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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 are the associations with RTA type 1
Acute - ATN - or chronic - HTN - DM
Inc GFR and mesangial expansion
Becomes concentrated and hypertonic
Hypokalemia - risk for Ca containing kidney stones
2. Defect in proximal tubule HCO3 reabsorption
Metabolic acidosis
RTA type 2 (proximal)
Renal tubular cells - polygonal clear cells
Huge palpable flank mass and hematuria
3. What are the main complications of kidney stones
Hydronephrosis and pyelonephritis
Size
All glomeruli
Inc plasma osm - dec blood volume
4. When is TF/P = 1
Vasocxn - inc BP
Complications of chronic kidney disease or HTN
Solute and water are reabsorbed at the same rate
Transitional cell carcinoma
5. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Medullary cystic disease
Involves only glomeruli
Intra = HIKIN!
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
6. What is the compensatory response in respiratory alkalosis
It has a longer renal vein
Dec renal bicarb reabsorption - delayed
Size
Acute renal failure
7. How do struvite stones appear on xray
Radiopaque
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Staghorn calculi - worsened by alkaluria
Thromboembolism and inc risk of infection
8. What are JG cells and what substance do they secrete
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Na reabsorption drives H20 reabsorption
Modified smooth muscle of afferent arteriole - secrete renin
Reabsorb Na in exchange for secreting K and H
9. What substance is secreted in response increase atrial pressure
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
ANP
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
10. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Reabsorb Na in exchange for secreting K and H
Negative charge
Size and charge
Chronic conditions - multiple myeloma - TB - RA
11. In renal failure - what happens to potassium
Hyperkalemia
Thromboembolism and inc risk of infection
Segmental sclerosis and hylanosis
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
12. What are the associations with RTA type 2
Makes urine less concentrated - impermeable to H20
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Hypokalemia and hypophosphatemic rickets
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
13. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Dec - dec - dec
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
NC - dec - dec
14. What are the associations with RTA type 4
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
ADPKD
15. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Small kidney - poor prognosis
16. What is the purpose of the JGA
UTI or acute gastroenteritis
Invades IVC and spreads hematogenously
Hypovent - immediate
To defend GFR
17. Why is there anemia in renal failure
Inhibits Na/phosphate cotransport leading to phosphate excretion
60% total body water - 40% ICF - 20% ECF
Failure of EPO
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
18. What 3 things stimulate the release of renin - and Where is it released from
Size and charge
HIV
Vasa recta - interlobular v - interlobar v - renal v
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
19. coarse - asymmetric - corticomedullary scarring and blunted calyx
Radiolabelled albumin
Dec - inc - inc
Chronic pyelonephritis
Dialysis cysts
20. What is the effect of aldosterone in principal cells
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Nephritic syndrome
No
NC - dec - dec
21. What are the two forms of renal failure and What are examples of each
Solute and water are reabsorbed at the same rate
Inc - dec - dec
Acute - ATN - or chronic - HTN - DM
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
22. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Dec - inc - dec
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
<3.5 g /day
V x Urine concentration
23. In renal failure What are the consquence sof Na/H20 retention
CHF - pulmonary edema - HTN
Filtered - secreted
Thickening of glomerular BM
Metabolic acidosis
24. What is the effect of of PTH on the distal convoluted tubule
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Inc Ca/Na exchange to inc Ca reabsoprtion
Filtered - secreted
25. The fenestrated capillary endothelium constitutes what portion of the barrier
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Size
Hyperceullular glomeruli
26. Congo - red stain - apple green birefringence
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Amyloidosis
No
Cx>GFR
27. What is winter's formula and when do you use it
Under and under
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Rxn from angiotensinogen to angiontensin I
28. 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
Small kidney - poor prognosis
Metabolic acidosis
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
29. What is the effect of PTH on the proximal tubule
Men 50 to 70 - inc incidence with smoking and obesity
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Cx<GFR
Inhibits Na/phosphate cotransport leading to phosphate excretion
30. What is the net effect of AT II
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
No
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Nonspecific
31. Why does Na conc nearly match Osm
1/4 plasma - and 3/4 interstitial volume
RTA type 1 (distal)
Na reabsorption drives H20 reabsorption
Radiopaque
32. How do calcium stones appear on x ray
Hypovent - immediate
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Anion gap = na - (Cl + bicarb)
Radiopaque
33. What does aldosterone do in the collecting tubule
Inhibits Na/phosphate cotransport leading to phosphate excretion
Involves glomeruli and other organs
Insertion of Na channel on luminal side
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
34. What are the 3 transporters of the intercalated cells
Modified smooth muscle of afferent arteriole - secrete renin
Dec - inc - inc
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Thromboembolism and inc risk of infection
35. Why is the left kidney taken during living donor transplantation
It has a longer renal vein
Filtered - secreted
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
36. What is the net effect of ANP
Radiopaque
Dialysis cysts
Dec - dec - dec
Na and volume loss
37. diffuse
Advanced renal dz - CRF
Na
White cell casts
All glomeruli
38. What does NEG lead to in the efferent arterioles
Metabolic acidosis
Chronic conditions - multiple myeloma - TB - RA
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Inc GFR and mesangial expansion
39. Which cells sense decreases in Na delivery
Macula densa
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Anion gap = na - (Cl + bicarb)
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
40. What is amyloidosis associated with
Chronic conditions - multiple myeloma - TB - RA
Crescent - moon shape
Invades IVC and spreads hematogenously
PH - then PC02
41. Under what circumstances is aldosterone secreted
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Involves only glomeruli
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Diabetic glomerulonephropathy
42. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Dec - inc - inc
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Excreted - filtered
Hydronephrosis and pyelonephritis
43. net tubular secretion of x
Acute pyelonephritis
Cx>GFR
Dec - inc - dec
Hypokalemia and hypophosphatemic rickets
44. What is the henderson hasselbalch equation
PH = pKa + log bicarb/0.03PCO2
UTI or acute gastroenteritis
Advanced renal dz - CRF
Na reabsorption drives H20 reabsorption
45. hypoaldosteronism or lack of collecting tubule response to aldosteron
RTA type 4 (hyperkalemic)
V x Urine concentration
Inc renal bicarb resabsoprtion - delayed
1alpha hydroxylase - PTH stimulates it
46. What happens in the thin descending loop of henle
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
20 percent
Anion gap = na - (Cl + bicarb)
Passively reabsorbs water via medullary hypertonicity
47. What is the genetic etiology of wilms tumor and What is WAGR complex
Diabetic glomerulonephropathy
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Inc Ca/Na exchange to inc Ca reabsoprtion
48. in acute cystitis with pyuria - do you see casts
To defend GFR
Radiopaque
No
Hypervent - immediate
49. WBC casts - ddx
ANP
Hyperceullular glomeruli
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Chronic pyelonephritis
50. how does this present in adults and What is the pattern of inheritence
Vasa recta - interlobular v - interlobar v - renal v
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
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