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Renal

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Answer 50 questions in 15 minutes.
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1. RBC casts - ddx
60% total body water - 40% ICF - 20% ECF
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
No
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

2. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Hypokalemia - risk for Ca containing kidney stones
NC - inc - inc
Na and volume loss
JG cells

3. What are the two forms of renal failure and What are examples of each
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Acute - ATN - or chronic - HTN - DM
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Thickening of glomerular BM

4. What is the purpose of the JGA
Passively reabsorbs water via medullary hypertonicity
Chronic pyelonephritis
Angio I to angio II and inhibits bradykinin
To defend GFR

5. What are the main causes of membranous GN
Principal cells and intercalated cells
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Hyperkalemia

6. inc in creatinine and BUN over a period of several days
Makes urine less concentrated - impermeable to H20
Acute renal failure
Thickening of glomerular BM
RTA type 4 (hyperkalemic)

7. What is the BUN/Cr ratio in prerenal azotemia and why?
Proximal tubule - na/glucose co transporter
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Invades IVC and spreads hematogenously
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

8. What does NEG lead to in the efferent arterioles
Inc GFR and mesangial expansion
Vasocxn - inc BP
NC - dec - dec
Hypervent - early high altitude - aspirin ingestion early

9. Where is potassium conc. Highest? Intra or extra
Inhibits Na/phosphate cotransport leading to phosphate excretion
Intra = HIKIN!
CHF - pulmonary edema - HTN
Acts on V2 receptors leading to insertion of aquaporins on luminal side

10. in acute cystitis with pyuria - do you see casts
Kids - peripheral and periorbital edema - resolves spontaneously
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Invades IVC and spreads hematogenously
No

11. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Needs to be bilateral
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

12. What is the BUN/Cr ratio in instrinsic renal ARF and why
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Inc in Ca and PO4 absoprtion from the gut
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Hypokalemia - risk for Ca containing kidney stones

13. How can NSAIDs cause acute renal failure
Needs to be bilateral
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Inulin
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

14. Why can PAH be used to measure ERPF
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Hypovent - immediate
Inc
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

15. hypoaldosteronism or lack of collecting tubule response to aldosteron
Failure of EPO
Size and charge
RTA type 4 (hyperkalemic)
PH = pKa + log bicarb/0.03PCO2

16. What is the net effect of AT II
Anion gap = na - (Cl + bicarb)
Dec - dec - NC
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Cx = GFR

17. What do patients die from ADPKD
Complications of chronic kidney disease or HTN
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
Amyloidosis
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

18. Defect in collecting ducts ability to excrete H+
RTA type 1 (distal)
2 ways - base exchanger and between epithelial cells
Membranoproliferative glomerulonephritis
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation

19. What is hartnup's disease
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
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
Radiopaque

20. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
EPO - endothelial cells of peritubular capillaries
Inhibits Na/phosphate cotransport leading to phosphate excretion
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Hypervent - immediate

21. cortical and medullary cysts resulting from long standing dialysis
Dialysis cysts
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

22. What is the 3rd most common kidney stone and What causes it
Radiopaque
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Macula densa and JG cells

23. What is the ddx for a respiratory alkalosis
Hypervent - early high altitude - aspirin ingestion early
Insertion of Na channel on luminal side
RTA type 2 (proximal)
V x Urine concentration

24. What is ADPKD also associated with
Insertion of Na channel on luminal side
Poor - days to weeks
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

25. What two cells make up the JGA
Inhibits Na/phosphate cotransport leading to phosphate excretion
Kids - peripheral and periorbital edema - resolves spontaneously
Macula densa and JG cells
Diuretics - vomiting - antacid - hyperaldosteronism

26. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
1alpha hydroxylase - PTH stimulates it
Nephrotic syndrome

27. hyaline casts ddx
NKCC
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Nonspecific
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

28. How do you interpret creatinine clearance
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Podocytes foot processes

29. What is the compensatory response in metabolic acidosis
Dec - dec - dec
Inc Ca/Na exchange to inc Ca reabsoprtion
Hypervent - immediate
Segmental sclerosis and hylanosis

30. What are the associations with nephrotic syndrome
Dialysis cysts
Thromboembolism and inc risk of infection
Corticosteroids
Inc - dec - dec

31. What do casts indicated about hematuria/pyuria
Renal in origin
Corticosteroids
Acute renal failure
Acute - ATN - or chronic - HTN - DM

32. In renal failure What acid - base disturbance is most likely
<3.5 g /day
Eosinphilic casts in tubules
Metabolic acidosis
Crescent - moon shape

33. What is the effect of AT II on GFR - FF and Na
Small kidney - poor prognosis
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Radiopaque

34. What is is Alport's syndrome and what else do you see with it other than renal path
Corticosteroids
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Segmental sclerosis and hylanosis

35. How do the ureters course in relation to the uterine artery and ductus deferens
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Cx = GFR
1/4 plasma - and 3/4 interstitial volume
Under and under

36. secondary glomerular dz
Transitional cell carcinoma
EPO - endothelial cells of peritubular capillaries
Involves glomeruli and other organs
Acute pyelonephritis

37. In what disease in FSGS the most common glomerular disease
ANP
Size and charge
Inc plasma osm - dec blood volume
HIV

38. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
160-200 - 350
Freely filtered and neither absorbed or secreted
Makes urine less concentrated - impermeable to H20
HIV

39. WBC casts - ddx
No
RTA type 4 (hyperkalemic)
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection

40. What effect does ANP have on GFR
Inc - inc - inc
Vasa recta - interlobular v - interlobar v - renal v
Radiopaque
Inc

41. In who is RCC most comon
Negative charge
Corticosteroids
Men 50 to 70 - inc incidence with smoking and obesity
Hypokalemia - risk for Ca containing kidney stones

42. The fused basement membrane with heparan sulfate constitutes what portion of the charge
CHF - pulmonary edema - HTN
Renal tubular cells - polygonal clear cells
Negative charge
Kids - peripheral and periorbital edema - resolves spontaneously

43. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
White cell casts
Nephritic syndrome
PH = pKa + log bicarb/0.03PCO2
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

44. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Membranoproliferative glomerulonephritis
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

45. What are the effects of AT II on vascular smooth muscle
ADPKD
Vasocxn - inc BP
Na
Acute renal failure

46. What is the 60-40-20 rule of body weight
Na reabsorption drives H20 reabsorption
Vasa recta - interlobular v - interlobar v - renal v
Acts on V2 receptors leading to insertion of aquaporins on luminal side
60% total body water - 40% ICF - 20% ECF

47. What happens to pH - PCO2 and bicarb in metabolic acidosis
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Dec - dec - dec
Becomes concentrated and hypertonic
Inc renal bicarb resabsoprtion - delayed

48. What does renin do
Rxn from angiotensinogen to angiontensin I
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

49. What happens to urine in the ascending limb
Radiopaque
Needs to be bilateral
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Makes urine less concentrated - impermeable to H20

50. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Simple cysts
HIV
NKCC

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