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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. Defect in proximal tubule HCO3 reabsorption
Few glomeruli
Modified smooth muscle of afferent arteriole - secrete renin
RTA type 2 (proximal)
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger

2. What dyslipidemia is most common in renal failure
Size
Inc
Hypervent - immediate
Triglycerides

3. What is lost in nephrotic syndrome resulting what urine and serum changes
Filtered - secreted
Dec - dec - dec
Inc plasma osm - dec blood volume
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

4. What are the effects of PTH hormone on the kidney
It has a longer renal vein
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
Von hippel laundau and gene deletion in chromosome 3
Hyperkalemia

5. What is the ddx for respiratory acidosis
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Segmental sclerosis and hylanosis
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse

6. What is the pathway from the efferent arteriorle to the renal v
NKCC
Dec - dec - NC
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Vasa recta - interlobular v - interlobar v - renal v

7. What does NEG lead to in the efferent arterioles
Inc GFR and mesangial expansion
Radiolabelled albumin
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Renal artery - interlobar a - interlobular a

8. In renal failure What acid - base disturbance is most likely
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Metabolic acidosis
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Inc in concentration - not amout - due to water reabsorption

9. What do macula densa cells sense
Hypervent - early high altitude - aspirin ingestion early
Carbonic anhydrase
Na
Hyperceullular glomeruli

10. With what genetic tumor syndrome is RCC associated
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Involves glomeruli and other organs
Inc renal bicarb resabsoprtion - delayed
Von hippel laundau and gene deletion in chromosome 3

11. What cells create the epithelial layer of the glomerular filtration barrier
Podocytes foot processes
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Transitional cell carcinoma
Hypovent - immediate

12. What effect does efferent arteriole cxn have on RPF - GFR and FF
Ectopic EPO - ACTH - PTHrP - prolactin
Beta 1
Radiopaque
Dec - inc - inc

13. In renal failure What are the consquence sof Na/H20 retention
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
CHF - pulmonary edema - HTN
Corticosteroids
Negative charge

14. What is the formula for reabsorption
Men 50 to 70 - inc incidence with smoking and obesity
Filtered - secreted
Segmental sclerosis and hylanosis
Acts on V2 receptors leading to insertion of aquaporins on luminal side

15. hypoaldosteronism or lack of collecting tubule response to aldosteron
RTA type 4 (hyperkalemic)
Inhibits Na/phosphate cotransport leading to phosphate excretion
Segmental sclerosis and hylanosis
Na

16. Which cells sense decreases in BP
Inc Ca/Na exchange to inc Ca reabsoprtion
Triglycerides
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
JG cells

17. How can NSAIDs cause acute renal failure
Huge palpable flank mass and hematuria
Thickening of glomerular BM
Metabolic acidosis
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

18. How does RCC manifest clinically
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Liver
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Hydronephrosis and pyelonephritis

19. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Antifreeze - ethyelene glycol or vit C abuse
Medullary cystic disease
Radiolabelled albumin
Stimulates thirst

20. hyaline casts ddx
Macula densa
Few glomeruli
UTI or acute gastroenteritis
Nonspecific

21. What is the second most common kidney stone
Hypervent - early high altitude - aspirin ingestion early
Solute is reabsorbed more quickly than water
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
RTA type 2 (proximal)

22. What is the 60-40-20 rule of body weight
GFR x plasma concentration
Cx = GFR
Inhibits Na/phosphate cotransport leading to phosphate excretion
60% total body water - 40% ICF - 20% ECF

23. do you see casts in bladder cancer - kidney stones with hematuria
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
No
Poor - days to weeks

24. What is the effect of aldosterone in principal cells
CHF - pulmonary edema - HTN
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Passively reabsorbs water via medullary hypertonicity

25. RBC casts - ddx
Poor - days to weeks
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

26. What is the ddx for a metabolic acidosis with nl anion gap (8-12)
Angio I to angio II and inhibits bradykinin
Diarrhea - glue - RTA - hyperchloremia
Hyperkalemia
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse

27. What does the crescent moon shape consist of in RPGN
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Amyloidosis
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus

28. What is the prognosis of RPGN
1alpha hydroxylase - PTH stimulates it
Hypervent - early high altitude - aspirin ingestion early
Poor - days to weeks
Macula densa and JG cells

29. What are the two kinds of cells in the collecting tubules
Eosinphilic casts in tubules
Macula densa
Principal cells and intercalated cells
1/4 plasma - and 3/4 interstitial volume

30. When is TF/P <1
Filtered - secreted
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
It has a longer renal vein
Solute is reabsorbed more quickly than water

31. What is the compensatory response in metabolic acidosis
Hypervent - immediate
No
Macula densa and JG cells
Needs to be bilateral

32. What is the effect of of PTH on the distal convoluted tubule
Inc Ca/Na exchange to inc Ca reabsoprtion
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Excreted - filtered
Phenacetin - smoking - aniline dyes - cyclophosphamide

33. What do you see on LM and IF with rapidly progressive GN
Inc - dec - dec
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Crescent - moon shape
Hyperceullular glomeruli

34. What needs to happen for postrenal obstruction to creat ARF
Intra = HIKIN!
1/4 plasma - and 3/4 interstitial volume
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
Needs to be bilateral

35. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
1/4 plasma - and 3/4 interstitial volume
ANP
Simple cysts
Dialysis cysts

36. What is the least common kidney stone - What causes it and How do you treat it
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
EPO - endothelial cells of peritubular capillaries
Size and charge
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

37. How is plasma volume measured
60% total body water - 40% ICF - 20% ECF
Macula densa
Radiolabelled albumin
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell

38. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
Cx = GFR
It has a longer renal vein
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Hydronephrosis and pyelonephritis

39. What is the compensatory response in metabolic alkalosis
Hypovent - immediate
NC - dec - dec
Chronic conditions - multiple myeloma - TB - RA
Nonspecific

40. What are the LM and EM of minimal change disease
Beta 1
Failure of EPO
LM - nl glomeruli - EM - foot process effacement
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

41. What is the pathway to the afferent arteriole
Renal artery - interlobar a - interlobular a
Principal cells and intercalated cells
Advanced renal dz - CRF
Actively reabsorbs NaCl - diluting - makes urine hypotonic

42. What is the effect of AT II on efferent arterioles
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Radiolabelled albumin
Contrict leading to inc FF - preserver renal GFR in low volume states
1/4 plasma - and 3/4 interstitial volume

43. WBC casts - ddx
Bladder cancer
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

44. What 3 disease can lead to RPGN
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Hypokalemia and hypophosphatemic rickets
Hypervent - early high altitude - aspirin ingestion early

45. Why is there anemia in renal failure
Solute and water are reabsorbed at the same rate
Failure of EPO
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Amyloidosis

46. What enzyme in the proximal tubule allows the conversion of carbonic acid to water and C02
Inc synthesis of IgA and LM and IF - Ics depsoti in mesangium
Carbonic anhydrase
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Na

47. How do the ureters course in relation to the uterine artery and ductus deferens
V x Urine concentration
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Under and under
Dialysis cysts

48. How is chlorid reabsorbed in the proximal tubule
JG cells
2 ways - base exchanger and between epithelial cells
GFR/RPF
Liver

49. inc in creatinine and BUN over a period of several days
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Inc
Acute renal failure
Vasa recta - interlobular v - interlobar v - renal v

50. Why can PAH be used to measure ERPF
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Men 50 to 70 - inc incidence with smoking and obesity
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Size