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Renal

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Answer 50 questions in 15 minutes.
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1. In renal failure What are the consquence sof Na/H20 retention
Von hippel laundau and gene deletion in chromosome 3
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
CHF - pulmonary edema - HTN

2. What is the effect of PTH on the proximal tubule
Anion gap = na - (Cl + bicarb)
To defend GFR
Growth retardation and developmental delay
Inhibits Na/phosphate cotransport leading to phosphate excretion

3. What are the two forms of renal failure and What are examples of each
Medullary cystic disease
Radiopaque
Acute - ATN - or chronic - HTN - DM
Proximal tubule - na/glucose co transporter

4. What happens in the collecting tubules
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
GFR/RPF
Eosinphilic casts in tubules
Reabsorb Na in exchange for secreting K and H

5. how does this present in adults and What is the pattern of inheritence
No
Under and under
Hypokalemia and hypophosphatemic rickets
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

6. What is the effect of AT II on the posterior pituitary
Acute - ATN - or chronic - HTN - DM
Huge palpable flank mass and hematuria
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Size and charge

7. in acute cystitis with pyuria - do you see casts
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Inc renal bicarb resabsoprtion - delayed
No
Inulin

8. What happens to urine in the ascending limb
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
NC - inc - inc
Makes urine less concentrated - impermeable to H20
NKCC

9. What is a normal filtration fraction
Inc plasma osm - dec blood volume
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
20 percent
Nonspecific

10. What do macula densa cells sense
No
160-200 - 350
Na
PH - then PC02

11. What are the effects of PTH hormone on the kidney
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
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

12. RBC casts - ddx
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Cx<GFR
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Contrict leading to inc FF - preserver renal GFR in low volume states

13. 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
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Macula densa
Diarrhea - glue - RTA - hyperchloremia

14. What dyslipidemia is most common in renal failure
Medullary cystic disease
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
No
Triglycerides

15. When is TF/P = 1
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Inc renal bicarb resabsoprtion - delayed
RTA type 4 (hyperkalemic)
Solute and water are reabsorbed at the same rate

16. What is the effect of angiotensin II on RPF - GFR - and FF - why - What do ACEi do?
60% total body water - 40% ICF - 20% ECF
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
No

17. What is is Alport's syndrome and what else do you see with it other than renal path
Inc plasma osm - dec blood volume
NC - inc - inc
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Inc GFR and mesangial expansion

18. What is generated and secreted in the proximal tubule
Hyperceullular glomeruli
Ammonia - buffer for secreted H+
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Dec - dec - dec

19. Defect in proximal tubule HCO3 reabsorption
Complications of chronic kidney disease or HTN
Radiopaque
Solute is reabsorbed more quickly than water
RTA type 2 (proximal)

20. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
160-200 - 350
PH = pKa + log bicarb/0.03PCO2
Membranoproliferative glomerulonephritis
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron

21. What is the BUN/Cr ratio in prerenal azotemia and why?
NC - dec - dec
Invades IVC and spreads hematogenously
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Hypervent - immediate

22. proliferative
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Stimulates thirst
Radiopaque
Hyperceullular glomeruli

23. net tubular secretion of x
Inc Ca/Na exchange to inc Ca reabsoprtion
PH = pKa + log bicarb/0.03PCO2
Cx>GFR
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

24. What is the pathway from the efferent arteriorle to the renal v
Vasa recta - interlobular v - interlobar v - renal v
Inc in concentration - not amout - due to water reabsorption
Renal artery - interlobar a - interlobular a
To defend GFR

25. What is the ddx for a metabolic acidosis with an inc anion gap
Dec - inc - dec
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Excreted - filtered
Acute - ATN - or chronic - HTN - DM

26. Why can inulin be used to calculate GFR?
Makes urine less concentrated - impermeable to H20
Freely filtered and neither absorbed or secreted
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Diabetic glomerulonephropathy

27. What does thyroidization of the kidney result in
Eosinphilic casts in tubules
Metabolic acidosis
Under and under
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

28. What cells create the epithelial layer of the glomerular filtration barrier
Inc - dec - dec
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
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Podocytes foot processes

29. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Beta 1
Complications of chronic kidney disease or HTN
Most of the bicarb - sodium - chloride - and water
Few glomeruli

30. When is TF/P <1
Solute is reabsorbed more quickly than water
Hyperkalemia
EPO - endothelial cells of peritubular capillaries
Contrict leading to inc FF - preserver renal GFR in low volume states

31. What does ADH do in the collecting tubule
Acute renal failure
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Acts on V2 receptors leading to insertion of aquaporins on luminal side

32. What is the compensatory response in respiratory alkalosis
Dec renal bicarb reabsorption - delayed
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Insertion of Na channel on luminal side
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

33. What percentage of ECF is plasma and What is interstitial volume
Filtered - secreted
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Na and volume loss
1/4 plasma - and 3/4 interstitial volume

34. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
160-200 - 350

35. How do struvite stones appear on xray
Simple cysts
Radiopaque
Negative charge
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

36. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
RTA type 1 (distal)
Cx<GFR
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
RPF/(1- Hct)

37. What effect does efferent arteriole cxn have on RPF - GFR and FF
Na and volume loss
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
Dec - inc - inc
Crescent - moon shape

38. Why does Na conc nearly match Osm
Cx>GFR
Na reabsorption drives H20 reabsorption
Eosinphilic casts in tubules
Nonspecific

39. Which cells sense decreases in BP
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
JG cells
Cx>GFR
Eosinphilic casts in tubules

40. What is hartnup's disease
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Cx = GFR

41. What can cause oxalate crystals
Failure of EPO
Inulin
Crescent - moon shape
Antifreeze - ethyelene glycol or vit C abuse

42. What is the genetic etiology of wilms tumor and What is WAGR complex
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Advanced renal dz - CRF
Renal artery - interlobar a - interlobular a
Liver

43. What is lost in nephrotic syndrome resulting what urine and serum changes
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Filtered - secreted
PH = pKa + log bicarb/0.03PCO2

44. What effect does ANP have on GFR
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Inc
UTI or acute gastroenteritis
Macula densa and JG cells

45. What is the 3rd most common kidney stone and What causes it
Diuretics - vomiting - antacid - hyperaldosteronism
Involves only glomeruli
Inc renal bicarb resabsoprtion - delayed
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia

46. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Na and volume loss
Vasa recta - interlobular v - interlobar v - renal v
Medullary cystic disease
Complications of chronic kidney disease or HTN

47. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
60% total body water - 40% ICF - 20% ECF
Wilms tumor (ages 2-4)
Diarrhea - glue - RTA - hyperchloremia
All glomeruli

48. What effect does inc plasma protein concentration have on RPF - GFR - and FF
NC - dec - dec
Eosinphilic casts in tubules
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Inc in Ca and PO4 absoprtion from the gut

49. Congo - red stain - apple green birefringence
Proximal tubule - na/glucose co transporter
Inhibits Na/phosphate cotransport leading to phosphate excretion
Amyloidosis
GFR x plasma concentration

50. hyaline casts ddx
Nonspecific
Filtered - secreted
Macula densa
Diarrhea - glue - RTA - hyperchloremia

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Renal

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