Test your basic knowledge |

Renal

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. What is the formula for clearance of a substance per unit time
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Filtered - secreted
Stimulates thirst
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

2. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Eosinphilic casts in tubules
RTA type 1 (distal)
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Beta 1

3. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Medullary cystic disease
Acute renal failure
Insertion of Na channel on luminal side
Hyperceullular glomeruli

4. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
Membranoproliferative glomerulonephritis
Inc in Ca and PO4 absoprtion from the gut
EPO - endothelial cells of peritubular capillaries
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb

5. massive proteinuria (>3.5g/day) frothy urine - hyperlipidemia - fatty casts - edema
Macula densa
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Nephrotic syndrome

6. What is the effect of PTH on the proximal tubule
Men 50 to 70 - inc incidence with smoking and obesity
Freely filtered and neither absorbed or secreted
Inhibits Na/phosphate cotransport leading to phosphate excretion
Inc GFR and mesangial expansion

7. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Dialysis cysts
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
ADPKD

8. Why does Na conc nearly match Osm
Na reabsorption drives H20 reabsorption
UTI or acute gastroenteritis
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

9. Subendothelial immune complexes with granular IF
Membranoproliferative glomerulonephritis
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Vasa recta - interlobular v - interlobar v - renal v
Amyloidosis

10. What are JG cells and what substance do they secrete
Needs to be bilateral
Makes urine less concentrated - impermeable to H20
Size and charge
Modified smooth muscle of afferent arteriole - secrete renin

11. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
NKCC
Nonspecific
Wilms tumor (ages 2-4)

12. Why is the left kidney taken during living donor transplantation
LM - nl glomeruli - EM - foot process effacement
It has a longer renal vein
1/4 plasma - and 3/4 interstitial volume
Intra = HIKIN!

13. What are the main causes of membranous GN
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
No
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron

14. How are amino acids reabsorbed
2 ways - base exchanger and between epithelial cells
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Renal artery - interlobar a - interlobular a
PH - then PC02

15. What is the compensatory response in respiratory acidosis
Insertion of Na channel on luminal side
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Inc renal bicarb resabsoprtion - delayed
Huge palpable flank mass and hematuria

16. What is the BUN/Cr ratio in prerenal azotemia and why?
All glomeruli
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Inc in concentration - not amout - due to water reabsorption
Diuretics - vomiting - antacid - hyperaldosteronism

17. How is extracellular volume measured
RTA type 2 (proximal)
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
To defend GFR
Inulin

18. What effect does inc plasma protein concentration have on RPF - GFR - and FF
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Makes urine less concentrated - impermeable to H20
NC - dec - dec
Chronic conditions - multiple myeloma - TB - RA

19. Why is there anemia in renal failure
Failure of EPO
Acute pyelonephritis
Eosinphilic casts in tubules
Von hippel laundau and gene deletion in chromosome 3

20. In renal failure - what happens to potassium
Hyperkalemia
Von hippel laundau and gene deletion in chromosome 3
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
1alpha hydroxylase - PTH stimulates it

21. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Diarrhea - glue - RTA - hyperchloremia
Dec renal bicarb reabsorption - delayed
Size
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

22. What is the effect of AT II on the posterior pituitary
Modified smooth muscle of afferent arteriole - secrete renin
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Diarrhea - glue - RTA - hyperchloremia
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

23. How can NSAIDs cause acute renal failure
Chronic conditions - multiple myeloma - TB - RA
Staghorn calculi - worsened by alkaluria
Freely filtered and neither absorbed or secreted
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

24. 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
2 ways - base exchanger and between epithelial cells
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Dec - inc - inc

25. What is the effect of AT II on the hypothalamus
Solute is reabsorbed less quickly than water or net secretion of substance
Inc in Ca and PO4 absoprtion from the gut
Segmental sclerosis and hylanosis
Stimulates thirst

26. What is the effect of angiotensin II on RPF - GFR - and FF - why - What do ACEi do?
V x Urine concentration
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Inc in concentration - not amout - due to water reabsorption
Cx = GFR

27. What effect does cxn of the ureter have on RPF - GFR and FF
NC - dec - dec
V x Urine concentration
Kids - peripheral and periorbital edema - resolves spontaneously
Proximal tubule - na/glucose co transporter

28. What do you see in the urine with acute pyelonephritis
Ectopic EPO - ACTH - PTHrP - prolactin
Eosinphilic casts in tubules
White cell casts
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

29. What is the least common kidney stone - What causes it and How do you treat it
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Dialysis cysts
No
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

30. What is the effect of aldosterone in principal cells
Ammonia - buffer for secreted H+
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Modified smooth muscle of afferent arteriole - secrete renin
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

31. What are the associations with RTA type 4
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Size and charge
Intra = HIKIN!
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

32. With what genetic tumor syndrome is RCC associated
Excreted - filtered
Failure of EPO
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Von hippel laundau and gene deletion in chromosome 3

33. How do calcium stones appear on x ray
Vasocxn - inc BP
Inc
Radiopaque
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

34. What happens to tubular inulin along the proximal tubule and why
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Acute renal failure
Crescent - moon shape
Inc in concentration - not amout - due to water reabsorption

35. In renal failure What acid - base disturbance is most likely
Reabsorb Na in exchange for secreting K and H
Chronic pyelonephritis
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Metabolic acidosis

36. What is the genetic etiology of wilms tumor and What is WAGR complex
Freely filtered and neither absorbed or secreted
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Radiolabelled albumin

37. Where is ACE made and What are 2 of its fxns
Cx = GFR
Radiopaque
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Angio I to angio II and inhibits bradykinin

38. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Nephritic syndrome
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock

39. Why can inulin be used to calculate GFR?
Excreted - filtered
Freely filtered and neither absorbed or secreted
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Complications of chronic kidney disease or HTN

40. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
PH - then PC02
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Simple cysts

41. What is ADPKD also associated with
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Filtered - secreted
HIV

42. What dyslipidemia is most common in renal failure
Failure of EPO
Triglycerides
Inc renal bicarb resabsoprtion - delayed
UTI or acute gastroenteritis

43. What is the henderson hasselbalch equation
Acute - ATN - or chronic - HTN - DM
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
PH = pKa + log bicarb/0.03PCO2
Negative charge

44. Which cells sense decreases in Na delivery
Macula densa
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Invades IVC and spreads hematogenously

45. What is the formula for excretion rate
Few glomeruli
Cx<GFR
V x Urine concentration
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb

46. Defect in proximal tubule HCO3 reabsorption
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
RTA type 2 (proximal)
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

47. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Inc renal bicarb resabsoprtion - delayed
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Inc in Ca and PO4 absoprtion from the gut
Type II - C3 nephritic factor

48. membranous
Renal in origin
20 percent
Thickening of glomerular BM
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

49. waxy casts ddx
Advanced renal dz - CRF
Hyperkalemia
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

50. What happens in the thin descending loop of henle
Passively reabsorbs water via medullary hypertonicity
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate