
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

6. By what percentage does EPRF underestimage true RPF
By 10%
Vasocxn - inc BP
No
Small kidney - poor prognosis

7. What is the compensatory response in metabolic alkalosis
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Hypovent - immediate
NC - inc - inc
Hyperceullular glomeruli

8. What is the formula for secreted
Excreted - filtered
RTA type 1 (distal)
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Amyloidosis

9. granular - muddy brown casts - ddx
Cx = GFR
Acute tubular necrosis
Kids - peripheral and periorbital edema - resolves spontaneously
Modified smooth muscle of afferent arteriole - secrete renin

10. What is the LM for diabetic glomerulonephropathy
JG cells
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Cx<GFR
Insertion of Na channel on luminal side

11. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
Nephritic syndrome
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
1/4 plasma - and 3/4 interstitial volume
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

12. How do calcium stones appear on x ray
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Radiopaque
RPF/(1- Hct)
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

13. Under what circumstances is aldosterone secreted
Contrict leading to inc FF - preserver renal GFR in low volume states
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Nephrotic syndrome
Principal cells and intercalated cells

14. What dyslipidemia is most common in renal failure
Radiolabelled albumin
Amyloidosis
No
Triglycerides

15. WBC casts - ddx
UTI or acute gastroenteritis
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

16. Congo - red stain - apple green birefringence
Membranoproliferative glomerulonephritis
Amyloidosis
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Negative charge

17. cortical and medullary cysts resulting from long standing dialysis
Wilms tumor (ages 2-4)
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Dialysis cysts
Dec renal bicarb reabsorption - delayed

18. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Cx<GFR
Inc - dec - dec
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

19. What do casts indicated about hematuria/pyuria
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Renal in origin
20 percent
Vasocxn - inc BP

20. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
V x Urine concentration
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
Hypokalemia - risk for Ca containing kidney stones

21. net tubular secretion of x
Transitional cell carcinoma
Cx>GFR
Renal in origin
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection

22. In renal failure What acid - base disturbance is most likely
Anion gap = na - (Cl + bicarb)
Dec - inc - inc
Metabolic acidosis
Diabetic glomerulonephropathy

23. In renal failure - what happens to potassium
Hyperkalemia
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Diabetic glomerulonephropathy

24. What are the two forms of renal failure and What are examples of each
Nonspecific
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Inc Ca/Na exchange to inc Ca reabsoprtion
Acute - ATN - or chronic - HTN - DM

25. Where is angiotensinogen made
Liver
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
CHF - pulmonary edema - HTN
Corticosteroids

26. What is the net effect of ANP
PH = pKa + log bicarb/0.03PCO2
Becomes concentrated and hypertonic
Na and volume loss
EPO - endothelial cells of peritubular capillaries

27. primary glomerular dz
Involves only glomeruli
Diabetic glomerulonephropathy
Chronic pyelonephritis
Acts on V2 receptors leading to insertion of aquaporins on luminal side

28. What is the effect of AT II on the hypothalamus
LM - nl glomeruli - EM - foot process effacement
NC - inc - inc
Stimulates thirst
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

29. What is winter's formula and when do you use it
Proximal tubule - na/glucose co transporter
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Inc renal bicarb resabsoprtion - delayed

30. In renal failure What are the consquence sof Na/H20 retention
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
2 ways - base exchanger and between epithelial cells
CHF - pulmonary edema - HTN

31. What substance is secreted in response increase atrial pressure
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
ANP
Needs to be bilateral
Nonspecific

32. Why does Na conc nearly match Osm
Na and volume loss
Na reabsorption drives H20 reabsorption
JG cells
Simple cysts

33. In renal failure with uremia - What are the 5 aspects of uremia
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Bladder cancer

34. Why is the left kidney taken during living donor transplantation
Vasocxn - inc BP
Negative charge
Actively reabsorbs NaCl - diluting - makes urine hypotonic
It has a longer renal vein

35. What is the formula for clearance of a substance per unit time
Solute and water are reabsorbed at the same rate
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

36. Which cells sense decreases in Na delivery
CHF - pulmonary edema - HTN
Intra = HIKIN!
Involves only glomeruli
Macula densa

37. What is the purpose of the JGA
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Hyperkalemia
To defend GFR
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

38. What is the prognosis of RPGN
Dialysis cysts
Poor - days to weeks
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
PH = pKa + log bicarb/0.03PCO2

39. What is the formula for excretion rate
Nephritic syndrome
Hypervent - immediate
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
V x Urine concentration

40. How do you interpret creatinine clearance
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Crescent - moon shape
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Dec renal bicarb reabsorption - delayed

41. What needs to happen for postrenal obstruction to creat ARF
Solute is reabsorbed less quickly than water or net secretion of substance
Chronic conditions - multiple myeloma - TB - RA
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Needs to be bilateral

42. What are the main complications of kidney stones
PH - then PC02
Cx<GFR
NC - dec - dec
Hydronephrosis and pyelonephritis

43. Why can inulin be used to calculate GFR?
Inc in concentration - not amout - due to water reabsorption
Freely filtered and neither absorbed or secreted
Under and under
Segmental sclerosis and hylanosis

44. How What does the glomerular filtration barrier distinguish by
Solute is reabsorbed less quickly than water or net secretion of substance
Size and charge
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Segmental sclerosis and hylanosis

45. What change (lack of) is common in children with renal failure
Growth retardation and developmental delay
Solute and water are reabsorbed at the same rate
Solute is reabsorbed less quickly than water or net secretion of substance
Solute is reabsorbed more quickly than water

46. In what clinical context does Berger's disease often present
Amyloidosis
UTI or acute gastroenteritis
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Proximal tubule - na/glucose co transporter

47. How is chlorid reabsorbed in the proximal tubule
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Wilms tumor (ages 2-4)
2 ways - base exchanger and between epithelial cells
Cx = GFR

48. What is the effect of AT II on efferent arterioles
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Contrict leading to inc FF - preserver renal GFR in low volume states
Metabolic acidosis
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

49. What is the least common kidney stone - What causes it and How do you treat it
Antifreeze - ethyelene glycol or vit C abuse
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Acute renal failure

50. What is the most frequent kind of kidney stone and What are causes that lead to it
Makes urine less concentrated - impermeable to H20
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Hypervent - immediate
JG cells