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Renal

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1. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Negative charge
Inc GFR and mesangial expansion
Eosinphilic casts in tubules
Liver

2. What is the effect of AT II on GFR - FF and Na
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Involves only glomeruli

3. What is ADPKD also associated with
NC - dec - dec
Stimulates thirst
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Polycystic liver disease - berry aneurysms - mitral valve prolapse

4. In what disease in FSGS the most common glomerular disease
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
HIV
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Solute is reabsorbed less quickly than water or net secretion of substance

5. What are the associations with nephrotic syndrome
JG cells
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Thromboembolism and inc risk of infection

6. When is TF/P <1
Membranoproliferative glomerulonephritis
Renal artery - interlobar a - interlobular a
Solute is reabsorbed more quickly than water
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

7. What is hartnup's disease
60% total body water - 40% ICF - 20% ECF
Amyloidosis
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Complications of chronic kidney disease or HTN

8. What is the compensatory response in metabolic acidosis
Hypervent - immediate
Actively reabsorbs NaCl - diluting - makes urine hypotonic
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
ANP

9. Why is the left kidney taken during living donor transplantation
It has a longer renal vein
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Reabsorb Na in exchange for secreting K and H
Most of the bicarb - sodium - chloride - and water

10. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Inc - dec - dec
Corticosteroids

11. When is TF/P ratio > 1
Solute is reabsorbed less quickly than water or net secretion of substance
Radiopaque
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Na and volume loss

12. What is the genetic etiology of wilms tumor and What is WAGR complex
Growth retardation and developmental delay
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Complications of chronic kidney disease or HTN
Failure of EPO

13. What is the ddx for respiratory acidosis
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Eosinphilic casts in tubules
Membranoproliferative glomerulonephritis
1/4 plasma - and 3/4 interstitial volume

14. what happens to pH - PCO2 - and bicarb in respiratory acidosis
It has a longer renal vein
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Membranoproliferative glomerulonephritis
Dec - inc - dec

15. What cells create the epithelial layer of the glomerular filtration barrier
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Podocytes foot processes
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss

16. What is the compensatory response in metabolic alkalosis
Hypovent - immediate
NKCC
Hypervent - immediate
Inc - dec - dec

17. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Size
Inc - inc - inc
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Advanced renal dz - CRF

18. What is the net effect of PTH
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Crescent - moon shape
Stimulates thirst
Inc in Ca and PO4 absoprtion from the gut

19. no net secretion or reabsorption of x
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Becomes concentrated and hypertonic
Cx = GFR

20. What does US show with medullary cystic disease
Stimulates thirst
All glomeruli
Small kidney - poor prognosis
Solute is reabsorbed less quickly than water or net secretion of substance

21. net tubular reabsorption of x
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Acute pyelonephritis
Inulin
Cx<GFR

22. in acute post strep GN - What do you see on LM - EM and IF

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23. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Inc plasma osm - dec blood volume
Chronic conditions - multiple myeloma - TB - RA
Diarrhea - glue - RTA - hyperchloremia
Acute pyelonephritis

24. hypoaldosteronism or lack of collecting tubule response to aldosteron
Diarrhea - glue - RTA - hyperchloremia
Hypokalemia and hypophosphatemic rickets
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
RTA type 4 (hyperkalemic)

25. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Liver
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Radiolabelled albumin

26. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Complications of chronic kidney disease or HTN
Intra = HIKIN!
Most of the bicarb - sodium - chloride - and water
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption

27. waxy casts ddx
Advanced renal dz - CRF
Freely filtered and neither absorbed or secreted
Hypovent - immediate
Failure of EPO

28. How do the ureters course in relation to the uterine artery and ductus deferens
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Under and under
Anion gap = na - (Cl + bicarb)
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

29. What is the henderson hasselbalch equation
2 ways - base exchanger and between epithelial cells
Involves only glomeruli
PH = pKa + log bicarb/0.03PCO2
UTI or acute gastroenteritis

30. What is amyloidosis associated with
Chronic conditions - multiple myeloma - TB - RA
ANP
Acute tubular necrosis
Actively reabsorbs NaCl - diluting - makes urine hypotonic

31. When is glucose reabsorbed and with What transporter
Proximal tubule - na/glucose co transporter
NC - inc - inc
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

32. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
V x Urine concentration
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

33. granular - muddy brown casts - ddx
Solute and water are reabsorbed at the same rate
Segmental sclerosis and hylanosis
White cell casts
Acute tubular necrosis

34. How is extracellular volume measured
Inulin
Segmental sclerosis and hylanosis
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Diarrhea - glue - RTA - hyperchloremia

35. nonenzymatic glycosylation of GBM - inc permeability and thickening
Size and charge
Diabetic glomerulonephropathy
Vasocxn - inc BP
Macula densa

36. What are the associations with RTA type 1
Hypokalemia - risk for Ca containing kidney stones
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Size and charge
Inc renal bicarb resabsoprtion - delayed

37. What circumstances causes ADH secretion
Inc plasma osm - dec blood volume
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
ANP
Kids - peripheral and periorbital edema - resolves spontaneously

38. hyaline casts ddx
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Inulin
Solute is reabsorbed less quickly than water or net secretion of substance
Nonspecific

39. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Carbonic anhydrase
Size
Excreted - filtered
NKCC

40. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Insertion of Na channel on luminal side
Chronic pyelonephritis
Stimulates thirst
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

41. What is the LM for diabetic glomerulonephropathy
GFR/RPF
Staghorn calculi - worsened by alkaluria
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Stimulates thirst

42. What is the ddx for a metabolic acidosis with an inc anion gap
Inc Ca/Na exchange to inc Ca reabsoprtion
Von hippel laundau and gene deletion in chromosome 3
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

43. What effect does ANP have on Na in the kidney
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Inhibits Na/phosphate cotransport leading to phosphate excretion
Filtered - secreted
Type II - C3 nephritic factor

44. What is the compensatory response in respiratory acidosis
Triglycerides
PH - then PC02
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Inc renal bicarb resabsoprtion - delayed

45. In what clinical context does Berger's disease often present
Freely filtered and neither absorbed or secreted
NC - dec - dec
GFR/RPF
UTI or acute gastroenteritis

46. What does the crescent moon shape consist of in RPGN
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Na and volume loss
Under and under
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

47. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Na
EPO - endothelial cells of peritubular capillaries
Carbonic anhydrase

48. What is the BUN/Cr ratio in prerenal azotemia and why?
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Inc - inc - inc
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Involves only glomeruli

49. What effect does ANP have on GFR
Acute pyelonephritis
Macula densa and JG cells
Antifreeze - ethyelene glycol or vit C abuse
Inc

50. Where does renal cell carcinoma originate and What do the cells look like
Segmental sclerosis and hylanosis
Von hippel laundau and gene deletion in chromosome 3
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Renal tubular cells - polygonal clear cells

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Renal

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