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Renal

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Answer 50 questions in 15 minutes.
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1. What aspect of vitamin D metabolism occurs in the proximal tubule of the kidney and What effect does that have on calcium and phosphate
Reabsorb Na in exchange for secreting K and H
NKCC
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate
Radiolabelled albumin

2. What is the net effect of AT II
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Inc renal bicarb resabsoprtion - delayed
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens

3. What is the second most common kidney stone
Type II - C3 nephritic factor
Na
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
UTI or acute gastroenteritis

4. How do you interpret creatinine clearance
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Approx measure of GFR - slightly overestimates because creatinine is secreted in by the renal tubules
Hyperkalemia
Goodpastures - type II hypersens - antibodies to GBM and alveolar BM - linear IF - Wegeners (c - ANCA) - mircoscopic polyangiitis (p - ANCA)

5. When is TF/P <1
Inhibiting renal production of prostaglandins which keep the afferent arteriole vasodilated to maintain GFR
Solute is reabsorbed more quickly than water
LM - nl glomeruli - EM - foot process effacement
To defend GFR

6. What cells create the epithelial layer of the glomerular filtration barrier
Podocytes foot processes
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Chronic conditions - multiple myeloma - TB - RA
Vasocxn - inc BP

7. Where is ACE made and What are 2 of its fxns
Angio I to angio II and inhibits bradykinin
Diarrhea - glue - RTA - hyperchloremia
Simple cysts
Rxn from angiotensinogen to angiontensin I

8. What is the effect of AT II on the posterior pituitary
ANP
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

9. What effect does dec plasma protein concentration have on RPF - GFR - and FF
Advanced renal dz - CRF
Chronic conditions - multiple myeloma - TB - RA
Antifreeze - ethyelene glycol or vit C abuse
NC - inc - inc

10. What is the compensatory response in metabolic acidosis
Hypokalemia and hypophosphatemic rickets
1alpha hydroxylase - PTH stimulates it
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Hypervent - immediate

11. What is the genetic etiology of wilms tumor and What is WAGR complex
HIV
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
60% total body water - 40% ICF - 20% ECF

12. What is the algorithim for acidosis/alkalosis
PH - then PC02
Intra = HIKIN!
V x Urine concentration
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron

13. What is the effect of aldosterone in principal cells
Ectopic EPO - ACTH - PTHrP - prolactin
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Renal in origin

14. What happens in the early distal convoluted tubule and What does that do to the urine
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Nonspecific
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Actively reabsorbs NaCl - diluting - makes urine hypotonic

15. What do patients die from ADPKD
RTA type 1 (distal)
Cx>GFR
Complications of chronic kidney disease or HTN
Radiolabelled albumin

16. Under what circumstances is aldosterone secreted
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion
Men 50 to 70 - inc incidence with smoking and obesity
Inc plasma osm - dec blood volume
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular

17. What is the most common renal malignancy of early childhood
Acute renal failure
Preservation of renal fxn in low volume states with simultaneous Na reabsorption to dec additional volume loss
Insertion of Na channel on luminal side
Wilms tumor (ages 2-4)

18. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Inc Ca/Na exchange to inc Ca reabsoprtion
Inc - inc - inc
Angio I to angio II and inhibits bradykinin

19. What is is Alport's syndrome and what else do you see with it other than renal path
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
Inc
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV

20. What is a normal filtration fraction
Kids - peripheral and periorbital edema - resolves spontaneously
No
Radiopaque
20 percent

21. What is the formula for excretion rate
V x Urine concentration
Dialysis cysts
Angio I to angio II and inhibits bradykinin
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

22. What are the effects of AT II on the adrenal gland
Aldosterone secretion leading to inc Na reabsorption and H20 reabsorption
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Negative charge
ADPKD

23. What is the formula for secreted
Size
Kids - peripheral and periorbital edema - resolves spontaneously
Excreted - filtered
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

24. What substance is secreted in response increase atrial pressure
Inc GFR - in FF but WITH compensatory Na reabsorption in proximal and distal nephron
ANP
Inc renal bicarb resabsoprtion - delayed
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

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

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26. What is the cutoff of proteinuria in nephritic syndrome
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
To defend GFR
<3.5 g /day
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular

27. gross hematuria and proteinuria possibly triggered by infxn or immune stimulus - dz - path associated conditions
Negative charge
Inc GFR and mesangial expansion
NC - inc - inc
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell

28. RBC casts - ddx
Complications of chronic kidney disease or HTN
Glomerulonephritis - inflammation - acute pyelonephritis - malignant HTN
Involves glomeruli and other organs
Makes urine less concentrated - impermeable to H20

29. By what percentage does EPRF underestimage true RPF
By 10%
Von hippel laundau and gene deletion in chromosome 3
Radiopaque
Rxn from angiotensinogen to angiontensin I

30. What substance is secreted from the kidney in response to hypoxia - and what cells do they come from
Huge palpable flank mass and hematuria
EPO - endothelial cells of peritubular capillaries
Renal in origin
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

31. What is the effect of AT II on efferent arterioles
Needs to be bilateral
Contrict leading to inc FF - preserver renal GFR in low volume states
NC - dec - dec
Modified smooth muscle of afferent arteriole - secrete renin

32. What is the henderson hasselbalch equation
PH = pKa + log bicarb/0.03PCO2
Inc
Triglycerides
Na reabsorption drives H20 reabsorption

33. What does ADH do in the collecting tubule
NC - dec - dec
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Beta 1
Principal cells and intercalated cells

34. What is lost in nephrotic syndrome resulting what urine and serum changes
Na
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
Na and volume loss
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia

35. granular - muddy brown casts - ddx
Acute tubular necrosis
Inc - dec - dec
No
RTA type 4 (hyperkalemic)

36. What therapy does miminal change respond to...
Passively reabsorbs water via medullary hypertonicity
Macula densa and JG cells
Radiopaque
Corticosteroids

37. What is the 60-40-20 rule of body weight
Men 50 to 70 - inc incidence with smoking and obesity
60% total body water - 40% ICF - 20% ECF
Macula densa
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH

38. What happens in the thin descending loop of henle
In Na channels - Na/K pumps - enhances K and H excretion - upregulates K channels and H channels
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Inc plasma osm - dec blood volume
Passively reabsorbs water via medullary hypertonicity

39. In pts with ammonium magnesium phophate stones - What can be the nidus for UTI and what worsens it
Staghorn calculi - worsened by alkaluria
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
Under and under
Inc GFR and mesangial expansion

40. proliferative
Hyperceullular glomeruli
Carbonic anhydrase
Vasocxn - inc BP
Cx<GFR

41. What receptor responds to inc sympathetic discharge leading to renin secretion from JG cells
PAH is freely filtered and actively secreted - all PAH entering kidney is secreted
Medullary cystic disease
Beta 1
Vasa recta - interlobular v - interlobar v - renal v

42. Why can inulin be used to calculate GFR?
GFR/RPF
Nephritic syndrome
Beta 1
Freely filtered and neither absorbed or secreted

43. What is the effect of AT II on the proximal tubule - and what kind of alkolosis does this allow for
Dialysis cysts
Few glomeruli
Excreted - filtered
Stimulates Na/H exchange - increasing Na and H20 reabsorption - contraction alkolosis

44. What are the 3 transporters of the intercalated cells
Simple cysts
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Nephrotic syndrome

45. Who commonly gets acute post strep GN
Chronic conditions - multiple myeloma - TB - RA
Kids - peripheral and periorbital edema - resolves spontaneously
Negative charge
Hypervent - immediate

46. net tubular reabsorption of x
Cx<GFR
Carbonic anhydrase
Filtered - secreted
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb

47. How is extracellular volume measured
Hyperkalemia - inhibition of ammonium excretion in proximal tubule - decrease urine pH due to dec bufferiing capacity
Inulin
Segmental sclerosis and hylanosis
LM - nl glomeruli - EM - foot process effacement

48. What is the ddx for respiratory acidosis
Macula densa and JG cells
20 percent
Hypoventilation - obstruction - acute lung dz - chronic lung dz - opiods - narcotics - sedatives - weakening of respiratory muscles
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn

49. What is the compensatory response in metabolic alkalosis
Hypovent - immediate
Podocytes foot processes
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Acute tubular necrosis

50. What is the effect of PTH on the proximal tubule
Simple cysts
Inhibits Na/phosphate cotransport leading to phosphate excretion
Renal papillary necrosis - sloughing of renal papillae - DM - acute pyelonephritis - phenacetin - sickle cell
No

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Renal

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