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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. in TCC - What does painelss hematuria suggest
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Bladder cancer
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra

2. In renal failure What acid - base disturbance is most likely
Simple cysts
Inc renal bicarb resabsoprtion - delayed
Metabolic acidosis
160-200 - 350

3. multiple - large - bilateral cysts that ultimately destroy the kidney parenchyma
Intra = HIKIN!
Radiopaque
Inc - inc - inc
ADPKD

4. What happens to Cl in the proximal 1/3 of the proximal tubule relative to Na
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
Stimulates thirst
2 ways - base exchanger and between epithelial cells

5. What is hartnup's disease
UTI or acute gastroenteritis
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Deficiency in neutral amino acid (tryptophan) transporter - resulting in pellagra
Inc GFR and mesangial expansion

6. What substance is secreted in response increase atrial pressure
ANP
Radiopaque
Dialysis cysts
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

7. What is the least common kidney stone - What causes it and How do you treat it
Acute tubular necrosis
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Inulin
Podocytes foot processes

8. most common cause of acute renal faiure in hospital - self reversible but fatal - dz and associations - key finding
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Segmental sclerosis and hylanosis
Acute tubular necrosis - renal ischemia (shock - sepsis) - crush injury (myoglobinuria) - toxins - muddy brown casts
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

9. What effect does cxn of the ureter have on RPF - GFR and FF
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
NC - dec - dec
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Principal cells and intercalated cells

10. What happens in the thin descending loop of henle
Podocytes foot processes
Macula densa and JG cells
Amyloidosis
Passively reabsorbs water via medullary hypertonicity

11. What is the formula for filtration fraction
RTA type 1 (distal)
GFR/RPF
Reabsorb Na in exchange for secreting K and H
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb

12. What effect does efferent arteriole cxn have on RPF - GFR and FF
Dec - inc - inc
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Proximal tubule - na/glucose co transporter
Intra = HIKIN!

13. What is the ddx for a metabolic acidosis with an inc anion gap
Few glomeruli
Hypervent - immediate
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Becomes concentrated and hypertonic

14. What is the cutoff of proteinuria in nephritic syndrome
GFR x plasma concentration
Von hippel laundau and gene deletion in chromosome 3
No
<3.5 g /day

15. How can NSAIDs cause acute renal failure
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Size and charge
Reabsorb Na in exchange for secreting K and H
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR

16. benign - common - incidental finding of renal cysts - thin - nonenhancing - cortical - fluid filled
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)
Simple cysts
Inc in Ca and PO4 absoprtion from the gut
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

17. What do you see on LM and IF with rapidly progressive GN
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Polycystic liver disease - berry aneurysms - mitral valve prolapse
Solute is reabsorbed less quickly than water or net secretion of substance
Crescent - moon shape

18. in acute post strep GN - What do you see on LM - EM and IF

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19. coarse - asymmetric - corticomedullary scarring and blunted calyx
HIV
JG cells
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Chronic pyelonephritis

20. What happens in the early distal convoluted tubule and What does that do to the urine
Dec renal bicarb reabsorption - delayed
Inc in concentration - not amout - due to water reabsorption
Amyloidosis
Actively reabsorbs NaCl - diluting - makes urine hypotonic

21. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
CHF - pulmonary edema - HTN
No
Inc
Beta 1

22. What are the main complications of kidney stones
Hydronephrosis and pyelonephritis
Hypokalemia and hypophosphatemic rickets
NC - dec - dec
Nonspecific

23. do you see casts in bladder cancer - kidney stones with hematuria
White cell casts
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
Excreted - filtered
No

24. When is TF/P <1
Small kidney - poor prognosis
It has a longer renal vein
Solute is reabsorbed more quickly than water
RTA type 2 (proximal)

25. What does aldosterone do in the collecting tubule
Insertion of Na channel on luminal side
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Vasocxn - inc BP
Renal in origin

26. In miminal change disease - who gets it - What are the triggers and What is their selective loss of?
GFR x plasma concentration
Eosinphilic casts in tubules
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Kids - triggered by recent infxn or immune stimulus - selective loss of albumin not globulins

27. hypoaldosteronism or lack of collecting tubule response to aldosteron
No
RTA type 4 (hyperkalemic)
ADPKD
Hyperkalemia

28. What does ADH do in the collecting tubule
60% total body water - 40% ICF - 20% ECF
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Insertion of Na channel on luminal side
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles

29. What is the net effect of PTH
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Inc in Ca and PO4 absoprtion from the gut
Simple cysts
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

30. What is the genetic etiology of wilms tumor and What is WAGR complex
Type II - C3 nephritic factor
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Poor - days to weeks
Most of the bicarb - sodium - chloride - and water

31. primary glomerular dz
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Nephrotic syndrome
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Involves only glomeruli

32. medullary cysts sometimes lead to fibrosis and progressive renal insuff with urinary concentrating defects
Huge palpable flank mass and hematuria
Liver
Triglycerides
Medullary cystic disease

33. Subendothelial immune complexes with granular IF
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Needs to be bilateral
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Membranoproliferative glomerulonephritis

34. tram track appearance on EM - typ - path - and associated dz
Needs to be bilateral
Hypovent - immediate
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

35. How is extracellular volume measured
Inulin
No
Angio I to angio II and inhibits bradykinin
Chronic pyelonephritis

36. What enzyme allows for conversion of 25- OH vit D to 1 -25 (OH)2 vit D
Membranoproliferative glomerulonephritis
Thromboembolism and inc risk of infection
Hypervent - early high altitude - aspirin ingestion early
1alpha hydroxylase - PTH stimulates it

37. What happens in the collecting tubules
Inc - inc - inc
Renal tubular cells - polygonal clear cells
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Reabsorb Na in exchange for secreting K and H

38. What is the compensatory response in metabolic alkalosis
Hypovent - immediate
Solute is reabsorbed less quickly than water or net secretion of substance
<3.5 g /day
Acute pyelonephritis

39. What are the two forms of renal failure and What are examples of each
Acute - ATN - or chronic - HTN - DM
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
Modified smooth muscle of afferent arteriole - secrete renin
NKCC

40. The fenestrated capillary endothelium constitutes what portion of the barrier
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Triglycerides
Size
Solute and water are reabsorbed at the same rate

41. Focal
Reabsorption is slower at first - then matches Na more distally thus relative concentration inc before it plateaus
It has a longer renal vein
Few glomeruli
Radiopaque

42. When is glucose reabsorbed and with What transporter
Ammonia - buffer for secreted H+
Rxn from angiotensinogen to angiontensin I
Proximal tubule - na/glucose co transporter
NC - dec - dec

43. In renal failure with uremia - What are the 5 aspects of uremia
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Intra = HIKIN!
Bladder cancer
RTA type 1 (distal)

44. Why is the left kidney taken during living donor transplantation
Dec - dec - dec
It has a longer renal vein
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption

45. Defect in proximal tubule HCO3 reabsorption
RTA type 2 (proximal)
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
Inc in concentration - not amout - due to water reabsorption
Freely filtered and neither absorbed or secreted

46. What serum changes cause a secretion in PTH
SLE and MPGN - most common cause of death in SLE (both of these can present as nephrotic syndrome as well)
Dec plasma Ca - inc plasma PO4 - dec plasma 1 -25 OH2 vit D
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Becomes concentrated and hypertonic

47. What do you see in the urine with acute pyelonephritis
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
White cell casts
Reabsorb Na in exchange for secreting K and H
Rxn from angiotensinogen to angiontensin I

48. TCC is associated with problems in your Pee SAC - ??
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
Phenacetin - smoking - aniline dyes - cyclophosphamide
Reabsorb Na in exchange for secreting K and H
It has a longer renal vein

49. In what disease in FSGS the most common glomerular disease
Macula densa and JG cells
RPF/(1- Hct)
HIV
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

50. What is the net effect of ANP
Dec - inc - dec
Inc in Ca and PO4 absoprtion from the gut
Hypovent - immediate
Na and volume loss