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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 ADPKD also associated with
Rxn from angiotensinogen to angiontensin I
60% total body water - 40% ICF - 20% ECF
Polycystic liver disease - berry aneurysms - mitral valve prolapse
UTI or acute gastroenteritis

2. What is the ddx for a respiratory alkalosis
Inulin
Nephritic syndrome
Hypervent - early high altitude - aspirin ingestion early
Vasocxn - inc BP

3. What are the two kinds of cells in the collecting tubules
Thickening of glomerular BM
V x Urine concentration
Principal cells and intercalated cells
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

4. granular - muddy brown casts - ddx
Polycystic liver disease - berry aneurysms - mitral valve prolapse
All glomeruli
Acute tubular necrosis
Eosinphilic casts in tubules

5. net tubular secretion of x
To defend GFR
Cx>GFR
UTI or acute gastroenteritis
Ammonia - buffer for secreted H+

6. 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
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
HIV
Modified smooth muscle of afferent arteriole - secrete renin

7. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
RTA type 4 (hyperkalemic)
Inc - dec - dec
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Small kidney - poor prognosis

8. Where is angiotensinogen made
Diabetic glomerulonephropathy
<3.5 g /day
Liver
Chronic pyelonephritis

9. What is winter's formula and when do you use it
Hypervent - immediate
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Becomes concentrated and hypertonic
Triglycerides

10. What is the net effect of PTH
Inc in Ca and PO4 absoprtion from the gut
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Macula densa

11. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Inc renal bicarb resabsoprtion - delayed
Inhibits Na/phosphate cotransport leading to phosphate excretion
1/4 plasma - and 3/4 interstitial volume

12. Why can PAH be used to measure ERPF
All glomeruli
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Eosinphilic casts in tubules
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

13. membranous
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
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Dec - inc - inc
Thickening of glomerular BM

14. Which cells sense decreases in BP
GFR/RPF
Simple cysts
JG cells
No

15. When is TF/P ratio > 1
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Solute is reabsorbed less quickly than water or net secretion of substance
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Macula densa

16. What is the compensatory response in respiratory acidosis
Inc renal bicarb resabsoprtion - delayed
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
It has a longer renal vein
Becomes concentrated and hypertonic

17. What is a normal filtration fraction
20 percent
PH = pKa + log bicarb/0.03PCO2
Macula densa
Solute is reabsorbed more quickly than water

18. TCC is associated with problems in your Pee SAC - ??
Phenacetin - smoking - aniline dyes - cyclophosphamide
Renal tubular cells - polygonal clear cells
Renal artery - interlobar a - interlobular a
Stimulates thirst

19. how does this present in adults and What is the pattern of inheritence
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Segmental sclerosis and hylanosis
20 percent
Cx>GFR

20. net tubular reabsorption of x
Principal cells and intercalated cells
Cx<GFR
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

21. What effect does ANP have on Na in the kidney
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Makes urine less concentrated - impermeable to H20
Inhibits Na/phosphate cotransport leading to phosphate excretion
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

22. In renal failure with uremia - What are the 5 aspects of uremia
Anion gap = na - (Cl + bicarb)
NC - dec - dec
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

23. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Wilms tumor (ages 2-4)
Beta 1
Transitional cell carcinoma

24. What do casts indicated about hematuria/pyuria
Anion gap = na - (Cl + bicarb)
Renal in origin
Inhibits Na/phosphate cotransport leading to phosphate excretion
EPO - endothelial cells of peritubular capillaries

25. Why is there anemia in renal failure
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Failure of EPO
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
20 percent

26. What is the effect of PTH on the proximal tubule
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
By 10%
Inhibits Na/phosphate cotransport leading to phosphate excretion
Huge palpable flank mass and hematuria

27. What is the effect of aldosterone in principal cells
Inc renal bicarb resabsoprtion - delayed
Inc - dec - dec
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels

28. What are the associations with RTA type 4
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
To defend GFR
Acts on V2 receptors leading to insertion of aquaporins on luminal side

29. In renal failure What acid - base disturbance is most likely
To defend GFR
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Dec - inc - inc
Metabolic acidosis

30. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
No
Under and under
ADPKD
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

31. What happens to tubular inulin along the proximal tubule and why
Inc in concentration - not amout - due to water reabsorption
2 ways - base exchanger and between epithelial cells
Inhibits Na/phosphate cotransport leading to phosphate excretion
Failure of EPO

32. When is TF/P <1
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Solute is reabsorbed more quickly than water
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Involves glomeruli and other organs

33. Defect in proximal tubule HCO3 reabsorption
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
All glomeruli
RTA type 2 (proximal)
Radiopaque

34. What are the main complications of kidney stones
Small kidney - poor prognosis
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Hydronephrosis and pyelonephritis

35. do you see casts in bladder cancer - kidney stones with hematuria
Triglycerides
Negative charge
Radiopaque
No

36. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Wilms tumor (ages 2-4)
EPO - endothelial cells of peritubular capillaries
RTA type 2 (proximal)

37. What does the crescent moon shape consist of in RPGN
Reabsorb Na in exchange for secreting K and H
Principal cells and intercalated cells
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

38. What is the effect of AT II on GFR - FF and Na
Solute is reabsorbed less quickly than water or net secretion of substance
Inc in Ca and PO4 absoprtion from the gut
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Makes urine less concentrated - impermeable to H20

39. What is the genetic etiology of wilms tumor and What is WAGR complex
Negative charge
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
NC - dec - dec

40. what happens to pH - PCO2 - and bicarb in respiratory acidosis
Dec - inc - dec
Podocytes foot processes
Failure of EPO
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules

41. Where is ACE made and What are 2 of its fxns
Insertion of Na channel on luminal side
Phenacetin - smoking - aniline dyes - cyclophosphamide
Angio I to angio II and inhibits bradykinin
Anion gap = na - (Cl + bicarb)

42. What do you see in the urine with acute pyelonephritis
Vasocxn - inc BP
White cell casts
Bladder cancer
Antifreeze - ethyelene glycol or vit C abuse

43. What are JG cells and what substance do they secrete
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Modified smooth muscle of afferent arteriole - secrete renin
Bladder cancer
Solute and water are reabsorbed at the same rate

44. What is the ddx for a metabolic acidosis with an inc anion gap
Freely filtered and neither absorbed or secreted
Most of the bicarb - sodium - chloride - and water
20 percent
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

45. in TCC - What does painelss hematuria suggest
Renal artery - interlobar a - interlobular a
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Bladder cancer
Hypokalemia - risk for Ca containing kidney stones

46. What is the most frequent kind of kidney stone and What are causes that lead to it
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Inc in Ca and PO4 absoprtion from the gut
Hypokalemia and hypophosphatemic rickets
Wilms tumor (ages 2-4)

47. hypoaldosteronism or lack of collecting tubule response to aldosteron
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
RTA type 2 (proximal)
Beta 1
RTA type 4 (hyperkalemic)

48. What is the formula for renal blood flow
Medullary cystic disease
Dec - dec - NC
RPF/(1- Hct)
Dec - inc - dec

49. What is the 3rd most common kidney stone and What causes it
ANP
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia

50. In who is RCC most comon
NC - dec - dec
NC - inc - inc
Men 50 to 70 - inc incidence with smoking and obesity
Inc Ca/Na exchange to inc Ca reabsoprtion