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Renal

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Answer 50 questions in 15 minutes.
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1. Why is the left kidney taken during living donor transplantation
It has a longer renal vein
Carbonic anhydrase
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

2. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
RTA type 1 (distal)
EPO - endothelial cells of peritubular capillaries
Renal artery - interlobar a - interlobular a
Solute is reabsorbed less quickly than water or net secretion of substance

3. What is the formula for clearance of a substance per unit time
Modified smooth muscle of afferent arteriole - secrete renin
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
ANP

4. What is the most common renal malignancy of early childhood
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Men 50 to 70 - inc incidence with smoking and obesity
Corticosteroids
Wilms tumor (ages 2-4)

5. What does aldosterone do in the collecting tubule
Stimulates thirst
Insertion of Na channel on luminal side
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Radiolabelled albumin

6. How does RCC spread
Macula densa
Invades IVC and spreads hematogenously
Huge palpable flank mass and hematuria
EPO - endothelial cells of peritubular capillaries

7. How do the ureters course in relation to the uterine artery and ductus deferens
Nephritic syndrome
Under and under
Triglycerides
Makes urine less concentrated - impermeable to H20

8. What is the net effect of ANP
Simple cysts
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Na and volume loss
Chronic pyelonephritis

9. What are the 3 transporters of the intercalated cells
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Complications of chronic kidney disease or HTN

10. What does LM - EM - IF show in diffuse proliferative GN
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Rxn from angiotensinogen to angiontensin I
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

11. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Nephritic syndrome
Complications of chronic kidney disease or HTN
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

12. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Passively reabsorbs water via medullary hypertonicity
Bladder cancer
Corticosteroids
Staghorn calculi - worsened by alkaluria

13. What is the formula for excretion rate
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Membranoproliferative glomerulonephritis
V x Urine concentration

14. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Hypokalemia - risk for Ca containing kidney stones
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Metabolic acidosis
Nonspecific

15. What does ADH do in the collecting tubule
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Inc - dec - dec
Transitional cell carcinoma

16. What does NEG lead to in the efferent arterioles
Hyperceullular glomeruli
Cx>GFR
Inc GFR and mesangial expansion
GFR x plasma concentration

17. What happens in the thin descending loop of henle
Staghorn calculi - worsened by alkaluria
Diuretics - vomiting - antacid - hyperaldosteronism
Passively reabsorbs water via medullary hypertonicity
Anion gap = na - (Cl + bicarb)

18. What are the associations with RTA type 2
Cx>GFR
Hypervent - immediate
Hypokalemia and hypophosphatemic rickets
Metabolic acidosis

19. What therapy does miminal change respond to...
Renal tubular cells - polygonal clear cells
<3.5 g /day
Corticosteroids
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

20. What is the LM for diabetic glomerulonephropathy
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Failure of EPO

21. What is the henderson hasselbalch equation
PH = pKa + log bicarb/0.03PCO2
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Failure of EPO
RTA type 2 (proximal)

22. What circumstances causes ADH secretion
Inc plasma osm - dec blood volume
Membranoproliferative glomerulonephritis
Intra = HIKIN!
Ammonia - buffer for secreted H+

23. in TCC - What does painelss hematuria suggest
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Bladder cancer
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Hyperkalemia

24. What is the 3rd most common kidney stone and What causes it
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Hypervent - early high altitude - aspirin ingestion early
Negative charge
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia

25. How What does the glomerular filtration barrier distinguish by
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Size and charge
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Diarrhea - glue - RTA - hyperchloremia

26. diffuse
Ammonia - buffer for secreted H+
Growth retardation and developmental delay
Segmental sclerosis and hylanosis
All glomeruli

27. tram track appearance on EM - typ - path - and associated dz
Nephrotic syndrome
NKCC
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
RTA type 2 (proximal)

28. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Inc
1alpha hydroxylase - PTH stimulates it
Hyperceullular glomeruli
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

29. What is the 60-40-20 rule of body weight
Dec - dec - NC
60% total body water - 40% ICF - 20% ECF
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Needs to be bilateral

30. waxy casts ddx
Eosinphilic casts in tubules
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Needs to be bilateral
Advanced renal dz - CRF

31. When is TF/P = 1
Poor - days to weeks
Modified smooth muscle of afferent arteriole - secrete renin
60% total body water - 40% ICF - 20% ECF
Solute and water are reabsorbed at the same rate

32. 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
Angio I to angio II and inhibits bradykinin
Reabsorb Na in exchange for secreting K and H
GFR x plasma concentration

33. cortical and medullary cysts resulting from long standing dialysis
Dialysis cysts
Complications of chronic kidney disease or HTN
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

34. What is renal osteodystrophy
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
CHF - pulmonary edema - HTN
Hypovent - immediate
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

35. What effect does cxn of the ureter have on RPF - GFR and FF
Acute pyelonephritis
Inc - inc - inc
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
NC - dec - dec

36. How are amino acids reabsorbed
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Type II - C3 nephritic factor
PH - then PC02
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular

37. What is the effect of aldosterone in principal cells
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Dec renal bicarb reabsorption - delayed
Dec - inc - dec

38. What 3 disease can lead to RPGN
1alpha hydroxylase - PTH stimulates it
Triglycerides
Hypokalemia - risk for Ca containing kidney stones
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

39. What change (lack of) is common in children with renal failure
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Growth retardation and developmental delay
Proximal tubule - na/glucose co transporter
Rxn from angiotensinogen to angiontensin I

40. What do you see on LM for focal segmental glomerulosclerosis
Thickening of glomerular BM
Segmental sclerosis and hylanosis
Poor - days to weeks
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

41. What is the second most common kidney stone
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

42. What cells create the epithelial layer of the glomerular filtration barrier
Cx>GFR
Podocytes foot processes
Diarrhea - glue - RTA - hyperchloremia
Cx = GFR

43. With what genetic tumor syndrome is RCC associated
Von hippel laundau and gene deletion in chromosome 3
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

44. hypoaldosteronism or lack of collecting tubule response to aldosteron
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Involves glomeruli and other organs
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
RTA type 4 (hyperkalemic)

45. What is the compensatory response in respiratory alkalosis
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Dec - dec - NC
CHF - pulmonary edema - HTN
Dec renal bicarb reabsorption - delayed

46. What 3 things stimulate the release of renin - and Where is it released from
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Diarrhea - glue - RTA - hyperchloremia
Hyperkalemia

47. In renal failure - what happens to potassium
Hyperkalemia
RTA type 2 (proximal)
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

48. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Crescent - moon shape
ADPKD
Acute - ATN - or chronic - HTN - DM
NC - inc - inc

49. What are the two kinds of cells in the collecting tubules
Metabolic acidosis
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Principal cells and intercalated cells

50. What does the crescent moon shape consist of in RPGN
Anion gap = na - (Cl + bicarb)
Dec - inc - inc
Nephrotic syndrome
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS

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Renal

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