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Test your basic knowledge |
Renal
Start Test
Study First
Subject
:
health-sciences
Instructions:
Answer 50 questions in 15 minutes.
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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. What is the BUN/Cr ratio in prerenal azotemia and why?
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Solute is reabsorbed less quickly than water or net secretion of substance
All glomeruli
White cell casts
2. What 3 things stimulate the release of renin - and Where is it released from
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
NC - dec - dec
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate
3. What is the pathway from the efferent arteriorle to the renal v
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Corticosteroids
Vasa recta - interlobular v - interlobar v - renal v
Triglycerides
4. What happens in the collecting tubules
Dec - inc - dec
Von hippel laundau and gene deletion in chromosome 3
Reabsorb Na in exchange for secreting K and H
Crescent - moon shape
5. What is the ddx for a metabolic acidosis with an inc anion gap
1/4 plasma - and 3/4 interstitial volume
CHF - pulmonary edema - HTN
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Size and charge
6. When is TF/P <1
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
NC - dec - dec
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
Solute is reabsorbed more quickly than water
7. secondary glomerular dz
Polycystic liver disease - berry aneurysms - mitral valve prolapse
White cell casts
Involves glomeruli and other organs
Acute - ATN - or chronic - HTN - DM
8. In renal failure - what happens to potassium
Hyperkalemia
Failure of EPO
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
9. What is is Alport's syndrome and what else do you see with it other than renal path
NC - dec - dec
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Transitional cell carcinoma
GFR/RPF
10. What therapy does miminal change respond to...
Corticosteroids
HIV
Involves glomeruli and other organs
Macula densa and JG cells
11. The fused basement membrane with heparan sulfate constitutes what portion of the charge
Negative charge
Freely filtered and neither absorbed or secreted
GFR/RPF
Simple cysts
12. What are the associations with RTA type 1
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Invades IVC and spreads hematogenously
Podocytes foot processes
Hypokalemia - risk for Ca containing kidney stones
13. What is ADPKD also associated with
Nephrotic syndrome
Filtered - secreted
Polycystic liver disease - berry aneurysms - mitral valve prolapse
HIV
14. What is renal osteodystrophy
Hypokalemia - risk for Ca containing kidney stones
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
NC - inc - inc
Nephrotic syndrome
15. What is transporter in the thick ascneding loop of Henle indirectly induces the paracellular reabsorption of Mg and Ca
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Fibrin and plasma proteins (C3b) with glomerular function parietal cells - monocytes and MACS
NKCC
16. How can NSAIDs cause acute renal failure
LM - nl glomeruli - EM - foot process effacement
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
White cell casts
Inhibits Na/phosphate cotransport leading to phosphate excretion
17. What does aldosterone do in the collecting tubule
Huge palpable flank mass and hematuria
Insertion of Na channel on luminal side
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Dec - inc - dec
18. In what clinical context does Berger's disease often present
Phenacetin - smoking - aniline dyes - cyclophosphamide
Nonspecific
Corticosteroids
UTI or acute gastroenteritis
19. What does LM - EM - IF show in diffuse proliferative GN
White cell casts
Men 50 to 70 - inc incidence with smoking and obesity
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
20. At what level of plasma glucose does glucosuria begin and what serum glucose is the transporter fully saturated
160-200 - 350
Actively reabsorbs NaCl - diluting - makes urine hypotonic
White cell casts
Hypovent - immediate
21. What are the associations with RTA type 4
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Amyloidosis
Nephrotic syndrome
22. Where does renal cell carcinoma originate and What do the cells look like
Solute and water are reabsorbed at the same rate
No
Stimulates thirst
Renal tubular cells - polygonal clear cells
23. What substance is secreted in response increase atrial pressure
NC - dec - dec
Carbonic anhydrase
Complications of chronic kidney disease or HTN
ANP
24. When is glucose reabsorbed and with What transporter
Proximal tubule - na/glucose co transporter
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Crescent - moon shape
Na reabsorption drives H20 reabsorption
25. What is the LM for diabetic glomerulonephropathy
Hematuria - palpable mass - polycythemia - flank pain - fever and weight loss
Excreted - filtered
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
26. What is the formula for secreted
Excreted - filtered
1/4 plasma - and 3/4 interstitial volume
Medullary cystic disease
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
27. Focal
Few glomeruli
Insertion of Na channel on luminal side
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
Antifreeze - ethyelene glycol or vit C abuse
28. What is the henderson hasselbalch equation
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
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Inc renal bicarb resabsoprtion - delayed
PH = pKa + log bicarb/0.03PCO2
29. What are the associations with RTA type 2
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Hypokalemia and hypophosphatemic rickets
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Cx>GFR
30. 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
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins
31. What effect does afferent arteriole cxn have on RPF - GFR and FF
Cx<GFR
Corticosteroids
PH = pKa + log bicarb/0.03PCO2
Dec - dec - NC
32. What effect does inc plasma protein concentration have on RPF - GFR - and FF
NC - dec - dec
Hypokalemia - risk for Ca containing kidney stones
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
33. What two cells make up the JGA
Stimulates thirst
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
NKCC
Macula densa and JG cells
34. What is the formula for renal blood flow
RPF/(1- Hct)
Hyperkalemia
Ectopic EPO - ACTH - PTHrP - prolactin
White cell casts
35. What happens to urine in the ascending limb
Filtered - secreted
Dialysis cysts
Makes urine less concentrated - impermeable to H20
Segmental sclerosis and hylanosis
36. Subendothelial immune complexes with granular IF
Membranoproliferative glomerulonephritis
Inc in concentration - not amout - due to water reabsorption
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
37. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Principal cells and intercalated cells
NKCC
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
ADPKD
38. What is the second most common kidney stone
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Contrict leading to inc FF - preserver renal GFR in low volume states
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
39. in TCC - What does painelss hematuria suggest
Hydronephrosis and pyelonephritis
GFR x plasma concentration
Bladder cancer
Men 50 to 70 - inc incidence with smoking and obesity
40. What is hartnup's disease
ANP
1/4 plasma - and 3/4 interstitial volume
White cell casts
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
41. net tubular secretion of x
Cx>GFR
No
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
PH = pKa + log bicarb/0.03PCO2
42. By what percentage does EPRF underestimage true RPF
Inc Ca/Na exchange to inc Ca reabsoprtion
Solute is reabsorbed more quickly than water
By 10%
Thromboembolism and inc risk of infection
43. What is the 3rd most common kidney stone and What causes it
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Hypervent - immediate
Modified smooth muscle of afferent arteriole - secrete renin
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
44. How do struvite stones appear on xray
GFR/RPF
Thromboembolism and inc risk of infection
Inulin
Radiopaque
45. What are JG cells and what substance do they secrete
Hydronephrosis and pyelonephritis
GFR/RPF
Cx<GFR
Modified smooth muscle of afferent arteriole - secrete renin
46. What is winter's formula and when do you use it
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
47. dense deposits on EM - type and association
Type II - C3 nephritic factor
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Nephrotic syndrome
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
48. coarse - asymmetric - corticomedullary scarring and blunted calyx
Chronic pyelonephritis
20 percent
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Reabsorb Na in exchange for secreting K and H
49. hyaline casts ddx
Nonspecific
Macula densa
Ammonia - buffer for secreted H+
Few glomeruli
50. What does renin do
Rxn from angiotensinogen to angiontensin I
Crescent - moon shape
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Nephrotic syndrome
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