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Renal

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1. In renal failure with uremia - What are the 5 aspects of uremia
Acts on V2 receptors leading to insertion of aquaporins on luminal side
NC - dec - dec
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Podocytes foot processes

2. in TCC - What does painelss hematuria suggest
Na reabsorption drives H20 reabsorption
Bladder cancer
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Diarrhea - glue - RTA - hyperchloremia

3. What is the ddx for a respiratory alkalosis
Contrict leading to inc FF - preserver renal GFR in low volume states
PH = pKa + log bicarb/0.03PCO2
Hypervent - early high altitude - aspirin ingestion early
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

4. What is the formula for the filtered load
GFR x plasma concentration
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
To defend GFR

5. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
Hypokalemia and hypophosphatemic rickets
Chronic conditions - multiple myeloma - TB - RA
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Triglycerides

6. 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
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Segmental sclerosis and hylanosis
Angio I to angio II and inhibits bradykinin

7. What does renin do
Dec - dec - dec
All glomeruli
Rxn from angiotensinogen to angiontensin I
Inc plasma osm - dec blood volume

8. net tubular reabsorption of x
Cx<GFR
Invades IVC and spreads hematogenously
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Dec - inc - inc

9. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
Radiolabelled albumin
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

10. Who commonly gets acute post strep GN
Eosinphilic casts in tubules
Kids - peripheral and periorbital edema - resolves spontaneously
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Renal tubular cells - polygonal clear cells

11. What are the associations with RTA type 1
Inc GFR and mesangial expansion
Hypokalemia - risk for Ca containing kidney stones
20 percent
60% total body water - 40% ICF - 20% ECF

12. What is the ddx for respiratory acidosis
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Membranoproliferative glomerulonephritis
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

13. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Ammonia - buffer for secreted H+
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
NC - inc - inc

14. What is the formula for renal blood flow
Small kidney - poor prognosis
Cx<GFR
Hypervent - immediate
RPF/(1- Hct)

15. What is lost in nephrotic syndrome resulting what urine and serum changes
Filtered - secreted
20 percent
Metabolic acidosis
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

16. By what percentage does EPRF underestimage true RPF
By 10%
Complications of chronic kidney disease or HTN
Acute renal failure
To defend GFR

17. coarse - asymmetric - corticomedullary scarring and blunted calyx
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Chronic pyelonephritis
Diarrhea - glue - RTA - hyperchloremia
Medullary cystic disease

18. What do you see on LM for focal segmental glomerulosclerosis
Segmental sclerosis and hylanosis
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Membranoproliferative glomerulonephritis
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

19. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Freely filtered and neither absorbed or secreted
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Needs to be bilateral
Angio I to angio II and inhibits bradykinin

20. Defect in collecting ducts ability to excrete H+
RTA type 1 (distal)
No
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

21. cortical and medullary cysts resulting from long standing dialysis
Dialysis cysts
Becomes concentrated and hypertonic
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
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

22. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Type II - C3 nephritic factor
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Most of the bicarb - sodium - chloride - and water
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

23. What is the formula for filtration fraction
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
White cell casts
Diabetic glomerulonephropathy
GFR/RPF

24. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Dec - dec - dec
Simple cysts
Triglycerides
Involves glomeruli and other organs

25. What are the effects of AT II on vascular smooth muscle
Hyperkalemia
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Size and charge
Vasocxn - inc BP

26. What are the LM and EM of minimal change disease
Diarrhea - glue - RTA - hyperchloremia
Na and volume loss
Radiopaque
LM - nl glomeruli - EM - foot process effacement

27. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
No
Principal cells and intercalated cells
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Involves only glomeruli

28. What happens to urine in the ascending limb
Inc in concentration - not amout - due to water reabsorption
Ectopic EPO - ACTH - PTHrP - prolactin
Nonspecific
Makes urine less concentrated - impermeable to H20

29. What is the LM for diabetic glomerulonephropathy
Becomes concentrated and hypertonic
Ammonia - buffer for secreted H+
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

30. What is amyloidosis associated with
Diuretics - vomiting - antacid - hyperaldosteronism
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Chronic conditions - multiple myeloma - TB - RA

31. What is generated and secreted in the proximal tubule
Macula densa and JG cells
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Ammonia - buffer for secreted H+
Poor - days to weeks

32. What is the purpose of the JGA
ANP
<3.5 g /day
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
To defend GFR

33. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Contrict leading to inc FF - preserver renal GFR in low volume states
Transitional cell carcinoma
Men 50 to 70 - inc incidence with smoking and obesity
V x Urine concentration

34. diffuse
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
All glomeruli

35. What is renal osteodystrophy
Needs to be bilateral
Invades IVC and spreads hematogenously
Small kidney - poor prognosis
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

36. What do patients die from ADPKD
Complications of chronic kidney disease or HTN
Thromboembolism and inc risk of infection
Reabsorb Na in exchange for secreting K and H
Inulin

37. What effect does ANP have on GFR
Medullary cystic disease
All glomeruli
JG cells
Inc

38. What is the effect of AT II on efferent arterioles
NKCC
Modified smooth muscle of afferent arteriole - secrete renin
Cx<GFR
Contrict leading to inc FF - preserver renal GFR in low volume states

39. What is the least common kidney stone - What causes it and How do you treat it
160-200 - 350
Size
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Simple cysts

40. What 3 things stimulate the release of renin - and Where is it released from
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Involves only glomeruli

41. When is TF/P = 1
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Solute and water are reabsorbed at the same rate
Dialysis cysts
Chronic conditions - multiple myeloma - TB - RA

42. do you see casts in bladder cancer - kidney stones with hematuria
Hydronephrosis and pyelonephritis
Involves only glomeruli
No
160-200 - 350

43. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Carbonic anhydrase
Von hippel laundau and gene deletion in chromosome 3
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

44. How do the ureters course in relation to the uterine artery and ductus deferens
Under and under
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Thickening of glomerular BM

45. Why does Na conc nearly match Osm
Na reabsorption drives H20 reabsorption
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Cx>GFR
All glomeruli

46. granular - muddy brown casts - ddx
By 10%
Dialysis cysts
Na reabsorption drives H20 reabsorption
Acute tubular necrosis

47. What is ADPKD also associated with
GFR x plasma concentration
Vasocxn - inc BP
Negative charge
Polycystic liver disease - berry aneurysms - mitral valve prolapse

48. What is the algorithim for acidosis/alkalosis
Staghorn calculi - worsened by alkaluria
Inc - inc - inc
PH - then PC02
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

49. What is the prognosis of RPGN
Diarrhea - glue - RTA - hyperchloremia
Poor - days to weeks
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

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

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Renal

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