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Renal

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Answer 50 questions in 15 minutes.
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1. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Radiopaque
Hypokalemia - risk for Ca containing kidney stones
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

2. In renal failure What acid - base disturbance is most likely
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Metabolic acidosis
Diabetic glomerulonephropathy
Contrict leading to inc FF - preserver renal GFR in low volume states

3. What is the most frequent kind of kidney stone and What are causes that lead to it
Dec renal bicarb reabsorption - delayed
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Bladder cancer
Hydronephrosis and pyelonephritis

4. What is the formula for reabsorption
Filtered - secreted
Renal tubular cells - polygonal clear cells
Inc plasma osm - dec blood volume
Inc

5. What happens when PTH is secreted
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Dec - dec - dec
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

6. When is TF/P ratio > 1
Dec - inc - dec
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Simple cysts
Solute is reabsorbed less quickly than water or net secretion of substance

7. What effect does ANP have on GFR
Inc
Phenacetin - smoking - aniline dyes - cyclophosphamide
Staghorn calculi - worsened by alkaluria
Ectopic EPO - ACTH - PTHrP - prolactin

8. Where is potassium conc. Highest? Intra or extra
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Intra = HIKIN!
Transitional cell carcinoma
Diuretics - vomiting - antacid - hyperaldosteronism

9. How can NSAIDs cause acute renal failure
Solute and water are reabsorbed at the same rate
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Invades IVC and spreads hematogenously

10. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Cx = GFR
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Acute pyelonephritis
Corticosteroids

11. What happens in the thin descending loop of henle
Chronic pyelonephritis
Passively reabsorbs water via medullary hypertonicity
Vasocxn - inc BP
Eosinphilic casts in tubules

12. What are the main causes of membranous GN
Angio I to angio II and inhibits bradykinin
Diarrhea - glue - RTA - hyperchloremia
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Amyloidosis

13. net tubular reabsorption of x
Cx<GFR
No
Acute tubular necrosis
Podocytes foot processes

14. What does aldosterone do in the collecting tubule
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Insertion of Na channel on luminal side
NC - dec - dec
CHF - pulmonary edema - HTN

15. Subendothelial immune complexes with granular IF
Membranoproliferative glomerulonephritis
Beta 1
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Hypovent - immediate

16. secondary glomerular dz
Dialysis cysts
PH = pKa + log bicarb/0.03PCO2
Involves glomeruli and other organs
Complications of chronic kidney disease or HTN

17. Defect in collecting ducts ability to excrete H+
RTA type 1 (distal)
Dec - inc - inc
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

18. What does US show with medullary cystic disease
Small kidney - poor prognosis
Negative charge
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Transitional cell carcinoma

19. What percentage of ECF is plasma and What is interstitial volume
1/4 plasma - and 3/4 interstitial volume
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Kids - peripheral and periorbital edema - resolves spontaneously
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

20. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Inc Ca/Na exchange to inc Ca reabsoprtion
Diarrhea - glue - RTA - hyperchloremia
20 percent
Inc - inc - inc

21. What is hartnup's disease
Vasocxn - inc BP
Podocytes foot processes
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Antifreeze - ethyelene glycol or vit C abuse

22. What is the effect of PTH on the proximal tubule
Inhibits Na/phosphate cotransport leading to phosphate excretion
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Wilms tumor (ages 2-4)
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

23. How do you interpret creatinine clearance
Needs to be bilateral
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
PH = pKa + log bicarb/0.03PCO2

24. How is chlorid reabsorbed in the proximal tubule
All glomeruli
Solute is reabsorbed less quickly than water or net secretion of substance
Involves only glomeruli
2 ways - base exchanger and between epithelial cells

25. What is the ddx for a respiratory alkalosis
Dec - inc - dec
Hypervent - early high altitude - aspirin ingestion early
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Inc - inc - inc

26. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Transitional cell carcinoma
RTA type 2 (proximal)
Beta 1
Segmental sclerosis and hylanosis

27. waxy casts ddx
Diuretics - vomiting - antacid - hyperaldosteronism
HIV
Advanced renal dz - CRF
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

28. What effect does dec plasma protein concentration have on RPF - GFR - and FF
NC - inc - inc
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Vasa recta - interlobular v - interlobar v - renal v

29. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Under and under
By 10%
Actively reabsorbs NaCl - diluting - makes urine hypotonic
ADPKD

30. What is the compensatory response in metabolic acidosis
Growth retardation and developmental delay
Macula densa
Metabolic acidosis
Hypervent - immediate

31. What effect does inc plasma protein concentration have on RPF - GFR - and FF
Inulin
NC - dec - dec
Inc in Ca and PO4 absoprtion from the gut
Few glomeruli

32. What do macula densa cells sense
Na
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Growth retardation and developmental delay
Renal in origin

33. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Carbonic anhydrase
Freely filtered and neither absorbed or secreted
Renal artery - interlobar a - interlobular a
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

34. When is TF/P = 1
Solute and water are reabsorbed at the same rate
Inc Ca/Na exchange to inc Ca reabsoprtion
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

35. What is the prognosis of RPGN
JG cells
Poor - days to weeks
Podocytes foot processes
Actively reabsorbs NaCl - diluting - makes urine hypotonic

36. How is extracellular volume measured
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
GFR/RPF
Inulin
Stimulates thirst

37. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Growth retardation and developmental delay
Under and under
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

38. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
No
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Dec - inc - inc
PH = pKa + log bicarb/0.03PCO2

39. What effect does cxn of the ureter have on RPF - GFR and FF
NC - dec - dec
Membranoproliferative glomerulonephritis
Solute is reabsorbed more quickly than water
Inc - dec - dec

40. What is winter's formula and when do you use it
Filtered - secreted
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
1/4 plasma - and 3/4 interstitial volume
Insertion of Na channel on luminal side

41. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Metabolic acidosis
Vasocxn - inc BP
NKCC
Hypervent - early high altitude - aspirin ingestion early

42. What are the associated paraneoplastic syndromes wth RCC
Few glomeruli
Inc - inc - inc
Inc - dec - dec
Ectopic EPO - ACTH - PTHrP - prolactin

43. acute generalized cortical infarction of both kidneys - dz - causes and associations
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Principal cells and intercalated cells
Inc in Ca and PO4 absoprtion from the gut
Inc - dec - dec

44. In what disease in FSGS the most common glomerular disease
60% total body water - 40% ICF - 20% ECF
PH = pKa + log bicarb/0.03PCO2
Involves glomeruli and other organs
HIV

45. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Staghorn calculi - worsened by alkaluria
Needs to be bilateral
Dec - inc - dec

46. What do you see on LM and IF with rapidly progressive GN
Dec renal bicarb reabsorption - delayed
Crescent - moon shape
Principal cells and intercalated cells
2 ways - base exchanger and between epithelial cells

47. What is the net effect of ANP
LM - nl glomeruli - EM - foot process effacement
Na and volume loss
White cell casts
Acute tubular necrosis

48. In a metabolic acidosis What additional calculation is necessary and How do you make it
GFR x plasma concentration
Anion gap = na - (Cl + bicarb)
Insertion of Na channel on luminal side
Advanced renal dz - CRF

49. How are amino acids reabsorbed
Crescent - moon shape
Inc in Ca and PO4 absoprtion from the gut
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

50. primary glomerular dz
RPF/(1- Hct)
Involves only glomeruli
Acute tubular necrosis
Renal tubular cells - polygonal clear cells

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Renal

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