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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 effect of angiotensin II on RPF - GFR - and FF - why - What do ACEi do?
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Acute tubular necrosis
Reabsorb Na in exchange for secreting K and H

2. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Inhibits Na/phosphate cotransport leading to phosphate excretion
Under and under
ADPKD
RTA type 4 (hyperkalemic)

3. What happens when PTH is secreted
Inulin
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Corticosteroids
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production

4. How do you interpret creatinine clearance
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
UTI or acute gastroenteritis
Most of the bicarb - sodium - chloride - and water
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN

5. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
Triglycerides
Renal artery - interlobar a - interlobular a
160-200 - 350
Wilms tumor (ages 2-4)

6. What is the compensatory response in metabolic acidosis
Negative charge
Hypervent - immediate
Hyperceullular glomeruli
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

7. What is renal osteodystrophy
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Becomes concentrated and hypertonic
Acute pyelonephritis
Reabsorb Na in exchange for secreting K and H

8. What does thyroidization of the kidney result in
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Eosinphilic casts in tubules
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

9. Subendothelial immune complexes with granular IF
Growth retardation and developmental delay
Ammonia - buffer for secreted H+
Radiopaque
Membranoproliferative glomerulonephritis

10. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
Rxn from angiotensinogen to angiontensin I
Transitional cell carcinoma
Inc in concentration - not amout - due to water reabsorption

11. Which cells sense decreases in Na delivery
Cx = GFR
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Contrict leading to inc FF - preserver renal GFR in low volume states
Macula densa

12. In a metabolic acidosis What additional calculation is necessary and How do you make it
Anion gap = na - (Cl + bicarb)
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Rxn from angiotensinogen to angiontensin I

13. What is the LM for diabetic glomerulonephropathy
Radiolabelled albumin
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Simple cysts
Polycystic liver disease - berry aneurysms - mitral valve prolapse

14. What is the ddx for respiratory acidosis
Beta 1
Under and under
Becomes concentrated and hypertonic
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

15. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Corticosteroids
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium

16. in acute cystitis with pyuria - do you see casts
No
Triglycerides
Renal tubular cells - polygonal clear cells
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH

17. 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
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Na
Na reabsorption drives H20 reabsorption

18. What is the ddx for a metabolic acidosis with an inc anion gap
Makes urine less concentrated - impermeable to H20
LM - nl glomeruli - EM - foot process effacement
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Reabsorb Na in exchange for secreting K and H

19. What 3 things stimulate the release of renin - and Where is it released from
Inc in concentration - not amout - due to water reabsorption
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
RTA type 4 (hyperkalemic)
Under and under

20. How is extracellular volume measured
NC - dec - dec
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
GFR x plasma concentration
Inulin

21. What is the second most common kidney stone
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Transitional cell carcinoma
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

22. What circumstances causes ADH secretion
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Inc plasma osm - dec blood volume
Von hippel laundau and gene deletion in chromosome 3
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

23. When is TF/P ratio > 1
Inc Ca/Na exchange to inc Ca reabsoprtion
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Solute is reabsorbed less quickly than water or net secretion of substance
PH - then PC02

24. What happens to tubular inulin along the proximal tubule and why
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Nephrotic syndrome
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Inc in concentration - not amout - due to water reabsorption

25. What is the 3rd most common kidney stone and What causes it
Actively reabsorbs NaCl - diluting - makes urine hypotonic
160-200 - 350
Transitional cell carcinoma
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia

26. diffuse
Dec - inc - inc
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
All glomeruli
EPO - endothelial cells of peritubular capillaries

27. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Liver
Podocytes foot processes
Stimulates thirst
Inc - inc - inc

28. When is TF/P = 1
Solute and water are reabsorbed at the same rate
2 ways - base exchanger and between epithelial cells
To defend GFR
Invades IVC and spreads hematogenously

29. inc in creatinine and BUN over a period of several days
Acute renal failure
Angio I to angio II and inhibits bradykinin
Renal tubular cells - polygonal clear cells
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

30. What therapy does miminal change respond to...
Insertion of Na channel on luminal side
Corticosteroids
Beta 1
Von hippel laundau and gene deletion in chromosome 3

31. What is the effect of AT II on efferent arterioles
Thickening of glomerular BM
RTA type 4 (hyperkalemic)
Filtered - secreted
Contrict leading to inc FF - preserver renal GFR in low volume states

32. By what percentage does EPRF underestimage true RPF
Most of the bicarb - sodium - chloride - and water
Inc Ca/Na exchange to inc Ca reabsoprtion
UTI or acute gastroenteritis
By 10%

33. proliferative
Advanced renal dz - CRF
Hyperceullular glomeruli
To defend GFR
Inc - inc - inc

34. What two cells make up the JGA
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Rxn from angiotensinogen to angiontensin I
Macula densa and JG cells
Principal cells and intercalated cells

35. What are the associations with RTA type 4
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Angio I to angio II and inhibits bradykinin
NC - dec - dec
160-200 - 350

36. What dyslipidemia is most common in renal failure
Failure of EPO
Triglycerides
Bladder cancer
Proximal tubule - na/glucose co transporter

37. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
Dec - dec - NC
To defend GFR
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
GFR/RPF

38. secondary glomerular dz
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
1/4 plasma - and 3/4 interstitial volume
Involves glomeruli and other organs
Beta 1

39. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Na
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Medullary cystic disease
Acute pyelonephritis

40. an inflammatory process leading to hematuria and RBC casts - associated with azotemia - oliguria - HTN and proteinuria
All glomeruli
Angio I to angio II and inhibits bradykinin
Nephritic syndrome
Complications of chronic kidney disease or HTN

41. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Solute is reabsorbed more quickly than water
2 ways - base exchanger and between epithelial cells
Diarrhea - glue - RTA - hyperchloremia
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant

42. What is the affect of prostaglandins on RPF - GFR - and FF - and why? What would NSAIDs do?
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Renal in origin
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted

43. How do calcium stones appear on x ray
Hypokalemia and hypophosphatemic rickets
Radiopaque
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Thromboembolism and inc risk of infection

44. What is the pathway from the efferent arteriorle to the renal v
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Insertion of Na channel on luminal side
Inc
Vasa recta - interlobular v - interlobar v - renal v

45. Who often has diffuse proliferative GN
Under and under
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Cx = GFR
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

46. Where is angiotensinogen made
Radiopaque
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Staghorn calculi - worsened by alkaluria
Liver

47. What is hartnup's disease
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Cx>GFR
By 10%
Inc renal bicarb resabsoprtion - delayed

48. What is the formula for filtration fraction
NC - dec - dec
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Vasa recta - interlobular v - interlobar v - renal v
GFR/RPF

49. primary glomerular dz
Cx>GFR
Involves only glomeruli
Radiopaque
Transitional cell carcinoma

50. What is the most common renal malignancy of early childhood
Na and volume loss
V x Urine concentration
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Wilms tumor (ages 2-4)