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Renal

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1. What circumstances causes ADH secretion
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Beta 1
Eosinphilic casts in tubules
Inc plasma osm - dec blood volume

2. In renal failure What are the consquence sof Na/H20 retention
Becomes concentrated and hypertonic
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
CHF - pulmonary edema - HTN

3. In what disease in FSGS the most common glomerular disease
HIV
Kids - peripheral and periorbital edema - resolves spontaneously
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Stimulates thirst

4. What two cells make up the JGA
HIV
Podocytes foot processes
Proximal tubule - na/glucose co transporter
Macula densa and JG cells

5. How is extracellular volume measured
Inulin
Dec - inc - dec
2 ways - base exchanger and between epithelial cells
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

6. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Acute pyelonephritis
1/4 plasma - and 3/4 interstitial volume
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Anion gap = na - (Cl + bicarb)

7. What does US show with medullary cystic disease
Involves only glomeruli
Hyperceullular glomeruli
Small kidney - poor prognosis
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

8. proliferative
Diabetic glomerulonephropathy
Hyperceullular glomeruli
Invades IVC and spreads hematogenously
Acts on V2 receptors leading to insertion of aquaporins on luminal side

9. What is the prognosis of RPGN
Radiopaque
Poor - days to weeks
All glomeruli
Simple cysts

10. What happens in the thin descending loop of henle
RTA type 2 (proximal)
Chronic pyelonephritis
Passively reabsorbs water via medullary hypertonicity
Segmental sclerosis and hylanosis

11. diffuse
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Intra = HIKIN!
All glomeruli
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

12. What is the LM for diabetic glomerulonephropathy
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Inc renal bicarb resabsoprtion - delayed
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)

13. no net secretion or reabsorption of x
NC - inc - inc
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Cx = GFR

14. membranous
Metabolic acidosis
Thickening of glomerular BM
EPO - endothelial cells of peritubular capillaries
No

15. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
White cell casts
All glomeruli
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
160-200 - 350

16. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
It has a longer renal vein
Diarrhea - glue - RTA - hyperchloremia
Reabsorb Na in exchange for secreting K and H
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

17. What are the associations with RTA type 4
Medullary cystic disease
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Segmental sclerosis and hylanosis
Hyperceullular glomeruli

18. What are the associations with nephrotic syndrome
No
Thromboembolism and inc risk of infection
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Diabetic glomerulonephropathy

19. How does RCC spread
Invades IVC and spreads hematogenously
HIV
GFR x plasma concentration
NC - dec - dec

20. What is the ddx for a respiratory alkalosis
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Dec - dec - dec
Type II - C3 nephritic factor
Hypervent - early high altitude - aspirin ingestion early

21. When is TF/P = 1
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Solute and water are reabsorbed at the same rate
Dec - dec - dec
Corticosteroids

22. What is the ddx for respiratory acidosis
Hyperceullular glomeruli
Antifreeze - ethyelene glycol or vit C abuse
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Radiopaque

23. What is the net effect of PTH
Reabsorb Na in exchange for secreting K and H
Thromboembolism and inc risk of infection
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
Inc in Ca and PO4 absoprtion from the gut

24. What change (lack of) is common in children with renal failure
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Size and charge
Growth retardation and developmental delay
NKCC

25. primary glomerular dz
Na reabsorption drives H20 reabsorption
Involves only glomeruli
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Principal cells and intercalated cells

26. RBC casts - ddx
Hypokalemia and hypophosphatemic rickets
Renal tubular cells - polygonal clear cells
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

27. What is the compensatory response in respiratory acidosis
Solute and water are reabsorbed at the same rate
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Inc plasma osm - dec blood volume
Inc renal bicarb resabsoprtion - delayed

28. Why can inulin be used to calculate GFR?
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Radiolabelled albumin
Wilms tumor (ages 2-4)
Freely filtered and neither absorbed or secreted

29. What does ADH do in the collecting tubule
Cx<GFR
20 percent
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Acts on V2 receptors leading to insertion of aquaporins on luminal side

30. What is renal osteodystrophy
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

31. Why is there anemia in renal failure
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Failure of EPO
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb

32. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Na reabsorption drives H20 reabsorption
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Staghorn calculi - worsened by alkaluria
LM - nl glomeruli - EM - foot process effacement

33. What does thyroidization of the kidney result in
Eosinphilic casts in tubules
Makes urine less concentrated - impermeable to H20
60% total body water - 40% ICF - 20% ECF
EPO - endothelial cells of peritubular capillaries

34. What is the compensatory response in metabolic acidosis
Wilms tumor (ages 2-4)
Liver
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Hypervent - immediate

35. What is the effect of AT II on GFR - FF and Na
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Modified smooth muscle of afferent arteriole - secrete renin
Transitional cell carcinoma
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

36. What is the effect of AT II on efferent arterioles
Liver
2 ways - base exchanger and between epithelial cells
Invades IVC and spreads hematogenously
Contrict leading to inc FF - preserver renal GFR in low volume states

37. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Diarrhea - glue - RTA - hyperchloremia
Complications of chronic kidney disease or HTN
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Failure of EPO

38. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
ADPKD
160-200 - 350
Acute tubular necrosis
NC - dec - dec

39. What do macula densa cells sense
Hypervent - immediate
All glomeruli
Na
Segmental sclerosis and hylanosis

40. What are the effects of AT II on the adrenal gland
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Dec - inc - inc
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

41. What are the associated paraneoplastic syndromes wth RCC
Modified smooth muscle of afferent arteriole - secrete renin
Ectopic EPO - ACTH - PTHrP - prolactin
It has a longer renal vein
CHF - pulmonary edema - HTN

42. What therapy does miminal change respond to...
Rxn from angiotensinogen to angiontensin I
Na
Corticosteroids
1alpha hydroxylase - PTH stimulates it

43. In renal failure with uremia - What are the 5 aspects of uremia
Acute pyelonephritis
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Podocytes foot processes
Intra = HIKIN!

44. What do casts indicated about hematuria/pyuria
RTA type 1 (distal)
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Renal in origin
Dec - inc - dec

45. What do you see on LM for focal segmental glomerulosclerosis
Medullary cystic disease
Inc plasma osm - dec blood volume
Segmental sclerosis and hylanosis
Vasa recta - interlobular v - interlobar v - renal v

46. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Makes urine less concentrated - impermeable to H20
Growth retardation and developmental delay
Inc - inc - inc
Principal cells and intercalated cells

47. What does renin do
Kids - peripheral and periorbital edema - resolves spontaneously
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Failure of EPO
Rxn from angiotensinogen to angiontensin I

48. net tubular reabsorption of x
UTI or acute gastroenteritis
Na and volume loss
Cx<GFR
EPO - endothelial cells of peritubular capillaries

49. When is TF/P ratio > 1
Solute is reabsorbed less quickly than water or net secretion of substance
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Wilms tumor (ages 2-4)
ANP

50. Where is ACE made and What are 2 of its fxns
Angio I to angio II and inhibits bradykinin
Vasocxn - inc BP
Hypervent - early high altitude - aspirin ingestion early
NKCC

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Renal

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