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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. net tubular reabsorption of x
Acute renal failure
Cx<GFR
RTA type 4 (hyperkalemic)
Podocytes foot processes

2. What can cause oxalate crystals
Chronic pyelonephritis
Acute renal failure
Antifreeze - ethyelene glycol or vit C abuse
Needs to be bilateral

3. What is the compensatory response in metabolic alkalosis
Hypovent - immediate
Hypokalemia - risk for Ca containing kidney stones
Thickening of glomerular BM
No

4. What do macula densa cells sense
Na
Acute renal failure
No
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

5. In a metabolic acidosis What additional calculation is necessary and How do you make it
Type II - C3 nephritic factor
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Anion gap = na - (Cl + bicarb)
Invades IVC and spreads hematogenously

6. do you see casts in bladder cancer - kidney stones with hematuria
NKCC
No
GFR/RPF
Hyperceullular glomeruli

7. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
NKCC
Stimulates thirst
Anion gap = na - (Cl + bicarb)
Inc - dec - dec

8. What is the pathway from the efferent arteriorle to the renal v
HIV
Vasa recta - interlobular v - interlobar v - renal v
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

9. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
UTI or acute gastroenteritis

10. In renal failure - what happens to potassium
Freely filtered and neither absorbed or secreted
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Hyperkalemia
Acute pyelonephritis

11. What is the ddx for a respiratory alkalosis
Triglycerides
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Hypervent - early high altitude - aspirin ingestion early
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

12. What happens in the collecting tubules
PH = pKa + log bicarb/0.03PCO2
Na reabsorption drives H20 reabsorption
Reabsorb Na in exchange for secreting K and H
Nephritic syndrome

13. nonenzymatic glycosylation of GBM - inc permeability and thickening
Failure of EPO
Diabetic glomerulonephropathy
By 10%
Acute pyelonephritis

14. What are the associations with RTA type 4
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Complications of chronic kidney disease or HTN
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Solute is reabsorbed more quickly than water

15. What are the effects of AT II on vascular smooth muscle
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Vasocxn - inc BP
Von hippel laundau and gene deletion in chromosome 3
Filtered - secreted

16. What are JG cells and what substance do they secrete
Acute - ATN - or chronic - HTN - DM
Nephritic syndrome
Modified smooth muscle of afferent arteriole - secrete renin
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys

17. What is the BUN/Cr ratio in prerenal azotemia and why?
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Staghorn calculi - worsened by alkaluria
Dec renal bicarb reabsorption - delayed

18. What is the compensatory response in respiratory alkalosis
Liver
To defend GFR
HIV
Dec renal bicarb reabsorption - delayed

19. WBC casts - ddx
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Poor - days to weeks
CHF - pulmonary edema - HTN
RPF/(1- Hct)

20. By what percentage does EPRF underestimage true RPF
RTA type 4 (hyperkalemic)
Inc Ca/Na exchange to inc Ca reabsoprtion
NC - dec - dec
By 10%

21. What two cells make up the JGA
Macula densa and JG cells
Ammonia - buffer for secreted H+
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Acute renal failure

22. What is the formula for the filtered load
Dec - inc - dec
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Inc Ca/Na exchange to inc Ca reabsoprtion
GFR x plasma concentration

23. What does renin do
Rxn from angiotensinogen to angiontensin I
Kids - peripheral and periorbital edema - resolves spontaneously
Makes urine less concentrated - impermeable to H20
RTA type 2 (proximal)

24. What 3 things stimulate the release of renin - and Where is it released from
GFR/RPF
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Filtered - secreted
Few glomeruli

25. How can NSAIDs cause acute renal failure
Cx<GFR
Poor - days to weeks
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
2 ways - base exchanger and between epithelial cells

26. In who is RCC most comon
Men 50 to 70 - inc incidence with smoking and obesity
Hypokalemia - risk for Ca containing kidney stones
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Vasa recta - interlobular v - interlobar v - renal v

27. What is the least common kidney stone - What causes it and How do you treat it
Solute and water are reabsorbed at the same rate
Freely filtered and neither absorbed or secreted
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
1/4 plasma - and 3/4 interstitial volume

28. What do you see on LM for focal segmental glomerulosclerosis
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Segmental sclerosis and hylanosis
White cell casts
CHF - pulmonary edema - HTN

29. Who commonly gets acute post strep GN
Von hippel laundau and gene deletion in chromosome 3
Kids - peripheral and periorbital edema - resolves spontaneously
Acute pyelonephritis
CHF - pulmonary edema - HTN

30. What is the effect of AT II on the hypothalamus
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Stimulates thirst
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Inulin

31. What does LM - EM - IF show in diffuse proliferative GN
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
2 ways - base exchanger and between epithelial cells
V x Urine concentration

32. In addition to glucose and amino acids - what other components of the filtrate are reabsorbed in the proximal tubule
Principal cells and intercalated cells
1alpha hydroxylase - PTH stimulates it
Most of the bicarb - sodium - chloride - and water
Ectopic EPO - ACTH - PTHrP - prolactin

33. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
NKCC
GFR/RPF
Inc - dec - dec
RTA type 2 (proximal)

34. With what genetic tumor syndrome is RCC associated
Cx>GFR
All glomeruli
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Von hippel laundau and gene deletion in chromosome 3

35. hyaline casts ddx
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Nonspecific
HIV

36. What is the formula for secreted
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
Chronic pyelonephritis
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Excreted - filtered

37. What does the crescent moon shape consist of in RPGN
1alpha hydroxylase - PTH stimulates it
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Stimulates thirst

38. What are the effects of AT II on the adrenal gland
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Renal artery - interlobar a - interlobular a
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

39. What is lost in nephrotic syndrome resulting what urine and serum changes
RTA type 2 (proximal)
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Inc - dec - dec
PH = pKa + log bicarb/0.03PCO2

40. What needs to happen for postrenal obstruction to creat ARF
Needs to be bilateral
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
1/4 plasma - and 3/4 interstitial volume

41. What is the effect of AT II on the posterior pituitary
Chronic conditions - multiple myeloma - TB - RA
Men 50 to 70 - inc incidence with smoking and obesity
Nonspecific
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

42. Which cells sense decreases in BP
Antifreeze - ethyelene glycol or vit C abuse
EPO - endothelial cells of peritubular capillaries
JG cells
Chronic pyelonephritis

43. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Inc Ca/Na exchange to inc Ca reabsoprtion
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

44. When is glucose reabsorbed and with What transporter
Proximal tubule - na/glucose co transporter
ADPKD
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell

45. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
Beta 1
EPO - endothelial cells of peritubular capillaries
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Anion gap = na - (Cl + bicarb)

46. How do the ureters course in relation to the uterine artery and ductus deferens
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Proximal tubule - na/glucose co transporter
Under and under
Size

47. Why can PAH be used to measure ERPF
Polycystic liver disease - berry aneurysms - mitral valve prolapse
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
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

48. How does Wilms tumor present
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Radiolabelled albumin
Negative charge
Huge palpable flank mass and hematuria

49. What is the ddx for respiratory acidosis
Simple cysts
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Inc renal bicarb resabsoprtion - delayed

50. When is TF/P <1
Solute is reabsorbed more quickly than water
All glomeruli
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Anion gap = na - (Cl + bicarb)