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Test your basic knowledge |
Renal
Start Test
Study First
Subject
:
health-sciences
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
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 effect does afferent arteriole cxn have on RPF - GFR and FF
Dec - dec - NC
Ectopic EPO - ACTH - PTHrP - prolactin
RTA type 4 (hyperkalemic)
Failure of EPO
2. What is the effect of PTH on the proximal tubule
Macula densa
White cell casts
Inhibits Na/phosphate cotransport leading to phosphate excretion
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
3. What 3 disease can lead to RPGN
All glomeruli
Medullary cystic disease
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Reabsorb Na in exchange for secreting K and H
4. What are the two forms of renal failure and What are examples of each
Poor - days to weeks
Complications of chronic kidney disease or HTN
160-200 - 350
Acute - ATN - or chronic - HTN - DM
5. What is the ddx for a metabolic acidosis with an inc anion gap
Vasocxn - inc BP
Cx>GFR
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
6. What is generated and secreted in the proximal tubule
Huge palpable flank mass and hematuria
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Ammonia - buffer for secreted H+
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
7. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Staghorn calculi - worsened by alkaluria
Podocytes foot processes
ADPKD
Diuretics - vomiting - antacid - hyperaldosteronism
8. What is the algorithim for acidosis/alkalosis
Eosinphilic casts in tubules
HIV
PH - then PC02
Size and charge
9. When is glucose reabsorbed and with What transporter
Needs to be bilateral
Advanced renal dz - CRF
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Proximal tubule - na/glucose co transporter
10. What happens to tubular inulin along the proximal tubule and why
NC - dec - dec
Inc in concentration - not amout - due to water reabsorption
PH - then PC02
Inc Ca/Na exchange to inc Ca reabsoprtion
11. When is TF/P <1
Vasa recta - interlobular v - interlobar v - renal v
Solute is reabsorbed more quickly than water
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Amyloidosis
12. What needs to happen for postrenal obstruction to creat ARF
Eosinphilic casts in tubules
EPO - endothelial cells of peritubular capillaries
Invades IVC and spreads hematogenously
Needs to be bilateral
13. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
20 percent
Size and charge
Inc - dec - dec
Simple cysts
14. What happens to the urine in the descending limb
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Poor - days to weeks
Becomes concentrated and hypertonic
Size
15. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Involves only glomeruli
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
1alpha hydroxylase - PTH stimulates it
16. When is TF/P = 1
Solute and water are reabsorbed at the same rate
Acute pyelonephritis
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Dec - dec - dec
17. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Medullary cystic disease
Dec - inc - dec
Hypovent - immediate
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
18. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Thromboembolism and inc risk of infection
Cx = GFR
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Makes urine less concentrated - impermeable to H20
19. What do you see on LM for focal segmental glomerulosclerosis
Segmental sclerosis and hylanosis
Vasa recta - interlobular v - interlobar v - renal v
Inc - dec - dec
Triglycerides
20. How is plasma volume measured
Renal artery - interlobar a - interlobular a
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Radiolabelled albumin
Vasocxn - inc BP
21. coarse - asymmetric - corticomedullary scarring and blunted calyx
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Chronic pyelonephritis
Diuretics - vomiting - antacid - hyperaldosteronism
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
22. secondary glomerular dz
Involves glomeruli and other organs
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Membranoproliferative glomerulonephritis
Podocytes foot processes
23. proliferative
Hyperceullular glomeruli
JG cells
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Bladder cancer
24. What 3 things stimulate the release of renin - and Where is it released from
Solute is reabsorbed less quickly than water or net secretion of substance
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Renal tubular cells - polygonal clear cells
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
25. What does aldosterone do in the collecting tubule
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Staghorn calculi - worsened by alkaluria
Insertion of Na channel on luminal side
Solute is reabsorbed less quickly than water or net secretion of substance
26. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Membranoproliferative glomerulonephritis
Hypervent - early high altitude - aspirin ingestion early
Principal cells and intercalated cells
NKCC
27. What is the 3rd most common kidney stone and What causes it
Ammonia - buffer for secreted H+
Inc GFR and mesangial expansion
Renal in origin
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
28. What is the net effect of PTH
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Inc in Ca and PO4 absoprtion from the gut
Liver
Na and volume loss
29. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Phenacetin - smoking - aniline dyes - cyclophosphamide
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
GFR/RPF
30. How does RCC spread
RTA type 2 (proximal)
Invades IVC and spreads hematogenously
Growth retardation and developmental delay
Hypokalemia and hypophosphatemic rickets
31. What happens to pH - PCO2 and bicarb in metabolic acidosis
Dec - dec - dec
Cx>GFR
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Few glomeruli
32. What cells create the epithelial layer of the glomerular filtration barrier
Inc Ca/Na exchange to inc Ca reabsoprtion
Inc plasma osm - dec blood volume
Na and volume loss
Podocytes foot processes
33. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Men 50 to 70 - inc incidence with smoking and obesity
Amyloidosis
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
34. What is the net effect of ANP
Na and volume loss
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Vasocxn - inc BP
EPO - endothelial cells of peritubular capillaries
35. What does thyroidization of the kidney result in
Eosinphilic casts in tubules
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Hyperceullular glomeruli
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
36. Where is potassium conc. Highest? Intra or extra
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Growth retardation and developmental delay
Intra = HIKIN!
37. What does US show with medullary cystic disease
Becomes concentrated and hypertonic
Small kidney - poor prognosis
Staghorn calculi - worsened by alkaluria
Inhibits Na/phosphate cotransport leading to phosphate excretion
38. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Excreted - filtered
Liver
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
39. What does the crescent moon shape consist of in RPGN
160-200 - 350
Inc plasma osm - dec blood volume
Invades IVC and spreads hematogenously
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
40. What is the cutoff of proteinuria in nephritic syndrome
Vasocxn - inc BP
<3.5 g /day
Hyperkalemia
Dec - dec - NC
41. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Macula densa
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Involves only glomeruli
ADPKD
42. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
Wilms tumor (ages 2-4)
EPO - endothelial cells of peritubular capillaries
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
43. What dyslipidemia is most common in renal failure
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Triglycerides
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Modified smooth muscle of afferent arteriole - secrete renin
44. What are JG cells and what substance do they secrete
Negative charge
Contrict leading to inc FF - preserver renal GFR in low volume states
Makes urine less concentrated - impermeable to H20
Modified smooth muscle of afferent arteriole - secrete renin
45. What does renin do
Growth retardation and developmental delay
Carbonic anhydrase
Rxn from angiotensinogen to angiontensin I
Inc in concentration - not amout - due to water reabsorption
46. What is amyloidosis associated with
Hypovent - immediate
CHF - pulmonary edema - HTN
Chronic conditions - multiple myeloma - TB - RA
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
47. Why does Na conc nearly match Osm
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
RTA type 1 (distal)
Diarrhea - glue - RTA - hyperchloremia
Na reabsorption drives H20 reabsorption
48. What is the formula for reabsorption
Cx>GFR
Simple cysts
Filtered - secreted
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
49. diffuse
All glomeruli
Inhibits Na/phosphate cotransport leading to phosphate excretion
Freely filtered and neither absorbed or secreted
Under and under
50. primary glomerular dz
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Inc renal bicarb resabsoprtion - delayed
Involves only glomeruli