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Renal

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 least common kidney stone - What causes it and How do you treat it
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Solute is reabsorbed more quickly than water

2. How does Wilms tumor present
Liver
Intra = HIKIN!
No
Huge palpable flank mass and hematuria

3. How do calcium stones appear on x ray
Renal artery - interlobar a - interlobular a
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
Phenacetin - smoking - aniline dyes - cyclophosphamide
Radiopaque

4. By what percentage does EPRF underestimage true RPF
By 10%
Dialysis cysts
Inhibits Na/phosphate cotransport leading to phosphate excretion
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

5. What effect does cxn of the ureter have on RPF - GFR and FF
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
RTA type 4 (hyperkalemic)
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
NC - dec - dec

6. What is the compensatory response in respiratory acidosis
Under and under
Radiopaque
Von hippel laundau and gene deletion in chromosome 3
Inc renal bicarb resabsoprtion - delayed

7. What are the associations with nephrotic syndrome
Na reabsorption drives H20 reabsorption
Thromboembolism and inc risk of infection
Growth retardation and developmental delay
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

8. What happens to urine in the ascending limb
Makes urine less concentrated - impermeable to H20
Hypokalemia and hypophosphatemic rickets
Nonspecific
Segmental sclerosis and hylanosis

9. How are amino acids reabsorbed
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Reabsorb Na in exchange for secreting K and H
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

10. What is the formula for filtration fraction
Renal artery - interlobar a - interlobular a
GFR/RPF
Inc
Dec renal bicarb reabsorption - delayed

11. What can cause oxalate crystals
Radiolabelled albumin
EPO - endothelial cells of peritubular capillaries
Antifreeze - ethyelene glycol or vit C abuse
Growth retardation and developmental delay

12. In renal failure What are the consquence sof Na/H20 retention
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Proximal tubule - na/glucose co transporter
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
CHF - pulmonary edema - HTN

13. What is the compensatory response in respiratory alkalosis
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
RTA type 2 (proximal)
By 10%
Dec renal bicarb reabsorption - delayed

14. What is the algorithim for acidosis/alkalosis
PH - then PC02
White cell casts
Small kidney - poor prognosis
Eosinphilic casts in tubules

15. What does NEG lead to in the efferent arterioles
Needs to be bilateral
Involves only glomeruli
Passively reabsorbs water via medullary hypertonicity
Inc GFR and mesangial expansion

16. In what clinical context does Berger's disease often present
Cx<GFR
Corticosteroids
Eosinphilic casts in tubules
UTI or acute gastroenteritis

17. What is the effect of AT II on the hypothalamus
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Stimulates thirst
Metabolic acidosis
Radiopaque

18. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Transitional cell carcinoma
Nephrotic syndrome
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

19. What is the pathway from the efferent arteriorle to the renal v
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Vasa recta - interlobular v - interlobar v - renal v
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

20. Defect in collecting ducts ability to excrete H+
RTA type 1 (distal)
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Dec - dec - NC
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular

21. When is TF/P = 1
Solute is reabsorbed more quickly than water
Solute and water are reabsorbed at the same rate
160-200 - 350
Eosinphilic casts in tubules

22. Who often has diffuse proliferative GN
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
V x Urine concentration
Thickening of glomerular BM
Nonspecific

23. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Involves only glomeruli
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Involves glomeruli and other organs
Acute - ATN - or chronic - HTN - DM

24. What is the formula for excretion rate
Inc
V x Urine concentration
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

25. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Antifreeze - ethyelene glycol or vit C abuse
Small kidney - poor prognosis
NKCC
Inc - dec - dec

26. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
Liver
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
Medullary cystic disease

27. What is generated and secreted in the proximal tubule
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Ammonia - buffer for secreted H+
Inc
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

28. What is amyloidosis associated with
UTI or acute gastroenteritis
Thromboembolism and inc risk of infection
Chronic conditions - multiple myeloma - TB - RA
Ectopic EPO - ACTH - PTHrP - prolactin

29. What are the two forms of renal failure and What are examples of each
Rxn from angiotensinogen to angiontensin I
Acute - ATN - or chronic - HTN - DM
Triglycerides
Hydronephrosis and pyelonephritis

30. What does the crescent moon shape consist of in RPGN
White cell casts
Radiopaque
Anion gap = na - (Cl + bicarb)
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

31. In a metabolic acidosis What additional calculation is necessary and How do you make it
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Simple cysts
Anion gap = na - (Cl + bicarb)
Membranoproliferative glomerulonephritis

32. What is renal osteodystrophy
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Podocytes foot processes
Radiopaque

33. What is the prognosis of RPGN
Poor - days to weeks
Becomes concentrated and hypertonic
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Segmental sclerosis and hylanosis

34. Which cells sense decreases in Na delivery
Macula densa
Nonspecific
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

35. What happens in the thin descending loop of henle
Passively reabsorbs water via medullary hypertonicity
Inc Ca/Na exchange to inc Ca reabsoprtion
Phenacetin - smoking - aniline dyes - cyclophosphamide
Men 50 to 70 - inc incidence with smoking and obesity

36. What is lost in nephrotic syndrome resulting what urine and serum changes
Proximal tubule - na/glucose co transporter
Antifreeze - ethyelene glycol or vit C abuse
Renal tubular cells - polygonal clear cells
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

37. What happens in the collecting tubules
Reabsorb Na in exchange for secreting K and H
ANP
Nonspecific
Vasa recta - interlobular v - interlobar v - renal v

38. What does thyroidization of the kidney result in
Na reabsorption drives H20 reabsorption
No
RTA type 1 (distal)
Eosinphilic casts in tubules

39. What is the effect of aldosterone in principal cells
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Reabsorb Na in exchange for secreting K and H
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

40. What is a normal filtration fraction
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Macula densa
20 percent

41. How do struvite stones appear on xray
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Radiopaque
Inc GFR and mesangial expansion
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

42. In who is RCC most comon
Corticosteroids
Principal cells and intercalated cells
Men 50 to 70 - inc incidence with smoking and obesity
Inc GFR and mesangial expansion

43. How do the ureters course in relation to the uterine artery and ductus deferens
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Amyloidosis
Under and under
Carbonic anhydrase

44. What does aldosterone do in the collecting tubule
Insertion of Na channel on luminal side
NC - inc - inc
Cx>GFR
GFR/RPF

45. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
Antifreeze - ethyelene glycol or vit C abuse
Ectopic EPO - ACTH - PTHrP - prolactin
2 ways - base exchanger and between epithelial cells
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

46. What is the henderson hasselbalch equation
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
PH = pKa + log bicarb/0.03PCO2

47. What is the BUN/Cr ratio in prerenal azotemia and why?
Becomes concentrated and hypertonic
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Acute - ATN - or chronic - HTN - DM

48. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Hyperkalemia
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

49. What substance is secreted in response increase atrial pressure
Ectopic EPO - ACTH - PTHrP - prolactin
Acute renal failure
ANP
Type II - C3 nephritic factor

50. Where does renal cell carcinoma originate and What do the cells look like
Reabsorb Na in exchange for secreting K and H
Renal tubular cells - polygonal clear cells
Size
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN