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Test your basic knowledge |
Renal
Start Test
Study First
Subject
:
health-sciences
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
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. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Macula densa and JG cells
Invades IVC and spreads hematogenously
Simple cysts
To defend GFR
2. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Amyloidosis
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Modified smooth muscle of afferent arteriole - secrete renin
Medullary cystic disease
3. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Radiopaque
Solute is reabsorbed less quickly than water or net secretion of substance
Acute pyelonephritis
60% total body water - 40% ICF - 20% ECF
4. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Type II - C3 nephritic factor
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Inc - dec - dec
Hypervent - early high altitude - aspirin ingestion early
5. RBC casts - ddx
1alpha hydroxylase - PTH stimulates it
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Hypervent - immediate
NC - inc - inc
6. How do struvite stones appear on xray
Triglycerides
Radiopaque
RTA type 2 (proximal)
Acute pyelonephritis
7. What does US show with medullary cystic disease
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Small kidney - poor prognosis
RPF/(1- Hct)
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
8. What do you see on LM for focal segmental glomerulosclerosis
Beta 1
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Inc - inc - inc
Segmental sclerosis and hylanosis
9. Why does Na conc nearly match Osm
Rxn from angiotensinogen to angiontensin I
Na reabsorption drives H20 reabsorption
Growth retardation and developmental delay
Bladder cancer
10. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Na
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
11. net tubular reabsorption of x
Cx<GFR
Inc GFR and mesangial expansion
Anion gap = na - (Cl + bicarb)
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
12. What substance is secreted in response increase atrial pressure
ANP
Nonspecific
Size and charge
LM - nl glomeruli - EM - foot process effacement
13. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Inulin
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Diarrhea - glue - RTA - hyperchloremia
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
14. how does this present in adults and What is the pattern of inheritence
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Diarrhea - glue - RTA - hyperchloremia
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
15. What is winter's formula and when do you use it
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Inc - inc - inc
Vasocxn - inc BP
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
16. What is the ddx for a respiratory alkalosis
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Hypervent - early high altitude - aspirin ingestion early
ANP
1/4 plasma - and 3/4 interstitial volume
17. What is the BUN/Cr ratio in prerenal azotemia and why?
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
NKCC
Chronic conditions - multiple myeloma - TB - RA
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
18. What effect does ANP have on GFR
Hypokalemia - risk for Ca containing kidney stones
Inc
NC - dec - dec
Actively reabsorbs NaCl - diluting - makes urine hypotonic
19. dense deposits on EM - type and association
Hypervent - early high altitude - aspirin ingestion early
Type II - C3 nephritic factor
Corticosteroids
White cell casts
20. no net secretion or reabsorption of x
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Dec - dec - dec
Cx = GFR
Vasa recta - interlobular v - interlobar v - renal v
21. What is the compensatory response in metabolic alkalosis
Reabsorb Na in exchange for secreting K and H
Hypovent - immediate
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Poor - days to weeks
22. In renal failure What are the consquence sof Na/H20 retention
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
CHF - pulmonary edema - HTN
PH = pKa + log bicarb/0.03PCO2
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
23. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Makes urine less concentrated - impermeable to H20
NKCC
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Passively reabsorbs water via medullary hypertonicity
24. How can NSAIDs cause acute renal failure
Type II - C3 nephritic factor
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Na reabsorption drives H20 reabsorption
25. Why can inulin be used to calculate GFR?
1alpha hydroxylase - PTH stimulates it
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Freely filtered and neither absorbed or secreted
26. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Liver
Inc - inc - inc
Acute pyelonephritis
LM - nl glomeruli - EM - foot process effacement
27. What happens to the urine in the descending limb
Becomes concentrated and hypertonic
Transitional cell carcinoma
Phenacetin - smoking - aniline dyes - cyclophosphamide
Crescent - moon shape
28. What happens to urine in the ascending limb
GFR/RPF
Chronic conditions - multiple myeloma - TB - RA
Inc Ca/Na exchange to inc Ca reabsoprtion
Makes urine less concentrated - impermeable to H20
29. What are the associations with RTA type 2
HIV
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Hypokalemia and hypophosphatemic rickets
30. waxy casts ddx
Poor - days to weeks
Dialysis cysts
Advanced renal dz - CRF
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
31. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Beta 1
Inc Ca/Na exchange to inc Ca reabsoprtion
Bladder cancer
32. in acute cystitis with pyuria - do you see casts
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Nonspecific
No
Inhibits Na/phosphate cotransport leading to phosphate excretion
33. What cells create the epithelial layer of the glomerular filtration barrier
Chronic conditions - multiple myeloma - TB - RA
Podocytes foot processes
Diuretics - vomiting - antacid - hyperaldosteronism
2 ways - base exchanger and between epithelial cells
34. What is the formula for excretion rate
Hyperceullular glomeruli
Acute pyelonephritis
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
V x Urine concentration
35. What does aldosterone do in the collecting tubule
Men 50 to 70 - inc incidence with smoking and obesity
Insertion of Na channel on luminal side
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Diuretics - vomiting - antacid - hyperaldosteronism
36. How are amino acids reabsorbed
Inc GFR and mesangial expansion
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Growth retardation and developmental delay
37. What dyslipidemia is most common in renal failure
Freely filtered and neither absorbed or secreted
Acute pyelonephritis
Hypokalemia - risk for Ca containing kidney stones
Triglycerides
38. What does NEG lead to in the efferent arterioles
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Inc GFR and mesangial expansion
Chronic pyelonephritis
Proximal tubule - na/glucose co transporter
39. Subendothelial immune complexes with granular IF
Thromboembolism and inc risk of infection
Inc in concentration - not amout - due to water reabsorption
Membranoproliferative glomerulonephritis
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
40. What happens in the thin descending loop of henle
Dec renal bicarb reabsorption - delayed
Passively reabsorbs water via medullary hypertonicity
LM - nl glomeruli - EM - foot process effacement
PH - then PC02
41. acute generalized cortical infarction of both kidneys - dz - causes and associations
JG cells
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Stimulates thirst
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
42. What is the ddx for respiratory acidosis
Chronic conditions - multiple myeloma - TB - RA
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Needs to be bilateral
43. What are the associations with RTA type 4
Inc in concentration - not amout - due to water reabsorption
Chronic conditions - multiple myeloma - TB - RA
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
44. proliferative
Von hippel laundau and gene deletion in chromosome 3
Needs to be bilateral
Hyperceullular glomeruli
NKCC
45. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Na
Proximal tubule - na/glucose co transporter
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Simple cysts
46. What is the ddx for metabolic alkalosis with compensation
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Diuretics - vomiting - antacid - hyperaldosteronism
Stimulates thirst
Medullary cystic disease
47. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Vasocxn - inc BP
GFR x plasma concentration
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
48. What is generated and secreted in the proximal tubule
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
RTA type 4 (hyperkalemic)
Ammonia - buffer for secreted H+
Inhibits Na/phosphate cotransport leading to phosphate excretion
49. membranous
GFR/RPF
Vasocxn - inc BP
Thickening of glomerular BM
Becomes concentrated and hypertonic
50. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Chronic conditions - multiple myeloma - TB - RA
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Macula densa and JG cells