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 are the associations with nephrotic syndrome
Beta 1
Hypervent - early high altitude - aspirin ingestion early
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Thromboembolism and inc risk of infection

2. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
1alpha hydroxylase - PTH stimulates it
Solute and water are reabsorbed at the same rate
Simple cysts
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

3. What happens in the early distal convoluted tubule and What does that do to the urine
Hyperceullular glomeruli
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Vasa recta - interlobular v - interlobar v - renal v
Acts on V2 receptors leading to insertion of aquaporins on luminal side

4. What is the pathway to the afferent arteriole
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Simple cysts
Renal artery - interlobar a - interlobular a
NC - dec - dec

5. coarse - asymmetric - corticomedullary scarring and blunted calyx
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Liver
CHF - pulmonary edema - HTN
Chronic pyelonephritis

6. granular - muddy brown casts - ddx
Inc renal bicarb resabsoprtion - delayed
Acute tubular necrosis
Inc
PH = pKa + log bicarb/0.03PCO2

7. What is lost in nephrotic syndrome resulting what urine and serum changes
NC - dec - dec
Renal artery - interlobar a - interlobular a
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
RPF/(1- Hct)

8. hypoaldosteronism or lack of collecting tubule response to aldosteron
Hypovent - immediate
Membranoproliferative glomerulonephritis
RTA type 4 (hyperkalemic)
Crescent - moon shape

9. What does aldosterone do in the collecting tubule
Insertion of Na channel on luminal side
Renal in origin
Vasa recta - interlobular v - interlobar v - renal v
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

10. What is the least common kidney stone - What causes it and How do you treat it
Phenacetin - smoking - aniline dyes - cyclophosphamide
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
JG cells
Stimulates thirst

11. What is is Alport's syndrome and what else do you see with it other than renal path
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Liver
Ectopic EPO - ACTH - PTHrP - prolactin
NC - inc - inc

12. What is the effect of angiotensin II on RPF - GFR - and FF - why - What do ACEi do?
Diabetic glomerulonephropathy
Few glomeruli
Dec - inc - inc
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

13. What does US show with medullary cystic disease
Small kidney - poor prognosis
Inc in concentration - not amout - due to water reabsorption
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Thickening of glomerular BM

14. In renal failure What are the consquence sof Na/H20 retention
Inulin
Hypokalemia and hypophosphatemic rickets
Antifreeze - ethyelene glycol or vit C abuse
CHF - pulmonary edema - HTN

15. in TCC - What does painelss hematuria suggest
Bladder cancer
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Proximal tubule - na/glucose co transporter

16. diffuse
Inc - inc - inc
All glomeruli
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Hyperceullular glomeruli

17. TCC is associated with problems in your Pee SAC - ??
Most of the bicarb - sodium - chloride - and water
Radiopaque
Hypovent - immediate
Phenacetin - smoking - aniline dyes - cyclophosphamide

18. What is amyloidosis associated with
ADPKD
Hypervent - early high altitude - aspirin ingestion early
Chronic conditions - multiple myeloma - TB - RA
Amyloidosis

19. How can NSAIDs cause acute renal failure
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
RTA type 4 (hyperkalemic)
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

20. What is winter's formula and when do you use it
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Renal tubular cells - polygonal clear cells
2 ways - base exchanger and between epithelial cells
Na reabsorption drives H20 reabsorption

21. What is the most common renal malignancy of early childhood
Acute pyelonephritis
Passively reabsorbs water via medullary hypertonicity
Becomes concentrated and hypertonic
Wilms tumor (ages 2-4)

22. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
PH = pKa + log bicarb/0.03PCO2
Excreted - filtered
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

23. What is the effect of of PTH on the distal convoluted tubule
Nephritic syndrome
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Inc Ca/Na exchange to inc Ca reabsoprtion
Von hippel laundau and gene deletion in chromosome 3

24. What is the formula for renal blood flow
RPF/(1- Hct)
Acute - ATN - or chronic - HTN - DM
Inc renal bicarb resabsoprtion - delayed
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

25. What are the associations with RTA type 4
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Nephrotic syndrome
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

26. proliferative
Simple cysts
Nonspecific
Hyperceullular glomeruli
RTA type 4 (hyperkalemic)

27. What percentage of ECF is plasma and What is interstitial volume
Inhibits Na/phosphate cotransport leading to phosphate excretion
Radiopaque
Bladder cancer
1/4 plasma - and 3/4 interstitial volume

28. What are the two forms of renal failure and What are examples of each
Inc plasma osm - dec blood volume
Cx>GFR
Acute - ATN - or chronic - HTN - DM
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

29. What is the compensatory response in respiratory acidosis
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
White cell casts
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Inc renal bicarb resabsoprtion - delayed

30. What is the effect of AT II on efferent arterioles
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Contrict leading to inc FF - preserver renal GFR in low volume states
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Acts on V2 receptors leading to insertion of aquaporins on luminal side

31. What is renal osteodystrophy
Liver
Hypervent - early high altitude - aspirin ingestion early
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

32. Why does Na conc nearly match Osm
Solute and water are reabsorbed at the same rate
Hypovent - immediate
Growth retardation and developmental delay
Na reabsorption drives H20 reabsorption

33. What is the compensatory response in metabolic alkalosis
Podocytes foot processes
Hypovent - immediate
Reabsorb Na in exchange for secreting K and H
Type II - C3 nephritic factor

34. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Simple cysts
Hyperceullular glomeruli
Podocytes foot processes
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

35. What is the purpose of the JGA
Stimulates thirst
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
JG cells
To defend GFR

36. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Staghorn calculi - worsened by alkaluria
Carbonic anhydrase
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Nephrotic syndrome

37. What is the algorithim for acidosis/alkalosis
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Ectopic EPO - ACTH - PTHrP - prolactin
PH - then PC02

38. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Acute pyelonephritis
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Passively reabsorbs water via medullary hypertonicity
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

39. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Size
Nephrotic syndrome
Corticosteroids

40. nonenzymatic glycosylation of GBM - inc permeability and thickening
Inc plasma osm - dec blood volume
Intra = HIKIN!
Diabetic glomerulonephropathy
Chronic conditions - multiple myeloma - TB - RA

41. What is the second most common kidney stone
Simple cysts
Macula densa and JG cells
Hyperkalemia
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

42. What is the compensatory response in metabolic acidosis
ANP
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Hypervent - immediate

43. What is the effect of AT II on the posterior pituitary
HIV
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Radiopaque
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

44. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Dec - inc - dec
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
PH = pKa + log bicarb/0.03PCO2
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

45. How do you interpret creatinine clearance
Dec - dec - dec
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Proximal tubule - na/glucose co transporter
RTA type 1 (distal)

46. What is the compensatory response in respiratory alkalosis
Complications of chronic kidney disease or HTN
Inc Ca/Na exchange to inc Ca reabsoprtion
Carbonic anhydrase
Dec renal bicarb reabsorption - delayed

47. What is the formula for the filtered load
Advanced renal dz - CRF
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
GFR/RPF
GFR x plasma concentration

48. What are the effects of AT II on vascular smooth muscle
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Vasocxn - inc BP
Acute - ATN - or chronic - HTN - DM
Hypervent - immediate

49. How do struvite stones appear on xray
Corticosteroids
Eosinphilic casts in tubules
2 ways - base exchanger and between epithelial cells
Radiopaque

50. What is the formula for excretion rate
Macula densa and JG cells
Diabetic glomerulonephropathy
V x Urine concentration
Contrict leading to inc FF - preserver renal GFR in low volume states