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 happens in the collecting tubules
Reabsorb Na in exchange for secreting K and H
PH - then PC02
Dec - inc - dec
To defend GFR

2. When is TF/P ratio > 1
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Hypokalemia - risk for Ca containing kidney stones
Solute is reabsorbed less quickly than water or net secretion of substance

3. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Dec - dec - dec
Radiopaque
Bladder cancer
Beta 1

4. What is amyloidosis associated with
Chronic conditions - multiple myeloma - TB - RA
Ectopic EPO - ACTH - PTHrP - prolactin
60% total body water - 40% ICF - 20% ECF
Complications of chronic kidney disease or HTN

5. cortical and medullary cysts resulting from long standing dialysis
Dialysis cysts
Kids - peripheral and periorbital edema - resolves spontaneously
Solute and water are reabsorbed at the same rate
Membranoproliferative glomerulonephritis

6. What does thyroidization of the kidney result in
Macula densa
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Eosinphilic casts in tubules

7. What is the cutoff of proteinuria in nephritic syndrome
No
<3.5 g /day
Bladder cancer
Acute renal failure

8. What is the effect of of PTH on the distal convoluted tubule
Ammonia - buffer for secreted H+
Inc Ca/Na exchange to inc Ca reabsoprtion
Simple cysts
Hypervent - early high altitude - aspirin ingestion early

9. What is the LM for diabetic glomerulonephropathy
Acute tubular necrosis
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Complications of chronic kidney disease or HTN
Na reabsorption drives H20 reabsorption

10. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Inc renal bicarb resabsoprtion - delayed
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Makes urine less concentrated - impermeable to H20
Solute is reabsorbed less quickly than water or net secretion of substance

11. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Staghorn calculi - worsened by alkaluria
Membranoproliferative glomerulonephritis
V x Urine concentration

12. What is the net effect of AT II
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Ammonia - buffer for secreted H+
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Cx>GFR

13. What is the formula for renal blood flow
RPF/(1- Hct)
Poor - days to weeks
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Macula densa

14. Defect in collecting ducts ability to excrete H+
RTA type 1 (distal)
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Dec - inc - inc

15. The fenestrated capillary endothelium constitutes what portion of the barrier
Size
2 ways - base exchanger and between epithelial cells
RTA type 1 (distal)
Acute tubular necrosis

16. What happens when PTH is secreted
Simple cysts
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

17. What substance is secreted in response increase atrial pressure
Corticosteroids
ANP
It has a longer renal vein
No

18. Who often has diffuse proliferative GN
Size and charge
CHF - pulmonary edema - HTN
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)

19. coarse - asymmetric - corticomedullary scarring and blunted calyx
Invades IVC and spreads hematogenously
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Macula densa and JG cells
Chronic pyelonephritis

20. Defect in proximal tubule HCO3 reabsorption
Advanced renal dz - CRF
RTA type 2 (proximal)
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
<3.5 g /day

21. What is the formula for secreted
Excreted - filtered
Size
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

22. What is the 60-40-20 rule of body weight
Men 50 to 70 - inc incidence with smoking and obesity
Ammonia - buffer for secreted H+
Dialysis cysts
60% total body water - 40% ICF - 20% ECF

23. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Inulin
Bladder cancer
Nonspecific
Dec - inc - dec

24. What is the ddx for a respiratory alkalosis
Passively reabsorbs water via medullary hypertonicity
Hypervent - early high altitude - aspirin ingestion early
Na
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

25. how does this present in adults and What is the pattern of inheritence
Segmental sclerosis and hylanosis
Principal cells and intercalated cells
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Carbonic anhydrase

26. What do casts indicated about hematuria/pyuria
Makes urine less concentrated - impermeable to H20
Under and under
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Renal in origin

27. What do you see in the urine with acute pyelonephritis
Inc plasma osm - dec blood volume
White cell casts
Inhibits Na/phosphate cotransport leading to phosphate excretion
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

28. What are the effects of PTH hormone on the kidney
Diuretics - vomiting - antacid - hyperaldosteronism
60% total body water - 40% ICF - 20% ECF
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
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

29. What is the compensatory response in respiratory acidosis
Inc renal bicarb resabsoprtion - delayed
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Huge palpable flank mass and hematuria
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

30. net tubular secretion of x
Cx>GFR
Liver
No
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

31. 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
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
By 10%
Cx<GFR

32. When is TF/P <1
Solute is reabsorbed more quickly than water
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Von hippel laundau and gene deletion in chromosome 3
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

33. What is lost in nephrotic syndrome resulting what urine and serum changes
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

34. What is the genetic etiology of wilms tumor and What is WAGR complex
Principal cells and intercalated cells
Proximal tubule - na/glucose co transporter
Ammonia - buffer for secreted H+
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

35. What are the 3 transporters of the intercalated cells
Size
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Hypervent - immediate
Ectopic EPO - ACTH - PTHrP - prolactin

36. What do you see on LM for focal segmental glomerulosclerosis
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Segmental sclerosis and hylanosis
Hypovent - immediate
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

37. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Advanced renal dz - CRF
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Hypokalemia - risk for Ca containing kidney stones
NC - inc - inc

38. What happens to pH - PCO2 and bicarb in metabolic acidosis
Dec - dec - dec
Nephritic syndrome
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Inc

39. What is ADPKD also associated with
Triglycerides
Complications of chronic kidney disease or HTN
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Polycystic liver disease - berry aneurysms - mitral valve prolapse

40. Why does Na conc nearly match Osm
Crescent - moon shape
1/4 plasma - and 3/4 interstitial volume
Metabolic acidosis
Na reabsorption drives H20 reabsorption

41. proliferative
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
RTA type 1 (distal)
Hyperceullular glomeruli

42. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Inc - dec - dec
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

43. What effect does cxn of the ureter have on RPF - GFR and FF
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Macula densa
NC - dec - dec
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

44. Subendothelial immune complexes with granular IF
Cx>GFR
Membranoproliferative glomerulonephritis
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

45. Which cells sense decreases in Na delivery
JG cells
Macula densa
Inc GFR and mesangial expansion
Rxn from angiotensinogen to angiontensin I

46. What therapy does miminal change respond to...
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Corticosteroids
Metabolic acidosis
HIV

47. in acute cystitis with pyuria - do you see casts
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
No
Size
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

48. Under what circumstances is aldosterone secreted
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Complications of chronic kidney disease or HTN
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Principal cells and intercalated cells

49. What is generated and secreted in the proximal tubule
Hypokalemia and hypophosphatemic rickets
Ammonia - buffer for secreted H+
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Acute tubular necrosis

50. membranous
PH - then PC02
Crescent - moon shape
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Thickening of glomerular BM