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Renal

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Answer 50 questions in 15 minutes.
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1. waxy casts ddx
Metabolic acidosis
Needs to be bilateral
Macula densa
Advanced renal dz - CRF

2. What is the effect of of PTH on the distal convoluted tubule
Corticosteroids
60% total body water - 40% ICF - 20% ECF
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
Inc Ca/Na exchange to inc Ca reabsoprtion

3. What is the BUN/Cr ratio in prerenal azotemia and why?
Respiratory compensation in response to metabolic acidosis - PC02 in 0.7mmHg for every mEq/L bicarb
Inc - dec - dec
RTA type 1 (distal)
Increased - dec RBF - dec GFR - Na/H20 and urea retained by kidney to conserve volume

4. What is the most common renal malignancy of early childhood
Na reabsorption drives H20 reabsorption
Growth retardation and developmental delay
AR - congenital hepatic fibrosis - renal failure in utero leading to potters - beyond = HTN - portal HTN - progressive renal insuff
Wilms tumor (ages 2-4)

5. What is the effect of AT II on efferent arterioles
Advanced renal dz - CRF
Contrict leading to inc FF - preserver renal GFR in low volume states
Complications of chronic kidney disease or HTN
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group

6. What is the compensatory response in metabolic acidosis
1alpha hydroxylase - PTH stimulates it
Inc Ca reabsoprtion in DCT - dec PO4 reabsorption in - inc in 1 -25 OH2 vit d production
Negative charge
Hypervent - immediate

7. What is the formula for clearance of a substance per unit time
RTA type 1 (distal)
ANP
Von hippel laundau and gene deletion in chromosome 3
C = UV/P U is urine concetration of substance x - P is plasma concentration of substance x - and V is urine flow rate

8. fever - CVA tenderness - N/V - affects cortex with relative sparing of glomeruli/vessels
LM- glomeruli enlarged and hypercellular - PMNs - 'lumpy- bumpy' appearance EM - supepithelial immunce complex humps - IF- granular
Diarrhea - glue - RTA - hyperchloremia
Acute pyelonephritis
JG cells

9. What happens to tubular inulin along the proximal tubule and why
Contrict leading to inc FF - preserver renal GFR in low volume states
Inc in concentration - not amout - due to water reabsorption
Liver
It has a longer renal vein

10. What does ADH do in the collecting tubule
Acts on V2 receptors leading to insertion of aquaporins on luminal side
Dec - dec - NC
Dec BP - dec in Osm - inc sympathetic tone - released from kidneys
Rxn from angiotensinogen to angiontensin I

11. What are the main causes of membranous GN
Bladder cancer
Intra = HIKIN!
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
Dec blood volume and inc plasma K causing in Na reabsorption - inc K secretion and inc H secretion

12. How is extracellular volume measured
No
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Hydronephrosis and pyelonephritis
Inulin

13. What is the pathway from the efferent arteriorle to the renal v
Vasa recta - interlobular v - interlobar v - renal v
Chronic pyelonephritis
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Men 50 to 70 - inc incidence with smoking and obesity

14. what happens to pH - PCO2 - and bicarb in respiratory alkalosis
Inc - dec - dec
Dec - inc - inc
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
Renal in origin

15. secondary glomerular dz
Involves glomeruli and other organs
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
Inc - dec - dec
Passively reabsorbs water via medullary hypertonicity

16. What effect does efferent arteriole cxn have on RPF - GFR and FF
Dec - inc - inc
Inc - inc - inc
Ammonium magnesium phosphate (struvite) - infection with urease pos magnesium or radiolucent bugs like (proteus - staph - klebs)
Becomes concentrated and hypertonic

17. What is the 60-40-20 rule of body weight
Carbonic anhydrase
Failure of EPO
Small kidney - poor prognosis
60% total body water - 40% ICF - 20% ECF

18. What are the associated paraneoplastic syndromes wth RCC
Diarrhea - glue - RTA - hyperchloremia
Cystine - 2ndary to cystinuria - hexagonal - treat with alkalization of urine
Ectopic EPO - ACTH - PTHrP - prolactin
Inc - inc - inc

19. How are amino acids reabsorbed
Size and charge
Sodium dependent transporters in proximal tubules - 3 distinct carrier systems - competitive inhibition within each group
Needs to be bilateral
Dec renal bicarb reabsorption - delayed

20. What effect does ANP have on GFR
Inc
Polycystic liver disease - berry aneurysms - mitral valve prolapse
RTA type 1 (distal)
Crescent - moon shape

21. What happens in the early distal convoluted tubule and What does that do to the urine
Advanced renal dz - CRF
Failure of vit d hydroxylation - ca wasting - phosphate retention - sencondary hyperPTH
Actively reabsorbs NaCl - diluting - makes urine hypotonic
Hypokalemia and hypophosphatemic rickets

22. membranous
Acute tubular necrosis
Thickening of glomerular BM
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Inc - inc - inc

23. What is the most frequent kind of kidney stone and What are causes that lead to it
It has a longer renal vein
Calcium (oxalate or phosphate or both) - hypercalcemia caused by cancer - inc PTH
Intra = HIKIN!
Inc in Ca and PO4 absoprtion from the gut

24. What is the effect of AT II on the posterior pituitary
ADH secretion - inc in aquaporin channels in principal cells and H20 reabsorption
Solute is reabsorbed less quickly than water or net secretion of substance
Hypervent - early high altitude - aspirin ingestion early
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

25. What is the formula for the filtered load
AD - flank pain - hematuria - HTN - urinary infxn - progressive renal failure
GFR x plasma concentration
UTI or acute gastroenteritis
Inc GFR and mesangial expansion

26. diffuse
All glomeruli
Radiopaque
Hypovent - immediate
Bladder cancer

27. What is the ddx for a metabolic acidosis with an inc anion gap
Apical face - K/H ATPase exchanger - H- ATPase secretion basolateral face - Cl/HCO3 exchanger
Growth retardation and developmental delay
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates

28. What are the associations with RTA type 2
Intra = HIKIN!
Hypokalemia and hypophosphatemic rickets
LM - wire looping of caps - EM - subendothelial DNA- anti - DNA IC - IF- granular
<3.5 g /day

29. When is TF/P <1
Men 50 to 70 - inc incidence with smoking and obesity
Solute is reabsorbed more quickly than water
Dec - dec - NC
Na reabsorption drives H20 reabsorption

30. What is the LM for diabetic glomerulonephropathy
Mesangial expansion - GBM thickening - nodular glomerulosclerosis (kimmelstiel - wilson lesion)
Von hippel laundau and gene deletion in chromosome 3
160-200 - 350
Acute renal failure

31. In renal failure with uremia - What are the 5 aspects of uremia
N/anorexia - pericarditis - asterixis - encephalopathy - platelet dysfxn
Vasocxn - inc BP
Membranoproliferative glomerulonephritis
White cell casts

32. TCC is associated with problems in your Pee SAC - ??
Inc plasma osm - dec blood volume
Phenacetin - smoking - aniline dyes - cyclophosphamide
Diffuse cortical necrosis - combo of vasospasm and DIC - associated with obstetric complications and and septic shock
Huge palpable flank mass and hematuria

33. What is the BUN/Cr ratio in instrinsic renal ARF and why
Poor - days to weeks
Amyloidosis
To defend GFR
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired

34. do you see casts in bladder cancer - kidney stones with hematuria
Dilate the afferent arteriole - inc RPF - inc GFR - FF is the same - NSAIDs reverse
2 ways - base exchanger and between epithelial cells
Hypokalemia - risk for Ca containing kidney stones
No

35. What are the features of membranous GN (diffuse membranous glomerulopathy) on LM - EM and IF
Drug induced interstitial nephritis - diuretics - NSAIDs - penicillin derivatives - sulfonamides - rifampin - act as haptens
Simple cysts
LM - diffuse capillary and GBM thickening - EM - spike and dome with subepithelial deposits - IF - granular
Converts 25- OH vitamin D to 1 -25 -(OH)2 vitamin D which inc intestinal reabsorption of both calcium and phosphate

36. What is the formula for renal blood flow
Radiopaque
Mutation in type IV collagen - split BM - nerve disorders - ocular disorders - X- linked dominant
RPF/(1- Hct)
Dec - inc - dec

37. What is the henderson hasselbalch equation
PH = pKa + log bicarb/0.03PCO2
Type 1 - GBM splitting caused by mesangial growth - HBV - HCV
Tumor suppresor gene WT1 on chrom 11 - WAGR =Wilms - Aniridia - Genitourinary malformation and mental - motor Retardation
1alpha hydroxylase - PTH stimulates it

38. What is the cutoff of proteinuria in nephritic syndrome
Becomes concentrated and hypertonic
LM - nl glomeruli - EM - foot process effacement
Dec - inc - inc
<3.5 g /day

39. What is the 3rd most common kidney stone and What causes it
Uric acid - hyperuricemia - dz with inc cell turnover like leukemia
Decreased - ATN - ischemia - toxins leads to obstruction and backflow - dec GFR - BUN reabsorption is impaired
Tubulointerstitial inflammation - acute pyelonephritis - transplant rejection
Size

40. What is the net effect of ANP
Hypokalemia - risk for Ca containing kidney stones
Stimulates thirst
Na and volume loss
Renal in origin

41. When is glucose reabsorbed and with What transporter
Negative charge
Triglycerides
Type II - C3 nephritic factor
Proximal tubule - na/glucose co transporter

42. no net secretion or reabsorption of x
Cx = GFR
Nephrotic syndrome
To defend GFR
NC - dec - dec

43. What is the effect of angiotensin II on RPF - GFR - and FF - why - What do ACEi do?
Angiotensin II constricts the efferent arteriole - dec RPF - inc GFR - in FF - ACEi reverse
Hyperceullular glomeruli
The charge barrier - albuminuria - hypoproteinemia - edema and hyperlipidemia
ADPKD

44. What circumstances causes ADH secretion
Angio I to angio II and inhibits bradykinin
Inc plasma osm - dec blood volume
Nephritic syndrome
Renal in origin

45. Congo - red stain - apple green birefringence
20 percent
Amyloidosis
Wilms tumor (ages 2-4)
Involves glomeruli and other organs

46. When is TF/P = 1
Few glomeruli
Becomes concentrated and hypertonic
Solute and water are reabsorbed at the same rate
Reabsorb Na in exchange for secreting K and H

47. What effect does afferent arteriole cxn have on RPF - GFR and FF
Phenacetin - smoking - aniline dyes - cyclophosphamide
Dec - dec - NC
Beta 1
White cell casts

48. What is the purpose of the JGA
Drugs - infections - SLE - solid tumors - most common cause of adult nephrotic syndrome
It has a longer renal vein
MUDPILERS - methanol - uremia - DKA - paraladehyde OR phenformin - Iron/INH - lactic acidosis - ethylene glycol - rhabdomyolysis - salicylates
To defend GFR

49. what happens to pH - PCO2 - and bicarb in metabolic alkalosis
Inc - inc - inc
Solute and water are reabsorbed at the same rate
Ammonia - buffer for secreted H+
No

50. What two cells make up the JGA
Inc
Macula densa and JG cells
Inc in Na filtration with NO compensatory Na reabsorption in the distal nephron
LM - nl glomeruli - EM - foot process effacement

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Renal

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