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Renal

Instructions:

Answer 50 questions in 15 minutes.
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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 is the ddx for respiratory acidosis
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Amyloidosis
Vasa recta - interlobular v - interlobar v - renal v
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)

2. TCC is associated with problems in your Pee SAC - ??
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Anion gap = na - (Cl + bicarb)
Phenacetin - smoking - aniline dyes - cyclophosphamide
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss

3. What is renal osteodystrophy
LM - nl glomeruli - EM - foot process effacement
Vasa recta - interlobular v - interlobar v - renal v
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

4. Where does renal cell carcinoma originate and What do the cells look like
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
No
Renal tubular cells - polygonal clear cells

5. What are the two kinds of cells in the collecting tubules
Medullary cystic disease
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Principal cells and intercalated cells
Podocytes foot processes

6. What effect does inc plasma protein concentration have on RPF - GFR - and FF
Dec - dec - NC
NC - dec - dec
Principal cells and intercalated cells
Growth retardation and developmental delay

7. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Diarrhea - glue - RTA - hyperchloremia
1alpha hydroxylase - PTH stimulates it
Growth retardation and developmental delay
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

8. In who is RCC most comon
Complications of chronic kidney disease or HTN
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Men 50 to 70 - inc incidence with smoking and obesity
Dec - dec - NC

9. What is the least common kidney stone - What causes it and How do you treat it
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Dec renal bicarb reabsorption - delayed
Hypovent - immediate

10. What is the 3rd most common kidney stone and What causes it
RPF/(1- Hct)
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
60% total body water - 40% ICF - 20% ECF
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

11. What is the ddx for a metabolic acidosis with an inc anion gap
Ammonia - buffer for secreted H+
1/4 plasma - and 3/4 interstitial volume
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

12. Why does Na conc nearly match Osm
Na reabsorption drives H20 reabsorption
Thromboembolism and inc risk of infection
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Acute tubular necrosis

13. What effect does efferent arteriole cxn have on RPF - GFR and FF
Inc in Ca and PO4 absoprtion from the gut
ANP
Dec - inc - inc
Under and under

14. What is lost in nephrotic syndrome resulting what urine and serum changes
Hypovent - immediate
NC - inc - inc
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
CHF - pulmonary edema - HTN

15. In renal failure What acid - base disturbance is most likely
Acute renal failure
Metabolic acidosis
Transitional cell carcinoma
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

16. dense deposits on EM - type and association
Polycystic liver disease - berry aneurysms - mitral valve prolapse
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Segmental sclerosis and hylanosis
Type II - C3 nephritic factor

17. How do struvite stones appear on xray
Solute and water are reabsorbed at the same rate
Acute - ATN - or chronic - HTN - DM
Reabsorb Na in exchange for secreting K and H
Radiopaque

18. When is glucose reabsorbed and with What transporter
Excreted - filtered
Proximal tubule - na/glucose co transporter
Involves glomeruli and other organs
PH - then PC02

19. How does RCC manifest clinically
NKCC
Metabolic acidosis
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

20. What needs to happen for postrenal obstruction to creat ARF
Size
Solute is reabsorbed less quickly than water or net secretion of substance
Needs to be bilateral
2 ways - base exchanger and between epithelial cells

21. What is the compensatory response in respiratory acidosis
Inc renal bicarb resabsoprtion - delayed
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Stimulates thirst
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

22. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Staghorn calculi - worsened by alkaluria
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Acute renal failure

23. What can cause oxalate crystals
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Involves glomeruli and other organs
Antifreeze - ethyelene glycol or vit C abuse

24. Congo - red stain - apple green birefringence
Amyloidosis
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
NKCC
Na

25. What is the effect of PTH on the proximal tubule
Inhibits Na/phosphate cotransport leading to phosphate excretion
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Involves only glomeruli
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome

26. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Modified smooth muscle of afferent arteriole - secrete renin
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell

27. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
ANP
Beta 1
Passively reabsorbs water via medullary hypertonicity
Cx>GFR

28. inc in creatinine and BUN over a period of several days
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
Acute renal failure
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

29. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
ADPKD
Vasa recta - interlobular v - interlobar v - renal v
Advanced renal dz - CRF
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

30. What do macula densa cells sense
Na
UTI or acute gastroenteritis
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Vasocxn - inc BP

31. What effect does ANP have on GFR
Excreted - filtered
By 10%
Inc GFR and mesangial expansion
Inc

32. What do you see in the urine with acute pyelonephritis
White cell casts
RTA type 4 (hyperkalemic)
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
PH = pKa + log bicarb/0.03PCO2

33. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
Hyperceullular glomeruli
60% total body water - 40% ICF - 20% ECF
Nephritic syndrome
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

34. WBC casts - ddx
Inc
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
<3.5 g /day
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia

35. What happens in the early distal convoluted tubule and What does that do to the urine
Inhibits Na/phosphate cotransport leading to phosphate excretion
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Na
Actively reabsorbs NaCl - diluting - makes urine hypotonic

36. Bergers' disease - which antibody and What do you see on LM and IF
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
CHF - pulmonary edema - HTN
Antifreeze - ethyelene glycol or vit C abuse
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

37. Why is there anemia in renal failure
Crescent - moon shape
Hyperkalemia
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Failure of EPO

38. tram track appearance on EM - typ - path - and associated dz
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Acute tubular necrosis
Nephrotic syndrome

39. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
By 10%
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
GFR x plasma concentration

40. What are the associations with RTA type 2
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
60% total body water - 40% ICF - 20% ECF
Hypokalemia and hypophosphatemic rickets
CHF - pulmonary edema - HTN

41. What is the effect of AT II on the posterior pituitary
Thickening of glomerular BM
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
White cell casts
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

42. What do you see on LM for focal segmental glomerulosclerosis
Segmental sclerosis and hylanosis
Na and volume loss
RTA type 1 (distal)
NC - inc - inc

43. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Growth retardation and developmental delay
Medullary cystic disease
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
ANP

44. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Inc - dec - dec
NKCC
Passively reabsorbs water via medullary hypertonicity

45. What is the compensatory response in respiratory alkalosis
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
RTA type 4 (hyperkalemic)
Dialysis cysts
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
Negative charge
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
1alpha hydroxylase - PTH stimulates it

47. What happens to the urine in the descending limb
V x Urine concentration
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
Becomes concentrated and hypertonic
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts

48. how does this present in adults and What is the pattern of inheritence
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Inc renal bicarb resabsoprtion - delayed
Inc Ca/Na exchange to inc Ca reabsoprtion

49. What is the BUN/Cr ratio in instrinsic renal ARF and why
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
<3.5 g /day
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Anion gap = na - (Cl + bicarb)

50. How is plasma volume measured
Radiolabelled albumin
Involves only glomeruli
Excreted - filtered
No