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Renal

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 is the LM for diabetic glomerulonephropathy
Nephrotic syndrome
Inc in concentration - not amout - due to water reabsorption
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
PH = pKa + log bicarb/0.03PCO2

2. Who commonly gets acute post strep GN
Hypervent - immediate
PH - then PC02
Kids - peripheral and periorbital edema - resolves spontaneously
Acute renal failure

3. How does RCC manifest clinically
Becomes concentrated and hypertonic
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Men 50 to 70 - inc incidence with smoking and obesity
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

4. What is the compensatory response in respiratory acidosis
1/4 plasma - and 3/4 interstitial volume
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Inc renal bicarb resabsoprtion - delayed
Dec renal bicarb reabsorption - delayed

5. In what clinical context does Berger's disease often present
Solute and water are reabsorbed at the same rate
UTI or acute gastroenteritis
Hyperkalemia
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

6. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
NKCC
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Hypervent - immediate
CHF - pulmonary edema - HTN

7. What is the compensatory response in metabolic acidosis
Inhibits Na/phosphate cotransport leading to phosphate excretion
Rxn from angiotensinogen to angiontensin I
Hypervent - immediate
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

8. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Kids - peripheral and periorbital edema - resolves spontaneously
Chronic conditions - multiple myeloma - TB - RA
Carbonic anhydrase
Corticosteroids

9. What happens to tubular inulin along the proximal tubule and why
Inc in concentration - not amout - due to water reabsorption
GFR/RPF
Bladder cancer
Complications of chronic kidney disease or HTN

10. What is the net effect of ANP
Na and volume loss
Inulin
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Hypervent - early high altitude - aspirin ingestion early

11. What happens in the collecting tubules
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Modified smooth muscle of afferent arteriole - secrete renin
Reabsorb Na in exchange for secreting K and H
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

12. What 3 disease can lead to RPGN
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Stimulates thirst
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Nonspecific

13. What is the henderson hasselbalch equation
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Von hippel laundau and gene deletion in chromosome 3
PH = pKa + log bicarb/0.03PCO2

14. membranous
Hypokalemia and hypophosphatemic rickets
Metabolic acidosis
Thickening of glomerular BM
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

15. What is the cutoff of proteinuria in nephritic syndrome
HIV
Freely filtered and neither absorbed or secreted
<3.5 g /day
Invades IVC and spreads hematogenously

16. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Acute pyelonephritis
Huge palpable flank mass and hematuria

17. What is the formula for the filtered load
GFR x plasma concentration
It has a longer renal vein
Hypervent - early high altitude - aspirin ingestion early
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

18. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Intra = HIKIN!
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

19. What does thyroidization of the kidney result in
Eosinphilic casts in tubules
Hypokalemia and hypophosphatemic rickets
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

20. Where does renal cell carcinoma originate and What do the cells look like
Renal tubular cells - polygonal clear cells
It has a longer renal vein
Intra = HIKIN!
Cx = GFR

21. How do calcium stones appear on x ray
JG cells
Macula densa and JG cells
Radiopaque
Renal artery - interlobar a - interlobular a

22. What are the main causes of membranous GN
Macula densa
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
LM - nl glomeruli - EM - foot process effacement
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

23. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Inc - dec - dec
Hyperkalemia
Complications of chronic kidney disease or HTN

24. How do you interpret creatinine clearance
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Anion gap = na - (Cl + bicarb)
GFR x plasma concentration
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

25. What does aldosterone do in the collecting tubule
Few glomeruli
Insertion of Na channel on luminal side
Stimulates thirst
Solute is reabsorbed less quickly than water or net secretion of substance

26. What effect does afferent arteriole cxn have on RPF - GFR and FF
It has a longer renal vein
Dec - dec - NC
ANP
Acute - ATN - or chronic - HTN - DM

27. Which cells sense decreases in BP
Acute tubular necrosis
JG cells
CHF - pulmonary edema - HTN
Membranoproliferative glomerulonephritis

28. What are the associations with nephrotic syndrome
Cx = GFR
Freely filtered and neither absorbed or secreted
Thromboembolism and inc risk of infection
Podocytes foot processes

29. Where is ACE made and What are 2 of its fxns
<3.5 g /day
Angio I to angio II and inhibits bradykinin
Inc in concentration - not amout - due to water reabsorption
Becomes concentrated and hypertonic

30. do you see casts in bladder cancer - kidney stones with hematuria
No
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Diabetic glomerulonephropathy
Stimulates thirst

31. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
Na and volume loss
Dec - dec - dec
RTA type 1 (distal)
Nephritic syndrome

32. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Beta 1
JG cells
Dec - inc - dec
160-200 - 350

33. What is ADPKD also associated with
RTA type 4 (hyperkalemic)
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

34. What is the effect of aldosterone in principal cells
Diabetic glomerulonephropathy
Proximal tubule - na/glucose co transporter
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Hyperkalemia

35. What is the formula for filtration fraction
GFR/RPF
Solute is reabsorbed more quickly than water
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Inc

36. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Men 50 to 70 - inc incidence with smoking and obesity
Invades IVC and spreads hematogenously
Solute is reabsorbed less quickly than water or net secretion of substance

37. By what percentage does EPRF underestimage true RPF
Proximal tubule - na/glucose co transporter
Most of the bicarb - sodium - chloride - and water
By 10%
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock

38. What happens in the thin descending loop of henle
Macula densa
Passively reabsorbs water via medullary hypertonicity
Failure of EPO
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

39. in TCC - What does painelss hematuria suggest
Angio I to angio II and inhibits bradykinin
Size and charge
By 10%
Bladder cancer

40. What are the effects of AT II on the adrenal gland
Thromboembolism and inc risk of infection
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Antifreeze - ethyelene glycol or vit C abuse
Transitional cell carcinoma

41. What two cells make up the JGA
Macula densa and JG cells
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
No
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

42. Where is potassium conc. Highest? Intra or extra
Na
Dec - dec - NC
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Intra = HIKIN!

43. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Type II - C3 nephritic factor
Beta 1
Dec renal bicarb reabsorption - delayed

44. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Radiopaque
Chronic pyelonephritis
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Inc - inc - inc

45. When is glucose reabsorbed and with What transporter
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Macula densa and JG cells
Proximal tubule - na/glucose co transporter
Diuretics - vomiting - antacid - hyperaldosteronism

46. How do the ureters course in relation to the uterine artery and ductus deferens
2 ways - base exchanger and between epithelial cells
Poor - days to weeks
Makes urine less concentrated - impermeable to H20
Under and under

47. When is TF/P = 1
Few glomeruli
Solute and water are reabsorbed at the same rate
Intra = HIKIN!
Failure of EPO

48. nonenzymatic glycosylation of GBM - inc permeability and thickening
Staghorn calculi - worsened by alkaluria
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Diabetic glomerulonephropathy
Growth retardation and developmental delay

49. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
White cell casts
Solute is reabsorbed less quickly than water or net secretion of substance

50. In who is RCC most comon
Inc in concentration - not amout - due to water reabsorption
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Men 50 to 70 - inc incidence with smoking and obesity
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular