Test your basic knowledge |

Renal

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Answer 50 questions in 15 minutes.
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1. What does aldosterone do in the collecting tubule
Insertion of Na channel on luminal side
Crescent - moon shape
Dec renal bicarb reabsorption - delayed
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

2. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
Nephritic syndrome
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Segmental sclerosis and hylanosis

3. hypoaldosteronism or lack of collecting tubule response to aldosteron
RTA type 4 (hyperkalemic)
Advanced renal dz - CRF
Hypervent - immediate
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

4. What are the main causes of membranous GN
Hydronephrosis and pyelonephritis
Radiopaque
Metabolic acidosis
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

5. What is the least common kidney stone - What causes it and How do you treat it
Passively reabsorbs water via medullary hypertonicity
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Von hippel laundau and gene deletion in chromosome 3
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine

6. How What does the glomerular filtration barrier distinguish by
Solute is reabsorbed more quickly than water
Inc - inc - inc
Size and charge
RPF/(1- Hct)

7. What do casts indicated about hematuria/pyuria
Renal in origin
Invades IVC and spreads hematogenously
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Nephrotic syndrome

8. What dyslipidemia is most common in renal failure
Vasocxn - inc BP
Solute and water are reabsorbed at the same rate
Triglycerides
Involves only glomeruli

9. Where is angiotensinogen made
Chronic pyelonephritis
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Liver

10. What is the formula for reabsorption
Principal cells and intercalated cells
Radiolabelled albumin
Simple cysts
Filtered - secreted

11. dense deposits on EM - type and association
Freely filtered and neither absorbed or secreted
Inc
Hydronephrosis and pyelonephritis
Type II - C3 nephritic factor

12. What is the most common renal malignancy of early childhood
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Macula densa
Wilms tumor (ages 2-4)
Medullary cystic disease

13. What are the associations with RTA type 1
NKCC
Hypokalemia - risk for Ca containing kidney stones
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Kids - peripheral and periorbital edema - resolves spontaneously

14. What is the ddx for a respiratory alkalosis
Hypervent - early high altitude - aspirin ingestion early
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Size and charge
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

15. What does renin do
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Triglycerides
Rxn from angiotensinogen to angiontensin I
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

16. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
GFR/RPF
Triglycerides
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

17. What is the formula for filtration fraction
Crescent - moon shape
Dec renal bicarb reabsorption - delayed
Inc renal bicarb resabsoprtion - delayed
GFR/RPF

18. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
ANP
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
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

19. What is the formula for renal blood flow
RPF/(1- Hct)
ANP
Makes urine less concentrated - impermeable to H20
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

20. Why does Na conc nearly match Osm
Na reabsorption drives H20 reabsorption
Principal cells and intercalated cells
Cx = GFR
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular

21. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Diabetic glomerulonephropathy
Inc in Ca and PO4 absoprtion from the gut

22. What is the second most common kidney stone
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Hypokalemia and hypophosphatemic rickets
Staghorn calculi - worsened by alkaluria

23. In what clinical context does Berger's disease often present
UTI or acute gastroenteritis
No
Antifreeze - ethyelene glycol or vit C abuse
NC - dec - dec

24. What is the formula for secreted
Inc in concentration - not amout - due to water reabsorption
Dialysis cysts
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Excreted - filtered

25. What is the 3rd most common kidney stone and What causes it
Renal in origin
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Invades IVC and spreads hematogenously
Bladder cancer

26. net tubular secretion of x
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Freely filtered and neither absorbed or secreted
Beta 1
Cx>GFR

27. What are the effects of AT II on vascular smooth muscle
Vasocxn - inc BP
Cx>GFR
Amyloidosis
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

28. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
60% total body water - 40% ICF - 20% ECF
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Carbonic anhydrase

29. What are the associated paraneoplastic syndromes wth RCC
Actively reabsorbs NaCl - diluting - makes urine hypotonic
No
Dec - inc - inc
Ectopic EPO - ACTH - PTHrP - prolactin

30. How do calcium stones appear on x ray
Radiopaque
Carbonic anhydrase
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

31. In renal failure with uremia - What are the 5 aspects of uremia
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Inc - dec - dec
Amyloidosis
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

32. What 3 disease can lead to RPGN
Na
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
ANP
Diabetic glomerulonephropathy

33. What are the associations with RTA type 2
Inc - inc - inc
Angio I to angio II and inhibits bradykinin
Hypokalemia and hypophosphatemic rickets
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

34. proliferative
Hyperceullular glomeruli
Cx>GFR
Excreted - filtered
NC - dec - dec

35. What is the formula for clearance of a substance per unit time
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Failure of EPO
Actively reabsorbs NaCl - diluting - makes urine hypotonic

36. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
ADPKD
Renal artery - interlobar a - interlobular a
Staghorn calculi - worsened by alkaluria
Hypokalemia - risk for Ca containing kidney stones

37. How are amino acids reabsorbed
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Hypokalemia - risk for Ca containing kidney stones
1alpha hydroxylase - PTH stimulates it
GFR/RPF

38. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
ADPKD
Cx<GFR
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

39. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Inc
Nephritic syndrome
NC - inc - inc
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

40. What effect does cxn of the ureter have on RPF - GFR and FF
NC - dec - dec
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
RTA type 4 (hyperkalemic)
Intra = HIKIN!

41. In renal failure What are the consquence sof Na/H20 retention
Filtered - secreted
All glomeruli
CHF - pulmonary edema - HTN
Size

42. What effect does inc plasma protein concentration have on RPF - GFR - and FF
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Stimulates thirst
NC - dec - dec
Inc plasma osm - dec blood volume

43. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Passively reabsorbs water via medullary hypertonicity
Diarrhea - glue - RTA - hyperchloremia
Inc GFR and mesangial expansion
Transitional cell carcinoma

44. What effect does afferent arteriole cxn have on RPF - GFR and FF
NC - inc - inc
Men 50 to 70 - inc incidence with smoking and obesity
Dec - dec - NC
Growth retardation and developmental delay

45. Where is potassium conc. Highest? Intra or extra
Intra = HIKIN!
Involves only glomeruli
Ectopic EPO - ACTH - PTHrP - prolactin
JG cells

46. What is the compensatory response in metabolic acidosis
Hypervent - immediate
Proximal tubule - na/glucose co transporter
UTI or acute gastroenteritis
Crescent - moon shape

47. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Beta 1
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Inc GFR and mesangial expansion
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

48. What are the LM and EM of minimal change disease
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Inc - dec - dec
Most of the bicarb - sodium - chloride - and water
LM - nl glomeruli - EM - foot process effacement

49. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Inc - dec - dec
EPO - endothelial cells of peritubular capillaries
Angio I to angio II and inhibits bradykinin

50. Where is ACE made and What are 2 of its fxns
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Angio I to angio II and inhibits bradykinin
Renal in origin
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

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Renal

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