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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. In what clinical context does Berger's disease often present
UTI or acute gastroenteritis
Liver
PH = pKa + log bicarb/0.03PCO2
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
2. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Carbonic anhydrase
Corticosteroids
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
CHF - pulmonary edema - HTN
3. What dyslipidemia is most common in renal failure
Triglycerides
V x Urine concentration
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Dec - dec - NC
4. What does LM - EM - IF show in diffuse proliferative GN
It has a longer renal vein
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Failure of EPO
5. What is hartnup's disease
Dec - inc - inc
Diarrhea - glue - RTA - hyperchloremia
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Angio I to angio II and inhibits bradykinin
6. when polycystic kidney disease presents in an infant - What is the pattern of inheritance - What are the associations - What are concernse post neonatal period
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Renal artery - interlobar a - interlobular a
Stimulates thirst
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
7. What happens to the urine in the descending limb
JG cells
Antifreeze - ethyelene glycol or vit C abuse
Becomes concentrated and hypertonic
Eosinphilic casts in tubules
8. What does US show with medullary cystic disease
Involves only glomeruli
Small kidney - poor prognosis
Beta 1
Contrict leading to inc FF - preserver renal GFR in low volume states
9. What is the effect of aldosterone in principal cells
Crescent - moon shape
Inulin
By 10%
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
10. What is the formula for the filtered load
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Renal artery - interlobar a - interlobular a
Macula densa
GFR x plasma concentration
11. What does renin do
Rxn from angiotensinogen to angiontensin I
Inc
Solute and water are reabsorbed at the same rate
RTA type 4 (hyperkalemic)
12. acute interstitial renal inflammation with pyuria with eosinphils - associated with fever - rash - hematuria and CVA tenderness - dz and causative agents
Hypervent - early high altitude - aspirin ingestion early
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Acute pyelonephritis
1alpha hydroxylase - PTH stimulates it
13. What are the associations with RTA type 1
Freely filtered and neither absorbed or secreted
160-200 - 350
Hypokalemia - risk for Ca containing kidney stones
ADPKD
14. How is plasma volume measured
Radiolabelled albumin
1/4 plasma - and 3/4 interstitial volume
20 percent
Hypervent - early high altitude - aspirin ingestion early
15. What happens in the collecting tubules
Reabsorb Na in exchange for secreting K and H
Stimulates thirst
Beta 1
JG cells
16. 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
Nonspecific
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Under and under
17. What are the associations with RTA type 2
Hypokalemia and hypophosphatemic rickets
Polycystic liver disease - berry aneurysms - mitral valve prolapse
All glomeruli
Diuretics - vomiting - antacid - hyperaldosteronism
18. Which cells sense decreases in BP
Bladder cancer
JG cells
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
20 percent
19. Where does renal cell carcinoma originate and What do the cells look like
Hypervent - immediate
GFR/RPF
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Renal tubular cells - polygonal clear cells
20. How is extracellular volume measured
Triglycerides
Medullary cystic disease
Makes urine less concentrated - impermeable to H20
Inulin
21. What is the ddx for metabolic alkalosis with compensation
Renal artery - interlobar a - interlobular a
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Diuretics - vomiting - antacid - hyperaldosteronism
Poor - days to weeks
22. What is the cutoff of proteinuria in nephritic syndrome
Corticosteroids
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
White cell casts
<3.5 g /day
23. What cells create the epithelial layer of the glomerular filtration barrier
Dec - inc - dec
Hydronephrosis and pyelonephritis
Podocytes foot processes
All glomeruli
24. Why can inulin be used to calculate GFR?
Freely filtered and neither absorbed or secreted
Renal in origin
Involves glomeruli and other organs
Thromboembolism and inc risk of infection
25. With what genetic tumor syndrome is RCC associated
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Inhibits Na/phosphate cotransport leading to phosphate excretion
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Von hippel laundau and gene deletion in chromosome 3
26. What 3 disease can lead to RPGN
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Involves only glomeruli
Few glomeruli
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
27. What is the genetic etiology of wilms tumor and What is WAGR complex
No
Segmental sclerosis and hylanosis
Crescent - moon shape
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
28. hyaline casts ddx
Nonspecific
CHF - pulmonary edema - HTN
Hypokalemia - risk for Ca containing kidney stones
Failure of EPO
29. What 3 things stimulate the release of renin - and Where is it released from
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
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
GFR/RPF
30. secondary glomerular dz
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Small kidney - poor prognosis
Involves glomeruli and other organs
RTA type 1 (distal)
31. 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
Modified smooth muscle of afferent arteriole - secrete renin
RTA type 1 (distal)
Small kidney - poor prognosis
32. How does Wilms tumor present
Liver
Freely filtered and neither absorbed or secreted
Huge palpable flank mass and hematuria
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
33. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Inc - inc - inc
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Ammonia - buffer for secreted H+
Inhibits Na/phosphate cotransport leading to phosphate excretion
34. What are the associations with RTA type 4
Dec - inc - dec
PH - then PC02
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Freely filtered and neither absorbed or secreted
35. What is the LM for diabetic glomerulonephropathy
Radiopaque
Wilms tumor (ages 2-4)
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
36. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
Principal cells and intercalated cells
Nephritic syndrome
EPO - endothelial cells of peritubular capillaries
Inc plasma osm - dec blood volume
37. most common tumor of urinary tract system (can occur in renal calyces - renal pelvis - ureters - bladder)
Transitional cell carcinoma
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Dec renal bicarb reabsorption - delayed
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
38. How do you interpret creatinine clearance
Solute is reabsorbed less quickly than water or net secretion of substance
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Macula densa and JG cells
RPF/(1- Hct)
39. What happens when PTH is secreted
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
1alpha hydroxylase - PTH stimulates it
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
40. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Insertion of Na channel on luminal side
Amyloidosis
Staghorn calculi - worsened by alkaluria
Failure of EPO
41. Under what circumstances is aldosterone secreted
EPO - endothelial cells of peritubular capillaries
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Hypervent - immediate
42. What are the 3 transporters of the intercalated cells
Thickening of glomerular BM
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Reabsorb Na in exchange for secreting K and H
Eosinphilic casts in tubules
43. When is TF/P <1
Solute is reabsorbed more quickly than water
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Corticosteroids
Growth retardation and developmental delay
44. Focal
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Few glomeruli
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
45. How do struvite stones appear on xray
Radiopaque
Vasocxn - inc BP
Dialysis cysts
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
46. What circumstances causes ADH secretion
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Angio I to angio II and inhibits bradykinin
Inc plasma osm - dec blood volume
Chronic pyelonephritis
47. What two cells make up the JGA
Macula densa and JG cells
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
48. What is the second most common kidney stone
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
RPF/(1- Hct)
HIV
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
49. By what percentage does EPRF underestimage true RPF
By 10%
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Na and volume loss
Beta 1
50. In a metabolic acidosis What additional calculation is necessary and How do you make it
Inc Ca/Na exchange to inc Ca reabsoprtion
Chronic conditions - multiple myeloma - TB - RA
Radiolabelled albumin
Anion gap = na - (Cl + bicarb)