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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 ddx for respiratory acidosis
Segmental sclerosis and hylanosis
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Involves glomeruli and other organs

2. coarse - asymmetric - corticomedullary scarring and blunted calyx
Intra = HIKIN!
Chronic pyelonephritis
Eosinphilic casts in tubules
White cell casts

3. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
160-200 - 350
Hypervent - immediate
LM - nl glomeruli - EM - foot process effacement
Chronic pyelonephritis

4. By what percentage does EPRF underestimage true RPF
By 10%
Staghorn calculi - worsened by alkaluria
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
20 percent

5. What is the formula for clearance of a substance per unit time
Inc in Ca and PO4 absoprtion from the gut
Wilms tumor (ages 2-4)
Reabsorb Na in exchange for secreting K and H
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

6. How do the ureters course in relation to the uterine artery and ductus deferens
Under and under
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Huge palpable flank mass and hematuria
Membranoproliferative glomerulonephritis

7. What is hartnup's disease
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Renal artery - interlobar a - interlobular a
No
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

8. What is renal osteodystrophy
Small kidney - poor prognosis
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Hydronephrosis and pyelonephritis
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

9. Bergers' disease - which antibody and What do you see on LM and IF
Involves only glomeruli
Nephrotic syndrome
Vasa recta - interlobular v - interlobar v - renal v
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

10. What is the effect of AT II on efferent arterioles
Contrict leading to inc FF - preserver renal GFR in low volume states
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
UTI or acute gastroenteritis
Von hippel laundau and gene deletion in chromosome 3

11. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Carbonic anhydrase
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff

12. What is the pathway from the efferent arteriorle to the renal v
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Vasa recta - interlobular v - interlobar v - renal v
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

13. What are the LM and EM of minimal change disease
Acts on V2 receptors leading to insertion of aquaporins on luminal side
LM - nl glomeruli - EM - foot process effacement
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Eosinphilic casts in tubules

14. TCC is associated with problems in your Pee SAC - ??
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Phenacetin - smoking - aniline dyes - cyclophosphamide

15. What can cause oxalate crystals
Inulin
Antifreeze - ethyelene glycol or vit C abuse
Intra = HIKIN!
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure

16. Under what circumstances is aldosterone secreted
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Insertion of Na channel on luminal side
Dec - dec - dec
Diuretics - vomiting - antacid - hyperaldosteronism

17. What are the associations with RTA type 4
Reabsorb Na in exchange for secreting K and H
Na
Diuretics - vomiting - antacid - hyperaldosteronism
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity

18. How do you interpret creatinine clearance
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Corticosteroids
Hypervent - immediate
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

19. What does the crescent moon shape consist of in RPGN
Acute pyelonephritis
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
2 ways - base exchanger and between epithelial cells

20. When is TF/P = 1
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Na and volume loss
Solute and water are reabsorbed at the same rate
1/4 plasma - and 3/4 interstitial volume

21. What do casts indicated about hematuria/pyuria
Reabsorb Na in exchange for secreting K and H
Inc in Ca and PO4 absoprtion from the gut
Triglycerides
Renal in origin

22. What is the 60-40-20 rule of body weight
Proximal tubule - na/glucose co transporter
60% total body water - 40% ICF - 20% ECF
Acute - ATN - or chronic - HTN - DM
1/4 plasma - and 3/4 interstitial volume

23. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Na reabsorption drives H20 reabsorption
Nephritic syndrome
HIV
Carbonic anhydrase

24. acute generalized cortical infarction of both kidneys - dz - causes and associations
Metabolic acidosis
Acute pyelonephritis
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
By 10%

25. What are the two kinds of cells in the collecting tubules
GFR x plasma concentration
Solute and water are reabsorbed at the same rate
Principal cells and intercalated cells
Hypervent - early high altitude - aspirin ingestion early

26. Why does Na conc nearly match Osm
Triglycerides
Na reabsorption drives H20 reabsorption
Wilms tumor (ages 2-4)
HIV

27. What do you see on LM and IF with rapidly progressive GN
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Inc plasma osm - dec blood volume
Crescent - moon shape

28. hyaline casts ddx
Nonspecific
<3.5 g /day
Inc Ca/Na exchange to inc Ca reabsoprtion
Renal tubular cells - polygonal clear cells

29. What are the effects of PTH hormone on the kidney
Staghorn calculi - worsened by alkaluria
All 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
Growth retardation and developmental delay

30. What is the compensatory response in metabolic acidosis
Hypervent - immediate
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Negative charge
Dec - inc - dec

31. in TCC - What does painelss hematuria suggest
RTA type 1 (distal)
Renal artery - interlobar a - interlobular a
Bladder cancer
Staghorn calculi - worsened by alkaluria

32. cortical and medullary cysts resulting from long standing dialysis
Dialysis cysts
Podocytes foot processes
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Hypervent - early high altitude - aspirin ingestion early

33. When is TF/P ratio > 1
Carbonic anhydrase
Solute is reabsorbed less quickly than water or net secretion of substance
Size
RTA type 1 (distal)

34. What does US show with medullary cystic disease
Dec - inc - inc
Crescent - moon shape
Small kidney - poor prognosis
RTA type 4 (hyperkalemic)

35. What is the formula for reabsorption
Needs to be bilateral
Solute is reabsorbed less quickly than water or net secretion of substance
Filtered - secreted
Poor - days to weeks

36. What is the net effect of ANP
Angio I to angio II and inhibits bradykinin
Inc Ca/Na exchange to inc Ca reabsoprtion
Na and volume loss
Diarrhea - glue - RTA - hyperchloremia

37. What is winter's formula and when do you use it
Invades IVC and spreads hematogenously
All glomeruli
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Medullary cystic disease

38. What substance is secreted in response increase atrial pressure
Failure of EPO
ANP
Macula densa and JG cells
Complications of chronic kidney disease or HTN

39. What are the effects of AT II on the adrenal gland
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Nonspecific
RTA type 1 (distal)

40. What does renin do
To defend GFR
Rxn from angiotensinogen to angiontensin I
Segmental sclerosis and hylanosis
It has a longer renal vein

41. do you see casts in bladder cancer - kidney stones with hematuria
Acute - ATN - or chronic - HTN - DM
1/4 plasma - and 3/4 interstitial volume
No
Kids - peripheral and periorbital edema - resolves spontaneously

42. What is the compensatory response in metabolic alkalosis
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Proximal tubule - na/glucose co transporter
Na
Hypovent - immediate

43. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Transitional cell carcinoma
Wilms tumor (ages 2-4)
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
1alpha hydroxylase - PTH stimulates it

44. What are the main causes of membranous GN
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Reabsorb Na in exchange for secreting K and H
Inc - inc - inc
Actively reabsorbs NaCl - diluting - makes urine hypotonic

45. What does ADH do in the collecting tubule
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Hypervent - early high altitude - aspirin ingestion early
Antifreeze - ethyelene glycol or vit C abuse
20 percent

46. tram track appearance on EM - typ - path - and associated dz
Eosinphilic casts in tubules
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
1/4 plasma - and 3/4 interstitial volume
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

47. What is the LM for diabetic glomerulonephropathy
Inc GFR and mesangial expansion
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
CHF - pulmonary edema - HTN
1/4 plasma - and 3/4 interstitial volume

48. In renal failure What are the consquence sof Na/H20 retention
Dec renal bicarb reabsorption - delayed
CHF - pulmonary edema - HTN
Advanced renal dz - CRF
Failure of EPO

49. What effect does cxn of the ureter have on RPF - GFR and FF
NC - dec - dec
Reabsorb Na in exchange for secreting K and H
Small kidney - poor prognosis
Freely filtered and neither absorbed or secreted

50. Defect in collecting ducts ability to excrete H+
RTA type 1 (distal)
Metabolic acidosis
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Involves only glomeruli